N/A Is Not an Injury: The Empty Ledger of Indian Athletics' Injury Surveillance

Patiala, a Federation Cup afternoon. A javelin thrower comes off the runway after his third attempt, holding his right elbow with his left hand, and walks straight to the physio. A team official answers my question before I finish it: "Nothing major, just tightness." I ask how many elbows in this event have been iced this season. The answer: "We don't count that."

Weeks later, a different document landed in front of me. A nine-dimension assessment sheet for an athletics injury story. Every cell carried the same two letters — N/A. Performance assessment, N/A. Athlete condition, N/A. Qualification pathway, N/A. Anti-doping risk, N/A. Coaching system, N/A. Public narrative cycle, N/A. Not because the athlete was healthy. Because nothing had been recorded.

That empty sheet turned out to be the cleanest sports-medicine story of the year. The crisis in Indian athletics is not that injuries are multiplying. It is that injuries are not counted, and what is not counted cannot be fixed. I have been reporting on athletics medicine long enough to know that the first diagnosis is rarely the whole injury. This time the problem sat even earlier. There was no first diagnosis on paper at all.

My own entry into this work came from the same emptiness. In 2026, at twenty, my career as a state-level 400m runner at Osmania University ended on a misdiagnosed navicular stress fracture. For three months I was told it was flat-foot pain. The day the correct scan came back, I understood the error was not the scanner's. The error belonged to a system in which my date of pain, my training-week volume and the state of my shoes had never been written down anywhere. I stopped trusting the first X-ray and started reading the week before it.

This piece is written from that habit. Two disclosures up front: no athlete is named here, no mark is cited, and no individual is blamed. This is an audit of a system that does not keep its own books.

How the rest of the world counts

Injury surveillance is not a mystery. It is arithmetic: injuries divided by exposure. Exposure means how many athletes, for how many hours, on what surface, at what intensity. With a denominator, a numerator means something. Without one, every number becomes an anecdote wearing a lab coat.

UEFA's Elite Club Injury Study has run for two decades. The IOC runs injury and illness surveillance at every Olympics, and the findings appear in journals such as the British Journal of Sports Medicine. The NCAA's surveillance programme has tracked college injury rates for decades. The value is always the same: once you know which event, which part of the season and which surface produce injuries, you can change the calendar instead of the athlete.

I could not find the Indian equivalent in public form. No season-wise injury list on a federation website, no open record from SAI centres, no national athletics injury registry. Medical records certainly exist at NIS Patiala — the distance between a record existing and a system learning from it is the actual story. I have asked for raw data repeatedly. The answer varies in wording and never in substance: "That is internal."

One clarification matters here. Missing data is not evidence of a clean record. If no injury appears against a season, it does not mean no injury occurred. It means nobody kept the ledger. In medical reporting, confusing those two is how systems get certified as safe by default.

The calendar is the injury report

The domestic season is thin. Federation Cup, Inter-State, National Open, a few Grand Prix links, then months of nothing. The gap hurts in two directions.

First, for long stretches an athlete trains under no supervision at all — no load monitoring, no weekly physio check, no audit of surfaces or footwear. Second, when the qualifying window closes in, three peak efforts get compressed into six weeks. An athlete who has not competed in four months suddenly produces maximal output three times in three weeks.

The hamstring data pointed to fatigue; the calendar pointed to the real story. When I analysed hamstring strains across the 32 teams at the 2026 World Cup, I found 17, with 11 in the second half. I could say that because I had a denominator — 64 matches, fixed squads, fixed minutes. On the Indian domestic circuit I cannot say the equivalent, because I have no meet count, no athlete-hours and no medical tent register from any of those events.

What I can describe is structure. Three peaks in six weeks followed by four months of silence is a load pattern, and load patterns are where hamstrings and Achilles tendons speak first. A hamstring is often a schedule in disguise.

The body on a sports quota

The real professional contract in Indian athletics is a job with Railways, Services, a police force or a PSU. That economy keeps the athlete alive. It also quietly degrades him.

Shift duty. Leave refused before a camp. Parade commitments. Rehabilitation squeezed into whatever hours remain, usually at night. All of it is training load, and none of it appears in a training log. When I ask an athlete for his week, I get track hours. I do not get shift hours, and I never get sleep hours.

