Sex-Specific Differences in Perceived Injury Management and Prevention in High School Student-Athletes


  • Eve Kantaros
  • Haylee Borgstrom, MD MS Massachusetts General Hospital/Spaulding Rehabilitation Hospital/Harvard Medical School



High school athlete, female athlete, sport injury, injury prevention, sex difference, womens sports medicine


BACKGROUND: Sport-related injuries are common among high school student-athletes with specific sex disparities in injury risk. Many of these injuries may be avoidable with the use of injury prevention programs (IPPs). Sex differences in injury management and return to sport are not well understood.

PURPOSE: To determine sex-specific differences in self-reported injury management and prevention strategies in high school student-athletes.

DESIGN: Cross-sectional, survey-based study.

METHODS: An anonymous 13-item electronic survey was distributed to all students in a private high school in December 2019 with responses recorded over a one-month study period. Primary outcomes were sex-specific differences in self-reported outcome measures assessing student-athlete experience during injury recovery and familiarity with IPPs. Groups were evaluated via descriptive statistics and differences between groups were compared.

RESULTS: From a total of 190 responses, 106 were included in the analysis (63F, 43M, mean age 16.7 years). Female athletes reported decreased exposure to injury prevention training (44.4% vs 69.8%, p=0.01) and practice-based utilization of IPPs (23.8% vs 55.8%, p=0.001) compared to male athletes. Overall, reported utilization of IPPs was low regardless of sex at less than 40% for all athletes. Nearly 85% of female athletes compared to 51% of male athletes felt they could benefit from IPPs (p=0.001), yet fewer than half of female athletes reported ever having training in injury prevention. There were no statistically significant differences in measures of injury management or return to sport between sexes. Females reported similar major impact of injury on life and future plans compared to male athletes.

CONCLUSIONS: Male athletes were 1.6x more likely to report injury prevention training and 2.4x more likely to report practice-based utilization of IPPs compared to female athletes. Sex-specific differences in injury management and return to sport were not identified. Better incorporation of IPPs, specifically at the high-school level, may help to address sex disparities in preventable sport-related injuries and allow student-athletes to maximize the myriad benefits of sport participation.


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2018-2019 High School Athletics Participation Survey [online database]. 2019, The National Federation of State High School Associations.

NCAA Sports Sponsorship and Participation Rates Database [online database]. 2019, National Collegiate Athletic Association.

Tanaka, M.J., et al., Changes in U.S. girls' participation in high school sports: implications for injury awareness. Phys Sportsmed, 2020: p. 1-5. DOI:

Summary Report National High School Sports-Related Injury Surveillance Study 2018-2019 School Year [online database]. 2019.

Brant, J.A., et al., Rates and Patterns of Lower Extremity Sports Injuries in All Gender-Comparable US High School Sports. Orthop J Sports Med, 2019. 7(10): p. 2325967119873059. DOI:

Carter, C.W., et al., Sex-based Differences in Common Sports Injuries. J Am Acad Orthop Surg, 2018. 26(13): p. 447-454. DOI:

Lin, C.Y., et al., Sex Differences in Common Sports Injuries. Pm r, 2018. 10(10): p. 1073-1082. DOI:

Borgstrom, H. and K.C. McInnis, Female Athlete Hip Injuries: A Narrative Review. Clin J Sport Med, 2020. DOI:

Ireland, M.L., The female ACL: why is it more prone to injury? Orthop Clin North Am, 2002. 33(4): p. 637-51. DOI:

Barengo, N.C., et al., The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. Int J Environ Res Public Health, 2014. 11(11): p. 11986-2000. DOI:

Rossler, R., et al., Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis. Sports Med, 2014. 44(12): p. 1733-48. DOI:

Crossley, K.M., et al., Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Br J Sports Med, 2020. 54(18): p. 1089-1098. DOI:

Norcross, M.F., et al., Factors influencing high school coaches' adoption of injury prevention programs. J Sci Med Sport, 2016. 19(4): p. 299-304. DOI:

Stevenson, B., Beyond the Classroom: Using Title IX to Measure the Return to High School Sports. The Review of Economics and Statistics, 2010. 92(2): p. 284-301. DOI:

Briere, F.N., et al., Prospective associations between sport participation and psychological adjustment in adolescents. J Epidemiol Community Health, 2018. 72(7): p. 575-581. DOI:

Fox, C.K., et al., Physical activity and sports team participation: associations with academic outcomes in middle school and high school students. J Sch Health, 2010. 80(1): p. 31-7. DOI:

McGuine, T., Sports injuries in high school athletes: a review of injury-risk and injury-prevention research. Clin J Sport Med, 2006. 16(6): p. 488-99. DOI:

Joseph, A.M., et al., A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train, 2013. 48(6): p. 810-7. DOI:

Gornitzky, A.L., et al., Sport-Specific Yearly Risk and Incidence of Anterior Cruciate Ligament Tears in High School Athletes: A Systematic Review and Meta-analysis. Am J Sports Med, 2016. 44(10): p. 2716-2723. DOI:

Beck, N.A., et al., ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics, 2017. 139(3). DOI:

DiStefano, L.J., et al., Influence of age, sex, technique, and exercise program on movement patterns after an anterior cruciate ligament injury prevention program in youth soccer players. Am J Sports Med, 2009. 37(3): p. 495-505. DOI:

