Training exposure, recovery, and injury incidence among course-based and competitive university Wushu Taolu practitioners: a 12-week prospective cohort study

Background Whether the large training-exposure difference between course-based and competitive-team university Wushu Taolu practitioners in China translates into a correspondingly different musculoskeletal health burden has not been well characterized prospectively. Methods In this observational, non-randomized cohort study, 255 practitioners (128 course-based, 127 university-team; mean age 20.7 ± 1.5) were followed over four waves (T0–T3) across 12 weeks, with training load, sleep, recovery, health problems, and injury recorded using recall windows matched to each variable’s time-scale. Results University-team practitioners had substantially higher training exposure than course-based practitioners. The 12-week cumulative incidence of new injury was substantially higher in university-team practitioners than in course-based practitioners (68.9% vs. 20.0%; p < 0.001), with higher adjusted odds of injury (OR = 6.31, 95% CI 1.49–26.69). However, when injury occurrence was expressed relative to estimated training exposure, the between-group difference was much smaller: 10.56 versus 8.98 positive new-injury person-wave observations per 1,000 estimated training hours, respectively (IRR = 1.18, 95% CI 0.79–1.75). Prior injury within the preceding 12 months was strongly associated with subsequent injury (OR = 4.06, 95% CI 2.03–8.13). Conclusion University-team practitioners experienced a substantially greater absolute injury burden than course-based practitioners, whereas the between-group difference was much smaller when injury occurrence was expressed relative to estimated training exposure. Prior injury history was a strong marker of subsequent injury. Because group membership and training exposure were highly correlated and the study was observational, these findings should not be interpreted causally.