Epidemiology of musculoskeletal injuries in Brazilian American football: associations with pre-activity routines, sleep, and mood

American football is a high-intensity contact sport associated with substantial mechanical load and risk of musculoskeletal injuries. Despite its growing popularity in Brazil, epidemiological data remain limited. This study aimed to describe the injury profile and explore factors associated with injuries in Brazilian American football players. A cross-sectional study was conducted between August and October 2025 using a questionnaire on demographic, anthropometric, training, competition, sleep, mood, and risk factors. Sixty athletes participated, with 33 reporting injuries and a median of two injuries per athlete. A total of 93 injuries were reported, most occurring during games. The ankle/foot, knee, and thigh were the most affected regions, with muscle strains and sprains predominating. Overall injury incidence was 7.26 injuries per 1,000 exposure hours, higher in games than training. Taller athletes reported more injuries, while non-restorative sleep and irregular routines were common.