The public health impact of injury during sport and active recreation

Injuries can be an adverse outcome of participation in sport and recreational activities. The aim of this study was to determine the public health impact of injury during sports and active recreation injury in a select population in Australia. A random household telephone survey was conducted quarterly over a 12-month period in a well-defined geographic region, the Latrobe Valley, Australia. Information was collected on participation in sport and active recreation and associated injuries over the previous 2 weeks for all household members aged over 4 years. Injury rates were calculated per 10,000 population and per 1000 sports participants. Data were collected on 1084 persons from 417 households. Overall, 648 people reported participating in at least one sport or active recreation and 34 (5.2%, 95% CI: 4.8, 5.6%) of these sustained an injury during this activity. Overall, 51.4% of injured cases had a significant impact: 26.5% sought treatment, 34.4% had their activities of daily living adversely affected and 36.0% had their performance/participation limited. Cricket (51 injuries/10,000 population), horse riding (29/10,000 population) and basketball (25/10,000 population) had the highest injury rates. After adjusting for participation, cricket (242 injuries/1000 participants), horse riding (122/1000 participants) and soccer (107/1000 participants) had the highest injury rates. Cricket and soccer were the sports most associated with ‘significant’ injuries. Injury prevention efforts should be aimed at team ball sports (especially cricket, soccer and netball) because of their comparatively high rate of both overall and ‘significant’ injury.     

Survey of sport participation and sport injury in Calgary and area high schools.

OBJECTIVE: To examine (1) sport participation and (2) sport injury in adolescents. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective survey design. In total, 2873 adolescents were recruited from a random sample of classes from 24 Calgary and area high schools. Each subject completed an in-class questionnaire in March 2004. MAIN OUTCOME MEASUREMENTS: Overall and sport-specific participation rates (number of sport participants/number of students completing survey). Overall and sport-specific injury rates (number of injuries/number of participants). RESULTS: In the previous 1 year, 94% of students participated in sport. The top 5 sports by participation for males were basketball, hockey, football, snowboarding, and soccer, and for females, basketball, dance, volleyball, snowboarding, and soccer. The injury rate including only injuries requiring medical attention was 40.2 injuries/100 adolescents/y (95% CI, 38.4-42.1), presenting to a hospital emergency department was 8.1 injuries/100 adolescents/y (95% CI, 7.1-9.2), resulting in time loss from sport was 49.9 injuries/100 adolescents/y (95% CI, 48-51.8), and resulting in loss of consciousness was 9.3 injuries/100 adolescents/y (95% CI, 8.3-10.5). The greatest proportion of injuries occurred in basketball, hockey, soccer, and snowboarding. The top 5 body parts injured were the ankle, knee, head, back, and wrist. The top 5 injury types were sprain, contusion, concussion, fracture, and muscle strain. A previous injury was associated with 49% of the injuries and direct contact with 45% of injuries. CONCLUSIONS: Rates of participation in sport and sport injury are high in adolescents. Future research should focus on prevention strategies in sports with high participation and injury rates to maximize population health impact.     

Catastrophic injuries and fatalities in high school and college sports, fall 1982-spring 1988

Direct and indirect deaths and catastrophic injuries, defined as any injury incurred during participation in a high school/college sponsored sport in which there is permanent severe functional neurological disability (nonfatal) or transient but not permanent functional neurologic disability (serious), are presented for all sports during the period of fall 1982 to spring 1988. Football contributed the greatest numbers of catastrophic injuries but also had the largest number of participants. Ice hockey, gymnastics, and wrestling are the other sports where participants are at greatest risk of catastrophic injury or death. Mechanisms of injury in each sport and corrective actions are identified and discussed. While high school and college catastrophic injuries may never be totally eliminated, they can be dramatically reduced by reliable injury data collection and analysis.     

The impact of sport and active recreation injuries on physical activity levels at 12 months post‐injury

The aim of this study was to evaluate the impact of serious sport and active recreation injury on 12‐month physical activity levels. Adults admitted to hospital with sport and active recreation‐related injuries, and captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Changes between preinjury and 12 month post‐injury physical activity was assessed using the short International Physical Activity Questionnaire (IPAQ). Independent demographic, injury, and hospital variables were assessed for associations with changes in physical activity levels, using multivariate linear regression. A total of 324 patients were recruited, of which 98% were followed up at 12 months. Mean short IPAQ scores decreased from 7650 METS (95% CI: 7180, 8120) preinjury to 3880 METS; (95% CI: 3530, 4250) post‐injury, independent of functional recovery. Education level and occupation group were the only variables independently associated with changes in physical activity levels post‐injury. These results highlighted that sport and active recreation injuries lead to significant reductions in physical activity levels. Hence, the prevention of sport and active recreation injuries is important when considering promotion of activity at a population level.     

Comparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players: implications for anterior cruciate ligament mechanism and prevention

BACKGROUND: Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts. HYPOTHESES: Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2. METHODS: Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men's and women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years. RESULTS: Anterior cruciate ligament injury rates in women's basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men's basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men's soccer over the study period. The rate of anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men's basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women's basketball and soccer. CONCLUSION: There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men's lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men's and women's lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk.     

Acute spine injuries in skiers and snowboarders

Skiing and snowboarding are popular winter sports associated with significant traumatic spinal injuries. Despite a decline in most injuries related to these sports over the years, acute injury rates of the spine have remained stable and even increased. Vertebral fractures and spinal cord injuries are the most common serious acute injuries of the spine in skiers and snowboarders. Due to the unique characteristics of each sport, different injury mechanisms are responsible for the majority of injuries. This article reviews injury patterns, injury types, mechanisms of injury, and strategies for prevention of spine injuries in skiers and snowboarders.     

Death in Sports and Recreation

In brief: The author studied deaths related to sports and recreation in Alberta, Canada. Of the 70 deaths in 1977, 37 were caused by drowning and occurred in such activities as boating, swimming, hunting, and fishing. The use of alcohol in excess, the absence of life jackets, and participation by nonswimmers were dominant factors. Proper safety precautions would have prevented most of these deaths.     

Injuries to riders in the cross country phase of eventing: the importance of protective equipment

OBJECTIVES: To determine the distribution of injuries in the eventing discipline of equestrian sports and the effectiveness of the protective equipment worn. METHODS: Data on all injuries sustained in the cross country phase over fixed obstacles were collected from 54 days of competition from 1992 to 1997. This involved 16,940 rides. RESULTS: Data on a total of 193 injuries were collected, which included two deaths. This represents an injury rate of 1.1%. Head and facial injuries represented the largest group (31%), with one third of these requiring treatment in hospital. All riders were wearing protective helmets and body protectors. CONCLUSIONS: Eventing is one of the most dangerous equestrian sports. Improved protective equipment, which is mandatory for 1999, should reduce the severity of these injuries.     

Equestrian Injuries

In brief: It has always been assumed that participants in equestrian sports are at high risk of serious injury and that minor injuries are common. This study of American Horse Shows Association and United States Pony Clubs horse shows tried to determine if shows are as safe as or safer than other sports, what the accident rate is for horse shows, if any factors influence the accident rate, and what types of accidents and injuries occur. There were 290 reported injuries and two deaths in the 984 responding shows. The accident rate per entry was 0.0003. There was no statistically significant relationship between any external factors and the accident rate. Anecdotes usually indicate a preponderance of shoulder injuries, but the statistics did not find this to be so. Bruises and being “shook up” accounted for 45.5% of the injuries, and fractures 15.5%.     

Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective

Recent data suggest that the risk of paediatric sport injury is high and constitutes a significant public health burden. A concern regarding long-term consequences of youth sports injury is the risk of developing osteoarthritis (OA) at a young age. Based on the available evidence, a link between youth sports injuries, particularly acute injury of the knee and ankle, and OA, is likely. Early OA development and intense participation in high-impact, high-stress elite sports at an early age also may be associated, but follow-up of elite athletes into the early adult years is needed to examine this relationship. Given that some antecedents of early adult-onset OA may be traced to child and adolescent sports injury and related surgery, and perhaps intense training regimens, it follows that efforts to prevent sports-related joint injury should begin during the childhood years. Based on the results of recent research evidence, programmes addressing prevention of youth sports injuries may provide the rewarding results of OA prevention.     

