Recommendations for a National Pro-Active Sports Injury Prevention Program

Because prevention solutions to the sports injury problem are scattered among numerous federal agencies -- including the Department of Health and Human Services, the Centers for Disease Control and Prevention, the National Center for Injury Prevention and Control, the Consumer Product Safety Commission and others -- a sports injury prevention task force should be established to implement a pro-active campaign concerning health, safety and injury prevention in sports with national responsibility for the reduction in number and severity of injuries in sports at all levels.

The sports injury prevention task force will require the superior knowledge of a sharply focused supportive constituency that is dedicated and skilled in pursuing the interests of sports injury prevention, implementing the needed programs, and dispersing the news, information and recommendations that will turn knowledge into action. As the attainable levels of sports health, safety and injury prevention rise, so do the moral imperatives to use them. Following are summarized recommendations for some of what a national pro-active sports injury prevention program should incorporate. For the most part, these principles are common sense steps that would improve public health if given priority and implemented by the federal government.

The sports injury prevention program must:

1) Work to ensure the use of proven protective equipment. Used specifically to prevent injury, protective equipment can include items worn by players, safer versions of objects used or propelled by players as well as safety provisions on or around the field of play. For the full benefits of safety and injury protection, the program should implement an evaluation system, based on independent scientific research, for federal safety standards, certification and recommendations for sports equipment as effective protection against injury.

For example, many eye care professionals see sports as an area ready for change. According to the American Academy of Ophthalmology, eye injuries are the leading cause of blindness in children. David Hunter, M.D., assistant professor of pediatric ophthalmology and strabismus at the Johns Hopkins University School of Medicine, says: “Anyone who works in ophthalmology sees cases of sports-related eye injuries. It’s frustrating because they’re almost all preventable.” Using baseball as an example to push the need for reasonable and realistic eye protection in sports, Dr. Hunter argues:

"Little League is one place we’d really like to see a change. There are some great helmets available with face shields, but peer pressure keeps them from being used. If shields were required, by law or by the league, peer pressure would no longer be an issue. An interesting footnote to this problem is that when kids wear face shields, their batting improves. This may be because they’re no longer scared that the ball is going to hit them."

2) Ensure a safe sports environment. This should include assessing the safety of outdoor and indoor facilities, playing surfaces, playing equipment and weather conditions. In addition, a qualified person properly trained in Cardiopulmonary Resuscitation (CPR) should be available to administer first aid at games and practices with quality first aid equipment, including a portable defibrillator. A qualified individual should provide supervision for youth sports participants at all times. Ensuring a safe environment, before play begins, will reduce the potential for injury and the severity of injury and allow for better play and more enjoyment. A system of monitoring and reporting environmental hazards, with written policies to deal with cancellation and postponement issues is crucial to making this step effective.

A system of federal safety standards, certification and recommendations, like that suggested for protective equipment (see recommendation 1), should also be implemented to ensure the safety of all artificial playing surface products, such as artificial turf, that are intended for use in place of natural grass or dirt playing surfaces. New artificial turf surfaces are being installed for recreational fields all across the country with the only claims of safety coming from the manufacturers. These should be tested for all types of potential injury and wear prior to installation. Absent certification by the federal government that artificial turf surfaces are at least as safe as natural surfaces in all potential injury categories, and do not sacrifice safety in one area for another, they should not be installed.

3) Disseminate information widely and comprehensively. Sports are played by different age groups and skill levels everywhere in the United States and participants are therefore at a certain degree of injury risk everywhere in the country. Athletes, physicians, athletic administrators, coaches, parents, educators and communities must be provided with, and have constant access to, the best and most current information available for their respective roles in empowering themselves and each other to prevent sports injuries.

4) Stress that injuries are not an inevitable part of sports participation. It would be imperative that the program dispel the myth ingrained within sports culture from elite professional sports to recreational youth sports that “injuries are part of the game.” Seemingly a daunting task, the program would have the benefit of calling on the talents of a vast array of experts who have studied injury prevention in sports, as well as the many communities which have already benefitted from such research, implementing proven techniques and using proven equipment while making injury prevention a top priority in their sports programs.

One such expert, Dr. David Janda, notes in The Awakening of a Surgeon: “The number one fallacy is that injuries are inherent: that they are going to happen no matter what you do. The vast majority of injuries are completely preventable.”

5) Design a system of recording, reporting and monitoring injuries. This important step is essential to gathering and analyzing information on injuries so we can learn about how and why they happen, uncover patterns, and develop ways to prevent them from happening again. Such a system should include deciding which injuries will be recorded, what information will be collected, and how the information will be collected and reported.

