Campus recreation centers provide a variety of programs to college students including fitness programs, organized sport programs, outdoor recreational activities, and facilities for students to utilize independently. Organized recreational sports include intramural and club sport programs.1 Intramural programs offer students the chance to participate in organized sports on campus with other students who attend the same university.2 Club sports operate similarly to National Collegiate Athletic Association (NCAA) varsity athletics where teams travel and compete against other universities of the same sport.3,4
Outside of organized sports, campus recreation programs offer other forms of physical activity and student engagement, including fitness centers and programs, outdoor recreation centers and programs, and facilities that provide an open space for students to play unorganized sports with other students on campus. Participating in recreational activities provides a multitude of benefits for students that include improving social connections and sense of belonging,2,5,6 enhancing leadership potential,6 and having a direct correlation to student academic success.1,2,7 Participation in recreational sports also can improve a student’s mental health, physical fitness, and overall health and well-being.2,5,8 Individuals who participate in recreational sports compared to NCAA Division I sports have better long-term health-related quality of life and physical health outcomes.9
Although there are a great number of benefits, there are risks involved in participating in recreational activities such as the risk of injury. In emergency care centers alone, there were approximately 3.6 million individuals being treated for a sport-related injury in 2022.10 Typically, athletic trainers are employed to prevent and manage injuries in various sport and nonsport-related settings, yet only 2% of respondents from the 2023 National Athletic Trainers’ Association Salary Survey are employed in the campus health/recreation setting.11
Sport injury surveillance systems track sport-related injuries within various sport settings, including high school, collegiate, and professional level.12,13 However, few record injuries in recreational settings.12,13 One study found that the most common types of injuries within club sport athletes were sprains (31%) and strains (26%), and the lower body was the most injured area.14 Two studies have calculated injury rates for common club sport teams as an overall 15.814–18.315 injuries per 1,000 exposures, which were higher than the combined documented 13.8 NCAA injuries per 1,000 exposures.15 NCAA sports report about 5.8% of their injuries classifying as a concussion while club sports almost double that percentage with reporting 10% of documenting injuries diagnosed as a concussion.14 An additional study observed that club and intramural sport participation contributed to 50% of the university’s students’ traumatic brain injuries.16 Documenting and understanding the frequency and details of the occurrence of injuries in the club, intramural, and open recreational settings are important due to the large number of students participating in these programs. Therefore, the aim of this study was to describe the frequency of injury in college recreational sports and activities depending on the year, semester, indoor or outdoor locations, playing surface type, activity, injury type, body region, and body part.
Methods
Participants
The data set included individuals who sustained any type of documented injury within the Recreation and Wellness Center of a southeastern Division I University in the United States. Individuals with reported injuries were either participating in intramural or club sport programs, or during open recreational facility sport hours. Individuals who sustained an injury during other recreational programs and offerings within the facility were not included within the analysis.
Instrumentation
Hard copy injury reports were used to document injuries that occurred at the Recreation and Wellness Center. All injury reports were documented by trained student or professional employees of the center. Student employees were trained to document initial injury reports by their direct professional staff members (i.e., full-time staff such as coordinators or assistant directors) as well as graduate assistants of the recreation center. Injury reports contained questions to describe details about the injury occurrence for liability and facility documentation purposes. Questions from injury reports and an example of what could have been written are further explained in Supplementary Material S1 (available online).
Procedures
Information gathered within the injury reports was compiled into an Excel document (Microsoft 365) for each academic year by medical staff at the facility. Certified athletic trainers at the Recreation and Wellness Center removed all personal information within the injury reports and sent the deidentified data to the research team for coding and statistical analysis. A member of the research team assigned variables and numerical codes to different categories of the injury reports, which established the variables within the study design (Supplementary Materials S2 and S3 [available online]). Numerical code assignments were based on previous epidemiological studies.17,18
Statistical Analysis
Numerical codes were uploaded to SPSS (version 29.0) for statistical analysis. Independent variables included: year, semester, indoor or outdoor locations, playing surface type, activity, injury type, body region, and body part. Dependent variable was injury frequency. Descriptive statistics were used to assess frequency of injuries for all dependent variables. Additional descriptive statistics included were the university student enrollment, and intramural or club sport activity participation (Table 1), as well as club or intramural sport program offerings at the University Recreation and Wellness Center (Table 2).
