BACKGROUND AND OBJECTIVES:Performing artists are at risk of head injuries, such as falling from an elevated surface, partner stunting, collisions with other performers or equipment, and/or tripping because of low ambient lighting. However, contemporary clinical guidelines have not addressed the demands of university-level performing arts students. Furthermore, current return-to-learn strategies do not take into consideration the physical aspects of performance-specific skillsets. The purpose of this study was to develop consensus on appropriate postconcussion recommendations to support university-level performing arts students returning to dance, music, and theater performance. METHODS:Prospective panelists were recruited using targeted emails from May to June 2024, to participate in a study using the modified Delphi technique. During round 1 of the Delphi process, panelists responded to open-ended questions on how to adapt the International Concussion in Sport Group's 2022 return-to-sport strategy to address the needs of university performing arts students. The research team conducted constant comparative qualitative analysis to generate statements to be voted on during the subsequent rounds. In round 2, panelists anonymously rated each statement using a 9-point scale (1 = not at all important, 9 = very important). During round 3, panelists received the aggregate group scores with their individual scores from round 2 with the option to modify their responses if desired. Consensus was established if statements achieved average scores ≥7 after the final round. RESULTS:Twenty-one panelists (mean age = 41.9 ± 11.6 years; 71.4% female) enrolled in a 3-part Delphi study from May to December 2024. They included university-affiliated clinicians (n = 5), concussion researchers (n = 5), performing arts faculty/staff (n = 7), and students/alumni with concussion history during their university performing arts training (n = 4). Following the Delphi process, the panel agreed on 101 of the initial 189 statements (53.4%) resulting in the Progressive Return-to-Performance Protocol (PRTPP), a stepwise approach supporting safe return to dance (n = 26), music (n = 36), and theater performance (n = 39) after concussion. DISCUSSION:The recommendations generated herein include considerations for participating with other performers, using stage equipment/props, increasing performance endurance, and reintroducing environmental stimuli (e.g., costumes, lighting, amplifiers, or instruments). The proposed PRTPP serves as a framework to guide university-based medical and academic teams when developing individualized postconcussion management plans for performing arts students.

Female athletes have been identified as having a significantly higher risk of anterior cruciate ligament (ACL) injury than their male counterparts. Does that trend exist in a general population? PURPOSE: We assessed ACL injury repair procedures by sex and age via a large claims database to determine if the incidence rate of ACL procedures differed across sexes and ages in a general population. METHODS: A large commercial claims database (primarily representing employer-based health plan patients and their families) and associated analysis tool were used in this project. Patients were included in the study if they had continuous enrollment in the database from January 1, 2018 - December 31, 2019, were between the ages of 14-65 on January 1, 2018, and did not have evidence of a previous ACL procedure. Patients were stratified by sex, as well as age group (14-17, 18-23, and ≥ 24 years). ACL procedures were identified using CPT and ICD-10-CM procedure codes. The incidence rate of ACL procedures was calculated within all cohorts and rates between males and females were compared statistically RESULTS: Approximately 9 million patients met the inclusion criteria for the study. A total of 16,700 had a claim for an ACL repair procedure during the study period. 52% of the patients who had an ACL procedure were male. Males were significant more likely than females to have an ACL repair among 18-23 year-olds (1.8 per 1000 person-years vs. 1.4 per 1000 person-years; p-value <0.001) and among patients ≥24 years-old (0.67 per 1000 person-years vs. 0.58 per 1000 person-years; p-value <.0001); females were significantly more likely to have an ACL repair among 14-17 year-olds than males (2.65 per 1000 person-years vs. 2.19 per 1000 person-years; p-value<.0001). CONCLUSIONS: This study examined ACL repair procedures by sex and age in a general population. Results show that the incidence rate of ACL repairs differ across sexes and age groups, and that in college-age and adult populations, males are more likely to have a procedure than females. contrary to findings in the collegiate athlete population. This study shows the value of using a general database population to compare to previous findings among athletes and suggests further research is needed to better isolate the factors faced by female athletes that result in higher ACL injury risk.

