Subsequent Musculoskeletal Injury Incidence Are Similar Between General Infection and COVID-19 Among High School Athletes in the Unites States Despite Higher Illness Incidence During Academic Years 2019-2020 and 2020-2021

J Orthop Sports Phys Ther. 2022 Aug;52(8):546-553. doi: 10.2519/jospt.2022.11200. Epub 2022 Jun 19.


Objectives: To describe overall illness and COVID-19- specific illness in high school athletes in the 2019-2020 and 2020-2021 academic school years, and to describe and assess the risk of musculoskeletal injury following general infection and after COVID-19.

Design: Ecological study.

Methods: High schools (6 states; 176 high schools) were matched between the 2019-2020 and 2020-2021 academic school years, based on 2020-2021 high school sport participation. Illness and injury data were collected from the high school athletic trainers. Illness was stratified by overall illness, general infection, and COVID-19. Injuries following moderate or severe infections or COVID-19 were recorded. Illness and injury incidence rate per 100 athletes per year, with 95% confidence intervals (95% CIs), were calculated. Negative binomial models comparing injury following general infections and COVID-19 infections were calculated.

Results: A total of 98 487 and 72 521 athletes participated in the 2019-2020 and 2020-2021 years. Illness incidence rate was less in the 2019-2020 academic school year [0.30 (95% CI: 0.27, 0.34)] than the 2020-2021 academic school year [1.1 (1.0-1.2)], resulting in a difference of 0.8 (95% CI: 0.7, 0.9). COVID-19 incidence rate was 0.52 (0.47-0.58) in the 2020-2021 year. Injury following general infection incidence rate was 27.9 injuries (21.4-34.5) per 100 athletes in 2019-2020, and 22.5 injuries (19.3-25.7) per 100 athletes in 2020-2021. There was no difference in injury risk following general infection and COVID-19 [rate ratio: 1.2 (95% CI: 0.7, 2.4)].

Conclusions: The incidence rate for all illnesses in high school athletes was slightly (0.8) greater in the 2020-2021 academic compared to the 2019-2020 year. Most of the incidence increase was due to infections and COVID-19. Subsequent injury incidence following moderate and severe infections were similar between years and between general infections and COVID-19. J Orthop Sports Phys Ther 2022;52(8):546-553. Epub: 19 June 2022. doi:10.2519/jospt.2022.11200.

Keywords: coronavirus; ecological; return to sport.

MeSH terms

  • Athletes
  • Athletic Injuries* / epidemiology
  • Athletic Injuries* / etiology
  • COVID-19* / epidemiology
  • Humans
  • Incidence
  • Reinjuries*
  • Students
  • United States / epidemiology