Comparison of Football-Related Injuries at US Emergency Departments Between High School and Collegiate Athletes: A 10-Year NEISS Analysis,2015-2024

Abstract

Background:

Contemporary, sport-specific comparisons of injury patterns and epidemiological trends between high school- and college-aged football athletes are limited and dated, particularly from a single, nationally representative data set.

Purpose:

To provide an updated, comparative assessment of the epidemiology of football-related injuries among male high school- and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States (US).

Study Design:

Descriptive epidemiology study.

Methods:

The National Electronic Injury Surveillance System (NEISS) was queried for football-related injuries among high school-aged (14-18 years) and college-aged (19-23 years) male athletes from 2015 to 2024. Injury characteristics, anatomic location, diagnosis, and ED disposition were analyzed. Annual National Federation of State High School Associations and National Collegiate Athletic Association participation counts defined at-risk populations. The incidence was calculated as ED visits per 100 at-risk participants, and incidence rate ratios (IRRs) with 95% CIs were used to compare levels of play.

Results:

Among 40,249 unweighted NEISS cases, the weighted national estimate was 1,377,935 football-related ED visits among male athletes aged 14 to 23 years during 2015 and 2024. College-aged athletes were significantly more likely than high school-aged athletes to be evaluated with football-related injuries (21.34 vs 12.02 per 100 at-risk persons; IRR, 1.78 [95% CI, 1.77-1.78]). The head, shoulders, knees, and fingers were most frequently involved. College-aged athletes had higher rates across most diagnosis categories—including laceration (IRR, 4.35 [95% CI, 4.26-4.45]), dislocation (IRR, 3.44; 95% CI, 3.38-3.50), and nerve damage (IRR, 2.23 [95% CI, 1.97-2.53]). Injuries to the mouth (IRR, 5.34 [95% CI, 5.11-5.57]) and face (IRR, 4.55 [95% CI, 4.45-4.66]) were disproportionately higher in college-aged athletes. Most visits resulted in treatment and discharge, but admissions and observations were more frequent among college-aged athletes.

Conclusion:

Among football-related injuries evaluated in US EDs from 2015 to 2024, the incidence was higher in college-aged than high school-aged athletes, with a concentration in head and upper-extremity presentations. Collegiate players sustained higher rates across nearly all injury types and locations, emphasizing the need for targeted prevention and clinical vigilance at advanced levels of play.

Keywords

epidemiology football high school National Collegiate Athletic Association National Electronic Injury Surveillance System

American tackle football has the largest youth and collegiate participation in the United States (US), with more than 1 million high school athletes and over 80,000 collegiate athletes competing^21,22 in 2023-2024. Despite this scale, contemporary, sport-specific comparisons of injury epidemiology between high school- and college-aged football athletes remain limited.

Football involves frequent high-energy actions such as tackling, blocking, cutting, and rapid acceleration and deceleration, which predispose athletes to both acute and overuse injuries.²⁰ Reported injury rates are substantially higher than in several other common sports, with a particularly high incidence of concussion, knee ligament sprains, ankle sprains, shoulder instability, and injuries to the hand and wrist.^3,16,27 Previous studies suggest broadly similar injury categories across levels of play; however, collegiate athletes may experience certain injuries more often and with greater severity, likely reflecting larger body size, higher velocity play, cumulative exposure, and competitive intensity.^8,9

Program-level differences between college and high school football in physical development, training demands, and medical coverage may influence injury incidence, anatomic distribution, and emergency department (ED) disposition.¹⁶ Variation in onsite medical coverage may alter the likelihood of ED evaluation compared with sideline care and outpatient follow-up.¹⁶ Understanding how injury patterns and ED resource use differ by level can inform prevention strategies, return-to-play (RTP) counseling, and allocation of sports-medicine resources.

