Safety Analysis Report
Aspen Institute Sports & Society Program
The Healthy Sport Index recognizes that the benefits of playing sports can be limited by short- and long-term injuries. The Aspen Institute evaluated how the 10 most popular high school boys and girls sports compare based on existing injury data and expert opinion from leading medical and sports health professionals. Calculations determined each sport’s Safety score and rank.
The following categories were applied in developing the Safety score. The percentage represents how much that category was weighted in creating the total score.
Overall Injury Rate was weighted the highest given how frequently it’s cited publicly and since it provides the best snapshot of injuries. Non-Fatal Catastrophic Injuries/Illnesses were weighted the lowest because of how infrequently they occur. Yet they still happen enough periodically to be included, and parents, news media and other stakeholders have recognized this information as relevant in assessing the risk of playing sports. The Expert Opinion component recognizes that there are limits to available data in high school sports and opinions from experts can assist in informing parents about sports health.
The existing data largely came from the National High School Sports-Related Injury Surveillance Study, also known as High School RIO. Each year, the Colorado School of Public Health produces a report by sport that shows a snapshot of the types of injuries, and their frequency, that occur in high school sports.
High School RIO produces a nationally disperse convenience sample of high schools. For the Healthy Sport Index tools evaluated using the data, the number of sampled schools ranged from 145 (football) to 57 (girls lacrosse). The injuries are reported by athletic trainers at select schools across the country, meaning lower-resourced schools without athletic trainers are not being counted. High School RIO results have been used by the National Federation of State High School Associations and are widely applied in studies, including research published by Nationwide Children’s Hospital, American Academy of Pediatrics, the National Athletic Trainers’ Association, and the University of Colorado School of Medicine.
1Injury rate per 10,000 exposures, National High School Sports-Related Injury Surveillance Study, 2016-17.
2 Percentage of all injuries resulting in greater than three weeks of time loss from the sport, National High School Sports-Related Injury Surveillance Study, 2016-17.
3 Concussion rate per 10,000 exposures, National High School Sports-Related Injury Surveillance Study, 2016-17.
4 Percentage of all injuries requiring surgery, National High School Sports-Related Injury Surveillance Study, 2016-17.
5 Non-fatal catastrophic injury/illness rate per 100,000 exposures, National Center for Catastrophic Sport Injury Research, 1982-2016.
6 Healthy Sport Index advisory group members rated each sport on a 10-point scale based on the risk-reward benefit of each sport per category, taking into account additional factors beyond the data used for the remainder of the Safety score.
Data were compiled by the Aspen Institute. Each measurement was standardized to create a Z-score so the measures were transformed onto the same scale. All Z-scores have a mean (average) of 0, and a standard deviation of 1 within a sport as:
Z-scores that are greater than 0 (positive Z-scores) indicate a sport that is better than average. For example, if a sport has a Z-score of 1.5, this indicates that the sport is 1.5 standard deviations above the average for all of the sports for that measure. The Overall Final Scores listed below are all shown as standardized scores; the measurements within those categories that are listed below are listed just by their data, though they were also standardized.
OVERALL FINAL SCORES
|Track and Field||0.608|
|Track and Field||0.678|
Analysis: Boys and girls tennis emerged as the safest sports, with very few overall injuries, concussions, time loss due to injuries, surgeries, and catastrophic injuries. Not surprisingly, several contact sports (football, boys and girls lacrosse, wrestling) scored near the bottom. Football’s overall safety score was by far the lowest among boys sports, a byproduct of finishing seventh or lower out of 10 sports in all of the categories. Soccer had a significantly lower score than any other girls sport.
Worth noting: There was not a huge gap in final scores for the top four sports in each gender. Tennis, swimming, cross country and track and field were all relatively close for boys and girls. The gap became larger at No. 5 with baseball and softball. Girls basketball scored lower than boys basketball due in part to girls having higher overall injury and concussion rates and more surgeries.
OVERALL INJURY RATES
|Boys Sport||Injuries Per 10,000 Exposures|
|Track and Field||7|
|Girls Sport||Injuries Per 10,000 Exposures|
|Track and Field||10.4|
Analysis: Girls sustained more injuries than boys, a common occurrence found in other research. The Healthy Sport Index evaluated eight sports with comparable boys and girls sports; girls had higher injury rates in six of the eight sports. Only tennis and lacrosse saw more injuries by boys.
In 2017, researchers at the University of North Carolina found a 59-percent increase in ACL injuries among girls ages 13-17 over a 13-year period, citing a lack of neuromuscular strength training. The incidence of ACL tears in female athletes has been found to be 2 to 10 times higher than in male counterparts. Reasons cited by experts as to why girls are more vulnerable to ACL injuries than boys include estrogen, landing flat-footed, wider pelvis, more lax ligaments, slower reflex time, weaker quadriceps/hamstring strength ratio, running upright, and less developed quads.
