Dr. Karen Liller scores big for sports injury prevention

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“We are working hard to bring injury prevention to the forefront. Injuries are the leading cause of death for children and young adults, from motor vehicle injuries to sport injuries; it is a huge public health problem,” said Dr. Karen Liller, USF College of Public Health professor in the Department of Community and Family Health.

Liller collaborated with Dr. Barbara Morris, director of sports medicine and performance at Florida Hospital Wesley Chapel, and other researchers to examine and report sports injuries among high school athletes. They have utilized the Reporting Information Online (RIO) data tool, an internet-based sports-related injury surveillance system, in order to garnish support for the role of surveillance in planning injury prevention programs for athletes.

Her report, “Sports injuries among High School Athletes in 15 West Central Florida Schools,” was published in the International Journal of Human Movement Science in 2015.

Starting in 2007, certified athletic trainers (ATCs) were hired and trained by researchers from the USF Sports Medicine and Athletic-Related Trauma Institute (SMART) to collect and report injury findings from high school athletes.

Schools were chosen for the study based on their willingness to participate, distance to health services, risk for injuries based on sports offered and their standing on having an ATC.

“We have consistently seen over the nine years of collecting data that sports such as football, basketball and wrestling usually have high numbers of injuries,” Liller said.

During the study, researchers not only counted the number of injuries that occurred for a certain sport, but also the amount of exposure the athletes had. Sports that have more practices and competitions allow for more exposure to injury risk, so factoring in the exposure rate can give researchers a better look at what sports have the greatest possibility for injury.

Generally the injuries reported were minor, but serious injuries did occur and several students missed days of school, practices and competitions.

“Most of the injuries are sprains and muscle strains, but we did see our fair share of concussions as well,” Liller said.


The results of the latest published study for the 2013-2014 academic year showed that the leading rate of injury per 1,000 athlete-exposures for practice was for girl’s lacrosse, followed by “other sports,” and then football. For competitions, the injury rate per 1,000 athlete-exposures was greatest for football, followed by “other sports,” and then wrestling.

Liller said that while the findings for football echoed what she has studied before, she was surprised by what they found with women’s lacrosse.

“Women’s lacrosse is new in our schools, so we definitely want to keep an eye out to see what will happen with that sport as it includes more athletes,” Liller said. “We hope to study the efficacy of the new Florida rule that high school girls’ lacrosse players must wear head gear. Right now good studies need to be conducted to determine the true risk of head injuries related to this sport.”

She also believes that particular attention should be paid to the differences in data for sports played by both boys and girls so that injury prevention can be tailored based on gender differences. For example, in the present study, girls’ soccer showed a greater injury rate than boys’ soccer.

Liller, along with Morris, was recently awarded a grant from the National Operating Committee on Standards for Athletic Equipment (NOCSAE) that corresponds to her previous research on sports injuries.

“It’s been good to work with the high school data because we’ve been trying to find injuries before students went to college, before they continued to play at the collegiate level,” Liller said. “But then Dr. Barbara Morris, of Florida Hospital Wesley Chapel, had an idea to study injuries in younger children based on her years in working as an ATC in the community.”

“Based on what we’ve learned in the high school, we’re hoping to see what the most common types of injuries are in younger children who play sports,” Liller said.

The grant, which began in May, focuses on children ages 5-11 who play sports in recreational or community leagues in Hillsborough County. They will specifically be covering football, girls’ and boys’ soccer, baseball, and softball leagues.

“Many times we do not have information on the types of injuries, when they happen, or how often they can happen,” Liller said. “We hope to gain a better understanding of these injuries so that we can prevent them in the future.”

Very few researchers have studied sports injuries among young children in recreational settings.

The study will have one ATC who is responsible for collecting injury data, and about 14 other ATC’s who will be conducting baseline concussion testing, also known as a neurocognitive testing. Liller designed the study and with her doctoral student research assistants, Michael Bubu and Yingwei Yang, and will analyze all findings.

“We are looking forward to the findings, although it will be challenging having a roster of more than 2,000 children playing in these leagues, but we do have the full support of the athletic organizations in Hillsborough County,” Liller said.

The study will also involve working with clinics, such as the orthopedic clinic at the USF Health Morsani Center, to see if any of the injured athletes are patients and to see what treatment plans are put in place. All patient information is kept anonymous and confidential.

The team will also be pilot-testing a new pediatric concussion tool from the company ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) where the ATC’s will perform baseline concussion tests on a certain number of these athletes.

The ATC will measure the athlete’s reaction time, memory capacity, speed of mental processing, and executive functioning of the brain. Then should the athlete have a concussion, a follow-up test will occur.

“One of the things we want to do in future research of these children is to look at not only when they return to play but when do they return to learn, being able to come back to school and function as they did before the concussion.


Liller, K., Jang, S., Wong, S., Morris, B., & Lee, S. (2015). Sports injuries among High School Athletes in 15 West Central Florida School. International Journal of Human Movement Science, 9(2), 5-23.


Story by Caitlin Keough, USF College of Public Health