Epidemiology of overuse injuries in U.S. secondary school athletics from 2014–2015 to 2018–2019 using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program.

ABSTRACT Context: With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012–2013 and therefore may not reflect current overuse injury rates in high school sports. Objective: To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014–2015 to 2018–2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location. Design: Descriptive epidemiology study. Setting: Online injury surveillance from 211 high schools (345 individual years of high school data). Patients or Other Participants: Athletes participating in secondary school-sponsored boys' and girls' sports. Main Outcome Measures: Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014–2015 to 2018–2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). Results: The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8). Conclusions: Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review

Background While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries. Objective The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes. Design Systematic review. Data Sources MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists. Eligibility Criteria for Selecting Studies Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies. Results Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries. Conclusions There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

Bilateral stress fracture of the femoral neck in association with simultaneously developing osteonecrosis of the femoral head: a case report

Background Femoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture. Case presentation A 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery. Conclusions Bilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient’s complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.

Relationship of footwear comfort, selected size, and lower leg overuse injuries among infantry soldiers

Background High rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should fit well and provide comfort to prevent injuries and decrease lower extremity pain effectively. The association of military boot comfort with overuse injuries remains unclear. This study investigates the relationship between the chosen military boot size, perceived boot comfort and lower leg overuse injury. Methods During the cross-sectional study, 227 (males, n = 213; females, n = 14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n = 32) and non-injured age-matched controls (n = 34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury. Results No relationship was found between footwear comfort and a history of lower leg overuse injury. N = 38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly. Conclusions Study results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.

Proceed With Caution: A Teaching Case Study of Youth Sport Specialization

As sport specialization continues to shape the youth sport landscape, it is critical for sport management professionals, coaches, parents, and athletes to understand how this trend affects programming and policy development. While youth sport specialization often leads to increased athletic skill in an accelerated time frame, specialization can result in overuse injury, burnout, and delayed social development for children. It is essential that sport management students are aware of the trend in youth sport specialization and the various opportunities available to help educate/collaborate with stakeholders. Furthermore, students need to be exposed to youth sport specialization to better understand how to efficiently manage policy and programs involved in youth, and to understand contemporary research and theory leading to best practices.

Overuse Injury in Military Working Dog Handlers: A Pattern of Behavior and a Path to Prevention

ABSTRACT Military working dog handlers and their canine partners continue to be invaluable team members on missions of national importance, but little information exists in the medical literature regarding specific musculoskeletal injuries to military working dog handlers. We report a case of a dog handler with overuse shoulder traction injuries due to leash lunges from their dog in an effort to provide diagnostic insight and treatment options and look at prevention of common musculoskeletal manifestations of overuse in working dog handlers.

An epidemiologic comparison of acute and overuse injuries in high school sports

Background Acute and overuse injuries affect millions of high school athletes annually and a better understanding of differences between these injuries is needed to help guide prevention, treatment, and rehabilitation strategies. This study compares acute and overuse injuries using a nationally representative sample of high school athletes. Methods Injuries among United States high school athletes participating in 5 boys’ sports (football, soccer, basketball, wrestling, baseball) and 4 girls’ sports (soccer, volleyball, basketball, softball) reported in the High School RIO™ surveillance system during the 2006-07 through 2018-19 school years were classified as acute or overuse. National estimates and injury rates were calculated. Results Of 17 434 646 estimated injuries, 92.0 % were acute and 8.0 % were overuse. The acute injury rate was higher than the overuse injury rate among both male (Rate Ratio [RR] 16.38, 95 % CI: 15.70–17.10) and female (RR 8.14, 95 % CI: 7.71–8.60) athletes. The overuse injury rate per 10,000 athlete exposures among female athletes (1.8) was slightly higher than among males (1.4). The rate of acute injury compared with the rate of overuse injury was higher during competition (RR 32.00, 95 % CI: 29.93–34.22) than practice (RR 7.19, 95 % CI: 6.91–7.47). Boys’ football contributed the most acute (42.1 %) and overuse (23.7 %) injuries among the 9 sports. Among female sports, girls’ soccer contributed the most acute (15.6 % of all acute injuries) and overuse (19.4 % of all overuse injuries) injuries. The lower extremity was most commonly injured in acute (48.9 %) and overuse (65.9 %) injuries. Ligament sprain (31.7 %) and concussion (21.0 %) were the most common acute injury diagnoses, while muscle strain (23.3 %) and tendonitis (23.2 %) were the most common overuse injury diagnoses. Compared with acute injuries, overuse injuries were more likely to result in time loss from sports participation of < 1 week among both boys and girls and across most sports. Acute injuries were more likely than overuse injuries to cause a time loss of 1–3 weeks or medical disqualification from sports participation. Conclusions Acute and overuse injuries display many differences that provide opportunities for data-informed athlete preparation, treatment, and rehabilitation, which may reduce injuries and improve injury outcomes in high school athletics.