Avoiding Sports Injuries - What Every Coach Should Know

Alex M. McDonald, MD

 

There have been countless studies demonstrating the physical, emotional, and psychological benefits of sports, which are an important part of a healthy lifestyle at any age - whether you're involved in youth soccer, coaching basketball, or doing football coaching or youth football drills, you've witnessed the positive impact sports can make in anyone's life. However, in order to reap the full benefits, athletes, parents, coaches, and other fitness professionals must work to minimize the risk of injury inherent to athletics.


What's the risk?

In general, the risk of injury is greater during a competitive athletic event than a practice or scrimmage. Half of all injuries are related to the legs, such as ankle sprains, anterior cruciate ligament (ACL) injuries, and nonspecific knee pain. Comparatively, 20 percent of injuries are related to the arms and upper extremities, the most common of which are shoulder injuries. Head and neck injuries account for another 10 percent, most commonly concussion. Spinal cord injuries make up the smallest percentage. Other injuries include heat illness and skin infections. Lastly, certain medical conditions can put an athlete at greater risk for injury, such as a heart condition.

Let's focus on some basic steps that athletes, parents, and coaches can take to ensure a positive, injury-free sports experience.


Basic Ways to Help Prevent Sports Injuries

Consult a physician

A thorough medical history and physical by a doctor should be sought prior to any involvement in sports and/or physical fitness routine. A physician can screen for any underlying medical conditions an athlete might have that could lead to potential injury. A physician may also be able to recommend specific strength or conditioning exercises that may help to lower the risk of injury or to compensate for a specific weakness that might predispose an athlete to injury.


Periodization

Physical injury, such as broken bones, sprains, or strains, account for approximately 70 percent of all medical issues related to athletic participation. Although there are lots of ways you can help prevent injury, the most important method is staying within one's physical limits. Periodization, the process of consistently and slowly increasing training load and volume with periodic recovery days or weeks, is the best way to produce long-term, sustainable fitness gains while avoiding injury and burnout. Often, participating at too high of a level, too quickly, will result in injury.


Ways to Prevent Some Specific Sports Injuries

Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury The ACL and PCL are the two major ligaments in the knee that work together to provide stability in the joint. They cross each other and form an "X," which allows the knee to flex and extend without side-to-side movement. Injuries to these ligaments are typically sprains; however, partial tears and complete tears are also common. The PCL can be injured by a direct impact from the outside of the knee joint, which might occur, for instance, during a game of soccer or football. ACL injuries, including partial or complete tears, tend to happen when an athlete changes direction rapidly, twists without moving the feet, slows down abruptly, or misses a landing from a jump.


Recently, there has been a significant increase in the number of ACL injuries in female athletes, particularly among soccer players. Studies show that a female soccer player's risk of an ACL injury is 2-8 times that of a man's. Adding neuromuscular and proprioceptive exercises to the training regimen can reduce the number of ACL injuries by 2-4 times.


Preventing injury to the ACL and PCL has been the topic of much research; as a result, several protocols have been established to help reduce the risk of injury, all of which include:

  • Avoiding vulnerable positions
  • Increasing flexibility
  • Increasing strength Including plyometric exercises in training
  • Increasing proprioception (awareness of the position of the joint/body)

Concussion

Concussions are most common in contact sports; however, they can occur in many different athletic settings. There is a great deal of research surrounding concussions and the short- and long-term consequences of them. There may be lasting neurocognitive problems that persist long after signs and symptoms of a concussion have disappeared. If a concussion occurs, an athlete should get evaluated by a physician. The evaluation should include a full exam, history of previous concussions, and a discussion about the symptoms and severity of the current concussion. Every concussion increases the risk of having another concussion in the future, and an athlete should not return to the playing field after experiencing a concussion until cleared by a medical professional. Cognitive testing may be warranted in some cases. Education of athletes, coaches, parents, and other fitness professionals about the importance of reporting concussion symptoms is a very important piece of prevention. Athletes and coaches also should be educated about what can lead to head injury (e.g., spearing, head-to-head contact, and leading with the head).


Signs and symptoms of a concussion can occur immediately - or later on. Early symptoms include headache, dizziness, confusion, ringing in the ears, nausea and/or vomiting, and vision changes. Delayed symptoms may be experienced hours to days later, and can include memory disturbances, poor concentration, irritability, sleep disturbances, personality changes, and general fatigue.


