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American Journal of Epidemiology Advance Access originally published online on November 23, 2005
American Journal of Epidemiology 2006 163(2):151-159; doi:10.1093/aje/kwj022
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Epidemiology of Musculoskeletal Injuries among High School Cross-Country Runners

Mitchell J. Rauh1, Thomas D. Koepsell2,3, Frederick P. Rivara2,3,4, Anthony J. Margherita5 and Stephen G. Rice6

1 Graduate Program in Orthopaedic and Sports Physical Therapy, School of Rehabilitation Sciences, Rocky Mountain University of Health Professions, Provo, UT
2 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
3 Harborview Injury Research and Prevention Center, Seattle, WA
4 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
5 West County Spine and Sports Medicine and Radiant Research Inc., St. Louis, MO
6 Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ

Correspondence to Dr. Mitchell J. Rauh, Graduate Program in Orthopaedic and Sports Physical Therapy, Rocky Mountain University of Health Professions, 1662 West 820 North, Provo, UT 84601 (e-mail: mrauh{at}rmuohp.edu).

To determine the incidence of lower-extremity injury among high school cross-country runners and to identify risk factors for injury, the authors prospectively monitored a cohort of 421 runners competing on 23 cross-country teams in 12 Seattle, Washington, high schools during the 1996 cross-country season. Collected were daily injury and athletic exposure (AE) reports, a baseline questionnaire on prior running and injury experience, anthropometric measurements, and coaches' training logs. The overall incidence rate of injury was 17.0/1,000 AEs. Girls had a significantly higher overall injury rate (19.6/1,000 AEs) than boys did (15.0/1,000 AEs) (incidence rate ratio = 1.3, 95% confidence interval: 1.0, 1.6). Compared with boys, girls had significantly higher rates of injuries resulting in ≥15 days of disability. For the overall sample and for girls, Cox regression revealed that a quadriceps angle of ≥20° and an injury during summer running prior to the season were the most important predictors of injury. For boys, a quadriceps angle of ≥15° and a history of multiple running injuries were most associated with injury. Results suggest that the incidence of lower-extremity injuries is high for cross-country runners, especially girls. Preseason screening to determine risk factors should be examined as a preventive approach for identifying high-risk runners.

adolescent; athletic injuries; female; prospective studies; risk factors; running; schools; sports

Abbreviations: AE, athletic exposure; Q-angle, quadriceps angle


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