An evaluation of illegal activity/foul play as a potential risk factor for injury

Purpose: Each sport has a unique set of rules developed to promote fair competition and protect participants from injury. To date, illegal activity/foul play has been largely overlooked as risk factor for sports-related injuries.

Methods: Using an internet-based data collection tool, RIO(TM) (Reporting Information Online), certified athletic trainers from 100 nationally representative high schools reported athletic exposure and injury data for students participating in nine sports during the 2005-06 school year.

Results: Nationally, 45,404 high school sports injuries (6.2%) were directly related to an action that was ruled illegal activity by a referee/official or disciplinary committee. Girls' basketball and soccer had the highest proportion of injuries attributed to illegal activity (13.7% and 12.1%, respectively). In comparison, 11.1% of boys' basketball, 10.6% of boys' soccer, 6.4% of boys' wrestling, and 3.8% of boys' baseball injuries were directly related to illegal activity. Less than 2% of injuries in boys' football, girls' softball, and girls' volleyball were attributed to illegal activity. A greater proportion of injuries related to illegal activity were to the head/face (29.0%) or were concussions (26.0%) compared to injuries to the head/face (12.9%) (RR: 2.5; 95% CI: 1.5-4.2) or concussions (10.5%) (RR: 2.7; 95% CI: 1.6-4.7) not related to illegal activity.

Conclusions: Illegal activity/foul play places athletes at an increased risk of injury above the risk of injury endemic to sports participants. Reducing illegal activity through preventative interventions such as enhanced enforcement of the rules and education about risks associated with illegal activity could lower injury rates.