SUMMARY REPORT
NATIONAL HIGH SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY
2012-2013 School Year
Compiled by:
R. Dawn Comstock, PhD
Christy L. Collins, MA
Dustin W. Currie, BS
2
Acknowledgements
We thank the certified athletic trainers (ATs) for their hard work and dedication in providing us
with complete and accurate data. Without their efforts, this study would not have been possible.
We would like to thank the National Federation of State High School Associations (NFHS) for
their support of this project. The content of this report was funded in part by the Centers for
Disease Control and Prevention (CDC) grants #R49/CE000674-01 and #R49/CE001172-01. The
content of this report is solely the responsibility of the authors and does not necessarily represent
the official views of the CDC. We would also like to acknowledge the generous research funding
contributions of the National Federation of State High School Associations (NFHS), National
Operating Committee on Standards for Athletic Equipment (NOCSAE), and DonJoy Orthotics.
Note
The analyses presented here provide only a brief summary of collected data, with the feasibility
of a more detailed presentation limited by the extensive breadth and detail contained in the
dataset. The principal investigator, Dr. R. Dawn Comstock, is happy to provide further
information or to discuss research partnership opportunities upon request.
For reprints/further information contact:
R. Dawn Comstock, PhD
Associate Professor
Epidemiology, Colorado School of Public Health
Pediatric Injury Prevention, Education, and Research (PIPER) program
Center for Injury Research and Policy
700 Children's Drive
Columbus, Ohio, 43205
(614) 355-5850 phone
(614) 355-5897 fax
[email protected]
3
Contents
I. INTRODUCTION & METHODOLOGY............................................................................... 8
1.1
P
ROJECT
O
VERVIEW
............................................................................................................... 9
1.2
B
ACKGROUND AND
S
IGNIFICANCE
......................................................................................... 9
1.3
S
PECIFIC
A
IMS
..................................................................................................................... 10
1.4
P
ROJECT
D
ESIGN
.................................................................................................................. 11
1.5
S
AMPLE
R
ECRUITMENT
........................................................................................................ 12
1.6
D
ATA
C
OLLECTION
.............................................................................................................. 12
1.7
D
ATA
M
ANAGEMENT
........................................................................................................... 13
1.8
D
ATA
A
NALYSIS
.................................................................................................................. 13
II. OVERALL INJURY EPIDEMIOLOGY ............................................................................ 15
T
ABLE
2.1
I
NJURY
R
ATES BY
S
PORT AND
T
YPE OF
E
XPOSURE
.................................................. 16
T
ABLE
2.2
P
ROPORTION OF
I
NJURIES
R
ESULTING IN
T
IME
L
OSS
................................................ 17
T
ABLE
2.3
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
A
THLETES BY
S
EX
.......................... 17
T
ABLE
2.4
B
ODY
S
ITE OF
I
NJURY BY
T
YPE OF
E
XPOSURE
......................................................... 18
T
ABLE
2.5
M
OST
C
OMMONLY
I
NJURED
A
NKLE
S
TRUCTURES
................................................... 19
T
ABLE
2.6
M
OST
C
OMMONLY
I
NJURED
K
NEE
S
TRUCTURES
..................................................... 19
T
ABLE
2.7
T
EN
M
OST
C
OMMON
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
........................... 20
T
ABLE
2.8
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
........................................... 21
T
ABLE
2.9
T
IME DURING
S
EASON OF
I
NJURY
............................................................................. 21
T
ABLE
2.10
P
RACTICE
R
ELATED
V
ARIABLES
............................................................................ 22
T
ABLE
2.11
I
NJURY
E
VALUATION AND
A
SSESSMENT
................................................................ 23
F
IGURE
2.1
I
NJURY
D
IAGNOSIS BY
T
YPE OF
E
XPOSURE
............................................................ 18
F
IGURE
2.2
T
IME
L
OSS BY
T
YPE OF
E
XPOSURE
......................................................................... 20
F
IGURE
2.3
N
EW AND
R
ECURRING
I
NJURIES BY
T
YPE OF
E
XPOSURE
........................................ 21
III. BOYS’ FOOTBALL INJURY EPIDEMIOLOGY ........................................................... 24
T
ABLE
3.1
F
OOTBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
................................................... 25
T
ABLE
3.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
F
OOTBALL
A
THLETES
.................... 25
T
ABLE
3.3
B
ODY
S
ITE OF
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..................................... 26
T
ABLE
3.4
T
EN
M
OST
C
OMMON
F
OOTBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
......... 27
T
ABLE
3.5
F
OOTBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
......................... 28
T
ABLE
3.6
T
IME DURING
S
EASON OF
F
OOTBALL
I
NJURIES
........................................................ 28
T
ABLE
3.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 29
T
ABLE
3.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 29
T
ABLE
3.9
A
CTIVITIES
L
EADING TO
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..................... 30
F
IGURE
3.1
D
IAGNOSIS OF
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................... 26
F
IGURE
3.2
T
IME
L
OSS OF
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................... 27
F
IGURE
3.3
H
ISTORY OF
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
...................................... 28
F
IGURE
3.4
P
LAYER
P
OSITION OF
F
OOTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
........................ 30
F
IGURE
3.5
A
CTIVITY
R
ESULTING IN
F
OOTBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
.................... 31
4
IV. BOYS’ SOCCER INJURY EPIDEMIOLOGY ................................................................. 32
T
ABLE
4.1
B
OYS
’
S
OCCER
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
............................................ 33
T
ABLE
4.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
B
OYS
’
S
OCCER
A
THLETES
............. 33
T
ABLE
4.3
B
ODY
S
ITE OF
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
.............................. 34
T
ABLE
4.4
T
EN
M
OST
C
OMMON
B
OYS
’
S
OCCER
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
.. 35
T
ABLE
4.5
B
OYS
’
S
OCCER
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
.................. 36
T
ABLE
4.6
T
IME DURING
S
EASON OF
B
OYS
’
S
OCCER
I
NJURIES
................................................. 36
T
ABLE
4.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 37
T
ABLE
4.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 37
T
ABLE
4.9
A
CTIVITIES
L
EADING TO
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
.............. 38
F
IGURE
4.1
D
IAGNOSIS OF
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................ 34
F
IGURE
4.2
T
IME
L
OSS OF
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................. 35
F
IGURE
4.3
H
ISTORY OF
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................ 36
F
IGURE
4.4
P
LAYER
P
OSITION OF
B
OYS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
................. 38
F
IGURE
4.5
A
CTIVITY
R
ESULTING IN
B
OYS
’
S
OCCER
I
NJURIES BY
I
NJURY
D
IAGNOSIS
............. 38
V. GIRLS’ SOCCER INJURY EPIDEMIOLOGY ................................................................. 40
T
ABLE
5.1
G
IRLS
’
S
OCCER
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
........................................... 41
T
ABLE
5.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
G
IRLS
’
S
OCCER
A
THLETES
............. 41
T
ABLE
5.3
B
ODY
S
ITE OF
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................. 42
T
ABLE
5.4
T
EN
M
OST
C
OMMON
G
IRLS
’
S
OCCER
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
.. 43
T
ABLE
5.5
G
IRLS
’
S
OCCER
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
................. 44
T
ABLE
5.6
T
IME DURING
S
EASON OF
G
IRLS
’
S
OCCER
I
NJURIES
................................................. 44
T
ABLE
5.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 45
T
ABLE
5.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 45
T
ABLE
5.9
A
CTIVITIES
L
EADING TO
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............. 46
F
IGURE
5.1
D
IAGNOSIS OF
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
........................... 42
F
IGURE
5.2
T
IME
L
OSS OF
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................ 43
F
IGURE
5.3
H
ISTORY OF
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................... 44
F
IGURE
5.4
P
LAYER
P
OSITION OF
G
IRLS
’
S
OCCER
I
NJURIES BY
T
YPE OF
E
XPOSURE
................. 46
F
IGURE
5.5
A
CTIVITY
R
ESULTING IN
G
IRLS
’
S
OCCER
I
NJURIES BY
I
NJURY
D
IAGNOSIS
............ 47
VI. VOLLEYBALL INJURY EPIDEMIOLOGY ................................................................... 48
T
ABLE
6.1
V
OLLEYBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
.............................................. 49
T
ABLE
6.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
V
OLLEYBALL
A
THLETES
................ 49
T
ABLE
6.3
B
ODY
S
ITE OF
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................ 50
T
ABLE
6.4
T
EN
M
OST
C
OMMON
V
OLLEYBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
..... 51
T
ABLE
6.5
V
OLLEYBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
..................... 52
T
ABLE
6.6
T
IME DURING
S
EASON OF
V
OLLEYBALL
I
NJURIES
.................................................... 52
T
ABLE
6.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 53
T
ABLE
6.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 53
T
ABLE
6.9
A
CTIVITIES
L
EADING TO
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................ 54
5
F
IGURE
6.1
D
IAGNOSIS OF
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................... 50
F
IGURE
6.2
T
IME
L
OSS OF
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
............................... 51
F
IGURE
6.3
H
ISTORY OF
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................................. 52
F
IGURE
6.4
P
LAYER
P
OSITION OF
V
OLLEYBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................... 53
F
IGURE
6.5
A
CTIVITY
R
ESULTING IN
V
OLLEYBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
............... 55
VII. BOYS’ BASKETBALL INJURY EPIDEMIOLOGY ..................................................... 56
T
ABLE
7.1
B
OYS
’
B
ASKETBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
.................................... 57
T
ABLE
7.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
B
OYS
’
B
ASKETBALL
A
THLETES
..... 57
T
ABLE
7.3
B
ODY
S
ITE OF
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
...................... 58
T
ABLE
7.4
B
OYS
’
B
ASKETBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
............................ 59
T
ABLE
7.5
B
OYS
’
B
ASKETBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
.......... 60
T
ABLE
7.6
T
IME DURING
S
EASON OF
B
OYS
’
B
ASKETBALL
I
NJURIES
......................................... 60
T
ABLE
7.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 61
T
ABLE
7.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 61
T
ABLE
7.9
A
CTIVITIES
L
EADING TO
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..... 62
F
IGURE
7.1
D
IAGNOSIS OF
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................... 58
F
IGURE
7.2
T
IME
L
OSS OF
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................... 59
F
IGURE
7.3
H
ISTORY OF
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
....................... 60
F
IGURE
7.4
P
LAYER
P
OSITION OF
B
OYS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
......... 62
F
IGURE
7.5
A
CTIVITY
R
ESULTING IN
B
OYS
’
B
ASKETBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
..... 63
VIII. GIRLS’ BASKETBALL INJURY EPIDEMIOLOGY ................................................. 64
T
ABLE
8.1
G
IRLS
’
B
ASKETBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
................................... 65
T
ABLE
8.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
G
IRLS
’
B
ASKETBALL
A
THLETES
.... 65
T
ABLE
8.3
B
ODY
S
ITE OF
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..................... 66
T
ABLE
8.4
G
IRLS
’
B
ASKETBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
........................... 67
T
ABLE
8.5
G
IRLS
’
B
ASKETBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
......... 68
T
ABLE
8.6
T
IME DURING
S
EASON OF
G
IRLS
’
B
ASKETBALL
I
NJURIES
........................................ 68
T
ABLE
8.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 69
T
ABLE
8.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 70
T
ABLE
8.9
A
CTIVITIES
L
EADING TO
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..... 71
F
IGURE
8.1
D
IAGNOSIS OF
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................... 66
F
IGURE
8.2
T
IME
L
OSS OF
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................... 67
F
IGURE
8.3
H
ISTORY OF
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
...................... 68
F
IGURE
8.4
P
LAYER
P
OSITION OF
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
........ 70
F
IGURE
8.5
A
CTIVITY
R
ESULTING IN
G
IRLS
’
B
ASKETBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
.... 71
IX. WRESTLING INJURY EPIDEMIOLOGY ...................................................................... 72
T
ABLE
9.1
W
RESTLING
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
................................................. 73
T
ABLE
9.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
W
RESTLERS
................................... 73
T
ABLE
9.3
B
ODY
S
ITE OF
W
RESTLING
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................... 74
T
ABLE
9.4
T
EN
M
OST
C
OMMON
W
RESTLING
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
....... 75
T
ABLE
9.5
W
RESTLING
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
....................... 76
T
ABLE
9.6
T
IME DURING
S
EASON OF
W
RESTLING
I
NJURIES
...................................................... 76
6
T
ABLE
9.7
C
OMPETITION
R
ELATED
V
ARIABLES
........................................................................ 77
T
ABLE
9.8
P
RACTICE
R
ELATED
V
ARIABLES
.............................................................................. 77
T
ABLE
9.9
A
CTIVITIES
L
EADING TO
W
RESTLING
I
NJURIES BY
T
YPE OF
E
XPOSURE
................... 77
F
IGURE
9.1
D
IAGNOSIS OF
W
RESTLING
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................. 74
F
IGURE
9.2
T
IME
L
OSS OF
W
RESTLING
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................. 75
F
IGURE
9.3
H
ISTORY OF
W
RESTLING
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................................... 76
F
IGURE
9.4
A
CTIVITY
R
ESULTING IN
W
RESTLING
I
NJURIES BY
I
NJURY
D
IAGNOSIS
.................. 76
X. BASEBALL INJURY EPIDEMIOLOGY ........................................................................... 79
T
ABLE
10.1
B
ASEBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
................................................. 80
T
ABLE
10.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
B
ASEBALL
A
THLETES
.................. 80
T
ABLE
10.3
B
ODY
S
ITE OF
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................... 81
T
ABLE
10.4
B
ASEBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
......................................... 82
T
ABLE
10.5
B
ASEBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
....................... 83
T
ABLE
10.6
T
IME DURING
S
EASON OF
B
ASEBALL
I
NJURIES
...................................................... 83
T
ABLE
10.7
C
OMPETITION
R
ELATED
V
ARIABLES
...................................................................... 84
T
ABLE
10.8
P
RACTICE
R
ELATED
V
ARIABLES
............................................................................ 85
T
ABLE
10.9
A
CTIVITIES
L
EADING TO
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................... 86
F
IGURE
10.1
D
IAGNOSIS OF
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................. 81
F
IGURE
10.2
T
IME
L
OSS OF
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................................. 82
F
IGURE
10.3
H
ISTORY OF
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..................................... 83
F
IGURE
10.4
P
LAYER
P
OSITION OF
B
ASEBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
...................... 85
F
IGURE
10.5
A
CTIVITY
R
ESULTING IN
B
ASEBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
.................. 86
XI. SOFTBALL INJURY EPIDEMIOLOGY ......................................................................... 87
T
ABLE
11.1
S
OFTBALL
I
NJURY
R
ATES BY
T
YPE OF
E
XPOSURE
.................................................. 88
T
ABLE
11.2
D
EMOGRAPHIC
C
HARACTERISTICS OF
I
NJURED
S
OFTBALL
A
THLETES
................... 88
T
ABLE
11.3
B
ODY
S
ITE OF
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................................... 89
T
ABLE
11.4
S
OFTBALL
I
NJURY
D
IAGNOSES BY
T
