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

2017 ◽  
Vol 45 (12) ◽  
pp. 2706-2712 ◽  
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.

scholarly journals Association of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower Extremity Injury History in High School Athletes

2017 ◽  
Vol 9 (6) ◽  
pp. 518-523 ◽  
Author(s):  
Eric G. Post ◽  
David R. Bell ◽  
Stephanie M. Trigsted ◽  
Adam Y. Pfaller ◽  
Scott J. Hetzel ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Sport Participation ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
High School Athletes ◽  
Level Of Evidence ◽  
Increased Risk ◽  
History Of ◽  
Club Sport

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.

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

2005 ◽  
Vol 161 (6) ◽  
pp. 511-519 ◽  
Author(s):  
J. Yang ◽  
S. W. Marshall ◽  
J. M. Bowling ◽  
C. W. Runyan ◽  
F. O. Mueller ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Lower Extremity Injury ◽  
Protective Equipment ◽  
Extremity Injury ◽  
High School Athletes

scholarly journals Timing of Lower Extremity Injuries in Competition and Practice in High School Sports

2017 ◽  
Vol 9 (3) ◽  
pp. 238-246 ◽  
Author(s):  
Kyle Nagle ◽  
Bernadette Johnson ◽  
Lina Brou ◽  
Tyler Landman ◽  
Ada Sochanska ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Epidemiologic Study ◽  
Lower Extremity Injury ◽  
High School Athletes ◽  
Level Of Evidence ◽  
Severe Injuries ◽  
Injury Surveillance System ◽  
High School Sports ◽  
School Sports

Background: Laboratory-based experiments demonstrate that fatigue may contribute to lower extremity injury (LEI). Few studies have examined the timing of LEIs during competition and practice, specifically in high school athletes across multiple sports, to consider the possible relationship between fatigue and LEIs during sport events. Hypothesis: The purpose of this study was to describe the timing of LEIs in high school athletes within games and practices across multiple sports, with a hypothesis that more and severe injuries occur later in games and practices. Study Design: Descriptive epidemiologic study. Level of Evidence: Level 4. Methods: Using the National High School RIO (Reporting Information Online) sport injury surveillance system, LEI severity and time of occurrence data during practice and competition were extracted for 9 high school sports. Results: During the school years 2005-2006 through 2013-2014, 16,967,702 athlete exposures and 19,676 total LEIs were examined. In all sports surveyed, there was a higher LEI rate, relative risk for LEI, and LEI requiring surgery during competition than practice. During practice, the majority of LEIs occurred over an hour into practice in all sports. In quarter-based competition, more LEIs occurred in the second (31% to 32%) and third quarters (30% to 35%) than in the first (11% to 15%) and fourth quarters (22% to 26%). In games with halves, the majority (53% to 66%) of LEIs occurred in the second half. The greater severity LEIs tended to occur earlier in games. Conclusion: Fatigue may play a role in the predominance of injuries in the second half of games, though various factors may be involved. Greater severity of injuries earlier in games may be because of higher energy injuries when athletes are not fatigued. Clinical Relevance: These findings can help prepare sports medicine personnel and guide further related research to prevent LEIs.

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

2016 ◽  
Vol 26 (6) ◽  
pp. 435-444 ◽  
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

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

2017 ◽  
Vol 52 (11) ◽  
pp. 1028-1034 ◽  
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.

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

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

Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players

2021 ◽  
pp. 036354652199711
Author(s):  
Kevin M. Biese ◽  
Stephanie A. Kliethermes ◽  
Andrew M. Watson ◽  
Timothy A. McGuine ◽  
Pamela J. Lang ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Female Athletes ◽  
Musculoskeletal Injury ◽  
Musculoskeletal Injuries ◽  
Lower Extremity Injury ◽  
Extremity Injury ◽  
Adolescent Athletes ◽  
Injury Rates ◽  
The Past