Cross-level comparisons exist, but recent work using a single, nationally representative data set is limited and often outdated.^8,16,27 The most recent study to directly compare high school and college football players within 1 nationally representative data set evaluated injuries from 2004 to 2014.¹⁶ Subsequent studies have narrowed focus to specific anatomic regions or diagnoses rather than the full spectrum of injuries.^5,7,9 An updated analysis is warranted, particularly across 2015-2024, a period that spans the coronavirus disease 2019 (COVID-19) pandemic and potential shifts in sport participation and care-seeking.

This study aimed to provide an updated, comparative assessment of football-related injuries among male high school- and college-aged athletes and to characterize their burden on US EDs. We hypothesized that collegiate athletes would exhibit higher injury incidence and greater utilization of ED resources than high school-aged athletes.

Methods

Database and Query

This cross-sectional epidemiologic study used data from the National Electronic Injury Surveillance System (NEISS) to evaluate football-related injuries treated in US EDs between 2015 and 2024.³¹ The NEISS database samples approximately 100 hospitals. It provides national estimates of consumer product-related injuries through a stratified probability design. Data are collected by trained hospital coders from clinical records and, when necessary, follow-up telephone interviews. As all patient data are deidentified and publicly available, institutional review board approval was not required for this study.

Data Collection

Injuries were included if the patient was male, aged 14 to 23 years, and the incident was classified under the NEISS football product code 1211. Patients aged 14 to 18 years were categorized as high school-aged, and those aged 19 to 23 years as college-aged. Injury characteristics, anatomic location, diagnosis, and ED disposition were recorded.

Statistical Analysis

Weighted national estimates and 95% CIs were calculated using NEISS sample weights. Football participation data were obtained from the National Federation of State High School Associations (NFHS) and National Collegiate Athletic Association (NCAA) to approximate level-specific at-risk populations.^21,22 Because NEISS captures ED-treated football injuries but does not identify school sanctions, league sanctions, or athlete exposure, these denominators were treated as participation-based proxies rather than exact exposure measures. Incidence rates were reported per 100 at-risk persons. Incidence rate ratios (IRRs) with corresponding 95% CIs were calculated to compare rates between high school- and college-aged athletes. IRRs were calculated using Poisson approximations, and confidence intervals were constructed using mid-P exact methods. Statistical analyses were performed using R (Version 4.4.1; R Foundation for Statistical Computing), and significance was set at α≤ .05.

Results

Among 40,249 unweighted NEISS cases, the weighted national estimate was 1,377,935 football-related ED visits among male athletes aged 14 to 23 years during 2015 and 2024. Male college-aged football players sustained significantly higher injury rates than high school-aged players, with an overall incidence of 21.34 versus 12.02 per 100 at-risk persons (Table 1). High school athletes exhibited relatively stable incidence rates, fluctuating by only 10.3 points, whereas college-aged athletes demonstrated consistently higher and more variable rates, with a 28.8-point decline from 2015 to 2020. Both groups demonstrated a sharp decline in 2020, coinciding with the onset of the COVID-19 pandemic (Figure 1).

Table 1

Comparative Characteristics of Male Football Injuries by Age Group ^a

	High School14-18 Years		College19-23 Years
	National Estimate	IR per 100 At-Risk Persons	National Estimate	IR per 100 At-Risk Persons	IRR (College vs High School)	95% CI
Overall incidence	1,218,824 (88.5)	12.02	159,109 (11.5)	21.34	1.78	1.77-1.78
Disposition
Treated and discharged	1,172,157 (88.6)	11.56	150,666 (11.4)	20.20	1.75	1.74-1.76
Transferred or admitted	33,185 (87.5)	0.33	4,741 (12.5)	0.64	1.94	1.88-2
Held for observation	2,059 (77.6)	0.02	596 (22.4)	0.08	3.94	3.59-4.31
Left against medical advice	11,339 (78.9)	0.11	3,029 (21.1)	0.41	3.63	3.49-3.78

Data are presented as n (%). IR, incidence rate; IRR, incidence rate ratio.

Figure 1.

Annual football-related injury incidence rates among high school-aged and college-aged male athletes treated in US EDs, 2015-2024. ED, emergency department; US, United States.

