Basketball is one of the most popular sports in the United
States, with 556 269 boys and 456 967 girls participating in
high school basketball during the 2006-2007 academic year.33
Over the past 20 years, boys’ participation rates have
increased more than 10%, whereas girls’ participation rates
have risen nearly 20%.33This higher participation rate
among girls is largely attributed to the effects of Title IX,
the federal law that requires gender equity in sports pro-
grams,7and to recent emphasis on the importance of physi-
cal activity.8Despite the numerous health benefits including
improved self-esteem, weight control, and increased
strength,41participation in a physically demanding sport,
such as basketball, can result in increased risk of injury.
Previously reported high school basketball competition
injury rates have been as high as 7.9 injuries per 1000 ath-
lete exposures (AEs) for girls and 7.1 injuries per 1000 AEs
for boys.35High school basketball injuries can result in loss
of playing time, doctor and hospital visits, and increased
health care cost.6
A number of epidemiological studies describing basketball
injuries have previously been published. Some have focused
on specific levels of competition, calculating injury rates
The Epidemiology of US High School
Basketball Injuries, 2005-2007
Laurel A. Borowski,*† MPH, Ellen E. Yard,†‡MPH, Sarah K. Fields,§JD, PhD,
and R. Dawn Comstock,‡llPhD
From the *Ohio State University, College of Public Health, Columbus, Ohio, ‡Center for Injury
Research and Policy, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,
§Ohio State University, School of Physical Activity and Educational Services, Columbus, Ohio,
and llOhio State University, College of Medicine, Department of Pediatrics and College of
Public Health, Division of Epidemiology, Columbus, Ohio
Background: With more than a million high school athletes playing during the 2006-2007 academic year, basketball is one of
the most popular sports in the United States.
Hypothesis: Basketball injury rates and patterns differ by gender and type of exposure.
Study Design: Descriptive epidemiology study.
Methods: Basketball-related injury data were collected during the 2005-2006 and 2006-2007 academic years from 100 nation-
ally representative US high schools via Reporting Information Online.
Results: High school basketball players sustained 1518 injuries during 780 651 athlete exposures for an injury rate of 1.94 per
1000 athlete exposures. The injury rate per 1000 athlete exposures was greater during competition (3.27) than during practice
(1.40; rate ratio, 2.33; 95% confidence interval, 2.10-2.57) and was greater among girls (2.08) than among boys (1.83; rate ratio,
1.14; 95% confidence interval, 1.03-1.26). The ankle/foot (39.7%), knee (14.7%), head/face/neck (13.6%), arm/hand (9.6%), and
hip/thigh/upper leg (8.4%) were most commonly injured. The most frequent injury diagnoses were ligament sprains (44.0%),
muscle/tendon strains (17.7%), contusions (8.6%), fractures (8.5%), and concussions (7.0%). Female basketball players sus-
tained a greater proportion of concussions (injury proportion ratio, 2.41; 95% confidence interval, 1.49-3.91) and knee injuries
(injury proportion ratio, 1.71; 95% confidence interval, 1.27-2.30), whereas boys more frequently sustained fractures (injury pro-
portion ratio, 1.87; 95% confidence interval, 1.27-2.77) and contusions (injury proportion ratio, 1.52; 95% confidence interval,
1.00-2.31). The most common girls’ injury requiring surgery was knee ligament sprains (47.9%).
Conclusion: High school basketball injury patterns vary by gender and type of exposure. This study suggests several areas of
emphasis for targeted injury prevention interventions.
Keywords: high school; basketball; injury; gender; epidemiology; surveillance
†Address correspondence to Ellen E. Yard, MPH, Center for Injury
Research and Policy, Research Institute at Nationwide Children’s
Hospital, 700 Children’s Drive, Columbus, OH 43205 (e-mail:
No potential conflict of interest declared.
The content of this article is solely the responsibility of the authors and
does not necessarily reflect the official view of the CDC.