Not surprisingly, football had the highest rate of injuries in either gender across all sports. The data showed high school football players were almost two times more likely to be injured than the next closest boys sport, lacrosse. Swimming sustained the fewest injuries for both boys and girls.
|Boys Sport||Concussions Per 10,000 Exposures|
|Track and Field||0.1|
|Girls Sport||Concussions Per 10,000 Exposures|
|Track and Field||0.5|
Analysis: Again, girls tended to sustain concussions at higher rates than boys in 2016-17, with the notable exception of football. For instance, while boys soccer players averaged 3.3 concussions per 10,000 exposures, the rate was more than doubled for girls soccer (7.1 concussions per 10,000 exposures). Girls basketball players were almost two times more likely to have a reported concussion than their boy counterparts, though these are still relatively low rates.
According to a 2017 study by the American Academy of Orthopaedic Surgeons (AAOS), girls were 12.1 percent more likely to sustain a concussion than boys. The study tracked high school sport concussions from High School RIO between 2005 and 2015. The researchers concluded that girls sustain more concussions than boys because the neck muscles of girls aren’t as developed as boys, increased risk due to a lack of protective equipment available for female athletes, and an increased emphasis on physical play for girls. It’s also possible that girls simply report their concussion symptoms more than boys, given a sports culture where boys often believe they must play through pain.
The AAOS results generated national media coverage because they showed football ranked fourth on the list of concussions as a percentage of total injuries, behind girls soccer, girls volleyball and girls basketball. That finding is due to football having a higher number of total injuries, plus different types of injuries. As evaluated by High School RIO, football clearly has the highest concussion rate among all sports. Football players were more than twice as likely to have reported concussions than lacrosse, the next closest boys sport.
TIME LOSS INJURIES (Boys Sports)
% Injuries Resulting in >3 Weeks Time Loss
TIME LOSS INJURIES (Girls Sports)
% Injuries Resulting in >3 Weeks Time Loss
Analysis: Time loss due to injury can be an indicator of how serious the injury is and/or the return-to-play practices of individual doctors and team staff. Boys and girls tennis reported the least amount of time its athletes missed more than three weeks due to injury. Girl swimmers were far more likely to miss extensive time than boy swimmers.
INJURIES REQUIRING SURGERY (Boys Sports)
% Injuries Requiring Surgery
INJURIES REQUIRING SURGERY (Girls Sports)
% Injuries Requiring Surgery
Analysis: Many individual sports injuries (cross country, swimming, tennis, and track and field) required a smaller percentage of surgeries, continuing a pattern seen in other Healthy Sport Index safety categories. One notable exception was wrestling, which had the highest rate of surgeries among injuries incurred. A handful of sports had 0 percent injuries requiring surgery because no injuries were reported in the sample size used by High School RIO.
Baseball was about two times more likely to have injuries result in surgery than softball. Baseball players are twice as likely as their softball counterparts to suffer a shoulder injury, according to a study in 2010 led by the Research Institute at Nationwide Children’s Hospital. Boys tend to have greater upper body strength, allowing them to accelerate their arms faster, putting more stress on the rotator cuff. Also, baseball pitchers use the same overhand motion from the time they first take to the mound, whereas girls learn a progression of pitching techniques before advancing to the rapid “windmill” style.
|Boys Sport||Non-Fatal Rate Per 100,000 Exposures|
|Track and Field||0.11|
|Girls Sport||Non-Fatal Rate Per 100,000 Exposures|
|Track and Field||0.01|
Analysis: It’s important to note that catastrophic injuries and illnesses are very rare. Given how infrequently deaths occur on the playing field, the Healthy Sport Index analyzed non-fatal rates (defined as permanent and severe functional disability). While these occurrences are still rare, there are noticeable differences by sport. Football and cheerleading had by far the highest chance for non-fatal injuries, though even those rates are just slightly a little over one per 100,000 exposures.
|Boys Sport||Average Score (10 Highest, 1 Lowest)|
|Track and Field||8.2|
|Girls Sport||Average Score (10 Highest, 1 Lowest)|
|Track and Field||8.4|
Analysis: Advisory group members rated each sport on a 10-point scale based on the risk-reward benefit of each sport per category. When voting, advisory group members agreed to consider overuse injuries, repetitive head contact, longterm arthritis, emergency room injury data, other academic research/literature, and access and longevity to playing sports, among other factors.
The Healthy Sport Index safety analysis shows that tennis, swimming, track and field, and cross country are the safest sports in both genders, and football and girls soccer carry the greatest risks, based on the data included in this report. Girls are more likely to sustain injuries than boys. More research is needed to evaluate high school sports injuries even further, particularly at lower-resourced schools that don’t have access to athletic trainers to report data.
This analysis is not intended to conclude which sports youth should or shouldn’t play given where they rank on the safety score. Rather, the scores and data offer one central location for parents, youth, coaches, school administrators, and other stakeholders to evaluate the risks. The Aspen Institute’s Project Play and a large body of existing research support the notion that playing sports is good for youth. Any sport, when served well, can produce myriad benefits for participants, as shown in the Healthy Sport Index physical activity, psychosocial survey and Monitoring the Future reports.