Total Enrollment and Participation Numbers
| Year | Total student enrollment | Intramural sport participation | Club sport participation |
|---|---|---|---|
| 2013–2014 | 59,740 | 10,745 (18.0) | 2,021 (3.4) |
| 2014–2015 | 60,810 | 10,543 (17.3) | 1,947 (3.2) |
| 2015–2016 | 63,002 | 8,370 (13.3) | 1,647 (2.6) |
| 2016–2017 | 64,321 | 7,983 (12.4) | 2,383 (3.6) |
| 2017–2018 | 66,183 | 7,931 (12.0) | 3,071 (4.6) |
| 2018–2019 | 68,571 | 6,895 (10.1) | 3,924 (5.7) |
Club and Intramural Sport Program Offerings
| Club sports | Intramural sports |
|---|---|
| Adaptive and inclusive | Fall semester |
| Badminton | 5 on 5 basketball |
| Baseball | 6 on 6 volleyball |
| Basketball | 7 on 7 flag football |
| Bowling | 7 on 7 outdoor soccer |
| Brazilian jiu-jitsu | Baseball |
| Chuong Nhu karate | Dodgeball |
| Cycling | Esports |
| Equestrian | Global world soccer cup |
| Esports | Pickleball |
| Fencing | Sitting volleyball |
| Flag football | Tennis |
| Golf | Wheelchair basketball |
| Ice hockey | Racquetball (1-day tournament) |
| Judo | 3 on 3 soccer (1-day tournament) |
| Kendo | Badminton (1-day tournament) |
| Kiteboarding | Spring semester |
| Men’s lacrosse | 2 on 2 sand volleyball |
| Women’s lacrosse | 3 on 3 basketball |
| Paintball | 3 on 3 floor hockey |
| Rock climbing | 4 on 4 flag football |
| Rowing | Dodgeball |
| Men’s rugby | Softball |
| Women’s rugby | Tennis |
| Running | Esports |
| Sailing | Wiffleball (1-day tournament) |
| SCUBA | Unified basketball (1-day tournament) |
| Men’s soccer | Ultimate frisbee (1-day tournament) |
| Women’s soccer | Spikeball (1-day tournament) |
| Softball | Kickball (1-day tournament) |
| Surf | Disc golf (1-day tournament) |
| Swimming | Cricket (1-day tournament) |
| Table tennis | Three-way soccer (1-day tournament) |
| Tae kwon do | Two-person golf scramble (1-day tournament) |
| Tennis | Summer semester |
| Triathlon | 4 on 4 flag football |
| Men’s ultimate frisbee | 4 on 4 indoor volleyball |
| Women’s ultimate frisbee | 5 on 5 basketball |
| Men’s volleyball | 6 on 6 indoor soccer |
| Women’s volleyball | Ultimate frisbee |
| Wakeboarding | Sand volleyball (1-day tournament) |
| Men’s water polo | Pickleball (1-day tournament) |
| Women’s water polo | Dodgeball (1-day tournament) |
| Wrestling | Table tennis (1-day tournament) |
Results
Injury Frequency
The deidentified data set contained 2,801 documented injuries between the academic years 2013–2019. Due to missing information, 10 documented injuries were excluded from analysis. Additionally, 589 injuries occurred during other recreational programs such as group exercise courses, outdoor adventure trips, or other activities within the recreation center; thus, leaving a total of 2,202 documented injuries during sport-related activities. Descriptive statistics assessed injury frequency for the following categories: academic year, by academic semesters, activity during injury, indoor or outdoor locations, playing surface type, injury type, injured body region, and injured body part (Tables 3 and 4).
