|Year : 2016 | Volume
| Issue : 3 | Page : 168-170
Injuries in archers
Anant Kumar Singh, Sang-Hoon Lhee
Department of Orthopedics, CM Chungmu Hospital General Hospital, Seoul, South Korea
|Date of Web Publication||28-Sep-2016|
Dr. Anant Kumar Singh
Department of Orthopedics, CM Chungmu Hospital General Hospital, Seoul
The popularity of archery has soared over the last few years, particularly among girls and women. Archery can be described as a comparatively static sport requiring strength and endurance of the upper body, in particular, the forearm and shoulder girdle. Although archery is not commonly associated with injuries, but injuries in archery are more common than one's thought and archers do present with a wide spectrum of injuries involving shoulder, elbow, wrist, hand, peripheral nerves, and spine. It is suggested that in order to avoid these injuries, sports coaches and archers should be aware of the risk of these injuries and should advise training accordingly.
على الرغم أن رياضة الرماية ليسن شائعة إلا أن شعبيتها ارتفعت على مدى السنوات القليلة الماضية، وخاصة بين الفتيات والنساء. ويمكن وصف الرماية كرياضة ثابتة نسبيا تتطلب القوة والتحملللجزء العلوي من الجسم، على وجه الخصوص، والساعد و حزام الكتف حزام. وعلى الرغم من أن الرماية ليست مرتبطة عموما بالإصابات لكن إصاباتها أكثر شيوعا مما كان يعتقد والرماة يواجهون طائفة واسعة من الإصابات التي تشمل الكتف والكوع والرسغ واليد و الأعصاب والعمود الفقري. ويقترح أنه من أجل تجنب هذه الإصابات لدي المدربين الرياضيين والرماة يجب أن يكون الجميع على بينة من مخاطر هذه الإصابات، وينبغي أن ينصح بالتدريب وفقا لذلك.
Keywords: Archers, injuries, overuse
|How to cite this article:|
Singh AK, Lhee SH. Injuries in archers. Saudi J Sports Med 2016;16:168-70
| Introduction|| |
Archery has become increasingly popular in recent years as schools and recreational programs are striving to find activities that appeal to all age groups in a variety of group settings. Archery is one of such noncontact sport that has evolved from bow and arrow weapon used in wars and hunting into the competitive and recreational game, and its popularity continues to grow ever since being included in Olympic games. Archery can be described as a comparatively static sport requiring strength and endurance of the upper body, in particular, the forearm and shoulder girdle.  However, every sport whether contact or noncontact has its own unique injury profile as each game has its own physical demands and stresses.  Sports injuries can be broadly divided into two groups: Acute (traumatic) injuries resulting from a sudden, specific, identifiable event, and overuse injuries caused by repeated microtrauma without any identifiable event.  Similarly, in archery, two sets of injuries are found such as acute and chronic. Acute injuries in archery mostly include contusion and laceration of skin and subcutaneous tissue by arrow, whereas chronic injuries affect different parts of body such as shoulder, elbow, wrist, and back due to repeated microtrauma. In this review article, we are going to focus on different injuries, which an archer can face during his/her lifetime so that archery education programs can focus on proper archery stance and joint strengthening to minimize such injuries.
| Shoulder injuries|| |
Shoulder injuries are common in archers. These injuries accounted for around 45-50% of total injuries archers had in a report by FITA medical committee in 1996.  Injured archers mostly complained of either rotator cuff impingement or rotator cuff tear. Few cases of scapular dyskinesia along recurrent posterior shoulder dislocation have also been reported, but they are few.  Recent report by Shinohara et al. concluded that archers with shoulder impingement syndrome exhibit different kinematics and muscle activity compared to uninjured archers. The impingement group had a greater angle of scapular elevation, smaller angle of horizontal extension, smaller angle of elbow flexion, higher the levels of upper trapezius, lower the levels of lower trapezius, higher deltoid middle muscle activity, and higher upper trapezius/lower trapezius ratio. They also suggested in order to prevent shoulder joint impingement during archery; training is necessary what can make lower trapezius muscle activity increased to decrease the upper trapezius/lower trapezius ratio.  Considering the above facts, it can be said that time has come when we should try to give individualized training to archers (while keeping their kinematics in mind) so that shoulder injuries can be minimized.
| Elbow injuries|| |
As far as archery is concerned, elbow is the second most common joint to be injured.  In archery, both elbows are subject to a lot of stress. As one brings bow to full draw, bow arm is held in extension, and elbow extensor muscles are doing most of the work. As one pull the string back, bowstring elbow is flexing, and elbow flexor muscles are doing more of the work. Repetitive stress to these muscles and tendons can cause pain on the either side of elbow where they attach to the bone. Hence, lateral and medial epicondylitis along with traumatic synovitis is very common in archers. Treatment of this consists of allowing the microtears to heal and then preventing recurrences. Nonsurgical management is generally effective in reducing daily symptoms and allowing return to sport at preinjury levels. Initially, efforts are focused on pain relief by reducing peritendinous synovitis and resisting tendon degeneration via noninvasive and invasive methods.
