Context: With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012–2013 and therefore may not reflect current overuse injury rates in high school sports.

Objective: To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014–2015 to 2018–2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location.

Design: Descriptive epidemiology study.

Setting: Online injury surveillance from 211 high schools (345 individual years of high school data).

Patients or Other Participants: Athletes participating in secondary school-sponsored boys' and girls' sports.

Main Outcome Measures: Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014–2015 to 2018–2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

Results: The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8).

Conclusions: Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

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