KIN 188 – Prevention and Care of Athletic Injuries

Epidemiology of Athletic Injuries

Definitions and Perspective

• Epidemiology – study of types and frequencies of athletic injury

• Can have significance for designing protective equipment, establishing or altering rules and providing information to athletes and parents

• Also can identify need for appropriate health care and medical coverage

Research in Sports Epidemiology

• Assists understanding of potential relationships between injuries and sports

• Investigators have gathered information on– Sport/recreational injuries seen in emergency rooms

and health care clinics– Retrospective data on injuries occurring during a

particular time period or in a particular sport/activity– Data from a wide variety of teams over a number of

years

Sports Injury Surveillance Systems

• Many organizations collect data on injuries during sport participation but differences in definitions/approaches/locations make uniform comparison/reference difficult at best

• Even so, collection of any data is potentially useful to gaining a greater understanding of injuries, the risks associated with certain activities and development of prevention strategies and techniques

Sports Injury Surveillance Systems

• National Athletic Injury Reporting System (NAIRS)– Wide sampling of college sports

• National Collegiate Athletic Association (NCAA)– Multiyear, ongoing survey of 16 NCAA sports

• National Athletic Trainers’ Association (NATA)– High school athletic injuries

• National Youth Sports Safety Foundation (NYSSF)– Youth sports, compilation of date from various sources

• National Football Head and Neck Injury Registry– All levels of football participants

• National Center for Catastrophic Sports Injury Research– High school/college athletes who suffer serious injury or death

during participation

NAIRS Reportable Injury Definition

• Example of definition of injury for reporting and data collection– Any brain concussion causing cessation of athlete’s

participation in order for medical evaluation prior to determining return to play criteria

– Any dental injury that should receive professional attention

– Any injury or illness that causes cessation of an athlete’s customary participation on the day following the onset of the problem

– Any injury or illness that requires substantive professional attention before athlete’s return to play is permitted (athlete could not have RTP the next day without that attention)

High-Risk Sports

• High risk sports classified as such due to potential for serious injury as well as the frequency of overall injuries

• Athletic training students must spend at least 25% of total hours of clinical experience working with one or more of these sports

High-Risk Sports

• Basketball– Ankle, hip/thigh, knee and wrist/hand/finger are,

in descending order, the most common injury sites

– Research has shown higher rates of ACL injuries for women vs. men

• Cheerleading– Relatively low injury rate, with LE (ankle) most

common area, but high severity of injury due to gymnastics/pyramid building/stunts

High-Risk Sports

• Football– LE more commonly injured than UE – relatively low risk

of head/neck injury but severity is high when it occurs

– NCAA data shows game injury rates higher than practice injury rates

• Gymnastics– Men tend to have higher UE injury rates and women

higher LE rates – event dependent

– High rate of LBP – one study showed 60%+ of Olympic gymnasts with back injuries – hyperextension is primary culprit

High-Risk Sports

• Hockey (Ice and Field)– IH has considerable body contact whereas FH

prohibits it – injury rates correspond– Speed of game due to surfaces also affects risks– Contusions/lacerations/sprains (face/head is

common), potential for spinal injury

• Lacrosse– Difference in equipment for men vs. women– Face injuries (stick) and LBP from rotational

stress most common – otherwise similar to soccer

High-Risk Sports

• Rugby– Significant variance between injury rates by position and in

US vs. rest of world– Contusions, joint sprains and lacerations most common

• Rodeo– Head/spine injuries, fractures, organ injury from being

thrown from animal– Bullriding has highest risk, then bareback riding

• Skiing– LE fractures, knee injuries most common– Also have thumb injuries from poles

High-Risk Sports

• Soccer– Lower extremity injuries predominate (thigh, ankle, knee)– Head/spine injuries from body to body/head/ground contact

• Volleyball– Lower extremity injuries (ankle) are most common– Upper extremity injuries (hands/fingers/shoulders) next in

occurrence rates

• Wrestling– Shoulder and knee sprains most common injury– Dermatological conditions and ear injuries also are common

Other Sports

• Baseball/Softball– Both have low rates of injury (2.86 and

2.57/1000 exposures)– Common injuries include abrasions, shoulder

and elbow injuries from overuse in pitchers – propensity for position specific injuries

• Track and Field– Throwing events apply stresses to knees/spine– Jumping/running events associated with impact

and/or repetitive microtrauma events

Other Sports

• Tennis– “Tennis elbow” injury with backhand stroke– Shoulder injuries from serves/volleys/smashes

and LE joint injuries from change of direction

• Golf– LBP is most common injury via repetitive

trauma during swing

• Swimming– Shoulder joint is most commonly injured from

repetitive stress of strokes

Intrinsic Risk Factors

• Risk factors associated with the individual– Age (development)– Gender– Psychological state– Medical condition/s

Intrinsic Risk Factors

• Risk factors of normal growth

• Adolescent risk factors

• Gender-specific concerns

• Psychological risk factors and trauma

• Risk factors associated with medical conditions

• Special risks for athletes with disabilities

Risk Factors of Normal Growth

• Multiple opportunities for children to participate in activities – therefore risk

• Little reliable research on frequency/severity of injury in youth activities

• Contact sports (football) presents fewer injuries than non-contact sports (swimming, gymnastics)

• More likely to have growth plate injury on playground vs. during sport participation

Risk Factors of Normal Growth

• Conditions to identify – difficult to prevent

• Legg-Calve-Perthes disease– Head of the femur fails to fully form or dies –

attributable to decreased blood supply– Most common in boys ages 4-12– Requires limited activities and/or surgery

