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Injury Prevention in Youth Sports: What Works, What Doesn

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Title: Addressing Youth Sports Safety Through Advocacy, Outreach and Education in Middle Tennessee Author: whitejm5 Last modified by: Matt Hoyle Created Date – PowerPoint PPT presentation

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Title: Injury Prevention in Youth Sports: What Works, What Doesn


1
Injury Prevention in Youth Sports What Works,
What Doesnt and Whats NextFebruary 10, 2012
40th Annual Meeting Southeast Chapter of the
American College of Sports Medicine (SEACSM)
  • Alex B. Diamond, D.O., M.P.H.
  • Assistant Professor of Orthopaedics and
    Rehabilitation
  • Assistant Professor of Pediatrics
  • Vanderbilt University Medical Center
  • Co-Chair, Youth Sports Safety Taskforce
  • Team Physician
  • Vanderbilt Belmont Universities
  • Nashville Sounds Nashville Predators

2
Disclosures
  • NO commercial relationships
  • Research Educational funding
  • NIH U54 Institutional Clinical Translational
    Science Award

3
Objectives
  • Review basic principles of injury prevention
  • Introduce key youth sports safety topics
  • Discuss strategies to prevent injuries in young
    athletes
  • Empower you to create a safer sporting
    environment and culture for youth athletes

4
Injury Prevention is a Team Sport
5
Injury Prevention 101
6
Youth Sports What We Know
Courtesy Safe Kids USA AOSSM
  • The Facts
  • More than 38 million children and adolescents
    participate in organized sports in the U.S. each
    year.
  • Another 10 million in some form of athletics
  • Estimated 3.5 million children under age 14
    receive medical treatment for a sports-related
    injury each year.
  • HS athletes account for additional 2 million
    injuries / 500,000 doctor visits / 30,000
    hospitalization

7
ER Data Sports Recreation
  • Leading cause of presentation for injury among
    adolescents
  • Emery CA. Epi Ped Sport Injur, 2005.
  • CDC data (Gilchrist J et al. MMWR, 2007.)
  • 2.4 million visits/yr (age 5-18)
  • 29 of all unintentional injury visits
  • 48 of injuries that require hospitalization or
    transfer involve age 5-18
  • NSW population health survey showed only 8.9 of
    sports injuries treated in hospital setting.
  • Mitchell R. J Sci Med Sport, 2010.

8
By the Numbers
AOSSM 2009 Annual Meeting Pre-Conference Program.
  • Injury reported during sport among athletes age
    5-14
  • 28 of football players
  • 25 of baseball players
  • 22 of soccer players
  • 15 of basketball players
  • 12 of softball players
  • Canadian study more than 1 in 3 adolescents
    seek medical attention from a sport injury every
    year
  • Emery CA. CJSM, 2006.

9
Public Health RelevanceSports Matter for (and
to) Kids
  • Physical activity effects morbidity mortality
  • Physical activity patterns track from childhood ?
    adolesc ? adulthood
  • Injury is potential barrier to physical activity
  • 8 of adolescents drop out of sporting
    activities/yr due to injury
  • Grimmer KA et al. J Adolesc Health, 2000.
  • Leading risk for OA development
  • Injury Cost Model of the U.S. CPSC (2003)
  • 588 million in direct expenses and 6.6 billion
    in indirect expenses from injuries in the top
    five female and male HS sports

10
Public Health RelevanceWe Can Make a Difference
  • Injury often predictable and preventable, not
    just accidents
  • As many as half the injuries sustained by youth
    while playing sports are likely preventable

11
Emery CA et al. CJSM, 2006.
  • Safety cannot be delegated, it is a shared
    responsibility of
  • Parents
  • Coaches
  • Youth athletes
  • Safety advocates
  • Athletic trainers
  • Schools
  • Health professionals

12
Prevention Responsibility Child Development
  • Perceptual cognitive status
  • Identify fewer hazards and do so more slowly
  • Age 10 (pedestrian data)
  • Overestimate physical abilities
  • Lack of understanding for consequences
  • Sense of invulnerability
  • Low level perceived risk over-estimation
    ability signif injury risk increase (age 11-14
    ? OR 3.77-7.92)
  • Kontos AP. J Ped Psych, 2004.

