Para Alpine skiing is one of the largest sports at the Paralympic Winter Games. Recent studies report high injury rates in this sport. However, limited evidence exists regarding sport-specific injury characteristics, which is essential for targeted prevention. The aim of this study was to describe the overall incidence proportion and incidence of injuries reported by athletes participating in Alpine skiing at the Sochi 2014, PyeongChang 2018, and Beijing 2022 Paralympic Winter Games, and to describe injuries by sex, age, impairment, competition period, onset (chronicity), anatomical area, and estimated injury burden. Prospective epidemiological data regarding injuries at the three Paralympic Games (including 486 athletes and 6002 athlete days) were reported by medical staff through the validated web-based injury and illness surveillance system (WEB-IISS) and Paralympic polyclinics. Data were coded and analyzed according to the IOC Para consensus statement using descriptive and analytical statistics (incidence, incidence proportion with 95% CIs, and generalized linear Poisson's regression modeling). The overall injury incidence was 29.4 (95% CI 24.9-34.6) injuries per 1000 athlete days, with an incidence proportion of 28.4%. Injury incidence was significantly higher in the pre-competition period (54.4; 95% CI 42.5-69.7) compared with the competition period (21.2; 95% CI 17.2-26.1). Acute injuries predominated, with 24% of athletes sustaining at least one acute injury during the Games. The head/face/neck (24%) and knee (20%) were most affected. Common mechanisms included collisions and loss of control. Ten percent of injuries resulted in > 28 days of expected time loss, and the overall injury burden was 70.6 days lost per 1000 days. No difference in injury incidence was found with regards to sex and age. Athletes with limb deficiency reported the highest injury proportions, followed by those with spinal cord injury. Across three Paralympic Games, nearly one-third of Para Alpine skiers sustained an injury. These findings highlight a need for enhanced prevention strategies, particularly those targeting the high-risk pre-competition period and focusing on mechanisms to protect the head/face/neck and knee.
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