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Kin 188  Epidemiology Of Athletic Injuries
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Kin 188 Epidemiology Of Athletic Injuries

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  • 1. KIN 188 – Prevention and Care of Athletic Injuries Epidemiology of Athletic Injuries
  • 2. Definitions and Perspective
    • Epidemiology – study of types and frequencies of athletic injury
    • Can have significance for designing protective equipment, establishing or altering rules and providing information to athletes and parents
    • Also can identify need for appropriate health care and medical coverage
  • 3. Research in Sports Epidemiology
    • Assists understanding of potential relationships between injuries and sports
    • Investigators have gathered information on
      • Sport/recreational injuries seen in emergency rooms and health care clinics
      • Retrospective data on injuries occurring during a particular time period or in a particular sport/activity
      • Data from a wide variety of teams over a number of years
  • 4. Sports Injury Surveillance Systems
    • Many organizations collect data on injuries during sport participation but differences in definitions/approaches/locations make uniform comparison/reference difficult at best
    • Even so, collection of any data is potentially useful to gaining a greater understanding of injuries, the risks associated with certain activities and development of prevention strategies and techniques
  • 5. Sports Injury Surveillance Systems
    • National Athletic Injury Reporting System (NAIRS)
      • Wide sampling of college sports
    • National Collegiate Athletic Association (NCAA)
      • Multiyear, ongoing survey of 16 NCAA sports
    • National Athletic Trainers’ Association (NATA)
      • High school athletic injuries
    • National Youth Sports Safety Foundation (NYSSF)
      • Youth sports, compilation of date from various sources
    • National Football Head and Neck Injury Registry
      • All levels of football participants
    • National Center for Catastrophic Sports Injury Research
      • High school/college athletes who suffer serious injury or death during participation
  • 6. NAIRS Reportable Injury Definition
    • Example of definition of injury for reporting and data collection
      • Any brain concussion causing cessation of athlete’s participation in order for medical evaluation prior to determining return to play criteria
      • Any dental injury that should receive professional attention
      • Any injury or illness that causes cessation of an athlete’s customary participation on the day following the onset of the problem
      • Any injury or illness that requires substantive professional attention before athlete’s return to play is permitted (athlete could not have RTP the next day without that attention)
  • 7. High-Risk Sports
    • High risk sports classified as such due to potential for serious injury as well as the frequency of overall injuries
    • Athletic training students must spend at least 25% of total hours of clinical experience working with one or more of these sports
  • 8. High-Risk Sports
    • Basketball
      • Ankle, hip/thigh, knee and wrist/hand/finger are, in descending order, the most common injury sites
      • Research has shown higher rates of ACL injuries for women vs. men
    • Cheerleading
      • Relatively low injury rate, with LE (ankle) most common area, but high severity of injury due to gymnastics/pyramid building/stunts
  • 9. High-Risk Sports
    • Football
      • LE more commonly injured than UE – relatively low risk of head/neck injury but severity is high when it occurs
      • NCAA data shows game injury rates higher than practice injury rates
    • Gymnastics
      • Men tend to have higher UE injury rates and women higher LE rates – event dependent
      • High rate of LBP – one study showed 60%+ of Olympic gymnasts with back injuries – hyperextension is primary culprit
  • 10. High-Risk Sports
    • Hockey (Ice and Field)
      • IH has considerable body contact whereas FH prohibits it – injury rates correspond
      • Speed of game due to surfaces also affects risks
      • Contusions/lacerations/sprains (face/head is common), potential for spinal injury
    • Lacrosse
      • Difference in equipment for men vs. women
      • Face injuries (stick) and LBP from rotational stress most common – otherwise similar to soccer
  • 11. High-Risk Sports
    • Rugby
      • Significant variance between injury rates by position and in US vs. rest of world
      • Contusions, joint sprains and lacerations most common
    • Rodeo
