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SPORTS MEDICINE :
SPORTS: INJURIES:
These Are the Most Common Sports Injuries
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These Are the Most Common Sports Injuries
Business Insider
Science
http://www.businessinsider.com/most-common-sports-injuries-2016-11
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That's one of the main takeaways from a newly released CDC study that
documents sports- and recreation-related injuries. Every year, there are
about 8.6 million of these injuries requiring medical attention in the US.
About half are treated at doctor's offices or clinics instead of emergency
rooms or hospitals.
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More than a quarter of those injuries, 27.9%, are caused by falls. Other
common injury causes include overexertion, "being struck by or against a
person or object," and injuries sustained in transportation related to
sports or recreation. These are each responsible for somewhere between 12%
and 17% of sports injuries.
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The most common actual injuries are strains or sprains (41%), broken bones
(20%), and bruises or superficial injuries (19%). Brain injuries like
concussions represent only about 4.5% of the total.
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National Health Statistics Reports
Number 99 November 18, 2016
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Sports- and Recreation-related Injury Episodes in the
United States, 2011-2014
by Yahtyng Sheu, Ph.D., Li-Hui Chen, Ph.D., and Holly Hedegaard, M.D.,
Office of Analysis and Epidemiology
https://www.cdc.gov/nchs/data/nhsr/nhsr099.pdf
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Abstract
Objective
Much of the research on sports- and recreation-related injuries
focuses on a specific population, activity, or type of injury, and
national estimates
of the total burden of sports- and recreation-related injuries are
limited. This study
provides national estimates of the injury burden and examines the
distribution of
sports- and recreation-related injuries across demographic groups,
activities, and injury
circumstances.
Methods
Information on medically attended injury episodes for persons aged 5 years
and over were obtained from the 20112014 National Health Interview Survey.
Sports- and recreation-related injuries are categorized by the associated
activity using a classification scheme based on the International
Classification of External Causes of Injury.
Results
An average annual estimate of 8.6 million sports- and recreation-related
injury episodes was reported, with an age-adjusted rate of 34.1 per 1,000
population. Males (61.3%) and persons aged 524 years (64.9%) accounted for
more than one-half of injury episodes. Injury rates were higher among
males, children aged 514 years, and non-Hispanic white persons than for
their counterparts. One-half of the sports- and recreation-related injury
episodes (50.0%) resulted in treatment at a doctors office or other health
clinic without an emergency department visit or hospitalization. Overall,
general exercise was the most frequently mentioned activity associated
with sports- and recreation-related injuries, but types of activities
varied across sex and age groups. Body regions injured while engaging in
sports and recreation activities included the lower extremity (42.0%),
upper extremity (30.3%), and head and neck (16.4%). ConclusionAs the
nation continues to recognize the importance of physical activity to
maintain health, more research efforts are needed to examine sport and
recreation injury across various activities, demographic groups, and
health care settings, especially settings other than emergency departments
and hospitals.
Keywords: exercise nonfatal injury National Health Interview Survey
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Introduction
Clinicians and public health advocates frequently promote physical
activity to maintain health and reduce the risk of obesity. Recent
estimates show that 213 million Americans aged 6 years and over took part
in sports and fitness activities in 2015, up from 209 million in 2014 (1).
As more people engage in sports and recreation activities, injuries
resulting from these activities pose an increasingly important public
health concern (25).
Many epidemiological studies of sports- and recreation-related injuries
focus on specific populations, activities, and outcomes. For example,
multiple studies have looked at sports injuries among pediatric patients
and athletes in organized sports (6). Football, soccer, and basketball are
among the most frequently studied sports, and knee injuries, ankle
sprains, and concussions are common outcomes in studies identifying risk
factors for sports-related injuries (6). A limited number of studies
provide national estimates on sports- and recreation-related injuries
among all populations. These studies generally focus on emergency
department (ED) visits using data from the National Center for Health
Statistics (NCHS) National Hospital Ambulatory Medical Care Survey
(NHAMCS) (5,79), or the Consumer Product Safety Commissions National
Electronic Injury Surveillance SystemAll Injury Program (2,1012). Using
NHAMCS data, researchers have provided several national estimates of
sports- and recreation-related injury visits to the ED. For example,
during 1997 1998, an estimated 3.7 million visits were made annually, and
among them, 2.6 million involved persons aged 524 years (7). Sports and
recreation activities were also the most frequently reported cause of
injury-related ED visits among pediatric patients, representing
approximately 1 in 5 injury-related ED visits among patients aged 19 and
under (8,9). One study using data from 1999 2008 showed that sports
accounted for 14% of all ED visits for life-threatening injuries, with a
higher proportion seen for children aged 18 and under (32%) than for
adults aged 19 and over (9%) (5). Because they tend to include more severe
injuries, studies using ED data may underestimate the overall burden of
injury from sports and recreation activities. For a more comprehensive
look, researchers have used NCHS National Health Interview Survey (NHIS)
to obtain estimates on all medically attended injuries, not just those
resulting in an ED visit or hospitalization. A study using NHIS data from
19971999 estimated that 7 million Americans received medical attention for
sportsand recreation-related injuries each year, and found that men,
persons aged 524 years, and white persons reported higher rates than their
counterparts (13). With increased participation in sports and recreation
activities in recent years, updated estimates of the burden of sports- and
recreation-related injuries in the United States are needed. In this
study, the overall sex- and age-specific estimated numbers, percentages,
and rates of medically attended sports- and recreation-related injuries
are described across various demographic groups, sport activities, and
injury circumstances using NHIS data from 20112014.
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Results
Overall estimates
From 2011 through 2014, Americans aged 5 years and over sustained an
average 8.6 million sports- and recreation-related injury episodes per
year, or 34.1 episodes per 1,000 persons (Table 1). Sixty-five percent of
these injury episodes involved persons aged 524 years, with the highest
rate observed among children aged 514 years (76.6 per 1,000 persons).
Males accounted for 61% of the sports- and recreation-related injury
episodes, with a rate of 41.2 per 1,000 persons. In both sexes, the
highest rate was seen for children aged 514, with rates of 86.0 episodes
per 1,000 persons for boys and 66.8 episodes per 1,000 persons for girls.
Among racial and ethnic groups, non-Hispanic white persons had the highest
age-adjusted sports- and recreation-related injury rate (42.5 per 1,000
persons).
Among place of injury occurrence, approximately one-third of the sportsand
recreation-related injury episodes occurred at a sport facility, athletic
field, or playground, representing about 2.9 million episodes annually.
One-half of the sports- and recreation-related injury episodes (or 4.3
million annually) resulted in treatment at a doctors office or other
health clinic without an ED visit or hospitalization, and more than
onethird (36.6% or 3.2 million) resulted in an ED visit without further
hospitalization. Approximately 230,000 sports- and recreation-related
injury episodes (2.7%) resulted in hospitalization. Activity-specific
estimates, by sex
Table 2 shows the estimated annual number, percentage, and rate of
sportsand recreation-related injury episodes by type of activity. General
exercise was the most frequently mentioned activity in injury episodes for
all persons (16.3%) and for females (18.6%). For males, the most
frequently mentioned activities were general exercise (14.9%), football
(12.4%), and basketball (12.2%) (estimates were not significantly
different), followed by pedal cycling (7.1%) and recreational sports
(6.5%). General exercise was further categorized into Aerobics, exercising
or weighttraining, Running or jogging, and School related (non-specific)
activity such as recess or a physical education class without a specific
sport mentioned. For all persons and for males, injury episodes resulting
from aerobics, exercising, or weight training were more common than
episodes resulting from running or jogging or nonspecific school-related
activities. For females, the proportion of injuries that involved
aerobics, exercising, or weight training (8.2%) was similar to the
proportion involving running or jogging (7.2%). Activity-specific
estimates, by age group
The sports and recreation activity at the time of injury also differed by
age group. Table 3 shows the top five activities among age groups 514
years, 1524, and 25 and over. General exercise was frequently mentioned in
all three age groups, accounting for 13.1%, 14.3%, and 21.9% of the injury
episodes for age groups 514 years, 1524, and 25 and over, respectively.
