This was a retrospective cohort study in which 170 basketball players from the same professional club over 22 seasons (1993/94–2015/16) were analysed. All the athletes signed an informed consent at the beginning of the season giving permission for their data to be used in their benefit and for their anonymised data to be used to carry out epidemiological studies. This study was approved by the Committee on Science and Ethics of the FC Barcelona.

The team physiotherapist recorded, for 22 years, all the incidents that happened to the players during the training sessions and games. The same methodology for recording and analysis was used, varying only with respect to technological advances. The variables described and recorded in this study were player, trainer, ethnic group, height, position, affiliate status, anatomical site affected by the injury, type of injury, severity (sports time loss). In this study, the players’ positions were the one each trainer initially stipulated when the players joined the club, although they could change later on. The players with a status of ‘affiliate’ (vinculados in Spanish) are those that play with the FC Barcelona senior team (whether in training sessions or games) while being members of the reserve team.

For every injury that happened, the day and time, exact moment and place where the injury happened (in a training session or a game), and the initial diagnosis were recorded. Injuries that the physiotherapist considered more severe were referred to the team physician, who confirmed the diagnosis based on a physical examination and imaging tests such as sonography or magnetic resonance imaging (MRI).

From the 2006–2007 season to the 2015–2016 season, all the injuries were recorded and stored using the FC Barcelona software “GEM” first and later on, “COR.” Before the 2007–2008 season, the physiotherapist recorded the information using spreadsheets. All the injuries from the entire study period were categorised following the Orchard Sports Injury Classification System (OSICS-10). This classification is hierarchically structured with four letters assigned to each type of injury. The first letter refers to the anatomical injury site; the second, to the specific tissue injured or the type of injuries; and the other two letters serve to elaborate on the diagnosis.3,4

An injury was considered to be any situation occurring during a team training session or a game that made it necessary for the physician and/or physiotherapist to conduct a physical examination of the player after that training session/game. Each such situation consequently required a working diagnosis, which generally needed only treatment by the physiotherapist and did not cause any loss of training or games.

A time-loss injury was considered to be any injury occurring during the season in a training session or a game that caused an absence from at least the following training session or game. This definition is the one accepted in the epidemiological study consensus of the Union of European Football Associations (UEFA)5,6 and has been used in the majority of sports in recent years. Any injury or accident that had no relationship with basketball was excluded from this study.

Players with injuries causing time loss or requiring specific treatment followed a rehabilitation programme under the guidance of the individual responsible for the physiotherapy, as well as the recommendations of international guidelines and, especially since 2009, those of the FC Barcelona itself.7,8 To establish the time for return to play, the criteria proposed in the previously-mentioned guidelines were followed.

A descriptive study of all the injuries was carried out, calculating the absolute frequencies and their percentages based on the injury site, type of pathology and severity. In addition, a descriptive analysis of the injuries was performed based on the ethnic group, player position, affiliate status, type of trainer and season. The frequency distribution was calculated for qualitative variables, and measures of central tendency and dispersion were calculated for the quantitative variables. The statistics software IBM SPSS Statistics 21 and statistical program R were used in all the analyses.

Between the 1993/94–2015/16 seasons, 170 professional players from a single club were treated in national and international games. Player characteristics, by ethnic group, position and affiliate status, are presented in Table 1. Mean player age was 26.5 years (standard deviation [SD]: 4.48), with a mean height of 200 cm (SD: 9.6). Most players were Caucasian (77.65%) and professionals (71.2%), and the position of centre was the most frequent (28.8%).

From all the players, a total of 3452 injuries were collected. The injury characteristics are shown in Table 2, and their comparative evolution during the 22 seasons included in this study are presented in Fig. 1.

Fig. 1.

Number of injuries by season*.

*The data for the 1995–1996 season are incomplete, because all the physiotherapy material was transferred to another sports centre (from Palau Sant Jordi to Palau Blaugrana).

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The characteristics of the injuries based on anatomical site and the type of injury can be seen in Table 3 (sites) and in Table 4 (type of injury).

Table 5 shows the results of the analysis of injuries according to trainer, considering the injury site, the type of injury and the player’s position in the game.

The 310 injuries that caused time losses are described in Table 6, analysing them by ethnic group, player position in the game and affiliate status. In Table 7, the analysis of these injuries based on site is presented, while Table 8 shows the analysis according to the type of injury.

