Methods of the National Collegiate Athletic Association Injury Surveillance Program, 2014–2015 Through 2018–2019

Background Since 1982, the National Collegiate Athletic Association (NCAA) has collaborated with athletic trainers (ATs) to create the largest ongoing collegiate sports injury database in the world. This report provides an operational update of the NCAA Injury Surveillance Program (NCAA ISP) during the academic years 2014–2015 through 2018–2019. Surveillance system structure The NCAA ISP used a convenience sampling technique via a rolling recruitment model. The ATs at contributing institutions voluntarily submitted data into their respective electronic medical record systems; common data elements were pushed to and maintained by the Datalys Center. The ATs provided information about all team-related activities, even if no injury occurred during that activity, as well as detailed reports on each injury, including condition and circumstances. Summary The NCAA ISP has a long-standing role in supplying NCAA stakeholders with crucial injury surveillance data, playing a critical part in safeguarding student-athletes participating in collegiate sports.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Football: 2014–2015 Through 2018–2019

Context Football is among the most popular collegiate sports in the United States, and participation in National Collegiate Athletic Association (NCAA) football has risen in recent years. Background Continued monitoring of football injuries is important for capturing the evolving burden of injuries in NCAA football. The purpose of this study was to describe the epidemiology of football-related injuries among men's NCAA football players during the 2014–2015 through 2018–2019 academic years. Methods Exposure and injury data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates. Results The overall injury rate was 9.31 per 1000 athlete-exposures. Most injuries occurred during general play (17.5%), blocking (15.8%), and tackling (14.0%). Concussions (7.5%), lateral ligament complex tears (6.9%), and hamstring tears (4.7%) were the most commonly reported injuries. Conclusions Results of this study were generally consistent with previous findings, though changes over time in rates of commonly reported injuries warrant attention. Continued monitoring of injury incidence is needed to appraise the effectiveness of recently implemented rules changes.

A - 09 The Epidemiology of Concussion in Middle School Wrestling

Objective Wrestling has among the highest concussion incidence in all high school and collegiate sports. Many children begin wrestling in middle school (MS), however, research describing concussion incidence in MS wrestling remains limited. Therefore, we sought to describe the incidence of concussion and subsequent sport time loss (TL) sustained by MS wrestlers. Methods Certified athletic trainers collected concussion and athlete exposure (AE) data for all MS wrestling practices and matches in a large metropolitan public-school division between 2015/16 and 2019/20. AE was defined as one athlete participating in one practice or match. Frequencies and proportions were calculated for diagnosed concussions by event type. TL was the number of days from date of injury to return to sport. Concussion injury rates (IR) per 1000 AEs and injury rate ratios (IRR) to compare IR between practice and matches were calculated with 95% Confidence Intervals (CIs). IRRs with 95% CIs excluding 1.0 were statistically significant. Results 43 concussions occurred across 38,297 AEs (IR = 1.12, 95%CI = 0.79–1.46). No significant difference in the concussion IR between practices (n = 33, IR = 1.11, 95%CI = 0.73–1.49) and matches (n = 10, IR = 1.16, CI = 0.44–1.87; IRR = 1.04, 95% CI = 0.51–2.11) was observed. The mean TL was 18.38 ± 8.25 days. Conclusions We observed higher practice and match concussion rates than those previously reported among middle and high school wrestlers. Additionally, our findings showed that MS wrestlers required approximately 5 more days to return to sport than reported among HS wrestlers. Further investigation of concussion risk factors for concussion and prolonged TL in MS wrestling is needed.

Double Punch to the Glass Ceiling: Career Experiences and Challenges of Ethnic Minority Female Athletic Directors

Women continue to struggle to reach senior-level leadership positions in collegiate sports, and ethnic minorities face the challenges due to their ethnicity as well. This research examined the experiences and challenges of ethnic minority women who are collegiate athletic directors at predominantly White institutions (PWIs). Semistructured interviews were conducted with eight participants using intersectionality as a theoretical framework. Three themes emerged from the data analysis: (a) intersectional challenges, (b) questions of competence, and (c) professional support. The women were continually battling the idea of having to prove themselves and negotiating the challenges of being an ethnic minority woman working in collegiate athletics. They credit their professional networks as a valuable resource during their career progression. The women noted that sexism was more prevalent in their experiences than issues related to their ethnicity. The masculine athletic director stereotype persists in collegiate sports, but the findings of this study can contest the notion of a standard leadership identity that has long been perceived as a White man.

