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In high school, fall means Friday night football games, pep rallies and homecoming traditions. While these activities bring students excitement and pride, they also pose serious risks: Between 1982 and 2012, fall sports accounted for more catastrophic events—that is, incidences where athletes suffered fatal, permanent, or otherwise severe injuries—than any other season, according to a report from the National Center for Catastrophic Sport Injury Research (NCCSIR).*

Here’s a look at the five most dangerous sports for this time of the year.

1. Football

Given the recent controversy surrounding head injuries in the National Football League, it’s not surprising that football, known for its fierce tackling, is the most dangerous high school sport by a long shot.

The most common injuries include ACL and MCL tears in the knee, concussions, ankle sprains and brachial plexus stretch injuries, or nerve damage to the neck, shoulder and spine, says Dr. Carlos Prietto, president of Hoag Orthopedic Institute in Orange, California. These accidents frequently send players to the hospital for costly procedures; for example, the average MRI costs $2,611.

2. Cheerleading

Cheerleading is even riskier than football by some standards: There are 2.68 catastrophic injuries for every 100,000 high school cheerleaders, compared with 1.96 injuries for every 100,000 high school football players.

Accidents have risen in recent years as the sport has become increasingly popular and competitive. It may even cause more injuries than the numbers suggest. “It’s common in cheerleading for kids to report their injuries as gymnastics so that it doesn’t fall back on the cheerleading industry,” says Kimberly Archie, founder of the National Cheer Safety Foundation.

She adds that head and neck injuries, ACL and MCL tears in the leg and stress fractures in the lower back are common. Overuse injuries also happen often, because many cheerleading programs run longer than other sport seasons.

Archie recalls her daughter’s experience with cheering. “It was a year-round program for them—they cheered constantly, and when I say cheering, I mean acrobatics and tumbling.”

3. Soccer

As they sprint down the field kicking and heading the ball, both men and women soccer players run the risk of concussions, ACL injuries and broken legs.

“That ball is not like a balloon; it’s pretty tough. And if a soccer player heads the ball over and over a number of times there’s the potential for some concussive-type symptoms,” says Jim Thornton, president of the National Athletic Trainers’ Association. “You can also get concussions in soccer when the ball is kicked in the air and two people go up to head it at the same time and they end up heading each other.”

On top of these accidents, moveable soccer goalposts that fall and crush players have caused at least 36 deaths since 1979, according to the Consumer Product Safety Commission.

4. Cross country

When up against rigorous contact sports, one might wonder why this solo sport makes the list. But cross country runners face their own set of risks, including heart complications and heat illnesses. Of the 31 indirect serious cross country injuries the NCCSIR study reported, 26 were heart-related.

Competitive runners frequently suffer overuse injuries such as stress fractures, shin splints and hip and knee overuse, Prietto says. Heat stroke poses another threat for these athletes, especially in warm climates.

Thornton also notes the challenge this sport poses for athletic trainers. “They go out into the wild blue yonder for their runs and it’s really tough to keep up with the cross country team.”

Heat stroke is not a threat limited to cross country, Thornton adds. Any athlete training in high temperatures should take precautions, such as drinking plenty of water and avoiding practicing in the middle of the day.

5. Field hockey

“You’ve got two people, they’re usually bent over going after a ball trying to hit it,” Thornton says. “You’re leading with your head a little bit, so concussions and injuries to the head can happen.”

Strikes from the stick and blows from the ball also pose risks to field hockey players. Of the four field hockey injuries cited in the NCCSIR study, three involved an athlete being hit with the ball or stick, and resulted in head and eye injuries. Athletes should wear protective eyewear and headgear to prevent this.

Like most athletes, field hockey players also face the risk of concussions, ACL tears and sprained ankles, Thorton adds.

Avoiding the worst case scenario

Coaches and players can prepare for serious head and neck injuries, a leading cause of death, by creating and practicing response plans. In addition, all sports facilities should have an automated external defibrillator (AED) on hand, which can be used to restart an athlete’s heart in a case of cardiac arrest, the top killer of athletes.

“You want to make sure they’re running through an emergency plan like you do a fire drill,” Archie says. “The time and the way you respond could be the difference between catastrophic injury or death.”

The list of potential injuries can be overwhelming, but at the end of the day, the physical benefits of sports are generally thought to outweigh the risks. So while you may not choose to pull your teen off the team, it’s important to encourage them to be careful.

*The National Center for Catastrophic Sport Injury Research (NCCSIR) report included direct and indirect fatal and permanent injuries for both men and women athletes.

Football player image courtesy of Shutterstock.

Illustration by Brian Yee.