Background: Sports-related concussions may have a neurobiological recovery period that exceeds the period of clinical recovery, and one consequence of an extended neurobiological recovery may be the risk of subsequent musculoskeletal injuries. Most literature citing an increased risk of musculoskeletal injury after a sports-related concussion has been reported in populations other than adolescent athletes. Purpose/Hypothesis: The purpose was to prospectively determine if incidence rates of musculoskeletal injury differ between adolescent athletes with and without a previous sports-related concussion, while controlling for sex, sport, and age. A secondary aim was to determine if this relationship differs between male and female athletes of the same sport. Our hypotheses were that acute-noncontact injury rates would be higher in athletes with a previous sports-related concussion when compared with athletes without a previous sports-related concussion, and that this relationship would exist only in female athletes and not male athletes. Study Design: Cohort study; Level of evidence, 2. Methods: High school soccer and volleyball players were recruited in 2 prospective cohort studies that observed 4837 athletes during their sporting season (females, 80%; soccer, 57%; mean [SD] age, 15.6 [1.1] years). At preseason, all participants self-reported demographics and previous sports-related concussion within the past 12 months. During the sport season, team athletic trainers electronically recorded athlete exposures and injury data, including injury characteristics. Injury rates per 1000 athlete exposures and injury rate ratios (IRRs) with 95% confidence intervals were calculated. All injury rates and IRRs were adjusted for sex, age, and sport. Results: The rate of acute-noncontact lower extremity injury was 87% greater (IRR, 1.87; 95% CI, 1.29-2.74) in participants with a previous sports-related concussion versus those without one. The acute-noncontact lower extremity injury rates (IRRs) for females and males with a previous sports-related concussion were 1.76 (95% CI, 1.19-2.59) and 2.83 (95% CI, 0.85-9.50), respectively. No difference was detected in acute-contact (IRR, 0.98; 95% CI, 0.56-1.73) or overuse (IRR, 1.09; 95% CI, 0.51-2.37) lower extremity injury rates by previous sports-related concussion. Conclusion: Female adolescent athletes who reported a sports-related concussion within the past 12 months were more likely to sustain an acute-noncontact lower extremity injury during their high school sports season when compared with female athletes without a previous sport-related concussion.

scholarly journals Lower Extremity Musculoskeletal Injury Is Associated with Increased Risk of Concussion in High School Athletes

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
Adam Lutz ◽  
Charles Thigpen ◽  
R. Gil Gilliland ◽  
John Thorpe ◽  
Michael Kissenberth ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Female Athletes ◽  
High School Athletes ◽  
Time Loss ◽  
Male Athletes ◽  
Lower Extremity Injuries ◽  
Increased Risk ◽  
Extremity Injuries ◽  
Combined Injuries

Objectives: Previous research indicates that concussion increases the risk of lower extremity injuries (LE) after return to sport. However, no study has examined the risk of precedent lower extremity injuries and their relationship to the development of a sport related concussion (SRC). To determine if the risk of combined injuries (LE injury-SRC) is elevated in high school athletes accounting for athlete sport and gender. Methods: 33,386 high school athletes were monitored over 4 seasons. 4223 LE injuries and 1132 concussions were reported. Injured athletes were identified by their school athletic trainer (AT) time-loss injury during a team-sponsored practice or game. ATs documented the date, mechanism, and sport of injury. Injured athletes were referred to a board-certified sports medicine physician for diagnoses and follow up care. Cumulative injury rates were calculated with 95% confidence intervals. Rate ratios were used to compare frequency of SRC after RTS following a LE injury. Comparisons were made overall cohort between those participating athletes with and without isolated and combined injuries as well as by gender. (α=0.05). Results: A cumulative incidence for athletes sustaining an isolated SRC was 2.3/100 athletes (95% CI= 2.1-2.5) and for isolated LE injury was 11.5/100 (95% CI=11.2-11.9) athletes. Athletes presenting with a LE injury had an increased risk (RR= 4.7; 95% CI = 4.2-5.2) of sustaining a subsequent SRC within 1 year when compared to athletes that did not suffer precedent LE injuries. Male athletes presenting with a LE injury had an increased risk (RR= 4.9; 95% CI = 4.2-5.7) of sustaining a subsequent SRC within 1 year when compared to male athletes that did not suffer precedent LE injuries. Female athletes presenting with a LE injury had an increased risk (RR= 4.4; 95% CI = 3.6-5.2) of sustaining a subsequent SRC within 1 year when compared to female athletes that did not suffer precedent LE injuries. In football, presenting with a LE injury had an increased risk (RR= 5.8; 95% CI = 4.5-7.4) of sustaining a subsequent SRC within 1 year when compared to football athletes that did not suffer precedent LE injuries. Conclusion: Our results are the first to show that high school athletes who suffer a time-loss LE injury are at 4.4-5.8 times increased risk to suffer a sports related concussion within the next year. Additional studies are warranted to confirm these findings.

