Athletic Training and Sports Health Care

Original Research 

Prospective Injury Epidemiology in Competitive Collegiate Club Sports, Quidditch, and Ultimate Frisbee

Thomas Brezinski, MS, ATC; Joel Martin, PhD, CSCS, ACSM, EP-C; Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS

Abstract

Purpose:

To prospectively examine injury epidemiology in collegiate club sports, quidditch, and ultimate frisbee.

Methods:

The authors examined injuries (per 1,000 athlete-exposures) in 196 collegiate club sport athletes in six club sports: football (American), men's soccer, women's soccer, quidditch (mixed sex), men's ultimate frisbee, and women's ultimate frisbee over a 16-week semester.

Results:

A total of 68 of 196 (35%) student-athletes suffered injuries, resulting in an overall injury rate of 15.8 per 1,000 athlete-exposures (95% confidence interval [CI]: 12.1 to 19.6). Football had the highest injury rate (25.1; 95% CI: 5.3 to 35.0), followed by men's soccer (19.5; 95% CI: 6.0 to 33.0), quidditch (16.2; 95% CI: 6.1 to 26.2), women's soccer (14.3; 95% CI: 3.7 to 24.9), women's ultimate frisbee (11.1; 95% CI: 2.2 to 19.9), and men's ultimate frisbee (9.6; 95% CI: 4.2 to 15.1).

Conclusions:

Overall, competitive collegiate club sport student-athletes appear to have equal or sometimes even greater injury rates than collegiate sport student-athletes. The findings support the need to provide athletic training services to ensure the well-being of students participating in club sports.

[Athletic Training & Sports Health Care. 20XX;X(X):XX–XX.]

Abstract

Purpose:

To prospectively examine injury epidemiology in collegiate club sports, quidditch, and ultimate frisbee.

Methods:

The authors examined injuries (per 1,000 athlete-exposures) in 196 collegiate club sport athletes in six club sports: football (American), men's soccer, women's soccer, quidditch (mixed sex), men's ultimate frisbee, and women's ultimate frisbee over a 16-week semester.

Results:

A total of 68 of 196 (35%) student-athletes suffered injuries, resulting in an overall injury rate of 15.8 per 1,000 athlete-exposures (95% confidence interval [CI]: 12.1 to 19.6). Football had the highest injury rate (25.1; 95% CI: 5.3 to 35.0), followed by men's soccer (19.5; 95% CI: 6.0 to 33.0), quidditch (16.2; 95% CI: 6.1 to 26.2), women's soccer (14.3; 95% CI: 3.7 to 24.9), women's ultimate frisbee (11.1; 95% CI: 2.2 to 19.9), and men's ultimate frisbee (9.6; 95% CI: 4.2 to 15.1).

Conclusions:

Overall, competitive collegiate club sport student-athletes appear to have equal or sometimes even greater injury rates than collegiate sport student-athletes. The findings support the need to provide athletic training services to ensure the well-being of students participating in club sports.

[Athletic Training & Sports Health Care. 20XX;X(X):XX–XX.]

Regular physical activity is the number one preventative health measure that adults can take against disease.1 Unfortunately, many college students are not meeting physical activity guidelines and are overweight.2,3 Therefore, opportunities to become, or remain, physically active are desirable for the health of college students.2 Collegiate club sports are student-run organizations with a shared interest in a particular competitive sport.4 In a study examining participation in collegiate club sports, Henchy5 found that students enjoyed taking part in campus recreation club sports, and this participation improved their quality of life. Participation in intramural and club sports provides college students an opportunity to maintain healthy lifestyles and positively influences their likeliness to return to school the following year.6 Due to these benefits of intramural and club sport participation, they are encouraged at many colleges.6

The National Intramural-Recreational Sports Association (NIRSA) estimated that 11 million college students used recreational facilities annually, in which more than 2 million college students played club sports.7 In 2014, the NIRSA and the Multi-Institutional Study of Leadership examined participation in club sports. The study revealed that 16% of respondents participated in club sports among 73,168 undergraduate students.4 In comparison, approximately 492,000 student-athletes participated in National Collegiate Athletic Association (NCAA) sports in the 2017–2018 year.8 Thus, the number of students participating in collegiate club sports is much larger than the number of NCAA student-athletes.