The time-loss injuries were also analysed considering severity according to days lost, as well as injury site and the type of pathology (see Table 9). The comparative evolution of the time-loss injuries over the 22 seasons is presented in Fig. 2.

Fig. 2.

Number of injuries causing time loss by season. Panel A - Total number of time-loss injuries. Panel B - Days of time loss by season*.

*The data for the 1995–1996 season are incomplete, because all the physiotherapy material was transferred to another sports centre (from Palau Sant Jordi to Palau Blaugrana).

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In the present study, the sites most often affected are the lower limbs (52.1%), followed by the upper limbs (15.2%), and the trunk and spine (13.2%). These data coincide with the existing literature. In a 6-season retrospective study on NBA basketball, Deitch et al.12 conclude that lower limb injuries could reach up to 65%. In European basketball, in a study conducted on the Belgium league, 51.2% of the injuries are seen to occur in lower limbs,13 data very similar to those presented in this study.

Focusing on specific anatomical injury area, most injuries in our study are produced in the knee (12.4%) and the ankle (10.1%). These results differ to a certain degree with the review by Andreoli et al.11 in which it is seen that in basketball in general (men, women and veterans), the knee and the ankle were the sites most affected, with 21.9% and 17.8%, respectively. In male professional players, 28.4% of the injuries occurred in the ankle and the foot, followed by the thigh, hip and leg (19.3%) and the knee (17.5%). In the present study, ankle and foot injuries were 19.2%; thigh, hip and leg injuries added up to 30.2%; and knee injuries accounted for 12.4%.

Based on the data obtained in our study, the ankle is not the site most affected, in contrast to the results of the study by Carazzato et al.14 even though the majority of the studies existing do indicate this.10–12 What is especially notable in our study is the high incidence of injuries involving the area of the thigh, hip and leg. This elevated incidence is probably due to the fact that there are more muscular and/or tendon injuries correctly recorded from the beginning of the study than ligament injuries of the ankle and knee.

Another of our findings that stand out is that there severe injuries in the knee are rare, but injuries from overuse are common. This has a relatively simple explanation; it stems from the way the players stand and move: during most of the game, the knee is semi-flexed at approximately 30° and the tension maintained favours the appearance of pathologies from overuse of the patellar tendon. This is particularly true in the area where the patellar tendon intersects with the inferior pole of the kneecap, a pathology called jumper’s knee.

At the muscle level, the injuries through direct mechanisms (contusion) of the vastus lateralis muscle of the quadriceps occur very often; they are direct contusions with the opponent's knee. Hamstring muscle injuries are also frequent and, at the level of the leg, a great number of gastrocnemius overload injuries and tearing of the medial gastrocnemius and the soleus muscle are produced (the latter ones in more veteran players).

Only 10.1% of injuries occur in the area of the ankle. At the level of clinical experience of basketball team physicians and physiotherapist, the ankle has historically been viewed as one of the areas with the greatest potential likelihood of pathology. However, the data show that this is not so, and the reason is probably that there is more attention paid to prevention from both the standpoint of proprioception work and preventative taping bandages in high-risk training sessions and games.

Due to the characteristics of this sport itself and, in contrast to others such as handball, injuries of the upper limb (shoulder, upper arm and elbow) are not normally seen in basketball. In the review by Andreoli et al.11 shoulder injuries account for 6.2% of all injuries and, in our series, they represent 5.9%.

At the level of the upper limb, the fingers are another of the areas significantly involved in injuries. They are generally caused by direct mechanism (from a poor reception of the ball, which hits the fingertips) or because the finger gets caught in another player’s shirt. In our study, wrist and finger injuries account for 8.8%, a figure that is very similar to that in the systematic review by Andreoli et al.11 (8.9% in professional players).

In the present study, the injuries of the trunk and spine represent 11.2%. This percentage is slightly above that observed in the studies analysed by Andreoli et al.11 (7.5%) and that of Starkey et al.15 (6.9% in NBA players). Our general case material in the study stems from 2 main situations. First of all, injuries happen through direct contusions on the flank or lumbar area itself. In the second place, they occur from overload in the lumbar area; it is important to remember that in each landing after a jump, the buffering waves directly impact the lumbar area (this was, at that time, one of the reasons prompting the development of all the range of sports shoes with cushioning).