While gymnastics/ cheerleading and football were frequently identified in
the age groups 514 and 1524, basketball was most common in age groups 1524
and 25 and over.
Pedal cycling was among the top five activities for age groups 514 years
and 25 and over, but not for teenagers and younger adults aged 1524.
Injuries from playground activity were frequently seen for age group 514
years, and injuries from recreational sports and water-related activities
were frequently seen for those aged 25 and over.
Estimates of injury by external cause, nature of injury, and body part
injured More than one-quarter of sports- and recreation-related injury
episodes (27.9%) resulted from falls. Other causes such as overexertion,
being struck by or against a person or object, or transportation each
accounted for 12%17% of the injury episodes (Table 4). The majority of the
injury diagnoses involved strains and sprains (41.4%), fractures (20.0%),
and superficial injuries and contusions (19.0%). Sports-related TBI, which
has received increasing public and research attention, accounted for 4.5%
of the total injury diagnoses. The parts of the body most frequently
injured while engaging in sports and recreation activities were lower
extremity (42.0%), upper extremity (30.3%), and head and neck (16.4%).
Discussion
Research efforts to understand the patterns, risk factors, and physiology
of sport injuries provide insights that can help inform prevention and
treatment approaches. While many studies have focused on specific sport
activities, particularly organized sports, the patterns of injury
associated with individual sports, especially those engaged in by
nonathletes, have not been welldescribed. The narratives from NHIS injury
data not only provide an in-depth understanding of the circumstances
surrounding the injury event, but also enable researchers to better
estimate the burden of sports- and recreation-related injuries for both
organized and individual activities. In addition, the inclusion of all
medically attended injury episodes in NHIS provides estimates on injury
episodes beyond traditional ED visits and hospitalizations.
This study presents updated estimates on nonfatal medically attended
sports- and recreation-related injuries across various demographic groups,
activities, and injury circumstances in the United States. From 2011
through 2014, an estimated 8.6 million sportsand recreation-related injury
episodes occurred annually, with a rate of 34.1 episodes per 1,000 persons
for persons aged 5 years and over. Although the 20112014 estimate was
greater than that reported in 19971999 (6.8 million episodes, 27.2 per
1,000 persons) (13), suggestion of an increase in the sportsand
recreation-related injuries in the past 15 years should be considered with
caution. Differences in survey design, duration of reference (recall)
period, and classification of certain sport and recreation activities may
hinder direct comparison. However, this studys findings of higher
proportions and rates of sports- and recreation-related injuries for
males, non-Hispanic white persons, and persons aged 24 and under were
consistent with the earlier NHIS study (13).
Although differences in methodology limit the direct comparison of
estimates between 19971999 and 20112014, distribution of the injury
episodes by activity provides insight into the patterns of these injuries
in recent years. In 20112014, general exercise (16.3% of sports- and
recreation-related injury episodes), basketball (9.9%), and football
(8.3%) were among common activities resulting in sports- and
recreation-related injury. In contrast, during 19971999, the most common
activities identified were basketball (14.4%), pedal cycling (9.6%), and
recreational sports (9.5%).
Results from this study also indicate that the activities at the time of
sportsand recreation-related injuries differ by sex and age group. In
contrast to males, none of the three most frequently mentioned activities
for females included team sports. While injuries related to general
exercise, playground equipment, and gymnastics were more common for
children aged 514, injuries from organized sports such as basketball,
soccer, and football were frequently seen among those aged 1524. For
adults aged 25 and over incurring injuries, individual activities such as
general exercise, recreational sports, pedal cycling, and water sports
were more common.
