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University Of Michigan Sports Medicine

SUMMER IS ALMOST HERE and, with the weather becoming balmy across the country, many people, young and old alike, are flocking to softball, baseball, and soccer fields to pursue one of their chief passions--sports. Unfortunately for many of these recreational athletes, they will also succumb to sports-related injuries, one of the least-recognized public health problems in America today. This year alone, an estimated 12,000,000 student-athletes, aged five-22, will sustain a sports or recreational injury. In addition, they will lose more than 20,000,000 school days, and billions of dollars will be spent needlessly on health care.

The general public, as well as medical professionals, have various misconceptions about the magnitude of sports injuries. Most individuals in the lay public and the medical community believe they are bumps and braises which do not have long-term ramifications and cannot be prevented. The bad news is that the majority of sports injuries can be severe and can carry significant long-term ramifications from pain, disability, and cost standpoints. The good news is that nearly 80% are avoidable. The answer falls under the umbrella of prevention--the biggest bang for the buck in all of medicine.

The Institute for Preventative Sports Medicine has completed studies targeting effective and practical solutions to prevent sports-related injuries. These offer educational tips for parents, coaches, and community activists by recommending the use of:

* Breakaway bases to reduce sliding mishaps in softball and baseball, which comprise over 70% of injuries in those sports

* Lighter-weight materials in baseballs to reduce serious injury and possible fatalities in children hit in the chest by balls, as well as utilizing AEDs (automated external defibrillators), along with CPR, to enhance survival if a chest impact occurs

* Padding on soccer goalposts that would reduce the force of impact by more than 60% (Eighteen children over the past 13 years have died due to impact with an unpadded post. Goalposts must be made unsecured so they can tip over, as well as being padded.)

* Beach balls for heading drills in soccer (A recent study shows that nearly 50% of youth players suffer symptoms from concussions due to heading, which could lead to memory deficits.)

* Air system shin guards in soccer that would reduce the force of impact by nearly 80%

* More-effective chest protectors to stop injury and fatality in baseball, hockey, and lacrosse.

For warm-weather sports, the Institute has focused largely on injury prevention in baseball and softball. These rank near the top of sports-related emergency room visits, according to the Consumer Product Safety Commission. Forty-million people participate in organized softball leagues, not including pick-up games. Another 15,000,000, from little T-ballers all the way up to the senior level, play baseball.

More than 70% of softball and baseball injuries result from sliding into a stationary base, a fixed immovable object. Many of these are severe and result in broken bones, torn ligaments, and dislocated joints--with the promise of arthritis in the future. The base deceptively may appear to be a little white pillow, but it is more like an iceberg sunk into a concrete anchor beneath the ground. A person's ankle will break before the base will disengage.

The number of those sliding accidents would drop precipitously with the use of breakaway bases, which move upon excessive impact with a foot or hand. Studies at the University of Michigan and the Institute have found that breakaway bases reduced sliding injuries by 96% compared with stationary ones and led to a 99% reduction in health care costs. The U.S. Center for Disease Control and Prevention extrapolated this data and found that breakaway bases could prevent 1,700,000 injuries per year and save $2,000,000,000 in annual health care costs. While this research encouraged the Bush Administration to install breakaway bases on the White House T-ball field, the vast majority of fields in our country remain equipped with hazardous stationary bases. If breakaway bases are good enough for the First Family, they should be good enough for every family.

In fact, after a Congressional hearing on the subject, the Federal government changed fields at all military installations and Federal prisons over to breakaway bases. Yet, only five percent of U.S. fields have this equipment. So, as of 2003, Charles Manson and other mass murderers are protected, yet 95% of the law-abiding public remains vulnerable to these injuries. In order to make your community safer, you and your neighbors need to demand immediate change.

Another alarming issue is heading in youth soccer, where a player deflects or advances the ball with his or her head. Repetitive heading can lead to concussive symptoms and information processing and memory deficits. Many such injuries occur in practice, when the coach repeatedly bounces a ball off a child's head at least 15 times before moving on to bounce it off the next kid, and punchdrunk youngsters start wobbling around the field. Using a lightweight ball in practice, such as a beach ball, would significantly reduce the risk of head-impact injuries.

A study at the Institute revealed that more than 50% of soccer players had concussive symptoms (headache, blurred and/or double vision, ringing in the ears, or nausea) long after heading drills were completed. In addition, it was determined over a two-year study that, as heading increased, memory ability started to diminish. What about helmets? At this time, there are no independent medical studies that have shown any model currently in production can satisfy the three critera for helmet use while heading: The helmet must have adequate capability to reduce the force of impact; it must "breathe well" so children do not overheat; and it must make the athlete look like Darth Vader and not a nerd.

Parents and coaches must also be aware of injuries in basketball, arguably the most-dangerous sport of all. Close to 600,000 people each year go to the emergency room because of basketball-related injuries. The vast majority of them occur to the ankle. Players competing on a potholed schoolyard surface often suffer ankle injuries, indicative that the safety of playing surfaces is key.

In light of heat stroke tragedies throughout the country, it is imperative that parents become focused on preventing this completely avoidable, often-tragic scenario. During 2002 alone, a high school student in Indiana died of heat exhaustion, as did a college football player at the University of Florida and a professional football player with the Minnesota Vikings. Between 1997 and 2002, 21 student-athletes succumbed to this preventable condition. Some very logical and easily implemented guidelines could completely eliminate fatalities related to heat stroke. Over the past few years, the Sports Injury Advisory Group to the Governor of Michigan has developed a number of recommendations relating to football that easily can be applied to every sport and recreational activity. It is important to be aware that heat stroke also can occur while gardening or, for that matter, walking around Disneyland.