13
Approaches To Prevention
Clinical Care
Research
14
Sport Injury Prevention Literature Status
Klugl M et al. CJSM, 2010.
  • 12,000 published articles on sports injury
    prevention since 1938
  • lt 50 of the 12K were original research
  • Most were incidence etiology studies
  • Only 492 actually evaluated efficacy or
    effectiveness of interventions to prevent injury
  • Regulatory change rarely evaluated

15
Risk Factors for Sports Injury
16
Bahr R et al. BJSM, 2005.
17
Risk Factor Findings
Emery CA. Risk Factors for Injury in Child and
Adolescent Sport A Systematic Review of the
Literature. CJSM, 2003. (LOE 2-4)
  • Non-Modifiable
  • Sex Males (OR 1.16-2.4)
  • Exception soccer, basketball
  • Previous injury
  • Reinjury rates 13.1-38
  • Fball (reinjury vs 1st time injury RR 1.4-1.7)
  • Sport Played
  • Boys hockey, football, basketball
  • Girls gymnastics, basketball, soccer
  • Age Older
  • Level of play Increasing
  • Organized vs rec, game vs practice, playoff vs
    regular season

18
Best Practice for Community and School Teams
19
CONCUSSION
  • Key Sports Safety Topics

20
Concussion Numbers
  • 1.6-3.8 million sports-related concussions/yr
  • CDC MMWR, July 2007.
  • From 2001 to 2009, the number of sports and
    recreation-related ED visits for TBI among
    persons aged 19 years increased 62
  • CDC MMWR, October 2011.
  • TBI represents almost 9 of all injuries reported
    in HS sports
  • National surveillance in 9 high school sports
  • Gessel LM et al. J Athl Train, 2007.

21
Concussion Prevention Equipment
  • Football Helmets
  • Mouth Guards
  • Head Gear

22
Football Helmet Ratings STAR Evaluation System
Virginia Tech National Impact Database. May 2011.
Reduction in concussion risk
  • 5 Stars
  • Riddell Revolution Speed
  • 4 Stars
  • Schutt ION 4D
  • Schutt DNA Pro
  • Xenith X1
  • Ridell Revolution
  • Riddell Revolution IQ
  • 3 Stars
  • Schutt Air XP
  • 2 Stars
  • Schutt Air Advantage
  • 1 Star
  • Riddell VSR4
  • 0 Stars
  • Adams A2000 Pro Elite

23
Mouth Guards
  • Effects of mouth guards on dental injuries and
    concussion in college basketball.
  • Labella et al. MSSE, 2002. (LOE 2)
  • Findings
  • No difference in concussion rate
  • Significantly lower rate of dental trauma

24
Head Gear in Soccer
  • Withnall et al. BJSM, 2005.
  • Three equipment types tested
  • No attenuation of mechanical forces due to
    heading ball
  • 33 reduction in acceleration forces from direct
    head-to-head contact
  • Further evidence needed for effect on injury or
    concussion prevention

25
Navarro RR. Curr Sports Med Reports, 2011.
26
Summary of Helmet Benefits in Sports
McIntosh AS et al. BJSM, 2011.
27
Heading in Soccer
  • Straume-Naesheime et al. Br J Sports Med, 2005.
    (LOE 3)
  • Norwegian elite footballers
  • Computerized neuropsychological testing
  • Conclusion
  • No evidence of impairment due to heading exposure
    or previous concussions

28
CDCs Heads Up Initiative
Courtesy Julie Gilchrist, MD, FAAP CDR, US
Public Health Service Division of Unintentional
Injury Prevention
  • Goal Improve prevention, recognition, and
    response to concussion among young athletes

29
Targeting Youth Sports
  • Heads Up Concussion in Youth Sports
  • 2007
  • 26 member partnership
  • Target volunteers, parents
  • Content
  • Audience ready appropriate
  • Fact sheets for coaches, parents, and athletes
  • Clipboard
  • Magnet
  • Poster
  • Concussion quiz

