"PLAY-BY-PLAY" Sport Specific Results and Recommendations
NATIONAL COLLEGIATE ATHLETIC ASSOCIATION (NCAA)
COLLEGIATE ATHLETIC INJURIES – TRENDS AND PREVENTION REPORT
16-Year Review of NCAA Injury Surveillance System (ISS) Data
The National Athletic Trainers’ Association (NATA) and National Collegiate Athletic Association (NCAA) have collaborated for 25 years to create the largest ongoing collegiate sports injury database in the world. In a special spring issue of the Journal of Athletic Training, the quarterly scientific publication of NATA, the study’s lead authors and journal editors summarized 16 years (1988-1989 through 2003-2004) of critical injury surveillance information across 15 collegiate sports. This comprehensive information, collected by certified athletic trainers, has and will continue to shape key health and sports safety issues and further injury prevention research designed to improve athletic programs and the quality of the student athlete care.
Highlighted below are sport-specific results from the data and key recommendations in the report to reduce the risk of injury. Consistent findings were that competition injury rates were higher than practice injury rates across all sports; that preseason practice injury rates were higher that regular season practice injury rates. Overall collegiate sports participation has increased 80 percent among women and 20 percent among men during this time. Nationally, more than 380,000 student-athletes participate in NCAA sports that offer national championships. Participation rates below reflect varsity team increases or decreases during the 16-year period. Note: Data collection for women’s ice hockey began in 2000-2001.
Disclaimer: The recommendations associated with the report summaries are those of the invited authors and do no necessarily represent the views of the National Athletic Trainers’ Association, National Collegiate Athletic Association or the Centers for Disease Control and Prevention.
Main results: College baseball has a relatively low rate of injury compared with other NCAA sports, but 25 percent are serious or severe and result in 10+ days of time loss from participation. A total of 10 percent of all game injuries occurred from an impact with a batted ball; sliding was involved in 13 percent of injuries. Recommendations: Proper preseason conditioning is important to reduce injuries. Further study of batted-ball injuries is warranted and use of break-away bases to prevent sliding injuries should be supported. Participation: Increased 39 percent.
Main results: Approximately 60 percent of all injuries were to the lower extremity, with ankle sprains being the most common injury overall and knee injuries being the most common causing athletes to miss more than 10 days of participation. A trend of increasing incidence of injuries to the head and face was noted over the 16-year span which may be related to an increase in physical contact in the game. Recommendations: Taping, bracing and neuromuscular training may help to prevent common injuries from the sport, though basketball-specific research on these interventions are lacking. The increase in head and facial injuries may indicate that officials need to investigate the current rules regarding player contact and potential new rules to decrease crowding in the lane. Participation: Increased 30 percent.
Main results: Game injury rates decreased 1.8 percent and practice rates decreased 1.3 percent over the study period. More than 60 percent of all game and practice injuries were to the lower extremity including many non-contact ACL and ankle injuries. Almost one quarter of all injuries were ankles sprains alone, and concussions accounted for approximately five percent of injuries. Recommendations: Evidence-based taping/bracing and neuromuscular conditioning programs may help reduce the incidence of lower extremity injuries in basketball. Future research should investigate mechanisms and risk factors for concussions in women’s basketball. Participation: Increased 34 percent.
Women’s Field Hockey
Main results: Game injury rates showed an annual 2.5 percent decline over 15 years, most likely fueled by drops in ankle, knee and finger injuries. Ankle sprains and hand injuries were common and a frequent cause of severe injuries while concussion and head laceration injuries seemed to be on the increase. Recommendations: Equipment (requiring helmets and padded gloves) and rule changes (to decrease congestion near goals) as well as evidence-based injury prevention interventions (taping, bracing, neuromuscular training) may be viable preventive measures for reducing injury rates. Participation: Increased 12 percent.
Main results: Competition injury rates decreased four percent over the study period. A total of sixty-nine percent of all competition and 53 percent of all practice injuries were to the lower extremity; of particular concern are the number of knee ligament and cartilage injuries and ankle sprains. The majority of competition injuries (70 percent) resulted from either landings in floor exercises or dismounts on other apparatus. Recommendations: Gymnasts with a history of ankle sprains should wear either ankle braces or use prophylactic tape to decrease risk of re-injury. Preventive efforts may incorporate neuromuscular training and core stability programs in the off-season and preseason to enhance landing and skill mechanics. Equipment manufacturers should re-evaluate the design of landing mats and other equipment to allow for better absorption of forces. Participation: Decreased 23 percent.