Athletes with a suspected concussion should not continue sports participation until they're evaluated by a physician. Helmets decrease the risk of skull fracture and severe head injury; however, they may increase the risk of concussion because of the way the head impacts the padding inside the helmet. Improper use or fit of a helmet may further increase the concussion risk. This research is still controversial, though, and the clear benefits of wearing a helmet far outweigh any potential concussion risk.


Lastly, there has been some investigation into whether or not wearing a mouth-guard may prevent a concussion, but right now, there is inconclusive evidence. Mouth guards should certainly be worn to prevent dental and jaw injuries. There is much regarding concussion that is as yet unknown or unclear, and research is ongoing. However, due to the prevalence of concussion in sports, it is important to be aware of the many factors involved; to teach tackling and contact procedures to help avoid or minimize the risk of head injury; and to be able to recognize a potential concussion to prevent further injury.


Heat illness

Heat illness results from the body's inability to dissipate heat. Heat illness may happen at any time during athletic participation, because the body produces 15-20 times more heat during exercise than at rest; however, heat illness most often occurs in combination with hot and humid weather. Heat stress is a result of numerous factors, most notably the air temperature and humidity. Heat illness occurs on a spectrum, with heat stroke being the most severe condition. During pre-season activities when the weather may be hot and humid and athletes are less conditioned and accustomed to physical activities in such conditions (acclimatized), athletes are at greater risk for heat illness.


There are several steps that athletes and coaches can take to help reduce the risk of heat illness:

  • Allow athletes to acclimatize to weather conditions (this may take 5-10 days depending on athletes' ages, fitness levels, and equipment)
  • Optimize hydration strategies before, during, and after athletic activity
  • Design and engage athletes in a slow and progressive fitness regime that allows for ample recovery Wear loose fitting, light-colored, breathable clothing
  • Minimize equipment on days with excessive heat and humidity
  • Modify or cancel athletic activity based on weather conditions

Sudden death

Sudden death of seemingly healthy, young individuals during athletic events and competitions is tragic; however, it should be noted that sudden death in sports is exceedingly rare. Usually, sudden death is due to a congenital heart condition. A consultation with a physician to review family history and other factors is important to determine if an individual is at risk of sudden death during sports.


Commotio cordis resulting from blunt chest trauma

One cause of sudden death in sports, which is not related to congenital conditions or individual risk factors, is commotio cordis. This is when a blunt trauma - a hit to the chest - at just the right moment results in disruption in the heartbeat and the heart's ability to effectively pump blood to the body. This is a condition that is very rare, and of course, there are no risk factors that predispose an individual to such an event. Commotio cordis typically strikes athletes less than 16 years of age that are engaged in sports that use a small ball or puck, and that were already wearing chest protection. The following precautions have been shown to be effective in preventing death after commotio cordis:

  • Have an emergency action plan in place
  • Have access to a cardiac defibrillator
  • Use age-specific safety balls (e.g. a softer baseball for younger age groups)
  • Have coaches educate young athletes to avoid taking a direct blow to the chest, since chest protectors are inadequate in preventing commotio cordis

Skin infection

Skin infections are not a major injury, but due to the emergence of resistant bacteria, they can cause lost playing time and other problems. Athletes become susceptible to infections when equipment is used repeatedly without washing it, when they share equipment, or when they come in close contact with common surfaces (gym equipment, floor mats, etc.). The following are some ways to reduce or eliminate bacterial skin infections in athletes:

  • Routine screening for athletes in high-risk sports (football, wrestling, fencing)
  • Abstention from participation when an athlete has an active lesion or infection
  • Promotion of good hygiene, including regular hand washing, equipment sanitization, and not sharing personal products such as towels, bedding, or bar soap
  • Encouragement of athletes to report skin lesions or rashes

Education is one of the best methods of injury prevention. Learning about the most common injuries in your specific sport, as well as an individual athlete's risk factors, can help to create an atmosphere of awareness and understanding that may prevent an injury from ever occurring - which is the ultimate goal.