30
Evaluation Youth Sports Toolkit
  • CDC Unpublished Data
  • Changed knowledge, attitudes, behavior
  • 63 viewed concussion more seriously
  • 77 reported more skill in indentifying potential
    concussions
  • 72 educated others athletes, parents, other
    coaches

31
YOUTH SPORTS LEGISLATION CONCUSSION
32
Youth Sports Safety LegislationNational Level
  • Childrens Sports Athletic Equipment Safety Act
    (HR 1127)
  • Latest Major Action 3/28/11
  • Encourage and ensure use of safe football
    helmets.
  • Protecting Student Athletes From Concussions Act
    of 2011 (HR 469)
  • Latest Major Action 2/25/2011
  • Regulations establishing minimum requirements for
    prevention and treatment of concussions.

33
Youth Sports Safety Legislation State-Level
http//nflhealthandsafety.com/
  • As of October 2011, 31 states (plus D.C. the
    city of Chicago) have enacted youth concussion
    laws

34
OVERUSE INJURIES
  • Key Sports Safety Topics

35
Overuse Injuries
  • Why is it happening more often?
  • Sports specialization at younger ages
  • Intense year round competition and practice
  • Growing bodies more susceptible to injury
  • Parental and coaching pressure and unrealistic
    expectations
  • Super competitive youth sports culture

36
Overuse Prevention Strategies
  • Activity modification
  • Avoid playing for multiple teams at same time
  • 1-2 days/wk off from competitive sport or
    training
  • 2-3 months/yr away from same sport
  • Incorporate cross training
  • 10 Rule Maximum 10 increase in training
    program variables/week

37
BURNOUT
Parents and Coaches Beware!
  • 70 of kids participating in sports drop out by
    age 13
  • Lose benefits that sports provide
  • Overtraining syndrome
  • Series of psychological, physiologic, and
    hormonal changes that result in decreased sports
    performance

38
Estimated Probability of Competing in
AthleticsBeyond High School
NCAA Research. Updated September 27, 2011.
39
Organized Sports Participation Factors
AAP COSMF COSH. Pediatrics, 2001.
  • Encourage Maintain
  • Discourage
  • Fun
  • Success
  • Variety
  • Freedom
  • Family participation
  • Peer support
  • Enthusiastic leadership
  • Failure
  • Embarrassment
  • Competition
  • Boredom
  • Regimentation
  • Injuries

40
SPECIFIC PREVENTION STRATEGIES
41
Educational Programs Rule Changes
  • Adherence to rules limit illegal play
  • 6.4 of overall injuries in 9 HS sports were
    related to rules transgressions (98,066
    injuries/yr)
  • Collins CL et al. Inj Prev, 2008. (RIO)
  • Teaching proper fundamentals technique
  • Tackle with head up (?head/neck trauma)
  • Educational Awareness campaigns
  • Improved knowledge attitudes, outcome data
    sparse on injury reduction

42
Protective Equipment
  • Eye goggles (lacrosse) ?incidence of head
    face injury (RR 0.52)
  • Webster et al. MSSE, 1999.
  • Knee pads ? incidence of knee injuries (RR
    0.44)
  • Yang et al. Am J Epi, 2005.
  • Knee braces no protective effect (RR 2.24)
  • Grace et al. JBJS (Am), 1988.
  • Contradictory evidence (MCL, ACL, ?LE injury)

43
Lace-Up Ankle Braces
  • McGuine TA et al. AJSM, 2011 (LOE 1)
  • HS Football Basketball (M W)
  • Lower incidence of acute ankle injuries
  • Degree of severity unchanged
  • No effect on other LE injuries
  • Benefit for both 1st time prior sprain
  • Findings independent of shoe type, taping, field
    surface

44
Proprioception Ankle Sprains
  • McGuine T et al. AJSM, 2006.
  • Injury rate
  • 6.1 balance training program vs 9.9 control
  • 50 risk reduction if prior sprain perform
    intervention