Although playing sports at the NCAA level or collegiate club has numerous health benefits,5 injuries are an inherent risk while participating in sports and physical activity. Thus, like NCAA student-athletes, club sport participants are also exposed to injury risk. Injuries related to sports and physical activity can have substantial negative impacts on the long-term health of student-athletes and academic success.9 Still, few studies10,11 have actually investigated the epidemiology of club sport injuries. Akinbola et al.10 examined injuries in ultimate frisbee and compared injury numbers to those of other club sports. They reported that after rugby, ultimate frisbee accounted for the second greatest number of injuries during a 12-year span.10 Similarly, Anderson et al.11 found that 6.4% of student-athletes taking part in club or intermural sports suffered a sport-related concussion, which is higher than previous reports in NCAA student-athletes (5.8%).12

At the NCAA level, colleges are required to support their student-athletes' medical needs with a sports medicine staff. However, club sports are not regulated by the NCAA,4 and unfortunately in the club sport setting there is a severe lack of medical coverage.13 For example, when Schneider et al.14 examined the availability of athletic training services in club sports, they found that only 35% of club sport student-athletes had access to athletic trainers provided by in-house campus recreation, 28% had access to athletic trainers from outside the institution, and 29% had access to care provided by non-certified students enrolled in an athletic training education program. In another examination of medical coverage in clubs and intramural sports, the researchers found that only 62.4% of club sport games and 35.7% of club sport practices had medical coverage.7

Overall, despite the large numbers of participants and the inherent risk of injury when taking part in club sports, little published literature exists describing injury epidemiology in collegiate club sports. Understanding the status of injuries in this setting can help administrators make evidence-based decisions to support the medical needs of students taking part in collegiate club sports. Thus, our purpose was to investigate injury epidemiology in competitive collegiate club sports including quidditch and ultimate frisbee over a 16-week semester.

Methods

Participants and Informed Consent

We prospectively examined injury exposure and injuries occurring in 196 collegiate club sport student-athletes in six club sports: football (American) (n = 52), men's soccer (n = 23), women's soccer (n = 27), quidditch (n = 25; mixed sex), men's ultimate frisbee (n = 48), and women's ultimate frisbee (n = 21) at a large suburban public university (Table 1). Student-athletes were excluded if they were younger than 18 years at the start of the season or if they participated in a NCAA sport. At the start of the semester, all participating student-athletes signed an informed consent form to allow their injury and participation data to be used for this study. All study procedures were approved by the local institutional review board at George Mason University.

Overall Injuries, Athlete-Exposures, and Injury Rates Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Table 1:

Overall Injuries, Athlete-Exposures, and Injury Rates Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Exposure and Injury

An in-house certified athletic trainer contracted by Select Physical Therapy for the George Mason University Recreation Department recorded all exposure and injury information over a 16-week period as part of standard operating procedures. One athlete-exposure was defined as one student-athlete participating in one sanctioned practice or competition in which he or she was exposed to the possibility of athletic injury, regardless of the time associated with that participation.9,12,15–21 An injury was defined as an incident that (1) occurred as a result of participation in an organized club practice or competition, (2) required medical attention by the athletic trainer, and (3) resulted in restriction of the athlete for 1 or more calendar day beyond the day of the injury.9,12,15–21 For each injury, the athletic trainer completed a detailed event report on the injury or condition (eg, body part injured or diagnosis) and the circumstances (eg, mechanism or activity). For events not held at the institution (ie, at away games), the team's safety officer created an incident report in the case of an injury. The safety officer was a student-athlete on the team who had training in cardiopulmonary resuscitation and first aid. Incident reports contained the name of the athlete, time/date of injury, location of injury, and a description of what happened. Following the team's return to the institution, the athletic trainer followed up on all incident reports submitted by the safety officer. This process was the standard operating procedure for the institution's Recreation Department.22

Statistical Analyses

We computed descriptive measures of the participants, injury rates, type of injury, and injury location. Then, we computed injury rate as the number of injuries per 1,000 athlete-exposures with a 95% confidence interval (CI). Microsoft Excel software (Microsoft Corporation, Redmond, WA) was used to conduct all analyses.

