Foot Pain: Injured athlete sitting on a wooden floor

California High School Injury Study

Dr. Carol Frey

The “Frey study” helps trainers and other doctors

An injury study among California High Schools reveals – ankles and knees are most vulnerable when it comes to injuries among High School students. This is the conclusion of an injury study my colleagues Keith Feder, MD, and Jill Sleight, ATC (a certified athletic trainer), and I conducted. We reported on 7,890 injuries in student-athletes from twenty-seven California high schools.

The data for this injury study were collected for three consecutive school years. Information was recorded on incidence and location of injury. In our sample, 62 percent of the athletes were male and 38 percent were female.

Nearly 40,000 athletes were evaluated for this study. We defined an injury as any mishap that occurred during a competitive event or practice that caused the athlete to miss one game or meet, or two or more practice sessions. The definition was expanded to include athletes who had to decrease or change their workout routines because of pain for two or more practice sessions.

The duration of the injury was recorded by coaches, athletic trainers, or the team physician. Athletes were returned to sports when they were able to compete without restrictions.

In what we call the Frey study, injuries occurred 50 percent of the time during games and 50 percent during practice. Football was responsible for 48 percent of the injuries overall. Football resulted in the highest injury rate for males. Soccer resulted in the highest injury rate for females in this study. The majority of injuries were in the lower extremity (legs, knees, ankles, feet) for both male and female athletes.

Here is what we found:

Ankle, 1,974 injuries (25%)
• Knee, 1,052 injuries (13%)
• Wrist, 875 injuries (11%)
• Lower leg, 627 injuries (8%)
• Upper leg, 542 injuries (7%)
• Shoulder, 444 injuries (6%)
• Back, head, foot, hand, general abrasions/contusions made up the rest of the injury study categories.

The sport with the most injuries was football (48%), followed by basketball (16%), soccer (9%), volleyball (8%), and track and field (7%). Other sports were reported on, but had less than a 5% injury rate for each sport. The rest of the sports studied included baseball, badminton, cross-country, cheerleading, golf, gymnastics, softball, swimming, tennis, water polo, wrestling, lacrosse, and surfing (remember, we’re in California!).

We analyzed specific positions played for certain sports to see if that made a difference in injuries. To look at a specific position, only the injuries that occurred during a game were studied. During practice, not only do the players play their position, but they participate in strength, conditioning, and drills that do not reflect a specific position. For example, of the 618 game injuries in volleyball, the outside hitter was the most commonly injured with 118 injuries, followed by middle blocker with 81 injuries, the setter with 74 injuries, and the back row with 55 injuries.

Football had the following game injury rate per position: wide receiver, 61; linebacker, 51; running back, 43; quarterback, 28; and defensive tackle, 21 injuries.

During games, baseball had 24 injuries in the pitcher, 21 for second base, 20 for the catcher, 20 for the short stop, 18 at first base, 18 at third base, 14 in center field, 9 in left field, and 4 injuries in right field.

During meets, track and field had the following injury rates: sprints, 23; shot put, 10; long jump 6; high jump, 5; and discus, 1.

This study reported that male athletes were at higher risk of injury than females, in general. Most of the injuries occurred in football, a male-dominated sport. Ultimately, such findings in our injury study should provide a database for coaches, trainers, and sports medicine doctors involved in the care and prevention of injuries for student-athletes.

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