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Although the overall number of sports-related injuries is decreasing, the severity of those injuries and the number of head and neck injuries are on the rise, with more than 5 million sports injuries occurring nationally between 2015 and 2019, according to a study presented at the 2023 annual meeting of the American Academy of Orthopaedic Surgeons.

The study, Epidemiology of Sports Injuries Among High School Athletes in the U.S., marks the first time epidemiologic data on sports-related injuries have been updated since 2006.

“The overall injury rate decreased, which you would think is great, but you also have to look at the types of injuries that are happening,” said lead author Jordan Neoma Pizzarro, a medical student at George Washington University.

“We are seeing an increase in head and neck injuries, especially concussions, as well as more severe injuries and those requiring surgery. Many organizations have adopted safety equipment and injury prevention guidelines; it is questionable if they are being applied correctly.”

5 Million Injuries

Nearly 8 million high school students are involved in sports each year, with 57% of students playing at least 1 sport. Previous literature reviewing high school sports injury rates and severity featured small sample sizes, and few studies were done in the past 10 years.

For this study, the researchers utilized data from the National Health School Sports-Related Injury Surveillance Study, High School Reporting Information Online (RIO), for 2015 to 2019. The RIO database includes injury data from 100 nationally representative high schools.

Athletic trainers at the participating high schools report weekly athletic exposure and injuries for 5 boys’ sports – football, soccer, basketball, wrestling, and baseball – and 4 girls’ sports – soccer, basketball, volleyball, and softball. Athletic exposure (AE) is defined as 1 athlete participating in 1 practice or competition. Reportable injuries met the following criteria:

• Injury that occurred due to athletic participation in an organized high school sport practice or competition
• Injury that required medical attention by a physician or athletic trainer
• Injury that resulted in 1 or more days of restricted participation in the sport

Athletic trainers reported 15,531 injuries during 6,778,209 exposures at the 100 schools in the RIO database, for an overall injury rate of 2.29 per 1000 AEs. These data were weighed to reflect national estimates, showing that 5,228,791 injuries occurred nationally between 2015 and 2019.

Highest Injury Rates

The researchers also found that:

• Football had the highest rate of injury (3.96), followed by girls’ soccer (2.65) and boys’ wrestling (1.56). Football accounted for 44% of all injuries between 2015 and 2019. Boys’ baseball had the lowest injury rate (0.89).
• Boys’ sports had higher injury rates (2.52) than girls’ sports (1.56).
• More injuries occurred during competition than during practice, with football having the greatest risk of injury during competition (6.14) followed by girls’ soccer (4.84). Overall, boys’ sports had a higher relative rate of injury during competition (3.70) compared with girls’ sports (2.96).
• The head/face was the most commonly injured body site (24.2%), followed by the ankle (17.6%) and the knee (14.1%).
• The most common diagnoses were sprains/strains (36.8%) and concussions (21.6%).
• Of all injuries, 39.2% resulted in a time loss of less than 1 week, and 34% of those injured were out for 1 to 3 weeks. Only 7% of injuries resulted in athletes not being able to participate in their sport for more than 3 weeks.
• Overall, 20.9% of injuries led to medical disqualification for the season or the athlete’s career, the athlete being out for the season, or the athlete’s decision to no longer play the sport.
• Surgery was required for 6.3% of injuries, with wrestling (9.6%), girls’ basketball (7.6%) and boys’ baseball (7.4%) having the highest surgery rates.

Contact, Collisions, Concussions

“It was important that we update the current sports injury data to help us gain a better understanding of injury rates, injury diagnoses, and injury severity so [that] proper prevention strategies can be implemented,” said Nima Mehran, MD, FAAOS, Los Angeles-based orthopaedic surgeon and sports medicine specialist.

“We need to take a hard look at current prevention programs and find ways to improve them.”

Compared with previous data, this study showed a nearly 10% increase in injuries affecting the head and neck. Additional studies have demonstrated an increase in the number of concussions during high school sports over the past decade.

Together, this suggests that play intensity, physical contact, and collisions are increasing, potentially counteracting the use of protective head gear. However, the increased awareness and understanding of the signs and symptoms of concussions may play a role.

“As more high school athletes get involved in sports, we must recognize that a change needs to be made not only to prevent these injuries, but to lower the associated impact of the patient’s physical health, overall health care costs for families and the health care burden for hospitals,” Pizzaro added.