Injury Patterns

The most frequently injured body regions among male football athletes aged 14 to 23 years included the head, shoulders, knees, and fingers, while strain or sprain remained the most commonly reported diagnosis (Figure 2; Appendix Tables A1 and A2). Weighted estimates showed that strains or sprains accounted for 73% (n = 98,773) of ankle injuries, 58% (n = 16,968) of neck injuries, and 46% (n = 69,728) of knee injuries among male football athletes aged 14 to 23 years between 2015 and 2024.

Figure 2.

Incidence rates among male football athletes evaluated in the emergency department. Bolded text indicates the top 5 injury sites by region. IR, incidence rate; IRR, incidence rate ratio.

Although high school athletes represented 89% of ED visits for football-related injuries, incidence rates adjusted for the at-risk population revealed consistently higher injury rates among college-aged athletes. Notably, college players had significantly elevated rates of injuries to the mouth (IRR, 5.34 [95% CI, 5.11-5.57]), face (IRR, 4.55 [95% CI, 4.45-4.66]), unspecified regions (IRR, 3.80 [95% CI, 3.50-4.13]), global areas (IRR, 3.45 [95% CI, 3.33-3.57]), and upper leg (IRR, 3.19 [95% CI, 3.07-3.32]) (Table 2). They also demonstrated higher rates of nearly all diagnoses—including laceration (IRR, 4.35 [95% CI, 4.26-4.45]), dislocation (IRR, 3.44 [95% CI, 3.38-3.50]), and nerve damage (IRR, 2.23 [95% CI, 1.97-2.53]).

Table 2

Injury Characteristics and Population-Adjusted Incidence Rates by Age Group ^a

	High School14-18 Years			College19-23 Years
	National Estimate	%	IR (Per 100 At-Risk Persons)	National Estimate	%	IR (Per 100 At-Risk Persons)
Body Region
Head	203178	93.4	2	14422	6.6	1.930
Shoulder	144069	86.0	1.420	23368	14.0	3.130
Knee	130347	86.0	1.290	21236	14.0	2.850
Finger	129992	87.1	1.280	19190	12.9	2.570
Ankle	120019	88.7	1.180	15287	11.3	2.050
Wrist	62802	92.7	0.620	4925	7.3	0.660
Upper trunk	57712	88.9	0.570	7183	11.1	0.960
Lower trunk	56575	89.6	0.560	6534	10.4	0.880
Hand	49598	90.5	0.490	5233	9.5	0.700
Lower leg	47759	89.3	0.470	5740	10.7	0.770
Lower arm	36629	94.5	0.360	2138	5.5	0.290
Elbow	30674	91.0	0.300	3041	9.0	0.410
Face	29226	74.9	0.290	9785	25.1	1.310
Neck	26988	92.3	0.270	2267	7.7	0.300
Foot	25609	86.2	0.250	4109	13.8	0.550
Global	15787	79.8	0.160	4001	20.2	0.540
Upper leg	13970	81.0	0.140	3278	19.0	0.440
Upper arm	8702	93.3	0.086	624	6.7	0.084
Toe	8689	87.3	0.086	1269	12.7	0.170
Mouth	7182	71.8	0.071	2818	28.2	0.380
Pubic region	5084	84.1	0.050	960	15.9	0.130
Eye	3593	84.1	0.035	679	15.9	0.090
Unspecified	2603	78.2	0.026	727	21.8	0.098
Ear	1988	87.0	0.020	296	13.0	0.040
Diagnosis
Strain or sprain	316082	87.8	3.116	43942	12.2	5.893
Fracture	232508	89.7	2.292	26820	10.3	3.596
Other/not stated	214653	86.8	2.116	32617	13.2	4.374
Contusions, abrasions	148303	91.4	1.462	13936	8.6	1.869
Concussions	116906	94.2	1.153	7232	5.8	0.970
Internal organ injury	80591	92.2	0.795	6777	7.8	0.909
Dislocation	60079	79.8	0.592	15196	20.2	2.038
Laceration	33727	75.8	0.333	10793	24.2	1.447
Hematoma	5176	91.3	0.051	493	8.7	0.070
Crushing	2453	99.3	0.024	18	0.7	0.002
Dermatitis, conjunctivitis	1764	93.9	0.017	114	6.1	0.020
Nerve damage	1734	85.9	0.017	285	14.1	0.040

