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High School Football, Girls Basketball Have Most Severe Injuries: Study

Injured football player

Overall injury picture

Over 7 million students participate in high school athletics every years.  

Here's the big picture on high school sports injuries:

  • Four out of ten of all non-fatal, unintentional injuries among high school students treated in emergency rooms are sports-related.

  • High school athletes suffer an estimated two million injuries every year, resulting in 500,000 doctor visits and 30,000 hospitalizations.

  • Of these injuries, an estimated 446,715 (14.9%) are severe enough to result in the loss of 21 or more days of sports participation, with almost 6 in 10 (56.8%) resulting in medical disqualification for the remainder of the season.

Football still tops the danger list

Which high school sports actually pose the highest risk of severe injury? 

Not surprisingly, and consistent with previous studies, football had the highest severe injury rate (0.69 per 1,000 "athletic exposures"; 38.1% of all severe injuries), followed by wrestling (0.52), girls' basketball (0.34) and girls' soccer (0.33).

Other findings

Examining data from 100 nationally representative high schools on injuiries during the 2005 to 2007 school years, researchers at the Research Institute at Nationwide Children's Hospital's Center for Injury Research and Policy in Columbus, Ohio also found:

  • Among directly comparable sports (soccer, basketball, baseball/softball), the severe injury rate was higher for girls (0.29 per 1,000 exposures) than for boys (0.23), with virtually all of the difference resulting from a much higher severe injury for girls' basketball (0.34) versus boys' basketball (0.24);

  • Confirming previous data, the severe injury rate was more than three times higher in competition (0.79) than practice (0.24), both overall and in each of the nine sports studied (boy's football, boys' and girls' soccer, girls' volleyball, boys' and girls' basketball, boys' wrestling, boys' baseball, and girls' softball). The severe injury rate in football and girls' soccer was more than five times higher in competition than during practice;

  • The most common severely injured parts of the body were the knee (29.0%), ankle (12.3%) and shoulder (10.9);

  • The most common severe injury diagnoses were fractures (36.0%), complete ligament sprains (15.3%) and incomplete ligament sprains (14.3%);

  • One in twenty (5.3%) of severe injuries were directly related to an action that was ruled illegal activity by a referee, official, or disciplinary committee.

  • Girls' volleyball had the lowest severe injury rate (0.15 per 1,000 exposures).

Injury prevention: focus on football, wrestling

"Finding ways to decrease the incidence and severity of sports-related injuries is critical to keeping kids playing sports long-term and reaping the benefits that organized athletics provides, " said Dawn Comstock, PhD, a co-author of the study and assistant professor at the Center for Injury Research and Policy at The Research Institute at Nationwide Children's Hospital.

"Efforts to prevent or lessen the injury severity in football and wrestling are crucial," said the study authors, "because these sports accounted for a disproportionately large proportion of severe injuries."

"Preventing these types of severe injuries is especially important to minimize health care costs both on the family and on the health care system itself," said Comstock. "Future studies should focus on risk factors and developing prevention interventions."

Three gender trends

The study found three interesting gender trends:

  1. Boys suffer a significantly greater proportions of fractures than girls in soccer and basketball, which the study suggested might be due to differences in size, speed and strength of athletes, or intensity of play.  Because pediatric sports-related fractures are expensive to treat and associated with a majority of hospitalizations and ER visits due to injury, the study suggested improvements/additions to protective equipment or changes in rules/rules enforcement to minimize collision forces during play. 
  2. Girls suffered a greater proportion of severe knee injuries, as has been previously reported, with a large disparity between the percentage suffered in softball (30.7%) versus baseball (3.0%).
  3. Girls suffered a greater proportion of severe injuries from ligament sprains. The study's authors recommended further study of the effectiveness of special conditioning programs, bracing and rehabilitation in preventing severe knee injuries in girls.


Sources: Am. J. Sports Med 37, no. 9 (2009);1798-1805; AJSM press release


Created September 7, 2009