Beruflich Dokumente
Kultur Dokumente
University of Massachusetts Primary Care Sports Medicine Fellowship, Fitchburg, Massachusetts; and
University of New Mexico School of Medicine, Department of Pediatrics, Albuquerque, New Mexico
VEIGEL, J.D. and M.D. PLEACHER. Injury prevention in youth sports. Curr. Sports Med. Rep., Vol. 7, No. 6, pp. 348Y352,
2008. Sport is the principal cause of injury in children and adolescents. Youth participation in organized athletics is estimated to be
45 million in the United States alone. These injuries influence health and fitness and have socioeconomic impact. Many injuries can be
prevented. This article outlines the efficacy of current injury prevention strategies in youth sports through the use of educational programs,
rule changes in baseball and hockey, safety equipment, and conditioning programs.
INTRODUCTION
1537-890X/0706/348Y352
Current Sports Medicine Reports
Copyright * 2008 by the American College of Sports Medicine
348
Copyright @ 2008 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Number 6
November/December 2008
SAFETY EQUIPMENT
A variety of safety devices have been designed for athletes
in nearly every sport. Many recent studies have evaluated
the efficacy of safety devices in preventing injury. Unfortunately, despite the availability of existing safety devices,
some athletes choose not to use the equipment. There is an
evolving body of literature looking at the effectiveness of
promotional campaigns to increase the use of safety devices.
Helmets and Headgear
Helmet use is mandatory in certain sports, but remains
optional for many other sports despite significant risk for
head injury. Headgear use has increased in soccer, as players
are more aware of the potential for traumatic brain injury.
A recent study evaluated the effectiveness of three brands
of soccer headgear at reducing forces transmitted to the
head as the result of heading or direct head-to-head contact.
None of the equipment tested showed any attenuation in
mechanical forces due to heading, but there was a 33%
reduction in acceleration forces from head-to-head impact
when the headgear was used (16). Further study is warranted
in soccer to evaluate the effectiveness of headgear at
preventing injury.
Alpine skiing and snowboarding are popular winter
activities that carry a significant risk for head injury.
TABLE. USA baseball pitch count recommendations.
Pitches
per Game
Pitches
per Week
Pitches
per Season
Pitches
per Year
9Y10
50
75
1000
2000
11Y12
75
100
1000
3000
13Y14
75
125
1000
3000
Age (Yr)
Copyright @ 2008 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
349
Helmets are mandatory equipment for Federation Internationale de Ski (FIS) ski events, but helmet use is optional
for the recreational skier or boarder. A recent case-control
study of recreational skiers and snowboarders revealed a
60% reduction in risk for head injury among skiers using
helmets compared with a control group (17). Efforts have
been made to increase helmet use among skiers and
snowboarders through promotional campaigns. A multifaceted helmet promotion campaign entitled It Aint Brain
Surgery has been evaluated in Colorado. This program used
numerous media outlets to promote helmet use. Another
component of the program involved a helmet loaner
program. Stores offering free loaner helmets with ski rental
packages noted a 10-fold increase in helmet acceptance and
use. This multi-faceted campaign resulted in an obvious
increase in helmet use, although data on injury prevention
have yet to follow (18).
Eye Protection
In 2004, the AAP Committee on Sports Medicine and
Fitness published a policy statement promoting the use of
protective eyewear for athletes. Specific manufacturing
standards exist for protective eyewear, and protective
goggles and glasses meeting these standards were recommended by the committee for specific sports. It was further
recommended that functionally one-eyed athletes should
wear eye protection for all sports. Functionally one-eyed
athletes were recommended to avoid boxing, martial arts,
and wrestling due to the significant risk of eye injury in
these sports (19).
Squash is a particularly high-risk sport for eye injury because
of its rapidly moving, small hard projectile and the close
quarters of the competitors wielding long hard rackets. A multifaceted eyewear promotion strategy similar to the previously
mentioned helmet campaign has been evaluated. Promotional
and educational materials about eye injury and eye protection
were provided at squash venues. Appropriate protective
eyewear was available for players to try or purchase. Compared
with controls, those players exposed to the promotional
program had a 2.4 times increased odds for wearing appropriate eyewear (20). This study, as does the helmet study,
shows the potential for increased use of safety equipment
when multi-faceted promotional campaigns are undertaken.