The American Journal of Sports Medicine, Vol. 36, No. 12
© 2008 American Orthopaedic Society for Sports Medicine
Vol. 36, No. 12, 2008 Epidemiology of US High School Basketball Injuries
among collegiate,21,29adult,10professional,11and high school
basketball players.14,19,30,35Other studies have focused on a
specific body site or diagnosis such as ankle injuries,26shoul-
der injuries,20or concussions.18Several have compared
injury rates between genders.27,28,36Although the most com-
prehensive study to date (conducted more than a decade ago)
found no gender differences in high school basketball injury
rates,35other research has reported that injury rates differ
by gender, especially for injuries to the knee.2These prior
studies are largely restricted by sample size10or geographic
location19,27,30or are simply outdated.30,35
In the current study, we describe and compare the epi-
demiology of injuries among high school basketball players
using a nationally representative sample. Specifically, we (1)
calculate basketball injury rates during the 2005-2006 and
2006-2007 academic years, (2) describe patterns of injury,
and (3) compare injury rates and patterns by gender and
type of exposure. Understanding the epidemiology of athletic
injuries is an important first step in the development of tar-
geted evidence-based interventions to reduce such injuries.
High School Reporting Information Online (RIO), an
Internet-based sports-related injury surveillance system
that captured injuries during the 2005-2006 and 2006-2007
academic years from 100 nationally representative US high
schools, has been described previously.9,13,34,38,42Briefly, eligi-
ble schools (ie, US high schools with a National Athletic
Trainers’ Association–affiliated certified athletic trainer [AT]
willing to serve as reporter) were categorized by geographic
location40and school size (enrollment ≤1000 students or
>1000 students), and participants were randomly selected
from each substrata to obtain 100 study schools. If a school
dropped out of the surveillance study, a replacement school
from the same sampling stratum was enrolled. Participating
certified ATs logged onto RIO weekly to report basketball
injury and exposure data. Only the primary injury sustained
during each injury event was reported.
Definition of Injury and Exposure
An AE consisted of 1 athlete participating in 1 basketball
practice or competition. An injury was defined as one that
met the following 3 criteria: (1) occurred as a result of par-
ticipation in an organized high school basketball practice or
competition, (2) required medical attention by an AT or a
physician, and (3) resulted in restriction of the student-
athlete’s participation for 1 or more days beyond the day of
the injury. For each injury, detailed injury reports describing
characteristics of the injured player (eg, age, height, weight),
the injury (eg, site, new or recurrence, severity), and the
event leading to injury (eg, mechanism, action ruled as ille-
gal activity by referee/disciplinary committee) were com-
pleted by the ATs.If a player sustained an injury,returned to
play, and sustained a second injury, ATs were instructed to
submit 2 separate injury reports and label the second injury
a recurrence.Throughout the study,ATs were able to view all
data they submitted as well as to update reports as needed
(eg, need for surgery, days until return to play).
Data were analyzed using SPSS software,version 14.0 (SPSS,
Chicago, Illinois) and Epi-Info, version 6.0 (Centers for
Disease Control and Prevention, Atlanta, Georgia). All rate
calculations and rate comparisons used unweighted case
counts.Additional analyses used national estimates, with the
standard errors for comparison between gender and between
practice and competition adjusted for the High School RIO
sampling plan using the SPSS complex samples module.
Rates of injury were calculated as the ratio of injuries per
1000 AE. Injury rate ratio (RR) and injury proportion ratio
(IPR) were calculated with 95% confidence interval (CI) and
P values (CI not including 1.00 and P < .05 were considered
statistically significant).An RR or IPR > 1.00 suggests a risk
association, whereas an RR or IPR < 1.00 suggests a protec-
tive association.The following is an example of the RR calcu-
lation comparing the rate of girls’ basketball injuries to the
rate of boys’ basketball injuries:
(No. girls’ basketball injuries/
No. girls’ basketball AEs)
RR = ——————————————
(No. boys’ basketball injuries/
No. boys’ basketball AEs).
The following is an example of an IPR calculation comparing
the proportion of fractures between competition and practice:
(National estimated No. competition
No. total competition injuries)
IPR = —————————————————
(National estimated No. practice
No. total practice injuries).
This study was approved by the institutional review board
at the Research Institute at Nationwide Children’s Hospital.
Rates of Adverse Events
During the 2005-2006 and 2006-2007 high school academic
years,ATs reported 1518 basketball injuries (745 girls’ and
773 boys’) occurred during 780 651 AE (357 412 girls’ bas-
ketball exposures and 423 239 boys’ basketball exposures)
for an injury rate of 1.94 per 1000 AE (Table 1). Applying
our weighting algorithm to the AT-reported number of
basketball injuries, we estimated 409 958 basketball-
related injuries occurred nationally (212 662 injuries in
girls’ basketball and 197 296 injuries in boys’ basketball)
during this period. The overall rate of injury for girls’ bas-
ketball was 2.08 per 1000 AE (3.66 and 1.43, respectively,
Borowski et alThe American Journal of Sports Medicine
for competition and practice) and for boys’ basketball was
1.83 per 1000 AE (2.93 and 1.38, respectively, for compe-
tition and practice). The girls’ basketball injury rate was
higher than the boys’ (RR, 1.14; 95% CI, 1.03-1.26; P <
.01). The risk of injury was significantly higher in compe-
tition than in practice for both girls (RR, 2.55; 95% CI,
2.21-2.95; P < .01) and boys (RR, 2.12; 95% CI, 1.84-2.45;
P < .01).