Data are presented as weighted national estimates and row percentages. Percentages represent the proportion of each injury category accounted for by high school-aged versus college-aged athletes. Incidence rates are reported per 100 at-risk persons. IR, incidence rate.

Disposition

Most football-related injuries were treated and discharged from the ED, accounting for 96.2% of high school-aged and 94.7% of college-aged athletes (IR, 11.56 vs 20.20 per 100 at-risk persons). College-aged athletes experienced significantly greater rates of hospital admission (IRR, 1.94 [95% CI, 1.88-2]), observation (IRR, 3.94 [95% CI, 3.59-4.31]), and leaving against medical advice (IRR, 3.63 [95% CI, 3.49-3.78]). Overall, college-aged athletes were nearly twice as likely to present to the ED with a football-related injury (IRR, 1.78 [95% CI, 1.77-1.78]).

Discussion

In this national analysis of 2015-2024 NEISS data, college-aged male football athletes were approximately 1.8 times more likely than high school-aged athletes to be evaluated in the ED for football-related injuries. Although most ED visits by count involved high school-aged athletes, the incidence, standardized to participation, was higher at the collegiate level. Injury distributions were similar across levels, with the head, shoulders, knees, and fingers most frequently involved. Nearly all patients were treated and released; however, college-aged athletes were more often admitted to the hospital or required short-term observation.

These findings are consistent with surveillance literature demonstrating a greater injury burden at higher levels of play across multiple sports, including football.^{6,15,16,23,25} Collegiate systems routinely report higher incidence per athlete-exposure and a greater proportion of severe injuries, surgical cases, and time-loss events compared with high school programs.^{6,15,16,23,25} In football specifically, collegiate injury rates can approach double those observed in high school cohorts, with a higher overuse burden and more injuries resulting in 21+ days of time loss.^16,25 Plausible contributing factors include larger body mass, higher play velocities, cumulative workload, and competitive intensity, each of which increases tissue loading and collision energy at the collegiate level.^8,9

Both levels experienced a marked decline in ED visit incidence in 2020, coincident with COVID-19-related disruptions to participation and care-seeking. National reports during this period document widespread reductions in ED utilization and organized sport participation.^12,17,30 These findings contribute to a growing body of research highlighting the pandemic's durable influence on musculoskeletal injury epidemiology.^11,24,32

Anatomic patterns were similar across levels; however, college-aged athletes had disproportionately higher rates of injuries to the mouth and face, unspecified or global regions, and the upper leg. These distributions are consistent with higher-velocity contact and collision forces typical of collegiate play.^4,8,16,27 Surveillance from the NCAA Injury Surveillance Program and complementary epidemiologic studies report elevated rates of maxillofacial, head, and upper-leg injuries among collegiate football athletes, with player contact cited as the predominant mechanism.^4,8,16,27

These data highlight practical prevention targets. Consistent mouthguard use reduces the risk of dentofacial injury in collegiate contact sports, although adherence is variable.^4,29 Technique-focused instruction for contact and tackling, especially in open-field scenarios, may mitigate head and facial injuries.⁸ For the lower extremity, neuromuscular and eccentric strengthening programs emphasizing the hamstrings, quadriceps, and adductors reduce injury risk in team-sport populations.^19,26