ABSTRACT Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a "living tool," which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

A new continuing education course from Performing Arts Medicine Association and American College of Sports Medicine enables sports medical health professionals to better care for performing artists. High occupational injury rates have been reported in performing artists, yet the quality of preventive and clinical care remains highly variable. Through the Athletes and the Arts collaboration, The Performing Arts Medicine Association, and the American College of Sports Medicine identified that health care practitioners' existing expertise should be enhanced to address the complex psychophysical needs of performing artists. In response, a 2-d continuing education course, "The Essentials of Performing Arts Medicine" (EOPAM), was developed and has been delivered at least annually since 2016. This course has been well-received by 149 physicians and 240 allied health professionals to date (average ratings, >= 3.5/5 from 2018 to present), with course quality significantly improved by a transition to online delivery in 2020 (average ratings >= 4.5/5; P < 0.01). Accordingly, EOPAM demonstrates that a brief continuing education course can enhance health professionals' understanding of the unique needs and demands of performing artists, addressing a key barrier to improved care.

Dick, Randall MS, FACSM; Ackermann, Bronwen J. BAppSci (Physiotherapy), MPH, PhD; McCrary, J. Matt BFA, BS, PhD; Miller, Clay MFA, MD, PMR; Guptill, Christine BMus, BSc, MS(OT), PhD, OT Reg. (Ont.) Author Information

Performing artists are athletes. Like athletes, performing artists practice and/or perform most days with little off-season, play through pain, “compete” in challenging environments, and risk career-threatening injury. Performing artists of all ages and genre are an underserved population related to medical coverage, care, injury prevention, performance enhancement, and wellness. Sports medicine professionals are a valuable resource for filling this gap by applying existing knowledge of treating sport athletes (nutrition, injury prevention, and rehabilitation) while gaining a better understanding of performers' unique needs (hearing loss, focal dystonia) and environment. Athletes and the Arts is a multiorganizational initiative linking the sport athlete and performing artist communities. It can assist in better understanding the needs of the performing arts population and help medical professionals expand their impact to a patient base that desperately needs support.

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on 1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, 2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, 4) Updates in Equipment: Their Relationship to Industry Standards, and 5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: 1) eliminate head hits from all levels of ice hockey, 2) change body checking policies, and 3) eliminate fighting in all amateur and professional hockey.

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Background: Although mild traumatic brain injury (MTBI) is not as common in professional baseball as in collision sports, it does occur and frequently results in significant loss of time away from the sport. To date, no study has investigated MTBI among an entire cohort of professional baseball players.Purpose: To investigate MTBIs in major and minor league baseball players to determine the most common mechanisms of injury, activity at time of injury, position, level of play, and time lost, as well as ultimately inform prevention efforts. A secondary objective was to document the association between MTBI and return to play using several different measures.Study Design: Descriptive epidemiologic study.Methods: Data were captured from a newly implemented league-wide injury surveillance system that records injuries among all professional baseball players as entered by certified athletic trainers and physicians. The MTBIs were identified with respect to level of play, activity, field location, and mechanism of injury. Time loss was assessed by 3 measures of return to play, and MTBI game rates were reported as injuries per 1000 athlete-exposures. Data were combined over the 2011-2012 seasons for analysis, and results were presented separately for minor and major league players. Chi-square tests were used to test the hypothesis of equal proportions between the various categories of MTBI injury characteristics.Results: There were 41 reported MTBIs in the major leagues and 266 in the minor leagues over the 2-year period under study. The overall MTBI game rate across both major and minor league ball clubs was 0.42 per 1000 athlete-exposures. The median time lost was 9 days. Mild traumatic brain injury accounted for 1% of all injuries resulting in time lost from play. For MTBIs that occurred while fielding, catchers were significantly overrepresented. No differences were noted among the 3 measures of time lost.Conclusion: Mild traumatic brain injury is an important problem in professional baseball players, especially for catchers. This study provides a foundation for future inquiry to reduce the incidence of MTBI in those positions at greatest risk and to provide a baseline as rules and equipment evolve.