Characteristics of High School Injuries
Overall. Of the estimated 409 958 basketball-related
injuries, 51.9% were sustained by girls. The majority of
injuries were new (83.6%) as opposed to recurrence of a
prior injury. Overall, the most common body sites injured
were the ankle/foot (39.7%), knee (14.7%), head/face/neck
(13.6%), arm/hand (9.6%), and hip/thigh/upper leg (8.4%).
The most frequent injury diagnoses were ligament sprains
(44.0%), muscle/tendon strains (17.7%), contusions (8.6%),
fractures (8.5%), and concussions (7.0%). Diagnoses of
muscle/tendon strains included complete and incomplete
muscle tears and tendon strains, tendinitis, and torn carti-
lage. Muscle/tendon strains were most common in the
hip/thigh/upper leg (32.6%), knee (23.2 %), trunk (12.0%),
and lower leg (11.8%). Fractures were most common to the
lower arm/hand (42.7%), head/face/neck (23.9%), and
More than half of the injuries resulted in a time loss of
less than a week (51.3%), 1 to 3 weeks (30.0%), and more
than 3 weeks (8.1%). More specifically, 8.5% of all injuries
were season ending, and 7.5% of all injuries required
surgery. Fractures (21.8%), muscle/tendon strains (7.9%),
and ligament sprains (6.7%) most frequently required
Gender comparisons. Overall, girls and boys sustained
ankle/foot (35.9% and 43.2%, respectively), knee (18.2%
and 10.6%, respectively), head/face/neck (14.2% and 12.8%,
respectively), lower arm/hand (9.5% and 9.4%, respec-
tively), and hip/thigh/upper leg (8.7% and 8.2%, respec-
tively) injuries most often (Figure 1). Girls were more
likely to injure a knee (IPR, 1.71; 95% CI, 1.27-2.30; P <
.01), whereas boys were more likely to injure their trunks
(IPR, 1.72; 95% CI, 1.05-2.83; P = .03) and ankle/foot (IPR,
1.20; 95% CI, 1.04-1.40; P = .01).
The most common injury diagnoses among both female and
male basketball players were ligament sprains (43.6%
and 44.5%, respectively) and muscle/tendon strains (19.4%
and 15.8%, respectively) (Figure 2). Female basketball
players sustained a greater proportion of concussions (IPR,
2.41; 95% CI, 1.49-3.91; P < .01), whereas boys more fre-
quently sustained fractures (IPR, 1.87; 95% CI, 1.27-2.77;
P < .01).
Although the difference was not significant, girls were
more likely to sustain injuries requiring surgery than were
boys (IPR, 1.51; 95% CI, 0.97-2.36; P < .01) (Table 2), par-
ticularly for ligament sprains (10.2% and 2.9%, respec-
tively) and muscle/tendon strains (10.1% and 5.0%,
respectively). The most common girls’ injuries requiring
surgery were knee ligament sprains (47.9%), knee mus-
cle/tendon strains (22.1%), head/neck/face fractures (6.5%),
and arm/hand fractures (5.1%). The most common boys’
injuries requiring surgery were head/face/neck fractures
(23.4%), knee ligament sprains (17.4%), knee muscle/ten-
don strains (13.5%), and arm/hand fractures (8.3%). Girls
more frequently required surgery for knee ligament
sprains (IPR, 2.74; 95% CI, 1.21-6.23; P < .01), whereas
boys more frequently required surgery for head/face/neck
fractures (IPR, 4.43; 95% CI, 1.25-15.68; P < .01).
Overall, girls and boys returned to activity after injury
most frequently in less than 1 week (47.7% and 55.3%,
respectively), followed by 1 to 3 weeks (30.7% and 29.2%,
respectively), and more than 3 weeks (including season
ending, athlete chooses not to continue, and athlete
released from team; 20.7% and 14.4%, respectively) after
injury (Table 2).