      • Head/spine injuries, fractures, organ injury from being thrown from animal
      • Bullriding has highest risk, then bareback riding
    • Skiing
      • LE fractures, knee injuries most common
      • Also have thumb injuries from poles
  • 12. High-Risk Sports
    • Soccer
      • Lower extremity injuries predominate (thigh, ankle, knee)
      • Head/spine injuries from body to body/head/ground contact
    • Volleyball
      • Lower extremity injuries (ankle) are most common
      • Upper extremity injuries (hands/fingers/shoulders) next in occurrence rates
    • Wrestling
      • Shoulder and knee sprains most common injury
      • Dermatological conditions and ear injuries also are common
  • 13. Other Sports
    • Baseball/Softball
      • Both have low rates of injury (2.86 and 2.57/1000 exposures)
      • Common injuries include abrasions, shoulder and elbow injuries from overuse in pitchers – propensity for position specific injuries
    • Track and Field
      • Throwing events apply stresses to knees/spine
      • Jumping/running events associated with impact and/or repetitive microtrauma events
  • 14. Other Sports
    • Tennis
      • “Tennis elbow” injury with backhand stroke
      • Shoulder injuries from serves/volleys/smashes and LE joint injuries from change of direction
    • Golf
      • LBP is most common injury via repetitive trauma during swing
    • Swimming
      • Shoulder joint is most commonly injured from repetitive stress of strokes
  • 15. Intrinsic Risk Factors
    • Risk factors associated with the individual
      • Age (development)
      • Gender
      • Psychological state
      • Medical condition/s
  • 16. Intrinsic Risk Factors
    • Risk factors of normal growth
    • Adolescent risk factors
    • Gender-specific concerns
    • Psychological risk factors and trauma
    • Risk factors associated with medical conditions
    • Special risks for athletes with disabilities
  • 17. Risk Factors of Normal Growth
    • Multiple opportunities for children to participate in activities – therefore risk
    • Little reliable research on frequency/severity of injury in youth activities
    • Contact sports (football) presents fewer injuries than non-contact sports (swimming, gymnastics)
    • More likely to have growth plate injury on playground vs. during sport participation
  • 18. Risk Factors of Normal Growth
    • Conditions to identify – difficult to prevent
    • Legg-Calve-Perthes disease
      • Head of the femur fails to fully form or dies – attributable to decreased blood supply
      • Most common in boys ages 4-12
      • Requires limited activities and/or surgery
    • Osteoid osteoma
      • Tumor in the bones of the extremities
      • Most cases between 5-25 years of age
      • Increased risk of fracture with participation, typically operate to remove tumor
  • 19. Adolescent Risk Factors
    • Adolescents more at risk of injury due to imbalances between muscular strength and skeletal maturity
  • 20. Adolescent Risk Factors
    • Growth plate injury
      • Injury to epiphysis (growth plate) can cause premature closure
    • Osgood-Schlatter disease
      • Excessive tension on tibial tuberosity attachment site for quadriceps muscle group
      • Especially prominent with jumping/running
    • Spondylolysis
      • Stress fracture to vertebrae – associated with hyperextension activities (gymastics, football)
      • Must recognize to avoid progression to bilateral condition with associated slippage of vertebral segment/s
  • 21. Adolescent Risk Factors
    • Slipped capital femoral epiphysis
      • “ Slip” of proximal growth plate of the femur
      • More common in overweight boys – stress of body and weight causes weakening of epiphysis
      • Almost always requires surgery
    • Osteochondritis dissecans (“joint mice”)
      • Fracture of articular cartilage (ends) of bones
      • Most common in hip, knee and elbow
  • 22. Gender-Specific Concerns
    • Most injuries affect men/women equally given participation at equal skill levels
    • Women predisposed to additional problems (female athlete triad)
      • Amenorrhea – loss of menstruation from low body weight due to excessive training
      • Osteoporosis – bone loss secondary to menstrual irregularities
      • Disordered eating – anorexia/bulemia, attempts to maintain low body weight/image
  • 23. Psychological Risk Factors and Trauma
    • Many researchers demonstrate a strong correlation between psychological and emotional stress and the frequency of injury
    • Minimizing outside stressors reduces anxiety and allows participants to focus on task at hand to minimize injury risk
