Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives

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Hootman, Jennifer M¹; Dick, Randall²; Agel, Julie³

Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives

J Athl Train. April–June 2007;42(2):311-319

© National Athletic Trainers’ Association, Inc.

Affiliations

¹Centers for Disease Control and Prevention, Atlanta, GA

²National Collegiate Athletic Association, Indianapolis, IN

³University of Minnesota, Minneapolis, MN
Abstract and keywords

Objective: To summarize 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for 15 sports and to identify potential modifiable risk factors to target for injury prevention initiatives.

Background: In 1982, the NCAA began collecting standardized injury and exposure data for collegiate sports through its Injury Surveillance System (ISS). This special issue reviews 182 000 injuries and slightly more than 1 million exposure records captured over a 16-year time period (1988–1989 through 2003–2004). Game and practice injuries that required medical attention and resulted in at least 1 day of time loss were included. An exposure was defined as 1 athlete participating in 1 practice or game and is expressed as an athlete-exposure (A-E).

Main Results: Combining data for all sports, injury rates were statistically significantly higher in games (13.8 injuries per 1000 A-Es) than in practices (4.0 injuries per 1000 A-Es), and preseason practice injury rates (6.6 injuries per 1000 A-Es) were significantly higher than both in-season (2.3 injuries per 1000 A-Es) and postseason (1.4 injuries per 1000 A-Es) practice rates. No significant change in game or practice injury rates was noted over the 16 years. More than 50% of all injuries were to the lower extremity. Ankle ligament sprains were the most common injury over all sports, accounting for 15% of all reported injuries. Rates of concussions and anterior cruciate ligament injuries increased significantly (average annual increases of 7.0% and 1.3%, respectively) over the sample period. These trends may reflect improvements in identification of these injuries, especially for concussion, over time. Football had the highest injury rates for both practices (9.6 injuries per 1000 A-Es) and games (35.9 injuries per 1000 A-Es), whereas men's baseball had the lowest rate in practice (1.9 injuries per 1000 A-Es) and women's softball had the lowest rate in games (4.3 injuries per 1000 A-Es).

Recommendations: In general, participation in college athletics is safe, but these data indicate modifiable factors that, if addressed through injury prevention initiatives, may contribute to lower injury rates in collegiate sports.

Keywords: athletic injuries
Links

PubMed: 17710181

PubMedCentral: PMC1941297

WoS: 000247382300019

Cited Works (7)

Year	Entry
2000	Verhagen EALM, van Mechelen W, de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med. October 2000;10(4):291-296.
2007	Fong DT-P, Hong Y, Chan L-K, Yung PS-H, Chan K-M. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94.
2004	Verhagen E, van der Beek A, Twisk J, Bouter L, Bahr R, van Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. September 2004;32(6):1385-1393.
2007	Dick R, Agel J, Marshall SW. National Collegiate Athletic Association Injury Surveillance System commentaries: introduction and methods. J Athl Train. April–June 2007;42(2):173-182.
1995	Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med. December 1995;23(6):694-701.
1999	Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. June 1999;34(2):86-92.
1992	van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Med. August 1992;14(2):82-99.

