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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
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