YPE OF
E
XPOSURE
.......................................... 90
T
ABLE
11.5
S
OFTBALL
I
NJURIES
R
EQUIRING
S
URGERY BY
T
YPE OF
E
XPOSURE
........................ 91
T
ABLE
11.6
T
IME DURING
S
EASON OF
S
OFTBALL
I
NJURIES
....................................................... 91
T
ABLE
11.7
C
OMPETITION
R
ELATED
V
ARIABLES
...................................................................... 92
T
ABLE
11.8
P
RACTICE
R
ELATED
V
ARIABLES
............................................................................ 93
T
ABLE
11.9
A
CTIVITIES
L
EADING TO
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
................... 94
F
IGURE
11.1
D
IAGNOSIS OF
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................................. 89
F
IGURE
11.2
T
IME
L
OSS OF
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
.................................. 90
F
IGURE
11.3
H
ISTORY OF
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
..................................... 91
F
IGURE
11.4
P
LAYER
P
OSITION OF
S
OFTBALL
I
NJURIES BY
T
YPE OF
E
XPOSURE
....................... 93
F
IGURE
11.5
A
CTIVITY
R
ESULTING IN
S
OFTBALL
I
NJURIES BY
I
NJURY
D
IAGNOSIS
.................. 94
XII. GENDER DIFFERENCES WITHIN SPORTS ............................................................... 95
12.1
B
OYS
’
AND
G
IRLS
’
S
OCCER
............................................................................................. 96
T
ABLE
12.1
C
OMPARISON OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURY
R
ATES
................................. 96
7
T
ABLE
12.2
C
OMPARISON OF
B
ODY
S
ITES OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURIES
................. 96
T
ABLE
12.3
C
OMPARISON OF
D
IAGNOSES OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURIES
................. 97
T
ABLE
12.4
M
OST
C
OMMON
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURY
D
IAGNOSES
......................... 97
T
ABLE
12.5
C
OMPARISON OF
T
IME
L
OSS OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURIES
................... 97
T
ABLE
12.6
C
OMPARISON OF
M
ECHANISMS OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURIES
.............. 98
T
ABLE
12.7
C
OMPARISON OF
A
CTIVITIES OF
B
OYS
’
AND
G
IRLS
’
S
OCCER
I
NJURIES
.................. 98
12.2
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
..................................................................................... 99
T
ABLE
12.8
C
OMPARISON OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURY
R
ATES
........................ 99
T
ABLE
12.9
C
OMPARISON OF
B
ODY
S
ITES OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURIES
........ 99
T
ABLE
12.10
C
OMPARISON OF
D
IAGNOSES OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURIES
..... 100
T
ABLE
12.11
M
OST
C
OMMON
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURY
D
IAGNOSES
............. 100
T
ABLE
12.12
C
OMPARISON OF
T
IME
L
OSS OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURIES
...... 100
T
ABLE
12.13
C
OMPARISON OF
M
ECHANISMS OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURIES
.. 101
T
ABLE
12.14
C
OMPARISON OF
A
CTIVITIES OF
B
OYS
’
AND
G
IRLS
’
B
ASKETBALL
I
NJURIES
..... 101
12.3
B
OYS
’
B
ASEBALL AND
G
IRLS
’
S
OFTBALL
...................................................................... 102
T
ABLE
12.15
C
OMPARISON OF
B
ASEBALL AND
S
OFTBALL
I
NJURY
R
ATES
.............................. 102
T
ABLE
12.16
C
OMPARISON OF
B
ODY
S
ITES OF
B
ASEBALL AND
S
OFTBALL
I
NJURIES
.............. 102
T
ABLE
12.17
C
OMPARISON OF
D
IAGNOSES OF
B
ASEBALL AND
S
OFTBALL
I
NJURIES
............... 103
T
ABLE
12.18
M
OST
C
OMMON
B
ASEBALL AND
S
OFTBALL
I
NJURY
D
IAGNOSES
....................... 103
T
ABLE
12.19
C
OMPARISON OF
T
IME
L
OSS OF
B
ASEBALL AND
S
OFTBALL
I
NJURIES
................ 103
T
ABLE
12.20
C
OMPARISON OF
M
ECHANISMS OF
B
ASEBALL AND
S
OFTBALL
I
NJURIES
............ 104
T
ABLE
12.21
C
OMPARISON OF
A
CTIVITIES OF
B
ASEBALL AND
S
OFTBALL
I
NJURIES
............... 104
XIII. TRENDS OVER TIME…………………………………………………………….......105
T
ABLE
13.1
I
NJURY
R
ATES BY
S
PORT
,
T
YPE OF
E
XPOSURE
,
AND
Y
EAR
.................................. 106
T
ABLE
13.2
N
ATIONALLY
E
STIMATED OF
I
NJURIES BY
S
PORT
,
E
XPOSURE
,
AND
Y
EAR
........... 108
T
ABLE
13.3
B
ODY
S
ITE OF
I
NJURY BY
Y
EAR
........................................................................... 109
T
ABLE
13.4
I
NJURY
D
IAGNOSIS BY
Y
EAR
............................................................................... 110
T
ABLE
13.5
M
OST
C
OMMON
I
NJURY
D
IAGNOSES BY
Y
EAR
.................................................... 110
T
ABLE
13.6
T
IME
L
OSS OF
I
NJURIES BY
Y
EAR
......................................................................... 111
T
ABLE
13.7
I
NJURIES
R
EQUIRING
S
URGERY BY
Y
EAR
............................................................. 111
XIV. REPORTER DEMOGRAPHICS & COMPLIANCE ................................................. 112
XV. SUMMARY ....................................................................................................................... 115
8
I. Introduction & Methodology
9
1.1 Project Overview
To combat the epidemic of obesity among youth in the United States (US), adolescents
must be encouraged to get up off the couch and participate in physically active sports, recreation,
and leisure activities. Participation in high school sports, one of the most popular physical
activities among adolescents, has grown rapidly from an estimated 4.0 million participants in
1971-72 to an estimated 7.7 million in 2011-12. While the health benefits of a physically active
lifestyle including participating in sports are undeniable, high school athletes are at risk of
sports-related injury because a certain endemic level of injury can be expected among
participants of any physical activity. The challenge to injury epidemiologists is to reduce injury
rates among high school athletes to the lowest possible level without discouraging adolescents
from engaging in this important form of physical activity. This goal can best be accomplished
by investigating the etiology of preventable injuries; by developing, implementing, and
evaluating protective interventions using such science-based evidence; and by responsibly
reporting epidemiologic findings while promoting a physically active lifestyle among
adolescents.
1.2 Background and Significance
High school sports play an important role in the adoption and maintenance of a physically
active lifestyle among millions of US adolescents. Too often injury prevention in this population
is overlooked as sports-related injuries are thought to be unavoidable. In reality, sports-related
injuries are largely preventable through the application of preventive interventions based on
evidence-based science. The morbidity, mortality, and disability caused by high school sports-
related injuries can be reduced through the development of effective prevention strategies and
through programmatic decisions based on injury prevention. However, such efforts rely upon
10
accurate national estimates of injury incidence, injury rate calculations, and risk and protective
factor data. Previously, no injury surveillance system capable of providing researchers with the
needed quality of injury and exposure data for high school sports-related injuries existed.
Since the 2005-06 school year, Dr. R. Dawn Comstock has conducted the National High
School Sports-Related Injury Surveillance System to monitor injuries among US high school
athletes participating in boys’ football, boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’
basketball, boys’ wrestling, boys’ baseball, and girls’ softball. This surveillance has been
conducted using the time- and cost-efficient RIO
TM
(Reporting Information Online) surveillance
system. Through the generous contributions of the Centers for Disease Control and Prevention
(CDC), National Operating Committee on Standards for Athletic Equipment (NOCSAE), and the
National Federation of State High School Associations (NFHS), the National High School
Sports-Related Injury Surveillance System was able to be continued during the 2012-13 school
year. Previous study years were funded by the Centers for Disease Control and Prevention
(CDC), National Federation of State High School Associations (NFHS), the National Operating
Committee on Standards for Athletic Equipment (NOCSAE), the Research Institute at
Nationwide Children’s Hospital, DonJoy Orthotics, EyeBlack, and The Ohio State University.
1.3 Specific Aims
The continuing objectives of this study are to maintain the National High School Sports-
Related Injury Surveillance System among a nationally representative sample of US high
schools. The specific aims of this study are:
A) To determine the incidence (number) of injuries among US high school boys’ football,
boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’ basketball, boys’ wrestling,
boys’ baseball, and girls’ softball athletes.
11
B) To calculate the rate of injuries per 1,000 athlete-competitions, per 1,000 athlete-
practices, and per 1,000 athlete-exposures for US high school athletes in the 9 sports of
interest.
C) To provide detailed information about the injuries sustained by US high school athletes
including the type, site, severity, initial and subsequent treatment/care, outcome, etc.
D) To provide detailed information about the injury events including athlete demographics,
position played, phase of play/activity, etc.
E) To identify potential risk or protective factors.
F) To compare injury rates and patterns from the 2005-06 through the 2011-12 school years.
1.4 Project Design
The National High School Sports-Related Injury Surveillance System defined an injury as:
A) An injury that occurred as a result of participation in an organized high school
competition or practice and
B) Required medical attention by a team physician, certified athletic trainer, personal
physician, or emergency department/urgent care facility and
C) Resulted in restriction of the high school athlete’s participation for one or more days
beyond the day of injury and
D) Any fracture, concussion, or dental injury regardless of whether or not it resulted in
restriction of the student-athlete's participation.
An athlete exposure was defined as one athlete participating in one practice or competition where
he or she is exposed to the possibility of athletic injury. Exposure was expressed in two parts:
12
A) Number of athlete-practices = the sum of the number of athletes at each practice during
the past week. For example, if 20 athletes practiced on Monday through Thursday and 18
practiced on Friday, the number of athlete-practices would equal 98.
B) Number of athlete-competitions = the sum of the number of athletes at each competition
during the past week. For example, if 9 athletes played in a Freshman game, 12 in a JV
game, and 14 in a Varsity game, the number of athlete-competitions would equal 35.
1.5 Sample Recruitment
All eligible schools (i.e., all US high schools with a National Athletic Trainers’
Association (NATA) affiliated certified athletic trainer (AT) willing to serve as a reporter) were
categorized into 8 sampling strata by geographic location (northeast, midwest, south, and west)
and high school size (enrollment ≤ 1,000 or > 1,000 students). Participant schools were then
randomly selected from each substrata to obtain 100 study schools. To maintain a nationally
representative sample, if a school dropped out of the study, another school from the same stratum
was randomly selected for replacement. Participating ATs were offered a $300-$400
honorarium depending on the number of sports reported along with individualized injury reports
following the study’s conclusion.
1.6 Data Collection
Each AT that enrolled their school in National High School Sports-Related Injury
Surveillance System received an email every Monday throughout the study period reminding
them to enter their school’s data into the surveillance system. Each participating AT was asked
to complete 45 weekly exposure reports: one for each week from July 30, 2012 through June 9,
2013. Exposure reports collected exposure information (number of athlete-competitions and
athlete-practices) and the number of reportable injuries sustained by student athletes of each
13
sport that was currently in session at their school. For each reportable injury, the AT was asked
to complete an injury report. The injury report collected detailed information about the injured
player (e.g., age, year in school, etc.), the injury (e.g. site, type, severity, etc.) and the injury
event (e.g., position played, phase of play, etc.). This internet-based surveillance tool provided
ATs with the ability to view all their submitted data throughout the study and update reports as
needed (e.g., need for surgery, days till resuming play, etc.).
1.7 Data Management
In an effort to decrease loss-to follow up, a log of reporters’ utilization of the internet-
based injury surveillance system was maintained throughout the study period. Reporters who
repeatedly failed to log on to complete the weekly exposure and injury reports or who had errors
with their reporting were contacted by the study staff and either reminded to report, asked to
correct errors, or assessed for their willingness to continue participating in the study.
1.8 Data Analysis
Data were analyzed using SAS software, version 9.3 and SPSS, version 19.0. Although
fractures, concussions, and dental injuries resulting in <1 day time loss were collected, unless
otherwise noted, analyses in this report excluded these injuries. With the exception of injury
rates, data were weighted for all analyses to produce national estimates. For each sport in each
stratum, weights account for the total number of US schools offering the sport and the average
number of participating study schools reporting each week for that sport. For example,
following is the algorithm used to calculate football weights for the small (enrollment ≤ 1,000)
west stratum:
national total # of small, west US high schools
Weight = ---------------------------------------------------------------------------------------------
average # of small, west participating schools reporting football each week
14
Injury rates were calculated as the ratio of unweighted case counts per 1,000 athlete-
exposures, and they were compared using rate ratios (RR) with 95% confidence intervals (CI).
Following is an example of the RR calculation comparing the rate of injury in boys’ soccer to the
rate of injury in girls’ soccer:
# boys’ soccer injuries / total # boys’ soccer athlete-exposures
RR = ------------------------------------------------------------------------------
# girls’ soccer injuries / total # girls’ soccer athlete-exposures
Injury proportions were compared using injury proportion ratios (IPR) and corresponding
confidence intervals calculated using the Complex Samples module of SPSS in order to account
for the sampling weights and the complex sampling design. Following is an example of the IPR
calculation comparing the proportion of male soccer concussions to the proportion of female
soccer concussions:
# boys’ soccer concussions / total # boys’ soccer injuries
IPR = -----------------------------------------------------------------------
# girls’ soccer concussions / total # girls’ soccer injuries
An RR or IPR >1.00 suggests a risk association while an RR or IPR <1.00 suggests a protective
association. CI not including 1.00 were considered statistically significant. Injury rates over
time were compared by running a linear regression and testing for trend.
15
II. Overall Injury Epidemiology
16
Table 2.1 Injury Rates by Sport and Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Overall total 4,049 1,874,256 2.16 1,361,986
Competition 2,228 517,502 4.31 779,055
Practice 1,821 1,356,754 1.34 582,931
Boys' football total 1,972 509,158 3.87 616,209
Competition 1,094 87,327 12.53 344,097
Practice 878 421,831 2.08 272,112
Boys' soccer total 263 173,442 1.52 149,049
Competition 168 51,168 3.28 89,429
Practice 95 122,274 0.78 59,620
Girls' soccer total 335 146,152 2.29 190,382
Competition 241 43,495 5.54 141,339
Practice 94 102,657 0.92 49,043
Girls' volleyball total 155 174,474 0.89 44,064
Competition 67 61,913 1.08 19,150
Practice 88 112,561 0.78 24,914
Boys' basketball total 337 229,897 1.47 85,819
Competition 171 70,092 2.44 44,095
Practice 166 159,805 1.04 41,724
Girls' basketball total 336 183,377 1.83 83,107
Competition 179 57,201 3.13 45,645
Practice 157 126,176 1.24 37,462
Boys' wrestling total 343 147,208 2.33 85,485
Competition 141 39,857 3.54 35,016
Practice 202 107,351 1.88 50,469
Boys' baseball total 161 182,376 0.88 49,747
Competition 82 62,971 1.30 24,807
Practice 79 119,405 0.66 24,940
Girls' softball total 147 128,172 1.15 58,124
Competition 85 43,478 1.96 35,477
Practice 62 84,694 0.73 22,647
*Only includes injuries resulting in ≥1 days’ time loss.
17
Table 2.2 Proportion of Injuries Resulting in Time Loss, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
≥1 days time loss <1 day time loss Total
Overall
98.0% 2.0%
100%
Boys’ football 97.9% 2.1%
100%
Boys’ soccer 98.5% 1.5%
100%
Girls’ soccer 97.4% 2.6%
100%
Girls’ volleyball 98.1% 1.9%
100%
Boys’ basketball 98.3% 1.7%
100%
Girls’ basketball 98.0% 2.0%
100%
Boys’ wrestling 99.4% 0.6%
100%
Boys’ baseball 97.0% 3.0%
100%
Girls’ softball 98.0% 2.0%
100%
*By study definition, non-time loss injuries were fractures, concussions, and dental injuries. Because
they accounted for only 2% of all injuries overall, they are not included in any other analyses.