Clinical Recovery Timelines following Sport-Related Concussion in Men's and Women's Collegiate Sports

Context: Past work has identified sex differences in sport-related concussion (SRC) incidence and recovery time; however, few have examined sex differences in specific recovery trajectories: time to symptom resolution, return-to-academics, and return-to-athletic activity across collegiate sports. Objective: To examine sex differences in SRC recovery trajectories across a number of varsity sports with differing levels of contact. Design: Descriptive Epidemiology Study. Setting: College varsity and club sports. Patients or Other Participants: SRCs sustained by student-athletes (N=1,974; 38.7% female) participating in Ivy League sports were tracked from 2013/14-2018/19. Intervention(s): Athletic trainers collected concussive injury and recovery characteristics as part of the Ivy League-Big Ten Epidemiology of Concussion Study's surveillance system. Main Outcome Measure(s): Time to symptom resolution, return-to-academics, and return-to-limited and full athletic activity were collected. Survival analyses determined time from injury to each recovery outcome for males and females by sport. Peto tests compared recovery outcomes between males and female athletes and by sport. Results: The median time to symptom resolution overall was 9 days [IQR:4,18], return-to-academics was 8 days [IQR:3,15], return-to-limited activity was 12 days [IQR:8,23], and return-to-full activity was 16 days [IQR:10,29]. There were significant differences overall between sexes for median time to symptom resolution (males: 8 days [IQR:4,17], females: 9 days [IQR:5,20], p=0.029) and return-to-academics (males: 7 days [IQR:3,14], females: 9 days [IQR:4,17], p<.001), but not return to athletics (limited activity, p=0.107; full activity, p=0.578). Within-sport comparisons found that female lacrosse athletes had longer symptom resolution (p=0.030) and return to academics (p=0.035) compared to males, while male volleyball athletes took longer to return to limited (p=0.020) and full (p=0.049) athletic activity compared to females. Conclusion: There were significant differences in recovery timelines between sexes. Females experienced longer symptom duration and time to return-to-academics compared to male athletes, but females and males presented similar timelines for return-to-athletics.

Journey From Control to Liberation: Exploring Student-Athletes’ Physical Activity Perceptions and Experiences in the Transition Out of Collegiate Sport

There is growing interest in how athletes’ physical activity participation may be impacted when they transition out of competitive sport; however, few studies have examined the process of physical activity transitions in collegiate student-athletes using a qualitative approach. The purpose of our study was to explore student-athletes’ perceptions of, and experiences with, physical activity in the transition out of collegiate sport. Our analysis of transcripts from 13 focus groups conducted with current and former student-athletes (n = 59) suggests that student-athletes experienced a journey from control to liberation as they transitioned into their postcompetitive lives. In this exciting yet challenging transitional journey, participants were faced with navigating newfound autonomy over their physical activity outside of the controlled environment of collegiate sports and were considering the value and meaning of physical activity within a health promoting context. We offer practical recommendations from these findings to support student-athletes in this transition.

Hand and Wrist Injuries Among Collegiate Athletes: The Role of Sex and Competition on Injury Rates and Severity

Background: There is a high incidence of hand and wrist injuries in athletes participating in collegiate sports, but there is little information published characterizing them. Purpose: To characterize hand and wrist injuries in collegiate athletes using a large national database. Study Design: Descriptive epidemiology study. Methods: This retrospective cross-sectional analysis was designed using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program database to identify hand and wrist injuries (exclusive of any radial or ulnar fractures) in male and female collegiate athletes participating in NCAA Division I, II, and III sports from 2004 to 2015. Descriptive analyses were performed on stratified data to examine the associations between these injuries and sport, event type, and sex. Results: Men’s ice hockey (8.25 per 10,000 athlete-exposures [AEs]) and women's ice hockey (8.21 per 10,000 AEs) had the highest rate of hand and wrist injuries in all exposures. In every sport except women’s gymnastics ( P = .107), injuries were more commonly sustained during competition rather than during practice. Ligamentous injury to the phalynx was the most commonly sustained injury overall (1.416 per 10,000 AEs), and a metacarpal fracture was the most commonly sustained hand or wrist fracture (0.507 per 10,000 AEs). Injuries sustained during men’s wrestling (14.08 days) and women’s gymnastics (10.39 days) incurred the most time lost from sport. Surgery for hand and wrist injuries was most commonly required for men’s football (0.413 per 10,000 AEs) and women’s field hockey (0.404 per 10,000 AEs). Conclusion: Hand and wrist injuries were common among collegiate athletes. Male athletes experienced injuries with more frequency and severity. Injuries occurred more commonly during competition. While the majority of injuries were minor and did not require surgery, certain sports conferred a much higher risk of significant injuries requiring a surgical intervention.