A new 10-year national analysis shows injury patterns are changing—especially among adults over 65
As more older adults turn to sports and recreational activities to stay active, injury rates among this group are rising—and now we have a better picture of what those injuries look like.
A new study published in the Orthopaedic Journal of Sports Medicine examined over 5,500 emergency department cases from 2014 to 2023 involving orthopaedic injuries in adults aged 55 and older. Using a national injury surveillance database, researchers analyzed injuries across 12 of the most popular non-contact and limited-contact sports for this demographic, from golf to weightlifting.
The results are both reassuring and revealing.
Key Takeaways at a Glance
- Most common injury type: Sprains and strains (57%)
- Fractures more common in certain sports (pickleball, tennis, baseball, and soccer)
- Injury odds shift with age: Fractures increase, sprains and strains decrease
- Higher risk for women: Women had 2.7 times higher odds of fracture than men
- Highest hospitalization odds: Basketball, tennis, and pickleball
The data reflect what many clinicians and fitness professionals already know: while staying active later in life is essential for health and well-being, certain types of sports may carry higher injury risks that deserve better understanding—not to discourage participation, but to improve safety and preparedness.
Which Sports Were Studied?
Researchers included 12 popular sports for adults aged 55 and older:
- Non-contact: Golf, pickleball, tennis, swimming, bowling
- Limited-contact: Basketball, baseball, softball, weightlifting, volleyball, football, soccer
Golf accounted for the highest share of injuries (22.8%), followed by pickleball (17.0%), tennis (13.4%), and weightlifting (12.9%). Basketball, bowling, and baseball followed in smaller proportions.
These numbers don’t necessarily reflect which sports are most dangerous—they reflect which ones are most commonly played among older adults, and which led to emergency department visits for orthopaedic issues during the study period.
Fractures Rise With Age
Across all sports, fractures became increasingly common with age, while sprains and strains declined.
- Adults aged 85 and older were 2.6 times more likely to suffer a fracture than those aged 55–59.
- Meanwhile, the same 85+ age group was 4.5 times less likely to have a sprain or strain than their younger counterparts.
This shift likely reflects age-related changes in bone density, balance, and neuromuscular coordination. Common causes of these injuries include falls from standing height, often due to muscle weakness, vision changes, or slower reaction times—rather than high-impact collisions.
The risk of hospitalization also increased steadily with age: those over 85 had five times higher odds of hospitalization than adults in their late 50s.
Gender Differences in Injury Risk
The data showed clear differences between men and women:
- Women had significantly higher odds of sustaining a fracture, regardless of sport
- Men were more likely to experience sprains, strains, and dislocations
These findings are consistent with prior research showing that postmenopausal bone loss and conditions such as osteoporosis make women more vulnerable to fractures from relatively low-impact activities.
In sports like pickleball, swimming, and bowling, women made up a greater share of total injuries. This likely reflects growing participation among women in these sports rather than a gender-specific risk inherent to the activity.
Injury Type by Sport
While sprains and strains were the most common injury type overall, fractures dominated in several key sports:
| Sport | Most Common Injury Type |
| Golf | Sprain/Strain (73%) |
| Pickleball | Fracture (54%) |
| Tennis | Fracture (53%) |
| Weightlifting | Sprain/Strain (74%) |
| Basketball | Sprain/Strain (51%) |
| Bowling | Sprain/Strain (62%) |
Pickleball and tennis both involve frequent pivoting, lateral movement, and sudden stops—making them more likely to result in falls or wrist fractures, particularly among those with slower reaction times or diminished balance.
Weightlifting, on the other hand, showed very low rates of fracture but high rates of soft tissue injury, especially when technique or form may be compromised by fatigue or lack of instruction.
Swimming was associated with higher odds of shoulder dislocation, consistent with the repetitive overhead motion required by strokes like freestyle and backstroke.
Most Frequently Injured Areas
The most commonly affected parts of the body were:
- Upper extremity (shoulder, arm, wrist, hand): 40%
- Lower extremity (hip, leg, knee, ankle): 30%
- Trunk (chest, abdomen, back): 24%
- Head/neck: 6%
Fractures occurred most often in the upper extremities, particularly the wrist, elbow, and shoulder, typically the result of trying to break a fall.
Which Sports Had the Highest Hospitalization Odds?
Sports typically perceived as low-risk were, in some cases, associated with higher hospitalization rates:
- Basketball: 1.76x higher odds of hospitalization than baseball (used as reference)
- Tennis: 1.59x higher
- Pickleball: 1.44x higher
- Bowling and golf: Also associated with elevated hospitalization odds
In these cases, it wasn’t necessarily the sport’s physicality driving hospitalizations—but rather how and where injuries occurred (e.g., a fall resulting in a broken wrist or hip).
By contrast, football, softball, and soccer showed lower odds of hospitalization in this older population—likely reflecting lower levels of intensity or modified rules when played recreationally.
What Can Be Done?
The takeaway isn’t to discourage older adults from staying active—far from it. The physical, mental, and social benefits of recreational sports are well established, particularly in reducing chronic disease and maintaining mobility.
But as this study shows, the type of sport matters, as does individual preparation.
Some strategies for reducing risk:
- Warm-up routines and muscle strengthening to reduce falls and strains
- Balance and flexibility training
- Proper footwear and court conditions to prevent slips
- Bone density screening for older adults, especially women
- Education on safe technique, especially in weightlifting and racquet sports
Even in sports like swimming—often considered low-risk—repetitive stress injuries to the shoulder can occur without proper form or rest.
A Changing Landscape
This study fills an important gap in research, offering one of the most comprehensive looks at how sport-related injuries affect older adults in the U.S. It challenges some common assumptions about which sports are safest, and how age and gender intersect with injury risk.
As participation continues to rise—especially in sports like pickleball—it’s likely we’ll see more attention paid to injury prevention, tailored coaching, and medical guidance specifically designed for aging athletes.
Because the ultimate goal isn’t to avoid risk altogether—it’s to help older adults keep moving, playing, and staying healthy as long as possible.