Table 2.3 Demographic Characteristics of Injured Athletes by Sex, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Male
n= 941,354
Female
n=
363,778
Year in School
Freshman 25.4% 29.3%
Sophomore 23.6% 24.8%
Junior 25.4% 26.5%
Senior 25.6% 19.4%
Total
†
100% 100%
Age (years)
Minimum 13 12
Maximum 19 19
Mean (St. Dev.) 15.8 (1.3) 15.7 (1.1)
BMI
Minimum 14.5 15.5
Maximum 49.9 42.4
Mean (St. Dev.) 24.7 (4.4) 21.9 (3.0)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
18
Figure 2.1 Injury Diagnosis by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
Table 2.4 Body Site of Injury by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
Competition
Practice
n
%
n
%
n
%
Body Site
Head/face 226,379 29.1% 123,977 21.3% 350,356 25.7%
Ankle 123,296 15.8% 88,230 15.1% 211,526 15.5%
Knee 130,775 16.8% 70,419 12.1% 201,194 14.8%
Hip/thigh/upper leg 54,772 7.0% 73,928 12.7% 128,700 9.5%
Hand/wrist 51,360 6.6% 49,823 8.5% 101,183 7.4%
Shoulder 47,669 6.1% 40,497 6.9% 88,166 6.5%
Trunk 28,474 3.7% 42,437 7.3% 70,911 5.2%
Lower leg 30,528 3.9% 22,616 3.9% 53,144 3.9%
Arm/elbow 26,523 3.4% 20,668 3.5% 47,191 3.5%
Foot 23,825 3.1% 19,922 3.4% 43,747 3.2%
Neck 18,571 2.4% 13,201 2.3% 31,772 2.3%
Other 16,482 2.1% 17,213 3.0% 33,695 2.5%
Total
778,654
100%
582,931
100%
1,361
,585
100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
39%
12%
9%
27%
13%
Competition n=778,412
Strain/sprain
Contusion
Fracture
Concussion
Other
47%
8%
7%
18%
20%
Practice n=582,288
19
Table 2.5 Most Commonly Injured Ankle Structures, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
Male Female Total
n
% of Ankle
Injuries
n
%
of
Ankle
Injuries
n
%
of
Ankle
Injuries
Ankle Ligament Injuries
Anterior talofibular ligament 92,472 71.8% 56,810
78.5% 149,282
74.2%
Calcaneofibular ligament 40,025 31.1% 24,931
34.4% 64,956 32.3%
Anterior tibiofibular ligament 28,339 22.0% 16,366
22.6% 44,705 22.2%
Deltoid ligament 15,175 11.8% 6,872 9.5% 22,074 10.9%
Posterior talofibular ligament 11,304 8.8% 9,635 13.3% 20,939 10.4%
Posterior tibiofibular ligament 6,924 5.4% 3,424 4.7% 10,348 5.1%
Total Ankle Injuries 128,839 72,409
201,248
*Multiple ligament responses allowed per injury report. Totals and n’s are not always equal due to slight rounding of the
weighted number of injuries and missing responses. Due to a low level of non-response, these totals are always similar but are
not always equal to the total number of injuries.
Table 2.6 Most Commonly Injured Knee Structures, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
Male Female Total
n
%
of
Knee
Injuries
n
%
of
Knee
Injuries
n
%
of
Knee
Injuries
Knee Ligament Injuries
Medial collateral ligament 46,426 34.6% 12,698 21.4% 59,124 30.5%
Anterior cruciate ligament 26,633 19.8% 22,878 38.6% 49,511 25.6%
Torn cartilage (meniscus) 32,013 23.8% 14,388 24.3% 46,401 24.0%
Patella and/or patellar tendon 19,751 14.7% 10,511 17.7% 30,262 15.6%
Lateral collateral ligament 8,071 6.0% 6,567 11.0% 14,638 7.6%
Posterior cruciate ligament 2,206 1.6% 739 1.2% 2,945 1.5%
Total Knee Injuries 134,281 59,320 193,601
*Multiple ligament responses allowed per injury report. Totals and n’s are not always equal due to slight rounding of the
weighted number of injuries and missing responses. Due to a low level of non-response, these totals are always similar but are
not always equal to the total number of injuries.
20
Table 2.7 Ten Most Common Injury Diagnoses by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=
778,009
Practice
n=
582,287
n=
1,360,296
n % n % n %
Diagnosis
Head/face concussion 208,809 26.8% 105,520 18.1% 314,329 23.1%
Ankle strain/sprain 114,709 14.7% 82,325 14.1% 197,034 14.5%
Knee strain/sprain 79,799 10.3% 32,379 5.6% 112,178 8.2%
Hip/thigh/upper leg strain/sprain 30,694 3.9% 60,022 10.3% 90,716 6.7%
Knee other 28,803 3.7% 27,511 4.7% 56,314 4.1%
Shoulder other 27,852 3.6% 18,528 3.2% 46,380 3.4%
Hand/wrist fracture 22,560 2.9% 20,820 3.6% 43,380 3.2%
Shoulder strain/sprain 16,433 2.1% 18,465 3.2% 34,898 2.6%
Hand/wrist strain/sprain 15,110 1.9% 18,925 3.3% 34,035 2.5%
Trunk strain/sprain 10,349 1.3% 20,269 3.5% 30,618 2.3%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 2.2 Time Loss by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
9%
23%
16%
22%
8%
22%
Competition n=779,055
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
17%
24%
17%
21%
8%
13%
Practice n=582,931
21
Table 2.8 Injuries Requiring Surgery by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 64,267 8.4% 32,726 5.7% 96,993 7.3%
Did not require surgery 698,989 91.6% 541,421 94.3% 1,240,410 92.7%
Total* 763,256 100% 574,147 100% 1,337,403 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 2.3 New and Recurring Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 2.9 Time during Season of Injury, High School Sports-Related Injury Surveillance
Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 290,231 21.4%
Regular season 1,000,878 73.8%
Post season 65,451 4.8%
Total 1,356,559 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
91%
3%
6%
Competition n=775,174
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
90%
3%
7%
Practice n=578,149
22
Table 2.10 Practice-Related Variables, High School Sports-Related Injury Surveillance
Study, US, 2012-13 School Year
*
n %
Time in Practice
First ½ hour 65,963 11.9%
Second ½ hour 104,653 18.9%
1-2 hours into practice 324,299 58.5%
>2 hours into practice 59,254 10.7%
Total 554,169 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
23
Table 2.11 Methods for Injury Evaluation and Assessment, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
n %
Injuries Evaluated by:*
Certified athletic trainer 1,284,517 94.3%
General physician 468,808 34.4%
Orthopedic physician 441,288 32.4%
Neurologist/neuropsychologist 23,950 1.8%
Physician’s assistant 19,860 1.5%
Chiropractor 13,980 1.0%
Nurse practitioner 5,226 0.4%
Dentist/oral surgeon 3,103 0.2%
Other 55,653 4.1%
Total 1,361,986 100%
Injuries Assessed by:*
Evaluation 1,343,491 98.6%
X-ray 449,093 33.0%
MRI 154,089 11.3%
CT-scan 47,272 3.5%
Surgery 17,422 1.3%
Blood work/lab test 10,008 0.7%
Other 11,490 0.8%
Total 1,361,986 100%
*Multiple responses allowed per injury report.
24
III. Boys’ Football Injury Epidemiology
25
Table 3.1 Football Injury Rates by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 1,972 509,158 3.87 616,209
Competition 1,094 87,327 12.53 344,097
Practice 878 421,831 2.08 272,112
Table 3.2 Demographic Characteristics of Injured Football Athletes, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=616,209
Freshman 27.1%
Sophomore 22.5%
Junior 25.7%
Senior 24.6%
Total
†
100%
Age (years)
Minimum 13
Maximum 19
Mean (St. Dev.) 15.7 (1.3)
BMI
Minimum 16.0
Maximum 49.9
Mean (St. Dev.) 25.5 (4.4)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
26
Figure 3.1 Diagnosis of Football Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 3.3 Body Site of Football Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Head/face 88,094 25.6% 70,978 26.1% 159,072 25.8%
Knee 58,243 16.9% 32,375 11.9% 90,618 14.7%
Ankle 46,475 13.5% 30,377 11.2% 76,852 12.5%
Hand/wrist 29,821 8.7% 27,862 10.2% 57,683 9.4%
Shoulder 32,215 9.4% 19,439 7.1% 51,654 8.4%
Hip/thigh/upper leg 19,736 5.7% 29,842 11.0% 49,578 8.0%
Trunk 12,436 3.6% 21,867 8.0% 34,303 5.6%
Lower leg 12,336 3.6% 10,077 3.7% 22,413 3.6%
Neck 15,226 4.4% 6,866 2.5% 22,092 3.6%
Arm/elbow 12,605 3.7% 8,402 3.1% 21,007 3.4%
Foot 4,356 1.3% 5,002 1.8% 9,358 1.5%
Other 12,554 3.6% 9,026 3.3% 21,580 3.5%
Total 344,097 100% 272,113 100% 616,210 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
38%
12%
10%
25%
15%
Competition n=344,097
Strain/sprain
Contusion
Fracture
Concussion
Other
39%
10%
8%
25%
18%
Practice n=272,113
27
Table 3.4 Ten Most Common Football Injury Diagnoses by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=344,095
Practice
n=272,113
Total
n=616,208
n % n % n %
Diagnosis
Head/face concussion 85,669 24.9% 67,687 24.9% 153,356 24.9%
Ankle strain/sprain 42,738 12.4% 27,859 10.2% 70,597 11.5%
Knee strain/sprain 36,914 10.7% 17,582 6.5% 54,496 8.8%
Hip/thigh/upper leg strain/sprain 8,702 2.5% 20,956 7.7% 29,658 4.8%
Shoulder other 18,335 5.3% 9,498 3.5% 27,833 4.5%
Hand/wrist fracture 13,584 3.9% 13,975 5.1% 27,559 4.5%
Knee other 12,723 3.7% 11,187 4.1% 23,910 3.9%
Should strain/sprain 10,781 3.1% 7,041 2.6% 17,822 2.9%
Hip/thigh/upper leg contusion 8,316 2.4% 7,300 2.7% 15,616 2.5%
Hand/wrist strain/sprain 7,600 2.2% 7,360 2.7% 14,960 2.4%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 3.2 Time Loss of Football Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
7%
27%
14%
21%
9%
22%
Competition n=344,096
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
17%
24%
15%
21%
9%
14%
Practice n=272,112
28
Table 3.5 Football Injuries Requiring Surgery by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 34,262 10.2% 13,409 5.0% 47,671 7.9%
Did not require surgery 301,392 89.8% 257,097 95.0% 558,489 92.1%
Total 335,654 100% 270,506 100% 606,160 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 3.3 History of Football Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 3.6 Time during Season of Football Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 153,584 25.0%
Regular season 427,370 69.5%
Post season 33,980 5.5%
Total 614,933 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
91%
3%
6%
Competition n=341,530
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
91%
3%
6%
Practice n=270,399
29
Table 3.7 Competition-Related Variables for Football Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 2,719 0.8%
First quarter 47,580 14.3%
Second quarter 99,262 29.9%
Third quarter 91,833 27.7%
Fourth quarter 89,857 27.1%
Overtime 532 0.2%
Total 331,782 100%
Field Location
Between the 20 yard lines 262,198 79.6%
Red zone (20 yard line to goal line) 60,088 18.2%
Off the field 3,145 1.0%
End zone 4,005 1.2%
Total 329,436 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 3.8 Practice-Related Variables for Football Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 27,791 10.8%
Second 1/2 hour 43,156 16.7%
1-2 hours into practice 150,132 58.2%
>2 hours into practice 36,777 14.3%
Total 257,856 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
30
Figure 3.4 Player Position of Football Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 3.9 Activities Leading to Football Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Being tackled 116,228 34.7% 60,152 22.5% 176,380 29.3%
Tackling 83,075 24.8% 49,128 18.4% 132,203 21.9%
Blocking 46,954 14.0% 45,482 17.0% 92,436 15.3%
Being blocked 40,916 12.2% 20,959 7.8% 61,875 10.3%
N/A (e.g., overuse, heat illness, etc.) 5,684 1.7% 33,152 12.4% 38,836 6.4%
Stepped on/fell on/kicked 16,369 4.9% 13,920 5.2% 30,289 5.0%
Rotation around a planted foot 11,314 3.4% 15,048 5.6% 26,362 4.4%
Uneven playing surface 1,648 0.5% 8,044 3.0% 9,692 1.6%
Contact with ball 107 0.0% 4,757 1.8% 4,864 0.8%
Contact with blocking sled/dummy 0 0.0% 2,755 1.0% 2,755 0.5%
Contact with out of bounds 376 0.1% 591 0.2% 967 0.2%
Other 12,721 3.8% 13,146 4.9% 25,867 4.3%
Total 335,392 100% 267,134 100% 602,526 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
20%
14%
7%
10%8%
41%
Competition n=331,330
RB/slotback
Linebacker
Cornerback
Flanker/WR
Defensive tackle
Other
19%
13%
6%
12%
9%
41%
Practice n=258,765
31
Figure 3.5 Activity Resulting in Football Injuries by Injury Diagnosis, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Tackling Being tackled Blocking Being blocked Stepped on/fell on/kicked Other
32
IV. Boys’ Soccer Injury Epidemiology
33
Table 4.1 Boys’ Soccer Injury Rates by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 263 173,442 1.52 149,049
Competition 168 51,168 3.28 89,429
Practice 95 122,274 0.78 59,620
Table 4.2 Demographic Characteristics of Injured Boys’ Soccer Athletes, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Year in School n= 142,172
Freshman 22%
Sophomore 29%
Junior 18%
Senior 31%
Total
†
100%
Age (years)
Minimum 13
Maximum 18
Mean (St. Dev.) 15.8 (1.3)
BMI
Minimum 15.7
Maximum 40.5
Mean (St. Dev.) 22.7 (3.1)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
34
Figure 4.1 Diagnosis of Boys’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 4.3 Body Site of Boys’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Head/face 33,863 37.9% 11,290 18.9% 45,153 30.3%
Hip/thigh/upper leg 8,074 9.0% 16,746 28.1% 24,820 16.7%
Ankle 13,431 15.0% 5,042 8.5% 18,473 12.4%
Knee 13,302 14.9% 8,251 13.8% 21,553 14.5%
Foot 8,223 9.2% 2,437 4.1% 10,660 7.2%
Lower leg 4,562 5.1% 4,445 7.5% 9,007 6.0%
Trunk 2,455 2.7% 3,187 5.3% 5,642 3.8%
Hand/wrist 1,721 1.9% 2,226 3.7% 3,947 2.6%
Arm/elbow 1,793 2.0% 1,042 1.7% 2,835 1.9%
Neck 0 0.0% 2,083 3.5% 2,083 1.4%
Shoulder 1,172 1.3% 379 0.6% 1,551 1.0%
Other 832 0.9% 2,492 4.2% 3,324 2.2%
Total 89,428 100% 59,620 100% 149,048 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
32%
14%
9%
35%
10%
Competition n=89,428
Strain/sprain
Contusion
Fracture
Concussion
Other
54%
6%
1%
13%
26%
Practice n=59,620
35
Table 4.4 Ten Most Common Boys’ Soccer Injury Diagnoses by Type of Exposure, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=89,431
Practice
n=59,618
Total
n=149,049
n % n % n %
Diagnosis
Head/face concussion 30,979 34.6% 7,539 12.6% 38,518 25.8%
Hip/thigh/upper leg strain/sprain 4,763 5.3% 14,378 24.1% 19,141 12.8%
Ankle strain/sprain 11,252 12.6% 5,042 8.5% 16,294 10.9%
Knee other 3,876 4.3% 4,947 8.3% 8,823 5.9%
Knee strain/sprain 6,091 6.8% 2,262 3.8% 8,353 5.6%
Foot strain/sprain 4,063 4.5% 1,258 2.1% 5,321 3.6%
Head/face other 1,712 1.9% 3,341 5.6% 5,053 3.4%
Knee contusion 3,336 3.7% 1,042 1.7% 4,378 2.9%
Lower leg contusion 2,663 3.0% 818 1.4% 3,481 2.3%
Trunk strain/sprain 818 0.9% 2,492 4.2% 3,310 2.2%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 4.2 Time Loss of Boys’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
10%
26%
18%
20%
7%
19%
Competition n=89,428
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
