Epidemiological Patterns of Ankle Sprains in Youth,High School,and College Football

Abstract

Background:

Variations in ankle injury rates and distributions among competition levels are unclear, but such data may help inform strategies to prevent ankle sprains during American football.

Purpose:

To describe the epidemiological patterns of ankle sprains in youth, high school (HS), and collegiate American football.

Study Design:

Descriptive epidemiological study.

Methods:

Data regarding youth, HS, and college football athletes were collected from 3 injury surveillance programs: (1) the Youth Football Safety Study (YFSS), (2) the National Athletic Treatment, Injury and Outcomes Network (NATION), and (3) the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). During the 2012-2014 seasons, the YFSS, NATION, and NCAA ISP included 310, 184, and 71 football team-seasons, respectively. Athletic trainers (ATs) attended each practice and game and reported injuries and athlete-exposures (AEs) via their preferred injury documentation application. Ankle sprain rates for each type of ankle sprain were calculated overall, by event type (ie, practices and games), and specifically for severe injuries (ie, participation restriction time >21 days) and recurrent injuries (as defined by ATs). Rate ratios (RRs) were used to compare ankle sprain rates by competition level and event type. Injury proportion ratios (IPRs) were used to compare differences in severity, surgical needs, recurrence, injury mechanism, and injury activity by competition level. RRs and IPRs with 95% confidence intervals excluding 1.00 were considered statistically significant.

Results:

A total of 124, 897, and 643 ankle sprains were reported in youth, HS, and college football, respectively. This led to respective rates of 0.59, 0.73, and 1.19 sprains per 1000 AEs. The ankle sprain rate in college football was higher than the rates in HS (RR = 1.64; 95% CI, 1.48-1.82) and youth (RR = 2.01; 95% CI, 1.65-2.43) football. The proportion of ankle sprains that were recurrent in youth football was higher than the proportions in HS (IPR = 2.73; 95% CI, 1.68-4.50) and college (IPR = 2.19; 95% CI, 1.33-3.61) football.

Conclusion:

Ankle sprain rates were highest in college athletes. However, level-specific variations in ankle sprain severity and recurrence may highlight the need to develop level-specific policies and prevention strategies to reduce injury incidence.

Keywords

ankle sprain incidence injury surveillance football

Get full access to this article

View all access options for this article.

References

Arnold

Wright

Ross

SE.

Functional ankle instability and health-related quality of life. J Athl Train. 2011;46(6):634-641.

Bailey

Physical education and sport in schools: a review of benefits and outcomes. J Sch Health. 2006;76(8):397-401.

Boytim

Fischer

Neumann

Syndesmotic ankle sprains. Am J Sports Med. 1991;19(3):294-298.

Darrow

Collins

Yard

. Epidemiology of severe injuries among United States high school athletes 2005-2007. Am J Sports Med. 2009;37(9):1798-1805.

Dick

Ferrara

Agel

. Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007;42(2):221-233.

Dompier

Marshall

Kerr

. The National Athletic Treatment, Injury and Outcomes Network (NATION): methods of the surveillance program, 2011-2012 through 2013-2014. J Athl Train. 2015;50(8):862-869.

Dompier

Powell

Barron

. Time-loss and non–time-loss injuries in youth football players. J Athl Train. 2007;42(3):395-402.

Gerber

Williams

Scoville

. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19(10):653-660.

Gribble

Hertel

Effect of lower-extremity muscle fatigue on postural control. Arch Phys Med Rehabil. 2004;85(4):589-592.

10.

Gribble

Hertel

Effect of hip and ankle muscle fatigue on unipedal postural control. J Electromyogr Kinesiol. 2004;14(6):641-646.

11.

Gribble

Terada

Beard

. Prediction of lateral ankle sprains in football players based on clinical tests and body mass index. Am J Sports Med. 2016;44(2):460-467.

12.

Gross

Marti

Risk of degenerative ankle joint disease in volleyball players: study of former elite athletes. Int J Sports Med. 1999;20(1):58-63.