Results

We found that 60 of 196 (31%) student-athletes suffered injuries, with a total of 68 injuries over 4,300 athlete-exposures, resulting in an overall injury rate of 15.8 per 1,000 athlete-exposures (95% CI: 12.1 to 19.6). Football had the highest injury rate (25.1; 95% CI: 5.3 to 35.0), followed by men's soccer (injury rate = 19.5; 95% CI: 6.0 to 33.0), quidditch (injury rate = 16.2; 95% CI: 6.1 to 26.2), women's soccer (injury rate = 14.3; 95% CI: 3.7 to 24.9), women's ultimate frisbee (injury rate = 11.1; 95% CI: 2.2 to 19.9), and men's ultimate frisbee (injury rate = 9.6; 95% CI: 4.2 to 15.1) (Table 1). The lower body was the most commonly injured body part (n = 41, 60%), followed by the upper body (n = 12, 18%) and then the head, face, and neck region (n = 11, 16%) (Table 2). The most common injury types we found in the current study were sprains (n = 21, 31%), followed by strains (n = 18, 26%) and then contusions (n = 11, 16%) (Table 3). Analyses of gender in the current study found that men's sports (injury rate = 17.0 per 1,000 athlete-exposures; ultimate frisbee, soccer, and football) had a higher overall injury rate than women's sports (injury rate = 12.6 per 1,000 athlete-exposures; ultimate frisbee and soccer), with the injury rate in the mixed-sex sport of quidditch (injury rate = 16.2 per 1,000 athlete-exposures) being in between these values.

Injuries Location by Body Part Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Table 2:

Injuries Location by Body Part Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Type of Injuries Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Table 3:

Type of Injuries Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Discussion

Primary Findings

Despite a large number of collegiate student-athletes taking part in competitive club sports, information about injury epidemiology in this setting is lacking. We found an overall injury rate of 15.8 injuries per 1,000 athlete-exposures in competitive collegiate club sports in the current study. Generally, we found that competitive collegiate club sport student-athletes had equal, and sometimes even greater, injury rates than prior reports in NCAA collegiate sport student-athletes. Interestingly, the novel sport of quidditch had the third highest injury rate across the sports examined in the current study (16.2 injuries per 1,000 athlete-exposures).

Overall Injury Rates

In prior examinations of injury epidemiology across 25 sports in the NCAA from 2008–2009 through 2013–2014, Kerr et al.23 found an overall injury rate of 5.9 injuries per 1,000 athlete-exposures, which is lower than the 15.8 injuries per 1,000 athlete-exposures that we found in the current study. When considering individual sports, in another study examining the injury rate in NCAA football, Kerr et al.19 reported an overall injury rate of 8.13 injuries per 1,000 athlete-exposures. Similarly, Roos et al.21 found an injury rate of 8.07 injuries per 1,000 athlete-exposures in men's NCAA soccer and 8.44 injuries per 1,000 athlete-exposures in women's NCAA soccer student-athletes. In contrast, in the current study we found injury rates in men's and women's soccer to be approximately two times greater (19.5 per 1,000 athlete-exposures for men and 14.3 per 1,000 athlete-exposures for women compared to 8.0 per 1,000 athlete-exposures for men and 8.4 per 1,000 athlete-exposures for women in NCAA soccer).21

Taken as a whole, when comparing prior injury rate reports to those in the current study, injury rates in our competitive collegiate club sports were generally higher than prior reports in NCAA sports. However, the current study had a much smaller sample and number of injuries than those in previous research.21,23 The current study had a total of 4,300 athlete-exposures and 68 injuries as compared to 2,222,155 athlete-exposures and 18,075 injuries by Kerr et al.19 and 192,538 athlete-exposures and 3,825 injuries by Roos et al.,21 respectively. Thus, caution must be used when comparing injury rates reported in this study to previously reported injury rates in the NCAA setting. Accordingly, the 95% CIs reported in this study have a wider range than the above-mentioned reports.

