Kitesurfing is a relatively new extreme water sport that is considered a high-risk sport and has rising popularity. Kitesurfing combines aspects of several water sports, including surfing, windsurfing, and wakeboarding. With a large controllable kite and a small board, kitesurfers travel over the water surface with speeds of up to 35 knots. The vertical lift of the kite makes it possible to perform jumps up to 15 m high and 30 m long, while doing different manoeuvres in the air. Few scientific data are available concerning the biomechanical and physiological demands of kitesurfing and the epidemiology of kitesurfing injury, and research methods used are often questionable. During kitesurfing, considerable stress is placed on the musculoskeletal and physiological systems, and the possibility of injury or fatality is an inherent part of participation. The lower back and thigh muscles are often perceived as being highly stressed, while abdominal muscles, knees, and feet are common sites of pain or discomfort. During kitesurfing, both aerobic and anaerobic metabolism contribute to energy delivery. It is reported in the literature that kitesurfing injuries are mainly acute, due to accidents or trauma. Non-competitive kitesurfing resulted in an overall injury rate of 5.9–7.0 injuries per 1,000 kitesurfing hours. It seems that the risk of injury increases dramatically in competitive kitesurfing. However, contradictory results have been found. Lower extremities were the most common major site of injuries, followed by upper extremities, trunk, and head. Most accidents during kitesurfing reported in the literature were attributed to the inability to detach the kite from the harness. Due to technical innovations, recent studies report uncontrolled actions and unsuccessful tricks and jumps with poor landings as the main mechanisms of injuries. The main purpose of the present paper is to critically analyse the current relevant scientific literature on the biomechanical and physiological demands of kitesurfing and the epidemiology of injury among kitesurfers, in order to obtain greater insights into (i) the stresses imposed on the musculoskeletal and physiological systems by kitesurfing, and (ii) the rate, pattern, and mechanisms of kitesurfing injuries.