Higher Bone Injury Rates in Lower NCAA Sports Divisions

A new study found evidence that bone stress injuries occur more in athletes at the NCAA Divisions II and III levels than those in division I.

The full results are in a paper titled, “Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II and III,” which was published online on July 9, 2021 in the Orthopaedic Journal of Sports Medicine.

“Bone stress injuries are a major source of functional impairment in athletes of all sports, with many risk factors, including athlete characteristics and type of sport. In National Collegiate Athletic Association athletics, the stratification of programs into divisions with difference characteristics and makeup has been identified as increasing the risk for certain kinds of injuries, but there have been no studies on the difference of Bone Stress injury rates and characteristics between athletes in Division 1 and those in Division II and III,” the researchers wrote.

The comparison was made based on five years of recorded Bone Stress Injury data via the NCAA Injury Surveillance Program. It included data from the academic years 2009-2010 to 2013-2014. Time lost to injury, time of season of injury, and class composition of injured athletes were also compared between divisions.

Overall, the Division II and Division III programs reported 252 Bone Stress Injuries more than 1,793,777 Athlete-Exposures (14.05 per 100,000 AEs) and Division I programs reported 235 Bone Stress Injuries over 2,022,592 athlete-exposures (11.62 per 100,000 AEs).

The risk ratio was significant for Division 1 versus Division II and Division III (1.2; 95% CI, 1.01-1.44). There was also a significant difference in time lost to injury in Division I compared with Division II and Division II.

“In the current study, NCAA Division II and Division III athletes had higher rates of Bone Stress Injuries than their Division I counterparts. As compared with Division II and Division III athletes, the Division I athletes had a significantly greater proportion of Bone Stress Injuries that did not result in absence from participation in sport,” the researchers wrote.

There are a few possible reasons for this they explained. They wrote, “First, given the higher level of competition, athletes may choose to be permitted to play through injury after a diagnosis of Bone Stress Injury. Additionally, early and aggressive identification in Division I athletics potentially related to the greater presence of athletic trainers may help sports medicine teams intervene early with training modifications and rehabilitation, allowing athletes to continue competing.”