High School Athletes


Every 25 seconds a youth athlete suffers an injury severe enough to require a trip to the emergency department, an August 2013 research report by Safe Kids Worldwide found.

Concussions account for 12% of those visits, with athletes aged 12 to 15 making up 47% of those cases-demonstrating the danger of concussions beyond high school football.

Meanwhile, knee injuries account for 10% of youth athlete emergency department visits, with female athletes up to 8 times more likely to have an anterior cruciate ligament (ACL) injury than males.

Concussions and ACL injuries have been topics of previous episodes of Move Forward Radio and are among the multitude of conditions for which physical therapists are part of the medical treatment team. Look into the APTA's website for more information! 


According to the APTA, among high school athletes, girls are at greater risk for overuse injuries than boys, according to a recent national study published in the Journal of Pediatrics (“Epidemiology of Overuse Injuries among High-School Athletes in the United States” – March 2015).

In analyzing 3,000 male and female high school athletes participating in 20 different sports, researchers found that overuse injuries represented 7.7% of injuries overall, but rates among girls and boys differed significantly, with overuse injuries representing 13.3% of all injuries for girls compared to only 5.5% for boys.

Girls and boys also differed in terms of when the injuries were likely to occur, with the proportion of overuse injuries decreasing in females from freshman to senior year, while it increased in males.

The highest overuse injury rates for girls were seen in track and field, field hockey, and lacrosse.

"This finding may be solely due to differences between males and females or that these girls’ sports have larger teams with younger, skeletally immature girls who were not physically ready to handle the repetitive motion associated with these sports," the researchers summarized. "Athletes in these sports may benefit most from overuse injury assessment and prevention."

In a video produced by Ohio State University, lead author Thomas Best, MD, also theorized that single-sport specialization could be a contributing factor.

"Many of these youngsters are playing a single sport, and that may in fact be a major risk factor for these overuse injuries because their bodies are seeing the same repetitive blows with one sport," Best said.

What can you do? Preventative measures are your best option. Although there's no guarantee, you can make a significant impact on yourself by working against nature to prevent it. 


On school days, young adolescents (12 to 16 years) get 55% of their physical activity on school grounds. But recent research suggests that’s not enough.

As reported by the Los Angeles Times (“More exercise at school may be key to improving teens’ health” – December 2015), only 8% of students get the recommended 60 minutes of exercise per day. To make up the difference, “a typical school would need to devote 7.5% of its instructional time to physical fitness,” instead of the 4.8% found to be the average in a recent study published in Pediatrics (“Locations of Physical Activity as Assessed by GPS in Young Adolescents” – January 2016).  

“Because adolescents spend so much time at school, even a small increase in the proportion of at-school time spent physically active could lead to meaningful increases in overall physical activity and metabolic health,” the study authors wrote.

So what can you do about it? Talk to your local high school about what hinders them from improving PE programs in their district; it is often correlated to lack of funds in, not just these programs, but sporting programs, in general. Speak to the representatives of your booster club and reach out to alumni of the programs to see if funding can be increased - or take it straight to the devil, himself - city council (for public schools). 


...according to the APTA, and a University of Wisconsin study published in Women's Health.

The study was small, but the results lined up with what many health care professionals have been saying for years: youth athletes who specialize in a single sport may be at a higher risk for injury.

In a study published in The American Journal of Sports Medicine (Prevalence of Sport Specialization in High School Athletics: A 1-Year Observational Study-February 26, 2016), athletes from 2 high schools were more likely to report knee injuries and hip injuries.

“There are so many great aspects to sports participation, and we don’t want this information to scare athletes or parents,” said study author David Bell of the University of Wisconsin-Madison, in a press release from the university. “We just want them to be wise consumers and to participate as safely as possible.”

Physical therapists typically encourage athletes of all ages to diversify their exercise to avoid injury, but it can be particularly important for young athletes.

According to physical therapist Sue Falsone, PT, ATC, MS, the former head physical therapist for the Los Angeles Dodgers, in an interview with Move Forward Radio (Avoiding Baseball Injuries-May 8, 2014), “Sometimes we ask the immature body to do things that they just physically can’t handle. And even if you’re getting through it at that time, it’s usually something that might break down later on.”

Attached is the URL to the Women's Health article.



The benefits of physical activity for women and girls are well established. Regular physical activity helps build and maintain bone strength, lower cholesterol and blood pressure, decrease symptoms of anxiety and depression, control weight and build lean muscle. These benefits can be gained with moderate or strenuous exercise five days a week.

However, when strenuous exercise is combined with inadequate calorie intake, serious health consequences can occur. The Female Athlete Triad is an interrelationship among menstrual cycle changes, inadequate calorie intake and decreased bone density in female athletes. Athletes may be affected by one or more of the components of the Triad.


It is useful to think of an athlete’s calorie intake in terms of “energy availability”, which is the amount of energy consumed in the diet minus the amount of energy used during exercise. The amount of energy left over is the “energy availability” to carry out other body functions, such as growth, development, and reproduction.

While some athletes may have an eating disorder, such as anorexia or bulimia, many do not meet the criteria for eating disorders or simply do not understand how many calories they need to eat to compensate for their amount of exercise.


Menstrual function disturbances in athletes can vary from longer than normal cycles (called oligomenorrhea) to completely missing periods (called amenorrhea).  The low estrogen associated with amenorrhea in athletes can adversely affect muscle function, cholesterol levels, and energy levels short term, and reproduction long term. 


Athletes affected by the Triad may have bone density that is less than expected for their age and may even have bone density low enough to be considered osteoporotic or in the early stages of bone loss. As a result, the athlete may experience stress fractures. More importantly, in adolescent athletes, who are still building bones, the athlete may not build enough bone, increasing their risk for fractures later in life.

The longer an athlete has had menstrual cycle changes and inadequate energy availability, the more likely she is to experience a stress fracture.


Athletes involved in sports at an elite level, endurance sports or aesthetic sports (i.e gymnastics or skating) are at an increased risk for the Triad, but athletes in ANY sport may be affected.

If you suspect that you or someone you know is affected by the Triad, you should make an appointment with a sports medicine physician familiar with the Triad or your regular doctor if you do not know of a sports medicine doctor. Usually, the doctor will order laboratory tests to evaluate hormone function and, sometimes, a bone density test. If the athlete has a suspected stress fracture, x-rays and, possibly, an MRI may be performed. The mainstay of treatment of the Triad is increasing calorie intake to improve energy availability. Significant improvements in bone density are seen with improved calorie intake and weight gain, although the decreased bone density associated with the triad is not always completely correctable. Improving energy availability also restores normal menstrual function. Even though taking an oral contraceptive pill (“The Pill”) will allow the athlete to have normal periods, it is unlikely to improve bone density.

A dietician can help the athlete determine how many calories they need to eat each day and if they are missing any important nutrients in their diet.

Athletes who meet the criteria for eating disorder will need treatment with a therapist or psychologist who specializes in eating disorders.


Amanda Weiss-Kelly, MD

Sports Tips provide general information only and are not a substitute for your own good judgement or consultation with a physician. To order multiple copies of a printable version of this fact sheet or to learn more about sports injury prevention, please visit www.STOPSportsInjuries.org