Elite Club National League

ECNL Injury Risk Reduction Program

• In order to generate actionable evidence in elite youth soccer athletes, an innovative, nationwide, embedded in injury data collection infrastructure was developed to record injuries at ECNL events, determine the relationship between injury incidence and various risk factors, and guide future decision-making.
• Across 24 events representing more than 200,000 player hours among ECNL athletes, girls had a higher overall injury incidence, but concussion incidence was similar. No increased injury incidence was identified during the later games of multi-day events when games were played on consecutive days with unlimited substitution, and injury incidence was not influenced by the inclusion of rest days.
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Research has consistently found that sleep is a crucial element of athlete performance, recovery and overall health. Importantly, athletes who sleep more are less likely to experience an injury. Specifically we have found that one hour of increased sleep is associated with a 30-40% reduction in injury risk the following day. In addition, athletes with chronically poor sleep may have an increased injury risk of nearly 60% over time. Unfortunately, athletes have been consistently found to have insufficient sleep and poor sleep quality. Young athletes experience a number of important threats to sleep, but simple steps to improve and increase sleep can have a profound impact on both health and performance.

• Decreased Sleep Is an Independent Predictor of In-Season Injury in Male Collegiate Basketball Players
  • This study found that among collegiate basketball players, decreased sleep is associated with a significant risk of injury the following day, even after accounting for training load, and well-being (mood, stress, fatigue).
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• Decreased Sleep and Subjective Well-Being as Independent Predictors of Injury in Female Collegiate Volleyball Players
  • This study of collegiate female colleyball athletes found that an extra hour of sleep was associated with a 30% reduction in injury risk the following day. While well-being also remained an independent predictor of injury risk, sleep was the most important predictor.
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• Sleep and the Young Athlete
  • This review highlights the relationships between sleep, injury, mental health and performance in young athletes. It offers specific recommendations, especially with respect to travel.
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• Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective
  • This study followed nearly 500 athletes from 16 different sports over a full year to evaluate the association between different risk factors and injury. Athletes with decreased sleep volume in a given week were more likely to be injured and this effect was amplified during periods of higher training load. Together this suggests that increased physical loads and decreased recovery have additive effects on injury risk.
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• Chronic lack of sleep is associated with increased sports injuries in adolescent athletes
  • This retrospective study asked middle and high school athletes from multiple sports to estimate their average nightly sleep and then looked at school training room logs to identify injuries. Athletes who estimated less than 8 hours of sleep per night were found to be 70% more likely to have an injury during the prior 21 months.
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• Impact of in-season injury on quality of life and sleep duration in female youth volleyball athletes: a prospective study of 2073 players
  • In a study of over 2000 high school volleyball athletes, athletes who slept less prior to the season were more likely to suffer an injury during the season.
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• Lack of Sleep and Sports Injuries in Adolescents: A Systematic Review and Meta-analysis
  • This review study identified and aggregated prior studies of the relationship between sleep and injuries on youth athletes. When analyzed together, adolescent athletes with chronically impaired sleep were 58% more likely to suffer an injury than those who slept well.
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The benefits of physical activity for children and adults are well known.  Increased physical activity is associated with improvements in virtually every physical system, including cardiovascular function, metabolic health, bone health, immune function, and more.  In addition, physical activity has been widely recognized as a powerful way to improve mental health across a broad range of populations.

Although organized sports represent the primary means of obtaining physical activity for children in the United States, the impacts of organized sports are not limited to the physical benefits.  Prior to COVID-19, we recognized that participation in organized sports was associated with a broad range of positive outcomes for children, including decreased risk-taking behavior and substance misuse, improved self-esteem, improved academic performance, greater levels of adult physical activity and even improved lifelong financial success.

But the COVID-19 pandemic truly highlighted the vital role that sports play in the mental health of children.  During the early school and sport cancellations, adolescent athletes were reporting startling high levels of anxiety and depression. As sports were reinitiated in parts of the country, we saw that the mental health improved dramatically among those athletes who returned to sports, irrespective of whether they returned to in-person school or not. Unfortunately we saw that those athletes unable to return after 6 or 12 months of restriction were reporting worsening mental health, and that athletes from racial/ ethnic minority groups and lower socioeconomic areas were the most negatively affected.