Athlete exposure comparisons. In girls’ basketball practice,
the most commonly injured body sites were the ankle/foot
(35.4%), knee (17.2%), and hip/thigh/upper leg (13.9%),
whereas in competition, the most commonly injured body
sites were the ankle/foot (37.0%), head/face/neck (21.3%), and
knee (19.5%). Girls were more likely to injure the
hip/thigh/upper leg (IPR,3.63;95% CI,1.79-7.35;P < .01) and
lower leg (IPR,3.14;95% CI,1.24-7.94;P< .01) in practice and
more likely to injure the head/face/neck in competition (IPR,
Rates of Injury by Type of Athlete Exposure in Girls’ and Boys’ High School Basketball, National High School
Sports-Related Injury Surveillance Study, United States, 2005-2006 and 2006-2007 Academic Years
Injury Rate per
1000 Athlete Exposures
Rate Ratio (95%
Vol. 36, No. 12, 2008 Epidemiology of US High School Basketball Injuries
3.26; 95% CI, 1.94-5.47; P < .01). In boys’ basketball practice,
the most commonly injured body sites were the ankle/foot
(45.2%), arm/hand (11.5%), knee (10.1%), and head/face/neck
(10.0%), whereas in competition, the most commonly injured
body sites were the ankle/foot (41.6%), head/face/neck
(16.4%),and knee (11.5%).Boys were more likely to injure the
arm/hand in practice (IPR, 1.47; 95% CI, 0.89-2.43; P = .13)
and more likely to injure the head/face/neck in competition
(IPR, 1.64; 95% CI, 1.06-2.55; P = .02), although the former
was not statistically significant.
In competition, girls were more likely to injure the knee
(IPR, 1.70; 95% CI, 1.13-2.55; P = .01), whereas boys were
more likely to injure the hip/thigh/upper leg (IPR, 2.26;
95% CI, 1.10-4.66; P = .02). In practice girls were more
likely than were boys to injure the lower leg (IPR, 2.49;
95% CI, 1.22-5.10; P = .01), knee (IPR, 1.70; 95% CI, 1.11-
2.61; P = .01), and hip/thigh/upper leg (IPR, 1.79; 95% CI,
1.07-2.98; P = .03).
In girls’ and boys’ basketball, muscle/tendon strains
(IPR, 1.96; 95% CI, 1.48-2.58; P < .01) were more common
in practice, whereas concussions occurred more fre-
quently in competition (IPR, 2.82; 95% CI, 1.69-4.71; P <
.01) (Figure 2). In boys’ basketball, contusions occurred
more frequently in competition (IPR, 2.20; 95% CI, 1.35-
3.59; P < .01).
The majority of competition injuries in both girls’ and
boys’ basketball resulted in a return to activity in 1 to 6
days (49.6% and 56.4%, respectively) (Table 2). Although
not a significant difference, more female basketball players
(13.3%) were medically disqualified and could not return to
play from competition injuries than were male players
(8.0%; IPR, 1.66; 95% CI, 1.00-2.76; P = .05). In practice, the
highest proportion of girls’ and boys’ basketball injuries
resulted in a return to activity in 1 to 6 days (45.7% and
Overall. In both girls’ and boys’ basketball, the guard posi-
tion accounted for the most injuries (50.3% and 45.9%,
respectively), followed by forward (34.7% and 40.8%, respec-
tively), and center (14.1% and 13.0%, respectively). Injury
diagnosis and body site varied little by position, with guards,
forwards, and centers all sustaining ligament sprains
(45.5%, 39.9%, and 48.5%, respectively) and ankle/foot
injuries (40.7%, 36.4%, and 44.7%, respectively) most fre-
quently. The basketball activities that most frequently
resulted in injuries were rebounding (25.1%), defending
(14.8%), general play (16.9%), ball handling/dribbling (8.9%),
and shooting (8.5%). The specific mechanisms that resulted
Girls’ Basketball, n = 211535† Boys’ Basketball, n = 196829†
upper leg, 8.7%
upper leg, 8.2%
United States, 2005-2006 and 2006-2007 academic years. Data were weighted to be nationally representative †Because a small
number of injury reports did not state the body site of injury, numbers are similar to but slightly smaller than the total number of
injuries ‡Other includes respiratory illness, internal organ damage, and so forth.