Main results: Spring practice injury rates declined 1.1 percent. Game injury rates were more than
nine times higher than in-season practice injury rates, and spring practice injury rates were more than two times higher than the regular season practice injury rate. Football had the highest game injury rate of all sports (36 injuries per 1,000 athlete-exposures) due to the collision aspects of the game. Due to the large numbers of participants, football had the largest absolute number of knee ligament and ankle sprain injuries.
Recommendations: Lower extremity injury prevention initiatives (neuromuscular balance training, bracing/taping, etc.), official attention to rule enforcement, and research into improvement of protective equipment are potential areas that may contribute to injury reduction. Participation: Increased by 18 percent.
Men’s Ice Hockey
Main results: A significant average annual increase of 1.3 percent in game injury rates occurred, but practice rates stayed static. The majority of game and practice injuries occurred to the lower extremity. Knee injuries were most commonly reported during games, whereas pelvis and hip muscle strains were most common during practices. Shoulder sprains were also common. Player-to-player contact was the most frequent mechanism of injury (50 percent of the time) in games. Recommendations: Investigating the utility of limiting player-to-player contact in the neutral zone and at the top of the offensive and defensive zones, research into improvement of protective equipment (helmets, shoulder pads, etc.) and groin muscle-specific conditioning programs are areas to target for injury prevention. Clinicians and researchers should identify risk factors and interventions for muscle strains at the pelvis and hip region. Participation: Increased six percent.
Women’s Ice Hockey
Main Results: Over the four years of the study (2000-2004), the rate of injury in games was more than five times higher than the injury rate in practices. Preseason injury rates were almost twice as high as in-season practice rates. Concussions were the most common injury in both games (21.6 percent) and practices (13.2 percent). The rate of concussions in games appeared to be trending upward over the study period although these data should be treated with caution due to the small number of years covered. The greatest number of game injuries (47 percent) resulted from player contact, whereas practice injuries were from either contact with another object or noncontact mechanisms. Recommendations: Though women’s ice hockey does not allow for formal body checking, approximately 50 percent of all game injuries were reported resulted from contact with another player. Future researchers need to evaluate the effectiveness of the no-checking rule. Attention should be paid to mechanism-of-injury issues, and to encourage more schools to report. The authors anticipate that the hypothesized inconsistencies in skill level across and within the women’s teams will also be reduced as more consistently skilled players develop. Participation over four years: Increased 10 percent.
Main results: Approximately half of all game (48.1 percent) and practice injuries (58.7 percent) were to the lower extremity, followed by upper extremity (26.2 in games, 16.9 percent in practices), and the head and neck (11.7 percent in games, 6.2 percent in practices). Changes in helmet design and improved reporting may account for the rise in concussion rates since the 1995/1996 season. Recommendations: Research into the mechanism of head injuries and the implications of design changes to protective helmets, as well as further investigation into best designs for shoulder and chest protection is needed. Participation: Increased by 41 percent.
Main results: Game injuries increased 2.4 percent over the 16 years. More than 60 percent of all severe game injuries were lower extremity sprains and strains to the knee, most frequently the result of non-contact situations. Contact from a stick accounted for 56 percent of above neck injuries in games; contact from the ball accounted for 20 percent of those injuries. Participants had five times the risk of sustaining a concussion in a game as in a practice.
Recommendations: To reduce lower extremity injuries, future research should evaluate proprioceptive, plyometric and balance training interventions designed for female lacrosse players. Other areas of interest include determining whether protective eyewear policy changes reduced injury to the eye, orbit and nasal area and identifying any unintended consequences of the mandate, such as increased risk of injuries to other areas of the face or more aggressive play. Participation: Increased 119 percent.
