Use of Discretionary Protective Equipment and Rate of Lower Extremity Injury in High School Athletes

Background: High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes. Hypothesis: Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex. Results: A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex. Conclusion: Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury. Clinical Relevance: Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

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Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000284 ◽

2016 ◽

Vol 26 (6) ◽

pp. 435-444 ◽

Cited By ~ 10

Author(s):

James A. Onate ◽

Joshua S. Everhart ◽

Daniel R. Clifton ◽

Thomas M. Best ◽

James R. Borchers ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Lower Extremity ◽

Physical Exam ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes

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Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-52.11.22 ◽

2017 ◽

Vol 52 (11) ◽

pp. 1028-1034 ◽

Cited By ~ 21

Author(s):

Robert C. Lynall ◽

Timothy C. Mauntel ◽

Ryan T. Pohlig ◽

Zachary Y. Kerr ◽

Thomas P. Dompier ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Musculoskeletal Injury ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Time Loss ◽

Lower Extremity Injuries ◽

Subsequent Time ◽

Extremity Injuries

Context: Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. Objective: To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. Design: Observational cohort study. Setting: One hundred ninety-six high schools across 26 states. Patients or Other Participants: We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. Main Outcome Measure(s): Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non–time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. Results: The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non–time-loss injury (OR = 1.01; 95% CI = 0.92, 1.10). Conclusions: Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non–time-loss injuries. By definition, time-loss injuries may be considered more severe than non–time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.

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The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00289 ◽

2017 ◽

Vol 5 (7_suppl6) ◽

pp. 2325967117S0028

Author(s):

Timothy A. McGuine ◽

David Bell ◽

Margaret Alison Brooks ◽

Scott Hetzel ◽

Adam Pfaller ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Injury Rates

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Association between Y Balance Test Performance and Noncontact Lower Extremity Injury in High School Athletes

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000536965.58672.91 ◽

2018 ◽

Vol 50 (5S) ◽

pp. 569-570

Author(s):

MARY NADELEN ◽

Emily Hildebrand ◽

Kyle Leppert ◽

Peter Lisman

Keyword(s):

High School ◽

Lower Extremity ◽

Test Performance ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Balance Test

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Injury History Predicts Musculoskeletal Lower Extremity Injury Risk in High School Athletes

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000485118.85547.4b ◽

2016 ◽

Vol 48 ◽

pp. 36

Author(s):

James Onate ◽

Cambrie Starkel ◽

James Borchers ◽

Ajit Chaudhari ◽

Daniel Clifton ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Injury Risk ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes

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The Association of Sport Specialization and the History of Lower Extremity Injury in High School Athletes.

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000487597.82416.4d ◽

2016 ◽

Vol 48 ◽

pp. 866 ◽

Cited By ~ 1

Author(s):

Timothy A. McGuine

Keyword(s):

High School ◽

Lower Extremity ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

History Of

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Single Leg Hop Limb Asymmetry and Lower Extremity Injury Risk in Healthy High School Athletes

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000478491.37724.f8 ◽

2015 ◽

Vol 47 ◽

pp. 650-651

Author(s):

Cambrie Starkel ◽

Dustin Grooms ◽

Thomas M. Best ◽

James Borchers ◽

Ajit Chaudhari ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Injury Risk ◽

Lower Extremity Injury ◽

Extremity Injury ◽

High School Athletes ◽

Limb Asymmetry

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A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546517710213 ◽

2017 ◽

Vol 45 (12) ◽

pp. 2706-2712 ◽

Cited By ~ 65

Author(s):

Timothy A. McGuine ◽

Eric G. Post ◽

Scott J. Hetzel ◽

M. Alison Brooks ◽

Stephanie Trigsted ◽

...

Keyword(s):

High School ◽

Lower Extremity ◽

Sport Participation ◽

Large Population ◽

Lower Extremity Injury ◽

High School Athletes ◽

Adolescent Athletes ◽

School Year ◽

Increased Risk ◽

Interscholastic Athletes

Background: Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes. Purpose: To determine if sport specialization was associated with an increased risk of LEIs in high school athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level. Results: A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1.12-3.06]; P = .02). Conclusion: Athletes with moderate or high sport specialization were more likely to sustain an LEI than athletes with low specialization. Sports medicine providers need to educate coaches, parents, and interscholastic athletes regarding the increased risk of LEIs for athletes who specialize in a single sport.

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