Body sites injured in high school girls’ and boys’ basketball, High School Sports-Related Injury Surveillance Study,
Borowski et al The American Journal of Sports Medicine
in injury most frequently were collision with another player
(22.5%), jumping/landing (17.5%), stepped on/fell on/kicked
(13.4%), and rotation around a planted foot/inversion
Injuries to the head/face/neck were caused most frequently
by collision with another player (71.4%) and contact with floor
(8.4%).Ankle/foot injuries were attributed to jumping/landing
(30.5%), stepped on/fell on/kicked (21.0%), and rotation
around a planted foot/inversion (20.6%). Knee injuries were
caused by collision with another player (24.6%), rotation
around a planted foot/inversion (19.9%),and jumping/landing
Ligament sprains were caused by jumping/landing
(29.4%), rotation around a planted foot/inversion (21.1%),
and stepped on/fell on/kicked (19.2%) and occurred most
often during rebounding (33.1%), general play (14.0%),
defending (13.0%), and shooting (12.1%). Muscle/tendon
strains were caused by overuse, conditioning, and so forth
(29.5%), as well as jumping/landing (13.8%), and occurred
during general play (24.5%), conditioning (20.6%), rebound-
ing (14.9%), and defending (14.9%). Concussions were
caused by collision with another player (64.7%) and contact
with floor (12.9%) and occurred during rebounding (29.4%)
and defending (19.2%). Fractures were caused by collision
with another player (36.8%) and contact with ball (16.9%).
Illegal activity was associated with 12.5% of all injuries.
These included 34.4% of head/face/neck, 19.3% of upper
arm/shoulder, 17.0% of arm/hand, 14.0% of trunk, and
11.8% of lower leg injuries, as well as 35.4% of concussions,
18.7% of contusions, and 18.2% of fractures.
Gender comparisons. Girls were more likely to become
injured while ball handling/dribbling (IPR, 1.68; 95% CI,
Girls’ Basketball, n = 212662
Boys’ Basketball, n = 197296
Figure 2. Most common injury diagnoses among high school female and male basketball players by type of athlete exposure,
National High School Sports-Related Injury Surveillance Study, United States, 2005-2006 and 2006-2007 academic years. Data
were weighted to be nationally representative. †Muscle/tendon strain includes complete and incomplete muscle tears, tendon
strain, tendinitis, and torn cartilage. ‡Other diagnoses include heatstroke, dehydration, infection, and so forth.
Vol. 36, No. 12, 2008 Epidemiology of US High School Basketball Injuries
1.10-2.55; P = .02), whereas boys were more likely to
become injured while rebounding (IPR, 1.72; 95% CI, 1.39-
2.13; P < .01). Girls were more often injured while running
(IPR, 9.06; 95% CI, 3.98-20.63; P < .01). Running resulted
in 32.2% of girls’ hip/thigh/upper leg and 15.8% of girls’
lower leg injuries. Overall, boys were more likely than
were girls to become injured by collisions with another
player (IPR, 1.31; 95% CI, 1.04-1.65; P = .02). Collisions
with another player resulted in 79.3% of boys’ head/
face/neck and 45.5% of boys’ upper arm/shoulder injuries,
along with 64.5% of boys’ concussions, 56.3% of boys’
contusions, and 41.8% of boys’ fractures.
Injuries related to illegal activity/foul play were more com-
mon in girls’ basketball (14.1%) than in boys’ basketball
(10.6%). The majority of these injuries were to the
head/face/neck (52.7%), knee (10.5%), and arm/hand (9.5%).
Athlete exposure comparisons. Injuries from collisions
with other players occurred more frequently during com-
petition than during practice for both girls and boys (IPR,
2.19; 95% CI, 1.71-2.79; P < .01). Overall, collisions with
another player most frequently resulted in head/face/neck
(44.2%), knee (15.7%), and ankle/foot (14.0%) injuries.
Our study, the only nationally representative study of high
school basketball injuries conducted this decade, found
that injury rates and patterns differed by gender and type
of exposure. The growth in high school basketball partici-
pation creates an urgent need for such surveillance to
identify potential avenues for injury prevention. The
awareness of sport-specific injury patterns should help
ATs, coaches, and researchers develop targeted injury pre-
vention interventions. Continued surveillance will be use-
ful to determine intervention effectiveness.
Our injury rates of 2.08 per 1000 AE in girls’ basketball
and 1.83 per 1000 AE in boys’ basketball are lower than
those reported in previous studies. Powell and Barber-
Foss35reported that rates for girls were 3.2 per 1000 AE in
practice and 7.9 per 1000 AE in competition and for boys
3.4 per 1000 AE in practice and 7.1 per 1000 AE in compe-
tition. Knowles et al19reported that girls’ injury rates were
1.28 per 1000 AE and boys’ basketball injury rates were
2.32 per 1000 AE. Differences between our findings and
those of Powell and Barber-Foss could be attributed to the
more inclusive injury definition used in their study.