Lim, B.O., et al., Effects of sports injury prevention training on the biomechanical risk factors of anterior cruciate ligament injury in high school female basketball players. Am J Sports Med, 2009. 37(9): p. 1728-34. DOI:

McGuine, T.A. and J.S. Keene, The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med, 2006. 34(7): p. 1103-11. DOI:

van der Horst, N., et al., The preventive effect of the nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med, 2015. 43(6): p. 1316-23. DOI:

Petushek, E.J., et al., Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis. Am J Sports Med, 2019. 47(7): p. 1744-1753. DOI:

Mugele, H., et al., General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates. PLoS One, 2018. 13(10): p. e0205635. DOI:

Lopes, T.J.A., et al., The Effects of Injury Prevention Programs on the Biomechanics of Landing Tasks: A Systematic Review With Meta-analysis. Am J Sports Med, 2018. 46(6): p. 1492-1499. DOI:

Brunner, R., et al., Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review. Br J Sports Med, 2019. 53(5): p. 282-288. DOI:

Thompson, J.A., et al., Biomechanical Effects of an Injury Prevention Program in Preadolescent Female Soccer Athletes. Am J Sports Med, 2017. 45(2): p. 294-301. DOI:

van Dyk, N., F.P. Behan, and R. Whiteley, Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med, 2019. 53(21): p. 1362-1370. DOI:

Tanaka, M.J., L.C. Jones, and J.M. Forman, Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs Among Female Collegiate Athletes. J Athl Train, 2020. 55(4): p. 359-364. DOI:

Bizzini, M., A. Junge, and J. Dvorak, Implementation of the FIFA 11+ football warm up program: how to approach and convince the Football associations to invest in prevention. Br J Sports Med, 2013. 47(12): p. 803-6. DOI:

Pfile, K.R. and B. Curioz, Coach-led prevention programs are effective in reducing anterior cruciate ligament injury risk in female athletes: A number-needed-to-treat analysis. Scand J Med Sci Sports, 2017. 27(12): p. 1950-1958. DOI:

McGuine, T.A., et al., Basketball coaches' utilization of ankle injury prevention strategies. Sports Health, 2013. 5(5): p. 410-6. DOI:

Mawson, R., et al., Lower limb injury prevention programs in youth soccer: a survey of coach knowledge, usage, and barriers. J Exp Orthop, 2018. 5(1): p. 43. DOI:

Lindblom, H., S. Carlfjord, and M. Hagglund, Adoption and use of an injury prevention exercise program in female football: A qualitative study among coaches. Scand J Med Sci Sports, 2018. 28(3): p. 1295-1303. DOI:

Donaldson, A., et al., A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme. Inj Prev, 2019. 25(4): p. 244-251. DOI:

Owoeye, O.B.A., et al., Advancing adherence research in sport injury prevention. Br J Sports Med, 2018. 52(17): p. 1078-1079. DOI:

Perera, N.K.P. and M. Hagglund, We have the injury prevention exercise programme, but how well do youth follow it? J Sci Med Sport, 2020. 23(5): p. 463-468. DOI:

Kontos, A.P., Perceived risk, risk taking, estimation of ability and injury among adolescent sport participants. J Pediatr Psychol, 2004. 29(6): p. 447-55. DOI:

Bolling, C., et al., Letting the cat out of the bag: athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports. Br J Sports Med, 2020. 54(14): p. 871-877. DOI:

Martinez, J.C., et al., Female adolescent athletes' attitudes and perspectives on injury prevention programs. J Sci Med Sport, 2017. 20(2): p. 146-151. DOI:

Desai, N., et al., Factors Affecting Recovery Trajectories in Pediatric Female Concussion. Clin J Sport Med, 2019. 29(5): p. 361-367. DOI:

Berz, K., et al., Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed, 2013. 41(2): p. 58-63. DOI:

Mollayeva, T., G. El-Khechen-Richandi, and A. Colantonio, Sex & gender considerations in concussion research. Concussion, 2018. 3(1): p. CNC51. DOI:

Webster, K.E. and J.A. Feller, Return to Level I Sports After Anterior Cruciate Ligament Reconstruction: Evaluation of Age, Sex, and Readiness to Return Criteria. Orthop J Sports Med, 2018. 6(8): p. 2325967118788045. DOI:

Lisee, C.M., et al., Gender Differences in Psychological Responses to Recovery After Anterior Cruciate Ligament Reconstruction Before Return to Sport. J Athl Train, 2020. 55(10): p. 1098-1105. DOI:

Druckman, J.N., et al., Racial bias in sport medical staff's perceptions of others' pain. J Soc Psychol, 2018. 158(6): p. 721-729. DOI:

Unruh, S., Perceptions of athletic training services by collegiate student-athletes: a measurement of athlete satisfaction. J Athl Train, 1998. 33(4): p. 347-50.

Unruh, S., et al., Collegiate Student-Athletes' Satisfaction With Athletic Trainers. J Athl Train, 2005. 40(1): p. 52-55.




How to Cite

Kantaros, E., & Borgstrom, H. (2021). Sex-Specific Differences in Perceived Injury Management and Prevention in High School Student-Athletes. Journal of Women’s Sports Medicine, 1(1), 30–37.