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Year	Entry
2017	Chorney SR, Sobin L, Goyal P, Suryadevara AC. Maxillofacial injuries among National Collegiate Athletic Association (NCAA) athletes: 2004 to 2014. Laryngoscope. June 2017;127(6):1296-1301.
2014	Crill M, Wilgus J, Berlet GC. Rehab back to sports. In: Philbin TM, ed. Sports Injuries of the Foot: Evolving Diagnosis and Treatment. New York, NY: Springer; 2014:203-213.
2016	Dekker TJ, Lampley AJ, Godin JA, Easley ME. Acute ankle instability/ankle sprains in athletes. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:249-256.
2010	Fischer WR. Using the Continuous Wavelet Transform to Characterize Differences Between Impact Signals from Non-Cleated and Cleated Turf Shoes [Master's thesis]. Boise, ID: Boise State University; 2010.
2016	Gross CE, Huh J, II JAN. Basketball. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:427-436.
2016	Lewis JS Jr, Easley ME. Overview and epidemiology of foot and ankle problems in sports. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:35-38.
2019	Terada M, Beard M, Carey S, Pfile K, Pietrosimone B, Rullestad E, Whitaker H, Gribble P. Nonlinear dynamic measures for evaluating postural control in individuals with and without chronic ankle instability. Motor Control. April 2019;23(2):243-261.
2017	Knowles BM, Dennison CR. Towards a helmet assessment metric capable of predicting diffuse brain injury while accounting for focal head injury. In: Proceedings of the 13th Ohio State University Injury Biomechanics Symposium. May 21-23, 2017; Columbus, OH.
2010	Waterman BR, Belmont PJ Jr, Cameron KL, DeBerardino TM, Owens BD. Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med. April 2010;38(4):797-803.
2011	Waterman BR, Philip J. Belmont J, Cameron KL, Svoboda SJ, Alitz CJ, Owens BD. Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med. 2011;39(5):992-998.
2017	Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and epidemiology of foot and ankle injuries in elite collegiate athletes. Am J Sports Med. February 2017;45(2):426-433.
2017	Mauntel TC, Wikstrom EA, Roos KG, Djoko A, Dompier TP, Kerr ZY. The epidemiology of high ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med. July 2017;45(9):2156-2163.
2012	Rowson S, Duma SM, Beckwith JG, Chu JJ, Greenwald RM, Crisco JJ, Brolinson PG, Duhaime A-C, McAllister TW, Maerlender AC. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann Biomed Eng. January 2012;40(1):1-13.
2012	Ocwieja KE, Mihalik JP, Marshall SW, Schmidt JD, Trulock SC, Guskiewicz KM. The effect of play type and collision closing distance on head impact biomechanics. Ann Biomed Eng. January 2012;40(1):90-96.
2013	Rowson S, Duma SM. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration. Ann Biomed Eng. May 2013;41(4):873-882.
2008	Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. June 2008;42(6):394-412.
2013	McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. April 2013;47(5):250-258.
2013	Hunt KJ, George E, Harris AHS, Dragoo JL. Epidemiology of syndesmosis injuries in intercollegiate football: incidence and risk factors from National Collegiate Athletic Association injury surveillance system data from 2004-2005 to 2008-2009. Clin J Sport Med. 2013;23(4):278-282.
2011	Burns PR, Lowery N. Etiology, pathophysiology, and most common injuries of the lower extremity in the athlete. Clin Podiatr Med Surg. 2011;28(1):1-18.
2018	D’Hooghe P, Axibal DP, Fuld RS, Sutphin BS, Hunt KJ. Return to play following arthroscopic vs. open treatment of lateral ankle instability in recreational/athletic. Clin Res Foot Ankle. 2018;6(2):1000265.
2010	Chinn L, Hertel J. Rehabilitation of ankle and foot injuries in athletes. Clin Sports Med. 2010;29(1):157-167.
2011	Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport-related concussion. Clin Sports Med. January 2011;30(1):1-17.
2019	Kent RW. Footwear and injury prevention in elite American football. Footwear Sci. 2019;11(suppl 1):S7-S8.
2010	Anderson RB, Hunt KJ, McCormick JJ. Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg. September 2010;18(9):546-556.
2013	Drakos MC, Taylor SA, Fabricant PD, Haleem AM. Synthetic playing surfaces and athlete health. J Am Acad Orthop Surg. May 2013;21(5):293-302.
2012	Wei F, Meyer EG, Braman JE, Powell JW, Haut RC. Rotational stiffness of football shoes influences talus motion during external rotation of the foot. J Biomech Eng. April 2012;134(4):041002.
2009	Hickey K, Quatman C, Myer G, Ford K, Brosky J, Hewett T. Methodological report: dynamic field tests used in an NFL combine setting to identify lower-extremity functional asymmetries. J Strength Cond Res. 2009;23(9):2500-2506.
2012	Brainard L, Beckwith J, Chu J, Crisco J, Mcallister T, Duhaime A-C, Maerlender A, Greenwald R. Gender differences in head impacts sustained by collegiate ice hockey players. Med Sci Sports Exer. February 2012;44(2):297-304.
2020	Mortensen BB, Mitchell UH, Johnson AW, Fellingham GW, Feland JB, Myrer JW. Preseason screen cannot predict injury over three years of college football. Med Sci Sports Exer. November 2020;52(11):2286-2292.
2015	Lievers WB, Adamic PF. Incidence and severity of foot and ankle injuries in men’s collegiate American football. Orthop J Sports Med. 2015;3(5):2325967115581593.
2018	Mulcahey MK, Bernhardson AS, Murphy CP, Chang A, Zajac T, Sanchez G, Sanchez A, Whalen JM, Price MD, Clanton TO, Provencher MT. The epidemiology of ankle injuries identified at the National Football League Combine, 2009-2015. Orthop J Sports Med. July 18, 2018;6(7):2325967118786227.