Because the study by Powell and Barber-Foss included
only varsity athletes, whereas the current study included
all levels, this could reflect an underlying higher injury
rate among varsity athletes. Although preventive meas-
ures such as strength and conditioning programs, protec-
tive equipment use, and stricter officiating may have
improved over the past decade, little research has quanti-
tatively measured these changes.
Our study found that the most commonly injured body
site was the ankle/foot, which is consistent with previous
studies.11,21,29,30,35We found that girls had a higher rate of
knee injuries, which also supports previous stud-
ies.11,21,30,31,36Because similar body sites in each gender are
repeatedly being injured, preventive measures should be
targeted toward these specific body parts to reduce the risk
of injury. The use of appropriate protective equipment,
such as foot orthotic devices,17should also be emphasized
during both practices and competitions because the ankle/
foot area accounts for the largest proportion of injuries.
More research is needed to determine the effectiveness
and correct use of ankle braces/taping26and knee braces.
Our data indicated ligament sprains and muscle/tendon
strains to be the most common injury diagnoses. Similar
results were reported by previous studies,27,36with Lanese
et al21reporting that strains/sprains accounted for nearly
Injury Severity Among High School Girls’ and Boys’ Basketball Players by Type of Athlete Exposure, National High
School Sports-Related Injury Surveillance Study, United States, 2005-2006 and 2006-2007 Academic Yearsa
Overall Girls’ BasketballBoys’ Basketball
Competition PracticeCompetition PracticeCompetition Practice
Returned to activity in <1 week
Returned to activity in 1-3 weeks
Returned to activity in >3 weeks
released from team or chooses
not to return
Need for surgery
aData are in percentages.
Borowski et al The American Journal of Sports Medicine
50% of all injuries. Meeuwisse et al29found that ankle and
thigh strains were most frequent followed by concussions,
and Messina et al30found sprains were most common fol-
lowed by contusion, fractures, dislocations, and concus-
sions. Our study found that muscle/tendon strains
occurred more frequently during practice, which could be
attributed to overuse or improper conditioning programs.
Rebounding accounted for the majority of basketball
injuries, and jumping/landing caused the majority of
ligament sprains. Programs that focus on jumping or bal-
ance training could prove to be effective injury prevention
We found injury rates and patterns differed between
genders. Previous studies have shown inconsistent results
regarding injury rates between genders; some reported no
differences,21,30,35and 1 study reported higher rates in
girls.11One specific difference we found was that girls were
50% more likely to require surgery than were boys. This is
similar to previous research.30,35One potential explanation
for the observed gender differences in these studies might
be different types of conditioning programs for female ath-
letes versus male athletes.16Extrinsic factors such as dif-
ferent equipment, different game facilities, and different
competition environments could also affect the different
injury rates as measured by the various studies. The dif-
ferent injury rates between genders generally might also
be explained by physiological differences such as the
anatomical differences in joint and bone structure,3,22,39
variations between flexibility and strength, and hormonal
differences.1,23Finally, it is possible that either male or
female athletes in our study may have been less likely to
seek AT care for minor injuries.
Consistent with previous research, we found girls were
twice as likely to sustain a concussion as were boys.11,37
Although it has been argued that male athletes may be at
greater risk for concussion owing to their aggressive play5
and the fast pace of their sports, female athletes actually
may be at greater risk owing to their smaller size and
weaker neck strength.5,24As the size and strength in the
girls’ game continue to increase in this relatively high-risk
contact sport, we expect the number of concussions to con-
tinue to increase unless preventive measures are taken.
Consistent with previous studies, we found higher injury
rates in competition than in practice.4,30Not only were the
rates of injury higher in competition, but severe injuries
such as concussions, contusions, and fractures were more
likely to occur. Contributing factors to the increased injury
rate in competition could be player-to-player contact,
increased intensity, and less controlled game situations.
Tougher regulations and officiating during competitions
could decrease serious injuries including concussions and
fractures, although previous research is limited in this
Like all studies, this study has limitations. Because only
high schools with National Athletic Trainers’ Association–
affiliated ATs were eligible, generalizability of our findings
could be limited. Although differences could exist
between schools with and without an AT, using trained med-
ical professionals as data reporters improved data quality.
