American Journal of Epidemiology Advance Access published online on November 23, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwj022
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1 Graduate Program in Orthopaedic and Sports Physical Therapy, School of Rehabilitation Sciences, Rocky Mountain University of Health Professions, Provo, UT
* To whom correspondence should be addressed. 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
Received May 18, 2005
Accepted September 1, 2005
ORIGINAL CONTRIBUTIONS
Epidemiology of Musculoskeletal Injuries among High School Cross-Country Runners
Mitchell J. Rauh 1 *,
Thomas D. Koepsell 2,
Frederick P. Rivara 3,
Anthony J. Margherita 4,
and
Stephen G. Rice 5
2 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA; Harborview Injury Research and Prevention Center, Seattle, WA
3 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA; Harborview Injury Research and Prevention Center, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
4 West County Spine and Sports Medicine and Radiant Research Inc., St. Louis, MO
5 Department of Pediatrics, Jersey Shore University Medical Center, Neptune, NJ
Mitchell J. Rauh, E-mail: mrauh{at}rmuohp.edu
Abstract 
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.
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