6) Focus on stemming the epidemic of overuse injuries. Our sports culture often pushes children to over-achieve and play through pain while specializing in, and training year-round for, one sport at an early age. These factors are dangerously conducive to overuse injuries.

As reported by Bill Pennington in the February 22, 2005 edition of The New York Times, “Dr. Lyle Micheli, a pioneer in the field of treating youth sports injuries and director of the sports medicine division of Boston Children’s Hospital, said that 25 years ago, only 10 percent of the patients he treated came to him for injuries caused by overuse. . . . overuse injuries now represented 70 percent of the cases he sees.” Dr. Micheli said, “By playing one sport year-round, there is no rest and recovery for the overused parts of their body. Parents think they are maximizing their child’s chances by concentrating on one sport.”

7) Develop a system of community, coaching, parenting and administrative sports health, safety and injury prevention clinics. Nothing is better than bringing the prevention message straight to the people who it would benefit. Nation-wide hands-on clinics with information and demonstrations of programs and techniques, including the highlighting of best practices around the country, would be an important aspect for the implementation of a federal program for sports injury prevention. Supplementing instruction in the best practices for injury prevention should be advocacy in “positive coaching” principles to replace those of “win-at-all-cost” coaching that dominate youth and school sports today.

Jim Thompson, founder of the Positive Coaching Alliance (PCA) and author of The Double-Goal Coach: Positive Coaching Tools for Honoring the Game and Developing Winners in Sports and Life, has developed a certification program that exposes coaches “to the most up-to-date, research-based strategies, tools and techniques in sports psychology and positive coaching.” PCA has established a goal of certifying one million coaches over the next decade through the National Double-Goal Coach Certification Program.

8) Ensure accountability to communities for safe sports. Prevention checklists for communities should be made available and promoted for all concerned to evaluate various community sports programs for safety and to make improvements where needed. For example, Dr. David Janda outlines in The Awakening of a Surgeon a 20-point injury prevention checklist for parents and community leaders that, if implemented and followed, could prevent the majority of sports injuries.

9) Stress the importance of screening (or physicals). A major part of sports injury prevention comes before a playing season even begins. Every player, at every skill level and age group should be screened to check the player’s health, lifestyle and physical condition. Previous injuries must be assessed to ensure players can safely return to play, and injuries during the season should prompt a re-screening before returning to play.

Unfortunately screening is often an overlooked and underestimated part of sports participation and injury prevention. But effective screening: clearly identifies players at risk of injury; pinpoints factors that may make players prone to injury; analyzes variables that may be affecting performance; appraises the effectiveness of a rehabilitation program; measures overall fitness; and most importantly, reduces the potential for injury.

10) Emphasize participation over winning. The pressure of a sports environment that has a “win-at-all-costs” attitude jeopardizes health and safety and increases the potential for injury. One of the biggest problems is with sports participants rushing back, or being pressured to rush back, too soon following an injury and increasing their risk for re-injury or improper healing. Putting the health and safety of players at risk just to win should have no place in sports. For players, sports should be about safe participation and enjoyment, never winning at all costs. Another serious result of the overemphasis on winning is the growing problem of steroids and other performance-enhancing substances in sports (see recommendation 16). Co-authors Chuck Yesalis and Virginia Cowart argue in their book The Steroids Game:

"The fact is that the appetite for steroids and other performance-enhancing drugs has been created predominantly by a social fixation on winning and physical appearance. This behavior is learned. Children play games for fun, at least as long as they can before adults intervene to tell them that winning is what’s important. . . . Competitiveness and a fierce desire to win are qualities that have made this nation great. But before we allow our children to compete, we must first establish in them a moral and ethical foundation so they have boundaries they will not cross in pursuit of victory."

11) Establish the necessity of physical conditioning, warming-up, cooling-down and stretching. Being in adequate condition for a sport allows players more participation, better performance and greater enjoyment. Conditioning for balance, flexibility, speed, strength, endurance and power that is specific to each player and sport or physical activity is fundamental to reducing the risk of injury.

Some of the most important and easy things to do to prevent injuries in sports, warming-up, cooling-down and stretching prepares the muscles, joints, heart and mind for physical activity and helps them to recover afterward. These procedures improve flexibility, and mental and physical performance.

12) Press for the enforcement of rules and the exercise of good sportsmanship. More important than winning to most people, is the ability to participate in sports and enjoy the games. Players must display good sportsmanship, know the rules of the game and be willing to abide by them at all times to ensure an injury-free environment. If these principles of fair play are broken, sports can become reckless and dangerous, increasing the potential for injury. As Bruce Svare comments in Reforming Sports Before the Clock Runs Out:

"Our young people see and hear what happens at the higher levels of sports and come to believe that it is okay for athletes to abuse the values of the game and engage in unethical and illegal behavior. Some athletes develop a sense of entitlement because they have been pampered by a society that treats them differently than normal citizens. This is a cocktail for disaster and it is surprising that our outlaw sports culture is not worse than it is. Clearly, something must be done to return our athletes, coaches, parents and fans to a more sane sports landscape; one in which ethics, sportsmanship and fair play become the focus instead of an afterthought."