Strain or sprain were the most frequently reported diagnoses, aligning with the dynamics of the football sport. Tackle football combines high-energy contact (tackling and blocking) with rapid acceleration-deceleration, cutting, and awkward landings that collectively load periarticular soft tissues and stabilizing ligaments.²⁰ In our analysis, strains and sprains were the most common diagnoses in both groups, with a higher incidence among collegiate-aged athletes than high school-aged athletes. This age-based gradient is directionally consistent with web-based injury surveillance data showing higher overall injury rates at the collegiate level and higher ankle and knee sprain rates among college athletes compared with high school athletes, likely reflecting greater collision energy, higher-velocity play, and cumulative workload at advanced levels of competition.^5,7,16 In addition, because our cohort reflects ED-treated injuries, sprain/strain presentations may be disproportionately represented when acute pain, swelling, perceived instability, or functional limitation prompts emergency evaluation to exclude fracture or other structural injury.²⁸ Collectively, these findings reinforce prevention priorities centered on neuromuscular and proprioceptive programs and targeted strength and landing-mechanics interventions, alongside coaching that emphasizes safer cutting and contact mechanics to mitigate the performance-injury tradeoffs inherent to high-speed directional change.^10,14,19

ED disposition patterns support a comparative severity signal among collegiate athletes, who were more likely to be admitted or observed and to leave against medical advice. This may reflect greater injury severity, expedited team-based follow-up preferences, and scheduling pressures around competition. In addition, because high school athletes are typically minors who present with a parent or guardian, reliable home monitoring after ED discharge (particularly after suspected concussion or sedating medications) may be easier to ensure. Conversely, college-aged patients may present unaccompanied, and if adequate home observation cannot be confirmed, clinicians may favor observation or admission.^1,18 ED-based and transport surveillance similarly indicate higher use of advanced imaging, procedures, and admission among collegiate athletes, especially for head, facial, and lower-extremity injuries.^2,13 Together, these findings support level-specific prevention and coordinated post-ED care pathways.

The clinical implications of these findings are threefold. First, ED clinicians evaluating collegiate football athletes may consider a lower threshold for advanced imaging, specialty consultation, or short-term observation, particularly for facial, lower-extremity, and high-energy contact injuries, given the higher rates of fracture, dislocation, and hospital-based disposition in this group. Second, these data support closer coordination between ED clinicians, athletic trainers, and team physicians to ensure timely follow-up, structured RTP counseling, and appropriate monitoring after discharge. Third, the differing injury distributions between levels suggest that prevention strategies should be level-specific: collegiate programs may particularly benefit from interventions targeting collision-risk mitigation, facial protection, and lower-extremity resilience, whereas both high school and collegiate programs should continue to emphasize concussion recognition, shoulder stabilization, and hand protection. Collectively, these findings may help guide resource allocation, sideline-to-ED referral decisions, and post-ED management pathways in football athletes.

Limitations

This study is not without limitations. As with any secondary database analysis, results are constrained by the variables captured and coded in NEISS and by its scope to ED encounters; injuries treated in urgent care, primary care, athletic training rooms, or team physician clinics are not represented. This limitation may have become more consequential over the study period, as increasing urgent care utilization may have diverted some lower-acuity football injuries away from EDs. Moreover, temporal changes in ED-treated injury incidence may reflect shifts in health care utilization in addition to changes in true injury burden or sport participation. This distinction is particularly relevant when comparing our findings with previous school-based surveillance studies, including Kerr et al,¹⁶ which relied on athletic trainer-reported injuries rather than ED-based case capture. These approaches likely sample different portions of the injury spectrum and should be viewed as complementary rather than directly comparable. Restricting to ED visits may bias the case mix toward conditions perceived to require immediate imaging or specialty input. NEISS records visits rather than unique athletes, precluding identification of repeat presentations, and lacks information on position, class year, competition versus practice, protective equipment use, and league or division. Incidence denominators were derived from annual NFHS and NCAA participation counts and therefore serve as participation-based proxies rather than as athlete-exposure measures. Because NEISS product code 1211 does not distinguish between school sanction, league, or governing body, some numerator cases may reflect football participation outside NFHS or NCAA membership, particularly among the 19- to 23-year-old age group. Accordingly, these estimates should be interpreted as comparative participation-adjusted ED visit rates rather than precise sport-surveillance incidence. Access to athletic trainers, team physicians, and imaging, as well as thresholds for ED referral, likely varies by institution and level of play, and collegiate programs may divert minor injuries away from the ED. Collegiate athletes are more likely to have access to on-site athletic trainers and team medical staff, which may reduce ED utilization. Finally, the pandemic period altered participation and care-seeking, complicating year-to-year comparisons despite consistent analytic methods.

