When I say that archery is an overuse sport, almost nobody believes me at first: there is no contact, no running, no jumping. And yet anyone who has been shooting for a few years knows the shoulder that aches in the evening and the elbow that makes itself felt after long sessions, especially when training volume climbs. That is exactly what the studies of archers describe: serious injuries are few, recurring complaints are many, and whether the sport counts as low or high risk depends on which of the two you count.
The picture also changes with the people being looked at. In emergency department records, which take in anyone who has been hurt with a bow and arrows, cuts to the fingers dominate; in competitive archers shoulder overuse dominates, and in the study that counted them the few acute injuries nearly all came from a piece of equipment breaking. Below I go through where archers get hurt, which risk factors have been measured in archers and what can be done, with the registry status of each claim. One caveat I always repeat: an article is no substitute for a doctor or physiotherapist, who remain the people to see about pain that does not go away.
How risky archery is
The idea of a safe sport has a precise source. A 2018 study of 62 competitive German and European archers found mild injuries, none of them serious according to the authors, and calculated a rate per hour of shooting that it places among the lowest ever measured; a 2021 review of thirty-three Olympic sports took up that figure and put archery last among the twelve disciplines with data per thousand hours. That rate, however, rests on 10,818,080 hours of exposure calculated by the authors, more than 170,000 hours per archer, a total that does not square with the volumes the same study reports, and the review had no other archery data to work from.
Count instead how often complaints appear, and the picture reverses. In the same 2018 study, 59% of the archers had had at least one overuse injury in their career; among 239 Florida archers almost half report at least one injury caused by shooting; among 156 Indian competitors whose shoulders were examined, more than half are in pain on the day of the survey and more than four in five have had shoulder pain at some point. Nor do the US emergency department data, about 43,000 visits over ten years, all treated and discharged according to the authors, turn into a rate, because nobody knows how many hours those people had shot.
This is why the registry lists the claim that archery is a sport with a low risk of injury as contested: severity is low, the frequency of complaints is high, and the two measures do not meet. The registry entry tells, year by year, how the picture has changed, from the first orthopaedic count in kyudo in 1971 to the clinical records of 2025. In practice, archers are seldom seriously hurt, but among competitive archers living with a niggle in the shoulder or back is common, and that is what the work is about.
Where injuries happen
The site depends on who is being counted. In US emergency departments from 2013 to 2022, the finger accounts for 66.2% of visits by men and the hand for 17.1%, and the most common injury is a cut. That database, however, takes in anyone hurt with a bow and arrows, at home, on a farm or at school, without saying whether they were shooting in competition. Among competitive archers the picture is different: over the whole careers of 62 archers there are six acute cases, and almost all the problems are overuse, with the shoulder at the top.
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Shoulder
Six independent samples, from Japanese kyudo to the European Youth Championships, put the shoulder first among overuse injuries, from 51% of kyudo practitioners to 70.3% of injured Florida archers. It is more often the string side, in 64.7% of shoulder overuse injuries among German and European competitors and in 80.5% of Korean archers with pain, and it hurts mostly during the draw. A small study of 13 Turkish youngsters puts the back first instead, which is why the status is reported rather than corroborated. How many archers have shoulder pain, how long it lasts and what is found in those who have it is the subject of the article on shoulder pain when shooting.
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Elbow
When the elbow hurts, the spot most often affected is the outer side, where the forearm extensors originate: in the 1971 kyudo survey pain at the lateral epicondyle appears in 12 cases against 6 at the medial one, and in the 2018 competitors the arm is the second site of overuse injury, 23.5%, two thirds on the bow side, with lateral epicondylitis mentioned by the authors but not counted. An ultrasound study of 12 elite archers, still a preprint, finds instead that compared with athletes from other sports archers have a thicker tendon on the inner side, not the outer one: the load of shooting reaches there too.
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Lower back
In kyudo and in young archers it comes straight after the shoulder: 59 of 122 kyudo practitioners report low back pain, and at the European Youth Championships it is the second site of pain. Among the Florida archers the back affects 31.7% of those injured, while among the adult competitors of 2018 it falls to 5.9% of overuse injuries. The only group to estimate the load, in thirteen students shooting barebows of 20 to 32 pounds, finds lumbar compression well below the risk thresholds, higher in those who lean the trunk forward.
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Fingers and hand
They are the site of acute injuries in the emergency department data, nearly always cuts. In competitive archers, by contrast, the six acute cases of 2018 mainly affected the arm, with four bruises and a single cut to the hand from a broken arrow. That is why the claim that acute archery injuries mostly affect the fingers and hand is contested, and the difference seems to lie in who is counted rather than in the shot itself.
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Neck
It turns up almost everywhere, with very different weights from one sample to the next: in the 1971 kyudo survey 44 of 122 practitioners report neck complaints, among the 2018 competitors it accounts for 5.9% of overuse injuries, 22.4% of 58 Korean competitors name it as a site of pain, and 15% of 75 adult German archers have a history of neck complaints.