BACKGROUND:Hamstring strains are a recognized cause of disability for athletes in many sports, but no study exists that reports the incidence and circumstances surrounding these injuries in professional baseball.HYPOTHESIS:Professional baseball players have a high incidence of hamstring strains, and these injuries are influenced by multiple factors including history of hamstring injury, time period within the season, and activity of base running.STUDY DESIGN:Descriptive epidemiologic study.METHODS:For the 2011 season, injury data were prospectively collected for every Major League Baseball (MLB) major and minor league team and recorded in the MLB's Injury Surveillance System. Data collected for this study included date of injury, activity in which the player was engaged at the time of injury, and time loss. Injury rates were reported in injuries per athlete-exposure (A-E). Athlete-exposures were defined as the average number of players on a team who were participating in a game multiplied by the number of games.RESULTS:In the major leagues, 50 hamstring strains were reported for an injury rate (IR) of 0.7 per 1000 A-Es and averaged 24 days missed. In the minor leagues, 218 hamstring strains were reported for an IR of 0.7 per 1000 A-Es and averaged 27 days missed. Base running, specifically running to first base, was the top activity for sustaining a hamstring strain in both major and minor leagues, associated with almost two-thirds of hamstring strains. Approximately two-thirds of these injuries in both the major and minor leagues resulted in more than 7 days of time loss. Approximately 25% of these injuries kept the player out for 1 month or longer. History of a previous hamstring strain in the prior year, 2010, was found in 20% of the major league players and 8% of the minor league players. In the major leagues, the month of May had a statistically significant higher frequency of hamstring injuries than any other month in the season (P = .0153).CONCLUSION:Hamstring strains are a considerable cause of disability in professional baseball and are affected by history of hamstring strain, seasonal timing, and running to first base.

Performing artists are athletes. Like athletes, performing artists practice and/or perform most days with little off season, play through pain, "compete" in challenging environments, and risk career-threatening injury. Athletes and the Arts is a multiorganizational initiative linking the sport athlete and musician/performing artist communities. Performing artists of all ages and genre are an underserved population related to medical coverage, care, injury prevention, performance enhancement, and wellness. Sports medicine professionals are a valuable resource for filling this gap by applying existing knowledge of treating sport athletes (nutrition, injury prevention) while gaining a better understanding of performers' unique needs (hearing loss, focal dystonia) and environment. These applications can occur in the clinical setting and through developing organizational policies. By better understanding the needs of the performing arts population and applying existing concepts and knowledge, sports medicine professionals can expand their impact to a new patient base that desperately needs support.

BACKGROUND:Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.HYPOTHESIS:A simple on-field alternative warm-up program can reduce noncontact ACL injuries.STUDY DESIGN:Randomized controlled trial (clustered); Level of evidence, 1.METHODS:Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons.RESULTS:Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries).CONCLUSION:This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Background Wrestling holds worldwide popularity, and large numbers of United States high school and college males participate. However, the sport's arduous nature results in high injury rates. Hypothesis Wrestling injury rates and patterns will differ between high school and college practice and match exposures. Study Design Descriptive epidemiology study. Methods Wrestling-related injury data were collected during the 2005–2006 academic year from 74 nationally representative high schools via High School Reporting Information Online (RIO) and from 15 Division I, II, and III colleges via the National Collegiate Athletic Association Injury Surveillance System. Results Certified athletic trainers reported 387 injuries among participating high school wrestlers during 166 279 athlete-exposures, for an injury rate of 2.33 injuries per 1000 athlete-exposures. Nationally, high school wrestlers sustained an estimated 99 676 injuries and 8741 skin infections during the 2005–2006 season. In college, 258 injuries occurred among participating wrestlers during 35 599 athlete-exposures, for an injury rate of 7.25 injuries per 1000 athlete-exposures. The injury rate per 1000 athlete-exposures was higher in college than high school (rate ratio [RR] = 3.11, 95% confidence interval [CI]: 2.66–3.64) and was higher in matches than in practice in high school (RR = 2.12, 95% CI: 1.73–2.59) and college (RR = 5.07, 95% CI: 3.96–6.50). Diagnoses in greater proportions of college wrestlers included lacerations (injury proportion ratio [IPR] = 5.98, 95% CI: 2.27–15.74) and cartilage injuries (IPR = 2.69, 95% CI: 1.26–5.74). Body parts injured in greater proportions of high school wrestlers included elbow (IPR = 3.90, 95% CI: 1.66–9.14) and hand (IPR = 2.59, 95% CI: 1.21–5.54). Almost half of all injured high school (44.9%) and college (42.6%) wrestlers resumed wrestling within <1 week. Skin infections represented 8.5% and 20.9% of all reported high school and college events, respectively, and frequently affected the head/face/neck (50.0%). Conclusions Rates and patterns of wrestling injury differ between high school and college and between practice and matches.

