Epidemiology of Bone-Stress Injuries and Health Care Use in Pac-12 Cross-Country Athletes.

Context: Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented.

Objective: To describe the rate and classification of injury and associated health care use 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: Pac-12 Conference collegiate cross-country athletes.

Main outcome measure(s): Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons.

Results: A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019-2020 season (0.20) than the 2020-2021 (0.14), 2018-2019 (0.12), and 2021-2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non-time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50).

Conclusions: Bone-stress injuries 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 be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns.