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Kin 188 Epidemiology Of Athletic Injuries


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Kin 188 Epidemiology Of Athletic Injuries

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