National Collegiate Athletic Association Injury Surveillance Program Research Articles

Descriptive Epidemiology of Injuries Sustained in National Collegiate Athletic Association Men’s and Women’s Lacrosse, 2004–2005 Through 2013–2014 Seasons

Background: Men’s and women’s lacrosse operate with significantly different rules, equipment, and contact. Previous studies have assessed injury rates (IRs) in either men’s or women’s lacrosse, but a few studies have compared injury patterns in the National Collegiate Athletic Association (NCAA) men’s and women’s lacrosse. Purpose: We sought to examine whether there were differences in injury type, mechanism, setting, and time loss in men and women playing lacrosse in the NCAA. Methods: We performed a retrospective case-control study using data collected by the NCAA Injury Surveillance Program (ISP) during a 10-season period (2004–2005 to 2013–2014). The data were assessed for potential differences in injuries between male and female lacrosse players and analyzed to obtain descriptive statistics through calculations of rates, percentages, and confidence intervals (CIs). Main outcomes measured were IRs per 1000 athletic exposures (AEs) and injury rate ratios (IRRs) with 95% CIs. Results: The IRs were 5.19 per 1000 AEs in women’s lacrosse and 6.52 per 1000 AEs in men’s lacrosse. Men had more injuries overall than women in competitions and practices and in preseason, regular season, and postseason play. Preseason IRs were higher than the regular season, and competition injuries were greater than practice injuries in both sexes. Women had more injuries to the head/face, knee, lower leg, and foot. Sprains, strains, concussions, and contusions were the most common types of injuries in both sexes. Overuse/gradual onset, cartilage, concussion, inflammation, and tendinosis injuries were more common in women than men. Injuries in men resulted in time loss more often than injuries in women. Conclusions: Our retrospective study’s findings suggest that there were differences in injury patterns between men’s and women’s lacrosse. Future prospective research should assess whether these disparities are due to differences in equipment and rules and whether changes to these factors can reduce injuries.

Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non–time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

Background: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. Purpose: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. Study Design: Descriptive epidemiology study. Methods: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non–time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. Results: A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men’s basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men’s (43.2%) and women’s sports (35.1%), although injuries were more prevalently attributed to player contact in men’s than in women’s sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. Conclusions: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men’s and women’s sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

Epidemiology Of Anterior Cruciate Ligament Injuries In National Collegiate Athletic Association Athletes: 2014/15 - 2018/19

PURPOSE: Approximately half of all anterior cruiciate ligament (ACL) injuries occur in young, athletic populations, including collegiate athletes. Following ACL injury, there is a heightened risk of secondary ACL injury and post-traumatic osteoarthritis, highlighting the detrimental nature of early life knee injury. Therefore, the purpose of this study was to describe the epidemiology of ACL injury in National Collegiate Athletic Association (NCAA) athletes. METHODS: ACL injuries reported by athletic trainers to the NCAA Injury Surveillance Program during 2014/15 - 2018/19 in 23 NCAA men’s and women’s sports were examined. Injury incidence (characterized as Injury Rate (IR) per 10,000 athlete exposures (AEs)) was examined both pooled and stratified by event type (practices/competitions). The distribution of ACL injuries was examined by injury mechanism (player contact/non-contact/other) using frequencies (%s). Differential injury incidence was examined across event types and sex (for sex-comparable sports) using Injury Rate Ratios (IRR); IRRs with 95% Confidence Intervals (CI) excluding 1.00 were considered statistically significant. RESULTS: A total of 729 ACL injuries were reported, resulting in IRs of 0.80/10,000 AEs and 0.95/10,000 AEs in men’s and women’s sports, respectively. ACL injury rates were most commonly reported in men’s football (N = 267, IR = 1.44) and women’s soccer (N = 118, IR = 2.60). Amongst all sports, competition related ACL rates were higher in men’s (IR = 2.37) and women’s sports (IR = 2.59) than practice related rates (IRs: men’s = 0.43, women’s = 0.48). Practice injury rates remained stable across the study period, while competition rates fluctuated. Injuries were more prevalently attributed to player contact in men’s sports (39.7%) than in women’s sports (22.9%). CONCLUSIONS: In most sex-comparable sports, overall ACL rates were higher in women’s sports compared to men’s sports in NCAA athletes from 2014/15 - 2018/19. Injury rates were greater in competition compared to practice in both men’s and women’s sports. This corroborates previous literature detailing higher ACL injury rates during competition and in females. Future research should evaluate the translation between injury reduction programming during practice to competition-related ACL injury programming.

