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Preventing Severe Head and Neck Injuries in High School and Collegiate Athletes
Preventing Severe Head and Neck Injuries in High School and Collegiate Athletes
Orthopaedic Research Reveals Benefits of Enhanced Protective Gear, Preventive Strategies, Rule Revis
Research shows collegiate athletes are more
susceptible to catastrophic (or severe) injury than athletes at the high
school level, particularly when it comes to certain sports like football
and cheerleading. However, the physical, mental and social benefits of team
sports significantly outweigh the risks involved: only one out of every
100,000 athletes suffers from a direct catastrophic injury. Trend data on
such injuries are the catalyst for sport-specific recommendations to help
reduce deaths and serious injuries in school-sponsored sports. According to
research published in the November 2005 issue of the Journal of the
American Academy of Orthopaedic Surgeons, the dramatic decrease in brain
injury-related fatalities and quadriplegic events in football over recent
decades may be attributed to identifying how injuries occur, enhanced
injury prevention instruction, improved equipment and protective gear, and
revision of sport regulations. The key is to strike a balance between
proliferating athletes' safety without drastically altering the dynamics of
the sport.
Catastrophic sports injuries that may result in death or permanent
neurologic disability are rare -- but tragic -- events that cause physical
and emotional devastation to injured athletes and their families. Direct
catastrophic injury -- mostly severe head and spinal cord injuries --
results from trauma while participating in the skills of a sport. An
example is a collision in football, the sport associated with the greatest
number of direct catastrophic injuries for all major team sports in the
U.S., according to the National Catastrophic Center for Sports Injury
Research (NCCSIR). As outlined in "Direct Catastrophic Injury in Sports" --
a review by Barry P. Boden, MD, orthopaedic surgeon in Rockville, MD, and
member of the American Academy of Orthopaedic Surgeons (AAOS) -- brain
injury fatalities and quadriplegic (spinal cord injury at the neck level
resulting in no or limited motor function in all four extremities) injuries
in football have declined drastically, thanks to data that support rule and
equipment changes to promote safety in the collision sport.
Head injuries are the most common direct cause of death among football
players: athletes who use their head to make contact dramatically increase
their risk of sustaining serious injury. However, there has been a dramatic
decrease in brain injury-related fatalities since the late 1960s; and
research concluded the improved helmet design and establishment of safety
standards by the National Operating Committee on Standards for Athletic
Equipment (NOCSAE) are largely responsible for this decline.
"While the frequency of brain injury-related fatalities fell after
implementation of the improved football helmet, the more protective helmets
gave athletes a false sense of invincibility," cautioned Dr. Boden. "This
resulted in a rise in quadriplegia, most commonly caused by the mechanisms
of spearing, a tackling method that uses the head (crown of the helmet) to
make the initial impact." Identification of this dangerous tackling
technique led to a ban on spearing (or spear tackling) which has resulted
in a significant decline in quadriplegic events in football: from 34 such
injuries before the ban in 1976, to 3 in 1992.
Concussions or nonfatal head injuries are extremely common in football and
currently receive significant scrutiny and evaluation. Videotape analysis
of football-related concussions revealed that the player being tackled
sustains the majority of injuries. Because the concussed player is often
hit on the side of the face by an opposing player, new football helmets
with better padding around the ear and jaw are currently being tested.
While the reduction in brain injury fatalities and quadriplegia in football
has been significant, further research of the epidemiology and mechanisms
of injury is critical to preventing other types of catastrophic head and
neck injuries according to the author.
Cheerleading -- with approximately two direct catastrophic injuries per
year -- is the number-one sport responsible for female direct catastrophic
injuries, and accounts for more than half the catastrophic injuries in high
school and collegiate female athletes. Over the last two decades,
cheerleading has evolved into a physically demanding sport requiring
complex gymnastic maneuvers that pose serious injury threats to
participants. The most common culprits are the pyramid and the basket toss.
The basket toss is a stunt in which a cheerleader is thrown into the air --
often between 6 and 20 feet -- by three or four tossers. In the pyramid
drill, the cheerleader at the top is most often injured after falling and
landing on a hard surface. Attune to the susceptibility of injury during
pyramid formations, the National Federation of State High School
Associations (NFHS) and the National Collegiate Athletic Association (NCAA)
have set limits on pyramid height -- two levels in high school and 2.5 body
lengths in college -- and specified positions for spotters. Safety measures
have also been instituted for the basket toss: limiting the stunt to four
throwers, banning flips, and positioning one of the throwers behind the top
person during the toss.
The study author also recommends further cheerleading injury prevention,
calling for increased spotter training, limiting the number of cheerleaders
involved in pyramids, mandating the use of floor mats for complex stunts,
restricting the height thrown for basket tosses, prohibiting stunts when
surfaces are wet, and encouraging safety education and certification for
coaches.
Catastrophic injury data has been the catalyst for rule changes to reduce
injuries in other sports, as well. Yet, this research review points out
that there is still room for further study and improvement. Ice hockey
rules prohibit pushing or checking from behind, as these actions may result
in cervical spine trauma if the athlete is pushed into the boards and makes
contact with the top of the head. Because amateur hockey players wearing no
facial protection are injured nearly seven times more frequently than those
wearing full facial protection, full facial protection is recommended. In
baseball there is concern that non-wood (aluminum) bats can be swung faster
than wood bats, resulting in a higher ball exit speed and increased risk of
injury. Therefore, the NCAA and NFHS now require all high school and
college bats to be labeled with a permanent certification mark that the
ball exit speed cannot exceed 97 mph when tested on a standardized batting
device. Another baseball regulation puts limitations on bat thickness and
weight. While these alterations show promise for minimizing the number of
baseball-related ball-to-head impact injuries, further data collection and
analysis is required to determine their true effectiveness. In soccer, the
U.S. Consumer Product Safety Commission (CPSC) cited 21 deaths over a
16-year period, due to movable goalposts. The study author recommends
anchoring movable goals to prevent tipping and never allowing children to
play or swing on goalposts.
"It all comes down to the risk-reward ratio: determining (through data
collection) how frequently a catastrophic injury occurs and whether safety
measures -- such as rule changes or equipment modifications -- can be
implemented without significantly affecting the nature of the sport," Dr.
Boden explained. "It is likely that catastrophic sports injuries may never
be completely eliminated, but with continued research and constant data
analysis we can work to ensure players' safety."
An orthopaedic surgeon is a physician with extensive training in the
diagnosis and nonsurgical as well as surgical treatment of the
musculoskeletal system including bones, joints, ligaments, tendons, and
nerves.
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a
publication of the 28,000-member American Academy of Orthopaedic Surgeons
(www.aaos.org) or
(www.orthoinfo.org), a not-for-profit organization that provides education
programs for orthopaedic surgeons, allied health professionals and the
public. An advocate for improved patient care, the Academy is participating
in the Bone and Joint Decade (www.usbjd.org) the global initiative in the
years 2002-2011 to raise awareness of musculoskeletal health, stimulate
research, and improve people's quality of life. President Bush has declared
the years 2002-2011 National Bone and Joint Decade in support of these
objectives. The Academy's 73rd Annual Meeting is being held March 22-26,
2006, at McCormick Place in Chicago.
Abstracts and full text of the monthly, peer-reviewed JAAOS are available
online at http://www.jaaos.org.
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