ABSTRACT
Background: COVID-19 restrictions created a period of disrupted sports participation for youth athletes. The physical conditioning and sports training habits of youth athletes during COVIDrelated sports interruption and upon returning to normal sports activity are currently unknown. The purpose of this study was to determine the extent to which athletes maintained their training levels during the COVID-19 pandemic and understand the strategies that enhanced motivation and adherence to a training regimen while in isolation. A secondary aim was to further understand the manner as to how youth athletes returned to activity and identify any secondary effects of the prolonged sports interruption as they resumed athletic activities. Methods: A two-part survey was designed to determine activity changes, type of organized instruction, and athlete preferences for training support. This was distributed by email using snowball sampling methodology to athletes 14-21 years-old who were involved in competitive sports when pandemic restrictions were enacted. As sports activities resumed, a follow-up survey was distributed to the same respondents to identify feelings of preparedness, training habits, and injuries. This study was reviewed and approved by the Institutional Review Board of the sponsoring organization. Results: Of the 155 subjects (mean age 16.1 ± 2 years, 64.5% female) that completed the initial survey, 98% reported a stoppage of in-person sports participation and 70% decreased their exercise/training volume, with 41% (n=63) reporting > 50% reduction. Most athletes (86%) received instruction from coaches, with written workouts (70%) being most common, however most athletes (70%) preferred instructor-led, group training sessions. Many athletes (73%) reported supplementing team-based training recommendations with independent workouts, primarily jogging (62%), strength training (54%) and sports specific skills (51%). With regards to their feelings of preparedness for returning to normal sports activity, 42% of athletes reported feeling only minimally or somewhat prepared. Of the 43 subjects that completed the follow up survey (34% response rate), 30% reported immediately returning to play for more than one team, and there was a sharp increase in athletic exposures compared to mid-pandemic levels (Figure 1). Despite this increase in structured athletic activity, 63% of the sample reported they still supplemented team-based practices with jogging (51%), sports specific skill work (47%) and strength training (40%) on an individual basis. Interestingly, 25% of athletes reported sustaining a sports-related injury a mean of 79 days after resuming sports activities. Conclusion: Pandemicrelated sports restrictions resulted in a large reduction in youth athlete training and conditioning. Coaches attempted to maintain training via use of written workouts, however athletes preferred instructor-led, group training sessions. There was a rapid resumption of sports activities, which may have contributed to the high rate of injuries seen in this study. Respondents' number of training days per week during remote led instruction and upon return to in-person sports.
ABSTRACT
Background: The COVID-19 pandemic has had a tremendous impact on youth sports participation for children and adolescents in the United States. Prior work demonstrated that pandemic-related closures led to a significant reduction in pediatric sports-related injury in the first half of 2020. However, these trends have yet to be evaluated on a national level and during the latter half of the year when organized youth sports began to re-emerge. Purpose: To estimate monthly and annual trends in youth sports-related injury over the last 5 years using a national injury database in order to measure the impact of the COVID-19 pandemic on overall and sport-specific rates of injury. Methods: We retrospectively reviewed data from the National Electronic Injury Surveillance System (NEISS) database identifying children and adolescents (0-18yo) presenting to US emergency departments with sport participation product codes (Table 1). Cases associated with >1 product code were excluded. The monthly and annual frequency of sports-related injuries was estimated. Quasi-experimental interrupted time series analysis was performed using the period of March-December 2020 as a binary variable. Differences in total and sport-specific injury estimates were calculated with pre-and post-trend analysis of the interrupted time series. Results: Our study criteria identified 152,560 youth sports-related injury cases corresponding to a national estimate of 4,582,892 injuries from 2016-2020 (95% CI=4,420,534-4,745,250). The mean yearly estimate from 2016-2019 was 1,041,944 injuries [890,047-1,193,841]. An estimated 415,115 injuries [357,779-480,594] occurred in 2020. Seasonal peaks in September and May were identified. There was a statistically significant decrease in national youth sportsrelated injuries that coincided with the nationwide COVID-19 shutdown in March 2020 (56,945 [33,143-80,747] fewer monthly injuries (P < 0.0001)). From March-December 2020, an estimated 457,221 [388,450-525,992] fewer sportsrelated injuries occurred than would have been expected based on prior trends. Sport-specific analyses (Table 1) demonstrated the greatest reduction of estimated injuries from March-December 2020 occurred in basketball (137,772 fewer injuries [130,192-145,246]), football (123,345 fewer injuries [86,883-159,807]), and soccer (70,383 fewer injuries [65,849-74,919]). Estimates of injuries associated with wrestling, ice hockey, and cheerleading had the greatest proportional reduction during the March-December time period (99%, 93%, and 79% respectively.) Conclusion: There was a significant reduction in youth sports-related injuries in 2020 coinciding with the nationwide COVID-19 shutdowns in March 2020 and persisting throughout the remainder of the year. Reduced injury burden was most notable for contact sports including basketball, football, and soccer.