The restrictions in the comparability of circus artists and other athletes result from their very different physical and artistic characteristics. Therefore, circus artist students are to be analyzed and evaluated as an individual/autonomous group [1, 2, 9, 10]
The acute injury rate is very low despite the intensive and monospecific training, and an increase of requirements to ensure the competitive capability observed in recent years 
. The results show a slight overbalance of lighter injuries 
and only one in twelve accidents resulted in a training interval of more than 3 days. The low injury rate corresponds with results from the professional dance [12, 13]
and dance student level 
. Each injury represents a potential danger to a career that has not yet begun 
. Due to high work load intensity and duration – as in professional dance [14–18]
chronic and overuse injuries can occur [2, 3, 4]
. Neither have they been considered in previous studies nor in this one. These should be the subjects of future focus. Compared to professional dance, apparatus gymnastics and numerous other types of sports, the lower extremity is the most commonly injured area during the training to become a circus artist [19, 20]
. Hardly any gender specific differences are observed in injury type, injured structure, causes, movement during the work accident and the activity before the accident. It is obvious that female students had a higher proportion of upper extremity injuries. These injuries in female students may result from the high workload as well as from the discrepancy between the degree of difficulty and the muscular stabilization capability and power capability together with the simultaneous hypermobility in extreme ranges of movement that are required in the circus arts [2, 21]
. Particularly in growth periods this mobility increases a temporary instability and imbalance and may result in a higher susceptibility to injuries/injury risk [30–32]
. The same could be valid for the high proportion of their knee and foot injury rates. However, it should be considered that the landings after jumps drive high forces through the musculoskeletal system.
In almost one in three accidents the spine is affected in male and in one out of five accidents the cervical spine is affected in female students. The spine is the most sensitive part of the musculoskeletal system and should be focused on during circus arts training. According to Kahle ,
repeated smaller injuries result in degenerative changes 
. The relevance of this finding is emphasized by the present study. Above all, weight, concussion and jolt expositions should be minimized 
Furthermore, it is to be taken into account that acute injuries may result from chronic unresolved problems that have been compensated for. An additional overall strength, conditioning and fitness coaching with stability and coordination training could be an initial step toward a successful injury prevention program [24–27]
. Depending on the time of the day the injury risk is increased while performing demanding movement combinations without a sufficient aerobic basic endurance status [28, 29]
. This may be the case for circus artists too, but there are little or no data on the cardiopulmonary capability.
The majority of injuries is multifactorial. Thus, the causes – as in professional dance – are on the one hand endogenous (nutritional and training status, physical prerequisites and technical skills of the student) and on the other hand exogenous (training plan, microclimatic conditions, lighting, partner, props/equipment 
. As in professional dance an influence of equipment on the injury patterns becomes apparent [33, 34]
. Thus, injury prevention comprises several aspects.
Time-related frequencies of injuries can be observed in circus arts students to overlap with those in professional dancers 
. Here, an adaptation to training intensity is required.
In the long run, injury-and work accident risks can only be reduced in circus arts students that entirely correspond to the anatomic-physiological and aesthetical aptitude criteria for a professional circus arts training, without having to adjust measures or methods 
. Any type of compromise, either by dietetic measures to correspond to the physical ideal, or by compensation mechanisms to perform a technique due to physical restriction results in an increased accident risk [37, 38]
Unlike in professional dance, the majority of injuries in circus arts students is sustained at non dance specific locations such as stairs, halls and showers and when executing non dance specific activities 
. These results explain the necessity not to exclusively limit injury prevention to training, for accidents occur at non specific locations, too.
Ignoring smaller injuries increases the risk to sustain a follow-up injury. Trivializing and not reporting a work accident can not be ruled out although it is mandatory. However, as minor injuries in acrobatics (e.g. in the trapeze) may result in life threatening situations, an almost complete case number can be presumed. In contrast with self reported questionnaires that consult personal assessments, objective findings were evaluated in the present study. Beyond the circus arts field, there are no direct comparative populations except elite gymnasts and professional dance students. The restrictions in the comparability of circus artists and other athletes result from their very different physical and artistic characteristics. Therefore, circus artist students are to be analyzed and evaluated as an autonomous group [1–3]