Background Published data has demonstrated that collegiate athletes sustain significantly higher game than practice injury rates (13.8 vs 4.0 injuries per 1000 A-Es). Review of this data demonstrates disparities within the practice injury rates with pre-season practice injury rates being significantly higher than in-season and post-season practice rates.

Objective Our a priori primary hypothesis was that Fall sports would show the largest differential in pre-season compared to in-season practice injury rates. Our secondary hypothesis was that Division I would report higher rates of pre-season practice injury rates compared to Divisions II and III.

Setting National Collegiate Athletic Association (NCAA).

Participants 250 NCAA Injury Surveillance System participating schools with 182 000 injuries with 1 300 000 exposures.

Assessment of risk factors The dependent variables are sport, season and division.

Main outcome measure The independent variable is injury; defined as time loss of 1 day or more from a scheduled athletic activity.

Results Pre-season practice consistently resulted in the highest injury rates across all Divisions regardless of season. Men's football (Fall) had the highest rate ratio of pre-season to in-season practice injury (3.47 (3.40, 3.54)). Men's and Women's soccer (Fall) were next (3.28 (3.11, 3.45), 3.27 (3.09, 3.45). Women's Division 1 soccer, had the greatest differential between pre-season and in-season practice injury as well as the highest pre-season practice injury rate for all sports except Division 1 men's wrestling (Winter). There was no consistent injury pattern demonstrated across season when sports were analyzed by Division.

Conclusion Pre-season practices are responsible for a disproportionate share of practice injuries. Fall sports demonstrate the highest within sport practice injury rates. Attention should be paid to this finding in order to ensure that practices are conducted in a safe manner for the athletes and all potential injury prevention options taken advantage of.