Injury Prevention in Sport

One of the building blocks of a healthy lifestyle across the lifespan is physical activity and participation in sport and recreation is encouraged by all health care professionals. The sport-related injury burden is however significant and there is a need for research into the evaluation of injury prevention strategies in all sports across all ages.^[2] The youth and young adult populations have the highest participation rates, but also the highest injury rates and sport is the leading cause of injury in youth.^[3][4] Studies have shown that 20% of schoolchildren will miss at least one day of school per year due to sports injuries, and one in three youth seek medical attention for sports-related injuries per year. Even adults lose at least one day a year from work as a result of sport-related injury.^[2][5] Sport is the the leading cause of all injuries in youth, but also has an impact on the adult population. Furthermore, the financial implications of sport-related injuries are huge. In Australia alone the direct cost of sport-related injury over a seven year period amounted to an estimated 265 million Australian dollars.^[6] From these injury rates and high financial costs, it is clear that the injury-burden is significant and that there is a need to implement evidence-based injury prevention strategies to reduce the risk of injury in youth, and also across the lifespan. Lower extremity injuries are the highest overall burden of sport-related injury at 60%, of which 60% of these are ankle and knee joint injuries.^[1]

Injuries in sport may also contribute to the rising burden of overweight and obesity in youth, with 8% of youth dropping out of sport per year because of injury or fear of injury.^[7][8] This leads to a further decline in physical activity participation and this has negative implications (obesity, post-traumatic osteoarthritis) on future health. Reducing the significant burden of sport-related injury would have great impact on quality of life through the promotion of physical activity.^[1]

Physical activity, sport and recreation is vital in youth and for all age groups to have a healthy lifestyle, to promote healthy growth and development, to prevent chronic disease and to reduce stress.These benefits from participation in sport and recreation has important implications for public health, but the injury risk must be balanced and addressed.^[1]

Prospective studies often investigate neuromuscular training injury prevention programs in team sports with attention toward amateur and elite athletes (adult and youth). These programs are often led by the coach or trainer, after a comprehensive training workshop by a physiotherapist or strength and conditioning coach with the relevant expertise.^[1]

Neuromuscular injury prevention programs do reduce the risk of injury as seen in various studies.^[18][19] In youth sports such as soccer, European handball and basketball, a 37% reduction in lower limb injury risk was reported.^[20] Other studies investigating the protective effect of exercise interventions as methods to reduce the risk of injury, showed 37% reduction in overall injury risk and a 47% reduction in overuse injury risk. An even greater preventative effect is reported when neuromuscular injury prevention programs concentrated on proprioception, balance and strength.^[21] No preventative effect is seen with intervention programs focused on stretching.

Neuromuscular injury prevention programs consist of exercises aimed to:^[20]

• improve balance
• improve strength
• improve agility (coordination, cutting and landing techniques)

These programs are usually introduced as part of an extended warm-up program and include several neuromuscular training components such as:

• aerobic components
• balance
• strength
• agility

Levels of progression are included and participants progress as they see fit. These programs need to be feasible and fit in a real world sporting context (e.g. as part of the warm-up routine and with no added equipment required).

There is evidence that these types of injury prevention programs are successful in reducing injury risk in elite, adolescent and pediatric athletes. These findings have also been translated to more generalised populations with good effect. More research is needed to gain a further understanding of the adherence to and the maintenance of these types of programs.^[1]

Rules and policies in sports are key in regulating the sport, but some of these rules and policies have been specifically developed and changed to reduce the risk of injury. Examples of evidence-informed policy and law changes are:

• Body checking in ice hockey: Disallowing body checking in all levels of play in 11- and 12 year old leagues, led to a 50% reduction in injury risk, and in older age groups in non-elite leagues led to a 54% reduction in injury risk.^[28][29]
• World Rugby’s Executive Committee has recently approved a package of law amendments to be trialed to prevent injury. One of the six laws to be further trialed includes the High Tackle Technique Warning. This law has been successfully trialed at the World Rugby U/20 Championship for the past two years and it showed a reduction of the incidence of concussion by 50%.^[30]
• Cricketers are required to wear British Standard compliant helmets when batting, wicket keeping or fielding close to the batter.^[31]

Further research is needed on the impact of rule and policy changes in sport to prevent injury.

The use of appropriate protective equipment may prevent musculoskeletal injury in sports. Such equipment may include taping, bracing and wrist guards.^[1] Dizon et al investigated the protective effect of ankle taping and bracing in previously injured adults and youth athletes. The risk of an ankle sprain re-injury was reduced by 69% and 71% respectively.^[32] However,taping or bracing is not a strategy for primary prevention in healthy populations with no previous history of ankle injury.

The use of wrist guards in snowboarding showed a significant protective effect in reducing the risk of wrist injuries, wrist fractures and wrist sprains.^[33]

A combination of educational approaches (social media and legislation) may be a good way to promote the use of protective equipment where required.