The Epidemiology Of Fractures In Ncaa Women’S Sports: 2009/10-2018/19

PURPOSE: Sport-related fracture is a concern among National Collegiate Athletic Association (NCAA) athletes, and previous research has shown higher rates of certain fractures in NCAA women’s sports than men’s sports. Yet, few studies have examined the relative burden of fractures across women’s sports. We described the epidemiology of sport-related fractures across women’s NCAA sports. METHODS: Sport-related fractures reported to the NCAA Injury Surveillance Program by athletic trainers during 2009/10-2018/19 in 12 women’s sports were analyzed. Injury incidence (rates per 10,000 athlete exposures (AEs)) was examined overall and by event type (practices/competitions). Specific fracture diagnoses and the distribution of fractures by injury mechanism (player-, non-contact, other) and injury history (new/recurrent) were examined using frequencies (%s). Time loss (TL; ≥1 day) following fractures was characterized using means (±SD). Differential injury incidence was examined across event types using Injury Rate Ratios (IRR); IRRs with 95% Confidence Intervals (CI) excluding 1.00 were considered statistically significant. RESULTS: A total of 944 sport-related fractures were reported during the study period (Rate = 2.0/10,000AEs), and fracture rates were highest in gymnastics (5.7/10,000AEs), and cross country (3.7/10,000AEs). The competition injury rate was higher than the practice rate (IRR = 2.1; 95%CI = 1.9, 2.4). The foot (24.1%) and hand/wrist (23.9%) accounted for the largest proportions of fractured body parts; phalangeal fractures (10.3%), nasal fractures (9.4%), and tibial stress fractures (9.2%) were the most common fractures. Fractures were most prevalently attributed to overuse (28.6%) and apparatus contact (22.3%) mechanisms; most player contact fractures were reported in soccer (38.5%) and basketball (35.8%). TL fractures accounted for 42.3% of all reported fractures (TL was not reported in ~36% of fractures) and average TL following fractures was ~36.7 days (SD = 39.4). CONCLUSIONS: Fracture incidence in women’s gymnastics warrants particular attention. The prevalence of nasal fractures is also noteworthy. Given the interest in female athlete bone health, the dynamics of overuse/gradual onset fractures in women’s sports also may be targets for focused research.

Patterns and predictors of concussion symptom presentations in NCAA athletes

ABSTRACT Sport-related concussion (SRC) is a complex injury, and SRCs are notably prevalent among National Collegiate Athletic Association (NCAA) athletes. We analysed SRCs and associated exposure data collected within the NCAA Injury Surveillance Program during 2014–2019. A total of 1,709 SRCs were reported with complete symptom profiles during the study period (Women’s sports n = 499; Men’s sports n = 1,210). Event type and academic class year most commonly predicted specific symptom presentations among athletes in men’s sports, while symptom presentation among athletes in women’s sports was most commonly predicted by class year and sport classification. We observed 78 and 69 significant pairwise symptom dependencies in men’s and women’s sports athletes, respectively; odds of longer symptom resolution time were higher with greater counts of symptoms with strongest cross-domain associations. Our findings highlight several contextual predictors of specific symptom presentations and identify parsimonious symptom subsets that may indicate protracted recovery among men’s and women’s sports athletes.

In National Collegiate Athletic Association Men’s and Women’s Soccer Athletes There Is a Low Rate of Lumbar Spine Injury, Women Suffer More Recurrent Injuries than Men, and Most Injuries Occur in the Preseason

PurposeTo use the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) from the 2009-2010 through the 2014-2015 seasons to report lumbar spine injury rates, characteristics, and time lost from sport in soccer players.MethodsCharacteristics of lumbar spine injuries by season, competition/practice, and time lost from sport were determined using the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the number of athlete exposures (AEs). AEs are any athlete participation in a competition or practice. Incidence rate ratios (IRRs) were calculated to compare rates between event types and time of season. Injury proportion ratios (IPRs) were used to evaluate differences in injury rates between men and women.ResultsThe NCAA-ISP estimated 4,464 LSIs over 5 years. The rate of LSI in men was 2.1/10,000 AEs and 3.0/10,000 AEs in women. Women were 1.43 times more likely to suffer an LSI compared to men. Women were 2.15 times as likely to suffer an LSI in competition compared to in practice while men were 1.10 times as likely. Women were 2.15 times as likely to be injured in the preseason compared to the regular season, while men were 3.76 times as likely. Non-contact injuries were the most common cause of lumbar spine injuries (LSIs) in men (35%); however, contact injuries were more common in women (33%). Most athletes both male (57%) and female (59%) returned to play within 24 hours.ConclusionThis study provides information on the characteristics of LSIs in NCAA soccer. The overall injury rate to the lumbar spine is relatively low. Injury rates are highest in the preseason and in competition. Women suffer from more recurrent LSI’s than men, and men acquired more injuries through non-contact mechanisms. More than one-half of athletes returned to sport within 24 hours.