21%
21%
25%
13%
5%
15%
Practice n=59,621
36
Table 4.5 Boys’ Soccer Injuries Requiring Surgery by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 6,661 7.7% 3466 6.2% 10,127 7.1%
Did not require surgery 79,872 92.3% 52,873 93.8% 132,745 92.9%
Total 86,533 100% 56,339 100% 142,872 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 4.3 History of Boys’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 4.6 Time during Season of Boys’ Soccer Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 37,289 25.7%
Regular season 101,914 70.1%
Post season 6,124 4.2%
Total 145,326 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
92%
3%
5%
Competition n= 89,427
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
88%
3%
9%
Practice n=59,620
37
Table 4.7 Competition-Related Variables for Boys’ Soccer Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 1,682 2.0%
First half 22,353 26.9%
Second half 58,503 70.5%
Overtime 409 0.5%
Total 82,947 100%
Field Location
Top of goal box extended to center line (offense) 27,962 34.6%
Goal box (defense) 15,159 18.7%
Top of goal box extended to center line (defense) 16,814 20.8%
Goal box (offense) 6,245 7.7%
Off the field 1,042 1.3%
Side of goal box (defense) 5,488 6.8%
Side of goal box (offense) 8,185 10.1%
Total 80,894 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 4.8 Practice-Related Variables for Boys’ Soccer Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 5,766 9.8%
Second 1/2 hour 9,184 15.6%
1-2 hours into practice 38,421 65.1%
>2 hours into practice 5,624 9.5%
Total 58,994 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
38
Figure 4.4 Player Position of Boys’ Soccer Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Table 4.9 Activities Leading to Boys’ Soccer Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
General play 17,268 19.5%
20,972 35.2%
38,240 25.8%
Chasing loose ball 13,310 15.0%
5,750 9.6% 19,060 12.9%
Defending 14,698 16.6%
2,678 4.5% 17,376 11.7%
Heading ball 9,093 10.3%
7,031 11.8%
16,124 10.9%
Goaltending 10,404 11.8%
4,012 6.7% 14,416 9.7%
Receiving pass 7,947 9.0% 3,193 5.4% 11,140 7.5%
Ball handling/dribbling 7,251 8.2% 2,963 5.0% 10,214 6.9%
Conditioning 0 0.0% 6,157 10.3%
6,157 4.2%
Passing (foot) 3,413 3.9% 1,451 2.4% 4,864 3.3%
Shooting (foot) 1,483 1.7% 2,554 4.3% 4,037 2.7%
Receiving a slide tackle 1,860 2.1% 1,035 1.7% 2,895 2.0%
Blocking shot 626 0.7% 379 0.6% 1,005 0.7%
Attempting a slide tackle 788 0.9% 0 0.0% 788 0.5%
Other 386 0.4% 1,444 2.4% 1,830 1.2%
Total 90,948 100% 71,219 100% 162,167 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
25%
40%
21%
13%
1%
Competition n=86,088
Forward
Midfield
Defense
Goalkeeper
Other
22%
50%
20%
8%
0%
Practice n=59,620
39
Figure 4.5 Activity Resulting in Boys’ Soccer Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
General play Chasing loose ball Heading ball Defending Goaltending Other
40
V. Girls’ Soccer Injury Epidemiology
41
Table 5.1 Girls’ Soccer Injury Rates by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 335 146,152 2.29 190,382
Competition 241 43,495 5.54 141,339
Practice 94 102,657 0.92 49,043
Table 5.2 Demographic Characteristics of Injured Girls’ Soccer Athletes, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=183,946
Freshman 29.8%
Sophomore 20.8%
Junior 31.0%
Senior 18.4%
Total
†
100%
Age (years)
Minimum 12
Maximum 18
Mean (St. Dev.) 15.6 (1.1)
BMI
Minimum 16.3
Maximum 40.3
Mean (St. Dev.) 21.4 (2.5)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
42
Figure 5.1 Diagnosis of Girls’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 5.3 Body Site of Girls’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Head/face 54,568 38.6% 9,047 18.4% 63,615 33.4%
Knee 27,575 19.5% 5,788 11.8% 33,363 17.5%
Hip/thigh/upper leg 16,810 11.9% 13,616 27.8% 30,426 16.0%
Ankle 20,635 14.6% 6,187 12.6% 26,822 14.1%
Foot 6,837 4.8% 6,281 12.8% 13,118 6.9%
Lower leg 7,453 5.3% 2,641 5.4% 10,094 5.3%
Hand/wrist 2,617 1.9% 2,201 4.5% 4,818 2.5%
Trunk 2,826 2.0% 1,975 4.0% 4,801 2.5%
Arm/elbow 1,308 0.9% 887 1.8% 2,195 1.2%
Shoulder 491 0.3% 75 0.2% 566 0.3%
Neck 220 0.2% 75 0.2% 566 0.2%
Other 0 0.0% 271 0.6% 271 0.1%
Total 141,340 100% 49,044 100% 190,384 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
39%
15%
3%
38%
5%
Competition n=141,339
Strain/sprain
Contusion
Fracture
Concussion
Other
58%
3%
7%
18%
14%
Practice n=49,043
43
Table 5.4 Ten Most Common Girls’ Soccer Injury Diagnoses by Type of Exposure, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=141,339
Practice
n=49,044
Total
n=190,383
n % n % n %
Diagnosis
Head/face concussion 53,329 37.7% 8,776 17.9% 62,105 32.6%
Ankle strain/sprain 20,169 14.3% 6,187 12.6% 26,356 13.8%
Hip/thigh/upper leg strain/sprain 9,762 6.9% 13,541 27.6% 23,303 12.2%
Knee strain/sprain 18,904 13.3% 1,423 2.9% 20,327 10.7%
Foot strain/sprain 3,439 2.4% 4,081 8.3% 7,520 3.9%
Hip/thigh/upper leg contusion 7,048 5.0% 75 0.2% 7,123 3.7%
Knee contusion 5,709 4.0% 1,239 2.5% 6,948 3.6%
Knee other 2,962 2.1% 3,127 6.4% 6,089 3.2%
Lower leg contusion 4,320 3.1% 0 0.0% 4,320 2.3%
Lower leg strain/sprain 2,471 1.7% 691 1.4% 3,162 1.7%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 5.2 Time Loss of Girls’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
12%
17%
16%
22%
4%
29%
Competition n=141,338
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
19%
27%
25%
15%
7%
7%
Practice =49,043
44
Table 5.5 Girls’ Soccer Injuries Requiring Surgery by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 8,910 6.4% 1,850 3.8% 10,760 5.7%
Did not require surgery 131,127 93.6% 47,193 96.2% 178,320 94.3%
Total 140,037 100% 49,043 100% 189,080 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 5.3 History of Girls’ Soccer Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 5.6 Time during Season of Girls’ Soccer Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 27,293 14.3%
Regular season 148,963 78.2%
Post season 14,127 7.4%
Total 190,382 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
92%
1%
7%
Competition n=140,947
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
90%
1%
9%
Practice n=47,534
45
Table 5.7 Competition-Related Variables for Girls’ Soccer Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 391 0.3%
First half 49,044 35.7%
Second half 88,010 64.0%
Overtime 0 0.0%
Total 137,446 100%
Field Location
top of goal box extended to center line (offense) 56,572 41.9%
top of goal box extended to center line (defense) 37,155 27.5%
goal box (defense) 15,139 11.2%
side of goal box (defense) 12,289 9.1%
side of goal box (offense) 6,909 5.1%
goal box (offense) 6,529 4.8%
off the field 391 0.3%
Total 134,985 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 5.8 Practice-Related Variables for Girls’ Soccer Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 3,737 8.2%
Second 1/2 hour 13,744 30.0%
1-2 hours into practice 26,355 57.5%
>2 hours into practice 2,015 4.4%
Total 45,851 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
46
Figure 5.4 Player Position of Girls’ Soccer Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Table 5.9 Activities Leading to Girls’ Soccer Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
General play 34,943 25.1% 17,447 35.9% 52,390 27.9%
Defending 32,446 23.3% 6,225 12.8% 38,671 20.6%
Chasing loose ball 15,730 11.3% 2,360 4.9% 18,090 9.6%
Receiving pass 15,239 10.9% 2,621 5.4% 17,860 9.5%
Heading ball 11,830 8.5% 1,518 3.1% 13,348 7.1%
Ball handling/dribbling 10,936 7.9% 2,299 4.7% 13,235 7.0%
Goaltending 8,006 5.8% 1,510 3.1% 9,516 5.1%
Passing (foot) 4,090 2.9% 3,383 7.0% 7,473 4.0%
Conditioning 0 0.0% 6,072 12.5% 6,072 3.2%
Shooting (foot) 2,511 1.8% 2,752 5.7% 5,263 2.8%
Blocking shot 1,158 0.8% 1,158 2.4% 2,316 1.2%
Attempting a slide tackle 391 0.3% 421 0.9% 812 0.4%
Receiving a slide tackle 782 0.6% 0 0.0% 782 0.4%
Other 1,158 0.8% 812 1.7% 1,970 1.0%
Total 139,220 100% 48,578 100% 187,798 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
45%
30%
18%
7%
0%
Competition n=135,816
Midfield
Forward
Defense
Goalkeeper
Other
41%
29%
26%
4%
0%
Practice n=47,796
47
Figure 5.5 Activity Resulting in Girls’ Soccer Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
General play Chasing loose ball Ball handling/dribbling Goaltending Heading ball Other
48
VI. Volleyball Injury Epidemiology
49
Table 6.1 Volleyball Injury Rates by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 155 174,474 0.89 44,064
Competition 67 61,913 1.08 19,150
Practice 88 112,561 0.78 24,914
Table 6.2 Demographic Characteristics of Injured Volleyball Athletes, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=42,488
Freshman 23.7%
Sophomore 34.0%
Junior 21.5%
Senior 20.9%
Total
†
100%
Age (years)
Minimum 13
Maximum 18
Mean (St. Dev.) 15.6 (1.2)
BMI
Minimum 17.5
Maximum 42.4
Mean (St. Dev.) 21.9 (3.2)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
50
Figure 6.1 Diagnosis of Volleyball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 6.3 Body Site of Volleyball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Ankle 7,624 39.8% 11,878 47.7% 19,502 44.3%
Head/face 3,909 20.4% 3,010 12.1% 6,919 15.7%
Hand/wrist 3,221 16.8% 1,758 7.1% 4,979 11.3%
Knee 1,901 9.9% 2,503 10.0% 4,404 10.0%
Trunk 955 5.0% 1555 6.2% 2,510 5.7%
Hip/thigh/upper leg 491 2.6% 1,657 6.7% 2,148 4.9%
Foot 149 0.8% 1,517 6.1% 1,666 3.8%
Shoulder 606 3.2% 768 3.1% 1,374 3.1%
Arm/elbow 294 1.5% 0 0.0% 294 0.7%
Lower leg 0 0.0% 269 1.1% 269 0.6%
Other 0 0.0% 0 0.0% 0 0.0%
Total 19,150 100% 24,915 100% 44,065 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
61%
0%
8%
20%
11%
Competition n=19,151
Strain/sprain
Contusion
Fracture
Concussion
Other
62%
6%
4%
12%
16%
Practice n=24,914
51
Table 6.4 Ten Most Common Volleyball Injury Diagnoses by Type of Exposure, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=19,150
Practice
n=24,915
Total
n=44,065
n % n % n %
Diagnosis
Ankle strain/sprain 7,624 39.8% 10,635 42.7% 18,259 41.4%
Head/face concussion 3,909 20.4% 3,010 12.1% 6,919 15.7%
Hand/wrist strain/sprain 1,872 9.8% 1,433 5.8% 3,305 7.5%
Knee strain/sprain 959 5.0% 1,046 4.2% 2,005 4.6%
Knee other 942 4.9% 942 3.8% 1,884 4.3%
Hand/wrist fracture 1,200 6.3% 325 1.3% 1,525 3.5%
Hip/thigh/upper leg strain/sprain 491 2.6% 841 3.4% 1,332 3.0%
Ankle other 0 0.0% 1,243 5.0% 1,243 2.8%
Trunk strain/sprain 464 2.4% 655 2.6% 1,119 2.5%
Trunk other 491 2.6% 606 2.4% 1,097 2.5%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 6.2 Time Loss of Volleyball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
9%
27%
20%
34%
10%
Competition n=19,149
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
19%
26%
26%
16%
5%
8%
Practice n=24,916
52
Table 6.5 Volleyball Injuries Requiring Surgery by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 768 4.0% 515 2.1% 1,283 2.9%
Did not require surgery 18,382 96.0% 24,399 97.9% 42,781 97.1%
Total 19,150 100% 24,914 100% 44,064 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 6.3 History of Volleyball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 6.6 Time during Season of Volleyball Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 9,875 22.4%
Regular season 33,508 76.0%
Post season 682 1.5%
Total 44,065 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
91%
0%
9%
Competition n=19,150
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
84%
2%
14%
Practice n=24,914
53
Table 6.7 Competition-Related Variables for Volleyball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 2,813 15.3%
First set 1,835 10.0%
Second set 6,867 37.3%
Third set 5,815 31.6%
Fourth set 1,097 6.0%
Total 18,426 100%
Court Location
Middle forward 4,802 26.0%
Left back 4,129 22.3%
Right forward 3,628 19.6%
Left forward 2,682 14.5%
At the net 1,564 8.5%
Off the court 959 5.2%
Outside court (your side) 721 3.9%
Right back (server) 0 0.0%
Outside court (opponent's side) 0 0.0%
Total 18,485 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 6.8 Practice-Related Variables for Volleyball Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 3,864 15.6%
Second 1/2 hour 3,052 12.3%
1-2 hours into practice 14,748 59.6%
>2 hours into practice 3,071 12.4%
Total 24,735 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
54
Figure 6.4 Player Position of Volleyball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 6.9 Activities Leading to Volleyball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Blocking 6,224 32.5% 7,998 33.4% 14,222 33.0%
Digging 5,078 26.5% 3,599 15.1% 8,677 20.1%
General play 2,074 10.8% 5,115 21.4% 7,189 16.7%
Spiking 2,167 11.3% 1,792 7.5% 3,959 9.2%
Setting 426 2.2% 2,073 8.7% 2,499 5.8%
Serving 1,007 5.3% 768 3.2% 1,775 4.1%
Passing 575 3.0% 553 2.3% 1,128 2.6%
Conditioning 0 0.0% 1,049 4.4% 1,049 2.4%
Other 1,600 8.4% 965 4.0% 2,565 6.0%
Total 19,151 100% 23,912 100% 43,063 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
35%
30%
8%
8%
9%
10%
Competition n=18,659
Outside hitter
Middle blocker
Libero
Setter
Opposite/diagonal
player
Other
34%
29%
10%
16%
10%
1%
Practice n=23,477
55
Figure 6.5 Activity Resulting in Volleyball Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Blocking General Play Spiking Passing Digging Other
56
VII. Boys’ Basketball Injury Epidemiology
57
Table 7.1 Boys’ Basketball Injury Rates by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 337 229,897 1.47 85,819
Competition 171 70,092 2.44 44,095
Practice 166 159,805 1.04 41,724
Table 7.2 Demographic Characteristics of Injured Boys’ Basketball Athletes, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=84,026
Freshman 22.5%
Sophomore 26.5%
Junior 30.2%
Senior 20.8%
Total
†
100%
Age (years)
Minimum 13
Maximum 19
Mean (St. Dev.) 15.9 (1.2)
BMI
Minimum 15.8
Maximum 38.7
Mean (St. Dev.) 23.1 (3.5)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
58
Figure 7.1 Diagnosis of Boys’ Basketball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 7.3 Body Site of Boys’ Basketball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Ankle 11,118 25.2% 14,690 35.2% 25,808 30.1%