The job roster is a training variable, no different from weekly mileage or intensity. In the week an athlete's leave is cancelled, his recovery day is cancelled too, regardless of what the coach has written. That information is not in a federation file. It is in the athlete's phone calendar, if he is willing to show it.

My disclosure rule is simple and I state it because my access runs through exactly these people. What is told to me off the record stays off the record. What breaks an athlete's medical privacy does not get published. What concerns the system — staffing levels, absent protocols, budget priorities — does get published, and when I am holding something back I say so and say for how long. Silence should read as a decision, not an oversight.

Auditing the rehab ledger

Here is the part that angers me, and I prefer to show the arithmetic rather than the anger.

Money does reach Indian sport. Through TOPS, foreign camps, imported equipment, travel and even biomechanics support get sanctioned. Flying in a biomechanist for javelin is not impossible. The physio standing next to that runway — the appointment, the contract, the continued training — is where the budget abruptly thins out.

I have seen centres where one physiotherapist carries a large group, sometimes across different event groups. Track in the morning, rehab at noon, travel logistics in the evening, and no slot in that day for a neuromuscular screening test on a knee. That is not negligence. It is staffing arithmetic.

The second half of this ledger matters more: the return-to-play protocol. A written document stating the criteria on which an athlete returns, not the absence of pain but measurable thresholds — strength ratios, single-leg hop tests, progressive sprint load. I have not found a public, standardised document of that kind in Indian athletics that could be applied to any athlete. What exists is individual judgement. Individual judgement is not bad, but it is not verifiable.

When an athlete is declared ready, I treat it as a claim rather than news. A claim invites evidence: which test, on what date, passed at what value, and how that value relates to the previous three weeks of load. Without those three things, it is not a medical clearance. It is a verbal permission that has been turned into a press note.

The first day decides, not the scan

The scan shows damage; the load history explains it. The same MRI image means two different things in two athletes. For one it is the price of speed. For the other it is the price of five months of neglect. The difference is never in the image.

That is why I build injury stories backwards. The MRI is the last page of a document that begins three weeks earlier — in a compressed domestic season, an unsanctioned training block, or the Railways shift roster that ate the recovery day. Any account of an injury that skips that sequence is incomplete by construction.

It is also why I insist that injuries do not arrive alone. Clusters are not accidents; they are calendars with pain. When one centre produces three Achilles cases or four hamstring strains in a single season, the weakest explanation is bad luck and the strongest is the training system. Reaching the strongest explanation requires the count nobody keeps.

I should record one of my own errors here. When I wrote about the Achilles cases after the lockdown, I had five of them and I tied all five to a single cause — a sudden jump in hill training. Five cases do not establish a cause. What should have been written was that the pattern was consistent with that mechanism, and that confirming it would require eight weeks of load data for those five athletes, which we did not have. I did not write that then. I am writing it now.

The weakest link is fear

The standard reform demand is for data, GPS, wearables, software. My first conclusion runs the other way. The data gap in Indian athletics is not a technology gap. It is an incentive gap.

Consider who benefits from logging an injury. A centre that logs injuries produces worse-looking numbers. A federation that publishes an injury list opens itself to selection disputes — if he was not fit, why was he sent? A coach who records his athlete's injury invites questions about his methods. A PSU employer who records it opens the door to medical leave and claims. Everyone has a reason not to keep the record. Nobody has a reason to keep it.

That is the real constraint, and it breaks through rules, not hardware. One plain rule is enough: no name goes on a championship entry list without a one-page medical declaration covering the previous three weeks of training load, the date of the last injury and the current rehabilitation status. Data volume will not rise. The cost of not recording simply becomes the price of entry.

I know this will be called bureaucracy. I call it insurance. You do not send a body onto a runway without the equivalent of a structural audit.

What happens next

I do not forecast which tendon in which named athlete gives way. That is neither my job nor ethical. I forecast systems.

The next cluster will arrive in the same window — six to eight weeks before a qualifying deadline, when someone tries to convert four months of silence into three peaks in three meets. That is a pattern, and patterns repeat. I cannot say how many will break, because I have no denominator. I can say that if someone asks me at the end of this season how many injuries occurred, the answer will be the one Patiala gave me: we don't count that.

That is the story. The injury on an Indian athlete's body is no longer only a medical event. It is an administrative one — a document that began three weeks earlier and that nobody wrote. An injury you cannot count is an injury you cannot prevent, and a system that does not record its own injuries keeps returning to the same place. Only, each time, on a different athlete's knee.