13) Urge proper technique and practice. Safety is key to preventing injuries and if technique is poor, player safety can be compromised, opening the door to injury risks no matter the sport. Without any physical contact with other players, poor technique used for an extended period of time can cause persistent injuries, aches and pains. And poor technique where other players are involved can lead to more severe injury.

The risky elements of each sport must be identified so technique can receive special focus. In addition, it's important for players to learn proper technique early to avoid habitual poor technique that can put themselves and others at risk of injury. After correct techniques are learned, they must be continually practiced and used during games or matches and reevaluated by coaches.

14) Stress the critical role of adequate hydration and proper nutrition. Maintaining a suitable fuel supply through nutrition and hydration allows players to maintain sports performance, recover more efficiently after or during physical activity, and promotes good overall health. Dehydration and poor nutrition can have detrimental effects on health, safety and injury prevention in sports due to fatigue, decreased concentration and endurance, delayed recovery, and poorly developed muscles and bones. Regarding hydration, Shari Young Kuchenbecker, Ph.D. writes in her book Raising Winners: A Parent’s Guide to Helping Kids Succeed On and Off the Playing Field:

"As simple as it is, drinking enough water before, during, and after games and practices provides a crucial mechanism for preventing injuries. Research shows that adequate hydration prevents muscle cramps during games, reduces muscle soreness after games, improves play, and even positively affects the number of points scored. A water-deprived athlete is more likely to make poor decisions, make errors, and be more vulnerable to injuries. The better-hydrated athlete does better, feels better, and suffers fewer problems."

15) Emphasize good injury management. When injury does occur, injured players shouldn't suffer unnecessary additional pain or delayed recovery. And they should never return to play before the injury is healed and the player's sport-specific skills are restored. The better the management of injuries, the less time players will experience discomfort, and the sooner they will be able to safely return to their sports. As Shari Young Kuchenbecker comments in Raising Winners:

"The family paying too little attention to a child’s feelings may ignore his or her injuries. . . . It is not uncommon for parents with emotional blinders to wait three or four weeks before having a child’s painful injury examined -- despite obvious signs their child is suffering. Damaged, uncared-for tissues during childhood and young adulthood produce chronic trouble and pain at older ages as well as emotional damage from their being ignored."

16) Work to eliminate performance-enhancing drugs and supplements from sports. From professional, collegiate and Olympic athletes taking performance-enhancers and trying to beat testing systems, to the teenaged athletes in middle school and high school sports putting their health at risk to gain an edge, the misuse of drugs and supplements to enhance sports performance is a growing concern in this country. Along with carrying the risk of serious health problems and the risk of injury (deaths and serious illnesses are occurring with increasing frequency), the use of performance-enhancing drugs and supplements is contrary to everything sports stand for. Their use breaks the code of fair play as well as the laws of sports and society.

The issues of cheating and illegal steroids aside, the use of legal performance-enhancers is a serious health issue that can no longer be taken lightly. These substances are advertised in sports, health and fitness magazines, and promoted by players, trainers, coaches and even some parents. But the boom for performance-enhancers began with passage of the Dietary Supplement Health & Education Act of 1994 (DSHEA).

Unlike drug products that must be proven by the FDA to be safe and effective for their intended use before marketing, DSHEA frees any product that calls itself a dietary supplement (like ephedra, which caused at least 150 deaths and tens of thousands of health problems before it was banned in 2004) from federal regulation before they reach the consumer and does not require manufacturers and distributors to record, investigate or forward to the FDA any reports they receive of injuries or illnesses that may be related to the use of their products. DSHEA must either be repealed, or amended to allow the FDA to perform its regulatory duties prior to supplements reaching consumers.


If our public health agencies were to use these simple principles to implement a national sports injury prevention program, people who now ignore the issue of injury prevention, including politicians, government officials and the business community, will move toward reaching the level of awareness that can prevent sports injuries. They would come to realize that identifying problems before they occur has many positive ramifications for the public welfare.


League of Fans is a sports reform project founded by Ralph Nader to increase awareness of the relationships between sports and society, identify and offer citizen action solutions to a broad range of issues in sports at all levels, and encourage the cooperative capacities that make the sports community capable of helping, rather than dominating, our society and culture.


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