There are many differences between youth, adolescent, and college athletes. Although it should not be assumed that college athletes are fully developed, the largest percentage of changes in their bodies have already occurred. Epiphyseal plates have, for the most part, closed, and the window for the highest prevalence of epiphyseal growth plate injuries—ages 10 to 16 years—has passed. Children have increased elastic soft tissue and greater potential for remodeling than adults. College-aged athletes are generally allowed to participate in a full spectrum of training, including heavy weight lifting and plyometrics without the more careful consideration that goes into adolescent guidelines.
Although the physical characteristics may appear to be more robust for coping with stresses, other external factors may influence musculoskeletal injury in college athletes. In college, the seasons are longer, and, in some sports, training and competition can last year-round, resulting in increased risk and exposure. The intensity increases, expectations are greater for performance, and the demands can be overwhelming. Travel associated with competition can be taxing and call for days on the road. Fatigue can influence injury susceptibility. Football players in the National College Athletic Association’s (NCAA’s) Division I Bowl Subdivision (formerly Division I-A) reported spending an average of 44.8 hours/week at their sport, the equivalent of a full-time job. Division I baseball players reported spending 40 hours/week on their sport, whereas men’s basketball players reported an average of 36.8 hours/week.25 These time commitments, in addition to schoolwork, can place a tremendous toll on the athlete’s mind and body.
In 2007, the NCAA and National Athletic Trainers’ Association partnered to publish 25 years of data collected on athletic injuries at the collegiate level. The NCAA Injury Surveillance System (ISS) is a valuable source from which to glean epidemiologic data. The ISS provides a resource for scientific examination of injury prevention. Tables 8-3 and 8-4 summarize these NCAA injury data.
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Characteristics of specific sports can pose demands that result in injury to specific areas and structures of the body. Thankfully, researchers working with the NCAA have collected years of epidemiologic data that provide insight into injury rates during various points during the season, as well as differences between practices and competitions.
Evidence suggests that high-contact sports are more commonly associated with a higher incidence of acute injury26-30, while non-contact sports are associated with a greater amount of overuse injuries.30,31 The high-impact sports generally yield the highest rate of injury due to the contact characteristics of the games. Specific sports can have notable risk factors. Table 8-5 shows college sport-specific injury risk highlights.
Female athletes experience overuse injuries at higher rates than males.30,32 Specifically, Yang et al30 reported that females have a rate of 24.6/10,000 AEs compared to 13.2/10,000 AEs in males. However, acute injury occurs more frequently in male athletes.30 A possible explanation for the gender differences could be attributed to structural and biomechanical differences.30 Females’ lower extremities comprise 51.2% of their total height, compared to 56% in males.33 Females have a wider pelvis and larger Q-angle, which are well known for predisposing female athletes to patellofemoral pain syndrome. The muscle mass of males and females prior to puberty is comparable; however, as testosterone begins to influence growth during puberty, males accumulate
The total cross-sectional area of muscles in women is 60%, compared to 80% in males.34 As a result, males are generally able to produce greater strength and power. Sport and sport injury are greatly influenced by forces created by the generation of physical power. Females also have greater general joint laxity compared to males. Finally, females have a larger percentage of body fat (22% to 26%) compared to males (12% to 16%).35
When examining the total number of overuse injuries, the incidence is higher in females (61.7%) than males (38.3%).26 Hootman et al26 examined injury rates of 16 college sport teams and found that 4 women’s teams—field hockey, soccer, softball, and volleyball—had the highest rates of overuse injury of the investigation. Females have higher rates of noncontact ACL injury (Table 8-6),26 patellofemoral pain, and stress fractures of the pelvis and hip.36,37 Other researchers have concluded that, for sex-comparable sports, the differences between genders is reduced.30 Ristolainen et al27 found no gender differences in the incidence of acute and overuse injuries in cross-country skiers, swimmers, distance runners, and soccer players. Even when calculating injury rate by 1000 training hours, 1000 competition hours, or all hours combined, there were no gender differences.27 Overall, gender-related differences for acute and overuse injuries in top-level athletes between the sexes have been found to be small.