Saturday, February 25, 2006

Sports Saturday: The Science Of Injury Prevention

With all of the physical activities that many children are participating in nowadays, there are so many ways in which kids can be hurt. I thought that it would be a good idea to take a look at how the effects of these injuries can be prevented or at least minimized:
During the preteen years (8 to 12), children become more independent and they start to wander away from their homes to explore their neighborhoods. Children become more adventurous and the number of recreational-related injuries increases during this time. The motor skills in this age group can vary widely and may range from a child who is still learning to ride a two-wheel bicycle to a child who has mastered not only bicycle riding, but who is also adept at using rollerblades, scooters, and/or skateboards.

Parents are often intrigued with their child's development and wonder how well they are maturing during their pre-adolescent years. During this period, parents encourage their child to acquire new motor skills and often compliment them for their physical abilities. Parents may allow adventurous behavior, not fully realizing the potential for serious injury. Parents may also have a false sense of security regarding their child's safety in the home, school, or with recreational activities. On the other end of the spectrum, parents can be overly protective and may restrict their child's activities. After interviewing a mother with two boys in this age group, her solution to injury prevention was to lock her two boys in a padded room. However tempting it is to overprotect our children, it is unrealistic to think we can be at our children's side at all time. Therefore, we need to think of different ways to keep them safe.

Some parents often neglect to go over safety rules with their children, thinking that their child will logically think things through and know the consequences of not following the rules. However, nothing can be further from the truth; children in this age group can often reiterate the safety rules, but they may truly not know how to follow those rules. It is the parent's responsibility to help their children understand how to best prevent injuries and secure their child's safety in the home, school, and recreational activities.

Haddon Matrix

The modern science of injury prevention was established in the 1940s and injuries became viewed as a public health problem largely by the efforts of Dr. William Haddon, Jr., a clinician and epidemiologist. Dr. Haddon emphasized that injuries are not the result of a single cause, but instead result from a chain of circumstances and therefore present with multiple opportunities to establish prevention countermeasures. Dr. Haddon shifted the injury prevention focus away from changing the behavior of the individual to examining the importance of the object (e.g., trampoline) or vehicle (e.g., bicycle) causing the injury and the physical and social environment surrounding the injury. Dr. Haddon developed a matrix that examines the host, agent, and environmental circumstances before, during, and after the injury.

Let's take, for example, rollerscooter injuries, and apply Haddon's matrix for prevention. Rollerscooter injuries are very common in school-age children and constitute an increasing number of emergency department visits each day. The "host" is the child who is inquisitive, somewhat daring, and wanting the thrill of rolling down a hill on a scooter. The "agent" is the scooter, which by design, makes it easy to tip over or lose control. The "environment" is the hill that may present with various bumps and holes in the path of the scooter.

Interventions before the injury for the:

Host: Make sure the child knows how to balance himself on a scooter.
Agent: Make sure the scooter is well built and the brakes work.
Environment: Clear the path of any branches or debris that may cause the scooter to tip over.

Interventions during the injury for the:

Host: Make sure the child wears a helmet and protective padding.
Agent: Make sure the child applies the brake periodically and does not speed out of control.
Environment: Make sure the child is supervised or has a "buddy" with him during the activity.

Interventions after the injury for the:

Host: Administer first aid, or cardiopulmonary resuscitation (CPR) if needed
Agent: Dispose of the scooter.
Environment: Ensure access to a certified trauma hospital or medical specialist to treat the injury. In addition, be aware of rehabilitation services needed to treat serious injuries.

Primary topics for this article include scooters, skateboards, rollerblades, and sports safety.

Recreational Activities

Inline skating and skateboarding activities have become two of the most attractive sports for children today. These sports not only provide a means of recreation, but also provide means of transportation and exercise. Children often view them as competitive sports that can be done in many environments, with kids trying to master tricks that pose a great risk for injury. These sports contribute to an increasing number of childhood injuries that are seen in emergency departments each year. Inline skating injuries most commonly occur in the wrist area, including the lower arm (40 percent), followed by the knee, face, and elbow. As can be expected, the most common area for skateboarding injuries includes the ankle (16 percent), followed by the face, wrist, and elbow. Approximately 23 percent sustain an ankle sprain and 21 percent sustain a fracture.