Head/face 12,661 28.7% 7,437 17.8% 20,098 23.4%
Knee 6,167 14.0% 4,471 10.7% 10,638 12.4%
Hand/wrist 2,440 5.5% 4,794 11.5% 7,234 8.4%
Hip/thigh/upper leg 2,669 6.1% 2,702 6.5% 5,371 6.3%
Trunk 3,278 7.4% 1,491 3.6% 4,769 5.6%
Foot 1,727 3.9% 1,066 2.6% 2,793 3.3%
Lower leg 958 2.2% 1,626 3.9% 2,584 3.0%
Shoulder 901 2.0% 1,484 3.6% 2,385 2.8%
Arm/elbow 1,275 2.9% 191 0.5% 1,466 1.7%
Neck 901 2.0% 0 0.0% 901 1.0%
Other 0 0.0% 1,771 4.2% 1,771 2.1%
Total 44,095 100% 41,723 100% 85,818 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
42%
10%
13%
16%
19%
Competition n=44,094
Strain/sprain
Contusion
Fracture
Concussion
Other
57%
6%
8%
12%
17%
Practice n=41,725
59
Table 7.4 Ten Most Common Boys’ Basketball Injury Diagnoses by Type of Exposure,
High School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=44,093
Practice
n=41,723
Total
n=85,816
n % n % n %
Diagnosis
Ankle strain/sprain 10,252 23.3% 13,536 32.4% 23,788 27.8%
Head/face concussion 6,903 15.7% 4,926 11.8% 11,829 13.8%
Head/face other 3,727 8.5% 2,048 4.9% 5,775 6.7%
Knee strain/sprain 3,306 7.5% 1,776 4.3% 5,082 5.9%
Knee other 1,939 4.4% 1,930 4.6% 3,869 4.5%
Hip/thigh/upper leg strain/sprain 911 2.1% 2,317 5.6% 3,228 3.8%
Hand/wrist fracture 1,348 3.1% 1,629 3.9% 2,977 3.5%
Hand/wrist strain/sprain 537 1.2% 2,345 5.6% 2,882 3.4%
Trunk contusion 1,602 3.6% 826 2.0% 2,428 2.8%
Trunk strain/sprain 1,581 3.6% 664 1.6% 2,245 2.6%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 7.2 Time Loss of Boys’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
13%
25%
19%
15%
12%
16%
Competition n=44,095
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
22%
21%
13%
20%
7%
17%
Practice n=41,725
60
Table 7.5 Boys’ Basketball Injuries Requiring Surgery by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 3,436 7.9% 3,031 7.5% 6467 7.7%
Did not require surgery 40,174 92.1% 37,204 92.5% 77,378 92.3%
Total 43,610 100% 40,235 100% 83,845 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 7.3 History of Boys’ Basketball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 7.6 Time during Season of Boys’ Basketball Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 13,489 15.8%
Regular season 69,479 81.3%
Post season 2,519 2.9%
Total 85,487 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
89%
6%
5%
Competition n=43,762
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
93%
2%
6%
Practice n=41,724
61
Table 7.7 Competition-Related Variables for Boys’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 774 1.8%
First quarter 2,809 6.5%
Second quarter 15,878 36.6%
Third quarter 12,909 15.0%
Fourth quarter 10,961 25.3%
Total 43,330 100%
Court Location
Inside lane (offense) 12,198 28.7%
Inside lane (defense) 10,186 23.9%
Between 3 point arc and lane (offense) 5,825 13.7%
Between 3 point arc and lane (defense) 4,947 11.6%
Outside 3 point arc - offense 3,650 8.6%
Outside 3 point arc - defense 3,176 7.5%
Backcourt 1,786 4.2%
Out of bounds 775 1.8%
Total 42,543 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 7.8 Practice-Related Variables for Boys’ Basketball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 3,976 10.1%
Second 1/2 hour 9,628 24.4%
1-2 hours into practice 22,899 58.1%
>2 hours into practice 2,904 7.4%
Total 39,407 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
62
Figure 7.4 Player Position of Boys’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Table 7.9 Activities Leading to Boys’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Rebounding 9,184 21.0% 11,681 28.8% 20,865 24.8%
Defending 10,767 24.7% 5,223 12.9% 15,990 19.0%
General play 5,224 12.0% 9,138 22.5% 14,362 17.1%
Shooting 6,534 15.0% 3,854 9.5% 10,388 12.3%
Chasing loose ball 6,737 15.4% 3,149 7.8% 9,886 11.7%
Ball handling/dribbling 3,571 8.2% 503 1.2% 4,074 4.8%
Receiving pass 393 0.9% 2,937 7.2% 3,330 4.0%
Conditioning 0 0.0% 2,227 5.5% 2,227 2.6%
Passing 0 0.0% 427 1.1% 427 0.5%
Other 1,251 2.9% 1,415 3.5% 2,666 3.2%
Total 43,661 100% 40,554 100% 84,215 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
53%
34%
13%
0%
Competition n=43,509
Guard
Forward
Center
Other
39%
42%
18%
1%
Practice n=41,725
63
Figure 7.5 Activity Resulting in Boys’ Basketball Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Rebounding General play Defending Chasing loose ball Shooting Other
64
VIII. Girls’ Basketball Injury Epidemiology
65
Table 8.1 Girls’ Basketball Injury Rates by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 336 183,377 1.83 83,107
Competition 179 57,201 3.13 45,645
Practice 157 126,176 1.24 37,462
Table 8.2 Demographic Characteristics of Injured Girls’ Basketball Athletes, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=80,997
Freshman 30.9%
Sophomore 30.2%
Junior 20.1%
Senior 18.8%
Total
†
100%
Age (years)
Minimum 14
Maximum 18
Mean (St. Dev.) 15.6 (1.1)
BMI
Minimum 15.5
Maximum 38.8
Mean (St. Dev.) 22.1 (2.9)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
66
Figure 8.1 Diagnosis of Girls’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Table 8.3 Body Site of Girls’ Basketball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Ankle 11,906 26.1% 10,744 28.7% 22,650 27.3%
Head/face 15,425 33.8% 5,773 15.4% 21,198 25.5%
Knee 8,874 19.4% 4,698 12.5% 13,572 16.3%
Hip/thigh/upper leg 2,270 5.0% 3,625 9.7% 5,895 7.1%
Trunk 1,110 2.4% 3,996 10.7% 5,106 6.1%
Hand/wrist 1,909 4.2% 2,406 6.4% 4,315 5.2%
Lower leg 709 1.6% 1058 2.8% 1,767 2.1%
Foot 1,281 2.8% 1,674 4.5% 2,955 3.6%
Shoulder 903 2.0% 1,990 5.3% 2,893 3.5%
Arm/elbow 1,257 2.8% 896 2.4% 2,153 2.6%
Neck 0 0.0% 268 0.7% 268 0.7%
Other 0 0.0% 333 0.9% 333 0.4%
Total 45,644 100% 37,461 100% 83,105 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
45%
9%
5%
28%
13%
Competition n=45,313
Strain/sprain
Contusion
Fracture
Concussion
Other
53%
8%
7%
14%
18%
Practice n=37,128
67
Table 8.4 Ten Most Common Girls’ Basketball Injury Diagnoses by Type of Exposure,
High School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=37,211
Pr
actice
n=29,980
Total
n=67,191
n % n % n %
Diagnosis
Ankle strain/sprain 11,479 25.3% 10,418 28.1% 21,897 26.6%
Head/face concussion 12,544 27.7% 4,970 13.4% 17,514 21.2%
Knee strain/sprain 3,961 8.7% 1,883 5.1% 5,844 7.1%
Hip/thigh/upper leg strain/sprain 1,851 4.1% 3,357 9.0% 5,208 6.3%
Knee other 3,291 7.3% 1,159 3.1% 4,450 5.4%
Knee contusion 1,623 3.6% 1,322 3.6% 2,945 3.6%
Trunk other 333 0.7% 2,382 6.4% 2,715 3.3%
Trunk strain/sprain 444 1.0% 1,615 4.3% 2,059 2.5%
Head/face fracture 1,191 2.6% 802 2.1% 1,993 2.4%
Shoulder other 520 1.1% 1,278 3.4% 1,798 2.2%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 8.2 Time Loss of Girls’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
19%
16%
17%
21%
9%
18%
Competition n=45,646
1-2 days
3-6 days
7-9 days
10-21 days
>21 days
Other*
11%
21%
17%
33%
8%
10%
Practice n=37,462
68
Table 8.5 Girls’ Basketball Injuries Requiring Surgery by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 4,436 9.8% 3,044 8.1% 7,480 9.0%
Did not require surgery 40,876 90.2% 34,418 91.9% 75,294 91.0%
Total 45,312 100% 37,462 100% 82,774 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 8.3 History of Girls’ Basketball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 8.6 Time during Season of Girls’ Basketball Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 13,094 15.8%
Regular season 69,050 83.1%
Post season 963 1.2%
Total 83,108 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
91%
4%
5%
Competition n=45,645
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
84%
1%
11%
Practice n=37,462
69
Table 8.7 Competition-Related Variables for Girls’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
n
%
Time in Competition
Pre-competition/warm-ups 1,254 2.9%
First quarter 2,972 6.8%
Second quarter 14,593 33.2%
Third quarter 12,503 28.5%
Fourth quarter 12,591 28.7%
Total 43,913 100%
Court Location
Inside lane (defense) 10,918 26.3%
Inside lane (offense) 8,214 19.8%
Outside 3 point arc - offense 6,059 14.6%
Between 3 point arc and lane (offense) 5,146 12.4%
Between 3 point arc and lane (defense) 3,609 8.7%
Outside 3 point arc - defense 3,012 7.2%
Backcourt 2,954 7.1%
Out of bounds 1,665 4.0%
Total 41,578 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
70
Table 8.8 Practice-Related Variables for Girls’ Basketball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 3,797 10.8%
Second 1/2 hour 8,334 23.7%
1-2 hours into practice 22,523 64.1%
>2 hours into practice 507 1.4%
Total 35,160 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 8.4 Player Position of Girls’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
52%
34%
14%
Competition n=42,902
Guard
Forward
Center
39%
43%
18%
Practice n=36,649
71
Table 8.9 Activities Leading to Girls’ Basketball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
General play 9,482 22.0% 11,652 31.8% 21,134 26.5%
Rebounding 7,335 17.0% 7,826 21.3% 15,161 19.0%
Defending 9,969 23.2% 3,646 9.9% 13,615 17.1%
Chasing loose ball 5,775 13.4% 2,793 7.6% 8,568 10.7%
Ball handling/dribbling 4,907 11.4% 2,048 5.6% 6,955 8.7%
Shooting 2,860 6.6% 2,350 6.4% 5,210 6.5%
Receiving pass 1,823 4.2% 3,102 8.5% 4,925 6.2%
Conditioning 0 0.0% 1,344 3.7% 1,344 1.7%
Passing 569 1.3% 762 2.1% 1,331 1.7%
Other 333 0.8% 1,153 3.1% 1,486 1.9%
Total 43,053 100% 36,676 100% 79,729 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 8.5 Activity Resulting in Girls’ Basketball Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Rebounding General play Defending Shooting Chasing loose ball Other
72
IX. Wrestling Injury Epidemiology
73
Table 9.1 Wrestling Injury Rates by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 343 147,208 2.33 85,485
Competition 141 39,857 3.54 35,016
Practice 202 107,351 1.88 50,469
Table 9.2 Demographic Characteristics of Injured Wrestlers, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=82,784
Freshman 27.2%
Sophomore 18.1%
Junior 27.5%
Senior 27.2%
Total
†
100%
Age (years)
Minimum 13
Maximum 18
Mean (St. Dev.) 16.0 (1.3)
BMI
Minimum 14.5
Maximum 39.6
Mean (St. Dev.) 23.5 (4.6)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
74
Figure 9.1 Diagnosis of Wrestling Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 9.3 Body Site of Wrestling Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Head/face 7,526 21.0% 10,276 20.4% 17,532 20.6%
Knee 5,979 17.3% 7,201 14.3% 13,180 15.5%
Shoulder 4,987 14.4% 6,142 12.2% 11,129 13.1%
Trunk 3,097 8.9% 5,681 11.3% 8,778 10.3%
Arm/elbow 2,849 8.2% 4,745 9.4% 7,594 8.9%
Ankle 3,237 9.4% 4,067 8.1% 7,304 8.6%
Hand/wrist 2,383 6.9% 4,534 9.0% 6,917 8.1%
Neck 773 2.2% 2,775 5.5% 3,548 4.2%
Hip/thigh/upper leg 1,120 3.2% 1,375 2.7% 2,495 2.9%
Lower leg 507 1.5% 1,114 2.2% 1,621 1.9%
Foot 451 1.3% 710 1.4% 1,161 1.4%
Other 1,975 5.7% 1,848 3.7% 3,823 4.5%
Total 34,614 100% 50,648 100% 85,082 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
38%
3%
14%
19%
20%
6%
Competition n=35,017
Strain/sprain
Contusion
Fracture
Concussion
Skin infection
Other
39%
6%
7%
11%
19%
18%
Practice n=50,470
75
Table 9.4 Ten Most Common Wrestling Injury Diagnoses by Type of Exposure, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=34,616
Practice
n=50,470
Total
n=85,086
n % n % n %
Diagnosis
Head/face concussion 6,793 19.6% 5,650 11.2% 12,443 14.6%
Ankle strain/sprain 2,689 7.8% 4,067 8.1% 6,756 7.9%
Knee strain/sprain 2,872 8.3% 3,380 6.7% 6,252 7.3%
Shoulder strain/sprain 2,222 6.4% 3,159 6.3% 5,381 6.3%
Shoulder skin infection 2,766 8.0% 2,532 5.0% 5,298 6.2%
Knee skin infection 2,655 7.7% 2,447 4.8% 5,102 6.0%
Head/face other 310 0.9% 3,000 5.9% 3,310 3.9%
Arm/elbow strain/sprain 902 2.6% 2,244 4.4% 3,146 3.7%
Hand/wrist strain/sprain 684 2.0% 2,063 4.1% 2,747 3.2%
Hand/wrist fracture 1,351 3.9% 1,135 2.2% 2,486 2.9%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 9.2 Time Loss of Wrestling Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
5%
15%
21%
29%
7%
23%
Competition n=35,016
1-2 days
3-6 days
7-9 days
10-21 days
> 21 days
Other*
10%
27%
12%
26%
6%
19%
Practice n=50,470
76
Table 9.5 Wrestling Injuries Requiring Surgery by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 1,399 4.1% 2,972 6.0% 4,371 5.3%
Did not require surgery 32,517 95.9% 46,291 94.0% 78,808 94.7%
Total 33,916 100% 49,263 100% 83,179 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 9.3 History of Wrestling Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 9.6 Time during Season of Wrestling Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 12,009 14.1%
Regular season 69,751 81.7%
Post season 3,628 4.2%
Total 85,388 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
87%
7%
6%
Competition n=35,017
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
92%
2%
6%
Practice n=49,167
77
Table 9.7 Competition-Related Variables for Wrestling Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 853 2.7%
First period 3,072 9.8%
Second period 14,192 45.3%
Third period 12,841 41.0%
Overtime 354 1.1%
Total 31,312 100%
Mat Location
Within 28 ft. circle 31,822 96.0%
Off the mat 1,063 3.2%
Out of bounds 251 0.8%
Total 33,137 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Table 9.8 Practice-Related Variables for Wrestling Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 10,786 22.1%
Second 1/2 hour 8,482 17.4%
1-2 hours into practice 22,680 46.5%
>2 hours into practice 6,836 14.0%
Total 48,783 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
78
Table 9.9 Activities Leading to Wrestling Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Takedown 16,056 48.7% 16,556 33.5% 32,612 39.5%
Sparring 6,124 18.6% 8,684 17.5% 14,808 18.0%
N/A (e.g., skin infection, overuse, etc.) 1,816 5.5% 9,012 18.2% 10,828 13.1%
Fall 378 1.1% 3,837 7.8% 4,215 5.1%
Riding 2,647 8.0% 1,230 2.5% 3,877 4.7%
Reversal 1,604 4.9% 1,889 3.8% 3,493 4.2%
Near fall 2,674 8.1% 593 1.2% 3,267 4.0%
Escape 1,504 4.6% 1,701 3.4% 3,205 3.9%
Conditioning 0 0.0% 2,896 5.9% 2,896 3.5%
Other 168 0.5% 3,096 6.3% 3,264 4.0%
