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Vanderbilt Sports Medicine Injury Prevention in Youth Sports: What Works, What Doesn’t and What’s Next February 10, 2012 Alex B. Diamond, D.O., M.P.H.

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Presentation on theme: "Vanderbilt Sports Medicine Injury Prevention in Youth Sports: What Works, What Doesn’t and What’s Next February 10, 2012 Alex B. Diamond, D.O., M.P.H."— Presentation transcript:

1 Vanderbilt Sports Medicine Injury Prevention in Youth Sports: What Works, What Doesn’t and What’s Next February 10, 2012 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 40th Annual Meeting Southeast Chapter of the American College of Sports Medicine (SEACSM)

2 Vanderbilt Sports Medicine Disclosures NO commercial relationships Research & Educational funding – NIH U54 Institutional Clinical & Translational Science Award

3 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Injury Prevention is a Team Sport

5 Vanderbilt Sports Medicine Injury Prevention 101

6 Vanderbilt Sports Medicine Youth Sports: What We Know 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 Courtesy: Safe Kids USA & AOSSM

7 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine By the Numbers 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. AOSSM 2009 Annual Meeting Pre-Conference Program.

9 Vanderbilt Sports Medicine Public Health Relevance: Sports 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 Vanderbilt Sports Medicine Public Health Relevance: We 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Clinical CareResearch Approaches To Prevention

14 Vanderbilt Sports Medicine Sport Injury Prevention Literature Status ~ 12,000 published articles on sports injury prevention since 1938 – < 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 Klugl M et al. CJSM, 2010.

15 Vanderbilt Sports Medicine Risk Factors for Sports Injury

16 Vanderbilt Sports Medicine Bahr R et al. BJSM, 2005.

17 Vanderbilt Sports Medicine Risk Factor Findings Non-Modifiable – Sex: Males (OR 1.16-2.4) Exception: soccer, basketball – Previous injury Reinjury rates 13.1%-38% Fball (reinjury vs 1 st 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 Emery CA. Risk Factors for Injury in Child and Adolescent Sport: A Systematic Review of the Literature. CJSM, 2003. (LOE 2-4)

18 Vanderbilt Sports Medicine Best Practice for Community and School Teams

19 Vanderbilt Sports Medicine CONCUSSION Key Sports Safety Topics

20 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Concussion Prevention: Equipment Football Helmets Mouth Guards Head Gear

22 Vanderbilt Sports Medicine Football Helmet Ratings: STAR Evaluation System 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 Virginia Tech National Impact Database. May 2011. Reduction in concussion risk

23 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Navarro RR. Curr Sports Med Reports, 2011.

26 Vanderbilt Sports Medicine Summary of Helmet Benefits in Sports McIntosh AS et al. BJSM, 2011.

27 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine CDC’s “Heads Up” Initiative Goal: Improve prevention, recognition, and response to concussion among young athletes Courtesy: Julie Gilchrist, MD, FAAP CDR, US Public Health Service Division of Unintentional Injury Prevention

29 Vanderbilt Sports Medicine “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 Targeting Youth Sports

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


32 Vanderbilt Sports Medicine Youth Sports Safety Legislation: National Level Children’s 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 Vanderbilt Sports Medicine Youth Sports Safety Legislation: State-Level As of October 2011, 31 states (plus D.C. & the city of Chicago) have enacted youth concussion laws

34 Vanderbilt Sports Medicine OVERUSE INJURIES Key Sports Safety Topics

35 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Parents and Coaches Beware! “BURNOUT”

38 Vanderbilt Sports Medicine Estimated Probability of Competing in Athletics Beyond High School NCAA Research. Updated September 27, 2011.

39 Vanderbilt Sports Medicine Organized Sports Participation Factors Encourage & Maintain Fun Success Variety Freedom Family participation Peer support Enthusiastic leadership Discourage Failure Embarrassment Competition Boredom Regimentation Injuries AAP COSMF & COSH. Pediatrics, 2001.


41 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 1 st time & prior sprain – Findings independent of shoe type, taping, field surface

44 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Neuromuscular Prevention Strategies 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) Abernethy L et al. BJSM, 2007.

46 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Neuromuscular Training Programs Contradictory findings regarding improvements on performance – Lindblom et al. Knee Surg Sports Trauma Arthrosc, 2011.

48 Vanderbilt Sports Medicine SPORT SPECIFIC STRATEGIES

49 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine Overuse Injury: Baseball 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. Olsen SJ et al. AJSM, 2006. (LOE 3)

51 Vanderbilt Sports Medicine Ray TR. CSMR, 2010. Youth Baseball Overuse Injuries 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 Vanderbilt Sports Medicine Competitive Cheerleading 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 Shulz MR et al. AJSM, 2004. (LOE 2)


54 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine 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 Vanderbilt Sports Medicine The World We Live In Matheson GO et al. CJSM, 2010.

57 Vanderbilt Sports Medicine Please Visit

58 Vanderbilt Sports Medicine Thank You Alex Diamond, D.O., M.P.H. – Alex.B.Diamond@Vanderbilt.Edu Alex.B.Diamond@Vanderbilt.Edu – 615.936.2455

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