Sports participation is on the rise for children and adolescents in the United States. Each year, more than 20 million American youth participate in school or community sports (Damore). This results in approximately one million serious sports-related injuries occurring annually, requiring hospitalization, surgery, missed school, or at least a half-day in bed (School Health Guidelines to Prevent Unintentional Injuries and Violence). The social, as well as economic consequences related to sports injury incidents are quite substantial, and are estimated to cost thousands of millions of dollars in the U.S. each year (Kelm).
In a recent study, sports-related injuries accounted for 41 percent of musculoskeletal injury treated in emergency rooms in 5 to 21 year olds (Damore). As shown in Table 1, basketball accounts for the most sports-related injuries, followed by football, and then baseball and softball
Table 1.
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Table 2 shows that the most sports-related injuries occur in early adolescence, with 13-year old children experiencing the highest number of sports-related injuries. These children and adolescents are anatomically, physiologically, and psychologically immature, which may make their bodies more susceptible to damage (Franklin).
Table 2 Sports-related injury distribution by age.
Source: Journal of Pediatric Orthopaedics, March/April 2001
Types of Injuries
There are many different types of sports-related injuries, from mild events to severe and life-threatening incidents. Although brain and spinal injuries are the most serious sports-related injuries, they account for relatively small percentages of the total injuries reported. According to a study by Michigan State University, in boys’ baseball and girls’ softball, forearm, wrist, and hand injuries were the most common type of injuries, with head, neck, and spine injuries accounting for 2-3% of all injuries. Ankle and foot injuries were the most frequent type of injuries in basketball, soccer, and volleyball. Football players had the highest prevalence of head, neck, and spine injuries at 13.3% of the total injury problem (Powell 282).
In order to decrease the frequency and incidence of these and all types of sports-related injuries, we must first understand the nature of these events.
Sprains
- Overstretching and stress to a ligament is called a sprain.
- Ligament damage is most common in sports, such as basketball, football, and soccer, where there is a high frequency of twisting and cutting movements.
- Sprains and tearing of ligaments are some of the more common injuries in adolescent and adult athletes
- Sprains occur less frequently in younger athletes because their epiphyseal plates tend to be the “weak link” in an injury event.
- Joint dislocations are the most severe form of ligament damage, and can lead to long-term disability in the child athlete (Hutchinson).
Strains
- A strain is damage to the muscle, as a result of forceful contraction.
- Common strains resulting from sports injuries occur in the hamstrings, quadriceps, and calf muscles.
- Children and adolescents who have recently gone through a growth spurt are at higher risk of suffering from a tprain (Hutchinson).
Fractures
- Fractures are usually a result of acute mechanical overload.
- The incidence of fractures is significantly higher in collision activities.
- The growth plate in the developing tissues of long bones is affected in 15% of all pediatric fractures with 15% of these injuries leading to growth arrest requiring surgery (Oeppen).
- Stress fractures, caused by excessive exercise without proper rest time, occur most commonly in the tibia, fibula, and tarsal bones.
Overuse Injuries
- All types of overuse injuries are becoming more prevalent in young athletes.
- Competitive year-round participation and specialization in one sport can lead to these chronic injuries to young bodies.
- Damage to the muscles, tendons, and ligaments commonly occur in the shoulder and elbow in sports involving throwing, whereas running and jumping sports may cause injuries to the leg, knee, ankle, or foot.
- Baseball, basketball, running, gymnastics, and swimming are the most common sports cited for contributing to overuse injuries (Sports Injuries a Growing Problem in Kids).
Brain Injuries
- Annually, approximately 300,000 mild to traumatic brain injuries are classified as sports-related (School Health Guidelines to Prevent Unintentional Injury and Violence).
- Twenty percent of all high school football players sustain brain injuries (Head Injury Fact Sheet).
- When an individual has a brain injury, depending on the severity, it may result in a concussion or a coma.
