A recent study helps to confirm that elite adolescent athletes don’t have to wonder IF they will get injured during their sport; instead, they should anticipate WHEN they will get injured. Our language has changed in regards to injury prevalence for adolescent athletes. Between ACL (anterior cruciate ligament) ruptures, Tommy-John surgeries for UCL (ulnar collateral ligament) tears, ankle sprains, or even common acute muscle strains, these injuries are not risk factors any more for athletes. It seems like it is now the reality of being an athlete. There is a high injury burden among elite adolescent athletes. Below are insights into what exactly is occurring in youth athlete populations during 52 weeks (one year) of engaging in their sport and the importance of recovery.
The study published in the Journal of Athletic Training gathered 284 elite adolescent (16-17 years old) athletes in endurance, power, and team sport athletic populations. Over the course of 52 weeks, the athletes were given a questionnaire to respond to in order to monitor prevalence and incidence of injuries, among other crucial injury parameters that athletes should be aware of.
There were 4.1 injuries per 1,000 hours of participation in sport volume. Volume includes training, practices, and competition. To put this in perspective, consider a basketball team of 10 players putting in, on average, 20 hours a week (per player). This amounts to 200 hours per week for the entire team. We can conclude in 5 weeks (1000/200= 5), the team as a whole, reaches 1,000 hours of participation in basketball. This study suggests there will be 4 injuries total on the team in 5 weeks of play.
Every week, 3 out of 10 (30.5%) athletes of the 284 subjects were injured. Average time to first injury is 20 weeks, or about 5 months of time. Injuries occurred the most during training (76.7%) as opposed to 23.3% during competition. Focus on injury prevention or rest strategies should be placed in the long, out-of-season, training phases rather than just in-season.
Among all the injuries from which athletes recovered, 22.2% resulted in absence from normal training for at least 2 months.
Among all athletes tracked over the course of a year, over half (57.4%) reported at least one NEW injury. The one-year prevalence was 91.6%, meaning that among the athletes that entered in the one year period WITH and WITHOUT an injury, close to ALL of them became or remained injured. To put this in perspective, less than 9% of the athlete sample reported no injury. This small group of 9% was completely healthy before, during, and after the surveillance period of one year. It is apparent if you go into your sport season injured, its very hard to resolve the injury without proper intervention.
Female athletes had more average weekly injuries, more substantial injuries (moderate to severe), more severity in grade of injury (such as a more damaged ankle ligament sprain), and had a more lengthy history of injuries. It is clear from the study that females have more difficulty competing injury-free once they’re committed to their sport in adolescent years.
By the end of the study, a large number of athletes had not recovered from injury, which may suggest injuries during normal training may be underestimated by coaches and healthcare professionals. Furthermore, there was a considerable number of elite athletes injured weekly, resulting in consequences such as lost time in sport participation.
This study suggests that despite injury prevention training strategies, such as strength training, engaging in multiple sports, or following proper warm up/cool down routines, sheer volume and exposure to the sport is the superior predictor of injury prevalence. Allowing recovery offsets this exposure. Athletes should create an off-season for themselves or implement other recovery strategies to manage their risk criteria (especially true for female athletes and those who still train during the off-season).
Source: Philip von Rosen, Annette Heijne, Anna Frohm, Cecilia Fridén, and Anders Kottorp (2018) High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study. Journal of Athletic Training: March 2018, Vol. 53, No. 3, pp. 262-270.