743570

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CPJXXX10.1177/0009922817743570Clinical PediatricsOlympia et al

Article
Clinical Pediatrics

Injuries Depicted in Sport-Related Films 2018, Vol. 57(9) 1033­–1040

© The Author(s) 2017
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DOI: 10.1177/0009922817743570
https://doi.org/10.1177/0009922817743570
journals.sagepub.com/home/cpj

Robert P. Olympia, MD1, Hannah Wakefield, MD, MPH2,

Bryan Wakefield, PhD3, and Christopher J. Weber, MD4

Abstract
The perception that children and adolescents have of injuries may be influenced by their depiction in sport-related
films. The objective of this study was to determine the depiction of injuries in a select number of sport-related
films. Forty-four films were analyzed. Injury category, on-the-field management, and long-term management were
determined for each injury. Major injuries were defined as injuries requiring prompt intervention and immediate
discontinuation of sport participation. A total of 49 injuries were depicted, categorized as fracture (n = 11),
contusion (n = 10), brain concussion (n = 8), muscle cramps (n = 5), laceration/abrasion (n = 4), ligamentous knee
injury (n = 4), shoulder dislocation (n = 2), rotator cuff injury (n = 2), ankle sprain (n = 2), and unspecified injury (n
= 1). Of the 38 (78%) injuries considered major, immediate return to the game was the disposition for 13 injuries
(34%). Pediatric health care providers, coaching staff, and parents should stress the importance of injury recognition/
disclosure and realistic expectations for rehabilitation to pediatric athletes.

