Keywords

FormalPara Key Points

  • Basketball is played by pediatric and adult males and females.

  • There is no mandatory personal protective equipment in basketball, although ankle taping/bracing, knee bracing, and use of mouthguards are common.

  • Injury rates vary between age groups, level of play, and genders.

  • Lower extremity injuries are the most common injury in basketball.

  • Minor injuries such as ankle and finger sprains are common.

  • Injuries are more likely to occur during game time.

  • Female players, especially at the college level, are prone to ACL rupture.

Introduction

Basketball is a limited contact sport consisting of five players on each team. Each team attempts to score by putting the ball in their respective basket, while preventing the opposing players from scoring in their own basket. The game is only stopped for fouls, timeouts, ball leaving the court, and end of time (quarters). Substitutions can be made only when the time clock is stopped. The sport requires extensive running (often explosive sprints) and jumping (Fig. 48.1).

Fig. 48.1
figure 1

A National Basketball Association (NBA) game. (Courtesy of Morteza Khodaee, MD, MPH)

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Injury Epidemiology

According to the Agency for Healthcare Research and Quality (AHRQ), team sports accounted for 33.7% of emergency department (ED) visits in 2013. Of these visits, 9.6% were sustained while participating in basketball [1]. Primary mechanisms of injury in basketball include contact with other players, contact with objects on/around the court (the ball, the court, standards, rarely the hoop rim), and noncontact [2, 3].

A general trend appears between both collegiate and high school age participants regardless of gender. Injuries occur most frequently during games [2,3,4]. Lower extremity injuries are the most common injuries associated with the sport, regardless of whether the injury is acute/traumatic or overuse. This is due largely in part to the maneuvers required to play the game, including jumping/landing, rapid changes in direction, lateral motion (cutting, pivoting), and sprinting [3, 5]. Of these lower extremity injuries, ankle and foot are the most commonly injured anatomic locations in basketball across gender and age groups.

Beyond the injuries outlined above, the rates of specific basketball-related injuries vary to a degree between pediatric/adolescent, high school, and collegiate/professional athletes. Gender disparities in injury rates can also be noted. For example, at the collegiate level, male players are more likely than female players to sustain contact injuries. Female college athletes are more likely than male athletes to sustain noncontact as well as overuse injuries [6]. The variability of injury patterns also depends on the setting of the injury (i.e., game time vs. practice).

Pediatric/Adolescent

Sports injuries are more likely to occur in older children as there is a trend toward more practice hours and more intense training as children age [7]. There is a growing trend in young athletes training and participating in sports year-round. Data on rates of specific injuries in pediatric patients is limited, especially in children younger than 12 years of age [7]. Younger players seem to be most susceptible to traumatic injuries such as fractures. Overuse injuries are common at this age. Upper extremity injuries also tend to be more common in younger players. These injury reports, however, are not sports specific [7]. Pediatric patients with injuries at specific body sites are more likely to injure the same site again [8].

Trends in injury rates change once players reach high school level. Students at this level often follow more vigorous training schedules than younger participants. Regardless of gender, players in guard position are more likely to sustain injury [4]. The most common injuries while playing this position are ligamentous injuries, muscle/tendon strains, and foot and ankle injuries. Players in forward and center positions also sustain similar injuries with lesser frequency [4].

Overall, the most commonly reported injuries are ligament strains and muscle/tendon injuries at the high school level [4]. Gender disparities, however, do exist in regard to injury rates and types. Among high school players, female players tend to have more reported injuries than male players. They are more likely to sustain ligament/tendon injuries than male players. Male players reportedly seem to sustain more fractures [4]. While upper extremity injuries are less common in basketball, they do still occur. Mallet finger is often a contact-related injury common in ball sports [9].

Concussions are also common among high school participants in basketball. Female players tend to experience concussions more frequently than male players. Rebound and defense maneuvers seem to be the most common activities leading to concussion [4].

Collegiate Level

Injury trends evolve again once players graduate to collegiate level . The most common mechanism of injury in practice in females was noted to be noncontact, while males tend to have higher injury rates resulting from contact (most commonly with other players) [2, 3].

Lateral ligament compartment sprain of the ankle is the most common lower extremity injury reported by NCAA across all collegiate sports regardless of gender and setting [5]. Basketball has the highest rate of this type of injury, with game times being the most common setting. Knee injuries follow second in commonality across both genders on both practice and game times. Practice time injuries are similar across genders. After ankle/foot, knee injuries, upper leg, and patellar injuries are common (Table 48.1) [2, 3, 10].

Table 48.1 Most common injury categories in collegiate basketball participants [2, 3, 10]
Full size table

However, game time injury rates diverge between male and female players. Game time injuries most common in male collegiate athletes include upper leg contusions, concussion, and patellar tendon injuries [3]. Practice time injuries most common in male players include hip/pelvis tendon strains, patellar injuries (direct patellar injury and patellar tendon injury), and low back muscle/tendon strains. After knee and ankle injuries, concussion and patellar injuries follow in frequency among female players during games. Muscle/tendon injuries and patellar injuries follow internal knee and ankle injuries in frequency during practice sessions for female players (Table 48.1) [2]. While knee injuries occur frequently in both male and female players, female athletes also tend to have higher rates of ACL rupture than male players [10]. Other common knee problems in female athletes include patellar tendinopathy and meniscal tears.

It should also be noted that concussions occur more frequently in this age group as compared to high school athletes. This is likely due to faster, more aggressive game play at this level [11].

What Is Unique About Basketball Injuries?

  • Basketball is a limited contact sport without any specific protective equipment required.

  • Injuries can occur from contact with other players or the court. Noncontact injuries can also occur (e.g., ACL rupture and ankle sprain).

  • Typically when there is notable blood, the athlete is required to be substituted immediately.

  • Lacerations need to be stabilized and secured against reinjury prior to return.

  • Lower extremity injuries can affect a player’s running and jumping ability and upper extremity injuries can affect ball dribbling, passing, and shooting.

What Do the Physicians Need to Know While Covering a Basketball on the Sideline

  • Concussion testing skills/protocols, laceration repair, braces for ankle, knee, elbow, and finger injuries may be required.

  • Prepare for dislocation (finger, shoulder, elbow, ankle, patellar) reduction.

  • Identify imaging options for fracture evaluation.

General Rule About Return to Play

Consider how the injury can limit the effectiveness of the athlete. Taping and bracing is allowed and may be used to stabilize the injured part for return. To limit deconditioning, encourage cross-training during the recovery from an injury. Consideration of reinjury especially after ankle sprains, ACL rupture, and concussions is essential.