WISCONSIN MEDICAL JOURNAL

Injuries from Ultimate Frisbee

Kristen H. Reynolds, MD; Sarah E. Halsmer, BS

ABSTRACT and there is little known about it in the medical litera-

Objective: This paper will explore ultimate frisbee in- ture. Ultimate frisbee is a non-contact disc sport played
juries. by 2 teams of 7 players on a field the size of a soccer
field. The object of the game is to score goals, which are
Method: This study uses an anonymous, retrospec-
achieved when a player catches the disc in the end zone.
tive, self-reported survey of 135 adult athletes at a
The disc is advanced through the air and players are
Midwestern ultimate frisbee tournament. Subjects were
not allowed to run with it. Ultimate frisbee combines
queried regarding injuries to specific body parts, those
elements of soccer, football, and basketball, and players
causing missed activity, recurring injuries, medical care
must run, cut, guard, jump, throw, catch, and at times
sought, basic demographic data, duration of participa-
layout (dive horizontally with an outstretched arm) for
tion, handedness, and eye color. Categorical data were
the disc. The sport is currently self-refereed.
analyzed by chi-square tests. Qualitative responses
Ultimate frisbee originated on the high school and
were categorized by themes.
college campuses of the 1960s and 1970s, but tended
Results: Respondents had a mean age of 28 years and to be mainly a college sport at that time. It has since
59% were male. Mean playing time was 8.2 hours per gained popularity at all levels, including high school,
week and 7.5 total years. Ultimate frisbee injuries in- college, club, and masters, and consists of men’s, wom-
cluded muscle strains (76% of subjects), ankle (65%), en’s, and mixed (co-ed) teams. Ultimate frisbee recently
knee (53%), shoulder (37%), head (30%), and rib debuted as a medal sport at the 2001 World Games in
(21%) injuries. Blisters/calluses and black toenails were Japan and is currently played by over 100,000 players
frequently mentioned. Recurrent injuries were reported worldwide in over 30 countries.1
in 49%. Shoulder injuries were more common in men There is little information in the medical literature
than women (47% versus 24%, P<0.02). Of respon- regarding ultimate frisbee and its associated injuries.
dents, 88% have missed ultimate frisbee activity due to A Medline search using the keywords “frisbee” and
injury, and 71% have sought medical care for ultimate “ultimate frisbee” yielded few articles, none of which
frisbee injuries. are specific to the sport of ultimate frisbee. The first
report was a letter to the editor in 1975 describing
Conclusions: The majority of surveyed ultimate fris-
“frisbee finger,” an abrasion of the middle finger of the
bee players experience injuries and seek medical care.
dominant hand from repetitive throwing.² Another let-
Health care professionals should be aware of the inju-
ter followed thereafter, suggesting adhesive tape to the
ries associated with ultimate frisbee and further studies
finger for prevention.3 Beer and Fleming reported that
should focus on prevention and education strategies.
dark-eyed individuals performed better at throwing a
frisbee through a hoop.4 (If it has been found that eye
INTRODUCTION
color affects frisbee skill, one might wonder if it also
The sport of ultimate frisbee is growing in popularity,
affects injuries.) A 1989 article reported distal ulnar ar-
tery thrombosis in a frisbee player, necessitating hospi-
Doctor Reynolds is with the Department of Family Medicine, University talization.5 Muller et al discussed hypothenar hammer
of Wisconsin School of Medicine and Public Health, Milwaukee Clinical syndrome in sports, and cited the frisbee player’s injury
Campus, Aurora Health Care. Ms Halsmer is with the Department of
Family Medicine, University of Wisconsin School of Medicine and from the prior article.6 Finally, complete rupture of the
Public Health, Milwaukee Clinical Campus. Please address corre- deltoid ligament of the ankle was reported in 1991.7
spondence to: Kristen H. Reynolds, MD, 8320 W Bluemound Rd, Ste
None of these studies specifically address injuries re-
125, Wauwatosa, WI 53213; phone 414.302.3800; fax 414.302.3813;
e-mail [email protected]. lated to the sport of ultimate frisbee.

