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  • Girls' High School Sports Post Highest Incidence of Overuse Injuries

    Larger numbers of girls participating in high school sports and the growing range of sports offerings available to them are very good things, with a not-so-good side-effect—an increase in overuse injuries.

    According to a recent study of 2,834 overuse injuries (.pdf) between 2006 and 2012, girls' track and field and field hockey have come to top the list of high school sports linked to higher rates of overuse injuries in a set of 20 boys' and girls' sports. While the all-sports average injury rate was 1.50 per 10,000 athletic "exposures," girls' track and field registered a 3.82 rate, while girls' field hockey reported a 2.93 rate. The highest overuse injury among boys' sports was in track and field, at 2.24 injuries per 10,000 exposures.

    Overall, overuse injuries represented 7.7% of all injuries, but rates among girls and boys differed significantly, with overuse representing 13.3% of all injuries for girls, and only 5.5% among boys.

    The study, which appeared this spring in the journal Pediatrics, was based on data submitted by school athletic trainers through the National High School Sports-Related Injury Surveillance System, which randomly selected 100 high schools from an even distribution of geographic regions and school sizes. The injury statistics were drawn from 18,889,141 "athletic exposures," defined as 1 athlete participating in 1 practice or competition.

    Among other findings in the study:

    • Of the 20 sports studied, overuse injuries were more likely to occur in practice than in competition in all sports except boys' baseball, boys' ice hockey, and cheerleading. Girls' lacrosse and girls' field hockey reported the greatest increased risk of injury at practice vs competition.
    • Of 2,832 overuse injuries, 79.9% were reported as new.
    • Among sex-comparable sports, girls had an overall injury rate of 2.08; the injury rate for boys was 1.44.
    • Although overall injury rates were fairly evenly distributed across athletes' year in school, girls' rates decreased as they advanced, while boys' rates increased.
    • The lower leg was the most frequently injured body site (21.8%), followed by knee (15.9%), shoulder (11.5%), and foot (11.3%).
    • Boys' volleyball (.18), boys' ice hockey (.32), cheerleading (.35), and boys' wrestling (.57) reported the lowest overuse injury rates.
    • Sports with the highest percentage of injuries related to overuse were boys' swimming (55.7%), girls' swimming (47.7%), girls' track and field (36.8%) and boys' track and field (28.5%).

    In a video produced by Ohio State University, where lead author Thomas Best, MD, teaches and practices, Best links the intensity of practice and focus on a single sport as potential areas to be watched.

    "Many of these youngsters are playing a single sport, and that may in fact be a major risk factor for these overuse injuries because their bodies are seeing the same repetitive blows with one sport," Best said.

    In the study, authors write that their work could inform the development of sport-specific preventive measures to avoid a potentially worsening problem.

    "As the popularity of high school sports continues to increase, the number of high school athletes sustaining overuse injuries may also increase unless effective prevention programs are developed," authors write. "The body sites affected with overuse injuries were sport specific. Identifying high school athletes at risk of overuse injuries is the first step in working to prevent these injuries."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Also available from APTA:  a recorded webinar on repetitive stress injury in youth sports, presented by Jeff Taylor-Hass, PT, DPT, OCS, CSCS, and Chad Cherny, PT, DPT, MS, SCS, CSCS.


    • Good morning, great article, thank you for sharing! I had one thought that I would like to share, as an ATC at a secondary school I often screen and monitor athletes particularly fall sports as summer to sport is a tough transition. I found it very interesting that nearly 80% of these overuse injuries are new, does that mean acute? Does that mean this injury was picked up on a pre-participatory physical? I am curious if these types of injuries are predictable and if so preventable. Thank you again, great read! David Enos, ATC St. Mary's Center for Orthopaedics Auburn, ME 207. 333. 4781

      Posted by David Enos on 7/8/2015 9:39 AM

    • Consider pre conditioning with regard to girls' knee varus; also relatively rapid (?) availability of more sports participation for girls.

      Posted by H.K. Peters, Jr., PT on 7/11/2015 7:41 PM

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