    • Occurrence of injury often causes psychological/emotional stress which can affect recovery from injury
  • 24. Risk Factors Associated with Medical Conditions
    • Scoliosis
    • Leg-length difference
    • Epilepsy
    • Diabetes
    • Asthma
    • Exercise-induced bronchoconstriction
    • Marfan syndrome
    • Congenital heart abnormalities
    • Myocarditis
    • Cardiomyopathy
    • Absence of one of a paired set of organs
    • Visual impairments
    • Communicable disease
  • 25. Scoliosis
    • Lateral curvature of the spine
    • Risk of participation with condition dependent upon extent of curvature
      • Mild/moderate curves may have no additional risk of injury
      • Extreme curves (>80 degrees) changes dimensions of chest and is often associated with difficulty breathing and/or increased heart rate
  • 26. Leg-Length Difference
    • Significant leg-length discrepancies increases risk of shin, knee, hip and/or low back problems due to uneven weight-bearing through the lower extremity
    • Most often treated with orthotic/shoe insert
  • 27. Epilepsy
    • Neurological disorder characterized by seizures – petit mal vs. grand mal
    • Typically controlled with anticonvulsive medications – seizures often preceded by aura
    • Most common risk is injury during seizure episode
    • If well controlled, not precluded from most activities
  • 28. Diabetes
    • Type I vs. Type II diabetes
    • For type I diabetics, must be aware of exercise lowering blood sugar (hypoglycemia) and utilize appropriate amount of insulin
    • Often function well in athletics if they carefully monitor food intake and activity level
  • 29. Asthma
    • Chronic respiratory condition
    • Often triggered by allergies and can impact breathing regardless of activity level
    • Inhalation typically not compromised, but difficulty exhaling is primary symptom – lack of gas exchange leads to reduced oxygen availability
    • Generally treated with medication daily regardless of symptoms
  • 30. Exercise-Induced Bronchoconstriction
    • Asthma-like symptoms occurring only during exercise
    • Typically controlled via use of inhalers (bronchodilators) during activity and typically doesn’t preclude one from participation
  • 31. Marfan Syndrome
    • Collagen tissue disorder associated with shortened life span
    • Characteristically tall/thin, visual difficulties and weakness of heart structures, especially aorta – cause of death is often aortic aneurysm
  • 32. Congenital Heart Abnormalities
    • Aortic stenosis, heart wall/valve defects, etc.
    • Typically discovered long before participation in activities occurs
    • Heart murmurs and arrhythmias are relatively common examples and often require nothing other than monitoring of the individual
  • 33. Myocarditis
    • Inflammation of the heart muscle
    • Some infections can damage heart muscle – often presents with fatigue, mild chest pain and/or shortness of breath - continued exertion can further damage heart
  • 34. Cardiomyopathy
    • Damage to heart muscle can be nutritional or hypertrophic
    • Nutritional damage from nutritional deficiency, poisoning or substance abuse
    • Hypertrophic damage is genetic condition where heart muscle thickens but chambers don’t get bigger – less blood output – high incidence of death
  • 35. Absence of One of a Paired Set of Organs
    • Sports participation under these conditions is not prohibited by rule nor medically prohibited, risks must be fully understood and accepted before participation allowed
    • Kidneys, lungs, testicles, ovaries
  • 36. Visual Impairments
    • Participation in contact sports with one eye is not recommended due to change in depth perception with monocular vision
    • Athletes with visual impairments encounter increased injury risks
    • Adapted sports/activities give those individuals opportunity to utilize typically well-developed auditory pathways
  • 37. Communicable Disease
    • Diseases transmitted through air or bodily contact
    • Risk of airborne transmission from athletes and spectators, especially in closed environment
    • Multiple sports require contact between participants and/or equipment increasing risk
    • Generally, risk no different than other community functions (school, etc.)
    • Education and sanitation (hand washing) are best preventative measures
  • 38. Special Risks for Athletes with Disabilities
    • Most studies indicate that injury rates amongst athletes with disabilities mirror injury rates for the general athletic population
    • Some conditions unique to certain conditions
      • Wheelchair athletes – pressure sores, urinary infections, carpal tunnel syndrome