* Acclimatize to heat gradually. Early practices, such as during the first seven-10 days, should be shorter and less intense, as should those on abnormally hot or humid days. In addition, athletes should be encouraged to initiate their own conditioning programs several months prior to the beginning of the season. During the hottest weather, practice sessions should be scheduled in cooler parts of the day.

* Pay attention to the Humidity Index. The temperature and relative humidity should be taken into account in determining the length of practice sessions. It has been suggested that, if the sum of the temperature and relative humidity are greater than or equal to 160, precautions must be taken. If the sum is greater than 180, practice and/or games should be cancelled.

* Take regular breaks. Adjust the activity level and provide frequent rest periods during hot weather. Rest should be accomplished in shaded areas, helmets taken off, and jerseys loosened or removed. Rest periods should consist of 15 minutes each hour of workout and, if the temperature and humidity are over 160, breaks should occur every 30 minutes.

* Water, water, water! Cold water should be available in unlimited quantities to players. Scheduled water breaks should be strictly enforced. A good general rule is two cups of water two hours prior to activity, plus half a water bottle every break, and, for every pound of weight loss, three cups of water after activity.

* Avoid salt tablets. Instead, salt should be replaced through seasoning of food.

* Measure water loss and replenish fluids. Athletes should be weighed before and after each practice to monitor water loss. A good way to monitor and document weight is in a chart in the bathroom by the scale. Weight loss greater than three percent indicates a substantial risk and five percent a significant danger. Remember to drink water before and after practice to replace fluids.

* Wear proper, breathable clothing for strenuous activities. During practice, athletes should wear cool clothing such as shorts and fishnet jerseys. Sweat-saturated T-shirts should be changed often because they retain heat. Helmets should be used sparingly in hot weather.

* Know what goes on at your child's practice. Parental involvement, such as observing practices, can be done on a rotating basis among all the parents of the student-athletes. A monitor for practices, as well as game situations, can help to alleviate the threat and danger of heat illness. If water breaks are not occurring, a parent needs to step forward and make them happen.

* Know your athletes' vulnerabilities. Some are more susceptible to heat illness than others. Identify and observe closely the ones at greatest risk of heat illness, especially those that are poorly conditioned, overweight, and/ or have an acute physical illness (such as cystic fibrosis or diabetes) or mental retardation. Student-athletes who have a previous history of heat illness should be watched closely during practices and hot weather.

* Be alert to the problem. It is imperative that all coaches, parents, and players be on the lookout for the signs of fatigue--lethargy, inattention, stupor, and/or awkwardness. The athlete must be removed immediately from participation, cooled down, and placed in a shaded environment. All too often, symptoms are present, but everyone ignores the signs until catastrophe occurs. In addition, supplements should never be taken. Many of them increase the metabolic rate and make the athlete more vulnerable to heat stroke. During spring training in Florida in 2003, a pitcher in the Baltimore Oriole's camp died from heat stroke after taking weight-loss supplements containing ephedra.

With implementation of the above 10 steps, heat-related illness could be eliminated. However, it is mandatory that parents become activists in their student-athletes practices and games to make sure the fatality scenario that has been seen recently in Indiana, Minnesota, and Florida does not occur in their schools.

Over the past 13 years, the Institute has pursued its mission of prevention behind the scenes with its research. It is necessary to empower people on the front lines by providing the information needed to make everyone safer. As to prevention guidelines, the following steps should be taken:

* Conduct a preparticipation physical examination for each of the student-athletes every year. From six to 20% will turn out to need further testing and two percent will be found to be vulnerable to sudden cardiac death.

* Use equipment and apparel independently found to be effective at preventing and reducing the risk of injury.

* Thoroughly evaluate playing fields and facilities to make sure they are well-lit and free of holes, broken glass, and other hazardous debris.

* Make sure the coaches involved in sporting activities are certified and trained to condition athletes to an age-appropriate level.

* Ensure that emergency first aid equipment, including defibrillators, is accessible on each field and in every gymnasium. More than 70 athletes in the past 16 years have died due to impact of a ball or puck to the chest. An AED can shock a heart back into rhythm and save a life.

* Make sure practices and game situations include appropriate warm-up and cool-down periods.

We find it surprising that the sporting goods industry, insurance companies, and government agencies have been lax in informing the public about the critical need for injury prevention in sports, and their collective silence has elevated sports injuries to epidemic levels. Moreover, some in the sports industry have misinformed the public on equipment and its potential benefits or lack thereof. The end result is continued preventable pain, suffering, disability, and increased health care costs. The Institute has exposed this misinformation campaign with scientific studies. A good example is how its multiyear, multiphase series of studies revealed that softer, heavier baseballs, which were touted by manufacturers as the solution to chest-impact injuries, were not the answer, and in some instances created the potential for greater problems. On the other hand, lighter-weight baseballs were only a partial solution to the problem. Other components of reducing the chest impact fatality scenario included teaching kids how to avoid a pitch and not walk into the baseball, and use an AED if an impact occurs and a player's heart stops.

It is of paramount importance that parents, grandparents, coaches, and community activists maintain persistent pressure on organized sports groups, schools, city leagues, and college and pro sports teams to consider and promote improved equipment, safer techniques, and preventive measures. It is obvious that, without such leadership by the public, the necessary changes will not be instituted and sports injuries will continue to drain our already overburdened health care system.

As the old saying goes, "An ounce of prevention is worth a pound of cure." In many cases, it can mean saving a life.

David H. Janda is an orthopedic surgeon in Ypsilanti, Mich.; director of The Institute for Preventative Sports Medicine; and the author of The Awakening of a Surgeon: One Doctor's Journey to Fight the System and Empower Your Community.

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