Keywords
sports, film, injury, rehabilitation

Introduction Several recently published studies have examined the

Sport participation is an important part of the develop-
ment, both physically and mentally, of children and ado-
lescents in the United States. According to the 2017
Physical Activity Council Report, for children born after
the year 2000, 47.6% participated in individual sports
and 56.7% participated in team sports.1 Based on data
from the National Federation of State High School
Association, sports participation by high school students
reached an all-time high of 7 807 047 participants during
the 2014-2015 academic school year.2
Unfortunately, injuries may occur because of this
participation. Approximately 3 million injuries occur
annually in children and adolescents in the United
States involved in sports, with 770 000 requiring physi-
cian visits and 45 000 to 90 000 requiring hospitaliza-
tion.3 According to the National Center for Catastrophic
Sport Injury Research, between July 2014 and June
2015, 92 catastrophic injuries/illnesses (either resulting
in permanent severe functional disability or no perma-
nent functional disability but considered a severe
injury) occurred among high school and college orga-
nized sport participants.4 Sport-related injuries account
for 2.5 million emergency department visits annually,
most often related to basketball and football injuries,
leading to fractures and dislocations, sprains and strains,
open wounds, and contusions.5-7
effect of media exposure, such as films, on behaviors
and choices made by children and adolescents. Reported
benefits to media exposure include acquisition of new
ideas and knowledge, increased opportunities for social
contact and support, and promotion of healthy behav-
iors.8 Recent studies have focused on media topics, such
as violence and gun use,9-12 drugs and alcohol use,
smoking, and other risk behaviors,13-15 and reported an
increase in health risk behaviors, such as substance use,
sexual behaviors, self-injury, or disordered eating, as
well as aggression, bullying, antisocial attitudes, and
sleep disturbance.16-25 The perception that children and
adolescents have of injuries, and the management and
disposition associated with these injuries, may be influ-
enced by their depiction in sport-related films.
1
Penn State Hershey Medical Center, Hershey, PA, USA
2
Medical University of South Carolina Children’s Hospital,
Charleston, SC, USA
3
Coastal Carolina University, Myrtle Beach, SC, USA
4
Naval Hospital, Jacksonville, FL, USA
Corresponding Author:
Robert P. Olympia, Department of Emergency Medicine, Penn State
Hershey Medical Center, 500 University Drive, Hershey, PA 17033,
USA.
Email: rolympia@pennstatehealth.psu.edu
1034 Clinical Pediatrics 57(9)
Because of the popularity of sport-related films,
coaches, athletic trainers, and parents/guardians have
utilized these films to both educate and motivate their
pediatric athletes. The objective of this study was to
determine the depiction of injuries in a select number of
sport-related films, focusing on the specific type of
injury, as well as both the on-the-field and the long-term
management of the injury.
Methods
We conducted a content analysis study examining injuries
depicted in a sample of sport-related films as identified by
several popular websites. Films included in the analysis
were categorized to either “Family films” (22 films) or
“Blockbuster films” (22 films). Family films were
included based on the number of times listed and order of
ranking on the following websites accessed on July 1,
2014: “10 sports films for families” (parents.com), “25
great kids sports films” (amazon.com), “10 best kids
sports films” (bleacherreport.com), “Top 10 kids sports
films” (youth1.com), and “Top 20 inspirational sports
films” (beliefnet.com). Blockbuster films were included
based on the number of times listed and order of ranking
on the following websites accessed on July 1, 2014: “Best
100 sports films” (sportinfilm.com), “The 101 greatest
sports films of all time” (bleacherreport.com), “Top 100
sports films” (best-sport-film.com), and “Best sports
films” (amazon.com). Family films included were not lim-
ited by date of release, and blockbuster films were limited
to date of release after the year 2000. We included films
that were rated by the Motion Picture Association of
American film rating system (www.mpaa.org) as either G
(general audience), PG (parental guidance suggested), or
PG-13 (parents strongly cautioned, some material may be
inappropriate for children under 13), and excluded films
rated as either R (restricted—under 17 requires accompa-
nying parent or adult guardian) or NC-17 (adults only—no
one 17 and under admitted). We also excluded nonhuman-
or animal-based sport films, documentaries, and films
focusing on extreme sports or the performing arts.
Each film was independently viewed by 4 reviewers
(RPO, HW, BW, CJW), and injury category, on-the-field
management (defined as initial medical stabilization,
treatment and disposition [out of competition, immedi-
ate return to competition, not addressed]), and long-term
management (defined as medical management after sta-
bilization of the initial injury [transfer to an emergency
department, hospitalization, operative treatment, out for
the season, rehabilitation, permanent disability, death,
not addressed]), were determined. Data were compiled
by the primary investigator, and discrepancies were dis-
cussed among the 4 reviewers.
In the analysis of data, “major injuries” were defined
as injuries requiring prompt intervention and immediate
discontinuation of sport participation, such as brain con-
cussions, musculoskeletal injuries that result in signifi-
cant limitation in range of motion and/or ambulation, or
lacerations/abrasions that result in significant cardiovas-
cular or neurologic compromise.
The institutional review board at the Pennsylvania
State Hershey Medical Center deemed the study exempt.
Results
Tables 1 and 2 describe the films included in the study.
For all included films, the mean year of release was
2001 (standard deviation [SD] = 8.1, 95% confidence
interval [CI] = 1999-2003), and the mean lifetime gross
profit was $55.5 million (SD = 43.3, 95% CI = 42.3-
68.6). Over half (55%) of included films were rated PG,
and the most common sports depicted were baseball
(27%), football (25%), and basketball (14%). For family
films, the mean year of release was 1995 (SD = 7.2
years, 95% CI = 1992-1998), and the mean lifetime
gross profit was $53.9 million (SD = 28.9, 95% CI =
41.1-66.8). For blockbuster films, the mean year of
release was 2005 (SD = 3.4, 95% CI = 2005-2008), and
the mean lifetime gross was $57.0 million (SD = 54.9,
95% CI = 32.7-81.3).
A total of 49 injuries were depicted (19 injuries [39%]
in family films and 30 injuries [61%] in blockbuster
films) in 29 films; 15 films (5 baseball, 4 football, 4 bas-
ketball, 1 soccer, 1 bobsledding) did not depict an injury
(Table 3). Sport injuries were categorized as fracture (n
= 11, 23%), contusion (n = 10, 21%), brain concussion
(n = 8, 16%), muscle cramps (n = 5, 10%), laceration/
abrasion (n = 4, 8%), ligamentous knee injury (n = 4,
8%), shoulder dislocation (n = 2, 4%), rotator cuff injury
(n = 2, 4%), ankle sprain (n = 2, 4%), and unspecified
injury (n = 1, 2%; child hockey player “Carted off the
ice”). The majority of injuries were depicted in films
associated with boxing (n = 11), football (n = 9), and
baseball (n = 9). The most common fractures were spe-
cific to the upper extremities (n = 5). The most common
contusions were to the face (n = 4) and extremities (n =
4). The majority of concussions were related to films
depicting boxing (n = 3) and hockey (n = 2).
Of the 49 injuries depicted, 38 (78%) were consid-
ered major injuries. For major injuries, immediate return
to the game/match was the disposition for 13 injuries
(34%), on-the-field management was not addressed for
3 injuries (1%), and further management was not
addressed for 23 injuries (61%). For all injuries depicted
in our sample of sport films, on-the-field management
was not addressed for 7 injuries (16%).
Olympia et al 1035

Table 1.  Family Film Descriptionsa.

