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As parents, we have all watched our children who participate in sports with a bit of fear and worry about injuries. And for parents of athletes who have already injured themselves, there's always a niggling concern that it might happen again. Researchers at the Center for Injury Research and Policy at the Ohio State University have made this area of interest a top priority.

They took data collected on high school sports injuries for a three-year period of time (2005-2008) and analyzed it looking for patterns that might help guide prevention strategies. With more and more students participating in organized sports, injury prevention and especially preventing repeat or recurring injuries is important.

Just to give you an idea of how common sports participation is -- there are over seven million high school students involved in athletics each year in the United States. And two million injuries each year as well. About one in 10 of those injuries is really a repeat or recurrent injury.

And as you might imagine, the second injury is usually worse than the first. For example, if a muscle or tendon was partially torn the first time, it ruptures fully the next. A second (or even third) concussion can lead to more severe symptoms and can even result in death. Recurrent concussions resulting in a life-threatening condition are called second-impact syndrome. Disability or death from second-impact syndrome is certainly a good reason to find ways to prevent sports injuries.

There's always the question of which sport has the most injuries. And in the case of this study, which sport is linked with the most recurrent injuries. The authors looked at nine sports from this perspective. They used information reported to the National High School Sports-Related Injury Surveillance System to gather their information. This is an on-line database into which 100 high schools selected randomly deposited (recorded) information about their athletes' injuries. Participants from football, soccer, volleyball, basketball, wrestling, baseball, and softball were included.

Everyone who participated was trained to define injuries and recurrent injuries in the same way. This helped make sure the information collected was consistent from school to school and athlete to athlete. For recurrent injuries, there had to be a repeat injury of the same area on the body. The first injury occurred in either the last school year or the current academic year. Details of the injury were reported along with information on the athlete such as their age, height, weight, and sport played. After analyzing all the data, here's what they found:

• New injuries were much more common than recurrent ones.
• Recurrent injuries occurred more often during competition than in practice. Football had the highest rate of competition-based recurrent
  injuries. Volleyball had the lowest rate of competition-based recurrent injuries. Volleyball players were more likely to injure themselves during practice.

• Basketball was the sport with the top number of recurrent injuries for boys and girls.
• Boys reinjured themselves more often than girls.
• In sports played by both sexes (volleyball, soccer, basketball, softball, baseball), girls had more recurrent injuries playing soccer.
• Girls participating in soccer, softball, and basketball had the highest rate of recurrent concussions.

When doing a study like this, it's natural to want to know what parts of the body get injured, what type of injuries occur, and if the injuries are more likely to occur with one sport over another. The authors provide many tables and bar graphs to help show us the answers to these questions. It looks like ankle injuries tops the list for injury type for most sports (boys and girls). Wrestling and baseball were slightly different with more shoulder injuries.

Partial tendon tears, partial muscle sprains, damage to knee cartilage, and shoulder subluxations (partial dislocation) were the injuries most likely to recur with greater severity requiring more aggressive treatment (e.g., surgery). Even for athletes who are dedicated and disciplined, some of the severe recurrent injuries put them out of the game permanently. Finding ways to prevent injury recurrence could help some of these young people continue participating in a sport they love.

What can be done to reduce the rate of injuries and especially reinjuries? The authors cite studies that support the use of protective equipment in adolescent athletes. Balance and strength training to protect muscles and joints are essential for all sports. Athletes who have suffered one concussion may want to think about discontinuing participation in that sport and maybe trying something else with a lower concussion-injury risk.

More research is needed to fully define what needs to be done to prevent injuries and put a stop to recurrent injuries. The role of surgery for first time injuries needs to be explored more fully. It's possible that surgery to repair/restore damaged soft tissues that are partially torn could save athletes from second injuries that result in complete tears. Shoulder injuries seem especially prone to reinjury. Shoulder braces are being redesigned with this in mind.

This is just the start of a tidal wave of research and effort to identify ways to prevent primary (first) and recurrent (second, third or more) injuries among athletes of all ages and involved in all sports. Research is needed that is evidence-based to find interventions that work to protect our children who are involved in sports at any level.

Reference: David M. Swenson, et al. Patterns of Recurrent Injuries Among US High School Athletes, 2005-2008. In The American Journal of Sports Medicine. August 2009. Vol. 37. No. 8. Pp. 1586-1594.