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.

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).

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?

Jane McDevitt, PhD
by: Jeff Driban


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