Concussions
- A concussion results from shaking the brain within the skull, and usually results in a short loss in consciousness (Head Injury Fact Sheet).
- Concussions are graded according to severity, which is a helpful tool in providing safe guidelines to return to activity.
- Grade I
- Usually no loss of consciousness
- Return to play after one week if asymptomatic
- Grade II
- Unconscious for < 5 minutes
- Return to play after one week if asymptomatic
- Grade III
- Unconscious for > 5 minutes
- Memory loss for more than 24 hours
- Return to play after one month or longer
- Grade I
- Repeated Concussions
- “Second Impact Syndrome” increases likelihood of permanent brain damage
Comas
- Comas are a much more severe brain injury than concussions.
- A coma is a deep state of unconsciousness, where the individual will not respond to stimuli.
- Recovery from a coma usually takes a long period of time and may result in permanent impairments.
Spinal Cord Injuries
- Approximately 55 percent of all spinal cord injuries occur between the ages of 16 and 30.
- 8 percent result from sports injuries (UA National Spinal Cord Injury Statistical Center)
- When the chin is flexed as little as 30 degrees, causing the natural curve of the neck to significantly lessen, the forces on the top of the head are directly transmitted to the cervical vertebrae.
- Football players using the tops of their helmets to “spear” opponents are at high risk for serious cervical spine injury (Lawrence).
- Athletes should be instructed to block and tackle with the head up to reduce the risk of head and spinal injuries.
Although only a small percentage of sports injuries involve the spinal cord, their significance should not be taken overlooked. These incidents may result in life-long paralysis or death. Spinal cord injured individuals are have an average hospitalization of 16 days, followed by stay in a rehabilitation unit for approximately 44 days (UA National Spinal Cord Injury Statistical Center).
Heat Stress Injuries
- From 1995 through the 2002 football season there have been 15 high school heat stroke deaths in football (Heat Stress and Athletic Participation).
- Heat injuries are classified from the least dangerous heat cramps, to heat exhaustion, to heat stroke, which is a life-threatening emergency.
- Children thermoregulate effectively in normal weather conditions with rehydration and proper clothing, but have a decreased ability to adapt to temperature extremes.
- Children acclimate to heat more slowly and show less heat dissipation than adults in a hot environment because of a lower sweat rate.
- Cold temperatures are another cause for concern, as the high surface area-to-body mass ratio can cause excessive heat loss, increasing the risk of hypothermia (Franklin 222).
- Games and practices should be suspended, delayed, or postponed during extreme weather conditions to prevent heat related injury and illness (Gerberich).
Prevention/Control Strategies
When developing injury prevention and control approaches, it is best to use a variety of methods. William Haddon Jr. developed ten technical strategies for controlling injuries (Robertson 16-19). Strategies one, four, six, eight, nine, and ten work particularly well in prevention and control on sports-related injuries in children and adolescents.
1. Prevent the creation of the hazard in the first place.
One way this can be accomplished is through pre-participation physical examinations, which should include screenings for neurological and cardiovascular disorders (Gerberich). By identifying individuals with congenital and other existing health problems, serious health incidents could be avoided.
Another way to prevent hazards is to reduce aggressive physical contact. Intentional spearing in football should be strongly discouraged by coaches and officials and blocking below the waist should be minimized in practice. Body checking in youth hockey has been shown to account for 86% of all injuries that occurred during games (American Academy of Pediatrics). Limiting checking in younger players and enforcing rules in all ages of players, such as lengthy penalties for pushing or checking from behind, can reduce injuries. Coaches should emphasize good sportsmanship and fair play at all times.
4. Modify the rate or spacial distribution of release of the hazard
According to the American College of Sports Medicine, injury risks can be significantly decreased by ensuring athletes are matched by size, maturation, or skill level (222). If competitors have large differences in speed and strength, the rate of injury may increase dramatically based on the applied forces and acceleration. A recent US study on youth hockey injuries found that size differences among the bantam players ages 14 and 15 had body weight variances of 53 kg from the smallest to largest players and also differed in a height of 55 cm (American Academy of Pediatrics).