2017	Jastifer J, Kent R, Crandall J, Sherwood C, Lessley D, McCullough KA, Coughlin MJ, Anderson RB. The athletic shoe in football: apparel or protective equipment? Sports Health. March–April 2017;9(2):126-131.
2022	Young KL, Morris B, Herda TJ. The role of strength and conditioning in the prevention and treatment of chronic lateral ankle instability. Strength Cond J. April 2022;44(2):61-75.
2009	Afifi Hegazy MAM. Developing a Field Test to Predict Knee Valgus During Landing from a Jump [PhD thesis]. Arizona State University; August 2009.
2018	Mortensen BB. Can a Preseason Screen Predict Injury or Performance Over Three Years of College Football? [PhD thesis]. Brigham Young University; 2018.
2018	Radley C. The Effects of Predisposition and Direction on Ankle Sprain Risk Predictive Factors During Jump Landing [Master's thesis]. Iowa State University; 2018.
2019	Stephenson ML. Anterior Cruciate Ligament Injury Risk is Modified by the Timing of the Successful Identification of Directional Cues [PhD thesis]. Iowa State University; 2019.
2012	Wei F. Biomechanical Investigations and Computational Modeling of the Human Ankle [PhD thesis]. East Lansing, MI: Michigan State University; 2012.
2015	Button KD. Biomechanical Response of the Ankle to Excessive External Rotation [PhD thesis]. East Lansing, MI: Michigan State University; 2015.
2017	Aggelou AE. Concussion as a Risk Factor for Lower Extremity Musculoskeletal Injury in Collegiate Athletes [PhD thesis]. University of Pittsburgh; 2017.
2011	Dowling AV. Understanding and Preventing Anterior Cruciate Ligament Injuries Using Novel Motion Analysis Systems [PhD thesis]. Stanford University; May 2011.
2015	Butz RC. An Impact Force Transducer for Anthropomorphic Test Dummy Headforms: Application to Study Effects of External Helmet Accessories on Biomechanical Measures of Head Injury Risk [Master's thesis]. Edmonton, AB: University of Alberta; 2015.
2017	Stuart CA. Snow Sport Head Injury: Characterization of Clinical Presentation and Design of a Relevant Head Impact Apparatus [Master's thesis]. Vancouver, BC: University of British Columbia; April 2017.
2012	Wannop JW. Footwear Traction and Lower Extremity Non-Contact Injury [PhD thesis]. Calgary, AB: University of Calgary; August 2012.
2016	MacDonald KJ. Identifying the Impact of Injury Definition and Training Load on the Study of Jumper’s Knee [PhD thesis]. Calgary, AB: University of Calgary; October 2016.
2018	Mohr M. Lower Extremity Muscle Activation Following a Previous Knee Injury: Implications for Post-Traumatic Knee Osteoarthritis [PhD thesis]. Calgary, AB: University of Calgary; December 2018.
2009	Whittaker EC. A Portable Instrumentation System to Evaluate Lower Extremity Athletic Performance and Injury Risk [Master's thesis]. Davis, University of California; 2009.
2013	Starkel CD. The Temporal Response of Anterior Knee Laxity Following Strenuous Exercise [Master's thesis]. Davis, University of California; 2013.
2019	Wisthoff BA. Long-Term Effects Following an Acute Lateral Ankle Sprain in a College-Aged Population [PhD thesis]. University of Delaware; 2019.
2017	McCann RS. Prediction of Acute and Recurrent Ankle Sprains in Athletes [PhD thesis]. University of Kentucky; 2017.
2014	Rousseau P. Analysis of Concussion Metrics of Real-World Concussive and Non-Injurious Elbow and Shoulder to Head Collisions in Ice Hockey [PhD thesis]. Ottawa, ON: University of Ottawa; 2014.
2018	Taylor K. The Use of Decoupling Structures in Helmet Liners to Reduce Maximum Principal Brain Tissue Strain for Head Impacts [PhD thesis]. University of Ottawa; 2018.
2019	Karton C. Profiling Brain Trauma in Professional American-Style Football and the Implications to Developing Neurological Injury [PhD thesis]. Ottawa, ON: University of Ottawa; 2019.
2012	Sorenson SC. Trojan Lifetime Champions: A Cross-Sectional Epidemiological Study of Lifetime Health, Wellness, and Exercise in Elite Intercollegiate Student-Athletes [PhD thesis]. University of Southern California (USC); May 2012.
2017	Sanchez EJ. Evaluation of the Efficacy of Head and Brain Injury Risk Functions [Master's thesis]. Charlottesville, VA: University of Virginia; December 2017.
2011	Rowson S. Head Acceleration Experienced by Man: Exposure, Tolerance, and Applications [PhD thesis]. Virginia Polytechnic Institute and State University; March 29, 2011.
2014	Daniel RW II. Evaluation of Football Safety Techniques Utilizing Biomechanical Measurements [PhD thesis]. Virginia Polytechnic Institute and State University; June 3, 2014.
2015	Tyson AM. Development and Implementation of Laboratory Test Methods for the Evaluation of Wearable Head Impact Sensors [Master's thesis]. Virginia Polytechnic Institute and State University; December 7, 2015.
2017	McConnell EP. Assessing Symmetry in Landing Mechanics During Single-Leg and Bilateral Tasks in Healthy Recreational Athletes [Master's thesis]. Virginia Polytechnic Institute and State University; April 5, 2017.
2019	Reiber TM. Using Laboratory Impact Devices to Quantify Football Helmet Performance [Master's thesis]. Virginia Polytechnic Institute and State University; April 30, 2019.
2014	Campbell K. Quantifying and Comparing the Head Impact Biomechanics of Different Player Positions for Canadian University Football [Master's thesis]. University of Western Ontario; 2014.
2019	Allison W. Strains in Regions of the Brain Modelled from Female Youth Soccer Players Performing Purposeful Headers in Season [Master's thesis]. University of Western Ontario; 2019.
2021	Weng Y. Investigation of Small Remotely Piloted Aircraft System (sRPAS) to Human Head Impact [Master's thesis]. University of Western Ontario; 2021.