Archery injuries: Redza 2022 review

This is a review in Serbian on injuries in archery, written by a lecturer at the sports faculty in Belgrade and built on other people's literature plus observations from the field. It brings no new data: it gathers figures and explanations from others and arranges them by site.

It starts from the load. In competition, the author says, citing a chapter from the international federation's sports medicine volume, an archer shoots an average of 75 arrows a day at draw weights of 15 to 16 kilograms for women and 18 to 20 for men: that comes to at least 1,125 to 1,200 kilograms drawn in a day by women and 1,350 to 1,500 by men, all of it through three fingers of one hand, the index, middle and ring fingers. In training, he adds, those figures are two or three times higher. The bow hand carries a load too: an Olympic bow weighs about 2.5 kilograms for women and up to 3 for men, which adds up to 200 to 350 kilograms held over a day of competition.

On the injury figures the review holds two readings together. On one side archery comes out among the lowest measured risks of any discipline: 0.00536 acute and overuse injuries per 1,000 hours, and 0.00056 for acute injuries alone among competitors, against 0.027 to 0.079 for indoor climbing and 0.41 for surfing. On the other, among those who shoot the complaint is widespread: in a study of 156 Indian archers, shoulder pain was present at the time of testing in 54.48 per cent of cases, 82.69 per cent had felt it at least once and for 64.74 per cent it was recurrent; 41.18 per cent located it in the drawing shoulder and 45.88 per cent felt it during the draw itself, which in 80 per cent of cases eased off in the pause between arrows. Overuse injuries sit in the shoulder in 52.9 per cent of cases, and in the drawing shoulder in 64.7 per cent of those; the arms follow with 23.5 per cent, mostly the bow arm (66.7 per cent). In the data collected at the 2012 European championship in Amsterdam, overuse concerned only shoulders (88.9 per cent) and arms (11.1). Back, hands and neck each appear in 5.9 per cent and fingers in 3.9. Tendons, ligaments and joints accounted for 67.9 per cent of overuse injuries, and the great majority were slight: 62 per cent in the first class of the scale used, meaning no medical intervention needed, and 30 per cent in the second. For the back, according to the international federation's medical committee, about 10 per cent of archers name it among their own problems.

The other sites the review works through are the back, where it recalls the general figure that 80 per cent of the western population will have low back pain and that 60 to 80 per cent of them develop recurrent or chronic symptoms, and the skin of the three string fingers, where a callus starts out thin and functional and can turn thick and tender if the pressure continues.

The journal classifies the article as a professional paper rather than original research, and it presents itself as a review. It declares no search strategy: it does not say which databases were searched, with what terms, over which years, or what criteria were used to include or exclude a study. The bibliography runs to about a dozen entries, among them two chapters by Littke on the mechanics of the archer's shoulder and back, a chapter by Ergen on skin problems, the 2017 study by Niestroj and colleagues from which the rates per 1,000 hours and the Amsterdam data come, and the 2017 paper by Grover and Sinha from which the percentages on the 156 Indian archers come.

The structure follows the sites: shoulder, overuse injuries, back, skin and fingers. In each section the author alternates between references to the literature, an anatomical and biomechanical description, and field observations explicitly labelled as such, gathered from watching how archers stand at competitions. The anatomical part describes the shoulder complex (scapula, scapulothoracic and glenohumeral joints, the acromiohumeral space), the rotator cuff muscles and the scapular rotators, then, following Littke, breaks the draw into stages: retraction of the scapula by the rhomboid, rotation of the scapula by the middle and lower trapezius fibres which clears the space under the acromion, raising of the arm by the deltoid with the cuff contracting as a group, and finally external rotation of the humerus by the infraspinatus. For the back the mechanism described is the thoracolumbar fascia and intra-abdominal pressure acting as an internal brace for the lumbar spine. For the skin, it is thickening of the stratum corneum under repeated pressure and shear.

The three preventive factors the author sets out, again following Littke, are shooting technique, with the axis of the shot resting on the back musculature rather than the shoulder joint, the choice of equipment (arrow length, draw length, draw weight, bow mass) and a conditioning programme combining general cardiovascular capacity, shoulder and back strengthening, specific work for the cuff and scapular stabilisation, flexibility and muscular endurance. No data were collected for this article: no sample, no measurement, no statistics.

It is a narrative review with no declared method, and should be read as such: a map of what the author has read and seen, not a systematic synthesis of the literature. We do not know which studies were left out or why, and the figures cited are neither weighted for quality nor set against one another.

The most precise numbers in the article are not its own. The percentages on shoulder pain all come from a single study of 156 Indian archers, so they describe that sample, in that country, at that time; the rates per 1,000 hours come from another study, and the comparison with climbing and surfing is the one the original source made. Something wears away in the handover: the point prevalence appears as 54.4 and as 54.48 per cent at two places in the same text, and the attribution of results sometimes doubles up, with an author cited through an intermediate source.

The load calculation, which is the most quotable part of the article, should also be taken for what it is: a multiplication of an average number of arrows a day by a typical draw weight, not a measurement. It assumes every archer draws their full weight on every arrow, takes no account of the bow's force curve or of the difference between drawing and holding, and the estimate that training is two or three times competition is stated without a reference. In the same way, the figure that 80 per cent of the western population will have low back pain concerns the general population and says nothing specific about archers, as the author himself notes.

The biomechanical and preventive sections rest on two chapters by a coaching author and on field experience, not on intervention studies: none of the three preventive factors proposed was tested here, and the author says so plainly, admitting that no data link an injury to a bow slightly too heavy or an arrow slightly too long. The journal is Serbian with regional circulation, and the text is in Serbian with an English summary; the title registered on Crossref is in English and differs from the one on the printed article.

What this review offers an archer is an order of magnitude and a map of sites, not a rule. The order of magnitude is the sum of the work: over a day of competition the sum comes to more than a tonne drawn with three fingers, and in training the figure multiplies. It is a rough calculation, but it explains why the typical problem in archery is not trauma but accumulation.

The map says where to look. The shoulder, and the drawing shoulder in particular, accounts for about half of overuse injuries; the arms come next, with the bow arm predominating; the fingers and the skin are a minor but daily site, where a thin callus is functional and a thick one is a sign of badly distributed pressure. Alongside this, two figures that sit together: archery has one of the lowest injury rates among activities that have been measured, and meanwhile more than half the archers in one sample reported shoulder pain on the day they were tested. A low injury rate and widespread pain are not in contradiction if almost everything that happens stays slight and never gets recorded as an injury.

One clinical detail is worth noting for the way it is described: in most cases the pain was felt only during the draw and eased off in the pause between arrows. This record reports that as an observation, not as a criterion: the review is not medical in the sense of an assessment, and shoulder pain that keeps coming back needs to be looked at by a doctor or a physiotherapist. The preventive pointers the author collects (a technique resting on the back musculature, equipment proportionate to the archer, conditioning that includes the cuff and the scapula) belong to the coaching tradition and are reported from a manual, not the result of a test.