The Epidemiology of Overuse Conditions in Youth Football and High School Football Players

The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review

Background

Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies.

Methods

All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included.

Results

Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect.

Conclusions

Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.

Epidemiology of youth and high school American football-related injuries presenting to United States emergency departments: 2010-2019

OBJECTIVES

American football is one of the most popular sports in the United States (US) among youth and high school athletes; however, participation is decreasing due to concerns about safety. This has led to many new safety initiatives over the last decade, but few studies have sought to evaluate if these interventions have made football safer. The purpose of this study is to investigate national-level data on football-related injuries to compare the injury characteristics and specific injury risks of high school and youth athletes over the last decade.

METHODS

This cross-sectional, retrospective study queried the National Electronic Injury Surveillance System (NEISS) database from 2010-2019 to compare national weighted estimates and injury characteristics of youth (ages 6-12) and high school (ages 14-18) athletes presenting to US emergency departments (EDs) with football-associated injuries.

RESULTS

The overall injury risk of football-related injuries presenting to US EDs for high school athletes was 16.17 (C.I. 13.85-18.38) per 1,000 participants/year compared to 11.97 (C.I. 10.34-13.41) per 1,000 participants/year in youth athletes. From 2010 to 2019, the overall injury risk for youth athletes participating in football significantly (p < 0.0001) decreased from 13.31 (C.I. 11.23-15.38) per 1,000 participants to 9.93 (C.I. 7.24-12.62) per 1,000 participants. Additionally, the overall injury risk for high school athletes participating in football significantly (p < 0.0001) decreased from 2010 (N = 18.63 [C.I. 16.05-21.21] per 1,000 participants) to 2018 (N = 13.19 [C.I. 9.94-16.44] per 1,000 participants). High school athletes were almost twice as likely and 2.37 times more likely to present with knee and shoulder injuries compared to youth athletes per 1,000 participants/year.

CONCLUSION

Our study provides evidence that the overall injury risk for both youth and high school football players has significantly decreased since 2010. Furthermore, our study demonstrates that these athletes sustain unique injury characteristics.

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

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.