The American Academy of Pediatrics and International Inline Skating Association recommend that all participants in these sports wear full protective gear, including helmets, wrist-guards, and knee and elbow pads. The wrist-guard alone will protect the wrist from lacerations, sprains, and reduce overall odds by sixfold of sustaining a wrist injury.

When to begin

Often parents ask how old their children should be before they can rollerblade or skateboard. Generally, your young elementary school child can start skating, assuming he or she has normal strength, coordination, and judgment. It is recommended that your child start off with roller skating (four-wheel skates) because these afford better control. If possible, the best place to skate is an indoor rink where there is good lighting, the surface is flat, and the speed is monitored and controlled. Depending on how well the child does with roller skating, he or she may then attempt inline skating, preferably in an indoor rink. Skateboarding may follow once the child has acquired sufficient skill, strength, and coordination to steer the board.

Sport Injuries

The following was obtained from the Injury Prevention and Control for Children and Youth manual published by the American Academy of Pediatrics.

As parents, we know that sports injuries are very common, but statistics on sports injuries are hard to obtain for this age group. The best studies on sports-related injuries use data collected from athletic trainers, school nurses, and team physicians covering the practice and the games. Most of the data collected are centered on high school sports. We can classify a sports-related injury as an acute, one-time event, or as a chronic injury, generally classified as an overuse injury. Some children become injured because they participate in too many sports during one season. Many injuries may be prevented if children have guidance during participation, take sport-specific training, and they are physically prepared.

Parents often want to know about their child's risk of injury in a particular sport, such as ice hockey. In general, injury rates are low for all sports at this age group, mainly because preteens are not physically big enough to generate enough force to cause substantial injuries, even in contact sports. Injury rates climb significantly in the adolescent age group and in high school sports. Again, looking at high school data, we know that the sports with the highest number of injuries are football, gymnastics, wrestling, and ice hockey. Chronic-type injuries are commonly seen in soccer and track and field.

Severe injury

When we think of sports injuries, we are most concerned about a catastrophic event causing a permanent and/or severe neurologic disability (spinal cord injury). There is no reporting system to collect data on catastrophic injuries in children below the high school level. From data collected at the college and high school level we know that gymnastics, ice hockey, and football are the sports most closely associated with a risk for catastrophic injury.

Injury control efforts have targeted these most severe injuries and have resulted in improvements in equipment and changing the rules of the game to prevent serious injuries. In football, a dramatic reduction of cervical spine injuries was seen after they stopped the practice of "spearing," which is driving one's helmet into the body of another player.

Additional information on the prevention of sport injuries is available in the Sport Medicine: Health Care for Young Athletes manual published by the American Academy of Pediatrics. I will list the sports with the highest levels of youth participation and provide some of the more important injury prevention tips.

Football: A properly fitted helmet will significantly reduce the degree and frequency of head and neck injuries. Most helmets on the market today are produced under strict guidelines written by the National Operating Committee on Standards for Athletic Equipment. Face masks and mouth guards will greatly reduce dental and facial injuries. Well-constructed thick shoulder padding will reduce the risk of shoulder sprains.

Baseball: Wearing helmets in the batting box and on the bases will reduce head injuries. Wearing safety goggles, or a polycarbonate shield connected to the helmet, will prevent eye and facial injuries by a pitched ball. Breakaway bases will prevent lower leg injuries when the child slides into base

Soccer: Shin guards can help prevent lower leg injuries. Properly fitted soccer shoes can help prevent chronic lower leg injuries as well, like shin splint syndrome or a painful heel caused by a bony spur on the calcaneous (heel).

Gymnastics: This sport is associated with a high number of injuries both acute and chronic. The most important method of preventing injury is to have a person supervising and spotting the child during difficult maneuvers.


Recreation activities are a big part of a child's life and enjoyment. Participation in these activities pose potential risks for injury. These injuries result in substantial number of emergency room visits each year. Parents can often play an active role in preventing these injuries by making sure the child follows the rules of the game as well as uses the proper safety equipment. A child should understand that many of the rules in sports and recreation activities are specifically made to reduce serious injuries. In addition, proper guidance and training can greatly reduce sports-related injuries.
I was lucky. After a very active childhood of football, baseball, and tree-climbing, my first real injury was the result of a motorcycle crash while in my 20s.
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