Good ideas for injury prevention

  • Participate in a conditioning program to build muscle strength and endurance gradually, over time
  • Be sure to follow an appropriate warm-up and cool-down regimen, including flexibility exercises
  • Keep a first aid kit handy, and learn how to treat minor cuts, bruises, and strains
  • Have an emergency plan in place for major injuries while playing and practicing for any sport. Injury can be minimized with immediate medical help
  • Dress in the most appropriate clothing and safety gear to prevent common injuries. Make sure uniforms and protective equipment fits properly, and wear all protective gear correctly at all times
  • Stay hydrated
  • Eat a well-balanced diet
  • Use proper technique and follow the rules of your sport, as well as the rules of the facility in which you are practicing/playing
  • Encourage immediate reporting of injuries
  • Check your sporting equipment prior to participation for damage and proper function, and clear away any debris from your playing area

Sport-Specific Rules to Live By


Baseball/Softball:

Baseball and softball injuries can be a result of both acute and traumatic events, as well as chronic overuse injuries. Soft tissue injuries can include bruises, scrapes, and cuts. Shoulder and elbow injuries are particularly common, especially for young pitchers, due to repeated stress from throwing. These injuries include those to the muscle of the rotator cuff, biceps tendon, ligaments of the elbow, bone underlying the joints, and the ligaments of the shoulder socket. Usually, rest, medication, and a rehabilitation program will enable return to play.


Helpful tips on injury prevention for softball/baseball:

  • Use proper technique for batting and pitching. Make sure you and your fellow teammates are not pitching or hitting excessively, as this can lead to overuse injury
  • Implement breakaway bases instead of the stationary type. This drastically reduces the risk of injury when players are sliding into the bases

Gymnastics:

Fractures of the wrist, fingers, and toes are the most common gymnastics injury, followed by sprains of the ankle and knee. Nearly 40% of sudden-onset injuries happen in the floor event. Most injuries occur with moves that are considered basic or moderately difficult by well-established gymnasts. There is also an increased chance of injury when a gymnast works on a single apparatus for an extended period of time. One major source of injury is loss of concentration; a key to injury prevention may be the awareness of when to end the practice session.


Body parts most injured by gymnasts vary by gender, and include the ankle, knee, wrist, elbow, lower back, and shoulder. Ankle sprains are a particular concern. Overuse and nonspecific pain conditions, especially the wrist and lower back, occur frequently among advanced-level female gymnasts. Factors associated with an increased injury risk among female gymnasts include greater body size and body fat, periods of rapid growth, and increased life stress. Also, eating disorders, such as anorexia nervosa or bulimia, are among the serious problems faced by female gymnasts.


Helpful tips for preventing injury in gymnastics:

  • Warm up and stretch prior to gymnastics practice and competition
  • Never attempt new or advanced skills without an experienced coach to spot you Know the correct way to use mats, belts, pits, and trampolines
  • Eat a well-balanced diet
  • Avoid rapid increases in skill difficulty and training load
  • Encourage immediate reporting of injuries

Basketball:

Basketball is the sport that most frequently causes sports-related emergency department visits for youth and adolescents. Females are more likely to be injured than males, especially with ankle and knee injuries, and their injuries are more likely to be severe. In basketball, acute injuries such as wrist, finger, and ankle strains or sprains are the most common types of injuries. Chronic overuse injuries are less common; however, tendonitis of the knee, Achilles tendon, or shoulder frequently occur.


Helpful ideas on injury prevention for basketball:

  • Wear mouth guards, as they reduce facial and dental injuries
  • Incorporate neuromuscular training (training designed to promote the mind-muscle connection) into your fitness routine, as this can reduce the risk of knee injury: Ask your coach, trainer or fitness professional about different ways to practice this
  • Wear supportive shoes with skid-resistant soles specifically designed for basketball

Soccer:

Common soccer injuries include concussion, ankle sprains and strains, Achilles tendonitis, ACL and PCL injuries, and torn cartilage in the knee joint. Sprain is the leading injury type, while the ankle was the most affected anatomical site. Factors such as weather, previous injury, experience, position, and activity tend to influence injury occurrence. Use of joint supports and proprioceptive/neuromuscular coordination training, which teaches the athlete to be more aware of his/her body in space and to avoid positions which might increase the risk of injury, is especially important in athletes with prior injuries, and has shown some benefits. Lastly, improvement of jumping and landing techniques seem to decrease the incidence of ACL injuries, especially in female athletes.