46 Wisconsin Medical Journal 2006 • Volume 105, No. 6

 WISCONSIN MEDICAL JOURNAL
The most applicable and complete information on Table 1. Ultimate Frisbee Survey Questions
ultimate frisbee injuries was found using the search en-
Dear Ultimate Player,
gine SPORT Discus with the same keywords. In 1991 My name is Kristen Hakes Reynolds and I am a Family Practice
Marfleet described thigh muscle strains, ankle ligament Physician in Milwaukee, Wisconsin. I am conducting a survey
sprains, and skin abrasions/friction burns to be the most on ultimate frisbee-related injuries. There is very little written
frequent injuries.8 in the medical literature regarding our sport and its associated
Because there is limited information on the subject of injuries. I would like to change this. Please help to get our sport
known in the medical community by filling out this anonymous
ultimate frisbee injuries, this study was undertaken to
survey. You can drop your completed survey in the large box at
further evaluate ultimate frisbee injuries and to educate the tournament coordinator’s station. Thank you for your par-
physicians about the sport. ticipation!
1. Are you 18 years of age or older? ___Yes ___No
METHODS 2. What is your age? ____
Adult attendees at a Midwestern ultimate frisbee tour- 3. What is your gender? ___ Male ___ Female
nament of approximately 900 players, sponsored by the
4. Are you right- or left-handed (while playing ultimate frisbee)?
Ultimate Players Association in 2002, participated by ___ Rt ___ Lt
voluntarily completing an anonymous survey. In order 5. What is your eye color?
to advance to this regional tournament, teams had par- a. Blue b. Green c. Dark brown d. Hazel e. Other ___
ticipated and advanced from sectionals; regionals are 6. Approximately how many hours per week do you play ulti-
the final step before nationals, so the level of play was mate frisbee? _____
competitive. Athletes were questioned about injuries 7. How many years have you played ultimate frisbee? ______
to specific body parts, injuries causing missed activ- 8. Have you ever experienced a muscle strain/pull while play-
ity, recurring injuries, and injuries for which medical ing ultimate?___ Yes ___ No
care was sought. Participants were also queried regard- If so, which body part? _______________________________
ing age, gender, duration of participation, handedness, 9. Have you ever injured your ankle while playing ultimate?
and eye color. For specific survey questions see Table ___ Yes ___ No
1. Categorical data were summarized and analyzed by If so, please describe. ________________________________

chi-square testing using Epi-Info software. Qualitative 10. Have you ever injured your head while playing ultimate?
___ Yes ___ No
responses were categorized by type and method of in-
If so, please describe. ________________________________
jury.
11. Have you ever injured your shoulder while playing ulti-
mate? ___ Yes ___ No
RESULTS If so, please describe. ________________________________
Of the 900 athletes, 135 returned the survey (129 com- 12. Have you ever injured your knee while playing ultimate?
pleted both sides). Survey respondents included 79 men ___ Yes ___ No
(59%) and 56 women (41%) with mean age of 28 (range If so, please describe. ________________________________
18-46) years. They reported playing ultimate frisbee for 13. Have you ever injured your ribs while playing ultimate?
a mean 8.2 (range 0-20) hours per week and an average ___ Yes ___ No
of 7.5 (range 0-26) total years. Seventy-five percent of If so, please describe. ________________________________