Total 37,768 100% 62,803 100% 100,571 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 9.4 Activities Resulting in Wrestling Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*N/A category consists of skin infections, overuse injuries, heat illness, etc.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Skin Infection
Concussion
Fracture
Contusion
Strain/sprain
Takedown N/A * Escape Sparring Near fall Other
79
X. Baseball Injury Epidemiology
80
Table 10.1 Baseball Injury Rates by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 161 182,376 0.88 49,747
Competition 82 62,971 1.30 24,807
Practice 79 119,405 0.66 24,940
Table 10.2 Demographic Characteristics of Injured Baseball Athletes, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year*
Year in School n=48,643
Freshman 22.9%
Sophomore 22.4%
Junior 28.7%
Senior 26.1%
Total
†
100%
Age (years)
Minimum 13
Maximum 19
Mean (St. Dev.) 16.2 (1.2)
BMI
Minimum 18.0
Maximum 34.4
Mean (St. Dev.) 23.6 (2.9)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
81
Figure 10.1 Diagnosis of Baseball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 10.3 Body Site of Baseball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Shoulder 3,445 13.9% 5,537 22.2% 8,982 18.1%
Head/face 2,927 11.8% 3,846 15.4% 6,773 13.6%
Arm/elbow 2,471 10.0% 3,098 12.4% 5,569 11.2%
Hand/wrist 3,456 13.9% 1,840 7.4% 5,296 10.6%
Hip/thigh/upper leg 2,648 10.7% 2,471 9.9% 5,119 10.3%
Knee 2,639 10.6% 2,310 9.3% 4,949 9.9%
Ankle 2,919 11.8% 1,706 6.8% 4,625 9.3%
Trunk 1,701 6.9% 1,295 5.2% 2,996 6.0%
Neck 1,113 4.5% 1,134 4.5% 2,247 4.5%
Other 683 2.8% 0 0.0% 683 1.4%
Foot 0 0.0% 577 2.3% 577 1.2%
Lower leg 804 3.2% 1,127 4.5% 1,931 3.9%
Total 24,806 100% 24,941 100% 49,747 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
42%
14%
10%
12%
22%
Competition n=24,496
Strain/sprain
Contusion
Fracture
Concussion
Other
51%
14%
6%
5%
24%
Practice n=24,631
82
Table 10.4 Ten Most Common Baseball Injury Diagnoses by Type of Exposure, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=24,495
Practice
n=24,629
Total
n=49,124
n % n % n %
Diagnosis
Shoulder other 2,697 11.0% 1,878 7.6% 4,575 9.3%
Head/face concussion 2,843 11.6% 1,219 4.9% 4,062 8.3%
Ankle strain/sprain 2,813 11.5% 1,220 5.0% 4,033 8.2%
Hip/thigh/upper leg strain/sprain 2,140 8.7% 1,852 7.5% 3,992 8.1%
Shoulder strain/sprain 641 2.6% 3,350 13.6% 3,991 8.1%
Trunk strain/sprain 1,701 6.9% 1,295 5.3% 2,996 6.1%
Knee strain/sprain 1,133 4.6% 1,817 7.4% 2,950 6.0%
Hand/wrist fracture 1,604 6.5% 711 2.9% 2,315 4.7%
Arm/elbow contusion 1,562 6.4% 492 2.0% 2,054 4.2%
Hand/wrist fracture 894 3.6% 641 2.6% 1,535 3.1%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 10.2 Time Loss of Baseball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
16%
25%
7%
23%
13%
16%
Competition n=24,807
1-2 days
3-6 days
7-9 days
10-21 days
> 21 days
Other*
26%
20%
11%
20%
9%
14%
Practice n=24,941
83
Table 10.5 Baseball Injuries Requiring Surgery by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 1,789 7.3% 4,002 16.3% 5,791 11.8%
Did not require surgery 22,730 92.7% 20,429 83.6% 43,159 88.2%
Total 24,519 100% 24,431 100% 48,950 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 10.3 History of Baseball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 10.6 Time during Season of Baseball Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 11,701 23.5%
Regular season 37,044 74.5%
Post season 1,001 2.0%
Total 49,746 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
86%
12%
2%
Competition n=24,617
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
96%
4%
1%
Practice n=24,940
84
Table 10.7 Competition-Related Variables for Baseball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 802 3.4%
First inning 1,387 5.9%
Second inning 2,559 10.9%
Third inning 3,843 16.3%
Fourth inning 5,671 24.0%
Fifth inning 6,001 25.5%
Sixth inning 1,306 5.5%
Seventh inning 1,520 6.4%
Extra innings 492 2.1%
Total 23,581 100%
Field Location
Home plate 8,078 33.1%
First base 3,921 16.1%
Second base 3,620 14.8%
Pitcher’s mound 3,500 14.3%
Infield 1,787 7.3%
Third base 1,428 5.9%
Outfield 1,256 5.1%
Other 802 3.3%
Total 24,391 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
85
Table 10.8 Practice-Related Variables for Baseball Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 3,885 16.3%
Second 1/2 hour 4,491 18.9%
1-2 hours into practice 14,278 59.9%
>2 hours into practice 1,166 4.9%
Total 23,821 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 10.4 Player Position of Baseball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
15%
15%
20%
4%
19%
27%
Competition n=24,807
Base runner
Pitcher
Batter
Shortstop
Catcher
Other
9%
19%
4%
5%
10%
53%
Practice n=24,834
86
Table 10.9 Activities Leading to Baseball Injuries by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Pitching 3,500 14.2% 4,196 16.8% 7,696 15.5%
Fielding a batted ball 2,760 11.2% 4,286 17.2% 7,046 14.2%
Running bases 4,608 18.7% 1,291 5.2% 5,899 11.9%
Batting 4,521 18.3% 1,373 5.5% 5,894 11.9%
Sliding 2,748 11.1% 2,000 8.0% 4,748 9.6%
Throwing (not pitching) 802 3.2% 3,164 12.7% 3,966 8.0%
Catching 2,144 8.7% 1,419 5.7% 3,563 7.2%
Other 492 2.0% 2,911 11.7% 3,403 6.9%
General play 1,127 4.6% 2,225 8.9% 3,352 6.8%
Fielding a thrown ball 1,998 8.1% 619 2.5% 2,617 5.3%
Conditioning 0 0.0% 1,457 5.8% 1,457 2.9%
Total 24,700 100% 24,941 100% 49,641 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 10.5 Activity Resulting in Baseball Injuries by Injury Diagnosis, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Fielding Pitching Running bases Batting General play Other
87
XI. Softball Injury Epidemiology
88
Table 11.1 Softball Injury Rates by Type of Exposure, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
# Injuries # Exposures
Injury rate
(per 1,000 athlete-
exposures)
Nationally
Estimated
# Injuries
Total 147 128,172 1.15 58,124
Competition 85 43,478 1.96 35,477
Practice 62 84,694 0.73 22,647
Table 11.2 Demographic Characteristics of Injured Softball Athletes, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Year in School n=58,124
Freshman 27.2%
Sophomore 24.3%
Junior 26.3%
Senior 22.2%
Total
†
100%
Age (years)
Minimum 13
Maximum 18
Mean (St. Dev.) 15.9 (1.1)
BMI
Minimum 17.2
Maximum 40.4
Mean (St. Dev.) 22.8 (4.0)
*All remaining analyses in this chapter present data weighted to provide national injury estimates.
†Throughout this chapter, totals and n’s represent the total weighted number of injury reports containing a
valid response for the particular question. Due to a low level of non-response, these totals are always
similar but are not always equal to the total number of injuries.
89
Figure 11.1 Diagnosis of Softball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 11.3 Body Site of Softball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Body Site
Head/face 7,676 21.6% 2,322 10.3% 9,998 17.2%
Ankle 5,949 16.8% 3,539 15.6% 9,488 16.3%
Knee 6,096 17.2% 2,821 12.5% 8,917 15.3%
Shoulder 2,949 8.3% 4,684 20.7% 7,633 13.1%
Hand/wrist 3,793 10.7% 2,203 9.7% 5,996 10.3%
Arm/elbow 2,672 7.5% 1,408 6.2% 4,080 7.0%
Lower leg 3,198 9.0% 258 1.1% 3,456 5.9%
Hip/thigh/upper leg 953 2.7% 1,893 8.4% 2,846 4.9%
Trunk 615 1.7% 1,390 6.1% 2,005 3.4%
Foot 801 2.3% 658 2.9% 1,459 2.5%
Neck 338 1.0% 0 0.0% 338 0.6%
Other 437 1.2% 1,471 6.5% 1,908 3.3%
Total 35,477 100% 22,647 100% 58,124 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
42%
21%
8%
17%
12%
Competition n=35,478
Strain/sprain
Contusion
Fracture
Concussion
Other
60%
5%
5%
8%
22%
Practice n=22,647
90
Table 11.4 Ten Most Common Softball Injury Diagnoses by Type of Exposure, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition
n=35,482
Practice
n=22,651
Total
n=58,133
n % n % n %
Diagnosis
Ankle strain/sprain 5,692 16.0% 3,362 14.8% 9,054 15.6%
Head/face concussion 5,841 15.5% 1,744 7.7% 7,585 13.0%
Knee strain/sprain 5,659 15.9% 1,210 5.3% 6,869 11.8%
Shoulder other 2,513 7.1% 1,419 6.3% 3,932 6.8%
Shoulder strain/sprain 258 0.7% 3,265 14.4% 3,523 6.1%
Lower leg contusion 3,198 9.0% 0 0.0% 3,198 5.5%
Hand/wrist strain/sprain 1,353 3.8% 1,435 6.3% 2,788 4.8%
Hip/thigh/upper leg strain/sprain 953 2.7% 1,715 7.6% 2,668 4.6%
Hand/wrist fracture 1,554 4.4% 431 1.9% 1,985 3.4%
Other other 437 1.2% 1,471 6.5% 1,908 3.3%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 11.2 Time Loss of Softball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Other category is made up of medical disqualification for season, medical disqualification for career,
athlete chooses not to continue, and season ended before athlete returned to play
8%
16%
11%
22%
7%
36%
Competition n=35,478
1-2 days
3-6 days
7-9 days
10-21 days
> 21 days
Other*
9%
32%
22%
29%
2%
6%
Practice n=22,647
91
Table 11.5 Softball Injuries Requiring Surgery by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Need for surgery
Required surgery 2,607 7.6% 435 2.0% 3,042 5.4%
Did not require surgery 31,918 92.4% 21,516 98.0% 53,434 94.6%
Total 34,525 100% 21,951 100% 56,476 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 11.3 History of Softball Injuries by Type of Exposure, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 11.6 Time during Season of Softball Injuries, High School Sports-Related Injury
Surveillance Study, US, 2012-13 School Year
*
n %
Time in Season
Preseason 11,897 20.5%
Regular season 43,800 75.4%
Post season 2,427 4.2%
Total 58,124 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
95%
3%
2%
Competition n=35,077
New injury
Recurrence (this
academic year)
Recurrence (previous
academic year)
80%
9%
11%
Practice n=22,388
92
Table 11.7 Competition-Related Variables for Softball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Competition
Pre-competition/warm-ups 3,239 9.8%
First inning 2,645 8.0%
Second inning 3,082 9.4%
Third inning 6,907 21.0%
Fourth inning 8,529 25.9%
Fifth inning 4,356 13.2%
Sixth inning 2,182 6.6%
Seventh inning 1,548 4.7%
Extra innings 401 1.2%
Total 32,889 100%
Field Location
Home plate 9,056 26.4%
Outfield 5,657 16.5%
Third base 5,051 14.7%
Second base 4,566 13.3%
First base 4,278 12.5%
Infield 2,784 8.1%
Pitcher’s mound 1,124 3.3%
Foul territory 979 2.9%
Other 780 2.3%
Total 34,274 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
93
Table 11.8 Practice-Related Variables for Softball Injuries, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
*
n %
Time in Practice
First 1/2 hour 2,360 12.1%
Second 1/2 hour 4,583 23.4%
1-2 hours into practice 12,264 62.7%
>2 hours into practice 355 1.8%
Total 19,563 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 11.4 Player Position of Softball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
10%
6%
5%
16%
5%
58%
Competition n=34,016
Base runner
Pitcher
Batter
Catcher
Right field
Other
14%
10%
0%
10%
12%
54%
Practice n=22,032
94
Table 11.9 Activities Leading to Softball Injuries by Type of Exposure, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*
Competition Practice Overall
n % n % n %
Activity
Running bases 6,944 20.3% 4,154 18.3% 11,098 19.5%
Fielding a batted ball 6,441 18.8% 3,432 15.2% 9,873 17.3%
Catching 5,899 17.2% 2,472 10.9% 8,371 14.7%
Fielding a thrown ball 5,119 14.9% 1,872 8.3% 6,991 12.3%
Throwing (not pitching) 1,037 3.0% 4,253 18.8% 5,290 9.3%
Sliding 1,726 5.0% 2,163 9.6% 3,889 6.8%
Batting 3,097 9.0% 615 2.7% 3,712 6.5%
Pitching 1,124 3.3% 886 3.9% 2,010 3.5%
General Play 437 1.3% 1,263 5.6% 1,700 3.0%
Conditioning 0 0.0% 1,453 6.4% 1,453 2.6%
Other 2,449 7.1% 85 0.4% 2,534 4.5%
Total 34,273 100% 22,648 100% 56,921 100%
* Totals and n’s are not always equal due to slight rounding of the weighted number of injuries and missing responses. Due to a
low level of non-response, these totals are always similar but are not always equal to the total number of injuries.
Figure 11.5 Activity Resulting in Softball Injuries by Injury Diagnosis, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
Concussion
Fracture
Contusion
Strain/sprain
Fielding Pitching Running bases Batting General play Other
95
XII. Gender Differences within Sports
96
12.1 Boys’ and Girls’ Soccer
Table 12.1 Comparison of Boys’ and Girls’ Soccer Injury Rates, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
*Throughout this chapter, rate ratios (RR) and injury proportion ratios (IPR) compare the gender with a
higher injury rate/proportion (bolded) to the gender with a lower injury rate/proportion.
†Throughout this chapter, statistically significant RR and IPR are bolded.
Table 12.2 Comparison of Body Sites of Boys’ and Girls’ Soccer Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Body Site
Hip/thigh/upper leg
16.7%
16.0% 1.04 (0.64, 1.70)
Head/face 30.3%
33.4%
1.10 (0.80, 1.53)
Ankle 12.4%
14.1%
1.14 (0.66, 1.95)
Knee 14.5%
17.5%
1.21 (0.75,1.95)
Hand/wrist
2.6%
2.5% 1.05 (0.28, 3.88)
Foot
7.2%
6.9% 1.04 (0.45, 2.39)
Lower leg
6.0%
5.3% 1.14 (0.53, 2.46)
Trunk
3.8%
2.5% 1.50 (0.54, 4.19)
Arm/elbow
1.9%
1.2% 1.65 (0.35, 7.70)
Shoulder
1.0%
0.3% 3.50 (0.63, 19.41)
Neck
1.4%
0.2%
9.03 (1.14, 71.71)
Other
2.2%
0.1%
15.68 (1.78, 138.07)
Total 100% 100%
--
Boys’ soccer Girls’ soccer* RR (95% CI)
†
Total
1.52
2.29 1.51 (1.29, 1.78)
Competition 3.28
5.54 1.69 (1.39, 2.06)
Practice 0.78
0.92
1.18 (0.89, 1.57)
97
Table 12.3 Comparison of Diagnoses of Boys’ and Girls’ Soccer Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Diagnosis
Strain/sprain 41.0%
44.2%
1.08 (0.84, 1.38)
Contusion 11.1%
12.2%
1.10 (0.62, 1.95)
Fracture
5.9%
3.8% 1.55 (0.66, 3.67)
Concussion 25.8%
32.6%
1.26 (0.89, 1.79)
Other
16.2%
7.2%
2.24 (1.25, 4.02)
Total 100% 100%
---
Table 12.4 Most Common Boys’ and Girls’ Soccer Injury Diagnoses*, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Diagnosis
Ankle strain/sprain 10.9%
13.8%
1.27 (0.73, 2.19)
Head/face concussion 25.8%
32.6%
1.26 (0.89, 1.79)
Hip/thigh/upper leg strain/sprain
12.8%
12.2% 1.05 (0.61, 1.82)
Knee strain/sprain 5.6%
10.7%
1.91 (0.92, 3.93)
Knee other
5.9%
3.2% 1.85 (0.75, 4.58)
*Only includes diagnoses accounting for >5% of boys’ or girls’ soccer injuries.
