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Authors: Field and O’Brien (2007)

OBJECTIVE: To characterize the risk of injury associated with 10 popular high school sports by comparing the relative frequency of injury and selected injury rates among sports, as well as the participation conditions of each sport.

DESIGN AND SETTING: A cohort observational study of high school athletes using a surveillance protocol whereby certified athletic trainers recorded data during the 2005-2007 academic years. SUBJECTS: Players listed on the school’s team rosters for football, wrestling, baseball, field hockey, softball, girls’ volleyball, boys’ or girls’ basketball, and boys’ or girls’ soccer.

MEASUREMENTS: Injuries and opportunities for injury (exposures) were recorded daily. The definition of reportable injury used in the study required that certified athletic trainers evaluate the injured players and subsequently restrict them from participation.

RESULTS: Football had the highest injury rate per 1000 athlete-exposures at 8.1, and girls’ volleyball had the lowest rate at 1.7. Only boys’ (59.3%) and girls’ (57.0%) soccer showed a larger proportion of reported injuries for games than practices, while volleyball was the only sport to demonstrate a higher injury rate per 1000 athlete-exposures for practices than for games. More than 73% of the injuries restricted players for fewer than 8 days. The proportion of knee injuries was highest for girls’ soccer (19.4%) and lowest for baseball (10.5%). Among the studied sports, sprains and strains accounted for more than 50% of the injuries. Of the injuries requiring surgery, 60.3% were to the knee.

CONCLUSIONS: An inherent risk of injury is associated with participation in high school sports based on the nature of the game and the activities of the players. Therefore, injury prevention programs should be in place for both practices and games. Preventing reinjury through daily injury management is a critical component of an injury prevention program. Although sports injuries cannot be entirely eliminated, consistent and professional evaluation of yearly injury patterns can provide focus for the development and evaluation of injury prevention strategies

Langran and Selvaraj conducted a study in Scotland to identify risk factors for snow sports injuries. They found that persons under 16 years of age most frequently sustained injury, which may be attributed to inexperience.

They conclude that protective wrist guards and safety release binding systems for skiboards help prevent injury to young or inexperienced skiers and snowboarders.

Ranalli and Rye provide an awareness of the oral health care needs of the female athlete. They report that a properly fitted, custom-fabricated or mouth-formed mouthguard is essential in preventing intraoral soft tissue lacerations, tooth and jaw fractures and dislocations, and indirect concussions in sports. Although custom-fabricated mouthguards are expensive, they have been shown to be the most effective and most comfortable for athletes to wear.

Pettersen conducted a study to determine the attitudes of Canadian rugby players and coaches regarding the use of protective headgear. Although he found that few actually wear headgear, the equipment is known .

When coaches, officials, sports first aiders, other safety personnel, parents and participants follow the safety guidelines, the risk of serious injury is minimal.

If an injury does occur, the golden rule in managing it is “do no further damage”.

It is important that the injured participant is assessed and managed by an appropriately qualified person such as a sports first aider or sports trainer. Immediate management approaches include DRABCD (checking Danger, Response, Airway, Breathing, Compression and Defibrillation) and RICER NO HARM (when an injury is sustained apply Rest, Ice, Compression, Elevation, Referral and NO Heat, Alcohol, Running or Massage).

Young participants returning to activity too early after an injury are more susceptible to further injury. Before returning to participation the participant should be able to answer yes to the following questions:

• Is the injured area pain free?

• Can you move the injured part easily through a full range of movement?

• Has the injured area fully regained its strength?

Whilst serious head injuries are uncommon in children and young peoples’ sport, participants who have lost consciousness or who are suspected of being concussed must be removed from the activity.

Prior to returning to sport or physical activity, any child who has sustained an injury should have medical clearance

– Approximately 3 million children and adolescents aged 14 and under get hurt annually playing sports or participating in recreational activities.

– Although death from a sports injury is rare, the leading cause of death from a sports-related injury is a brain injury.

– Sports and recreational activities contribute to approximately 18 percent of all traumatic brain injuries among Canadian children and adolescents.

– The majority of head injuries sustained in sports or recreational activities occur during cycling, skateboarding, or skating incidents.

Guidelines for junior sports injury management suggest that there is only a small risk of being ….(1)…. . However statistics show that injury of some kind is reasonably common. In Canada, for example, around ….(2)…. children under 15 are injured every ….(3)…. . While it is very unusual for these injuries to ….(4)…. they do make up just under one fifth of ….(5)…. among children and adolescents in Canada.

A US study which investigated the ….(6)…. of injuries across a range of sports found that the safest sport was ….(7)…. , whereas ….(8)…. was the most likely to cause injury. Of the injuries observed, more than half were ….(9)…. , and knee injuries accounted for 60.3% of those that ….(10)…. . The scope of the US study was limited, however, with ….(11)…. being the only non-ball game studied. Canadian data, on the other hand, revealed that cycling, skateboarding and ….(12)…. were the cause of most ….(13)…. associated with sporting activities.

For those adults and children involved in junior sports, it is best practice to ensure that ….(14)…. is done if an injury does occur. In the first instance, the injury should be evaluated by a ….(15)…. . Two management plans which should be followed are RICER NO HARM and ….(16)…. ; a key feature of the former is that the child should be prevented from doing any further ….(17)…. . It is advised that any child who has been injured should have ….(18)…. before returning to play.

Head injuries are considered very serious, and children who have lost consciousness should be ….(19)…. . Ideally, children involved in sports such as rugby should wear ….(20)…. , because according to recent research such preventative measures can ….(21)…. of concussion and also stop ….(22)…. . Other preemptive measures that might be considered are ….(23)…. to prevent intraoral ….(24)…. and fractures of the ….(25)…. , as well as ….(26)…. and ….(27)…. systems to help prevent snow sports injuries.