13.

Harrington

KD.

Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg Am. 1979;61(3):354-361.

14.

Hootman

Dick

Agel

Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311-319.

15.

Hopper

Elliott

BC.

Do selected kinanthropometric and performance variables predict injuries in female netball players?

J Sports Sci. 1995;13(3):213-222.

16.

Kerr

Dompier

Snook

. National Collegiate Athletic Association Injury Surveillance System: review of methods for 2004-2005 through 2013-2014 data collection. J Athl Train. 2014;49(4):552-560.

17.

Kerr

Marshall

Dompier

. College sports-related injuries—United States, 2009-10 through 2013-14 academic years. MMWR Morb Mortal Wkly Rep. 2015;64(48):1330-1336.

18.

Konradsen

Factors contributing to chronic ankle instability: kinesthesia and joint position sense. J Athl Train. 2002;37(4):381-385.

19.

Malina

Morano

Barron

. Incidence and player risk factors for injury in youth football. Clin J Sport Med. 2006;16(3):214-222.

20.

McGuine

Greene

Best

. Balance as a predictor of ankle injuries in high school basketball players. Clin J Sport Med. 2000;10(4):239-244.

21.

Medina McKeon

Bush

Reed

. Return-to-play probabilities following new versus recurrent ankle sprains in high school athletes. J Sci Med Sport. 2014;17(1):23-28.

22.

National Collegiate Athletic Association. Student-athlete participation: 1981-82–2014-15. NCAA sports sponsorship and participation rates report. http://www.ncaa.org/sites/default/files/Participation%20Rates%20Final.pdf. Accessed January 19, 2016.

23.

National Council of Youth Sports. Reports on trends and participation in organized youth sports. 2008 edition. http://www.ncys.org/pdfs/2008/2008-ncys-market-research-report.pdf. Accessed January 18, 2016.

24.

National Federation of High School Associations. 2014-15 High school athletics participation survey. http://www.nfhs.org/ParticipationStatistics/PDF/2014-15_Participation_Survey_Results.pdf. Accessed January 19, 2016.

25.

Norkus

Floyd

RT.

The anatomy and mechanisms of syndesmotic ankle sprains. J Athl Train. 2001;36(1):68-73.

26.

Olsen

O-E

Myklebust

Engebretsen

. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports. 2006;16(6):426-432.

27.

Plisky

Rauh

Kaminski

. Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911-919.

28.

Pryor

Casa

Vandermark

. Athletic training services in public secondary schools: a benchmark study. J Athl Train. 2015;50(2):156-162.

29.

Rechel

Yard

Comstock

RD.

An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train. 2008;43(2):197-204.

30.

Reeser

Gregory

Berg

. A comparison of women’s collegiate and girls’ high school volleyball injury data collected prospectively over a 4-year period. Sports Health. 2015;7(6):504-510.

31.

Shankar

Fields

Collins

. Epidemiology of high school and collegiate football injuries in the United States, 2005-2006. Am J Sports Med. 2007;35(8):1295-1303.

32.

Simon

Docherty

CL.

Current health-related quality of life in older adults with chronic ankle instability. Br J Sports Med. 2015;49:A10.

33.

Sobhani

Dekker

Postema

. Epidemiology of ankle and foot overuse injuries in sports: a systematic review. Scand J Med Sci Sports. 2013;23(6):669-686.

34.

Stuart

Morrey

Smith

. Injuries in youth football: a prospective observational cohort analysis among players aged 9 to 13 years. Mayo Clin Proc. 2002;77(4):317-322.

35.

Turbeville

Cowan

Asal

. Risk factors for injury in middle school football players. Am J Sports Med. 2003;31(2):276-281.

36.

Wang

Chen

Shiang

. Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility. Arch Phys Med Rehabil. 2006;87(6):821-825.

37.

Waterman

Owens

Davey

. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279-2284.

38.

Yeung

Chan

. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28(2):112-116.