Table 12.5 Comparison of Time Loss of Boys’ and Girls’ Soccer Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Time Loss
1-2 days
14.5%
13.8% 1.05 (0.61, 1.82)
3-6 days
23.8%
19.7% 1.21 (0.79, 1.85)
7-9 days
20.7%
18.3% 1.13 (0.73, 1.77)
10-21 days 17.4%
20.0%
1.15 (0.76, 1.74)
22 days or more
6.5%
5.2% 1.25 (0.57, 2.76)
Other 17.1%
23.1%
1.35 (0.87, 2.10)
Total 100% 100%
---
98
Table 12.6 Comparison of Mechanisms of Boys’ and Girls’ Soccer Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Soccer Mechanism
Contact with another player
38.4%
32.7% 1.17 (0.88, 1.57)
Stepped on/fell on/kicked 9.3%
9.6%
1.03 (0.54, 1.98)
Rotation around a planted foot/inversion 7.3%
12.1%
1.67 (0.84, 3.30)
Overuse, heat illness, conditioning, etc.
20.1%
14.2% 1.42 (0.88, 2.27)
Contact with ball 8.4%
19.0% 2.26 (1.27, 4.03)
Uneven playing surface
2.8%
1.2% 2.31 (0.62, 8.57)
Slide tackle
5.2%
2.0% 2.56 (0.99, 6.62)
Contact with goal
0.1%
-- --
Other 8.4%
9.2%
1.09 (0.54, 2.20)
Total 100% 100%
---
Table 12.7 Comparison of Activities of Boys’ and Girls’ Soccer Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’ soccer Girls’ soccer IPR (95% CI)
Soccer Activity
General play 25.8%
27.9%
1.08 (0.75, 1.55)
Defending 11.7%
20.6% 1.76 (1.02, 3.03)
Chasing loose ball
12.9% 9.6%
1.34 (0.69, 2.58)
Ball handling/dribbling 6.9%
7.0%
1.02 (0.50, 2.11)
Goaltending
9.7%
5.1% 1.92 (0.90, 4.08)
Shooting (foot) 2.7%
2.8%
1.03 (0.36, 2.94)
Heading ball
10.9%
7.1% 1.53 (0.78, 3.00)
Passing (foot) 3.3%
4.0%
1.21 (0.47, 3.11)
Receiving pass 7.5%
9.5%
1.27 (0.60, 2.65)
Conditioning
4.2%
3.2% 1.29 (0.50, 3.34)
Other
4.4%
3.1% 1.41 (0.61, 3.26)
Total 100% 100%
---
99
12.2 Boys’ and Girls’ Basketball
Table 12.8 Comparison of Boys’ and Girls’ Basketball Injury Rates, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Table 12.9 Comparison of Body Sites of Boys’ and Girls’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Body Site
Ankle
30.1%
27.3% 1.10 (0.84, 1.45)
Knee 12.4%
16.3%
1.32 (0.86, 2.01)
Head/face 23.4%
25.5%
1.09 (0.81, 1.47)
Hip/thigh/upper leg 6.3%
7.1%
1.13 (0.60, 2.16)
Hand/wrist
8.4%
5.2% 1.62 (0.84, 3.15)
Shoulder 2.8%
3.5%
1.25 (0.47, 3.37)
Trunk 5.6%
6.1%
1.11 (0.54, 2.28)
Lower leg
3.0%
2.1% 1.42 (0.54, 3.73)
Arm/elbow 1.7%
2.6%
1.52 (0.50, 4.62)
Foot 3.3%
3.6%
1.09 (0.45, 2.67)
Neck
1.0%
0.3% 3.25 (0.32, 33.51)
Other
2.1%
0.4% 5.15 (0.60, 44.32)
Total 100% 100%
---
Boys’
basketball Girls’ basketball RR (95% CI)*
Total
1.47
1.83 1.25 (1.08, 1.45)
Competition 2.44
3.13 1.28 (1.04, 1.58)
Practice 1.04
1.24
1.20 (0.96, 1.49)
100
Table 12.10 Comparison of Diagnoses of Boys’ and Girls’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Diagnosis
Strain/sprain
49.3%
48.4% 1.02 (0.85, 1.21)
Contusion 8.4%
8.6%
1.05 (0.58, 1.80)
Fracture
10.5%
6.2% 1.68 (0.93, 3.05)
Concussion 13.8%
21.2% 1.54 (1.06, 2.24)
Other
18.0%
15.5% 1.17 (0.79, 1.72)
Total 100% 100%
---
Table 12.11 Most Common Boys’ and Girls’ Basketball Injury Diagnoses*, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Diagnosis
Ankle strain/sprain
27.7%
26.3% 1.05 (0.80, 1.39)
Head/face concussion 13.8%
21.1% 1.53 (1.05, 2.22)
Knee strain/sprain 5.9%
7.0%
1.19 (0.63, 2.25)
Knee other 4.5%
5.4%
1.19 (0.55, 2.56)
*Only includes diagnoses accounting for >5% of boys’ or girls’ basketball injuries.
Table 12.12 Comparison of Time Loss of Boys’ and Girls’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Time Loss
1-2 days
17.3%
15.2% 1.14 (0.76, 1.69)
3-6 days
22.9%
18.5% 1.23 (0.88, 1.73)
7-9 days 16.2%
17.2%
1.06 (0.73, 1.56)
10-21 days 17.5%
26.0% 1.48 (1.06, 2.07)
22 days or more
9.7%
8.6% 1.13 (0.66, 1.95)
Other
16.4%
14.5% 1.14 (0.76, 1.69)
Total 100% 100%
---
101
Table 12.13 Comparison of Mechanisms of Boys’ and Girls’ Basketball Injuries, High
School Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Basketball Mechanism
Collision with another player
30.8%
28.0% 1.10 (0.84, 1.43)
Jumping/landing
26.1%
18.6%
1.40 (1.00, 1.95)
Overuse, heat illness, conditioning, etc. 8.4%
10.8%
1.28 (0.75, 2.20)
Rotation around a planted foot/inversion 12.2%
15.1%
1.24 (0.81, 1.91)
Stepped on/fell on/kicked
8.2%
7.3% 1.12 (0.60, 2.10)
Contact with ball 4.6%
6.6%
1.44 (0.70, 2.97)
Other 9.7%
13.6%
1.39 (0.86, 2.24)
Total 100% 100%
---
Table 12.14 Comparison of Activities of Boys’ and Girls’ Basketball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Boys’
basketball Girls’ basketball IPR (95% CI)
Basketball Activity
Rebounding
24.8%
19.0% 1.30 (0.93, 1.83)
General play 17.1%
26.5% 1.55 (1.11, 2.17)
Defending
19.0%
17.1% 1.11 (0.77, 1.61)
Chasing loose ball
11.7%
10.7% 1.09 (0.67, 1.77)
Shooting
12.3%
6.5%
1.89 (1.06, 3.37)
Conditioning
2.6%
1.7% 1.57 (0.49, 4.98)
Ball handling/dribbling 4.8%
8.7%
1.80 (0.90, 3.63)
Receiving pass 4.0%
6.2%
1.56 (0.74, 3.30)
Other
3.7%
3.5% 1.04 (0.45, 2.42)
Total 100% 100%
---
102
12.3 Boys’ Baseball and Girls’ Softball
Table 12.15 Comparison of Baseball and Softball Injury Rates, High School Sports-Related
Injury Surveillance Study, US, 2012-13 School Year
Table 12.16 Comparison of Body Sites of Baseball and Softball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Body Site
Ankle 9.3%
16.3%
1.76 (0.86, 3.57)
Knee 9.9%
15.3%
1.54 (0.75, 3.17)
Head/face 13.6%
17.2%
1.26 (0.69, 2.32)
Hip/thigh/upper leg
10.3%
4.9% 2.10 (0.91, 4.88)
Hand/wrist
10.6%
10.3% 1.03 (0.47, 2.27)
Shoulder
18.1%
13.1% 1.38 (0.72, 2.61)
Trunk
6.0%
3.4% 1.75 (0.46, 6.61)
Lower leg 3.9%
5.9%
1.53 (0.43, 5.46)
Arm/elbow
11.2%
7.0% 1.60 (0.64, 4.00)
Foot 1.2%
2.5%
2.17 (0.31, 15.29)
Neck
4.5%
0.6%
7.77 (1.35, 44.63)
Other 1.4%
3.3%
2.39 (0.36, 15.91)
Total 100% 100%
---
Baseball Softball RR (95% CI)
Total
0.88
1.15 1.30 (1.04, 1.63)
Competition 1.30
1.96 1.50 (1.11, 2.04)
Practice 0.66
0.73
1.11 (0.79, 1.54)
103
Table 12.17 Comparison of Diagnoses of Baseball and Softball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Diagnosis
Strain/sprain 46.6%
49.0%
1.05 (0.80, 1.39)
Contusion 13.9%
15.0%
1.08 (0.55, 2.11)
Fracture
8.4%
6.8% 1.23 (0.47, 3.20)
Concussion 8.3%
13.0%
1.58 (0.75, 3.33)
Other
22.9%
16.1% 1.42 (0.83, 2.44)
Total 100% 100%
---
Table 12.18 Most Common Baseball and Softball Injury Diagnoses*, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Diagnosis
Ankle strain/sprain 8.1%
15.6%
1.92 (0.90, 4.11)
Hand/wrist fracture
4.7%
3.4% 1.36 (0.35, 5.28)
Head/face concussion 8.2%
13.0%
1.60 (0.76, 3.37)
Hip/thigh/upper leg strain/sprain
8.0%
4.6% 1.75 (0.70, 4.39)
Knee strain/sprain 5.9%
11.8%
1.99 (0.77, 5.14)
*Only includes diagnoses accounting for >5% of baseball or softball injuries.
Table 12.19 Comparison of Time Loss of Baseball and Softball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Time Loss
1-2 days
21.0%
8.5%
2.46 (1.27, 4.79)
3-6 days
22.4%
22.0% 1.02 (0.61, 1.69)
7-9 days 9.3%
14.9%
1.59 (0.78, 3.27)
10-21 days 21.1%
25.0%
1.19 (0.74, 1.92)
22 days or more
11.1%
5.2% 2.14 (0.72, 6.35)
Other 15.1%
24.3%
1.61 (0.93, 2.79)
Total 100% 100%
---
104
Table 12.20 Comparison of Mechanisms of Baseball and Softball Injuries, High School
Sports-Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Baseball/Softball Mechanism
Overuse, heat illness, conditioning, etc.
14.1%
11.4% 1.24 (0.64, 2.39)
Contact with another player 8.1%
15.0%
1.86 (0.86, 4.02)
Contact with bases 9.9%
11.4%
1.15 (0.53, 2.52)
Throwing - not pitching 8.0%
9.3%
1.16 (0.49, 2.77)
Throwing - pitching
12.4%
3.6%
3.47 (1.10, 10.91)
Contact with thrown ball (non-pitch) 3.8%
6.5%
1.72 (0.60, 4.92)
Rotation around a planted foot/inversion 6.7%
8.2%
1.22 (0.47, 3.20)
Hit by batted ball 6.9%
14.5%
2.11 (0.94, 4.72)
Hit by pitch
11.9%
4.5% 2.66 (0.94, 7.53)
Other 18.3%
18.5%
1.01 (0.57, 1.78)
Total 100% 100%
---
Table 12.21 Comparison of Activities of Baseball and Softball Injuries, High School Sports-
Related Injury Surveillance Study, US, 2012-13 School Year
Baseball Softball IPR (95% CI)
Baseball/Softball Activity
Fielding a batted ball 14.2%
17.3%
1.22 (0.66, 2.27)
Fielding a thrown ball 5.3%
12.3%
2.33 (0.86, 6.29)
Running bases 11.9%
19.5%
1.64 (0.89, 3.01)
Pitching
15.5%
3.5%
4.39 (1.87, 10.29)
Batting
11.9%
6.5% 1.82 (0.73, 4.57)
Sliding
9.6%
6.8% 1.40 (0.52, 3.77)
Throwing (not pitching) 8.0%
9.3%
1.16 (0.49, 2.77)
General play
6.8%
3.0% 2.26 (0.78, 6.54)
Conditioning
2.9%
2.6% 1.15 (0.29, 4.60)
Catching 7.2%
14.7%
2.05 (0.91, 4.61)
Other
6.9%
4.5% 1.54 (0.50, 4.79)
Total 100% 100%
---
105
XIII. Trends over Time
106
Table 13.1 Injury Rates by Sport, Type of Exposure, and Year, High School Sports-Related
Injury Surveillance Study, US, 2005/06-2012/13 School Years
2005
-
06
2006
-
07
2007
-
08
2008
-
09
2009
-
10
2010
-
11
2011
-
12
2012
-
13
p
-
value
for trend*
Overall total 2.51 2.59 2.31 2.01 2.10 1.97 2.17 2.16 0.049
Competition
4.63 4.88 4.45 4.05 4.19 4.10 4.26 4.31 0.083
Practice 1.69 1.75 1.52 1.26 1.32 1.16 1.40 1.34 0.038
Boys’ football total 4.36 4.45 4.18 3.50 3.81 3.50 3.78 3.87 0.063
Competition 12.09 13.50 12.80 11.26 12.95 12.30 12.41 12.53 0.820
Practice 2.54 2.68 2.47 1.92 2.06 1.74 2.16 2.08 0.051
Boys’ soccer total
2.43 2.27 1.75 1.62 1.75 1.56 1.64 1.52 0.007
Competition
4.22 4.31 3.63 3.43 3.39 3.08 3.47 3.28 0.011
Practice
1.58 1.45 0.96 0.87 1.04 0.90 0.90 0.78 0.010
Girls’ soccer total 2.36 2.51 2.35 2.07 2.00 1.93 2.42 2.29 0.453
Competition 5.21 5.43 5.15 4.59 4.67 4.13 5.68 5.54 0.941
Practice 1.10 1.31 1.16 1.00 0.85 0.93 1.09 0.92 0.099
Girls’ volleyball total
1.64 1.37 1.22 0.89 0.99 0.96 1.00 0.89 0.008
Competition 1.92 1.40 1.43 0.90 1.00 1.18 1.27 1.08 0.079
Practice
1.48 1.36 1.12 0.88 0.99 0.85 0.85 0.78 0.001
Boys’ basketball total 1.89 1.75 1.39 1.35 1.45 1.34 1.40 1.47 0.063
Competition 2.98 2.87 2.23 2.32 2.72 2.30 2.60 2.44 0.239
Practice
1.46 1.28 1.04 0.95 0.92 0.91 0.91 1.04 0.031
Girls’ basketball total 2.01 2.09 1.61 1.54 1.58 1.73 1.57 1.83 0.233
Competition 3.60 3.60 3.30 3.13 2.84 3.59 3.03 3.13 0.155
Practice 1.37 1.44 0.90 0.87 1.02 0.92 0.98 1.24 0.341
Boys’ wrestling total 2.50 2.51 2.27 2.17 1.98 2.01 2.50 2.33 0.473
Competition 3.93 3.80 3.70 3.35 3.09 3.32 3.56 3.54 0.146
Practice 2.04 2.06 1.76 1.75 1.56 1.55 2.10 1.88 0.580
Boys’ baseball total
1.19 1.25 0.93 0.78 0.82 0.81 0.83 0.88 0.037
Competition
1.77 2.01 1.37 1.32 1.27 1.49 1.14 1.30 0.038
Practice 0.87 0.82 0.68 0.48 0.57 0.46 0.65 0.66 0.135
Girls’ softball total 1.13 1.11 1.29 1.04 1.12 0.94 1.46 1.15 0.688
Competition 1.78 1.96 1.86 1.62 1.66 1.45 2.04 1.96 0.873
Practice 0.79 0.65 0.98 0.72 0.85 0.69 1.16 0.73 0.574
*Statistically significant tests for trend are bolded.