• Osteoid osteoma– Tumor in the bones of the extremities– Most cases between 5-25 years of age– Increased risk of fracture with participation, typically

operate to remove tumor

Adolescent Risk Factors

• Adolescents more at risk of injury due to imbalances between muscular strength and skeletal maturity

Adolescent Risk Factors

• Growth plate injury– Injury to epiphysis (growth plate) can cause premature

closure

• Osgood-Schlatter disease– Excessive tension on tibial tuberosity attachment site for

quadriceps muscle group– Especially prominent with jumping/running

• Spondylolysis– Stress fracture to vertebrae – associated with

hyperextension activities (gymastics, football)– Must recognize to avoid progression to bilateral condition

with associated slippage of vertebral segment/s

Adolescent Risk Factors

• Slipped capital femoral epiphysis– “Slip” of proximal growth plate of the femur– More common in overweight boys – stress of

body and weight causes weakening of epiphysis– Almost always requires surgery

• Osteochondritis dissecans (“joint mice”)– Fracture of articular cartilage (ends) of bones– Most common in hip, knee and elbow

Gender-Specific Concerns

• Most injuries affect men/women equally given participation at equal skill levels

• Women predisposed to additional problems (female athlete triad)– Amenorrhea – loss of menstruation from low body

weight due to excessive training

– Osteoporosis – bone loss secondary to menstrual irregularities

– Disordered eating – anorexia/bulemia, attempts to maintain low body weight/image

Psychological Risk Factors and Trauma

• Many researchers demonstrate a strong correlation between psychological and emotional stress and the frequency of injury

• Minimizing outside stressors reduces anxiety and allows participants to focus on task at hand to minimize injury risk

• Occurrence of injury often causes psychological/emotional stress which can affect recovery from injury

Risk Factors Associated with Medical Conditions

• Scoliosis• Leg-length difference• Epilepsy• Diabetes• Asthma• Exercise-induced

bronchoconstriction• Marfan syndrome

• Congenital heart abnormalities

• Myocarditis• Cardiomyopathy• Absence of one of a

paired set of organs• Visual impairments• Communicable

disease

Scoliosis

• Lateral curvature of the spine

• Risk of participation with condition dependent upon extent of curvature– Mild/moderate curves may have no additional

risk of injury– Extreme curves (>80 degrees) changes

dimensions of chest and is often associated with difficulty breathing and/or increased heart rate

Leg-Length Difference

• Significant leg-length discrepancies increases risk of shin, knee, hip and/or low back problems due to uneven weight-bearing through the lower extremity

• Most often treated with orthotic/shoe insert

Epilepsy

• Neurological disorder characterized by seizures – petit mal vs. grand mal

• Typically controlled with anticonvulsive medications – seizures often preceded by aura

• Most common risk is injury during seizure episode

• If well controlled, not precluded from most activities

Diabetes

• Type I vs. Type II diabetes

• For type I diabetics, must be aware of exercise lowering blood sugar (hypoglycemia) and utilize appropriate amount of insulin

• Often function well in athletics if they carefully monitor food intake and activity level

Asthma

• Chronic respiratory condition

• Often triggered by allergies and can impact breathing regardless of activity level

• Inhalation typically not compromised, but difficulty exhaling is primary symptom – lack of gas exchange leads to reduced oxygen availability

• Generally treated with medication daily regardless of symptoms

Exercise-Induced Bronchoconstriction

• Asthma-like symptoms occurring only during exercise

• Typically controlled via use of inhalers (bronchodilators) during activity and typically doesn’t preclude one from participation

Marfan Syndrome

• Collagen tissue disorder associated with shortened life span

• Characteristically tall/thin, visual difficulties and weakness of heart structures, especially aorta – cause of death is often aortic aneurysm

Congenital Heart Abnormalities

• Aortic stenosis, heart wall/valve defects, etc.

• Typically discovered long before participation in activities occurs

• Heart murmurs and arrhythmias are relatively common examples and often require nothing other than monitoring of the individual

Myocarditis

• Inflammation of the heart muscle

• Some infections can damage heart muscle – often presents with fatigue, mild chest pain and/or shortness of breath - continued exertion can further damage heart

Cardiomyopathy

• Damage to heart muscle can be nutritional or hypertrophic

• Nutritional damage from nutritional deficiency, poisoning or substance abuse

• Hypertrophic damage is genetic condition where heart muscle thickens but chambers don’t get bigger – less blood output – high incidence of death

Absence of One of a Paired Set of Organs

• Sports participation under these conditions is not prohibited by rule nor medically prohibited, risks must be fully understood and accepted before participation allowed

• Kidneys, lungs, testicles, ovaries

Visual Impairments

• Participation in contact sports with one eye is not recommended due to change in depth perception with monocular vision

• Athletes with visual impairments encounter increased injury risks

• Adapted sports/activities give those individuals opportunity to utilize typically well-developed auditory pathways

Communicable Disease

• Diseases transmitted through air or bodily contact

• Risk of airborne transmission from athletes and spectators, especially in closed environment

• Multiple sports require contact between participants and/or equipment increasing risk

• Generally, risk no different than other community functions (school, etc.)

• Education and sanitation (hand washing) are best preventative measures

Special Risks for Athletes with Disabilities

• Most studies indicate that injury rates amongst athletes with disabilities mirror injury rates for the general athletic population

• Some conditions unique to certain conditions – Wheelchair athletes – pressure sores, urinary

infections, carpal tunnel syndrome