Overall Injury Frequency Data (N = 2,202)
| Total frequency (%) | Intramural frequency (%) | Club sport frequency (%) | Open recreational sports frequency (%) | |
|---|---|---|---|---|
| Year | ||||
| 2013–2014 | 526 (23.9) | 352 (66.9) | 27 (5.1) | 147 (28.0) |
| 2014–2015 | 445 (20.2) | 249 (56.0) | 26 (5.8) | 170 (38.2) |
| 2015–2016 | 345 (15.7) | 178 (51.6) | 29 (8.4) | 138 (40.4) |
| 2016–2017 | 248 (11.2) | 135 (54.4) | 31 (12.5) | 82 (33.1) |
| 2017–2018 | 242 (11.0) | 161 (66.5) | 32 (13.2) | 49 (20.3) |
| 2018–2019 | 396 (18.0) | 220 (55.5) | 73 (18.4) | 103 (26.1) |
| Semester | ||||
| Fall | 1,106 (50.2) | 705 (63.7) | 109 (9.9) | 292 (26.4) |
| Spring | 794 (36.1) | 431 (54.3) | 97 (12.2) | 266 (33.5) |
| Summer | 302 (13.7) | 159 (52.6) | 12 (4.0) | 131 (43.4) |
| Activity | ||||
| Intramural sports | 1,295 (58.8) | — | — | — |
| Club sports | 218 (9.9) | — | — | — |
| Open recreation sports | 689 (31.3) | — | — | — |
| Indoor/outdoor location | ||||
| Indoor | 1,112 (50.5) | 453 (40.7) | 57 (5.2) | 602 (54.1) |
| Outdoor | 1,090 (49.5) | 842 (77.2) | 161 (14.8) | 87 (8.0) |
| Playing surface type | ||||
| Turf field | 892 (40.5) | 800 (89.7) | 40 (4.5) | 52 (5.8) |
| Grass field | 132 (6.0) | 39 (29.5) | 90 (68.2) | 3 (2.3) |
| Court | 1,079 (49.0) | 453 (42.0) | 24 (2.2) | 602 (55.8) |
| Other | 99 (4.5) | 3 (3.0) | 64 (64.7) | 32 (32.3) |
Injury Frequency Data: Injury Classifications (N = 2,202)
| Total frequency (%) | Intramural frequency (%) | Club sport frequency (%) | Open recreational sports frequency (%) | |
|---|---|---|---|---|
| Injury type | ||||
| General medical | 354 (16.1) | 159 (44.9) | 41 (11.6) | 154 (43.5) |
| Musculoskeletal | 1,692 (76.8) | 1,031 (60.9) | 142 (8.4) | 519 (30.7) |
| Head/concussion | 156 (7.1) | 105 (67.3) | 35 (22.4) | 16 (10.3) |
| Body region | ||||
| Head/face/neck | 509 (20.0) | 289 (56.8) | 69 (13.5) | 151 (29.7) |
| Upper extremity | 385 (20.0) | 221 (57.4) | 44 (11.4) | 120 (31.2) |
| Lower extremity | 1,240 (50.6) | 751 (60.6) | 88 (7.1) | 401 (32.3) |
| Trunk | 35 (2.5) | 22 (62.8) | 3 (8.6) | 10 (28.6) |
| Whole body | 31 (6.8) | 11 (35.5) | 13 (41.9) | 7 (22.6) |
| Unspecified | 2 (0.1) | 1 (50.0) | 1 (50.0) | 0 (0.0) |
| Body part | ||||
| Foot/toes | 66 (3.0) | 39 (59.1) | 8 (12.1) | 19 (28.8) |
| Ankle | 565 (25.7) | 282 (49.9) | 35 (6.2) | 248 (43.9) |
| Lower leg/Achilles | 28 (1.3) | 20 (71.4) | 4 (14.3) | 4 (14.3) |
| Knee | 457 (20.8) | 309 (67.6) | 32 (7.0) | 116 (25.4) |
| Thigh/upper leg | 64 (2.9) | 52 (81.2) | 6 (9.4) | 6 (9.4) |
| Hip/pelvis | 18 (0.8) | 15 (83.3) | 1 (5.6) | 2 (11.1) |
| Abdominothoracic | 12 (0.5) | 5 (41.7) | 2 (16.6) | 5 (41.7) |
| Vertebral/paraspinal | 23 (1.0) | 16 (69.6) | 2 (8.7) | 5 (21.7) |
| Shoulder | 133 (6.0) | 71 (53.4) | 21 (15.8) | 41 (30.8) |
| Arm/elbow | 41 (1.9) | 26 (63.4) | 4 (9.8) | 11 (26.8) |
| Hand/wrist | 207 (9.4) | 120 (58.0) | 20 (9.7) | 67 (32.3) |
| Neck | 6 (0.3) | 3 (50.0) | 1 (16.7) | 2 (33.3) |
| Head/face | 494 (22.4) | 280 (56.7) | 66 (13.4) | 148 (29.9) |
| Multijoint | 21 (1.0) | 14 (66.7) | 2 (9.5) | 5 (23.8) |
| Unspecified lower extremity | 36 (1.6) | 31 (86.1) | 2 (5.6) | 3 (8.3) |
| General medical condition | 31 (1.4) | 12 (38.7) | 12 (38.7) | 7 (22.6) |
Discussion
The purpose of this study was to describe injury frequency for college recreational sport activities by year, semester, indoor/outdoor locations, playing surface type, activity, injury type, body region, and body part. Overall, the fall semester had the highest frequency of injuries reported especially on turf and court surfaces. Intramural sports also had the highest frequency of injury for all activity types. Musculoskeletal injuries accounted for 76.8% of injury types while intramural and club sports accounted for almost 90% of all head/concussion injuries.