Lifetime Gross
Name Year Released Rating Sport ($ Million)
The Bad News Bears 1976 PG Baseball 32.2
The Karate Kid 1984 PG Karate 90.8
Hoosiers 1986 PG Basketball 28.6
The Mighty Ducks 1992 PG Hockey 50.8
Ladybugs 1992 PG-13 Soccer 14.8
A League of Their Own 1992 PG Baseball 107.5
Rudy 1993 PG Football 22.8
Cool Runnings 1993 PG Bobsledding 68.9
The Sandlot 1993 PG Baseball 32.4
Rookie of the Year 1993 PG Baseball 53.6
Angels in the Outfield 1994 PG Baseball 50.2
Little Giants 1994 PG Football 19.3
The Big Green 1995 PG Soccer 17.7
Space Jam 1996 PG Basketball 90.4
Remember the Titans 2000 PG Football 115.6
Bring it On 2000 PG-13 Cheerleading 68.4
Hard Ball 2001 PG-13 Baseball 40.2
Bend it Like Beckham 2002 PG-13 Soccer 32.5
The Rookie 2002 G Baseball 75.6
Friday Night Lights 2004 PG-13 Football 61.2
Kicking and Screaming 2005 PG Soccer 52.8
The Benchwarmers 2006 PG-13 Baseball 59.8
a
General film information from IMDB.com as of June 1, 2017. Lifetime gross information from boxofficemojo.com as of June 1, 2017.

Table 2.  Blockbuster Film Descriptionsa.

Lifetime Gross
Name Year Released Rating Sport ($ Million)
Love & Basketball 2000 PG-13 Basketball 27.5
Radio 2003 PG Football 52.3
Dodgeball 2004 PG-13 Dodgeball 114.3
Miracle 2004 PG Hockey 64.3
Million Dollar Baby 2004 PG-13 Boxing 100.5
Coach Carter 2005 PG-13 Basketball 67.2
Cinderella Man 2005 PG-13 Boxing 61.6
Rocky Balboa 2006 PG Boxing 70.3
Gridiron Gang 2006 PG-13 Football 38.4
Facing the Giants 2006 PG Football 10.2
Glory Road 2006 PG Basketball 42.6
We Are Marshall 2006 PG Football 43.5
Invincible 2006 PG Football 57.8
Crossover 2006 PG-13 Basketball 7.0
Pride 2007 PG Swimming 7.0
The Express 2008 PG Football 9.8
The Blind Side 2009 PG-13 Football 256.0
Moneyball 2011 PG-13 Baseball 75.6
Warrior 2011 PG-13 Mixed martial arts 13.7
Trouble with the Curve 2012 PG-13 Baseball 35.8
Home Run 2013 PG-13 Baseball 2.9
42 2013 PG-13 Baseball 95.0
a
General film information from IMDB.com as of June 1, 2017. Lifetime gross information from boxofficemojo.com as of June 1, 2017.
1036 Clinical Pediatrics 57(9)

Table 3.  Sport Injuries Depicted in Selected Films.

Injury Long-Term
Category Specific Injury Sport Film Category On-the-Field Management Management