Epidemiology of NCAA Track and Field Injuries From 2010 to 2014.

Background:Track and field (T&F) athletes compete in a variety of events that require different skills and training characteristics. Descriptive epidemiology studies often fail to describe event-specific injury patterns.Purpose:To describe the epidemiology of injuries in National Collegiate Athletic Association (NCAA) T&F by sex, setting (practice vs competition), and time of season (indoor vs outdoor) and to compare injury patterns by events within the sport.Study Design:Descriptive epidemiology study.Methods:Data were obtained from the NCAA Injury Surveillance Program for all indoor and outdoor T&F injuries during the academic years 2009-2010 to 2013-2014. Injury rates, injury rate ratios, and injury proportion ratios (IPRs) were reported and compared by sex, injury setting, season, and event. Analysis included time-loss as well as no-time loss injuries.Results:Over the 5 seasons, the overall injury rate was 3.99 injuries per 1000 athletic-exposures (95% CI, 3.79-4.20). After controlling for injury diagnoses, women’s T&F athletes experienced an 18% higher risk of injury (95% CI, 7% to 31%) and missed 41% more time after an injury (95% CI, 4% to 93%) when compared with men. Among all athletes, the injury risk during competition was 71% higher (95% CI, 50% to 95%) compared with practice and required 59% more time loss (95% CI, 7% to 135%). Distance running accounted for a significantly higher proportion of overuse injuries (IPR, 1.70; 95% CI, 1.40-2.05; P < .05) and required 168% more time loss (95% CI, 78% to 304%) than other events. The hip and thigh were the body regions most commonly injured; injury type, however, varied by T&F event. Sprinting accounted for the greatest proportion of hip and thigh injuries, distance running had the greatest proportion of lower leg injuries, and throwing reported the greatest proportion of spine and upper extremity injuries.Conclusion:Injury risk in NCAA T&F varied by sex, season, and setting. Higher injury rates were found in women versus men, indoor versus outdoor seasons, and competitions versus practices. The hip and thigh were the body regions most commonly injured; however, injury types varied by event. These findings may provide insight to programs aiming to reduce the risk of injury and associated time loss in collegiate T&F.

Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19

Background: Updated epidemiology studies examining sports-related concussions (SRCs) are critical in evaluating recent efforts aimed at reducing the incidence of SRCs in National Collegiate Athletic Association (NCAA) sports. Purpose: To describe the epidemiology of SRCs in 23 NCAA sports during the 2014/15-2018/19 academic years. Study Design: Descriptive epidemiology study. Methods: SRC and exposure data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics by sport, event type (practices, competitions), injury mechanism (player contact, surface contact, equipment/apparatus contact), and injury history (new, recurrent). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. Results: A total of 3497 SRCs from 8,474,400 athlete-exposures (AEs) were reported during the study period (4.13 per 10,000 AEs); the competition-related SRC rate was higher than was the practice-related SRC rate (IRR, 4.12; 95% CI, 3.86-4.41). The highest SRC rates were observed in men’s ice hockey (7.35 per 10,000 AEs) and women’s soccer (7.15 per 10,000 AEs); rates in women’s soccer and volleyball increased during 2015/16-2018/19. Player contact was the most prevalently reported mechanism in men’s sports (77.0%), whereas equipment/apparatus contact was the most prevalently reported mechanism in women’s sports (39.2%). Sex-related differences were observed in soccer, basketball, softball/baseball, and swimming and diving. Most SRCs reported in men’s sports (84.3%) and women’s sports (81.1%) were reported as new injuries. Conclusion: Given the increasing SRC rates observed in women’s soccer and volleyball during the latter years of the study, these results indicate the need to direct further attention toward trajectories of SRC incidence in these sports. The prevalence of equipment/apparatus contact SRCs in women’s sports also suggests that SRC mechanisms in women’s sports warrant further investigation. As most SRCs during the study period were reported as new injuries, the prevalence of recurrent SRCs in men’s and women’s ice hockey is also noteworthy.

