Epidemiology of Bone Stress Injuries and Healthcare Utilization in PAC-12 Cross-Country Athletes

Abstract

Context Bone stress injury (BSI) is common in collegiate athletics. Injury rate and healthcare utilization is not well documented in running athletes. Objective The purpose of this study was to describe the rate, classification, and healthcare utilization in collegiate cross-country runners with BSI. Design Descriptive Epidemiology Study Setting Sports medicine facilities participating in the PAC-12 Health Analytics Program. Patients or Other Participants Collegiate cross-country athletes. Main Outcome Measures Counts of injury and healthcare resources utilized for each injury. Injury rates were calculated based on athlete seasons. Results A total of 168 BSIs were reported over four seasons from 80 team season (M: 34, F: 46) and 1,220 athlete seasons, resulting in 1,764 AT services and 117 physician encounters. BSIs represented 20% of all injuries reported by cross-country athletes. The average bone stress injury rate was 0.14 per athlete season. Injury rates were higher in female athletes (0.16) compared to males (0.10) and rates were higher in the 2019–2020 season (0.20) compared to the 2020–21(0.14), 2018–2019 (0.12) and 2021–2022 (0.10) seasons. A majority of BSI's occurred in the lower leg (23.8%) and the foot (23.8%). Most injuries were classified as overuse and time-loss (73%) and accounted for the majority of AT services (75%) and physician encounters (73%). On average, there were 10.89 AT services per overuse-TL injury and 12.20 AT service per overuse-NTL injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) compared to AT services. Conclusions BSIs are common in collegiate cross- country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population and suspected BSIs should b e confirmed with medical diagnosis. Future investigations should track treatment codes associated with BSI to determine best-practice patterns.