Fall sports season is in full swing across Whatcom County. Bellingham, Sehome, Squalicum, Ferndale, Lynden, and Nooksack Valley all have teams back in preseason, and just down the road, the WWU Vikings are opening their fall slate in men's and women's soccer, volleyball, and cross country, with the Vikings' cross country teams kicking off their season right here at the Bill Roe Classic in Ferndale. A number of this year's WWU rosters even include local products from programs like Sehome and Lynden Christian.
Every September, I also see a predictable wave of new injuries walk through my door. Not because fall sports are inherently more dangerous, but because of what's happening physiologically: student-athletes are moving from a summer of inconsistent activity into several hours a week of structured, high-intensity training, often with contact, cutting, and jumping added back in all at once. That combination (a sudden jump in training load after a lower-activity stretch) is one of the most consistent risk factors for injury in the sports science literature, regardless of sport.
Here's what the research actually shows about the injuries I see most in fall athletes, sport by sport, and what actually helps prevent them.
Football remains the fall sport with the highest concussion risk. In one of the largest studies of U.S. high school athletes across 20 sports, football had the highest concussion rate of any sport during competition, and accounted for nearly half of all concussions recorded across the entire study (Marar et al., 2012). Concussions made up over 13% of all reported injuries across every sport studied.
Washington has a personal stake in getting this right: the Zackery Lystedt Law, passed here in 2009 following the injury of a Tahoma middle school football player, was the first law in the nation requiring that any athlete suspected of a concussion be immediately removed from play and cleared in writing by a licensed healthcare provider before returning. It became the model for similar laws in every other state. If you're a parent, coach, or athlete in Whatcom County, it's worth actually knowing this law exists and what it requires; a suspected concussion is not something to "shake off" and finish the half.
What actually helps: proper tackling technique, well-fitted and properly maintained equipment, and (most importantly) strict adherence to return-to-play protocols after any suspected head injury. There's no supplement, brace, or neck-strengthening gadget with strong evidence behind it as a substitute for those basics.
Cross country has one of the highest overuse-injury burdens of any high school sport. A large surveillance study of U.S. high school athletes found that cross country running consistently produces some of the highest stress fracture rates among all sports tracked, with the tibia and metatarsals as the most common sites, and female runners affected disproportionately more often than male runners (Changstrom et al., 2015).
The mechanism is straightforward: stress fractures are cumulative bone injuries that develop when training volume increases faster than bone can adapt. This is exactly the pattern that shows up every August and September, when runners go from a loosely structured summer to full team mileage in a matter of weeks.
What actually helps: a genuinely gradual buildup in weekly mileage (not a jump straight to full team volume), replacing running shoes before they're visibly worn out (most breakdown happens well before shoes look "dead"), and not running through pain that's sharp, localized, and gets worse during a run rather than better. That pattern is a shin splint until proven otherwise, and it's worth having checked before it becomes a stress fracture.
Volleyball doesn't get the same public attention as football or soccer for knee injuries, but a 2025 systematic review pooling data from over three million volleyball athletes found that female players sustain ACL injuries at 2 to 4 times the rate of male players, outside hitters are the most frequently affected position, and the vast majority of these injuries (85–97%) are non-contact, meaning they happen from the athlete's own landing mechanics after a spike, not from a collision (Sassi et al., 2025). Notably, that same review found high school players showed a higher injury prevalence than collegiate players, which runs counter to the assumption that this is mainly a college-level problem.
What actually helps: landing mechanics matter enormously here. Structured neuromuscular training (programs that specifically drill landing with bent knees, good hip and trunk control, and even weight distribution rather than landing stiff-legged or with the knees caving inward) has real evidence behind it for reducing non-contact ACL injury risk. This isn't a "nice extra"; for a jumping-heavy sport like volleyball, it's one of the few interventions with real data behind it.
Boys' soccer is a fall sport in Washington (girls' soccer runs in the spring under WIAA), and it brings the injury profile you'd expect from a sport built on cutting, sprinting, and contested balls: ankle sprains are the single most common injury, with knee and hamstring injuries not far behind.
The best-studied intervention here is the warm-up itself. Structured neuromuscular warm-up programs (FIFA's "11+" protocol is the best known) that combine running drills, balance work, and controlled strength exercises have been evaluated in multiple randomized controlled trials and shown to meaningfully reduce injury rates in soccer players compared to a standard warm-up. It takes about the same amount of time as a normal warm-up.