Second,only time loss injuries were included in our study,and
by not including less severe injuries,we ultimately underesti-
mated the true injury rate. This limitation was necessary to
reduce reporter time burden and was considered acceptable
given the decreased clinical importance of non–time loss
injuries. Finally, the AE classification could have been a limi-
tation because it does not include the actual amount of time
each player participated in each practice or competition.
However,our definition of AE was more feasible because high
school ATs cannot be present to record the time-based expo-
sure for every athlete in every practice and competition. In
addition,we believe every athlete is at risk during every prac-
tice or competition in which he or she participates.This study
is limited to in-season high school basketball events and does
not include off-season or club events because the ATs did not
track out-of-school exposures. Despite these limitations, this
is the most comprehensive study of basketball injuries among
a nationally representative population of US high school ath-
letes in the past decade.
Future research is needed to enhance our knowledge
of high school basketball injuries. Randomized, controlled
clinical trials investigating the effectiveness of specific
preventive interventions, such as tailored knee condition-
ing programs or the use of prophylactic braces, could be
useful. Such research would add to the growing body of
knowledge on the patterns of injury among high school
basketball athletes and could help drive the development
and implementation of more effective targeted preventive
interventions. Continued surveillance of nationally repre-
sentative samples of US high school basketball players is
essential to fully understand the injuries in this popular
US sport. The increased quantity of data will aid in the
development of more precise prevention methods and can
measure the impact of any interventions.
This report was funded in part by the Centers for Disease
Control and Prevention (CDC) grant No.R49/CE000674-01.
1.Adachi N, Nawata K, Maeta M, Kurozawa Y. Relationship of the
menstrual cycle phase to anterior cruciate ligament injuries in
teenaged female athletes. Arch Orthop Trauma Surg. 2008;
2. Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in
National Collegiate Athletic Association basketball and soccer: a 13-
year review. Am J Sports Med. 2005;33(4):524-530.
3. Anderson AF, Dome DC, Gautam S, Awh MH, Rennirt GW. Correlation
of anthropometric measurements, strength, anterior cruciate ligament
size, and intercondylar notch characteristics to sex differences in
anterior cruciate ligament tear rates. Am J Sports Med. 2001;
4. Arendt E, Dick R. Knee injury patterns among men and women in col-
legiate basketball and soccer: NCAA data and review of literature. Am
J Sports Med. 1995;23(6):694-701.
5. Barnes BC, Cooper L, Kirkendall DT, McDermott TP, Jordan BD,
Garrett WE Jr. Concussion history in elite male and female soccer
players. Am J Sports Med. 1998;26(3):433-438.
Vol. 36, No. 12, 2008Epidemiology of US High School Basketball Injuries Download full-text
6. Burt CW, Overpeck MD. Emergency visits for sports-related injuries.
Ann Emerg Med. 2001;37(3):301-308.
7. Carpenter L, Acosta R. Title IX. Champaign, Ill: Human Kinetics; 2005.
8. Centers for Disease Control and Prevention. Guidelines for school
and community programs to promote lifelong physical activity among
young people. MMWR Recomm Rep. 1997;46(RR-6):1-36.
9. Centers for Disease Control and Prevention. Sports-related injuries
among high school athletes: United States, 2005-06 school year.
MMWR Morb Mortal Wkly Rep. 2006;55(38):1037-1040.
10. Cumps E. Prospective epidemiological study of basketball injuries
during one competitive season: ankle sprains and overuse knee
injuries. J Sports Sci Med. 2007;6(2):204-208.
11. Deitch JR, Starkey C, Walters SL, Moseley JB. Injury risk in professional
basketball players: a comparison of Women’s National Basketball Asso-
ciation and National Basketball Association athletes. Am J Sports Med.
12. Emery CA, Rose MS, McAllister JR, Meeuwisse WH. A prevention strat-
egy to reduce the incidence of injury in high school basketball: a cluster
randomized controlled trial. Clin J Sport Med. 2007;17(1):17-24.
13. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD.
Concussions among United States high school and collegiate ath-
letes. J Athl Train. 2007;42(4):495-503.
14. Gomez E, DeLee JC, Farney WC. Incidence of injury in Texas girls’
high school basketball. Am J Sports Med. 1996;24(5):684-687.
15. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of
neuromuscular training on the incidence of knee injury in female ath-
letes: a prospective study. Am J Sports Med. 1999;27(6):699-706.