respondents started playing between ages 17-22. 14. Have you ever sought out medical care for an ultimate-re-
lated injury?___ Yes ___ No
The most common specific lifetime injury was mus-
If so, was there a diagnosis? ___ Yes ___ No
cular, reported in 103 respondents (76%), followed by What was the diagnosis? _____________________________
ankle, knee, shoulder, head, and rib injuries (Figure 1). 15. Have you ever needed to miss a practice or game due to
Other injuries were reported by 99 respondents (77%) an ultimate-related injury? ___ Yes ___ No
and consisted of minor injuries, mostly of the feet If so, for what injury? ________________________________
(78%), such as blisters, calluses, black toenails, lost toe- For how long? ______________________________________
nails, and abrasions. Ruptured spleen was reported in 1 16. Have you ever experienced an ultimate frisbee-related
injury that was not mentioned above? (Can be during game/
subject.
practice or related to repetition/overuse. For example, collision
Muscle injuries were further broken down into sub- injuries, joint injuries, sore body parts, calluses/blisters, etc.)
types (Figure 2). Lower extremity muscles, mainly ham- ___ Yes ___ No
strings and quadriceps, were injured most frequently. If so, please explain. _________________________________
Calf and groin strains were also common, and upper 17. Do you have any recurring injuries? ___ Yes ___ No
extremity muscle injuries were reported less often. If so, please describe. ______________________________

Wisconsin Medical Journal 2006 • Volume 105, No. 6 47

 WISCONSIN MEDICAL JOURNAL
Figure 2: Ultimate Frisbee Injuries (Figure 3), the majority of which were lower extremity
90 as well. Recurrent knee injuries were reported in over
80
76
77
a third of respondents. Recurrent foot, toe, and ankle
70
65 injuries were also noted.
Percent of People with Injury

60
53 Shoulder injuries occurred more frequently in men
50
than women (35, 47% versus 13, 24%, P<0.02). All
40 37
30 other injuries were analyzed but no significant differ-
30

20
22
ences were found between genders (P=0.08-0.99)
10
One hundred thirteen respondents (88%) missed a
0
game or practice from an injury incurred while play-
Muscle Ankle Knee Shoulder Head Ribs Other
Type of Injury ing ultimate frisbee, primarily due to knee (37, 33%)
Figure 1. Ultimate frisbee injuries. and ankle (30, 27%) injuries. Ninety-one respondents
(71%) sought medical care for ultimate frisbee injuries,
again mainly for injuries to the lower extremity. All 135
Figure 3: Muscle Injuries
participants (100%) reported some form of injury, rang-
60
ing anywhere from blisters/calluses to much more seri-
55

50
ous injuries.
Percent of People with Injury

40
36
DISCUSSION
30
25
26
The results of this survey demonstrate that ultimate
21

20
frisbee injuries are common, that players are plagued by
10
11
10
recurrent injuries, and that medical care is often sought.
0
In comparing these results to those of Marfleet in 1991,8
Hamstring Quadricep Calf Groin Shoulder Back Other
Muscle this study confirms a high rate of lower extremity in-
Figure 2. Muscle injuries. juries. This injury pattern is consistent with sports re-
quiring sprinting and cutting, such as soccer. In fact, in
a study by Pardon in 1977, the most frequent soccer
injuries were those to the knees, thighs, and lower legs
Figure 4: Recurring Injuries

40
(mainly strains, pulled muscles, torn menisci, and con-
35
35
34 tusions).9
30
Given that players must catch a fast moving, hard
Percent of People with Injury

25
21
plastic disc, one might suspect hand injuries to be com-
20 18
mon. However only 10 people (8%) reported hand in-
15

10 8
juries. This is consistent with Marfleet’s finding of hand
injuries in 5.7%.8
6