Fracture Wrist Football Family Out of competition Out for the season
Arm Baseball Family Out of competition Cast
Leg Cheerleading Family Out of competition Out for 3 months
Nasal Boxing Blockbuster Reduction in ring, return to To emergency room
competition after competition
Cervical spine Boxing Blockbuster Out of competition Hospitalized,
tracheostomy,
paralysis
Clavicle Football Blockbuster Out of competition NA
Shoulder Mixed martial arts Blockbuster Return to competition NA
Rib Boxing Blockbuster Return to competition NA
Hand Boxing Blockbuster Return to competition NA
Hand Boxing Blockbuster Return to competition NA
Leg Mixed martial arts Blockbuster Out of competition Out of the tournament
Contusion Face Karate Family NA NA
Face Baseball Family Ice to face, return to NA
competition
Hand Baseball Family Return to competition NA
Abdominal Karate Family Taped and return to NA
competition
Buttocks Baseball Family NA NA
Leg Karate Family “Magical healing” NA
Face Dodgeball Blockbuster Return to competition NA
Nose Basketball Blockbuster Return to competition, wearing NA
a catcher’s mask
Trunk Football Blockbuster Ace bandaged, return to NA
competition
Leg Hockey Blockbuster Return to competition, “I can NA
play through pain”
Concussion Hockey Family NA NA
  Soccer Family Return to competition, NA
“shake it off son, get some
circulation back into your
skull”
  Boxing Blockbuster Return to competition NA
  Boxing Blockbuster Out of competition Long-term
rehabilitation
  Boxing Blockbuster Out of competition Hospitalized,
tracheostomy,
paralysis
  Hockey Blockbuster Return to competition NA
  Football Blockbuster Out of competition Out for the season
  Swimming Blockbuster NA NA
Muscle Arm Baseball Family Ice, out of competition NA
cramps Leg Soccer Family NA NA
Leg Swimming Blockbuster Stretch it out, out of NA
competition
Hamstring Football Blockbuster Out of competition NA
Hamstring Football Blockbuster Return to competition NA

(continued)
Olympia et al 1037

Table 3. (continued)
Injury Long-Term
Category Specific Injury Sport Film Category On-the-Field Management Management
Laceration/ Facial abrasion Baseball Family NA NA
abrasion Facial abrasion Basketball Blockbuster Cleaned and dressed, return to NA
competition
Facial laceration Boxing Blockbuster Anticoagulant, return to NA
competition
Leg laceration Baseball Blockbuster Repair with stitches, out of NA
competition
Ligament Knee Football Family Out of competition Out for 1 week
injury Knee Basketball Blockbuster Out of competition NA
Knee Basketball Blockbuster Out of competition Brace and rehabilitation
Knee Hockey Blockbuster Out of competition Out for 1 to 2 weeks
Shoulder Football Family Reduction, return to NA
dislocation competition
  Football Blockbuster Out of competition Return the next game
Rotator cuff Baseball Family Out of competition Tendon fused to
injury humerus resulting in
superhuman pitching
  Baseball Blockbuster Out of competition NA
Ankle sprain Soccer Family NA NA
  Basketball Blockbuster Out of competition Crutches
Undisclosed Hockey Family Out of competition, carted off NA
injury the ice

Abbreviation: NA, not addressed.