16. Hutchinson MR, Ireland ML. Knee injuries in female athletes. Sports
17. Jenkins WL, Raedeke SG. Lower-extremity overuse injury and use of
foot orthotic devices in women’s basketball. J Am Podiatr Med
18. Kelly JP. Concussion in sports and recreation. Semin Neurol.
19. Knowles SB, Marshall SW, Bowling JM, et al. A prospective study of
injury incidence among North Carolina high school athletes. Am J
20. Kocher MS, Waters PM, Micheli LJ. Upper extremity injuries in the
paediatric athlete. Sports Med. 2000;30(2):117-135.
21. Lanese RR, Strauss RH, Leizman DJ, Rotondi AM. Injury and disabil-
ity in matched men’s and women’s intercollegiate sports. Am J Public
22. LaPrade RF, Burnett QM II. Femoral intercondylar notch stenosis and
correlation to anterior cruciate ligament injuries: a prospective study.
Am J Sports Med. 1994;22(2):198-203.
23. Liu SH, Al-Shaikh RA, Panossian V, Finerman GAM, Lane JM.
Estrogen affects the cellular metabolism of the anterior cruciate liga-
ment: a potential explanation for female athletic injury. Am J Sports
24. Mansell J, Tierney RT, Sitler MR, Swanik KA, Stearne D. Resistance
training and head-neck segment dynamic stabilization in male and
female collegiate soccer players. J Athl Train. 2005;40(4):310-319.
25. McGuine TA, Keene JS. The effect of a balance training program on
the risk of ankle sprains in high school athletes. Am J Sports Med.
26. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in bas-
ketball: injury rate and risk factors. Br J Sports Med. 2001;35(2):
27. McKay GD, Goldie PA, Payne WR, Oakes BW, Watson LF. A prospec-
tive study of injuries in basketball: a total profile and comparison by gen-
der and standard of competition. J Sci Med Sport. 2001;4(2):196-211.
28. McQuillan R, Campbell H. Gender differences in adolescent injury
characteristics: a population-based study of hospital A&E data.
Public Health. 2006;120(8):732-741.
29. Meeuwisse WH, Sellmer R, Hagel BE. Rates and risks of injury during
intercollegiate basketball. Am J Sports Med. 2003;31(3):379-385.
30. Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas
high school basketball: a prospective study among male and female
athletes. Am J Sports Med. 1999;27(3):294-299.
31. Mountcastle SB, Posner M, Kragh JF Jr, Taylor DC. Gender differ-
ences in anterior cruciate ligament injury vary with activity: epidemi-
ology of anterior cruciate ligament injuries in a young, athletic
population. Am J Sports Med. 2007;35(10):1635-1642.
32. Myer GD, Ford KR, Palumbo JP, Hewett TE. Neuromuscular training
improves performance and lower-extremity biomechanics in female
athletes. J Strength Cond Res. 2005;19(1):51-60.
33. National Federation of State High School Associations. 2004-06 high
school athletics participation summary. Available at: http://www.nfhs
.org/custom/participation_figures/default.aspx. Accessed September
34. Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle
injuries among United States high school sports athletes, 2005-2006.
J Athl Train. 2007;42(3):381-387.
35. Powell JW, Barber-Foss KD. Injury patterns in selected high school
sports: a review of the 1995-1997 seasons. J Athl Train. 1999;34(3):
36.Powell JW, Barber-Foss KD. Sex-related injury patterns among
selected high school sports. Am J Sports Med. 2000;28(3):385-
37. Schulz MR, Marshall SW, Mueller FO, et al. Incidence and risk factors
for concussion in high school athletes: North Carolina, 1996-1999.
Am J Epidemiol. 2004;160(10):937-944.
38.Shankar PR, Fields SK, Collins CL, Dick RW, Comstock RD.
Epidemiology of high school and collegiate football injuries in
the United States, 2005-2006. Am J Sports Med. 2007;35(8):
39. Shelbourne KD, Davis TJ, Klootwyk TE. The relationship between
intercondylar notch width of the femur and the incidence of anterior
cruciate ligament tears: a prospective study. Am J Sports Med.
40. United States Census Bureau. Census regions and divisions of the United
States. Available at: http://www.census.gov/geo/www/us_regdiv.pdf.
Accessed November 9, 2007.
41. United States Department of Health and Human Services. 1996 sur-
geon general’s report on physical activity and health. Available at:
http://www.cdc.gov/nccdphp/sgr/sgr.htm. Accessed December 18,
42. Yard EE, Collins CL, Dick RW, Comstock RD. An epidemiologic com-
parison of high school and college wrestling injuries. Am J Sports