Hand and wrist injuries among collegiate athletes vary with athlete division

BackgroundThe rates, severity and consequences of hand and wrist injuries sustained by National Collegiate Athletic Association athletes are not well characterized. This study describes the epidemiology of hand and wrist injuries among collegiate athletes competing in different divisions.MethodsThe National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) was accessed from 2004 to 2015 for the following sports: baseball, basketball, football, ice hockey, lacrosse, soccer, wrestling, field hockey, gymnastics, softball and volleyball. The data were used to identify all hand and wrist injuries, the specific injury diagnosis, mean time loss of activity following injury, and need for surgery following injury. These were then stratified by gender. Descriptive statistics were performed to examine the association between sports, event type and division. Student's t test was used to calculate p-values for independent variables. Chi-Square test was used to calculate odds ratio. P < 0.05 was considered significant.Results103,098 hand and wrist injuries were reported in in the studied NCAA sports from 2004 to 2015. Male athletes sustained 72,423 injuries (6.01/10,000 athlete exposure) and female athletes sustained 30,675 injuries (4.13/10,000 athlete exposure). Division I athletes sustained significantly more injuries compared to divisions II and III. Overall, 3.78% of hand and wrist injuries required surgical intervention. A significantly higher percentage of division I athletes (both male and female) underwent surgical intervention compared to divisions II and III. The mean time lost due to hand and wrist injury was 7.14 days for all athletes. Division I athletes missed the fewest days due to injury at 6.29 days though this was not significant.ConclusionsHand and wrist injuries are common among collegiate athletes. Division I athletes sustain higher rates of injuries and higher surgical intervention rates, while tending to miss fewer days due to injury. Improved characterization of divisional differences in hand and wrist injuries can assist injury management and prevention.

Lower Back Injuries in NCAA Female Volleyball Athletes: A 5-Year Epidemiologic Characterization.

Background:Although lower back injuries (LBIs) are common among National Collegiate Athletic Association (NCAA) female volleyball athletes, their incidence and etiology has not been well-defined.Purpose:To describe the epidemiology of LBIs in collegiate female volleyball athletes over a 5-year period from the academic years 2009 to 2010 and 2013 to 2014.Study Design:Descriptive epidemiology study.Methods:The incidence and characteristics of spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries by the total number of athlete-exposures (AEs). AEs were defined as any student participation in any single NCAA-sanctioned practice or competition. The injury rate was computed as the number of injuries per the total number of AEs and reported as a ration of injuries per 10,000 exposures. The ratio was then reported as overall number as well as stratified for event, time of season, and athletic NCAA division. Incidence rate ratios were then calculated to compare rates between event type. Results with 95% CIs that did not include 1.0 were considered statistically significant.Results:An estimated 3384 LBIs occurred in NCAA female volleyball players during this 5-year time frame. These LBIs occurred at a rate of 4.89 injuries per 10,000 AEs. LBIs were 2.76 times more likely in preseason when compared with regular season. More injuries occurred in practice (85%) when compared with competition (15%). The outside hitter and middle blocker were the most commonly position to sustain an LBI. Almost 70% of injuries were new injuries, and another 29% were recurrent injuries. The most common mechanism of injury was equally split between contact (50.4%) and overuse (45.5%) injuries, whereas the remaining mechanisms of injury were secondary for unknown reasons (4.14%). Most players returned to play within 24 hours (72.3%) followed by 1 to 6 days (16.4%), and finally 7 to 12 days (11.3%). No patient required surgical intervention.Conclusion:The rate of LBIs was high (4.89/10,000 AEs) and injuries commonly recurred (29.2%). Most injuries were new, with most athletes returning to play with 24 hours.

Women and Men National Collegiate Athletic Association Ice Hockey Players Were Similarly Likely to Suffer Lumbar Spine Injuries

