Jan 29, 2015
Injury Rates for Practice Vs. Competition

By Dawn Comstock

Contributor Dawn Comstock, PhD, Principle Investigator at The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital, compares rates and trends for injuries sustained during competition versus those that occur at practice.

Over seven million high school athletes compete in interscholastic sports every year, with millions more participating in recreational and community leagues. Sports play a key role in the successful development of students, specifically being linked to higher grade point averages, fewer school absences, and better behavior. Of course, injuries can and do occur. Fortunately, researchers and sports professionals are working hard from all angles to decrease these occurrences and keep athletes where they belong–on the field.

Sports injury studies often take an in-depth look at the injury profiles and risk factors leading to injury in one specific sport or for one specific type of injury. However, sometimes it can be refreshing to take a step back and see the big picture. The National High School Sports-Related Injury Surveillance Study, the largest, most comprehensive database of high school sports injuries collected this decade, is a great source of such information.

So how do injury rates compare between sports? As reported in a recent publication by the Journal of Athletic Training (1), this depends on whether you look at practice or competition. In practice, injuries occur most frequently in football. On average, one football injury is sustained in every 400 exposures. In other words, a team with 40 players sees about one injury in every 10 practices. Wrestling and boys’ soccer follow football with the next highest practice injury rates, with injuries in one out of every 500 and 650 exposures, respectively. In competition, injuries also occur most frequently in football (on average, one football injury is sustained for every 85 practices), followed by girls’ and boys’ soccer (on average, one injury is sustained for every 200 and 240 exposures, respectively).

Although injury rates are usually about 2.7 times higher in competition compared to practice, competition and practice usually account for equal numbers of injuries. This is because athletes usually spend much more time in practice compared to competition. The National High School Sports-Related Injury Surveillance Study tracks nine of the most popular sports (boys’ football, soccer, basketball, baseball, and wrestling and girls’ soccer, basketball, softball, and volleyball). In these nine sports, an estimated 683,199 injuries were sustained in practice and an estimated 759,334 injuries were sustained in competition during the 2005-06 school year, for a total of 1.4 million injuries.

So what is the big picture? Here is a brief overview:

Most commonly injured body regions: • Lower extremities: 57 percent • Upper extremities: 22 percent • Head/face/neck: 15 percent • Trunk: seven percent

Most common injury diagnoses: • Sprains/strains: 52 percent • Contusions: 12 percent • Fractures: 10 percent • Concussions: nine percent

Time loss: • Less than one week: 53 percent • 1-3 weeks: 30 percent • More than three weeks: 17 percent Major differences between injuries sustained during practice and competition:

• Compared to practice injuries, competition injuries were twice as likely to be concussions. This relationship was particularly strong in boys’ soccer and girls’ basketball, where competition injuries were six to seven times more likely to be concussions.

• Compared to practice injuries, competition injuries were 30 percent more likely to result in the athlete missing three or more weeks of participation. This relationship was particularly strong in baseball, where competition injuries were 3.5 times more likely to require the athlete to miss three or more weeks of play.

• Compared to competition injuries, practice injuries were 20 percent more likely to be sprains/strains. This relationship was particularly strong in boys’ and girls’ soccer, where practice injuries were 40 to 65 percent more likely to be sprains/strains.

What can we learn from this information?

• Efforts should be made to decrease the rate and severity of competition injuries. One solution is to incorporate drills of potentially high-risk situations into controlled practice conditions. For example, in football the incidence and severity of tackle-related injuries may be reduced if coaches emphasize the development of tackling skills in practice through a progression of closely supervised drills (i.e., from tackling stationary dummies, to partial speed drills, to tackling teammates at full speed).

• Sprains/strains and lower extremity injuries were most common across all sports in practice and competition, indicating that attention paid to these areas may have the biggest impact in reducing injury. Previous research has shown that sprains/strains and lower extremity injuries may be reduced by preseason neuromuscular training, increased vigilance during preseason conditioning, or better field conditions.

• As always, coaches should continue to stress the diligent use of appropriate protective equipment in both practice and competition. 1) Rechel J, Yard EE, Comstock RD. An Epidemiologic Comparison of High School Sports Injuries Sustained in Practice and Competition. Journal of Athletic Training. 2008;43(2):197-204.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at [email protected].

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