scholarly journals ANKLE BRACE USE AND RISK OF ACUTE LOWER EXTREMITY INJURY AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Stephanie Kliethermes ◽  
Timothy McGuine ◽  
Kevin Biese ◽  
David Bell ◽  
Andrew Watson ◽  
...  
Keyword(s):  
High School ◽  
Lower Extremity ◽  
Injury Severity ◽  
Ankle Injury ◽  
Ankle Injuries ◽  
Lower Extremity Injury ◽  
Increased Risk ◽  
Ankle Brace ◽  
Volleyball Players ◽  
Female High School

Background: Lower extremity injuries (LEIs), particularly ankle sprains, are the most common injury reported among female volleyball players. Many athletes wear ankle braces to help prevent injury; however, it is unknown whether ankle brace use reduces the rate and severity of ankle and LEI in these athletes. Hypothesis/Purpose: Determine if ankle brace use is associated with a reduced rate and severity of LEIs and ankle injuries among female high school volleyball players. Methods: 2073 female volleyball players from 78 high schools were prospectively followed for injury, including acute LEI, during their fall 2018 volleyball season. Baseline data was collected on each participant including ankle brace use and type worn. Brace type was classified as soft- (e.g. fabric) or hard-shell. Injury severity was measured as days lost from sport. Incidence rates are reported per 1000 athlete exposures. Results: 210 acute LEIs were observed during the season, of which 122 (58%) were ankle injuries. 76% of non-contact LEIs were due to jumping/landing or rotating around a planted foot. Similarly, 76% of contact LEIs were due to the floor or a teammate. The rate of LEI for athletes wearing soft-shell(SS) braces was 1.14 (95% CI: 0.76, 1.72), compared to 0.53 (95% CI: 0.25, 1.10) for those wearing hard-shells (HS) and 0.52 (95% CI: 0.37, 0.71) for those not wearing braces (NONE). The rate of a LEI for athletes wearing SS was 2.22 (95% CI: 1.31, 3.74) times as high as that for NONE (p=0.003). No association was found between LEI risk in athletes wearing HS versus NONE (IRR: 1.02, 95% CI: 0.45, 2.30). Similarly, the rates of ankle injury for HS, SS and NONE were 0.08 (95% CI: 0.01, 0.530), 0.40 (95% CI: 0.20, 0.79), and 0.16 (95% CI: 0.09, 0.28), respectively. The rate of ankle injury was 2.5 times as great in participants wearing SS compared to NONE (p=0.04). No association was detected for HS braces (p=0.48). No difference in median days lost for LEI (HS: 2[IQR 1,13], SS: 4[1, 10] None: 3[1,9]) or ankle injury (HS: 7[IQR 2,13], SS: 5[1, 11] None: 3[1,10]) was detected by brace use (p=0.99, p=0.79, respectively). Conclusion: The use of SS braces resulted in an increased risk of LEI and ankle injury among female high-school volleyball players; moreover, HS braces were not found to be associated with injury risk nor did ankle brace use affect severity of LEI and ankle injury in this population.

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