The low frequency of injuries in academic years 2016–2017 and 2017–2018 suggests that there could have been some determinant in the reporting of injuries. It is possible that some injuries that occurred during these time periods were not reported, since all injury reports in this data set were reported by student employees. There was also a notable shift in reported club sport injuries with the range from 26 to 32 reported injuries/year in 2013–2018, while there were 73 reported injuries in the 2018–2019 academic year. This could be attributed to club sport participation increasing by over 800 club sport athletes from years 2017–2018 to 2018–2019 alone, and nearly doubling from 2013–2014 to 2018–2019 (Table 1).
The fall semester had the highest number of injuries followed by the spring semester, and the least number of injuries were in the summer. This could be due to lower student enrollment in the summer (Table 1), and usage of facilities and programs being highest in the fall and spring semesters. The injury frequencies for semester and activity revealed intramural sport injuries were most frequent in the fall, dropping in spring, and much less in the summer (Table 3). This change in frequency could be explained by the types of intramural sports active in the different semesters (Table 2). Club sport injury frequency was steady between fall and spring semesters and dropped in the summer. Most club sport teams were only active in the fall and spring semesters, which support the decrease in reported injuries in the summer semesters (Table 3).
The playing surface type suggests that most reported injuries occurred at a turf field or on a court surface while there was a close split between indoor and outdoor injuries (Table 3). We also observed a steady increase in reported injuries on the grass playing surface over the 6-year period, which should be expected since club sports at this institution were typically the only activity utilizing the grass fields.
Musculoskeletal injuries were the most common type of injury followed by general medical and head/concussion (Table 4). Overall head/concussion frequency (7.1%) is slightly larger than the NCAA findings of 5.8%.14 Lower-extremity injuries accounted for over 50% of the injured body regions followed by head/face/neck and upper extremity. These results are similar to other findings that lower-extremity injuries are the most frequently injured body region.14 Ankle and knee were two of the most injured body parts, which is consistent with many NCAA epidemiological reports.19–23 However, head/face injuries similarly accounted for 22.4% of all injured body parts, which is much higher compared with all NCAA epidemiological studies.19–29
Although the total head/concussion frequency was still close to the NCAA findings of 5.8%14; the head/concussion frequency is much higher for intramural sports (8.1%) and club sports (16.1%) individually. Lower-extremity injuries were the most common injured body region for intramural, club, and open recreational sports. Sport-related activities continue to present higher frequencies of musculoskeletal and head/concussion injuries (Table 4).
One limitation to the study is that this data is representative of only one institution and may not reflect injury frequencies of other institutions that vary in size, geographical location, and number and types of recreational sports offered. Injury reports used in this study were not created for injury tracking or documenting follow-up care for injured individuals, but for liability reasons for the facility and programming. A second limitation is that the injuries in this study are all acute in nature and majority of initial injury documentation were reported by various student employees. Thus, student employees may have different reporting strategies depending on their training and supervisory roles.
This research provides clinical implications for quality improvement within the college and university recreation center facilities and programs. Findings suggest that the prioritization of medical coverage should be dependent on activity and location since the highest frequency of musculoskeletal injury occurred within recreational sport programs and locations hosting recreational sport events. Subsequently, training of student employees who document injury reports should be consistent year to year to ensure that all injuries that occur are documented appropriately and in a detailed manner.
Further research is needed of recreational injury data frequencies and sport-specific injury rates (per 1,000 exposures) across other universities of different sizes, climates, and organizational structures. College recreation centers should also consider using injury surveillance systems to efficiently track injuries occurring during these activities and for specific intramural or club sport team analysis. Additionally, due to the high frequency of musculoskeletal injury, future research should investigate injury frequencies of college recreation centers with and without the employment and assignment of athletic trainers who can implement preventative care programs.30
Conclusions
Within a large, Division I Recreation and Wellness Center, musculoskeletal injuries were the most common type of injury with the lower extremity as the most often injured body region and ankle, knee, and head/face as the most often injured body parts. Sport participation had a high frequency of musculoskeletal injury, and organized sports (intramural and club) had a high frequency of head/concussion injury types. These results support the need for employing medical professionals such as athletic trainers to provide medical services during these activities, and prioritizing their placement, depending on activity and location. These results also suggest the need for consistent documentation procedures within college recreation programs, injury surveillance systems to accurately track acute and chronic injuries, as well as further tracking of participation statistics for specific intramural and club sport participation.
Acknowledgment
The authors would like to acknowledge the University of Central Florida Recreation and Wellness Staff for their assistance in data collection.
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