Sports related injuries in Scottish adolescents aged 11-15

OBJECTIVES: To measure the age and sex distribution of self reported sports and leisure injuries in a 12 month retrospective recall period among a representative national sample of Scottish adolescents, and to examine the characteristics (gender, age, handedness, and level of sports participation) of sports related injuries in relation to injuries sustained during other activities. DESIGN/SETTING: Self completion questionnaire survey administered in schools during April- June 1994. SUBJECTS: 4710 pupils aged 11, 13, and 15 years drawn from a representative sample of 270 classes with returns from 224 classes (83% completion rate). RESULTS: 42.1% of the sample reported a medically attended injury. These were significantly more frequent among boys but there were no significant age differences in overall frequency of injury. Sport related injuries accounted for 32.2% of all medically attended injuries. As with all injuries, frequency was greater in boys than girls at all ages, and there are differences in the pattern of lesions in sports and nonsports injuries. Lower limb injuries were more frequent than upper limb injury in sports (57.6 v 23.9%), whereas there were no differences in non-sports injuries (31.5 v 31.3%). Age and handedness differences in sports injury rates were also identified. High sports participation was significantly associated with a higher risk of injury in general and sports related injury in particular. CONCLUSION: Age, gender, handedness, and level of sports participation have been shown to be implicated in differential risk of sports related injury. Reducing sports injury among adolescents should be a priority, but research into the injury profiles of different sports is needed before detailed injury prevention strategies can be developed.     

Rider injury rates and emergency medical services at equestrian events

BACKGROUND: Horse riding is a hazardous pastime, with a number of studies documenting high rates of injury and death among horse riders in general. This study focuses on the injury experience of cross country event riders, a high risk subset of horse riders. METHOD: Injury data were collected at a series of 35 equestrian events in South Australia from 1990 to 1998. RESULTS: Injury rates were found to be especially high among event riders, with frequent falls, injuries, and even deaths. The highest injury rates were among the riders competing at the highest levels. CONCLUSION: There is a need for skilled emergency medical services at equestrian events.     

A new look at horse-related sport and recreational injury in New Zealand

Although equestrian injury studies to date have provided useful information for injury prevention, these studies have not been detailed enough or inclusive enough, to identify and characterise all sub-populations that may be at risk. One study has reported injury rates for the population-at-risk. The present study was carried out to determine, more precisely, who is injured in horse-related activities in New Zealand, what sorts of injuries they sustain, the circumstances of injury and the cost of treatment. A novel search of linked hospital discharge and compensation claim data for 2002 and 2003 was carried out. Of 716 newly hospitalised cases, 29% were in the 5–19-year and 28% in the 35–49-year age groups. Incidence rates for regular riders peaked at 13–15 years (900/100 000) and 50+ years (880/100 000). Where the ‘place of occurrence’ was specified only 12% of cases sustained injury in a ‘sports and athletics area’. This new study has highlighted injuries occurring in farm and other ‘open’ locations such as mountains and forest, injuries to older riders and injuries to bystanders/handlers during non-organised recreational activity. Attention was drawn to the high in-patient cost of hospitalised injuries in persons >40 years and the need for injury information relating to specific riding activities. Current equestrian injury prevention tends to target young females and organised riding; in focusing on these, other significant population groups and injury mechanisms may be overlooked and opportunities for injury prevention missed.     

Epidemiology of medically treated sport and active recreation injuries in the Latrobe Valley, Victoria, Australia

OBJECTIVE: To quantify and describe medically treated sport and active recreation injuries in a defined region of the Latrobe Valley from 7 November 1994 to 6 November 1995. METHOD: A geographic target area was defined, restricted to the six postcodes that fell wholly within the catchment area of the Latrobe Regional Hospital. Data describing medically treated sport and active recreation injuries to Latrobe Valley residents aged over 4 years (about 70,000) were selected by postcode from three sources: the Victorian Admitted Episodes Dataset (hospital admissions), the Victorian Injury Surveillance System (presentations to hospital emergency departments), and the Extended Latrobe Valley Injury Surveillance (ELVIS) project (presentations to general practitioners). RESULTS: At least 2300 cases of medically treated sport and active recreation injury were recorded. This corresponds to a hospital admission rate of 16/10,000 population, emergency department presentation rate of 169/10,000 population, and a general practitioner presentation rate of 187/10,000 population. There were more male patients than female, and younger age groups were also overrepresented, but these data may reflect the greater participation of these groups in sport and active recreation. Australian football was associated with the highest number of injuries (accounting for 24.0% and 22.0% of presentations to emergency departments and general practitioners respectively) followed by cycling (15.7% and 12.6%) and basketball (17.5% and 13.5%). CONCLUSIONS: This study shows that routine health sector data collections in defined populations can provide useful information on the size, distribution, and characteristics of the problem of sport and active recreation injuries at the community level. However, all current health sector systems for injury data collection and surveillance require attention to improve case capture and identification and data quality.     

Injuries to athletes with disabilities: identifying injury patterns

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.     