The differences in the distribution of activities among sports- and
recreationrelated injury episodes by sex and age group may be partially
explained by the level of participation in these sports. According to the
Sport and Fitness Industry Association (19), from 2009 through 2012, the
U.S. population aged 6 years and over showed a trend in higher
participation rates in exercise and fitness activities, particularly in
aerobic activities (including use of stationary exercise machines),
running and jogging, strengthtraining activities, and gymnastics than in
organized sports. Among organized sports, more Americans participated in
basketball than any other team sports, while participation rates from 2009
through 2012 decreased for baseball and football (19). In addition,
according to a 2015 telephone poll developed by Harvard Opinion Research
Program (20) and the 20032010 American Time Use Survey (21), males are
more likely to participate in sports and exercise than females. Compared
with males, females also had a lower participation rate in team sports but
a higher participation rate in aerobics, yoga, and dancing (21).
In terms of the cause or mechanism of injury, this study found that falls,
overexertion, and being struck by or against an object or a person
accounted for more than one-half of the injury episodes (60.1%), with
falls being the most common cause. This finding was similar to that
reported in a study using NHIS data, which identified the most common
mechanisms involved in recreational injury (22). In the body regions
injured and the type of anatomical injury that occurred, the upper and
lower extremities were the most common body regions associated with sports
and recreation injuries. Similar to other studies, the most common injury
diagnoses were sprains and strains, fractures, superficial injuries,
contusions, and open wounds (7,9,13).
National Health Statistics Reports ? Number 99 ? November 18, 2016 Page 5
One-half of the sports- and recreation-related injury episodes were
presented to a doctors office or other health clinic without a further ED
visit or hospitalization (4.3 million episodes). This supports earlier
observations from the Netherlands that one-half of all sports- and
recreation-related injuries were seen by general practitioners (23). The
current study estimates that 2.2 million sports- and recreation-related
injury episodes among children aged 519 years were presented to a doctors
office annually, which is similar to estimates from a study using National
Ambulatory Medical Care Survey data from 19971998 (2.7 million injury
visits to a primary care office) (24). Although sports- and
recreation-related injuries presenting to a doctors office are likely to
be less severe than ones presenting to EDs, the findings suggest a need
for more injury research in alternative non-ED and nonhospitalization
settings.
Several study limitations should be noted. NHIS injury data may be subject
to recall bias due to the retrospective reporting method and use of proxy.
Although NHIS interviews are conducted year-round and weights are used for
annualized estimates, the 5-week recall period used in this study may
still introduce seasonal effects. In addition, the narratives for
approximately 10% of the sports- and recreation-related injury episodes
lacked essential details for categorizing the sport activity involved.
It is unknown how the appropriate categorization of these episodes would
affect the overall distribution across the sport activity categories.
Compared with episodes that mention specific sports and recreation
activities, episodes that could not be categorized had a similar
demographic distribution but were less likely to occur at school or on a
river, lake, stream, or ocean, or to result from transportation-related
events (data not shown).
Finally, the lack of data on participation rates for different sports and
recreation activities prevents evaluation of the risk of injury for
individual sports. The findings from this study provide updated
information on the demographics, types of activity, and injury diagnoses
associated with sports- and recreation-related injuries.
These findings can be used to develop recommendations for prevention
strategies and further research. Results from this study also suggest that
a substantial proportion of sports- and recreation-related injuries are
treated in health care facilities other than a hospital or ED. As the
nation continues to recognize the importance of physical activity, more
research efforts are needed to address the complexity of these injuries
across various activities, demographic groups, and medical settings.
References
1. Physical Activity Council. 2016 participation report: The Physical
Activity Councils annual study tracking sports, fitness, and recreation
participation in the US. 2016.
2. CDC. Nonfatal traumatic brain injuries related to sports and recreation
activities among persons aged = 19 yearsUnited States, 20012009. MMWR
60(39):1337 42. 2011.