Conclusion

Among football-related injuries evaluated in US EDs from 2015 to 2024, incidence was higher in college-aged than high school-aged athletes, with a concentration in head and upper-extremity presentations. Collegiate players sustained higher rates across nearly all injury types and locations, emphasizing the need for targeted prevention and clinical vigilance at advanced levels of play.

Footnotes

Appendix

Appendix Table A2

Unweighted NEISS Sample Counts Underlying Diagnosis for Football-Related Injuries Among Male Patients Aged 14 to 23 Years, 2015-2024 ^a

Diagnosis	High School-Aged, Raw n	College-Aged, Raw n	Total Raw n
Strain or sprain	8858	1048	9906
Fracture	7965	657	8622
Other/not stated	6529	845	7374
Contusions, abrasions	3935	307	4242
Concussions	3686	190	3876
Internal organ injury	2216	165	2381
Dislocation	1693	365	2058
Laceration	985	255	1240
Hematoma	167	12	179
Crushing	49	1	50
Dermatitis, conjunctivitis	47	4	51
Nerve damage	44	11	55

Values are unweighted case counts from the NEISS sample. NEISS, National Electronic Injury Surveillance System.

Final revision submitted March 8, 2026; accepted March 21, 2026.

One or more of the authors has declared the following potential conflict of interest or source of funding: N.P. has received consulting fees from DePuy/Medical Device Business Services. This study used publicly available, deidentified data from the National Electronic Injury Surveillance System and was deemed exempt from institutional review board oversight.

ORCID iDs

John R. Tyler

Alexis B. Sandler

Nata Parnes

References

Broglio

Cantu

Gioia

, et al. National Athletic Trainers' Association position statement: management of sport concussion. J Athl Train. 2014;49(2):245-265.

Burt

Overpeck

MD.

Emergency visits for sports-related injuries. Ann Emerg Med. 2001;37(3):301-308.

Carter

Westerman

Hunting

KL.

Risk of injury in basketball, football, and soccer players, ages 15 years and older, 2003-2007. J Athl Train. 2011;46(5):484-488.

Chorney

Sobin

Goyal

Suryadevara

AC.

Maxillofacial injuries among National Collegiate Athletic Association athletes: 2004-2014. Laryngoscope. 2017;127(6):1296-1301.

Clifton

Koldenhoven

Hertel

, et al. Epidemiological patterns of ankle sprains in youth, high school, and college football. Am J Sports Med. 2017;45(2):417-425.

Clifton

Onate

Hertel

, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school boys' basketball (2005-2006 through 2013-2014) and National Collegiate Athletic Association Men's basketball (2004-2005 through 2013-2014). J Athl Train. 2018;53(11):1025-1036.

Clifton

Onate

Schussler

, et al. Epidemiology of knee sprains in youth, high school, and collegiate American football players. J Athl Train. 2017;52(5):464-473.

Dick

Ferrara

Agel

, et al. 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

Kerr

Marshall

, et al. Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatrics. 2015;169(7):659-665.

10.

Dos'Santos

Thomas

McBurnie

Comfort

Jones

. Biomechanical determinants of performance and injury risk during cutting: a performance-injury conflict? Sports Med. 2021;51(9):1983-1998.

11.

Evcik

Musculoskeletal involvement: COVID-19 and post COVID 19. Turk J Phys Med Rehabil. 2023;69(1):1-7.

12.

Hartnett

KP.

Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(23):699-704.

13.