Men’s Soccer Injuries
Main results: In both games and practices, more than two-thirds of men’s soccer injuries occurred to the lower extremities, with a particularly high proportion of all injuries being ankle sprains (17 percent). Player to player contact was the primary cause of injury during games; though most practice injuries occurred without direct contact to the injured body part. Recommendations: Preventive efforts should focus on player-to-player contact that often leads to lower extremity injuries and greater enforcement of rules that are in place to limit their frequency and severity. Emphasis should also be put on addressing high rate of first time and recurrent ankle sprains with neuromuscular exercise and taping and bracing. Participation: Increased 35 percent.
Women’s Soccer Injuries
Main results: Approximately 70 percent of all game and practice injuries affected the lower extremities. Ankle sprains accounted for 16 percent of all injuries. Player-to-player contact accounted for more than half of all game injuries (54 percent) but less than 20 percent of all practice injuries. Recommendations: The specific nature of the player contact leading to concussions and lower-extremity injuries should be investigated. Preventive efforts should continue to focus on reducing knee and ankle injuries with neuromuscular exercise and/or taping/bracing and concussions. Participation: Increased 226 percent.
Women’s Softball Injuries
Main results: Over 40 percent of all injuries were to the lower extremity, and a total of 71 percent of game injuries resulted from contact mechanisms. Fifty-five percent of practice injuries resulted from non-contact mechanisms. In games, ankle and knee injuries accounted for 19 percent of injuries. Twenty-three percent of all game injuries were due to sliding, most of which were ankle sprains. Most injuries occurred during base running and batting (42 percent). Recommendations: Preventive efforts should focus on sliding technique regardless of skill level, potential equipment changes (i.e. breakaway bases), neuromuscular training programs, position-specific throwing programs, and mechanisms of low back injury. Further research is needed on these efforts as well as the area of windmill-pitching biomechanics. Participation: Increased 65 percent.
Women’s Volleyball Injuries
Main results: The lower extremity accounted for more than 55 percent of all game and practice
injuries, with ankle sprains representing 44.1 percent of game injuries and 29.4 percent of practice injuries. Approximately 21 percent of all game injuries involved the upper extremity. The majority of injures during a game situation occurred while the athletes were in one of three front positions. A player landing on another player and contact with the floor each accounted for 21 percent of game injuries. Recommendations: Ankle and knee injuries appear to be the most common injuries in women’s volleyball. Future preventive efforts should focus on preventing first-time ankle sprains and acute traumatic knee injuries as well as reducing the risk of ankle sprain recurrence. Participation: Increased 36 percent.
Men’s Wrestling Injuries
Main results: Patterns of injury were consistent with the person-to-person, combative contact between wrestlers. Knee injuries, concussions and skin infections are a continuing concern in wrestling. Most musculoskeletal injuries occurred during takedown maneuvers. The impact of changes in weight management policies need to be evaluated in terms of injury reduction. Recommendations: Expansion of the ISS to include indirect causes of injury, such as weight loss practices, would strengthen the analysis of data. Efforts by referees to be vigilant for potentially dangerous holds and by athletic trainers to improve wrestler and mat hygiene should be continued. Participation: Decreased 23 percent.
Results of the surveillance information were based on a sampling of NCAA Division I, II and III schools representing approximately 15 percent of schools sponsoring the above sports. Data collection for women’s ice hockey began in 2000-2001. In 2004 the ISS converted to a Web-based interface program, which reflects the continued commitment to this project while providing a real-time electronic athletic-training facility record for each institution that simultaneously contributes to the aggregate national database.
For more information, please visit www.nata.org/collegiate-athletic-injuries-trends-prevention and http://www2.ncaa.org/portal/media_and_events/press_room/.
About the National Athletic Trainers’ Association (NATA):
Athletic trainers are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. The National Athletic Trainers' Association represents and supports 30,000 members of the athletic training profession through education and research. NATA advocates for equal access to athletic trainers for athletes and patients of all ages, and supports H.R. 1846. www.nata.org. NATA, 2952 Stemmons Freeway, Ste. 200, Dallas, TX 75247, 214.637.6282; 214.637.2206 (fax).
About the National Collegiate Athletic Association (NCAA)
The NCAA is a membership-led nonprofit association of colleges and universities committed to supporting academic and athletic opportunities for more than 380,000 student-athletes at more than 1,000 member colleges and universities. Each year, more than 49,000 student-athletes compete in NCAA Championships in Division I, II and III sports. For more information, go to www.ncaa.org.