3. Marshall SW, Gilchrist J, Taneja G, Liller KD. Sports and recreational
injuries. In: Liller KD, editor. Injury prevention for children and
adolescents: Research, practice and advocacy. 2nd ed. Washington DC:
American Public Health Association. 2012.
4. Merkel DL. Youth sport: Positive and negative impact on young athletes.
Open Access J Sports Med 4:15160. 2013.
5. Meehan WP 3rd, Mannix R. A substantial proportion of life-threatening
injuries are sport-related. Pediatr Emerg Care 29(5):6247. 2013.
6. McGuine T. Sports injuries in high school athletes: A review of
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7. Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann
Emerg Med 37(3):3018. 2001.
8. Simon TD, Bublitz C, Hambidge SJ. External causes of pediatric
injury-related emergency department visits in the United States. Acad
Emerg Med 11(10):10428. 2004.
9. Simon TD, Bublitz C, Hambidge SJ. Emergency department visits among
pediatric patients for sports-related injury: Basic epidemiology and
impact of race/ethnicity and insurance status. Pediatr Emerg Care
22(5):30915. 2006.
10. CDC. National estimates of nonfatal injuries treated in hospital
emergency departmentsUnited States, 2000. MMWR 50(17):3406. 2001.
11. Yard EE, Comstock RD. Injuries sustained by pediatric ice hockey,
lacrosse, and field hockey athletes presenting to United States emergency
departments, 1990 2003. J Athl Train 41(4):4419. 2006.
12. CDC. Nonfatal traumatic brain injuries from sports and recreation
activities United States, 20012005. MMWR 56(29):7337. 2007.
13. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury
episodes in the US population, 199799. Inj Prev 9(2):11723. 2003.
14. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the
National Health Interview Survey, 20062015. National Center for Health
Statistics. Vital Health Stat 2(165). 2014.
15. Barell V, Aharonson-Daniel L, Fingerhut LA, Mackenzie EJ, Ziv A, Boyko
V, et al. An introduction to the Barell body region by nature of injury
diagnosis matrix. Inj Prev 8(2):916. 2002.
16. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the
United States: Emergency department visits, hospitalizations and deaths
20022006. Atlanta, GA: Centers for Disease Control and Prevention,
National Center for Injury Prevention and Control. 2010.
17. Warner M, Schenker N, Heinen MA, Fingerhut LA. The effects of recall
on reporting injury and poisoning episodes in the National Health
Interview Survey. Inj Prev 11(5):2827. 2005.
18. ICECI Coordination and Maintenance Group. International classification
of external causes of injuries (ICECI), version 1.2: A related
classification in the World Health Organization family of internal
classifications. Consumer Safety Institute, Amsterdam, Netherlands, and
AIHW National Injury Surveillance Unit, Adelaide, Australia. 2004.
Available from: http://www.rivm.nl/who-fic/ICECI/ ICECI_1-2_2004July.pdf.
19. Sports and Fitness Industry Association. 2013 sports, fitness and
leisure activities topline participation report. 2013.
20. National Public Radio, Robert Wood Johnson Foundation, Harvard T.H.
Chan School of Public Health. Sports and health in America. 2015.
21. Deaner RO, Geary DC, Puts DA, Ham SA, Kruger J, Fles E, et al. A sex
difference in the predisposition for physical competition: Males play
sports much more than females even in the contemporary U.S. PLoS One
7(11):e49168. 2012. Page 6 National Health Statistics Reports ? Number 99
? November 18, 2016
22. Ni H, Barnes P, Hardy AM. Recreational injury and its relation to
socioeconomic status among school aged children in the US. Inj Prev
8(1):605. 2002.
23. Baarveld F, Visser CA, Kollen BJ, Backx FJ. Sports-related injuries in
primary health care. Fam Pract 28(1):2933. 2011.
24. Hambidge SJ, Davidson AJ, Gonzales R, Steiner JF. Epidemiology of
pediatric injury-related primary care office visits in the United States.
Pediatrics 109(4):559 65. 2002.
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The complete article may be read at the URL above.
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David Dillard
Temple University
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