For athletes with distinct tendon disruption or patients with symptoms that are refractory to nonsurgical treatment, open debridement, and simultaneous treatment of secondary pathologies can be beneficial. Once acute symptoms are alleviated, most important thing in preventing recurrences is to strengthen the muscles surrounding elbow, so that they can withstand greater stress. 
| Wrist and hand injuries|| |
In archers, wrist and hand injuries mostly include acute traumatic injuries caused by mishandling of arrows. Palsbo found that in recreational archers, leading injuries were lacerations (62 ± 2%), followed by puncture wounds (8 ± 1%) and foreign bodies (6 ± 1%). Contusions and abrasions, often caused by the bowstring hitting the arm, accounted for (6 ± 1%) of injuries.  Open metacarpal fracture from the bow during the arming phase has also been reported. 
Apart from acute wrist and hand injuries, archers do suffer from chronic wrist and hand tendon injury. Overuse type of tendon injuries such as de Quervain's tenosynovitis, extensor tendon tenosynovitis are among the most common musculoskeletal pathologies in competitive archers and the structural changes have been widely reported.  These injuries occur when tendons exposed to chronic overloading are injured and/or undergo adaptation via biomechanical, biochemical, or structural changes.  Treatment methods include immobilization, steroid injections, or operation. Nonsurgical treatment of steroid injections and thumb spica splinting is usually successful. However, in the event that conservative management fails, surgery should be considered. 
| Nerve injury|| |
Considering the kind of physical and physiological demands that archery places on its players it could be well imagined that they too remain under constant risk of nerve injuries. Co-ordination of muscles for repetitive motion requires archers to possess muscular strength, upper body endurance and high levels of stability. In archers, upper limb nerves are at risk of pathological changes induced by repetitive stresses inherent to game of archery. There have been few reports of nerve injuries in archer such as isolated long thoracic nerve palsy, median nerve compression at wrist and elbow, , but their incidence is less as compared to other injuries in archers. Considering the fact that nerves of archery players are at risk developing subclinical neuropathy that can become evident at any point of time and can plague the performance of archer, There is an urgent need to aware the archers, coaches, trainers, and physiotherapists about impending risk of nerves injuries in game of archery, so appropriate measures could be taken during training of archery to prevent archery-related nerve injuries.
| Back injuries|| |
Among archers, back pain may result from acute macrotrauma, repetitive microtrauma (stress), or from a combination of these two mechanisms. During a 4-day international event, a male archer will pull a 45-pound bow, and a female archer a 35-pound bow, 75 times. That is equivalent to pulling approximately 3400 pounds (1545 kg) for a male and 2625 pounds (1193 kg) for a female in a single day. Pulling such a huge amount of weight creates a lot of strain in back muscles of archers; in addition to this, acute injuries affecting the intervertebral disks, end plates, or ring apophyses may contribute to early degenerative process seen in archers. There are reports indicating that moderate physical activity is beneficial to the back, and it apply to archers also, but at the same time, excessive repetitive loading of spine creates a lot of stress in the spine which eventually leads to early degenerative changes.  Keeping both things in mind, it can be suggested that archers should refrain themselves from activity which involves excessive loading of spine, along with there may be a need to modify the rules of sports events which involve a high risk for back trauma, and these improvements would then be reflected in training methods also.
| Other injuries|| |
In addition to above injuries, archers can present with symptoms of thoracic outlet syndrome, bow hunter syndrome, and coracoid epiphyseal avulsion. ,, In such cases, archers present with completely different set of complain making it very difficult for the clinician to diagnose. Fortunately, such injuries are very rare in archers, but clinicians should be aware of these injuries also while treating an archer.
| Conclusion|| |
Archery, being a noncontact sport, is undoubtedly has lower incidence of injury as compared to contact sports such as football, hockey, boxing, and wrestling. However, archers do present with a wide spectrum of injuries involving shoulder, elbow, wrist, hand, peripheral nerves, and spine. It is suggested that in order to avoid these injuries, sports coaches and archers should be aware of the risk of injury and should advise training accordingly.
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Conflicts of interest
There are no conflicts of interest.
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