A substantial portion of the population competes in athletic events at the grade school, high school, collegiate, master, recreational, and professional levels.

A preparticipation physical examination should be performed annually in any individual competing in sporting events to ensure safe play.

A team physician at the event needs to be able to stabilize and triage injuries as necessary.

Treating athletes requires knowledge of return-to-play guidelines.

The National High School Sports-Related Injury Surveillance System offers the most comprehensive epidemiologic data for the 2005–06 to 2015–16 school years.

An estimated 7.8 million adolescents participated in high school sports in 2014–15.

High school athletes suffered approximately 1.4 million injuries during the 2015–16 school year, at an injury rate of 2.32 per 1000 athlete exposures (AE).

More than 460,000 student athletes compete at the collegiate level in 25 different sports.

The National Collegiate Athletic Association (NCAA) uses a Web-based Injury Surveillance System (ISS) to collect data on injuries, injury rates, and AEs ( Fig. 11.1 ).

Injury rates from the The National Collegiate Athletic Association Injury Surveillance Program. ACL, Anterior collateral ligament; MCL, medial collateral ligament.

Annual preparticipation physical evaluations (PPE) have not been proven to prevent sports-related morbidity/mortality; however, they may help detect conditions that predispose athletes to illness and injury.

PPEs should include a personal history of injury/illness and a family history of cardiac pathology or sudden cardiac death.

The physical exam should at minimum assess blood pressure, vision, cardiovascular, and musculoskeletal systems.

At this time, routine ECG and echocardiogram screening of asymptomatic, low-risk athletes is not recommended.

Certain athlete populations at greater risk for sudden cardiac death (i.e., football, men’s basketball) may be considered for ECG screening.

The 36th Bethesda Conference offers additional information regarding eligibility and disqualification criteria for competitive athletes with cardiovascular abnormalities.

The PreParticipation Physical Evaluation Monograph, 4th edition, should be reviewed for disease-specific participation guidelines.

The provider should consider preseason baseline concussion testing using computer-based neurocognitive batteries if resources are available.

No-time-loss (NTL) injuries are defined as those resulting in participation restriction <24 hours.

Severe injuries are defined as participation restriction >28 days or early termination of season.

Football

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  Data collected from the NCAA Injury Surveillance Program (NCAA-ISP) from the 2004 to 2009 academic years revealed that:

  
  
  
  
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    Over half (55.9%) of all injuries were reported during regular practices, although the highest injury rates occurred during competitions and scrimmages.

    
    
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    The most common injuries were sprains and strains (50.6%) of the lower extremity.

    
    
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    Most sprains involved the lateral ligament complex of the ankle and medial collateral ligament (MCL)/anterior collateral ligament (ACL) of the knee.

    
    
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    Common injury mechanisms included contact with another player while tackling or being tackled, and noncontact/overuse.

    
    
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    See Suggested Reading for the 2017 interassociation consensus recommendations on Year-Round Football Practice Contact for College Student-Athletes.

    
    
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    Concussions account for about 6% of injuries in collegiate athletics and 7% in the National Football League.

  
  

Soccer

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  Data collected from the NCAA-ISP from the 2009 to 2015 academic years.

  
  
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  Majority of men’s and women’s soccer injuries occurred to the lower extremity and included ankle sprains, knee sprains, upper leg strains, and hip/groin strains.

  
  
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  Overall injury rates during competition and practice did not differ between men and women.

  
  
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  Rate of concussion caused by ball contact was 2.43 times higher in women than men, thought as due to weaker neck musculature and level of contact.

  
  
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  Approximately 50% of all soccer injuries were NTL.

  
  
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  Women suffered a higher percentage of severe injuries compared to men (9.2% vs. 5.1%)

Basketball

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  Data collected from the NCAA-ISP from the 2009 to 2015 academic years.

  
  
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  The majority of injuries in men’s and women’s basketball were to the lower extremity, with ankle sprains (17.9% and 16.6% of all injuries, respectively) being the most common.

  
  
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  Knee injuries accounted for the largest proportion of severe injuries, and the rate of knee internal derangement was approximately 35% higher in women than men.

  
  
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  The number of ACL tears was almost 2.5 times higher in women than men.

  
  
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  NTL injuries accounted for 57.7% and 52.3% of men’s and women’s basketball injuries, respectively.

Tennis

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  Data collected from the NCAA-ISP from the 2009 to 2015 academic years.

  
  
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  The overall injury rate for men’s and women’s tennis was just under 5/1000 AEs.

  
  
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  Competition injury rates were higher than practice injury rates for both men’s and women’s tennis.

  
  
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  The majority of injuries in men’s and women’s tennis were to the lower extremities (47.0% and 52.4%, respectively), followed by the trunk (16.6% and 17.6%, respectively) and shoulder/clavicle (14.4% and 11.9%, respectively).

  
  
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  The most common specific injury for men’s and women’s tennis was sprain of the lateral ankle ligament complex.

  
  
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  The proportion of severe injuries reported in men’s tennis was disconcerting, with about one of every nine injuries categorized as severe.