PurposeTo describe and compare the epidemiology of lumbar spine injuries (LSIs) in women’s and men’s ice hockey during the 2009-2010 to 2013-2014 academic years and to investigate sex-specific differences, using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) database.MethodsThe incidence and characteristics of LSIs were identified utilizing the NCAA ISP. Rates of injury were calculated as number of injuries divided by total number of athlete exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Incidence rate ratios (IRRs) were calculated to compare rates of injury between season, event type, mechanism, injury recurrence, and time lost from sport, and injury proportion ratios (IPRs) were calculated to examine the differences in injury rates between men and women.ResultsThere were a total of 165 LSIs from an average of 10 and 19 women’s and men’s teams, respectively, calculated to 1,254 LSIs nationally. Women were 2.48 times more likely to suffer a noncontact injury than men (95% CI: 1.33-4.61), whereas men were more likely than women to suffer contact LSIs (IPR: .51 [95% CI: .28-.92]). In Divisions II and III, women were 6.64 (95% CI: 4.14-10.64) and 1.28 (95% CI: 1.12-1.46) times more likely to suffer LSIs than men, respectively.ConclusionsWomen and men were similarly likely to suffer an LSI, but sex-specific differences existed in a mechanism of injury and likelihood of injury within NCAA Divisions.

Epidemiology of Spine Injuries in National Collegiate Athletic Association Men's Wrestling Athletes.

Background:Spine injuries are common in collegiate wrestlers and can lead to reinjury, persistent pain, and time lost from participation.Purpose:To describe the epidemiology of spine injuries in National Collegiate Athletic Association (NCAA) wrestlers between academic years 2009 to 2010 and 2013 to 2014.Study Design:Descriptive epidemiology study.Methods:The incidence and characteristics of spine injuries were identified utilizing the NCAA–Injury Surveillance Program database. Spine injuries were assessed for injury type, injury mechanism, time of season, event type, recurrence, participation restriction, and time lost from participation. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). Injury rate ratios (IRRs) were calculated for event type and time of season, and results with 95% confidence intervals that did not include 1.0 were considered statistically significant.Results:There were an estimated 2040 spine injuries reported in the database over the 4-year period, resulting in an injury rate of 0.71 per 1000 AEs. Spine injuries were over twice as likely to occur in competitions as in practices (IRR, 2.02; 95% confidence interval, 1.10-3.69). More injuries occurred in both the preseason (0.94 per 1000 AEs) and the postseason (1.12 per 1000 AEs) compared with the regular season (0.55 per 1000 AEs). Contact injuries (42%) were the most common mechanism of injury, and brachial plexus injury (20%) was the most common diagnosis. Only 1.3% of injuries required surgery, and athletes most commonly returned to sport within 24 hours (33%) or within 6 days (25%).Conclusion:This investigation found an overall injury rate of 0.71 per 1000 AEs in wrestling athletes between academic years 2009 to 2010 and 2013 to 2014. The majority of these injuries were new, and athletes most commonly returned to sport within 24 hours. The injury rate was highest in competition, and both the preseason and the postseason showed a higher injury rate than that in season. Efforts to improve injury prevention and management should be informed by these findings.

Sports Injury Epidemiology: Foundation of Evidence of, by, and for Athletic Trainers.

Sports Injury Epidemiology: Foundation of Evidence of, by, and for Athletic Trainers.

Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II, and III.

Background:Bone stress injuries (BSIs) are a major source of functional impairment in athletes of all sports, with many risk factors, including athlete characteristics and type of sport. In National Collegiate Athletic Association (NCAA) athletics, the stratification of programs into divisions with different characteristics and makeup has been identified as increasing the risk for certain kinds of injuries, but there have been no studies on the difference of BSI rates and characteristics between athletes in Division I (DI) and those in Divisions II and III (DII and DIII).Purpose/Hypothesis:To characterize the BSI rates in each division and compare the incidence and characteristics of BSIs within divisions. Our hypothesis was that BSI rates would be higher in DII and DIII athletes as compared with DI athletes.Study Design:Descriptive epidemiology study.Methods:Five years of recorded BSI data in collegiate athletes via the NCAA Injury Surveillance Program were examined for the academic years 2009-2010 to 2013-2014. BSI rates per 100,000 athlete-exposures (AEs) were compared for DI versus DII and DIII athletes using risk ratios and 95% CIs. Time lost to injury, time of season of injury, and class composition of injured athletes were also compared between divisions.Results:Over the 5 years studied, DII and DIII programs reported 252 BSIs more than 1,793,777 AEs (14.05 per 100,000 AEs), and DI programs reported 235 BSIs over 2,022,592 AEs (11.62 per 100,000 AEs). The risk ratio was significant for D1 versus DII and DIII (1.21; 95% CI, 1.01-1.44). There was a significant difference in time lost to injury in DI versus DII and DIII, χ2(5, n = 449) = 16.54; P = .006. When data were stratified by individual sport, there were no significant divisional differences in high-risk sports.Conclusion:In the current study, NCAA DII and DIII athletes had higher rates of BSI than their DI counterparts. As compared with DII and DIII athletes, the DI athletes had a significantly greater proportion of BSIs that did not result in absence from participation in sport.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Cross-Country: 2014-2015 Through 2018-2019.

