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The Challenge:
Sports Injuries Can Last A Lifetime

Play 7

Prioritize Health and Safety

Athletic trainers often serve as the main healthcare professionals trained in injury prevention and on-site treatment for high school sports programs. They coordinate care, conduct rehabilitation, and return players to games. They help with concussions, orthopedic injuries, eating disorders, heat illnesses, heart issues, weight management, diabetic episodes, and opioid and prescription drug abuse. They maintain a database of injuries and treatments. 

To be clear: Athletic trainers alone don’t solve all of the many challenges that schools face. Underpaid and overworked, they can only do so much, with so many students who need help.

Still, every high school should strive to have an athletic trainer, or access to an appropriate medical professional who can provide basic care. It should be a requirement in schools that offer collision sports. Almost 8 in 10 schools with low athletic trainer availability exist in rural and inner-city areas, and athletes in those communities are 50% more likely to have a concussion that goes unidentified or mismanaged.³⁶ Among all high schools, one in three lacks access to an athletic trainer.

We recognize the barriers: Budget constraints, lack of awareness about the role of the trainer, school size and remote locations. In many places, there aren’t enough trainers to service schools. The profession is producing fewer of them out of school.

For schools that can’t hire a full-time trainer, there are other options. Physical therapists have a board certification in sports and the profession is evolving to attempt to mimic the skills of athletic trainers. The National Athletic Trainers’ Association (NATA) and American Physical Therapy Association offer databases with certified professionals. Schools can meet with their local health care organization, nutritionist or exercise physiologist to identify a medical partnership.

Some schools and National Governing Bodies of sports use the Go4 app, which connects schools with on-demand athletic trainers who are NATA members. It’s a quick way to get medical coverage for games. Jobs get posted for free without contracts. Schools set their hourly or monthly rate.

In our survey, students generally feel looked after by athletic personnel when it comes to injury. Still, among students who don’t play high school sports, 11% said they don’t participate due to fear of injury or illness and 7% cited previous injuries. By junior year, nearly 1 in 10 students said they don’t play sports due to previous injuries – almost double the rate for freshmen.

High school sports injuries can last a lifetime – chronic mental and physical pain, financial hardship, and impairment to stay active. While fatalities are rare, high schools lead the nation in sports-related deaths with more than 400 between 2008 and 2019.³⁷ While schools are often protected from successful legal claims by injury waivers, state caps on damages and other measures, they still have a moral obligation to help students feel safe when playing sports.

WHO CAN HELP

Policymakers

State and local governments could copy Hawaii and fund every high school to have a full-time athletic trainer. In 1993, Hawaii authorized $371,000 to hire 10 athletic trainers for a pilot program. Hawaii is the only state with at least one trainer in every high school – most schools have two – by earmarking $4.28 million for 74 positions. Hawaii is an outlier because of its small population and statewide educational model. If state legislatures won’t fund this while tied to health and safety legislation, counties or cities might.

Business & Industry

Research shows that telemedicine can work to diagnose concussions at sports events, though someone on the ground must still act on the diagnosis.³⁸ Multiple school districts could have one concussion specialist on standby for all of their games, checking in when needed through a robot or less expensive interface. This could especially help in rural areas.

Membership Organizations

Organizations training coaches and PE teachers can offer education on preventive strategies to try to keep students physically healthy. Many free courses are available at Hospital for Special Surgery Sports Medicine Institute Learning Center. Coaches can learn how to lead a neurodynamic warmup to reduce the risk of ACL knee injuries. PE teachers can learn curriculum on how to get students moving better.

Agencies

Poor air quality due to wildfires and climate change is now a regular consideration for high school sports across the western U.S. Sports medicine, public health and environmental health professionals should develop evidence-informed best practices for deciding whether to play outside. In the meantime, the NFHS Medicine Advisory Committee offers considerations for policy development at the school district level.³⁹

Local School Districts

Good health for students of color includes feeling welcome and safe, especially as racist slurs occur at high school sports events across the country. The Vermont Principals’ Association developed a clear statement of expectations read at games, with the understanding that ejections or ending games early are possible. Vermont added an online system for anyone to report racist behavior, and officials and coaches are trained annually on implicit bias.

FINDING SUCCESS

With mental health challenges rampant among its students, Center Moriches High School in New York intentionally places every sports team with a coach who’s familiar with social and emotional learning (SEL). That way there’s balance among the coaching staff in case another coach lacks SEL skills. Center Moriches plans to create a “decision tree” with basic training for coaches to help any athlete struggling with mental health. Center Moriches finds simple training is best for coaches, so it’s not overwhelming and they don’t make a costly mistake.