In brief:

• Study tracked detailed information on injury rates among high school soccer players over a 10-year period (2005 – 2014).
• Concussion rates are on the rise for both boys and girls; may be due to better recognition of symptoms.
• Boys experienced decline in nonconcussion injuries; girls' rates remained steady.
• Girls experienced significantly higher rate of knee ligament sprains that result in surgery.
• Authors say that data points to need for tailored preventive approaches in training, with specific attention paid to reducing incidence of knee ligament sprains among girls.

In what authors say is the largest-scale study to date, an analysis of high-school soccer injuries from 2005 to 2014 reveals similarly increasing rates of concussion among boys and girls but differences in nonconcussion injuries, with boys' rates dropping while girls' rates hold fairly steady. Researchers believe the data they've collected may help coaches and trainers create more targeted injury prevention programs.

Overall, injury rates during the study period were recorded at 2.06 per 1,000 "athletic exposures" (AEs)—defined as "a single athlete participating in a single practice or competition." That works out to 6,154 injuries in the study group (55.4% sustained by girls and 44.6% by boys), which researchers say corresponds to an estimated 3.38 million injuries nationally for the 10-year study period. Data were drawn from the National High School Sports-Related Injury Surveillance System, High School Reporting Online (RIO), based on a nationally representative sample of 100 schools in the US. The study appears in the British Journal of Sports Medicine.

Over time, a rise in concussions was reported in both boys and girls. Boys' rates rose from about 0.25 to 0.45 per 1,000 AEs, and girls' incidence climbed from .4 to around .7 during the same time, resulting in an overall rate of 0.36 per 1,000 AEs for the study period. Similar to other studies of youth sports concussion, authors believe part of the reason for the recorded increase is better recognition of concussion symptoms among coaches and trainers.

As for nonconcussion injuries, the trends among boys and girls started to part ways, with a drop for boys from about 2.3 to 1.3 per 1,000 AEs vs a relatively steady rate for girls, at close to 1.9 per 1,000 AEs.

Other findings from the study:

• The 3 most common injuries among boys and girls were grade II-III ligament sprains (29.7%), followed by concussions (17.9%) and muscle strains (16.1%). Most injuries resulted in activity time loss of less than 1 week, but 6.7% resulted in more than 3 weeks' wait before return-to-play, and 5.8% resulted in a season-ending medical disqualification.
• Of the injuries resulting in a loss of play for 3 weeks or more, the 3 most common injuries for boys were concussions (17.8%), knee sprains (15.5%), and ankle sprains (8.9%). Among girls, knee sprains topped the list (26%), followed by concussions (22%), and ankle sprains (13.2%).
• Girls sustained a higher proportion of ligament sprains than boys, with a 34.4% rate compared with 23.9% in boys. Boys were more likely to sustain fractures, at 8.9% vs 6% for girls.
• Injuries were much more prevalent during competition than during practice and tended to result in a higher proportion of injury resulting in 3 or more weeks without play (24.3% vs 15.3%).
• In the competition setting, the rate of ligament sprains that required surgery was much higher in girls (0.28 per 1,000 AEs) than boys (0.09 per 1,000 AEs).
• Most injuries (37.6%) were sustained by midfielders, followed by forwards (28.9%), defenders (23.6%), and goalies (9.4%). The most common area of the field for injuries to occur was between the goal box lines, with 34.6% occurring while players were on their offensive side of the field and 21.5% occurring while on the defensive side.

While some of the findings were more-or-less in line with other research—particularly related to concussion rates—authors believe that the larger scale and more extensive detail offered in the current study should give coaches and trainers better insight into the prevention needs of their players.

Based on these data, "a re-evaluation of injury prevention programs, especially in girls, should be performed with the goal of more effectively reducing non-concussion soccer injury rates," authors write, adding that the study revealed a "need for targeted preventive programs for girls' knee ligament sprains to reduce the need for surgical intervention, as well as further research into potential reasons for this observed difference between sexes."

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. 

Get the latest perspectives on youth sports issues at the upcoming NEXT Conference and Exposition, June 21-24: "One Size Doesn’t Fill All: Safe/Inclusive Youth and Adaptive Sports," and "Back in the Game: Treating Young Athletes With Low Back Pain." Also worth checking out: APTA Learning Center courses on postconcussion return-to-play and repetitive stress injury in youth athletes. More insight is available through PTNow's clinical summary on concussion.