Sports Medicine Research: In the Lab & In the Field: Timing is Everything & Fatigue is Inevitable (Sports Med Res)


Wednesday, March 1, 2017

Timing is Everything & Fatigue is Inevitable

Timing of Lower Extremity Injuries in Competition and Practice in High School Sports.

Nagle K, Johnson B, Brou L, Landman T, Sochanska A, Comstock RD. Sports Health. 2017; ahead of print.

Take Home Message: Athletes suffered more lower extremity injuries towards the middle to end of the competition and practices, which suggest that fatigue may play a role in lower extremity injury risk.

Fatigue is associated with increased injury risk, especially in regards to the lower extremity. However, no one has verified that injuries occur more often during certain times during sports events. Therefore, the authors used data from the National High School Reporting Information Online sports injury surveillance system across 8 different school populations and regions (a total of 100 randomly selected schools) from 2005-2006 through 2013-2014 to describe the timing of lower extremity injuries within games and practices across 9 sports (boys’ and girls’ basketball, boys’ and girls’ lacrosse, boys’ and girls’ soccer, football, boys’ ice hockey, girls’ field hockey). Over the 9 seasons the athletes sustained 19,676 total lower extremity injuries during 16,967,702 athletic exposures, resulting in a rate of 11.6 lower extremity injuries per 10,000 athletic exposures. Overall, football athletes sustained the highest lower extremity injury rate (15.2 per 10,000 athletic exposures) followed by girls’ soccer (13.9), and girls’ basketball (10.3). Boys’ ice hockey suffered the smallest lower extremity injury rate (4.8), followed by girls’ field hockey (7.7), and boys’ and girls’ lacrosse (7.8). Sprains, strains, and contusions were the most frequently reported diagnoses of injury. In each sport the lower extremity injury rate was higher in competition compared with practice. During practices, the majority of injuries occurred over an hour into practice in all sports. In sports played in halves more than half of the injuries (55-66%) occurred in the second half. In sports played in quarters more injuries were sustained in the second (31-32%) or third quarters (30-53%). Boys’ hockey was the only sports divided into 3 periods and 44% of the injuries were suffered during the second period. Boys’ soccer and football athletes suffered a greater percentage of severe injuries (injuries resulting >3 weeks of time loss) during the early portion of the game (first quarter, half).

The authors successfully described the timing of lower extremity injuries. High school athletes sustained most injuries during competition, specifically, during the middle to end of the game. This suggests that fatigue may play a role in lower extremity injury risk. Though, due to the lack of real playing time of the injured athletes the authors are unable to draw a firm conclusion about the association between fatigue and lower extremity injury rate. Despite the trend for more lower extremity injuries later in games, more severe injuries occurred during the beginning of a game. This may be attributed to more energy equating to higher intensity of play, which could lead to more severe injuries. During practice many of the injuries occurred over an hour into the practice. This pattern is expected since most high school practices begins with low intensity, non-contact drills and end with game like situations or scrimmages. It should be noted that an overall lower extremity injury rate of 11.6 per 10,000 exposures is high, and identifying patterns such as timing of injuries will help medical professionals create prevention programs as well as provide parents, coaches and athletes with advice about how to curate the practices to alleviate some of the injuries that athletes experience due to fatigue.

Question for Discussion: Have you observed a similar pattern with your athletes? What suggestions do you provide athletes and coaches to decrease risk of injury due to fatigue?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:
External Rotation Fatigue and the Scapula. What’s the Relationship?

Nagle K, Johnson B, Brou L, Landman T, Sochanska A, & Comstock RD (2017). Timing of Lower Extremity Injuries in Competition and Practice in High School Sports. Sports health PMID: 28146414


Haley said...

I thought this article provided some good information. I think in an effort to prevent these injuries from occuring due to fatigue, athletes need to be training at higher intensities for shorter amounts of time so they are exposed to the same stimulant that they would be in a game. During two hour practices, athletes aren't able to go 100% for the entire practice so by shortening the practice time, it may increase the likelihood for athletes to practice like they play.
I wouldn't say that I can actually see this trend of injuries towards ends of games and practices when athletes are fatigued by observation but I think exposing athletes to more game-like scenarios would reduce injuries caused by fatigue.

Jane McDevitt said...


I think you bring up a great point on how we should we be talking with coaches about practices. Maybe some practices need to be short and game like and others can be longer but work on technique and finesse. I think if trends like this continue to pop up in the research we will need to change something in regards to practice to help prevent injuries while still elevating athlete's performance.

Tyler Keith said...

I think this article raises some interesting points. One thought that specifically came to my mind, would be to similarly look at the timing of injuries as done here, but also look to see what percentage of these injuries are contact and what percentage of these injuries are non-contact. I agree that more severe injuries appear to happen earlier due to higher intensity levels which one can assume is associated with minimal fatigue early on, but I think the idea of contact/non-contact is important to. From my experience, sports that are "contact sports" such as football, hockey, and even soccer, the amount of contact between players typically rises as the game progresses, leading to increased possibility of contact injuries. This may be due to competitiveness or even hostility between teams, but I do think this (in combination with fatigue) play a role in why injuries tend to add up later in games.

Beyond the idea of fatigue leading to increased injury risk during competitions, coaches must adapt their practice schedules, and even game plans to potentially address this issue. From my experience at the high school level, some coaches are not willing to provide their athletes lighter practices the day before a game or even between games, thus decreasing the athletes overall recovery, and maybe even leading them to a fatigue-based injury. These "overtraining" practice regiments need to be addressed going forward.

Jeffrey Driban said...

Tyler, great points. I agree that some of the late game injuries, esp contact injuries, may be attributable to aggressiveness. I'm sure we can all recall close games where the players get a bit more aggressive or frustrated.

It's also a great point that we need to be more proactive about discussing these types of findings with our coaches to help them understand the benefits of modifying their practices/schedules.

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