In the anatomical area of the head and neck, injury incidence varies among the studies consulted, ranging between 8% and 14%.12,15,16 These data fully coincide with those obtained in our study for the head and neck area (11.9%). These injuries are principally injuries and/or wounds caused by direct contusions or muscle contractures at the cervical level.

Tendon and muscle injuries are the most frequent in our study. This fact is especially important because it demonstrates a clear trend towards which injuries are evolving in current basketball. In the studies mentioned up to now, ankle injuries and sprains are, generally speaking, the most common. In the study by Drakos et al.10 on NBA players, ankle sprains were the most frequent injuries (1658 injuries, which represented 13.2%), followed by patellofemoral pain (1493 injuries; 11.9%), backaches (999 injuries; 7.9%) and hamstring injuries (413 injuries, which represented only 3.3%).

In our study, the most frequent injuries are the muscular, with a frequency of 51.9%, as well as the tendon, with 11.2%. The ligament injuries in our study, such as joint sprains, accounted for 19.2%. There are 2 body areas with greater incidence: the ankles, due to sprains, and the fingers (capsulitis), due to the impact of the ball against the fingers, especially when the ball hits the fingertips.

Cartilage injuries (especially in the knees) were 2.6% in our study, while synovitis basically knee and ankle) accounted for 2.5%. These are injuries from overload due to continuous jumping and the player’s position standing and moving in permanent semi-flexion. This position makes it possible for the player to initiate a jump or a run almost instantly.

Bony injuries, or fractures, are rare (1.2%) in our study. Perhaps the most characteristic bony injuries have been of the fingers, with stress fractures likewise common. The latter appear mainly affecting the base of the fifth metatarsal. This can be explained by the repeated impact received in both jumping and in landing with considerable player weight, and also considering the speed of the fall and the often off-balance position in which players fall.

In the literature review on basketball injury epidemiology, no article has been found to date linking the injuries observed with the game positions of the players. There is only the study by Tummala et al.17 which mentions solely ankle injuries ankle and concludes that the centers are the players most affected by lateral ankle sprains, especially involving rebounds.

According to the characteristics of the 170 players in our study sample, the players with the greatest number of injuries are those playing in the position of centre. This is due to their own physical characteristics, given that they are generally the ones that weigh the most, are the tallest and shift the most weight in their movements.

In second place, the most injuries appear in athletes in the position known as point guard or playmaker. These are smaller players, weighing less, but they are very fast and explosive in their moves; that is the reason why their musculoskeletal system is exposed to more types of injuries, especially muscular ones. In the last places, the positions of small forward, power forward and shooting guard were found. The characteristics of these players are their speed and quick shots, and they usually play a bit far from the basket; consequently, they are exposed to less physical contact.

There is no other article in the scientific literature comparing the injuries observed over different seasons in a single team according to the different basketball trainers. The injuries differentiated by trainer can vary widely due to the philosophy, style and work methods that each trainer has.

Ekstrand et al.18 have recently published an article noting how trainer style can affect the incidence of injury in professional football/soccer. This is the first study to find a relationship between the form or style of training and the incidence of injury; specifically, it finds a link with the leadership style of the group and the severity of the injuries and willingness of the players. In our study and remembering physiotherapist experience, we can sense trends with respect to frequencies and types of injury, but our study is purely descriptive.

Among all the sports time-loss injuries in the data, those that occur most frequently are tendon and muscle injuries affecting the lower limb. As has been mentioned previously, these data fully coincide with similar studies available to date.10,16,19 In these studies, there is no classification of the injuries according to degree of severity such as that provided in the present study (Table 9). Our data reveal that the greatest number of time-loss injuries were very slight (1–3 days of time loss), with 41.6% of the injuries; followed by the moderate (8–28 days of loss), with 25.8%. In their study, Drakos et al.10 indicate that the injury that causes the greatest number of games lost due to injury are those involving patellofemoral pain, accounting for 17.5% of all the causes.

Just as Starkey et al.15 point out in their study, there has been a clear trend towards rising number of injuries and severity of injuries. This is due in great part to the increase in the physical demands of the game and to the characteristics of the players themselves, as they are ever taller, stronger and faster. Likewise, improved diagnostic tools and the awareness that epidemiological databases need to be created for each sport can also be a factor to consider in this jump in the number of injuries recorded.