107
Table 13.2 Nationally Estimated Number of Injuries by Sport, Type of Exposure, and Year, High School Sports-Related Injury
Surveillance Study, US, 2005/06-2012/13 School Years
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
Overall total
1,442,533
1,472,849 1,419,723 1,248,126 1,359,897 1,195,815
1,392,262 1,361,986
Competition
759,334
766,512 763,034 690,525 754,091 711,642 740,493 779,055
Practice
683,199
706,337 656,689 557,601 605,805 484,173 651,769 582,931
Boys’ football total 516,150 574,367 616,665 527,321 581,414 483,016 559,064 616,209
Competition
280,919
292,316 311,780 288,637 322,801 296,199 287,710 344,097
Practice
235,231
282,051 304,885 238,684 258,614 186,817 271,354 272,112
Boys’ soccer total 218,760 171,874 159,351 149,229 153,485 138,974 172,070 149,049
Competition
119,703
93,295 99,785 87,082 83,985 81,238 97,540 89,429
Practice
99,058
78,579 59,566 62,147 69,500 57,736 74,530 59,620
Girls’ soccer total 185,770 230,769 215,850 192,108 181,159 180,254 222,679 190,382
Competition
122,803
149,231 146,102 123,312 129,754 124,674 145,469 141,339
Practice
62,967
81,538 69,748 68,796 51,405 55,580 77,210 49,043
Girls’ volleyball total 81,813 80,493 72,261 56,609 67,760 50,711 52,662 44,064
Competition
32,677
27,423 26,539 19,764 21,728 21,416 24,439 19,150
Practice
49,136
53,069 45,722 36,845 46,032 29,295 28,223 24,914
(cont). next page
108
Table 13.2 Nationally Estimated Number of Injuries by Sport, Type of Exposure, and Year, High School Sports-Related Injury
Surveillance Study, US, 2005/06-2012/13 School Years (continued)
2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13
Boys’ basketball total
100,058
96,670 82,612 79,230 85,063 79,762 75,872 85,819
Competition
44,826
46,109 36,766 40,152 46,787 41,252 41,978 44,095
Practice
55,232
50,561 45,846 39,078 38,276 38,510 33,894 41,724
Girls’ basketball total 103,566 102,831 73,283 64,933 78,709 83,033 67,280 83,107
Competition
53,812
53,703 45,236 38,277 44,026 53,931 37,213 45,645
Practice
49,753
49,128 28,047 26,656 34,684 29,102 30,067 37,462
Boys’ wrestling total
105,542
101,139 91,625 88,996 80,390 80,569 107,992 85,485
Competition
36,259
38,750 40,698 39,029 37,742 36536 40,235 35,016
Practice
69,283
62,389 50,927 49,967 42,647 44,033 67,757 50,469
Boys’ baseball total
67,560
60,296 44,760 39,869 64,053 46,796 43,590 49,747
Competition
33,639
33,494 22,803 25,584 36,502 29,789 20,818 24,807
Practice
33,922
26,802 21,957 14,285 27,551 17,008 22,772 24,940
Girls’ softball total
63,313
54,411 63,316 49,831 67,862 52,700 91,053 58,124
Competition
34,696
32,191 33,325 28,688 30,767 26,607 45,091 35,477
Practice
28,618
22,220 29,991 21,143 37,096 26,093 45,962 22,647
109
Table 13.3 Body Site of Injury by Year, High School Sports-Related Injury Surveillance Study, US, 2005/06-2012/13 School Years*
2005-06
n=1,442,048
2006-07
n=1,464,926
2007-08
n=1,411,621
2008-09
n=1,248,126
2009-10
n=1,359,897
2010-11
n=1,194,319
2011-12
n=1,391,577
2012-13
n=1,361,584
Body Site
Ankle 22.7% 19.8% 18.5% 16.4% 17.5% 17.7% 16.1% 15.5%
Knee 14.2% 16.6% 14.6% 14.8% 15.7% 14.2% 13.4% 14.8%
Head/face 12.3% 12.4% 12.4% 15.3% 17.2% 23.3% 25.1% 25.7%
Hip/thigh/upper leg 10.8% 10.5% 10.2% 10.3% 9.2% 8.3% 9.8% 9.5%
Shoulder 7.9% 8.0% 10.1% 9.3% 8.4% 7.0% 6.6% 6.5%
Hand/wrist 8.0% 7.5% 9.1% 8.5% 10.3% 8.9% 8.5% 7.4%
Trunk 6.2% 6.7% 6.5% 6.6% 5.8% 4.7% 4.9% 5.2%
Lower leg 4.6% 5.2% 5.7% 5.8% 4.7% 5.0% 4.5% 3.9%
Arm/elbow 4.1% 3.9% 4.6% 4.1% 4.0% 3.1% 4.0% 3.5%
Foot 4.0% 4.0% 4.2% 5.0% 4.1% 4.0% 3.4% 3.2%
Neck 2.2% 1.9% 1.8% 1.9% 1.9% 1.8% 1.7% 2.3%
Other 3.2% 3.6% 2.4% 2.1% 1.2% 2.1% 2.0% 2.5%
Total 100% 100% 100% 100% 100% 100% 100% 100%
*Throughout this chapter, n’s represent the total number of injury reports containing a valid response for the particular question. Due to a low
level of non-response, these totals are always similar but are not always equal to the total number of injuries.
110
Table 13.4 Injury Diagnosis by Year, High School Sports-Related Injury Surveillance Study, US, 2005/06-2012/13 School Years
2005-06,
n=1,444,172
2006-07,
n=1,466,398
2007-08
n=1,414,139
2008-09
n=1,248,126
2009-10
n=1,359,897
2010-11
n=1,191,484
2011-12
n=1,392,262
2012-13
n=1,360,701
Diagnosis
Strain/sprain 52.0% 48.2% 48.3% 45.7% 44.7% 43.2% 42.2% 42.3%
Contusion 12.2% 13.7% 12.4% 11.5% 14.0% 9.6% 10.8% 10.6%
Fracture 9.8% 8.9% 10.2% 10.9% 9.9% 10.2% 7.7% 7.8%
Concussion 9.1% 8.4% 9.2% 11.8% 14.0% 20.0% 22.2% 23.1%
Other 16.8% 20.9% 19.9% 20.2% 17.5% 17.0% 17.1% 16.2%
Total 100% 100% 100% 100% 100% 100% 100% 100%
Table 13.5 Most Common Injury Diagnoses by Year, High School Sports-Related Injury Surveillance Study, US, 2005/06-2012/13
School Years
2005
-
06
n=1,435,954
2006
-
07
n=1,463,273
2007
-
08
n=1,410,654
2008
-
09
n=1,248,126
2009
-
10
n=1,359,897
2010
-
11
n=1,189,985
2011
-
12
n=1,388,873
2012
-
13
n=1,360,303
Diagnosis
Ankle strain/sprain 20.6% 17.8% 17.3% 15.0% 16.0% 16.3% 14.7% 14.5%
Head/face concussion 9.0% 8.4% 9.2% 11.7% 13.9% 20.0% 22.2% 23.1%
Knee strain/sprain 7.6% 8.8% 7.8% 7.9% 8.0% 7.7% 7.6% 8.2%
Hip/thigh/upper leg strain/sprain 7.9% 7.7% 7.3% 7.7% 6.5% 6.4% 6.9% 6.7%
Knee other 4.3% 4.9% 4.7% 4.5% 5.2% 4.8% 3.9% 4.1%
Shoulder other 3.1% 3.7% 4.1% 4.0% 3.3% 3.7% 3.1% 3.4%
Hand/wrist fracture 3.2% 3.3% 4.0% 4.0% 4.2% 4.0% 3.7% 3.2%
Shoulder strain/sprain 3.4% 2.9% 3.4% 3.7% 3.3% 2.2% 2.9% 2.6%
Trunk strain/sprain 2.8% 2.7% 3.2% 2.8% 2.5% 2.4% 1.9% 2.3%
Hand/wrist strain/sprain 3.1% 2.5% 3.8% 2.9% 2.8% 2.8% 3.0% 2.5%
111
Table 13.6 Time Loss of Injuries by Year, High School Sports-Related Injury Surveillance Study, US, 2005/06-2012/13 School
Years
2005
-
06
n=1,378,145
2006
-
07
n=1,423,183
2007
-
08
n=1,355,981
2008
-
09
n= 1,248,126
2009
-
10
n= 1,359,897
2010
-
11
n=1,195,815
2011
-
12
n=1,392,262
2012
-
13
n=1,361,986
Time Loss
1-2 days 22.5% 26.6% 22.8% 13.7% 14.7% 12.8% 15.9% 12.6%
3-6 days 30.0% 28.5% 28.8% 28.5% 27.3% 25.2% 23.3% 23.6%
7-9 days 15.3% 14.7% 15.8% 17.7% 16.1% 16.7% 16.1% 16.3%
10-21 days 14.9% 14.1% 16.7% 19.7% 16.9% 19.2% 19.6% 21.3%
≥22 days 17.2% 16.1% 15.9% 20.3% 25.0% 26.1% 25.0% 26.2%
Total 100% 100% 100% 100% 100% 100% 100% 100%
Table 13.7 Injuries Requiring Surgery by Year, High School Sports-Related Injury Surveillance Study, US, 2005/06-2012/13
School Years
2005
-
06
n=1,429,072
2006
-
07
n=1,428,960
2007
-
08
n=1,380,872
2008
-
09
n= 1,248,126
2009
-
10
n= 1,359,897
2010
-
11
n=1,169,423
2011
-
12
n=1,392,262
2012
-
13
n=1,337,403
Need for surgery
Required surgery 5.3% 6.4% 6.1% 6.7% 8.0% 8.2% 6.7% 7.3%
Did not require surgery 94.7% 93.6% 93.9% 93.3% 92.0% 91.8% 93.3% 92.7%
Total 100% 100% 100% 100% 100% 100% 100% 100%
112
XIV. Reporter Demographics & Compliance
113
During the 2012-13 school year, 108 ATs were invited to participate in the study at the
beginning of the school year. ATs were expected to report for every week in which they were
enrolled. For example, an AT who joined the study as a replacement school in week 10 was not
expected to report for weeks 1-9. Overall, 100 enrolled ATs reported an average of 43 study
weeks. The majority of ATs (73.0%) reported all the weeks during which they were enrolled,
with only 4 ATs (4.0%) missing over 10 weeks. Internal validity checks during the 2012-13
academic year yielded 95.8% sensitivity, 100.0% specificity, a positive predictive value of
100.0%, and a negative predictive value of 98.2%.
Prior to the start of the 2012-13 High School RIO
TM
study, participating ATs were asked
to complete a short demographics survey. Three-quarters (81.0%) of participating high schools
were public schools, with the remainder being private. All ATs except one provided services to
athletes of their high school on 5 or more days each week. Over 80% (84.0%) of ATs
participating during the 2012-13 study year had previously participated in the High School
RIO™ study.
An online “End of Season” survey gave all participating ATs (both in the original study
as well as in the expanded study (n=216 including those ATs who did not report any data)) the
opportunity to provide feedback on their experiences with High School RIO
TM
. This survey was
completed by 138 ATs (63.9%). Average reporting time burdens were 17 minutes for the
weekly exposure report and 9 minutes for the injury report form. Using a 5 point Likert scale,
RIO
TM
was overwhelmingly reported to be either very easy (56.5%) or somewhat easy (37.0%)
to use (5 and 4 on the Likert scale, respectively), with ATs being either very satisfied (70.0%) or
somewhat satisfied (24.6%) with the study (5 and 4 on the Likert scale, respectively).
Suggestions provided by ATs, such as the addition or clarification of questions or answer
114
choices, will be used to improve the National High School Sports-Related Injury Surveillance
Study for the 2013-14 school year.
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XV. Summary
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High school sports play an important role in the adoption and maintenance of a physically
active lifestyle among millions of US adolescents. Too often injury prevention in this population
is overlooked as sports-related injuries are thought to be unavoidable. In reality, sports-related
injuries are largely preventable through the application of evidence-based preventive
interventions. Such preventive interventions can include educational campaigns, introduction of
new/improved protective equipment, rule changes, other policy changes, etc. The morbidity,
mortality, and disability caused by high school sports-related injuries can be reduced through the
development and implementation of improved injury diagnosis and treatment modalities as well
as through effective prevention strategies. However, surveillance of exposure based injury rates
in a nationally representative sample of high school athletes and subsequent epidemiologic
analysis of patterns of injury are needed to drive evidence-based prevention practices.
Prior to the implementation of the High School Sports-Related Injury Surveillance Study
by Dr. Comstock, the study of high school sports-related injuries had largely been limited by an
inability to calculate injury rates due to a lack of exposure data (i.e., frequency of participation in
athletic activities including training, practice, and competition), an inability to compare findings
across groups (i.e., sports/activities, genders, schools, and levels of competition), or an inability
to generalize findings from small non-representative samples. The value of national injury
surveillance studies that collect injury, exposure, and risk factor data from representative samples
has been well demonstrated by the National Collegiate Athletic Association’s Injury Surveillance
System (NCAA ISS). Data collected by the NCAA ISS since 1982 has been used to develop
preventive interventions including changes in coaching habits, increased use of protective
equipment, and rule changes which have had proven success in reducing injuries among
collegiate athletes. For example, NCAA ISS data has been used to develop several interventions
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intended to reduce the number of preseason heat-related football injuries including the
elimination of consecutive days of multiple practices, daily hour limitations, and a gradual
increase in equipment for conditioning and heat acclimation. Additionally, several committees
have considered NCAA ISS data when making recommendations including the NCAA
Committee on Competitive Safeguards and Medical Aspects of Sports’ recommendation for
mandatory eye protection in women’s lacrosse, the NCAA Men’s Ice Hockey Rules
Committee’s recommendation for stricter penalties for hitting from behind, checking into the
boards, and not wearing a mouthpiece, and the NCAA Men’s Basketball Rules Committee’s
recent discussions of widening the free-throw lane to prevent injuries related to player contact.
Unfortunately, because an equivalent injury surveillance system to collect injury and exposure
data from a nationally representative sample of high school athletes had not previously existed,
injury prevention efforts targeted to reduce injury rates in this population were based largely
upon data collected from collegiate athletes. This is unacceptable because distinct
biophysiological differences (e.g., lower muscle mass, immature growth plates, etc.) means high
school athletes are not merely miniature versions of their collegiate counterparts.
The successful implementation and maintenance of the National High School Sports-
Related Injury Surveillance Study demonstrates the value of a national injury surveillance system
at the high school level. Dr. Comstock and her research staff are committed to maintaining a
permanent national high school sports injury surveillance system.
While the health benefits of a physically active lifestyle including sports participation are
undeniable, participants are at risk of injury because a certain endemic level of injury can be
expected during any physical activity, especially those with a competitive component. However,
injury rates among high school athletes should be reduced to the lowest possible level without
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discouraging adolescents from engaging in this important form of physical activity. This goal
can best be accomplished by monitoring injury rates and patterns of injury among high school
athletes over time; investigating the etiology of preventable injuries; and developing,
implementing, and evaluating evidence-based preventive interventions. Surveillance systems
such as the model used for this study are critical in achieving these goals.