Population considerations

  • Increased risk. The risk of injury in many sports is high (Fuller, 2007). Falls from lifts, throw jumps and rapid, intricate footwork at high speeds cause acute injury in pairs skating and ice dancing (Dubravcic-Simunjak, 2003).  Facial injuries from falls often occur in ice hockey, lacrosse and field hockey players (Yard, 2006). Falls from heights are one of the most common causes of injury in cheerleading (Schulz, 2004). The thumb is commonly injured during skiing as a result of a fall on the outstretched hand (Kocher, 2000). Most traumatic dental injuries are unintentional injuries most commonly caused by falls, collisions or being struck by an object (Glendor, 2009). Wrist fractures typically occur in active, energetic adolescents and young adults, most often as a result of a direct blow, such as a fall on an outstretched hand (Rizzo, 2006). Traumatic injuries to the elbow such as fracture and dislocation are not uncommon in the athlete and may result from a fall onto the outstretched arm (Rettig, 2002). Falls are the most common cause of injury in skiing and snowboarding (Kocher, 1998).
  • Inexperience.  Amateur jockeys have more falls than their professional counter parts, presumably because professional jockeys are more skilled at riding and have access to better horses (Balendra, 2007).  Most injured snowboarders are either of beginner or intermediate level (Matsumoto, 2004).  First-time or beginner snowboarders are more likely to be injured as a result of a simple fall than are intermediates or experts (Matsumoto, 2004).  The most common events leading to an injury in snowboarding are falling and jumping (Matsumoto, 2004). Most injured snowboarders never received professional instruction (Matsumoto, 2004).  A snowboarder’s feet are attached firmly to the board, they cannot widen their stance; therefore, the full impact of a fall is usually absorbed by the upper extremities (Matsumoto, 2004). 
  • Lack of concern. There appears to be a general perception amongst the public that injuries are an inevitable and acceptable consequence of sport and exercise; for this reason, little attempt is made to investigate and determine the specific causes of injuries in sport (Fuller, 2007). 
  • Lack of protective equipment. Most injured snowboarders did not use protective equipment (Matsumoto, 2004). 
  • Insufficient conditioning. Athletes considered more at risk of injury may have suffered a previous injury or have reduced flexibility (Fuller, 2007).

  Strategies to address these considerations

  • Proper conditioning. Balance training is under study to improve mobility and prevent falls and injury (Harvard, 2007).  Strong hip, knee and ankle muscles provide for a solid foundation and help athletes stay upright (Harvard, 2007). Appropriate training regimens may reduce the risk of falls and the severity of fall-related injuries (Suominen, 2006). A lower risk of injury in athletes may be the result of an effective conditioning program, protective equipment or taping (Fuller, 2007). Skiing and snowboarding require flexibility, cardiopulmonary fitness, strength and finely controlled neuromuscular coordination. Shoulder and rotator cuff strengthening may allow for protective muscular splinting or resistance to muscle-tendon injuries. Agility and flexibility training may also decrease the chance of joint injury. In older skiers, overall conditioning may play an important role in increased bone density and resistance to fractures (Kocher, 1998).
  • Increase use of protective equipment. Head injuries and facial lacerations sustained during polo are largely preventable by using helmets with face protection devices (Costa-Paz, 1999). Wrist protectors have been reported as effective in protecting snowboarders against wrist injury (Matsumoto, 2004). Helmet fit and adjustment are crucial if the helmet is to function well (McIntosh, 2003). Studies in the sports medicine literature strongly suggest that ankle bracing can reduce the incidence of ankle injuries (Jones, 1999). A brace to limit shoulder abduction and external rotation in skiers with anterior instability has been designed, but remains impractical given the range of motion demands and style-conscious nature of skiing. Wrist guards are becoming common in snowboarding and have been incorporated in some snowboard glove designs. Whether these reduce the number of wrist fractures or transmit forces proximally resulting in forearm, elbow or shoulder injuries remains to be seen (Kocher, 1998).
  • Increase awareness. It is up to informed healthcare providers to educate polo players about the benefits of helmet and face protection (Costa-Paz, 1999). Snowboarders seem to be at risk during loading/unloading of chair-lifts and riding tow-lifts. Instruction in loading and changes in lift design to be more user-friendly to sideways-facing snowboarders may be of benefit (Kocher, 1998). The risk of injury in many sports is high, therefore, the governing bodies, teams and individuals involved with these sports have a responsibility to control and reduce the risks where possible (Fuller, 2007). Coaches can only optimize their team’s performance on the basis of the players they have available for selection, therefore injury risks should be managed effectively in order to minimize the number of injured players.  The consequences of some situations are self-evident; for example the more players train and compete, the more likely they are to be injured.  Some training practices and aggressive playing behaviors are more likely to increase the risk of injury, while the use of effective personal protective equipment is likely to reduce the risk of injury (Fuller, 2007). This information can be used to identify potential risk reduction strategies for the benefit of all athletes (Fuller, 2007).

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