Sex-Specific Differences in Perceived Injury Management and Prevention in High School Student-Athletes
Keywords: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.
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: https://doi.org/10.1080/00913847.2020.1852861
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: https://doi.org/10.1177/2325967119873059
Carter, C.W., et al., Sex-based Differences in Common Sports Injuries. J Am Acad Orthop Surg, 2018. 26(13): p. 447-454. DOI: https://doi.org/10.5435/JAAOS-D-16-00607
Lin, C.Y., et al., Sex Differences in Common Sports Injuries. Pm r, 2018. 10(10): p. 1073-1082. DOI: https://doi.org/10.1016/j.pmrj.2018.03.008
Borgstrom, H. and K.C. McInnis, Female Athlete Hip Injuries: A Narrative Review. Clin J Sport Med, 2020. DOI: https://doi.org/10.1097/JSM.0000000000000857
Ireland, M.L., The female ACL: why is it more prone to injury? Orthop Clin North Am, 2002. 33(4): p. 637-51. DOI: https://doi.org/10.1016/S0030-5898(02)00028-7
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: https://doi.org/10.3390/ijerph111111986
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: https://doi.org/10.1007/s40279-014-0234-2
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: https://doi.org/10.1136/bjsports-2019-101587
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: https://doi.org/10.1016/j.jsams.2015.03.009
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: https://doi.org/10.1162/rest.2010.11623
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: https://doi.org/10.1136/jech-2017-209656
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: https://doi.org/10.1111/j.1746-1561.2009.00454.x
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: https://doi.org/10.1097/01.jsm.0000248848.62368.43
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: https://doi.org/10.4085/1062-6050-48.6.03
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: https://doi.org/10.1177/0363546515617742
Beck, N.A., et al., ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics, 2017. 139(3). DOI: https://doi.org/10.1542/peds.2016-1877
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: https://doi.org/10.1177/0363546508327542
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: https://doi.org/10.1177/0363546509334220
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: https://doi.org/10.1177/0363546505284191
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: https://doi.org/10.1177/0363546515574057
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: https://doi.org/10.1177/0363546518782460
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: https://doi.org/10.1371/journal.pone.0205635
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: https://doi.org/10.1177/0363546517716930
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: https://doi.org/10.1136/bjsports-2017-098944
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: https://doi.org/10.1177/0363546516669326
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: https://doi.org/10.1136/bjsports-2018-100045
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: https://doi.org/10.4085/1062-6050-150-19
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: https://doi.org/10.1136/bjsports-2012-092124
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: https://doi.org/10.1111/sms.12828
McGuine, T.A., et al., Basketball coaches' utilization of ankle injury prevention strategies. Sports Health, 2013. 5(5): p. 410-6. DOI: https://doi.org/10.1177/1941738113491072
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: https://doi.org/10.1186/s40634-018-0160-6
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: https://doi.org/10.1111/sms.13012
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: https://doi.org/10.1136/injuryprev-2017-042639
Owoeye, O.B.A., et al., Advancing adherence research in sport injury prevention. Br J Sports Med, 2018. 52(17): p. 1078-1079. DOI: https://doi.org/10.1136/bjsports-2017-098272
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: https://doi.org/10.1016/j.jsams.2019.11.008
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: https://doi.org/10.1093/jpepsy/jsh048
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: https://doi.org/10.1136/bjsports-2019-100773
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: https://doi.org/10.1016/j.jsams.2016.06.009
Desai, N., et al., Factors Affecting Recovery Trajectories in Pediatric Female Concussion. Clin J Sport Med, 2019. 29(5): p. 361-367. DOI: https://doi.org/10.1097/JSM.0000000000000646
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: https://doi.org/10.3810/psm.2013.05.2015
Mollayeva, T., G. El-Khechen-Richandi, and A. Colantonio, Sex & gender considerations in concussion research. Concussion, 2018. 3(1): p. CNC51. DOI: https://doi.org/10.2217/cnc-2017-0015
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: https://doi.org/10.1177/2325967118788045
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: https://doi.org/10.4085/1062-6050-558.19
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: https://doi.org/10.1080/00224545.2017.1409188
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.
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