Sports rule/policy changes designed to reduce the incidence of injuries have the potential to have a sizeable effect, reach a large population, with little to no cost. PURPOSE: To investigate the effectiveness of rule/policy changes on injury rates in 3 collegiate sports. METHODS: The National Collegiate Athletic Association Injury Surveillance System (ISS) conducts ongoing, annual surveillance of injuries using a sample of all member schools. Data from 16 academic years were analyzed to assess the effect of rule/policy changes on incident injury rates. Injuries were defined as: 1) occurring from sport participation, 2) required medical treatment, and 3) restricted the athlete's participation for 1 or more days. An exposure was defined as 1 athlete participating in 1 practice/game where there was a risk of injury. 3 specific sport rule/policy changes were evaluated: 1) Field hockey - 1996-1997 offsides/corner shot rule, 2) Baseball - 1999-2000 bat design rule, and 3) Football - 1997-1998 Spring practice contact/equipment policy. Injury rates (IR) per 1000 athlete-exposure (AE) and 95% confidence intervals (CI) were calculated and compared for two time periods: pre and post rule/policy change. Significance was defined as non-overlapping CIs or p< 0.05. RESULTS: For Field Hockey, the overall game injury rate significantly declined from pre (IR 8.65, CI 8.03-9.28) to post (IR 6.91, CI 6.29-7.53); a 35.1% reduction in the absolute number of injuries. For baseball, the IRs from batted balls did not significantly change for all players (pre-IR = 0.53, CI 0.45-0.61; post-IR = 0.60, CI 0.51-0.69) or for pitchers only (pre-IR = 0.15, CI 0.11-0.20; post-IR =0.18, CI 0.13-0.23); a slight increase (5.5% all players, 8.3% pitchers) in the absolute number of batted ball injuries. For Spring football practice, there was a small, but significant (p<0.01), reduction in overall injury rates from pre (IR 9.87, CI 9.61-10.13) to post (IR 9.37, CI 9.12-9.62); a 6.0% reduction in the absolute number of injuries. CONCLUSIONS: Simple changes in sport rules and/or policies may be an effective and wide-reaching intervention to prevent sports injuries, however, changes may not always result in the desired effect. Therefore it is critical to evaluate rule and policy changes in sports to assess both wanted and potentially unwanted consequences.

PURPOSE: To discover the effects of an active weight loss (AWL) module in a comprehensive worksite health promotion (WHP) program for employees beyond the age 40. METHODS: 180 subjects (m: 70.6%; f: 29.4%; age: 47.5 ± 6.3) out of 660 employees from a Swiss insurance company enrolled in a modular 3-month program. This WHP program included 8 intervention categories such as "exercise", "nutrition" and "relaxation" with multiple offerings. Participants had to select at least one offering from each of the 8 categories. AWL, in the nutrition category, included 8 behavioral and nutritional education lessons and independent training in the fitness center 2/week. In a randomized delayed treatment design 12 health and fitness variables, including body composition analysis (% of body fat (%BF)), body mass index in kg/m2 (BMI) and waist hip ratio (WHR) were measured at baseline, 3 (end of program), 6 and 9 months post-baseline to assess potency of the intervention modules. Analyses were made with SPSS 15.0. RESULTS: 33 (P-AWL) (m: 66.7%; f: 33.3%; age: 47.1 ± 6.0) out of 158 subjects who completed the study chose the AWL module. The remaining 125 subjects (OTHERS) (m: 72.8%; f: 27.2%; age: 47.3 ± 6.3) did not select the AWL. At baseline P-AWL had significant higher mean values than OTHERS in %BF, BMI and WHR. Both groups showed a significant decrease in all 3 variables between baseline and 3 months post-baseline (end of program). For P-AWL the decrease in BMI (baseline - 28.7 ± 4.3 vs. 3-months - 27.8 ± 3.6 vs. 9-months - 27.9 ± 3.8), %BF (28.0 ± 6.9 vs. 26.9 ± 7.1 vs. 27.7 ± 7.1) and WHR (.89 ± .10 vs. .87 ± .09 vs. .88 ± .10) lasted until the 9 months measurement contrary to OTHERS (BMI: 24.8 ± 3.2 vs. 24.7 ± 3.2 vs. 24.7 ± 3.4; %BF: 22.1 ± 8.0 vs. 22.5 ± 8.1 vs. 23.0 ± 8.1 and WHR: .85 ± .07 vs. .85 ± .08 vs. .85 ± .08). The two-way (group*time) ANOVA with repeated measures showed a significant decrease over time in the P-AWL group compared to the OTHERS group in BMI (p<0.00), %BF (p<0.03) and WHR (p<0.01). CONCLUSION: The subjects who chose AWL, a combination of behavioral and nutritional education and exercise, had greater and lasting health benefits compared to those who did not choose this module. A recommendation of the ideal WHP module combination to maximize health effects is currently being developed.

