Epidemiology of Injuries in High School Football: Does School Size Matter?

in Journal of Physical Activity and Health
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More than 1 million US high school students play football. Our objective was to compare the high school football injury profiles by school enrollment size during the 2013–2014 season.


Injury data were prospectively gathered on 1806 student athletes while participating in football practice or games by certified athletic trainers as standard of care for 20 high schools in the Atlanta Metropolitan area divided into small (<1600 students enrolled) or large (≥1600 students enrolled) over the 2013–2014 football season.


Smaller schools had a higher overall injury rate (79.9 injuries per 10,000 athletic exposures vs. 46.4 injuries per 10,000 athletic exposures; P < .001). In addition, smaller schools have a higher frequency of shoulder and elbow injuries (14.3% vs. 10.3%; P = .009 and 3.5% vs. 1.5%; P = .006, respectively) while larger schools have more hip/upper leg injuries (13.3% vs. 9.9%; P = .021). Lastly, smaller schools had a higher concussion distribution for offensive lineman (30.6% vs. 13.4%; P = .006) and a lower rate for defensive backs/safeties (9.2% vs. 25.4%; P = .008).


This study is the first to compare and show unique injury profiles for different high school sizes. An understanding of school specific injury patterns can help drive targeted preventative measures.

King, Campbell, Herzog, and Popoli are with the Dept of Sport Medicine, Children’s Healthcare of Atlanta, Atlanta, GA. Reisner is with the Dept of Neurosurgery, Children’s Healthcare of Atlanta, Atlanta, GA. Polikandriotis (john.polikandriotis@choa.org) is with the Dept of Ambulatory Operations, Children’s Healthcare of Atlanta, Atlanta, GA.