Injury Prevention in Sport Urho Kujala Professor of Sports & Exercise Medicine Department of Health Sciences University of Jyväskylä, Finland

Ideal steps in injury prevention The extent of the problem must be identified Mechanisms and factors involved should be identified Measures likely to reduce the risk of injury should be introduced and their effect monitored

Strategies in injury prevention Population strategy: general information to all using public media etc.  Educating groups Teaching individuals: trainers, coaches, and team physiotherapists & physicians have a challenge to identify injury-prone athletes and to tailor their (mental and physiological) training and rehabilitation programs

Basics in injury prevention We have to know sports-specific injury profiles and mechanisms and inform the participants  Just a sound knowledge of risks is likely to have a preventive effect (Saari 1988). Giving advice how to prevent the injury is likely to increase the preventive effect

Injuries among top-ranking Finnish athletes REF: Ristolainen L et al. Submitted for publication Injuries/1000 training hours

Shoulder stress injuries among top-ranking Finnish athletes REF: Ristolainen L et al. Submitted for publication % of athletes with shoulder stress injury/year

Injuries among top-ranking Finnish athletes (injuries per 1000 training hours) Ristolainen L et al. Submitted for publication In swimmers 81% of the overuse injuries were sustained while swimming, but only 32% of the acute injuries occurred in their own sport! Injuries/1000 training hours

EVIDENCE? Historically changes in rules and equipment/protective equipment/supports has been shown to change the injury profile most clearly; Examples from american football, downhill skiing etc. Cohort and case-control studies have shown the effect of external supports

Final/best evidence Comes from randomized controlled trials

Insoles Either custom-made or prefabricated insoles compared to no insoles reduces lower limb injuries in military recruits. Aaltonen et al. Arch Intern Med 2007;167:

External joint supports External joint supports show a tendency to prevent ankle, wrist or knee injuries. Aaltonen et al. Arch Intern Med 2007;167:

Balance board + training programs Multi-intervention preventive training programs are effective in preventing sports injuries, but programs using balance board training only give contradictory results. Aaltonen et al. Arch Intern Med 2007;167:

Stretching + warm up Aaltonen et al. Arch Intern Med 2007;167: Stretching did not prevent sports injuries (studied mainly among military recruits)

Can the preventive work be based on scientific evidence? Experience Case series Epidemiological studies Case-control studies RCTs (Randomised Clinical Trials) Most important measures will never be tested by RCTs? (Compare evacuation of malignant tumours, treating juvenile diabetes with insulin etc.)

Meeting an injured athlete Proper treatment and rehabilitation reduces re-injury risk Proper treatment and rest is the only choice to reach top level later Analysis of risk factors and education of an athlete when he (due to an injury) visits a sports physician for the first time - behaviour is more important than biomechanics?

Meeting a group: Preventive aspect can always be a part of your lecture to athletes and their support teams I) Explain the sports-pecific injury profile II) Ask the audience how many have missed important games due to injuries  In many situations avoiding an injury is an essential part in reaching team success or individual top-performance III) Ask the audience how is it possible to prevent injuries in your sport  List of best ways

10 tips to prevent sports injuries I Choose a safe sport as well as a proper place and surface II Treat and rehabilitate your old injuries III Start all new training modalities progressively IV Learn the techniques and train so that you are fit enough to participate V Remember warm-ups (and stretching?)

10 tips to prevent sports injuries VI Use proper equipment including protective equipment and supports VII Follow the rules and control your nerves VIII Do not participate when you are sick or injured XI Remember that injury risk is higher during competition than training, but journey to training court is more dangerous than sports when only catastrophic accidents are counted up X Concentrate in what you are doing and do not go over the limits of your skills

Tip 11 No doping! Use of many doping substances can increase the risk of death and risk of injuries, especially various anabolic agents (Pärssinen et al. Int J Sports Med 2000;21: ).

Meeting a group: Group interventions - Downhill skiing (REF: Jørgensen et al. Knee Surg Sports Traumatol Arthrosc 1998;6: ) Randomized study Showed instructional ski video in the bus on the way from Denmark to the Alps During 8 skiing days video-group had 30% lower injury risk Advice on many different factors

Young athletes is an important target group: Growth and loading During adolescent growth spurt the skeleton is at a vulnerable phase, modify training?

Population strategy Public media can provide effective support at least in distributing specific pieces of knowledge to many participants

Widening the scope of preventive work: Traumatic deaths and permanent disabilities due to injuries in organized sports The risk for catastrophic injury is higher in normal traffic during the journey to sports place than during many of the popular sports events Injuries causing severe permanent disabilities are very uncommon in commonly practiced team games in Finland (Kujala et al. BMJ 1995;311:1465-8)

Accidental injuries; trends in Finland Sports & Exercise TrafficWorkHomeOtherViolence

Safety education for moving to sports place Pedestrian safety education can result in improvement in children’s knowledge and behaviour - changes decline with time - education must be repeated at regular intervals (Duperrex et al. Cochrane Review) Helmets provide a reduction in the risk of brain and other head injuries (Thompson et al. Cochrane review).

Safety education for moving to sports place Visibility aids have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier (Kwan et al. Cochrane Review) New (young) drivers are at a higher risk in traffic - also many athletes have died in traffic Find safe routes (is also a matter of society planning)

How do children participate in sports and exercise? n

Where do children exercise? %

Future challenges (I) Preventive work is beneficial, but more research is needed to find optimal targets and ways Increasing numbers of young people participate in modern sports types with high injury risk (air sports etc.)  Important targets for research and education

Future challenges (II) Medical staff is usually paid better for treating than for preventing an injury Technical means of distributing information have developed – use them Our memory is short, the knowledge on measures to reduce injuries must be refreshed repeatedly

Thank you for your attention!