INJURY PREVENTION: WHAT EVERY COACH SHOULD KNOW

There have been countless studies demonstrating the physical, emotional, and psychological benefits of sports, which are an important part of a healthy lifestyle at any age - whether you're involved in youth football, coaching basketball, or doing football coaching or youth rugby drills, you've witnessed the positive impact sports can make in anyone's life. However, in order to reap the full benefits, athletes, parents, coaches, and other fitness professionals must work to minimize the risk of injury inherent to athletics.

WHAT IS THE RISK?

In general, the risk of injury is greater during a competitive athletic event than a practice or scrimmage. Half of all injuries are related to the legs, such as ankle sprains, anterior cruciate ligament (ACL) injuries, and nonspecific knee pain. Comparatively, 20 percent of injuries are related to the arms and upper extremities, the most common of which are shoulder injuries. Head and neck injuries account for another 10 percent, most commonly concussion. Spinal cord injuries make up the smallest percentage. Other injuries include heat illness and skin infections. Lastly, certain medical conditions can put an athlete at greater risk for injury, such as a heart condition.

Let's focus on some basic steps that athletes, parents, and coaches can take to ensure a positive, injury-free sports experience.

BASIC WAYS TO PREVENT SPORTS INJURIES

CONSULT A PHYSICIAN

A thorough medical history and physical by a doctor should be sought prior to any involvement in sports and/or physical fitness routine. A physician can screen for any underlying medical conditions an athlete might have that could lead to potential injury. A physician may also be able to recommend specific strength or conditioning exercises that may help to lower the risk of injury or to compensate for a specific weakness that might predispose an athlete to injury.

PERIODIZATION

Physical injury, such as broken bones, sprains, or strains, account for approximately 70 percent of all medical issues related to athletic participation. Although there are lots of ways you can help prevent injury, the most important method is staying within one's physical limits. Periodization, the process of consistently and slowly increasing training load and volume with periodic recovery days or weeks, is the best way to produce long-term, sustainable fitness gains while avoiding injury and burnout. Often, participating at too high of a level, too quickly, will result in injury.

WAYS TO PREVENT SOME SPECIFIC SPORTS INJURIES

ANTERIOR CRUCIATE LIGAMENT (ACL) AND POSTERIOR CRUCIATE LIGAMENT (PCL) INJURY

The ACL and PCL are the two major ligaments in the knee that work together to provide stability in the joint. They cross each other and form an "X," which allows the knee to flex and extend without side-to-side movement. Injuries to these ligaments are typically sprains; however, partial tears and complete tears are also common. The PCL can be injured by a direct impact from the outside of the knee joint, which might occur, for instance, during a game of football or rugby. ACL injuries, including partial or complete tears, tend to happen when an athlete changes direction rapidly, twists without moving the feet, slows down abruptly, or misses a landing from a jump.

Recently, there has been a significant increase in the number of ACL injuries in female athletes, particularly among football players. Studies show that a female football player's risk of an ACL injury is 2-8 times that of a man's. Adding neuromuscular and proprioceptive exercises to the training regimen can reduce the number of ACL injuries by 2-4 times.

Preventing injury to the ACL and PCL has been the topic of much research; as a result, several protocols have been established to help reduce the risk of injury, all of which include:

• Avoiding vulnerable positions
• Increasing flexibility
• Increasing strength
• Including plyometric exercises in training
• Increasing proprioception (awareness of the position of the joint/body)

HEAT STROKE

Heat illness results from the body's inability to dissipate heat. Heat illness may happen at any time during athletic participation, because the body produces 15-20 times more heat during exercise than at rest; however, heat illness most often occurs in combination with hot and humid weather. Heat stress is a result of numerous factors, most notably the air temperature and humidity. Heat illness occurs on a spectrum, with heat stroke being the most severe condition. During pre-season activities when the weather may be hot and humid and athletes are less conditioned and accustomed to physical activities in such conditions (acclimatized), athletes are at greater risk for heat illness.

There are several steps that athletes and coaches can take to help reduce the risk of heat illness:

• Allow athletes to acclimatize to weather conditions (this may take 5-10 days depending on athletes' ages, fitness levels, and equipment)
• Optimize hydration strategies before, during, and after athletic activity
• Design and engage athletes in a slow and progressive fitness regime that allows for ample recovery
• Wear loose fitting, light-colored, breathable clothing
• Minimize equipment on days with excessive heat and humidity
• Modify or cancel athletic activity based on weather conditions

CONCUSSION

Concussions are most common in contact sports; however, they can occur in many different athletic settings. There is a great deal of research surrounding concussions and the short- and long-term consequences of them. There may be lasting neurocognitive problems that persist long after signs and symptoms of a concussion have disappeared. If a concussion occurs, an athlete should get evaluated by a physician. The evaluation should include a full exam, history of previous concussions, and a discussion about the symptoms and severity of the current concussion. Every concussion increases the risk of having another concussion in the future, and an athlete should not return to the playing field after experiencing a concussion until cleared by a medical professional. Cognitive testing may be warranted in some cases. Education of athletes, coaches, parents, and other fitness professionals about the importance of reporting concussion symptoms is a very important piece of prevention. Athletes and coaches also should be educated about what can lead to head injury (e.g., spearing, head-to-head contact, and leading with the head).

Signs and symptoms of a concussion can occur immediately - or later on. Early symptoms include headache, dizziness, confusion, ringing in the ears, nausea and/or vomiting, and vision changes. Delayed symptoms may be experienced hours to days later, and can include memory disturbances, poor concentration, irritability, sleep disturbances, personality changes, and general fatigue.

Athletes with a suspected concussion should not continue sports participation until they're evaluated by a physician. Helmets decrease the risk of skull fracture and severe head injury; however, they may increase the risk of concussion because of the way the head impacts the padding inside the helmet. Improper use or fit of a helmet may further increase the concussion risk. This research is still controversial, though, and the clear benefits of wearing a helmet far outweigh any potential concussion risk.

Lastly, there has been some investigation into whether or not wearing a mouth-guard may prevent a concussion, but right now, there is inconclusive evidence. Mouth guards should certainly be worn to prevent dental and jaw injuries.

There is much regarding concussion that is as yet unknown or unclear, and research is ongoing. However, due to the prevalence of concussion in sports, it is important to be aware of the many factors involved; to teach tackling and contact procedures to help avoid or minimize the risk of head injury; and to be able to recognize a potential concussion to prevent further injury.

INJURY PREVENTION TIPS

• Participate in a conditioning program to build muscle strength and endurance gradually, over time
• Be sure to follow an appropriate warm-up and cool-down regimen, including flexibility exercises
• Keep a first aid kit handy, and learn how to treat minor cuts, bruises, and strains
• Have an emergency plan in place for major injuries while playing and practicing for any sport. Injury can be minimized with immediate medical help
• Dress in the most appropriate clothing and safety gear to prevent common injuries. Make sure uniforms and protective equipment fits properly, and wear all protective gear correctly at all times
• Stay hydrated
• Eat a well-balanced diet
• Use proper technique and follow the rules of your sport, as well as the rules of the facility in which you are practicing/playing
• Encourage immediate reporting of injuries
• Check your sporting equipment prior to participation for damage and proper function, and clear away any debris from your playing area