6. Separate the hazard and that which is to be protected by interposition of a material barrier.
Effective prevention strategies for youth athletes may includes properly fitted helmets, face shields, pads, mouth guards, and other protective properly fitting equipment.
Source: Parmet: JAMA, Volume 289(5).February 5, 2003.652
8. Make what is to be protected more resistant to damage from the hazard.
By ensuring proper skills development, a number of sports injuries may be avoided. According to the chart below, motor skills cause the majority of injuries in young athletes. Coaches should ensure that athletes have learned skills involved in sports-specific tasks before moving on to more advanced motor movements.
Reasons for Injuries
Source: Journal of Pediatric Orthopaedics, March/April 2001
Another way to make young athletes more resistant to injury events is to have them participate in an overall fitness program, including muscular strength and endurance, cardio-respiratory endurance, and flexibility. By training and strengthening the entire body, imbalances may be identified and remedied.
9. Begin to counter the damage already done by the environmental hazard.
Injured athletes should seek prompt medical care where a licensed physician can assess the damage. Athletes should then rest until sufficient healing has taken place before returning to play.
10. Stabilize, repair, and rehabilitate the object of the damage.
Proper rehabilitative care should be provided to the injured athlete. Also, a physician may prescribe the use of a stabilization device, such as a knee brace or ankle brace.
Another method of injury prevention and control developed by William Haddon Jr. is known as Haddon’s Matrix. This can serve as a guide to realizing the factors contributing to injuries and their severity, as well as the timing of these factors. As shown in the table below, there are many different factors involved in controlling injuries.
| Phases | Factors | |||
| Human | Environment | |||
| Vehicles & Equipment | Physical Environment | SocioEconomic Environment | ||
| Pre-Injury Phase | *Train athletes properly on following rules and playing safely. *New skills should be mastered before moving on and learning more. |
*Ensure athletes have adequate and properly fitting safety equipment. *Encourage less physical play in practice. |
*Make sure playing surfaces are safe. *Check weather, i.e. temperature, humidity, storm conditions |
*Athletic trainer or physician should be at all practices and games. If this is not possible, coaches should devise emergency response procedures. |
| Injury Phase | *Ensure players do not exceed abilities and fitness level. *Emphasize fair play and following rules. |
*Athletes must wear protective equipment. | *Athletes must always be supervised in practice. | *Emergency response system ready, i.e. phone, first aid equipment, etc. |
| Post-Injury Phase | *Give prompt and appropriate first aid. | *First aid kit utilized. | *Athlete should seek prompt medical care. | *Athlete should participate in physical therapy or other means of rehabilitation. |
There are many limitations to injury prevention and control in youth sports. Funding coaches, trainers, and proper safety equipment can be costly, but the long-term economic and physical consequences of injury may rationalize these expenses. I believe more research and education is needed in the area of the training and conditioning principles. For example, the long-term effects of repeatedly throwing a baseball from age 8 to age 18 may undoubtedly cause long term arm and shoulder pain. Strict guidelines in regards to use of safety equipment, as well as the frequency, intensity, and duration of competitive athletes’ conditioning programs may prove to nearly diminish these chronic injuries. Also, comprehensive education to the athletes, parents, coaches, and officials is needed to share the importance of injury prevention and control.
In conclusion, the growing number injuries in youth sports and recreational activities will only continue to rise as participation increases. Coaches, parents, athletes, and athletic trainers and physicians must work together to decrease the likelihood and seriousness of sports-related injuries. A multi-factoral approach must be used to combat the many issues involved in preventing the incidence and severity of sports-related injuries.
References
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Franklin, Barry A., and Mitchell H Whaley, eds. et.al. ACSM’s Guidelines for Exercise Testing and Prescription, 6th ed. Baltimore: Lippincott Williams & Wilkins, 2000.
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