45
Neuromuscular Prevention Strategies
Abernethy L et al. BJSM, 2007.
  • Systematic review (12 studies RCT/controlled
    intervention studies)
  • Effective in reducing knee ankle injuries
  • Preseason conditioning
  • Functional sport-specific training
  • Proprioceptive balance training
  • Structured warm-up (strengthening, stretching,
    plyometrics, sport-specific agility, /-
    education)
  • Optimized when sustained during sporting season
    (RR 0.2-0.73)
  • NNT 4-10 for minor/moderate injuries -66 for
    serious injury (ACL)
  • Not Effective
  • Stretching alone stretching warm-up
    cool-down
  • No difference in timing of program (pregame,
    halftime, etc)

46
Neuromuscular Interventions
  • Hewett TE et al. AJSM, 2006.
  • Meta-analysis 6 studies
  • Neuromuscular training programs may reduce risk
    of ACL injury in female athletes
  • Encourage use of training programs that also
    emphasize performance enhancement as means to
    motivate compliance
  • Increased program effectiveness in athletes

47
Neuromuscular Training Programs
  • Contradictory findings regarding improvements on
    performance
  • Lindblom et al. Knee Surg Sports Trauma Arthrosc,
    2011.

48
SPORT SPECIFIC STRATEGIES
49
Baseball
  • Safety balls
  • Reduced risk of ball-related head body injury
    by 23
  • Marshall SW et al. JAMA, 2003.
  • Mixed findings Re commotio cordis
  • Chest protectors
  • No risk reduction of commotio cordis evident
  • Viano DC et al. J Trauma, 2000.
  • Sliding
  • Proper technique timing
  • Break-away bases
  • Hosey RG et al. AJSM, 2000.
  • Faceguards
  • Risk reduction of oculofacial injury by 35
  • Danis RP et al. Inj Prev, 2000.

50
Overuse Injury Baseball
Olsen SJ et al. AJSM, 2006. (LOE 3)
  • Pitchers with history of significant shoulder or
    elbow injury were more likely than uninjured
    counterparts to have
  • Pitched more months per year, more innings per
    year, more pitches per game and more pitches per
    year.
  • Participated in showcases and pitched through arm
    pain or fatigue.

51
Youth Baseball Overuse Injuries
Ray TR. CSMR, 2010.
  • Proper throwing biomechanics
  • Arm fatigue
  • Age-specific pitch count rest guidelines
  • Refrain from participating in
  • Multiple leagues
  • Year-round baseball
  • Scouting showcases
  • Pitch type ?

52
Competitive Cheerleading
Shulz MR et al. AJSM, 2004. (LOE 2)
  • Coaching education training
  • Lower injury risk if
  • Coached by individuals with a college degree and
    more years of coaching experience vs those only
    with HS diploma and fewer years experience

53
FUTURE EFFORTS IN YOUTH SPORTS INJURY PREVENTION
54
Outline for Success
  • Development and Delivery of Effective Programs to
    Reduce Burden of Sport Injury
  • Scientific approach
  • Create awareness
  • Build partnerships
  • RE-AIM
  • True Change
  • Establish position on public health ( sports
    league) agenda

55
Youth Sports
  • Three big picture concepts
  • Safe participation
  • Children adolescents at increased injury risk
  • High levels of exposure at a time of major
    physiological change
  • Socialization for lifelong pleasure in the sport
  • Setting for health promotion delivery
  • Adoption of active lifestyles as adults
  • Requires attitude adoption
  • Community Resist shift from child-oriented goals
    to adult-oriented goals
  • Sports Health Professionals Prevention-centered
    thinking

56
The World We Live In
Matheson GO et al. CJSM, 2010.
57
www.vanderbiltsportsmedicine.com
Please Visit
58
Thank You
  • Alex Diamond, D.O., M.P.H.
  • Alex.B.Diamond_at_Vanderbilt.Edu
  • 615.936.2455

http//www.childrenshospital.vanderbilt.org/sports
safety
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