Rare cases
Alongside the common complaints, the literature describes a few single cases. A case shows that something can happen, not how often, and should be read that way; it does, however, help to recognise a warning sign that would otherwise be put down to the usual shoulder.
The first concerns a rib. A 15-year-old Japanese girl, who had taken up kyudo at secondary school with two or three hours of practice a day, starts to feel pain in the shoulder blade and upper back on the left after about seven months; a few weeks later, while drawing the bow, she hears a sharp crack and the pain suddenly worsens. The X-ray shows a stress fracture of the first rib on the bow side. With rest the pain is gone within a month, but after a year the bone has still not united. The authors attribute it to the head turned towards the target, with the scalenes under tension while the arm holds the bow, without having measured it.
The second concerns the neck, and it is again from kyudo. A 16-year-old schoolboy, two months after starting, loses strength in the deltoid, biceps and brachioradialis on both sides, while the hand muscles stay normal. Imaging with the neck rotated to the left, as in the shooting posture, shows the spinal cord pushed forward and compressed at three levels, and the X-rays show a cervical kyphosis: this is the case on which the registry states that the rotated head position can compress the cervical cord in susceptible people. Once he stopped shooting and limited bending and turning his neck, the condition resolved completely within eighteen months. The boy also studied with his neck bent over his books, and the authors describe kyudo as an aggravating factor, not the sole cause. For a coach, the detail to remember is that the weakness was in the shoulder and arm, exactly what on the range would be blamed on the shoulder.
The third is a 28-year-old elite archer whose shoulder vessels and nerves were compressed at full draw, presenting with weakness, reduced grip and altered sensation along the ulnar nerve; after surgery he was shooting again at four months and competing at eight.
Finally, the eyes. In ten years of paediatric eye injuries collected at two hospitals in Indianapolis, archery appears among the minor sports, far behind baseball, basketball and football, and only in children aged 3 to 11. In the two archery cases where vision was measured, though, the initial loss was serious, 20/63 on average, before returning to 20/15 at follow-up. The registry entry on risk keeps this as context: few injuries, but not mild ones when the eye is hit.
When the equipment breaks
Among the 2018 competitors an acute injury was almost always a matter of equipment: of the six cases collected, five, or 83.3%, came from a bow, arrow or string breaking during the shot and the sixth from string slap on the bow arm, and all were mild.
For the arrow there is also a laboratory test. Two types of duralumin kyudo shaft, loaded end-on as happens when the point slips behind the bow at release and the arrow is crushed between string and bow, buckle at about 50 and 65 newtons and snap exactly in the middle, leaving sharp metal edges, in about two tenths of a second in the fast test. It is not the material that gives way, since it reaches about 30 megapascals against the alloy's 500 or so, but the stability of the shaft, and the authors warn that the fragments fly right in front of the archer's face. The test covers kyudo aluminium only: carbon target shafts were not tested. An estimate for a compound with 500-spine shafts puts the peak load at around 60 newtons, against a critical load of about 100, and beyond 800 spine the author expects the shaft to fail. It is an estimate, in a preprint, but it is a reminder that a spine matched to draw weight matters for safety as well as for arrow flight.
Risk factors measured in archers
General conditioning has firm rules about risk factors, but in archers the data are thin and sometimes point the opposite way from what one would expect. The three that research has worked on most are volume, the asymmetry of the shot and fatigue.
Volume and level
That more arrows mean more injuries is the most widespread idea, and the studies of archers do not bear it out. The only supporting figure is a weak correlation among 239 Florida archers, with r between 0.15 and 0.17 for training days per week; among 156 Indian competitors, by contrast, those with shoulder pain shoot the same number of arrows a day as those without, 145 against 143, and the pain is linked above all to earlier pain. This is why the registry lists the link between training days and overuse injuries as contested, and the rule of raising arrow volume by no more than 10% at a time, which circulates in general conditioning, has not been studied in archery.
The most surprising figure comes from comparing levels. Among 62 recurve archers, those competing at the European Championships had had at least one overuse injury in 36.4% of cases, against 71.8% of those competing at the German Championships, despite shooting 696.5 arrows a week against 273.7 and at higher draw weights, 42.9 against 38.5 pounds; and those in a national or regional squad reported fewer. That higher-level archers and those in a squad report fewer overuse injuries is therefore reported, on a single study. The authors read it as the effect of better coaching, but they acknowledge that the direction may be reversed: archers who do not get injured are more likely to reach the top and stay there. Raising arrow volume gradually remains a cautious choice, but no study of archers has followed the load as it grew.
