Unraveling Hidden Injury Networks Across Eight Elite Sports: A Data-Driven Anatomical and Age-Stratified Co-Occurrence Analysis

Unraveling Hidden Injury Networks Across Eight Elite Sports: A Data-Driven Anatomical and Age-Stratified Co-Occurrence Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unraveling Hidden Injury Networks Across Eight Elite Sports: A Data-Driven Anatomical and Age-Stratified Co-Occurrence Analysis Daewoong Yang, Chanhee Park, Youngjoo Cha This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9489396/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract BACKGROUND Injury surveillance in elite sports has traditionally emphasized injury incidence and anatomical distribution, often treating injuries as isolated events. However, musculoskeletal injuries frequently arise through interconnected biomechanical and kinetic-chain interactions across multiple anatomical regions. Network-based analytical approaches offer a novel framework for identifying such latent interaction structures, yet their application across diverse elite sports remains limited. METHODS This retrospective observational study analyzed injury surveillance data collected over a 10-month competitive season from eight elite sports: boxing, athletics (running), bowling, badminton, para table tennis, short-track speed skating, fencing, and taekwondo. Injuries were classified into ten anatomical regions and aggregated into monthly co-occurrence profiles. Weighted, undirected anatomical networks were constructed based on injury co-occurrence frequency. Network characteristics, including centrality measures, frequent co-injury pairs, and community structure, were examined using graph-theoretical analysis and Louvain modularity detection. RESULTS The anatomical injury network demonstrated a densely connected structure, indicating that injuries rarely occurred in isolation. The lumbar spine emerged as a central hub, frequently co-occurring with both upper- and lower-extremity injuries. Prominent co-injury pairs included lumbar–shoulder, lumbar–wrist, shoulder–wrist, lumbar–knee, and knee–ankle. Community detection revealed two primary modules corresponding to upper- and lower-body kinetic-chain clusters, with the lumbar spine acting as a structural bridge. CONCLUSIONS Injuries in elite athletes reflect complex, multi-regional interaction patterns rather than isolated anatomical events. Network-based co-occurrence analysis provides valuable insight into kinetic-chain injury mechanisms and supports the development of integrated, chain-based injury prevention strategies in elite sport. injury network co-occurrence analysis elite athletes kinetic chain musculoskeletal injuries sports medicine network analysis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 May, 2026 Editor assigned by journal 07 May, 2026 Submission checks completed at journal 06 May, 2026 First submitted to journal 05 May, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9489396","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639246995,"identity":"bd00aef4-38cc-451e-8de9-a0c8d23ae0a3","order_by":0,"name":"Daewoong Yang","email":"","orcid":"","institution":"Kyung Hee University","correspondingAuthor":false,"prefix":"","firstName":"Daewoong","middleName":"","lastName":"Yang","suffix":""},{"id":639246996,"identity":"9a24d8f9-5312-4766-8a73-eccab88cb9c6","order_by":1,"name":"Chanhee Park","email":"","orcid":"","institution":"Jeonju University","correspondingAuthor":false,"prefix":"","firstName":"Chanhee","middleName":"","lastName":"Park","suffix":""},{"id":639246997,"identity":"0476103e-0ab7-489b-9799-3eae91b0ab9e","order_by":2,"name":"Youngjoo Cha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYDACCQgpx9jefIAZIsRGlBYbY+aeYwkkaUlLbJ+RY0CcFv7ZzY8/fKg4bMw7I+fj58I2Bnn+Bra0D3gtuXPMwHDGmcNykj1vN0vPbGMwnHGA7fAMfFoMJBIMknnbDhsbtuduY+ZtY2DcwMDejNdhBhLpHw4DtSTuP5DzDKTFnggtOYbNvG1piY0dOWwgLYkbGNgO49UicSOnmHHGGRtjxp5jxtI85ySSZxxmS8arhX9G+mZgiIGj8uFnnjIb2/72NmO8WjBsZWBgJknDKBgFo2AUjAJsAACteEWul07/0AAAAABJRU5ErkJggg==","orcid":"","institution":"Cheju Halla University","correspondingAuthor":true,"prefix":"","firstName":"Youngjoo","middleName":"","lastName":"Cha","suffix":""}],"badges":[],"createdAt":"2026-04-22 01:23:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9489396/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9489396/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109324055,"identity":"c4205f9d-46aa-4384-9f4a-454fce621f3e","added_by":"auto","created_at":"2026-05-15 14:13:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":302333,"visible":true,"origin":"","legend":"","description":"","filename":"UnravelingHiddenInjuryNetworksAcrossEightEliteSports.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9489396/v1_covered_7c98e641-56ee-4ee0-bf14-1cdb29d4cd7c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unraveling Hidden Injury Networks Across Eight Elite Sports: A Data-Driven Anatomical and Age-Stratified Co-Occurrence Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"injury network, co-occurrence analysis, elite athletes, kinetic chain, musculoskeletal injuries, sports medicine, network analysis","lastPublishedDoi":"10.21203/rs.3.rs-9489396/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9489396/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e \u003cp\u003eInjury surveillance in elite sports has traditionally emphasized injury incidence and anatomical distribution, often treating injuries as isolated events. However, musculoskeletal injuries frequently arise through interconnected biomechanical and kinetic-chain interactions across multiple anatomical regions. Network-based analytical approaches offer a novel framework for identifying such latent interaction structures, yet their application across diverse elite sports remains limited.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eThis retrospective observational study analyzed injury surveillance data collected over a 10-month competitive season from eight elite sports: boxing, athletics (running), bowling, badminton, para table tennis, short-track speed skating, fencing, and taekwondo. Injuries were classified into ten anatomical regions and aggregated into monthly co-occurrence profiles. Weighted, undirected anatomical networks were constructed based on injury co-occurrence frequency. Network characteristics, including centrality measures, frequent co-injury pairs, and community structure, were examined using graph-theoretical analysis and Louvain modularity detection.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eThe anatomical injury network demonstrated a densely connected structure, indicating that injuries rarely occurred in isolation. The lumbar spine emerged as a central hub, frequently co-occurring with both upper- and lower-extremity injuries. Prominent co-injury pairs included lumbar\u0026ndash;shoulder, lumbar\u0026ndash;wrist, shoulder\u0026ndash;wrist, lumbar\u0026ndash;knee, and knee\u0026ndash;ankle. Community detection revealed two primary modules corresponding to upper- and lower-body kinetic-chain clusters, with the lumbar spine acting as a structural bridge.\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eInjuries in elite athletes reflect complex, multi-regional interaction patterns rather than isolated anatomical events. Network-based co-occurrence analysis provides valuable insight into kinetic-chain injury mechanisms and supports the development of integrated, chain-based injury prevention strategies in elite sport.\u003c/p\u003e","manuscriptTitle":"Unraveling Hidden Injury Networks Across Eight Elite Sports: A Data-Driven Anatomical and Age-Stratified Co-Occurrence Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-15 14:12:57","doi":"10.21203/rs.3.rs-9489396/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-05-07T06:35:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T06:05:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-06T04:02:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2026-05-06T03:58:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55b7fe8f-7e7c-4bb1-9b99-95c4edb6ed0c","owner":[],"postedDate":"May 15th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewersInvited","content":"33","date":"2026-05-07T06:35:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-07T06:05:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-06T04:02:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2026-05-06T03:58:27+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T14:12:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-15 14:12:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9489396","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9489396","identity":"rs-9489396","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}