High School Sports Injuries


As we enter into the next sports season, we are again noticing an uptick of young athletes here in our clinics at Ortho Rhode Island. We wanted to take the time to review an article that discusses injury rates, types of injuries and severity of injuries found in high school athletes.

This study is unique because it looks at a variety of different sports and injuries in a single study. Most studies that look at injury rates only examine one sport or one type of injury. The sports being examined in this study are boys football, soccer, basketball, wrestling and baseball as well as girls soccer, volleyball, basketball and softball.

The injury data for this study came from 100 nationally representative United States high schools. These 100 schools were randomly chosen from a much larger pool of schools and data was collected by each school's athletic trainers. The study used athlete-exposures to help determine injury rates. Athletic-exposure was defined as each time one athlete participated in either a practice or competition.

Injuries had to meet 3 criteria in order to be counted in the study:
(1) Occurred during and organized high school practice or competition
(2) Required medical attention by athletic trainer, physical therapist or Physician
(3) Resulted in restriction of athlete participation for one day or more beyond the day of injury

There were 4350 injuries reported in this study out of a total of 1,730,764 athletic exposures from all of the athletes. This resulted in an overall injury rate of 2.51 injuries per 1000 athletic exposures. For example, let’s say you are a soccer coach and have 30 kids on your team. Your team practices 5 days a week for 2 hours. You multiply 10 hours and the 30 kids to get 300 athletic exposures during practices for the week. After 4 weeks, your team has been exposed to 1,200 athletic exposures at practice and according to this study your team would likely sustain about 2-3 injuries.



The Chart above shows the injury rates for each of the sports included in the study. As you can see football had the highest injury rate. Next we’ll look at the most common site of injury, type of injury and severity of injury.



Site of Injury:

The lower limb was found to be the most common site of injury. Specifically the ankle which accounted for about 23% of all injuries recorded in the study. Boys and Girls soccer were the sports that had the most injuries to the lower limb. Injuries to the upper limb were the second most common site of injuries. It was found that baseball and wrestling athletes were most likely to suffer injuries to the upper limb. Head and neck injuries were the next most common site of injury and athletes that played softball and wrestling were most likely to sustain these injuries. And finally, injuries to the trunk were found to be the least common site of injury.

It’s interesting that trunk injuries were the least common site of injury given that lower back pain is one of the most common conditions that we encounter here in the clinic. However, it is important to remember that in order for an injury to be counted in this study, it had to occur during either practice or competition.

This data can be helpful when it comes to injury reduction. If you know that certain sports are more likely to sustain specific injuries then athletes and coaches can work in the off season or even mid season to help better prepare the athlete and hopefully avoid the injury to begin with.


Most Common Diagnosis:

The most common type of injury for high school athletes were sprain/strain injuries. Perhaps a simpler way to interpret that would be injuries to the soft tissue. A sprain is an injury to a ligament, which provides stability to joints. A strain is an injury to a muscle or tendon, which allows us to move our bodies. Sprains and strains were found to be the most common in volleyball and girls basketball. These injuries occurred more commonly in practice than in competition.

The second most common type of injury was found to be a contusion injury. These injuries occur with blunt force to an area and often result in bruising. This type of injury was most common in baseball and boys soccer and more likely to occur in competition than in practice.

The next most common type of injury is a concussion, which happens when you hit your head. More specifically the damage is done to the brain itself, not the skull. Concussions were the most common in girls soccer and girls basketball. Concussions were also found to be more common in competition than in practice.

Finally, fractures were the least common type of injury found in high school athletes. A fracture is when a bone breaks, there are a few different types of fractures. Fractures were the most common in softball and wrestling.


Injury Severity:

Injuries can be scary, and often when we first feel pain our minds imagine the worst possible outcome. It’s reassuring to see that the majority of injuries recorded in this study resulted in less than a week of missed practice/game time. Over 80% of all injuries recorded in this study resulted in less than 3 weeks of missed time. It’s never fun to be in pain and to miss practices or games, but when you do have injury you should let your coach know and be sure to listen to your doctor, athletic trainer and physical therapist.

Not all injuries are created equally. More severe injuries will take longer to heal resulting in longer periods of missed practices and games. Again, it is very important that the coach, doctor, athletic trainer and physical therapist are working together to manage these injuries and get the athlete back when they are ready and when it is safe.

Of all the injuries in the study, only about 5% of them required surgery. Injuries that happened in competition were more likely to require surgery than injuries that happened during practice. The authors of the study didn’t find one sport to have significantly higher surgical rates than other sports. In almost all cases, athletes that required surgery had to miss the rest of the season.



Injuries are an unfortunate part of playing sports. When an injury does happen, good communication between the athlete and coach is critical. Athletes often remain silent and try to play through their injuries which can lead to the injury lingering for longer than it has to. The majority of injuries result in less than a week of missed practice and game time, don’t let that week turn into months.

Some tips for athletes to help reduce injury rates include:
● Stay active in the off season. Don’t become a couch potato once the season is over. Injuries can happen if you go from no activity to all of a sudden practicing everyday
● Play more than one sport. Athletes that specialize early tend to be more prone to overuse injuries from playing the same sport year round. Multisport athletes will have a more diverse set of skills from playing a variety of sports.
● Get Strong. Strength training has been shown time and time again to help reduce the risk of injury. If possible, find a trainer or coach that can teach you how to move safely, especially if you don’t have a lot of experience.

A limitation of this study was that it was published in 2008. The information may be considered slightly outdated but it still gives a good idea of the types of injuries occurring in each sport. This study was chosen because it looked at several different sports and a variety of injuries. The participation of high school sports has continued to increase and it’s likely that the number of injuries would also increase, but not necessarily the rate of injury.

Rechel, J. A., Yard, E. E., & Comstock, R. D. (2008). An epidemiologic comparison of high school sports injuries sustained in practice and competition. Journal of Athletic Training, 43(2), 197–204.



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