Eye injury in sport

Eye injury sustained during sport is increasing in incidence worldwide, reflecting the rise in popularity of sport as recreation. It can account for up to 25% of severe eye injuries. This paper considers the historical context and demography of sports injuries, and the physical mechanisms and results of various types of ocular trauma in relation to sport. It reviews the specific problems associated with the sports considered to be most important in the epidemiology of eye injuries today. Certain sports, such as boxing, have an intrinsic risk of injury so high that some consider the sport should be banned. The risk of injury in many sports can be mitigated by changes in rules, such as the prevention of high sticking in ice hockey. Other sports with high risk of trauma could be made far safer with the widespread introduction of eye protection, and this applies especially to squash and badminton. The various types of eye protection are discussed. There is an urgent need to increase awareness of the risk of eye injury, to teach safe techniques, and to encourage the use of appropriate ocular protective wear in those at high risk of injury, especially the one-eyed.     

Martial arts injuries. The results of a five year national survey

A 5 year national survey of martial arts was done using the National Electronic Injury Surveillance System (NEISS). Seventy-four percent of the injuries involved the extremities and 95% were mild to moderate in nature. Even though most of the injury types were contusions/abrasions (36%). lacerations (14%), and sprains/strains (28%), 15% were dislocations and fractures. Five percent of all injuries were severe, and there were 18 hospitalizations. There were no deaths. Weapon-related injuries were rare and never serious. Overall, the risk of serious injury in the sport was found to be low, especially when compared to other contact sports.     

The Harstad injury prevention study: the epidemiology of sports injuries. An 8 year study.

OBJECTIVE--To describe the epidemiology of sports injuries occurring in a community during 8 years and to evaluate the outcome of an intervention implemented against injuries occurring in downhill skiing. METHODS--Hospital treated sports injuries occurring in Harstad, Norway (population 22 600) were recorded prospectively during an 8 year period. A prevention programme targeting downhill skiing injuries was evaluated. RESULTS--2234 sports injuries accounted for 17.2% of recorded unintentional injuries. Two out of three injuries occurred in team sports. Soccer accounted for 44.8% of all sports injuries. Downhill skiing injuries had higher mean score on the abbreviated injury scale than all other sports analysed combined (P < 0.01). Postintervention injury rates for downhill skiing were reduced by 15% when adjusting for exposure (P = 0.24). Further observations are needed for assessing the effectiveness of the downhill skiing safety programme. CONCLUSIONS--Strategies for future sports injury prevention include community involvement, particularly sports organisations. Local data analysis seems to justify some priorities, for example, promotion of helmet use in downhill skiing for young adolescents and prevention of lower limb fractures in male soccer players 15+ years old. Prospective hospital recording of injuries provides a tool for the design and outcome evaluation of sports injury intervention research.     

Effective Injury Prevention in Soccer

Abstract

Sports participation is accompanied by risk of injury, and each specific sport has its own unique injury profile. One of the goals of a sports medicine professional is injury prevention, and the past decade has seen numerous reports on the outcomes of injury-prevention studies. Health care professionals have been particularly vigilant in attempting to reduce common injuries in soccer, beginning with work in the early 1980s to the rigorous randomized trials of today. The use of a structured, generalized warm-up program has been shown to be effective in preventing common soccer injuries, reducing overall injury rates by approximately 30%. Given the number of individuals who play soccer worldwide, any injury reductions will likely have an impact on public health. It is an important goal of the sports medicine community to inform physicians and other sports medicine professionals about the effectiveness of prevention programs to increase use and compliance.     

A 1‐year prospective analysis of injuries in amateur and elite fistball

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport‐specific exposure, 240 players reported 492 injuries, representing an overall injury rate of 12.2 injuries/1000 h of exposure. Most injuries were classified as bagatelle injuries (67.8%). The majority of the injuries were located in the knee (23.5%) followed by the elbow (11.9%) and the hip (11.5%). Ankle injuries resulted in the longest impairment from sports participation. The most common types of injury were abrasions (38.2%), contusions (21.1%), distortions (7.5%) and muscle strains (6.9%). Wrong or insufficient equipment (15.0%) was the most commonly mentioned causes of injury. The data indicate that the injury risk in fistball is rather high; however, the sport should not be considered a high‐risk sport because most of the injuries are slight and do not prevent the players from training or competition. Injury prevention strategies should include the development of fistball‐specific protective equipment with focus on the knee and elbow joint.