Background Stress fractures are common sports-related injuries; female and endurance athletes are known to be at a higher risk than the general athlete population. There are thousands of collegiate athletes in the United States competing in high-impact sports, but no large study has been conducted to determine the incidence of stress fractures in this population. Our objective was to calculate the incidence of stress fractures in National Collegiate Athletic Association athletes and investigate epidemiological trends in specific subgroups of athletes.
Methods Data were analysed from the NCAA Injury Surveillance Program from 2009–2010 to 2014–2015 academic years.
Results A total of 747 stress fractures resulting in time loss were reported during 18,054,757 athletic exposures (AE) for an overall rate of 0.53/10,000 AE (95% CI: 0.50, 0.57). The rate of fracture was higher overall among female athletes (RR = 2.06; 95% CI: 1.71, 2.47). Female cross country runners had higher fracture rates than males runners (RR = 1.77; 95% CI: 1.05, 2.98), but this was also noted in female versus male soccer (RR = 1.69; 95% CI: 1.09, 2.63) and basketball (RR = 1.69; 95% CI: 1.26, 2.28) players. The pre-season rate was larger than the regular-/post-season rate (RR = 3.27; 95% CI: 2.83, 3.78). The most common stress fracture locations were the metatarsals (38.8%, N = 290), tibia (20.7%, N = 155), and the lower back/lumbar spine/pelvis (13.4%, N = 100) and 22.5% (N = 165) of stress fractures were recurrent.
Conclusion Females had higher fracture rates of stress fractures than males; but future work needs to focus on improved screening tools for female athletes for all sports as our results found a gender disparity in additional sports from the well-known cross-country athletes. A fifth of fractures are recurrent, potentially highlighting the need to reassess post-injury return to play policies.
- stress fracture
- overuse injury
- college athlete
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