Finally, it became clear that the mental health benefits of returning to sports were not just due to the increase in physical activity.  In fact, the increases in physical activity only explained around 25% of the total improvement in mental health.  This suggested that while physical activity is beneficial, the majority of the mental health benefits of organized sport participation are attributable to psychosocial factors such as the re-establishment of peer networks, role models, athletic identity and purpose for young athletes.  This highlighted the crucial role that sports play in the lives of children throughout the US, as well as the profound negative impacts that loss of sports can have.

• Mental Health, Physical Activity, and Quality of Life of US Adolescent Athletes During COVID-19-Related School Closures and Sport Cancellations: A Study of 13 000 Athletes
  • This nationwide survey of over 13,000 adolescent athletes in May 2020 found that around 40% of the respondents reported moderate to severe levels of anxiety and/or depression immediately following to cancelation of school and sports. In addition, female athletes, team sport athletes, and athletes from areas of greater levels of poverty reported worse mental health and quality of life. This study highlighted the profound immediate impact that school closure and the loss of sports had on young athletes.
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• Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the COVID-19 Pandemic
  • This study compared data from over 3000 adolescent athletes in May 2020 to data collected from over 5000 athletes before COVID-19. It found that during the pandemic, athletes reported dramatically lower physical acitivity and quality of life scores and were 3 times more likely to report moderate to severe levels of depression. This study continued to demonstrate the profound short-term effects of school and sport cancelation on the physical and mental health of young athletes.
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• Does Increased Physical Activity Explain the Psychosocial Benefits of Sport Participation During COVID-19?
  • This study found that adolescent athletes in a single state who had returned to sports during COVID-19 had significantly better mental health than those who had not, but the increased physical activity among those who had returned to sports only explained a small amount of the mental health benefit. This suggests that the majority of the mental health benefits of returning to sports is related to psychosocial factors such as the re-establishment of peer networks, athletic identity, role modeling and competitive opportunities.
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• The Impact of COVID-19 on the Physical Activity, Quality of Life and Mental Health of Adolescent Athletes: a Two Year Evaluation of Over 17,000 Athletes
  • In a nationwide sample of adolescent athletes in spring 2020 and spring 2021, this study found that athletes who had returned to sports in 2021 reported dramatically better anxiety, depression and quality of life.
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• A Multiyear Assessment of the Effect of Sport Participation on the Health of Adolescent Athletes During the COVID-19 Pandemic
  • This study compared mental health and quality of life among adolescent athletes from before the COVID-19 pandemic, in May 2020 during the school and sport cancelations, and in May 2021 after returning to sports. It found that athletes who had returned to sports had dramatic improvements in anxiety, depression, and quality of life, even after for accounting for the influence of school instructional delivery. Unfortunately, levels of depression remained higher than those reported prior to the pandemic, suggesting that the mental health impacts of the pandemic had not improved back to pre-pandemic levels.
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• High School Sports During the COVID-19 Pandemic: The Effect of Sport Participation on the Health of Adolescents
  • This study compared mental health outcomes between adolescent athletes who had or had not returned to sports in the fall of 2021. It found that those athletes who had not been able to return to sports were more than 5 times more likely to report moderate to severe levels of anxiety and more than twice s likely to report moderate to severe levels of depression. This highlighted the profound benefits of returning to sports, and the negative mental health impacts of prolonged restriction from sports.
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• The Influence of Race, Socioeconomic Status, and Physical Activity on the Mental Health Benefits of Sport Participation During COVID-19
  • This study compared the benefits of returning to sports in May 2021 following the COVID pandemic across race/ ethnicity, socioeconomic status and gender. It found that the mental health benefits were similar between males and females, but that athletes from traditionally underrepresented racial and ethnic groups, as well athletes from areas of lower socioeconomic status, had the greatest mental health benefits from returning to sports. This study helped clarify that virtually all adolescent athletes saw significant mental health benefits from returning to sports following the COVID-19 pandemic, but that prolonged restriction had a disproportionately negative impact on certain groups of athletes. In addition, this study replicated the previous finding that the increased physical activity upon returning to sports, only explained ~25% of the mental health and quality of life benefits. This reinforced the finding that the mental health benefits of sports are predominantly not due to physical activity, but likely attributable to factors such as the re-establishment of peer networks, athletic identity, purpose and role models.
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