Helpful tips on injury prevention for soccer:

  • Use protective equipment
  • Use ankle support, especially if previously injured
  • Employ proprioceptive/coordination training
  • Learn proper jumping and landing techniques

Football:

The risk of injury for football players is higher in older athletes and lower in teams with more experienced coaches and more assistant coaches. Football injuries are much more likely to happen in a game, although injury can occur frequently during practice, as well. Injuries typically take place when players are blocking, tackling, or being tackled. Contact sessions are over 4 times more likely to produce injuries than controlled sessions. Overall, lower-extremity injuries account for half of all injuries, with knee injuries being most prevalent. Football is the cause of the greatest number of ACL injuries. Interestingly, injury rates have been shown to be reduced by athletes wearing shorter cleats.


Sprains and strains account for 40% of injuries, contusions 25%, fractures 10%, concussions 5%, and dislocations 15%. Skin infections can also be common among football teams with dirty equipment. Due to early season and pre-season summer temperatures and the amount of equipment worn, heat illness is a major concern among football players. In fact, heat illness is the leading cause of death in high school athletes.


Most football injuries are mild, including bruises, strains, and sprains. Rule changes disallowing initial contact with the helmet or face mask have greatly reduced catastrophic head and neck injuries. Because football is a high-risk sport, coaches, players, and trainers must all become aware of the best ways to prevent injuries.


Helpful injury prevention tips for football:

  • Wear shorter cleats
  • Teach and enforce proper tackling technique
  • Wear protective equipment in training and game situations
  • Maintain proper hydration
  • Eliminate or alter practice and games that are scheduled to occur in high-heat stress


References:

Abernethy L. Bleakley C., Strategies to prevent injury in adolescent sport: a systematic review. Br J Sports Med. 2007 Oct;41(10):627-38.

American College of Sports Medicine. Team physician consensus statement. Med. Sci. Sports Exerc. 32(4):877-878, 2000.

American College of Sports Medicine. Sideline preparedness for the team physician: A consensus statement. Med. Sci. Sports Exerc. 33(5):846-849, 2001.

American College of Sports Medicine. The team physician and conditioning of athletes for sports: a consensus statement. Med. Sci. Sports Exerc. 33(10):1789-1793, 2001.

American College of Sports Medicine. Female athlete issues for the team physician: a consensus statement. Med. Sci. Sports Exerc. 35(10):1785-1793, 2003.

American College of Sports Medicine. Mass participation event management for the team physician: a consensus statement. Med. Sci. Sports Exerc. 36(11):2004-2008, 2004.

American College of Sports Medicine. Concussion (mild traumatic brain injury) and the team physician: a consensus statement. Med. Sci. Sports Exerc. 37(11):2012-2016, 2005.

American College of Sports Medicine. Psychological issues related to injury in athletes and the team physician: a consensus statement. Med. Sci. Sports Exerc. 38(11):2030-2034, 2006.

Caine DJ, Nassar L. Gymnastics injuries. Med Sport Sci. 2005;48:18-58 Daly RM, Bass SL, Finch CF. Balancing the risk of injury to gymnasts: how effective are the counter measures? Br J Sports Med. 35:8-10, 2001.

Emery CA. Injury prevention and future research. Med Sport Sci. 2005;49:170-91.

Harmer PA. Basketball injuries. Med Sport Sci. 2005;49:31-61.

Harmon, KG, Assessment and Management of Concussion in Sports. American Family Physician, 1999, Sept; 60 (3).

Junge A, Dvorak J. Soccer injuries: a review on incidence and prevention. Sports Med. 2004;34(13):929-38

Lindner KJ, Caine DJ. Injury patterns of female competitive club gymnasts. Can J Sport Sci. 1990 Dec;15(4):254-61.

National Collegiate Athletic Association(NCAA). Injury surveillance system. Indianapolis. Available from: http://www1.ncaa.org/membership/ed_outreach/health-safety/iss/index.html.

Saal JA. Common American football injuries. Sports Med. 1991 Aug;12(2):132-47.

Sands WA. Injury prevention in women's gymnastics. Sports Med. 30(5): 359-373.

Stuart MJ. Gridiron football injuries. Med Sport Sci. 2005;49:62-85.

Wang Q., Baseball and softball injuries. Curr Sports Med Rep. 2006 May;5(3):115-9.

Zetaruk MN. The young gymnast. Clin Sports Med. 19(4): 757-780.

About The Author

A graduate with a medical degree from the University of Vermont and also the Amateur Ironman World Champion at Kona 2007, Alex is temporarily putting his medical career on hold to race as a professional triathlete.

Fun Fact: While a 4th-year medical student, Alex found time to train and win Ironman USA Lake Placid in 2007

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