Asymmetry
The worry I hear most often is that a movement done entirely on one side will end up unbalancing the body. Electromyography shows that the load is asymmetric: at the draw the string arm uses more latissimus dorsi and biceps, the bow arm more lateral deltoid and triceps. Whether this leaves an asymmetric body depends on the area, and the studies of archers point in opposite directions. In the arms and hands the asymmetry is there: in 13 young Turkish archers the drawing side is stronger, slightly in the large shoulder and elbow movements and markedly in the finger grips, and its shoulder external rotators are tighter. In the trunk and spine it is not: no scoliosis in the 30 kyudo practitioners examined and X-rayed in 1971, and the same deep trunk muscle thickness on both sides in 15 elite youth archers. Nobody has followed the same archers over time, and in right-handers a difference between the two hands exists without any bow.
Two remedies have been studied. The first is shooting from the other side as well: among 75 German competitors, the 25 who trained on both sides did not show the shoulder and scapular rotation asymmetries found in the 50 who shot from one side only. On this comparison, made at a single point in time, the registry reports that training both sides reduces the asymmetries, and in the same study the history of shoulder complaints was the same in both groups, 42% and 44%. The second is lower trapezius work: in 14 Taiwanese university archers, twelve weeks of exercises halved the ratio between upper and lower trapezius on the drawing side, from 2.2 to 1.1, because the upper part was working less. That lower trapezius exercises rebalance the trapezius muscles is also reported, with seven archers per group, chosen by preference, and an unreliable measure. Neither study counted injuries, so whether correcting asymmetry protects the shoulder remains to be shown.
Fatigue and the hundred-arrow mark
Fatigue is the step that should connect volume with overuse, and for the shoulder the threshold that research has put to the test is a hundred arrows. In 20 Polish traditional club archers, between 50 and 100 arrows the infraspinatus of the string arm drops in signal amplitude and frequency and the lower trapezius produces a lower peak, while the deltoids and upper trapezius raise their activation: rather than a failure, the work shifts to other muscles. In the same sample, however, tone, stiffness and elasticity of six muscles do not change after a hundred arrows, and for these archers a hundred arrows is a normal session, 111 on average. This is why the claim that beyond 100 arrows in a session the shoulder muscles fatigue is contested. What changes in the body and the bow after many arrows is the subject of the article on fatigue.
What can be done
Prevention here should be taken for what it is: a set of sensible habits rather than results measured on archers' injuries.
The first is the warm-up, which nearly all competitive archers now do: 86% of 156 Indian archers and 88% of 200 elite youth archers report it, for about a quarter of an hour. The 1971 figure, when one kyudo practitioner in four warmed up or did supplementary exercises, no longer describes today's competitors, and indeed the claim that few archers warm up or do supplementary exercises is contested. The second half does hold: 85% of the Indian archers do no gym work for the shoulder, and among 75 German competitors only 22% add strength training related to shooting. The cool-down is also little practised, with fewer than half of those young Europeans doing one.
The second is shoulder strengthening: external rotation with a resistance band, controlled scaption, work on the deep muscles and the lower trapezius. It is the baseline usually recommended for anyone who shoots a lot of arrows, but whether rotator cuff strengthening prevents injuries in archers has not been studied: a systematic review of the fifteen exercise studies on archers published between 2015 and 2025 finds none that reports injury incidence, severity or days lost. It takes little time and also works the infraspinatus, one of the two muscles whose signal drops at a hundred arrows, so it remains a sensible choice, as long as it is called what it is.
The third is thoracic mobility: the idea in circulation is that a thoracic spine that rotates freely takes load off the shoulder at the draw, but it is biomechanical reasoning, and in archers nobody has measured either the mobility or the effect of a programme. The fourth is load management, raising arrow volume gradually and building in lighter days. More than any rule, one signal counts: a pain that keeps coming back to the same spot is something to take to a doctor or physiotherapist, not least because among the Indian competitors shoulder pain was linked above all to pain they had had before.
A special case: adolescents
The most solid figure on young archers comes from the European Youth Championships: among 200 archers aged 13 to 20, with the questionnaire given by physiotherapists, 50.5% report training-related pain that has lasted more than three months, only 32% shoot without any discomfort, 45% find it hard to perform their technique properly because of the pain and almost a third have had to stop training. It is a snapshot of the European elite, not of club youngsters, but it is enough to say that half of elite youth archers shoot with pain that has lasted for months.
On load there is a single case, from 1999. An eleven-year-old who competed almost every Sunday in summer with a 28-pound bow, shooting up to 144 arrows in a day, felt something give in the shoulder of his non-dominant arm while shooting in competition: it was an overuse injury to the growth cartilage at the base of the coracoid process. The first X-rays had been read as normal, and ten months earlier a milder episode had settled with a few days of rest. After four months off he went back to shooting with a 24-pound bow, which the authors considered more suitable for his age. One case does not say above what load the risk rises, but for parents and coaches it is reason enough for caution: draw weights and volumes suited to age, and attention to pain that young archers tend to play down so as not to miss training.