Because high school student-athletes are still in the earlier stages of physical maturity, particularly freshmen and sophomores who may still be in an active growth spurt, it's worth knowing about Osgood-Schlatter disease, one of the most common causes of knee pain in this age group. It develops when the patellar tendon repeatedly pulls on the growth plate at the top of the shinbone during activities involving running and jumping, causing pain and a tender bump just below the kneecap. It shows up most often in sports like soccer, volleyball, basketball, and football (StatPearls, NCBI Bookshelf).
The reassuring news: it's a self-limiting condition. It responds well to activity modification, ice, and targeted stretching and strengthening of the hamstrings and quadriceps, and it resolves on its own once the growth plate fuses. There's no evidence supporting injections or surgery for typical cases. If a younger high schooler on your team is dealing with this, it's very manageable; it just needs to be identified and managed rather than played through.
Most of what's above is genuinely preventable with the basics: a gradual training buildup, real landing and movement mechanics work, proper equipment, and taking head injuries seriously every single time. But when something doesn't resolve with rest, or a niggling ache turns into pain that changes how an athlete moves, that's the point to get it looked at rather than wait it out through the rest of the season.
At Advanced Sports Chiropractic and Massage, Dr. Rachel Hetherington and I work with a lot of Whatcom County student-athletes, from weekend recreational leagues up through WWU competitors, on everything from movement screening and landing mechanics to hands-on treatment for the overuse injuries above. If something's nagging at you or your athlete this season, we're happy to take a look before it costs someone real time on the field.
Call (360) 671-5706 to book or ask a question.
Here's to a healthy season, Whatcom County.
Dr. Bob Curtis, DC, CCSP Advanced Sports Chiropractic and Massage Bellingham, WA | (360) 671-5706
Q: What is the most common serious injury in fall high school sports? Concussion is the most studied and most serious injury risk, concentrated heavily in football, which accounts for a large share of all concussions across high school sports (Marar et al., 2012). Washington's Zackery Lystedt Law requires any athlete suspected of a concussion to be removed from play and medically cleared before returning.
Q: Why do so many cross country runners get stress fractures in the fall? Stress fractures happen when training volume increases faster than bone can adapt to the new load. Cross country has one of the highest stress fracture rates of any high school sport, and the risk is highest in the first several weeks of the season when runners jump from a lighter summer schedule into full team mileage (Changstrom et al., 2015).
Q: Is ACL injury risk really that high in volleyball? Yes; it's an underappreciated risk. A 2025 systematic review found female volleyball players are injured at 2 to 4 times the rate of male players, with the vast majority of injuries happening from landing mechanics after a spike rather than contact with another player (Sassi et al., 2025).
Q: What is Osgood-Schlatter disease and should I be worried about it? It's a common, self-limiting cause of knee pain in adolescent athletes, caused by repetitive tension on the growth plate below the kneecap during running and jumping sports. It typically resolves with activity modification, ice, and stretching/strengthening.
Q: What actually reduces injury risk, beyond "warming up"? Structured neuromuscular training, which includes programs that specifically drill landing mechanics, balance, and controlled strength (like the FIFA 11+ protocol for soccer) has real trial evidence behind it, more so than general stretching alone.
Changstrom, B. G., Brou, L., Khodaee, M., Braund, C., & Comstock, R. D. (2015). Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013. The American Journal of Sports Medicine, 43(1), 26–33. https://doi.org/10.1177/0363546514562739
Marar, M., McIlvain, N. M., Fields, S. K., & Comstock, R. D. (2012). Epidemiology of concussions among United States high school athletes in 20 sports. The American Journal of Sports Medicine, 40(4), 747–755. https://doi.org/10.1177/0363546511435626
Osgood-Schlatter Disease. StatPearls [Internet]. National Center for Biotechnology Information, NCBI Bookshelf.
Sassi, L. B., Miguel, A. C., Serafim, T. T., de Menezes, F. S., Martins, T. B., & Okubo, R. (2025). Understanding ACL injuries in volleyball: a systematic review of epidemiology and risk factors. Frontiers in Sports and Active Living. https://doi.org/10.3389/fspor.2025.1675136
Washington State Legislature. Zackery Lystedt Law (RCW 28A.600.190), enacted 2009.