It is estimated that 30 million children and adolescents participate in organized sports. In addition, some 150 million adults participate in physical activity and recreational activities that are not related to their employment.1 However, both these large at-risk populations lack a systematic mechanism for tracking musculoskeletal injuries and conditions.

While professional, collegiate, and even high school athletics have epidemiologic systems in place to track injury patterns, recreational athletics lack any type of surveillance system. However, the US Consumer Product Safety Commission established the National Electronic Injury Surveillance System (NEISS) in 1997 to track emergency room visits and injury patterns associated with specific products. This database has also been helpful as a means of documenting injuries associated with athletic, physical activity, and recreational endeavors. However, a major limitation of this data is that injuries not significant enough to require an emergency room visit, or injuries that are seen in other healthcare settings (e.g., athletic training room, primary care clinic, specialty clinic) may not be documented and reported. Regardless, the NEISS probably provides the best available nationwide estimates on recreation related and physical activity injuries significant enough to require an emergency room visit.

Using the data from the NEISS, a 2002 CDC report detailed 4.3 million sports and recreation related injuries that were treated in US emergency departments.1 The injury rate was highest for boys ages 10-14. A more recent paper documented that an estimated 600,000 knee injuries present annually to emergency rooms in the United States. Of these, 49.3% resulted from participating in sports and recreation activities.2

More recent data from the NEISS for the years 2014 through 2016 reveal similar patterns. During this time period a total of 4.2 million emergency room visits were documented for injuries related to sports participation, physical activity, and recreational endeavors. Of those, 1.5 million were due to participation in team sports and 2.8 million injuries resulted from individual sports and recreational activities, of which 61% impacted the musculoskeletal system. Two out of three musculoskeletal injuries occur to males, with the proportion lower for individual sports (57%) than for team sports (77%). Of the estimated 2.8 million injuries resulting from individual sports that present annually to emergency rooms in the US, 57% impact the musculoskeletal system. Two out of three musculoskeletal injuries (65%) occur to males, with the proportion being slightly smaller among males for individual sports than for team sports. (Reference Table 5E.1.1 PDF CSV)

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Cycling and wheeled sports account for 19.9% of all recreational sports injuries and musculoskeletal injuries serious enough to warrant a visit to the ED. Fitness training results in an additional 16.3% of the total number of musculoskeletal injuries seen. Musculoskeletal injuries account for more than 50 percent of all injuries in all sports, with the exception of water sports. (Reference Table 5E.1.1 PDF CSV)

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Musculoskeletal injuries treated in the ED as a result of a recreational sport injury occur in the highest proportion in kids ages 2 through 18. According to the latest data, nearly 60% of all musculoskeletal injuries due to participating in individual and team sports and recreational activities occur in this age range. This is, in part, due to the high number of playground injuries, as well as biking and other wheeled equipment, such as skateboards and scooters, but kids account for a higher proportion of treated sports injuries in all but a few sports that are more adult focused. Adults between the ages of 19 and 44 also account for a substantial proportion (29%) of treated musculoskeletal injuries, but they are also a larger share of the population and more likely to be active in recreational sport activities. (Reference Table 5E.1.2.1 PDF CSV)

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Sprains and strains, primarily affecting the joints and muscles, are the most common reason for seeking care in the emergency department for sports and physical activity related injuries. An estimated 41.2% of musculoskeletal injuries seen in emergency departments due to participating in recreational sports and physical activities result in sprains or strains, followed by bone fractures (30.4%), contusions (24.3%), and joint dislocations (3.8%). (Reference Table 5E.1.3 PDF CSV)

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Injuries from team and individual sports to the extremities are the most common, with 41.3% occurring in the upper extremity compared with 37.5% in the lower extremity. The trunk sustains most of the remaining injuries (14.4%), with less than 6% involving the head, although head injuries are often unreported. (Reference Table 5E.1.4 PDF CSV)  Among team sports, kids age 2 to 12 are the most likely to injure the upper extremity in all except those playing hockey, where participation numbers in this age range are low. (Reference Table 5E.1.7 PDF CSV)

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Nearly all (96%) musculoskeletal injuries due to sports and recreational activities seen in the ED are treated and released. This compares to just over 81% for all emergency department visits. Only 3% of recreational activity and sports injuries seen in EDs result in hospitalization. Among individual sports, 4.1% of musculoskeletal injuries seen in the ED resulted in hospitalization with the highest proportion of injuries from mountain climbing (12.1%), all-terrain vehicles and motorized bikes (8.1%), and bicycle/wheeled activities (bicycles, skateboards, scooters, etc.) (6.1%). Among team sports only 1.1% of injuries seen in the ED resulted in hospitalization, with the highest proportion reported in soccer (1.5%), followed by hockey (1.4%) and football (1.3%).  (Reference Table 5E.1.5 PDF CSV)

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It is not surprising that the majority of injuries treated in emergency departments due to sports participation and recreational physical activities occur on sports fields (37.5%), with 50.9% of team sports injuries and 29.2% of individual sports injuries occurring in this setting. (Reference Table 5E.1.6 PDF CSV)

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• 1. a. b. Centers for Disease Control. Nonfatal sports-and recreation-related injuries treated in emergency departments, United States, July 2000 to June 2001. MMWR 2002;51(33):736-740.
• 2. Gage BE, McIlvain NM, Collins CL, et al. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med  2012;19(4):378-385.