Injury patterns and cumulative injury burden among U.S. competitive fencers: a survey

Background: Fencing is a highly asymmetrical sport that combines both repetitive upper-extremity and lower-extremity actions. Although fencing related injuries have been described in clinical- and competition-based cohorts, population level data capturing both training and competition exposures and cumulative injury burden remains limited. Objective: To characterize injury patterns, mechanisms, and anatomical distribution among adult competitive fencers and to examine associations between training related exposures and reported injury burden. Methods: Adult competitive fencers registered with USA Fencing were invited to complete an anonymous web-based survey capturing demographics, training and competition exposures, and self-reported fencing related injuries. Injury burden was defined as experiencing three or more lifetime fencing-related injuries among injured respondents. Multivariable logistic regression was used to examine associations between training exposures and injury burden with continuous predictors modeled using restricted (natural) cubic splines to allow for non-linear relationships. Descriptive analyses, correlation analyses, and Poisson regression were performed as sensitivity analyses. Results: Among 303 respondents, 270 (89.1%) reported at least one fencing related injury, accounting for 571 total injuries. Overuse injuries predominated and most frequently involved the knee, ankle and dominant upper extremity with gradual-onset, non-contact mechanisms accounting for the majority of the injuries. Upper-extremity injuries were significantly more likely to occur on the dominant side. In multivariable analyses, years of fencing experience demonstrated a significant non-linear association with higher injury burden, while weekly training volume showed a non-linear association that approached statistical significance. Age at starting fencing, competition frequency, and sex were not independently associated with injury burden. Sensitivity analyses using Poisson regression yielded qualitatively similar findings. Conclusions: Among adult competitive fencers, higher injury burden is most strongly associated with cumulative training exposure, particularly years of fencing experience, with additional contribution from weekly training volume. Injury patterns are characterized by overuse and pronounced dominant-side upper-extremity involvement, consistent with the sport’s asymmetrical biomechanical demands. These findings underscore the importance of monitoring cumulative exposure and addressing asymmetrical loading to mitigate recurrent injury burden in fencing.