Discussion associated with training and “injury” pain is of utmost

Injuries in pediatric athletes can hinder performance and
negatively affect mental health and well-being, leading
to feelings of anger, anxiety, fear, vulnerability, isola-
tion, and low self-worth.26-31 Unfortunately, athletes
may be influenced by the way injuries are portrayed,
both acutely and long-term, in sport-related films.
Although injuries portrayed in our sample of films are
similar to those reported in the literature,5-7 an immedi-
ate return to the game/match was the acute management
depicted for 34% of major injuries. Pediatric athletes,
who may feel that they are immune from injury or be
emotionally attached to their teams and their sport, may
not report their injuries or downplay the severity of their
symptoms to their coaches, athletic trainers, and parents/
guardians as to not disappoint them and their teammates.
Furthermore, overbearing coaches and parents/guard-
ians may pressure pediatric athletes to compete while
injured or to participate against their wills for the benefit
of the team. Discreet injuries, such as fractures/contu-
sions/ligamentous injuries not associated with deformi-
ties and swelling, concussions, and muscle cramps,
often rely on the athlete to convey their symptoms to
their coaching staff. Teaching athletes how to distin-
guish between the “normal” pain and discomfort
importance.32 In addition, pediatric athletes may be
exposed to themes found in sport-related films that may
affect their ability to disclose acute injuries. In a recently
published study, we determined that negative themes,
such as “ignoring injuries/playing while injured,” “win-
ning is more important than having fun,” “your best is
not good enough,” and “peer pressure,” were depicted in
many sport-related films in our sample, while positive
themes, such as “having fun is more important than win-
ning” and “honesty is the best policy,” were portrayed
less often.33 We suggest that coaches, athletic trainers,
and parents/guardians emphasize the importance of dis-
closing symptoms associated with acute injuries and
clearly delineate the on-the-field management and dis-
position as a result of their injury.
The depiction of injuries requiring long-term man-
agement in sport-related films may also influence the
approach injured pediatric athletes have on their reha-
bilitation. In our sample of films, long-term manage-
ment was not addressed for 61% of major injuries.
Attention has recently been given to the development
and implementation of psychological interventions dur-
ing the sport injury rehabilitation process.34-36 Skills
necessary for coping with injury include understanding
the nature of the injury and treatment, comprehending
1038 Clinical Pediatrics 57(9)
realistic rehabilitation goals, building a team to meet the
challenges and demands of rehabilitation, understanding
how to identify and cope with the distress associated
with injury, visualizing the stages of recovery and antici-
pating challenges and uncertainties, facilitating task
focus and distraction control, managing pain effectively,
building confidence and accepting fear during the reha-
bilitation process, controlling personal thoughts, feel-
ings, and actions in the face of adversity, and
remembering the aspirations that drive sport participa-
tion.37 Coaches, athletic trainers, and parents/guardians
should emphasize that injury is a potential complication
of sport participation and that rehabilitation involves a
realistic approach to the return to sport participation.
It is important for pediatric health care providers,
coaching staff, and parents/guardians to be aware of the
content of films and to understand the impact the content
may have on the children and adolescents who view them.
A method to optimize the comprehension of children and
adolescents who view sport-related films involves co-
viewing these films as a team or family, along with active
mediation. Co-viewing with active mediation occurs
when the coaching staff and/or parents/guardians discuss
what it is being watched, either during or following the
film. This method encourages the development of critical
thinking and internally regulated values, and it has been
shown to decrease aggressive behavior, substance use,
and early sexual behavior in adolescents.38 While pediat-
ric health care providers frequently recommend restric-
tion and monitoring of media time,8 the promotion of
co-viewing with active mediation would allow the coach-
ing staff and/or parents/guardians to be involved in devel-
oping a realistic approach that a pediatric athlete has
toward their injury and rehabilitation.
There are several limitations to our study. Because
the films chosen for analysis were based on subjective
lists of “best,” “greatest,” or “top” sport films, usually
derived from the opinion of the article’s author or a con-
gregate of opinions from readers or subscribers of the
website, we may have included films that were dated or
unknown to a larger audience. If we decided to analyze
sports films based on their lifetime gross, we would
have analyzed films that may be more familiar to and
viewed by pediatric audiences, such as the Rocky mov-
ies, Field of Dreams, Chariots of Fire, and The Longest
Yard, and our inclusion of sport injuries may have been
different. Nonetheless, injuries depicted in our sample
of films were similar to those reported previously in the
literature. Furthermore, because we chose only 44 films
for analysis and excluded extreme sports and perfor-
mance art-based sports, we may have neglected films
that, although not the most popular, are based on sports
that many children and adolescents participate in, such
as track and field, cross country, wrestling, tennis, vol-
leyball, lacrosse, and gymnastics. Last, our sample of
films rarely depicted injuries that would be considered
life-threatening or limb-threatening (a boxer sustaining
a cervical spine fracture resulting in paralysis and tra-
cheostomy in Million Dollar Baby, a boxer sustaining a
concussion requiring long-term rehabilitation in
Cinderella Man). However, significant injuries, such as
catastrophic brain or spinal injuries resulting in perma-
nent functional disability, “second impact syndrome,”
blunt chest and abdominal injuries resulting in surgical
intervention, commotio cordis, and extremity injuries
resulting in surgical intervention or functional disability,
occur in pediatric athletes.4,39-42 By excluding sport-
related films rated R or NC-17 we may have omitted
life-threatening or limb-threatening injuries too graphic
or violent for rated G, PG, or PG-13 films that poten-
tially provide pediatric athletes with a realistic view of
sport participation, rehabilitation, and the consequences
of not disclosing symptoms associated with injury.
In conclusion, films play an important role in influ-
encing pediatric psychosocial and behavioral develop-
ment. Unfortunately, pediatric athletes may be influenced
by the way injuries are depicted, both acutely and long-
term, in sport-related films. Pediatric health care provid-
ers should encourage co-viewing with active mediation,
focusing on a realistic approach to the management of
acute injury and rehabilitation, to augment the education
and psychological well-being of children and adoles-
cents who participate in sport and sustain injury.
Author Contributions
RPO, HW, BW, and CJW contributed to conception and design,
contributed to acquisition, analysis, and interpretation of data,
drated the manuscript, critically revised the manuscript for
important intellectual content, gave final approval, and agree to
be accountable for all aspects of the work in ensuring that ques-
tions relating to the accuracy or integrity of any part of the work
are appropriately investigated and resolved.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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