Types of Injury

Our observations of the most common injury types being sprains and strains are in agreement with several observations in the previous literature.21,23 However, an interesting finding in the current study was that approximately 10% of club sport injuries were concussions—almost double compared to 5.8% in the NCAA setting.12 As mentioned earlier, we again recommend caution when comparing our findings to those previously reported due to the small sample size of this study. More specifically, we recorded 8 concussions per 68 total injuries as compared to prior reports of 482 concussions per 8,293 injuries in the NCAA setting.12

It is important to note that concussion training and adherence to graduated return-to-play protocols is generally mandatory for NCAA student-athletes. Likewise, although there was a consistent and formal training for collegiate club sport student-athletes included in the current study, and the athletic trainer adhered to a consistent return-to-play protocol at the institution, how much awareness the collegiate club sport student-athletes actually had about concussions remains unclear. Overall, this finding suggests that additional concussion education may be needed in the competitive collegiate club sport setting.

Location of Injury

We found that the lower extremity was the most commonly injured body part in the current study. Similarly, Hootman et al.18 examined NCAA injuries for 15 sports over a 16-year period and found that 53.8% of injuries occurred to the lower extremity, followed by upper extremity (18.3%), head, face, and neck (9.8%), trunk (13.2%), and then general medical (4.9%). These reports are consistent with our findings, suggesting that generally in sport, the lower body is at greater risk for injury in collegiate club sport settings, irrespective of the level of the student-athlete (ie, NCAA or club sport).

Injuries in Quidditch and Ultimate Frisbee

One of the most novels aspects of this study is that two of the sports we examined are non-NCAA sports, namely quidditch and ultimate frisbee. To our knowledge, only one previous group of researchers has published an injury epidemiological study of quidditch.20 In that study, Pennington et al.20 had athletes self-report injuries over the prior 12-month period in the United Kingdom using an online survey. A total of 348 participants reported 315 injuries across 77,532 athlete-exposures, resulting in an overall injury rate of 4.1 injuries per 1,000 athlete-exposures,20 which was lower than the injury rate found in the current study. We are more confident of the methodological rigor of our study because we prospectively recorded and confirmed injuries and exposures by health care professionals, so our findings likely did not suffer from the limitations of self-reporting and self-recall that may have influenced the above-mentioned findings. Although our study had a stronger research design, we did have a much smaller sample than Pennington et al.,20 leading to fewer athlete-exposures and injuries overall. Consequently, we can only speculate that the injury rate of quidditch appears to be comparable to more traditional collegiate club sports.

Similarly, there is a scarcity of information regarding injuries in ultimate frisbee. We found only a single study investigating injuries from ultimate frisbee. Specifically, Akinbola et al.10 retrospectively analyzed injuries over a 12-year period from collegiate club sport student-athletes. During this time, 143 of 461 injuries occurred in ultimate frisbee (men's and women's).10 The only sport with more injuries than ultimate frisbee was rugby, with 156 total injuries.10

Combining our findings with the prior examinations, it appears that both quidditch and ultimate frisbee have high injury rates. Furthermore, these injury rates are equal to and sometimes even greater than those of more traditional sports in the collegiate club or NCAA settings. The current evidence thus supports the need to further investigate injury patterns in these sports so that health care professionals can understand what might be done to ensure the safety of student-athletes choosing to compete in these sports.

Limitations and Future Recommendations

We acknowledge some study limitations. One of the main limitations of the current study is the limited sample size from a single institution. Still, our study is among the first prospective examinations of injury epidemiology in the collegiate club sport setting. With many institutions likely using other injury tracking means (eg, software), we encourage colleagues to retrospectively analyze data collected as part of their standard practice to further the current knowledge about injury epidemiology in this setting. We also note the single season data collection duration as a study limitation. We recommend that prospectively collecting this information across several years and several institutions will help us better understand injury rates in collegiate club sports and devise appropriate intervention and policy changes to mitigate injuries in collegiate club sports.

The injury reporting during away games and matches is another study limitation. Although our injury numbers were generally derived from reports from athletic trainers, some injuries may have been missed if the safety officers who were responsible for alerting the athletic trainer of possible injuries during away games did not report them to the athletic trainer due to limited knowledge of sports injuries. However, if an athlete seemed injured on the following practice or game, the athletic trainer proactively approached the athlete to check on the injury status.

We also recommend caution when directly comparing our injury rates to those seen in NCAA sports. This is because there is generally a higher ratio of competition-to-practice athlete-exposures in club sports than in NCAA sports. Specifically, NCAA student-athletes often practice three to four times per week and have games one to two times per week. Alternatively, our collegiate club sport athletes typically practiced one to two times per week (maximum) and then had a weekend game (football) or played one to two times per week (other sports). Thus, they had less time to practice their skills than NCAA student-athletes.

