Injury Prevention in Sport

Urho Kujala

Professor of Sports & Exercise Medicine

Department of Health Sciences

University of Jyväskylä, Finland

E-mail: urho.kujala@sport.jyu.fi

Ideal steps in injury prevention

• The extent of the problem must be identified

• Mechanisms and factors involved should be identified

• Measures likely to reduce the risk of injury should be introduced and their effect monitored

Strategies in injury prevention

• Population strategy: general information to all using public media etc.

• Educating groups

• Teaching individuals: trainers, coaches, and team physiotherapists & physicians have a challenge to identify injury-prone athletes and to tailor their (mental and physiological) training and rehabilitation programs

Basics in injury prevention• We have to know sports-specific injury

profiles and mechanisms and inform the participants

• Just a sound knowledge of risks is likely to

have a preventive effect (Saari 1988).

• Giving advice how to prevent the injury is likely to increase the preventive effect

Injuries among top-ranking Finnish athletes

0

1

2

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7

Acute Stress All

Cross-country skiingSwimmingLong-distance runningSoccer

REF: Ristolainen L et al. Submitted for publication

Inju

ries

/100

0 tr

aini

ng

hour

s

Shoulder stress injuries among top-ranking Finnish athletes

0

5

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15

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30

35

40

Cross-country skiingSwimmingLong-distance runningSoccer

REF: Ristolainen L et al. Submitted for publication

% o

f at

hlet

es w

ith

shou

lder

str

ess

inju

ry/y

ear

Injuries among top-ranking Finnish athletes (injuries per 1000 training hours)

0

1

2

3

4

5

6

7

Acute Stress All

Cross-country skiingSwimmingLong-distance runningSoccer

Ristolainen L et al. Submitted for publication

In swimmers 81% of the overuse injuries were sustained while swimming, but only 32% of the acute injuries occurred in their own sport!

Injuries/1000training hours

EVIDENCE?Historically changes in rules and equipment/protective equipment/supports has been shown to change the injury profile most clearly; Examples from american football, downhill skiing etc.

Cohort and case-control studieshave shown the effectof external supports

Final/best evidence

Comes from randomized controlled trials

Insoles

Either custom-made or prefabricated insoles compared to no insoles reduces lower limb injuries in military recruits.

Aaltonen et al. Arch Intern Med 2007;167:1585-1592

External joint supports

External joint supports show a tendency to prevent ankle, wrist or knee injuries.

Aaltonen et al. Arch Intern Med 2007;167:1585-1592

Balance board + training programs

Multi-intervention preventive training programs are effective in preventing sports injuries, but programs using balance board training only give contradictory results.

Aaltonen et al. Arch Intern Med 2007;167:1585-1592

Stretching + warm up

Aaltonen et al. Arch Intern Med 2007;167:1585-1592

Stretching did not prevent sports injuries (studied mainly among military recruits)

Can the preventive work be based on scientific evidence?

• Experience• Case series• Epidemiological studies• Case-control studies• RCTs (Randomised Clinical Trials)• Most important measures will never be tested by

RCTs? (Compare evacuation of malignant tumours, treating juvenile diabetes with insulin etc.)

Meeting an injured athlete

• Proper treatment and rehabilitation reduces re-injury risk

• Proper treatment and rest is the only choice to reach top level later

• Analysis of risk factors and education of an athlete when he (due to an injury) visits a sports physician for the first time - behaviour is more important than biomechanics?

Meeting a group:Preventive aspect can always be a part of your lecture to athletes and their support teams

I) Explain the sports-pecific injury profile

II) Ask the audience how many have missed important games due to injuries In many situations avoiding an injury is an essential part in reaching team success or individual top-performance

III) Ask the audience how is it possible to prevent injuries in your sport List of best ways

10 tips to prevent sports injuries

I Choose a safe sport as well as a proper

place and surface

II Treat and rehabilitate your old injuries

III Start all new training modalities

progressively

IV Learn the techniques and train so that you

are fit enough to participate

V Remember warm-ups (and stretching?)

10 tips to prevent sports injuriesVI Use proper equipment including protective

equipment and supports

VII Follow the rules and control your nerves

VIII Do not participate when you are sick or injured

XI Remember that injury risk is higher during

competition than training, but journey to

training court is more dangerous than sports

when only catastrophic accidents are counted up

X Concentrate in what you are doing and do not go

over the limits of your skills

Tip 11

• No doping!

Use of many doping substances can increase the risk of death and risk of injuries, especially various anabolic agents

(Pärssinen et al. Int J Sports Med 2000;21:216-220).

Meeting a group: Group interventions - Downhill skiing(REF: Jørgensen et al. Knee Surg Sports Traumatol

Arthrosc 1998;6:194-200.)

• Randomized study

• Showed instructional ski video in the bus on the way from Denmark to the Alps

• During 8 skiing days video-group had 30% lower injury risk

• Advice on many different factors

Young athletes is an important target group: Growth and loading

During adolescent growth spurt the skeleton is at a vulnerable phase, modify training?

Population strategy

• Public media can provide effective support at least in distributing specific pieces of knowledge to many participants

Widening the scope of preventive work:

Traumatic deaths and permanent disabilities due to injuries in organized sports • The risk for catastrophic injury is higher in

normal traffic during the journey to sports place than during many of the popular sports events

• Injuries causing severe permanent disabilities are very uncommon in commonly practiced team games in Finland

(Kujala et al. BMJ 1995;311:1465-8)

Accidental injuries; trends in Finland

Sports &Exercise

Traffic Work Home Other Violence

Safety education for moving to sports place

• Pedestrian safety education can result in improvement in children’s knowledge and behaviour - changes decline with time - education must be repeated at regular intervals (Duperrex et al. Cochrane Review)

• Helmets provide a reduction in the risk of brain and other head injuries (Thompson et al. Cochrane review).

Safety education for moving to sports place

• Visibility aids have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier (Kwan et al. Cochrane Review)

• New (young) drivers are at a higher risk in traffic - also many athletes have died in traffic

• Find safe routes (is also a matter of society planning)

How do children participate in sports and exercise?

050000

100000150000200000250000300000350000400000450000500000

Data from Young Finland -project

Together with friends

Organized by a sportsclubAlone

Other types

n

Where do children exercise?

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Data from Young Finland -project

Around home

School yard

"Official" sportsplaces

%

Future challenges (I)

• Preventive work is beneficial, but more research is needed to find optimal targets and ways

• Increasing numbers of young people participate in modern sports types with high injury risk (air sports etc.) Important targets for research and education

Future challenges (II)

• Medical staff is usually paid better for treating than for preventing an injury

• Technical means of distributing information have developed – use them

• Our memory is short, the knowledge on measures to reduce injuries must be refreshed repeatedly

Thank you for your attention!