The Epidemiology of Overuse Conditions in Youth Football and High School Football Players

J Athl Train. 2017 Oct;52(10):976-981. doi: 10.4085/1062-6050-52.10.04. Epub 2017 Sep 26.


Context: High-intensity sport training at the youth level has led to increased concern for overuse conditions. Few researchers have examined overuse conditions in youth sports.

Objective: To examine the rates, risks, and distributions of overuse conditions between youth and high school football players.

Design: Descriptive epidemiologic study.

Setting: Youth and high school football teams.

Patients or other participants: The Youth Football Safety Study (YFSS) investigated youth football athletes from age 5 to 14 years. The National Athletic Treatment, Injury and Outcomes Network (NATION) focused on high school football athletes 14 to 18 years old. The YFSS data consisted of 210 team-seasons, and the NATION data consisted of 138 team-seasons.

Main outcome measure(s): Athletic trainers collected football injury and exposure data during the 2012 and 2013 seasons. Injury rates, risks, and distributions were calculated, with injury rate ratios, risk ratios, and injury proportion ratios with 95% confidence intervals (CIs) comparing youth and high school football players.

Results: The YFSS reported 1488 injuries, of which 53 (3.6%) were overuse conditions. The NATION reported 12 013 injuries, of which 339 (2.8%) were overuse conditions. The overuse condition rate did not differ between high school and youth football (3.93 versus 3.72/10 000 athlete-exposures; injury rate ratio = 1.06; 95% CI = 0.79, 1.41). However, the 1-season risk of overuse condition was higher in high school than in youth football players (2.66% versus 1.05%; risk ratio = 2.53; 95% CI = 1.84, 3.47). Compared with high school football players, youth football players had greater proportions of overuse conditions that were nontime loss (ie, <24 hours participation-restriction time; 83.0% versus 67.0%; injury proportion ratio = 1.24; 95% CI = 1.07, 1.43) and affecting the lower extremity (92.5% versus 62.5%; injury proportion ratio = 1.48; 95% CI = 1.32, 1.65).

Conclusions: Overuse conditions may not present a primary concern in youth and high school football players. However, differences existed between the 2 levels of competition. Although additional research on the incidence of overuse conditions across all youth and high school sports is needed, these findings may highlight the need for programming that is specific to competition level.

Keywords: body part injuries; injury diagnosis; injury rate; injury risk; non–time-loss injuries; sports; time-loss injuries.

MeSH terms

  • Adolescent
  • Athletic Injuries / epidemiology*
  • Child
  • Child, Preschool
  • Cumulative Trauma Disorders / epidemiology*
  • Female
  • Football / injuries*
  • Humans
  • Incidence
  • Male
  • Schools / statistics & numerical data
  • Seasons
  • United States / epidemiology