PURPOSE: To compare the rate of concussions between genders in selected NCAA sports competitions METHODS: The National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) conducts ongoing annual surveillance of sport injuries using a sample of all NCAA member schools. Competition data from men's (M) and women's (W) soccer and M and W basketball (similar sports, similar rules, similar equipment -16 years) and M and W ice hockey (similar sport, similar equipment, different rules - 4 years) were analyzed to assess risk of concussion. Concussion was one of thirty distinct choices to report for injury type. To be reported, it must have occurred during a competition, required medical treatment and restricted the athlete's participation for 1 or more days. Exposures were defined as the number of athletes with playing time in each game and thus exposed to a risk of injury. Injury rates (IR) per 1,000 athlete-exposure (AE) and 95% confidence intervals (CI) were calculated and compared between genders. Significance was defined as non-overlapping CIs or p< 0.05. Results. Soccer (W - IR 1.42 concussion /1000 AE, CI 1.29-1.55, M - IR 1.08 / 1000 AE, CI 0.98-1.19) and basketball (W - IR 0.50 concussion/1000 AE, CI 0.43-0.56, M - IR 0.32/1000 AE, CI 0.27-0.37) showed significantly higher rates of game concussions for W participants. W ice hockey players showed similar rates (2.72 concussions/1000 AE, CI 2.02-3.43) to their male counterparts (2.29 concussions/1000 AE, CI 1.94-2.64) despite rules in the women's game that prohibit body checking. However, concussions accounted for 22% of W ice hockey game injuries over the sample period compared to13% for M. CONCLUSION: After evaluating multiple years of competition concussion data in selected sports, collegiate women athletes may be at greater risk for concussion than their male counterparts. This finding was apparent in sports where rules and equipment were similar (soccer, basketball) as well as in ice hockey where it would be hypothesized that women would have smaller concussion rates because of rules prohibiting body checking. While definitive definitions and assessment techniques for concussions have changed over the sample period, the consistent higher concussion rates among women in each of the sports analyzed justifies further research.

PURPOSE: Position papers by the ACSM warn of the dangers of exertional heat illness (EHI) among athletes. The NCAA has embraced the ACSM warnings through rules and recommendations to medical staff, coaches and student-athletes. Using a retrospective review, the present investigation sought to determine the incidence of EHI in 16 years of NCAA injury surveillance data. METHODS: Data were extracted from injury surveillance surveys collected by the NCAA from 1988 through 2004 for 15 men's and women's sports. EHI causing loss of one day or more of practice/game were reported and included: heat cramps, heat exhaustion, heat stroke, hyponatremia, and heat syncope. Injury rates are expressed as the ratio of injury events per 1000 athlete exposures (A-E). RESULTS: 2095 EHI were reported which represents 1.1% of the 182,655 injury events and a rate of 0.06 EHI per 1000 A-E. 91.9% of the EHI (1925) occurred in practice with an A-E rate of 0.09/ 1000 A-E. EHI occurred predominantly in preseason 86.9% (rate 0.17/1000 A-E) compared to in-season (11.6% 0.02/1000 A-E) or postseason (1.6% rate 0.04/ 1000 A-E). The majority of EHI (1632 or 77.9%) occurred in men's fall football (MFB) practices and represented 3.9% (rate 0.15/ 1000 A-E) of MFB practice injuries. 96.0% of the MFB practice EHI (n=1567) occurred during preseason Two other sports men's (MSO) and women's (WSO) soccer report EHI greater than 1% in practices. Among MSO 1.7% of all practice injuries were related to EHI (n=106, rate 0.08/ 1000 A-E) and among WSO practices, EHI accounted for 1.2% (n=70, rate= 0.06/ 1000 A-E). CONCLUSIONS: EHI represents a significant risk for student-athletes, particularly among fall sports that begin practice in late summer. Football protective equipment may increase the risk in MFB. Medical staff, coaches, and student-athletes should adhere to ACSM and NCAA guidelines for exercise in the heat.