Hirschhorn

Kerr

Wasserman

, et al. Epidemiology of injuries requiring emergency transport among collegiate and high school student-athletes. J Athl Train. 2018;53(9):906-914.

14.

Kaminski

Hertel

Amendola

, et al. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train. 2013;48(4):528-545.

15.

Kerr

Putukian

Chang

, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school boys' soccer (2005-2006 through 2013-2014) and National Collegiate Athletic Association Men's soccer (2004-2005 through 2013-2014). J Athl Train. 2018;53(9):893-905.

16.

Kerr

Wilkerson

Caswell

, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in United States high school football (2005-2006 through 2013-2014) and National Collegiate Athletic Association football (2004-2005 through 2013-2014). J Athl Train. 2018;53(8):738-751.

17.

Law

Wolkin

Patel

, et al. Injury-related emergency department visits during the COVID-19 pandemic. Am J Prev Med. 2022;63(1):43-50.

18.

Levin

Diaz-Arrastia

RR.

Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol. 2015;14(5):506-517.

19.

Monajati

Larumbe-Zabala

Goss-Sampson

Naclerio

The effectiveness of injury prevention programs to modify risk factors for non-contact anterior cruciate ligament and hamstring injuries in uninjured team sports athletes: a systematic review. PLoS One. 2016;11(5):e0155272.

20.

Morris

Simon

Grooms

, et al. The epidemiology of overuse conditions in youth football and high school football players. J Athl Train. 2017;52(10):976-981.

21.

National Collegiate Athletic Association. NCAA sports sponsorship and participation rates report. Accessed August 30, 2025. https://ncaaorg.s3.amazonaws.com/research/sportpart/2024RES_SportsSponsorshipParticipationRatesReport.pdf

22.

National Federation of State High School Associations (NFHS). High school athletics participation survey. Accessed August 30, 2025. https://assets.nfhs.org/umbraco/media/7213111/2023-24-nfhs-participation-survey-full.pdf

23.

Pierpoint

Lincoln

Walker

, et al. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in US high school boys' lacrosse (2008-2009 through 2013-2014) and National Collegiate Athletic Association Men's lacrosse (2004-2005 through 2013-2014). J Athl Train. 2019;54(1):30-41.

24.

Popa

Gurzu

Handra

, et al. Impact of the COVID-19 pandemic on musculoskeletal disorder-related absenteeism among pediatric healthcare workers. Healthcare. 2025;13(10):1116.

25.

Roos

Marshall

Kerr

, et al. Epidemiology of overuse injuries in collegiate and high school athletics in the United States. Am J Sports Med. 2015;43(7):1790-1797.

26.

Rudisill

Varady

Kucharik

Eberlin

Martin

SD.

Evidence-based hamstring injury prevention and risk factor management: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med. 2023;51(7):1927-1942.

27.

Shankar

Fields

Collins

Dick

Comstock

RD.

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

28.

Smart

Haring

Asemota

, et al. Tackling causes and costs of ED presentation for American football injuries: a population-level study. Am J Emerg Med. 2016;34(7):1198-1204.

29.

Stanbouly

Lee

Chuang

SK.

Prevalence of dentofacial injuries and concussions among college athletes and their perceptions of mouthguards. J Craniofac Surg. 2021;32(4):1600-1603.

30.

Tyler

Sandler

Albagli

, et al. The national epidemiology of ankle sprains in the United States: updates from 2010 to 2024. Orthopedics. 2025;48(6):371-377.

31.

U.S. Consumer Product Safety Commission Division of Hazard and Injury Data Systems. The National Electronic Injury Surveillance System: a tool for researchers. Accessed July 2025.http://www.cpsc.gov/LIBRARY/neiss.html

32.

Zerbo Šporin

Kozinc

Prijon

Metličar

Šarabon

. The impact of the COVID-19 pandemic on musculoskeletal disorders-related sick leave among healthcare workers: a retrospective analysis of Slovenian national data. Front Public Health. 2024;12:1478204.