Women's cross-country is a thriving sport at the National Collegiate Athletic Association (NCAA) level with over 1000 sponsored programs association-wide. Routine examinations of women's cross-country injuries are important for identifying emerging time trends in injury incidence and outcomes. Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates. The overall injury rate was 3.96 per 1000 athlete-exposures. Most reported injuries were inflammatory conditions (33.6%), strains (17.7%), and fractures (9.1%). The most commonly reported injuries were medial tibial stress syndrome (10.0%) and lateral ligament complex tears (ankle sprains; 4.2%). Findings of this study were not entirely consistent with existing evidence. Future studies are needed to examine the nature of inflammatory conditions and fractures in this population, as well as temporal patterns in commonly reported injuries.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Wrestling: 2014-2015 Through 2018-2019.

The first men's wrestling National Collegiate Athletic Association (NCAA) Championship was sponsored in 1928; since then, participation has increased. Continued study of wrestling injury data is essential to identify areas for intervention based on emerging trends. Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) were used to examine differential injury rates. The overall injury rate was 8.82 per 1000 athlete exposures. The competition injury rate was significantly higher than practice injury rate (IRR = 4.11; 95% CI = 3.72, 4.55). The most commonly injured body parts were the knee (21.4%), shoulder (13.4%), and head/face (13.3%), and the most prevalently reported specific injury was concussion. These findings provide the most current update to injury incidence and outcomes in NCAA men's wrestling. We identify notable trends that warrant consideration in future research.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Swimming and Diving: 2014-2015 Through 2018-2019.

The National Collegiate Athletic Association (NCAA) has sponsored men's swimming and diving since 1937. Routine examinations of men's swimming and diving injuries are important for identifying emerging injury-related patterns. Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates. The overall injury rate was 1.56 per 1000 athlete-exposures (AEs) for swimmers and 1.52 per 1000 AEs for divers. Shoulder (27.0%) injuries accounted for the largest proportion of all swimming injuries, and most injuries were attributed to overuse mechanisms (42.6%). Shoulder (23.3%) and trunk (23.3%) injuries accounted for the largest proportion of all diving injuries, and most injuries resulted from surface contact (32.6%). Findings were consistent with existing literature on swimming and diving. The need for continued surveillance, coupled with more robust participation by swimming and diving programs was also highlighted.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Softball: 2014-2015 Through 2018-2019.

Women's softball athletes account for approximately 9% of all female athletes competing within the National Collegiate Athletic Association (NCAA). Routine surveillance of NCAA women's softball injuries is important for identifying the emerging injury patterns in this sport. Exposure and injury data collected during competitive seasons in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 (5 years) academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios (IRRs) were used to examine differential injury rates. The overall injury rate was 3.92 per 1000 athlete exposures. Practice and preseason injury rates increased during 2015/16 through 2018/19. Most injuries were shoulder (15.2%), hand/wrist (11.8%), knee (11.2%), and head/face injuries (11.2%) and were classified as contusions (14.2%), sprains (14.1%), and inflammatory conditions (14.1%). Concussion (6.8%) was the most commonly reported injury, and concussion incidence fluctuated during 2014-2015 through 2018-2019. Results indicate an increasing trend in practice and preseason injury incidence. Findings also suggest that workload accumulation in the shoulder and the mechanisms of concussion warrant further attention in this population.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Tennis: 2014-2015 Through 2018-2019.

The National Collegiate Athletic Association (NCAA) has sponsored women's tennis programs since 1966. Women's tennis has risen in global prominence and popularity within the NCAA. Continued surveillance of athletic injuries in the NCAA is critical for identifying emerging injury trends and assessing injury prevention strategies. Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates. The overall injury rate was 4.16 per 1000 athlete exposures. Injury to the shoulder, foot, and trunk were the most prevalent throughout the study period. Approximately 30% of all injury diagnoses were related to inflammatory conditions. Also, 32.1% of all injuries were time-loss injuries, and 45.0% of all injuries were non-time-loss injuries. The findings of this study differed slightly from those of previous investigations, most notably with regard to injury rate by season segment and commonly injured body parts. Future surveillance efforts should attempt to capture the nuances of tennis competitions.