Faceguards, Safety Balls, and Chest Protectors
Baseball has a high rate of injury as the result of being
struck by the ball. Numerous safety devices are used in
youth baseball to reduce the risk of injury. Many youth
baseball organizations support the use of faceguards, safety
balls, and chest protectors.
In 2001, USA Baseball recommended that youth baseball
organizations use reduced-impact safety balls in leagues with
young players. This recommendation was made based on the
high incidence of injuries related to being struck with the
baseball (21). In a recent 3-yr study of Little League
Baseball, the injury rate was reduced by 23% when safety
balls were used. The use of faceguards reduced the risk
of facial injury by 35% (22). Safety balls and faceguards
appear to be effective injury prevention strategies when
implemented in youth baseball.
350 Current Sports Medicine Reports
CONDITIONING PROGRAMS
Traditional warm-up and cool-down stretching exercises
have been a standard routine in competitive and recreational sports. The utility of these exercises has been
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extensively studied, but findings are inconclusive. A systematic review suggests there is not sufficient evidence to
support or discontinue routine stretching before or after
exercise to prevent injury (29). Although there is little
evidence for injury prevention, nearly all coaches surveyed
believe that warm-up stretching routines do, in fact, prevent
injury (30).
Several recent injury prevention studies have focused on
preseason and in-season neuromuscular training, proprioceptive training, and sport-specific skill interventions. Many
of these studies have shown beneficial effect with regards to
injury prevention.
Neuromuscular Interventions
Neuromuscular training programs have been a mainstay
in physical therapy for treatment of injuries. There is
evidence that neuromuscular training programs also may be
effective in injury prevention, especially with regards to
female anterior cruciate ligament (ACL) injuries. A
prospective cohort study found that a structured warm-up
including strengthening, stretching, plyometrics, and soccer
specific skill sets was more effective in reducing ACL
injury in adolescent female soccer players than traditional
warm-up stretching exercises (31). Another study showed
that it is possible to prevent ACL injuries with a neuromuscular program in female handball athletes (32). A metaanalysis of six studies relating to ACL injury prevention in
female athletes concluded that neuromuscular training
programs may reduce the risk of ACL injury (33). This
study recommends training programs that also emphasize
performance enhancement as a means to motivate compliance in athletes.
It is unknown whether any one training program is
superior to other training regimens for preventing ACL
injuries. One study compared a basic resistance training
program with a plyometric training program in high
school female athletes. Both regimens induced favorable
mechanics, but outcome data regarding injuries were not
reported (34).
Myrick performed a small study of one basketball team
using performance enhancement and an injury prevention
training program with positive results (35). However, this
study was limited by small sample size and lack of a control
group. The results suggest that programs incorporating
performance enhancement to motivate athlete compliance
may produce lower injury rates, but further study is
warranted.
Proprioception
Proprioceptive balance training, like neuromuscular
training, is used frequently for treatment of sports-related
injuries and has been studied as an element in injury
prevention. Emery et al. studied the effectiveness of a homebased wobble board program. Initial studies were promising
in reducing sports-related injuries among healthy adolescents (36). In a follow-up wobble board study, no statistically significant results were observed, but self-reported
compliance was low. However, a potentially clinically
relevant trend in favor of reducing lower extremity injuries
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Number 6
November/December 2008
CONCLUSION
Based upon the recent available data, there are numerous
strategies that can be implemented in youth sports to
effectively prevent injuries. Enhancing the safety of
athletes may lead to greater enjoyment of and longer
participation in sports. Given the recent pediatric obesity
epidemic, it stands to reason that medical professionals
should promote safe and enjoyable physical activities for
our youth. Strong evidence exists that supports the
implementation of altered rules, use of safety equipment,
and participation in specific conditioning programs.
Enforcement of rules designed to protect athletes should
be uniform. Education of parents and coaches must
continue regarding evolving injury prevention methods.
Sports medicine providers who care for young athletes are
in a unique position to stay abreast of new literature on
injury prevention and to educate athletes, parents, and
coaches of new ways to protect our young athletes.
References
1. Goldberg, A.S., L. Moroz, A. Smith, and T. Ganley. Injury surveillance
in young athletes: a clinicians guide to sports injury literature. Sports
Med. 37:265Y278, 2007.
2. Abernethy, L., and C. Bleakley. Strategies to prevent injury in
adolescent sport: a systematic review. Br. J. Sports Med. 41:627Y638,
2007.
Injury Prevention in Youth Sports
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Copyright @ 2008 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.