The Statistics of Staying Safe in Youth and High School Sports
I enjoyed reading a recent article in the Chronicle written by former San Francisco 49er General Manager Carmen Policy, regarding his decision on whether to let his grandson in Napa play Pop Warner football. Mr. Policy carefully researched the sports statistics available, weighed his love for football with the concern for his grandson’s safety, and finally decided to let the boy play.
There is considerable information in the current media regarding the safety of high school sports, most of it centering upon concussions and football. However, much of this information needs to be placed in the proper perspective, as many other sports produce similar injuries, and college injuries are of a higher occurrence rate than high school injuries for a given sport.
My first reference is a study called “National High School Sports Related Injury Surveillance Study, 2012–2013” by R. Dawn Comstock, Phd (and others) of the Colorado School of Public Health. This study reveals that overall, head injuries comprise roughly 25% of high school sports injuries, while knee and ankle injuries make up around 15% each. While football has the highest overall incidence of injury at 3.87 occurrences per 1000 exposures, boy’s wrestling is not far behind at 2.33 while girl’s soccer is third at 2.29, boys and girl’s basketball and boy’s soccer are at around 1.5, while girl’s softball and boy’s baseball are at 1.15 and 0.88 respectively, and girl’s volleyball is at 0.89. Presumably, the sports not listed (like track, cross country and swimming for instance) are much lower in injury occurrence, but then some of the sports not listed (like lacrosse, water polo, girl’s field hockey) are known to be relatively high in sports injury in other studies, and perhaps not listed here because they have a relatively small national participation.
Of note in the study is that the percentage of knee and head injuries is higher for girls in an equivalent sport (ie girl’s soccer produces 34% head injuries while boy’s produces 30%, girl’s soccer produced 38% thigh/knee/ankle injuries while boy’s soccer produced 34% of these injuries). This disparity is thought to be due to anatomical differences between boys and girls, and perhaps differences in the way the two games are played (ie the amount of “headers” employed and the ways that players hit the turf). Another study that compares high school sports injuries to college sports injuries is entitled “Concussions Among United States High School and Collegiate Athletes” by Luke Gessel et al. In this study, there is clear evidence that collegiate sports produce 1.5–4 times the number of injuries per 1000 exposures (average just under 2x), which makes sense as collegiate athletes tend to be larger and move faster than high school athletes.
All of this said, there is a category of sports injuries called “catastrophic sports injuries” that lies below the radar of these studies (which tend to call attention to concussions, knee and ankle injuries). One of these would be in the cardiovascular category, in which the participant is disabled or dies primarily due various heart defects (50% of which are classified are Hypertrophic Cardiomyopathy, in a 2003 study called “Risk of Competitive Sport in Young Athletes with Heart Disease”). Heart defects represent a small but significant number of sports injuries, and can perhaps be prevented with tests prior to engaging in sports. Other small statistical but catastrophic sports injury occurrences would be head trauma affecting little league players getting hit by a batted ball (as the diamond is smaller and aluminum bats are now allowed), spinal chord trauma affecting athletes (typically in contact sports), and anorexia nervosa affecting female long distance runners.
What really needs to be said after considering the above, and what is less statistically known but known by common sense is that the biggest risk is staying home and doing nothing, second only to sitting around eating bad food and watching television, and cruising around in your car looking to do drugs and cause trouble. Somehow we all know that these present a terrible risk, and that sports for high school aged kids tends to create healthy, enthusiastic kids benefitting from sunlight, fresh air, endorphins, and hormonal balance if not better diets and increased interest in school & a tendency to not complain about everything. I’m sure that the esteemed Mr. Policy took this into account, as he perhaps considered that most of the 1981 49ers Super Bowl Champ injuries were perhaps offset by their opportunities to test their abilities to the fullest and become heroes.
In conclusion, the following ten items would seem to be prudent ways to minimize the risks of youth sports:
1) Have baseline concussion testing prior to engaging in sports (the local high schools now do this)
2) Have an EKG or echocardiogram prior to engaging in sports
3) In little league, have pitcher’s wear protective headgear and replace aluminum bats with wooden bats
4) In the studies above, “practice injuries” were typically 10–20% of “game injuries”. Local football teams now conduct “non-contact practices” where players use pads to prevent full contact. The number of practice injuries should ideally go down to about 5% of game injuries using best practices.
5) Utilize grass fields instead of artificial turf fields. Artificial turf is implicated in a certain number of head and other injuries. Grass is typically more forgiving for impact.
6) Ban “headers” in high school and youth boys and girls soccer
7) Consider rule changes in football that may include linemen standing up prior to the snap or less distance between kicker and kick returner (lowering high speed impacts).
8) Enjoy youth and high school sports, but be very careful about engaging in collegiate sports and beyond, unless you are in certifiably great shape, know the risks and have something to gain (ie scholarship or career). Avoid becoming a college lineman “meat” (ie healthy weight 210, gets pumped up to 280 like a fattened steer, risks a lifetime of bad health or injury with no scholarship or pro career in return).
9) Monitor health and diet if you are a long distance runner, and stop running if your BMI goes below 17.
10) Disallow dangerous throws in wrestling. Increase penalties for “dirty” wrestling programs.