0
Lower Extrimity (not Knee Foot/Toe Ankle Low Back Shoulder/Wrist
While it has been shown that dark-eyed individuals
knee, ankle)
Injury performed better at throwing a frisbee through a hoop,4
Figure 3. Recurring injuries. we found no difference in injuries between participants
with different eye colors.
Ultimate frisbee also entails some unique maneuvers,
Ankle injuries were reported by 88 respondents such as a layout for the disc. This could account for the
(65%), mostly by rolling or twisting the ankle due to high rate of shoulder injuries. Though not specifically
an uneven surface or hard ground. Knee injuries were addressed in this study, it is of the author’s personal ex-
reported in 68 (53%), but no specific knee injury was perience and opinion that men tend to be more aggres-
discernable. Forty-eight players (37%) had shoulder sive than women in this regard, which could account for
injuries, and a third of those were from doing a lay- the greater number of shoulder injuries in men. Proper
out. Forty players (30%) suffered a head injury, and of technique for laying out has been described in the lit-
those, 14 (35%) reported a concussion. Fifteen (38%) of erature.8
the head injuries resulted from colliding with another Several factors that contribute to sports injuries have
player or the disc, and 13 (33%) were from laying out. been reported in the literature, including athlete’s con-
Half of respondents reported recurring injuries ditioning, skill level, pre-game preparation, warming

48 Wisconsin Medical Journal 2006 • Volume 105, No. 6

 WISCONSIN MEDICAL JOURNAL
up, stretching, fluid and nutrition status, duration of also occur frequently. Most players (71%) have sought
play, fatigue, and field condition (level, uneven, hard, medical care for ultimate frisbee injuries. Well-informed
soft, etc.). Pre-season injury prevention and condition- health care professionals will be able to treat and edu-
ing programs have been shown in the literature to re- cate the growing numbers of young adults participating
duce injuries, including serious knee injuries, in soccer in this exciting sport. Future studies should focus on
players.10,11 Use of prevention strategies such as these, prevention and education strategies.
proper attire and field conditions, and education of
players by physicians and coaches would be helpful in REFERENCES
reducing ultimate frisbee injuries. 1. Ultimate Players Association Website. Available at: www.upa.
org. Accessed September 5, 2006.
Though this is 1 of few studies detailing ultimate fris- 2. Faust HS, Dembert ML. Frisbee finger. N Engl J Med.
bee injuries, it is limited by the retrospective nature and 1975;293:304.
survey format; therefore, there may be reporting bias. 3. Wegman DH, Peters JM. Frisbee finger (cont.). N Engl J
Med. 1975;293(14):725.
Also, because information was not received directly 4. Beer J, Fleming P. Effects of eye color on frisbee toss.
from medical professionals, the accuracy of reported in- Percept Mot Skills. 1988;66(2):675-676.
juries is unclear. Though only 1 tournament was used in 5. McCarthy WJ, Yao JS, Schafer MF, et al. Upper extremity
injuries in athletes. J Vasc Surg. 1989;9(2):317-327.
this study, the participants varied widely in age, number
6. Muller LP, Rudig L, Kreitner KF, et al. Hypothenar hammer
of years playing and frequency of play, providing for a syndrome in sports. Knee Surg Sports Traumatol Artrhosc.
wide variety of respondents, including similar numbers 1996;4(3):167-170.
of men and women. 7. McConkey JP, Lloyd-Smith R, Li D. Complete rupture of the
deltoid ligament of the ankle. Clin J Sport Med. 1991;1:133-
137.
CONCLUSION 8. Marfleet P. Ultimate injuries: a survey. Br J Sports Med.
As ultimate frisbee grows in popularity, physicians need 1991;25(4):235-240.
9. Pardon ET. Lower extremity injuries are site of most soccer
to be aware of its associated injuries. Lower extremity injuries. Phys Sportsmed. 1977;5:43-48.
injuries, such as muscle strains, ankle sprains, and knee 10. Heidt RS Jr. Avoidance of soccer injuries with preseason
injuries are common and contribute to missed prac- conditioning. Am J Sports Med. 2000;28(5):659-662.
11. Junge A, Rosch D, Peterson L, et al. Prevention of soccer
tices and games. Recurrent injuries, mainly to the knees
injuries: a prospective intervention study in youth amateur
and lower extremities, occurred in half of respondents. players. Am J Sports Med. 2002;30(5):652-659.
Foot injuries, including blisters and toenail injuries,

Wisconsin Medical Journal 2006 • Volume 105, No. 6 49

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