Also, although we cannot generalize for all student-athletes in the current study, the skill level of our collegiate club sport student-athletes was likely lower than student-athletes who are competitively selected to represent their college at the NCAA level. This difference in skill levels between NCAA and collegiate club sport student-athletes in the current study could also influence the overall injury rate across the settings. We also found that concussions may occur at greater rates in collegiate club sports than in NCAA sports. Thus, colleges sponsoring club sports should establish consistent concussion return-to-play protocols similar to those for NCAA student-athletes.12

Future investigators should also consider prior experience level, age, time loss due to injury, contact versus non-contact injury, and practice versus game injuries, and collect data over longer periods of time to comprehensively understand injury epidemiology in competitive collegiate club sports.

Implications for Clinical Practice

One of the most important implications for clinical practice of the current study is highlighting the need for medical support for collegiate club sports. We found that collegiate club sport student-athletes may have higher overall injury rates than previous reports in collegiate athletics. Our findings provide evidence to support suggestions in prior work that college recreation departments should provide athletic training services to club sport programs. Overall, our findings support the need to provide athletic training services to ensure the well-being of collegiate club sport student-athletes.

Conclusion

Overall, competitive collegiate club sport student-athletes appear to have equal or sometimes even greater injury rates than collegiate sport student-athletes, keeping in mind the abovementioned study limitations. Our findings add to the limited knowledge on injury epidemiology in collegiate club sports. Given the large numbers of collegiate club sport participants, practitioners and administrators can use our findings to guide policy and procedures to proactively support the need to provide athletic training services to ensure the well-being of their students taking part in competitive club sports.

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Overall Injuries, Athlete-Exposures, and Injury Rates Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

SportNumber of AthletesNumber of InjuriesAthlete-ExposuresInjury Rate per 1,000 Athlete-Exposures (95% CI)
Football522599525.1 (15.3 to 35.0)
Quidditch251061916.2 (6.1 to 26.2)
Men's soccer23841019.5 (6.0 to 33.0)
Women's soccer27749014.3 (3.7 to 24.9)
Men's ultimate frisbee48121,2449.6 (4.2 to 15.1)
Women's ultimate frisbee21654211.1 (2.2 to 19.9)
Total96684,30015.8 (12.1 to 19.6)

Injuries Location by Body Part Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

LocationNumber of InjuriesPercentageInjury Rate per 1,000 Athlete-Exposures (95% CI)
Lower extremity41609.5 (6.6 to 12.5)
Upper extremity12182.8 (1.2 to 4.4)
Head, face, and neck11162.6 (1.2 to 4.4)
Trunk340.7 (−0.1 to 1.5)
General medical110.2 (−0.2 to 0.7)
Total6810015.8 (12.1 to 19.6)

Type of Injuries Over a 16-Week Semester in Competitive Collegiate Club Sport Student-Athletes

Type of InjuryNumber of InjuriesPercentageInjury Rate per 1,000 Athlete-Exposures (95% CI)
Sprain21314.9 (2.8 to 7.0)
Strain18264.2 (2.3 to 6.1)
Contusion11162.6 (1.0 to 4.1)
Concussion8121.9 (0.6 to 3.1)
Fracture571.2 (0.1 to 2.2)
Overuse460.9 (0.0 to 1.8)
Heat illness110.9 (−0.2 to 0.7)
Total6810015.8 (12.1 to 19.6)
Authors

From Sports Medicine Assessment, Research and Testing (SMART) Laboratory, George Mason University, Manassas, Virginia.

The authors have no financial or proprietary interest in the materials presented herein.

The authors thank the athletic trainers from Select Physical Therapy, and Paul J. Bazzano and the staff at George Mason University Recreation.

Correspondence: Jatin P. Ambegaonkar, PhD, ATC, OT, CSCS, Sports Medicine Assessment, Research, and Testing (SMART) Laboratory, School of Kinesiology, College of Education and Human Development, K Johnson Hall 201F, MS 4E5, 10890 George Mason Circle, George Mason University, Manassas, VA 20110. E-mail: jambegao@gmu.edu

Received: May 15, 2019
Accepted: October 18, 2019
Posted Online: February 20, 2020

10.3928/19425864-20200107-01

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