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Download Tips To embed this Safety Tip in your site use the following code:<iframe width="100%" height="500" frameborder="0" src="https://www.safekids.org/embed/119"></iframe> Journal Article Jingzhen Yang, Correspondence to Dr. Jingzhen Yang, Department of Community and Behavioral Health, College of Public Health, University of Iowa, 200 Hawkins Drive, E236 GH, Iowa City, IA 52242 (e-mail: ). Search for other works by this author on: Stephen W. Marshall,Search for other works by this author on: J. Michael Bowling,Search for other works by this author on: Carol W. Runyan,Search for other works by this author on: Frederick O. Mueller,Search for other works by this author on: Megan A. LewisSearch for other works by this author on: Accepted: 19 October 2004
Close Navbar Search Filter Microsite Search Term Search AbstractUse of protective equipment is an important sports injury prevention strategy, yet use of protective equipment by high school athletes has seldom been studied. The authors analyzed data from a 3-year (1996–1999), stratified, two-stage cluster sample of athletes from 12 organized sports in 100 North Carolina high schools (n = 19,728 athlete-seasons). Information on each athlete's use of protective equipment and prior injury was collected during the preseason. Prospective information on injuries and weekly participation in games and practices was collected during the playing season. Use of lower extremity discretionary protective equipment tended to decrease the overall rate of lower extremity injury (rate ratio (RR) = 0.91, 95% confidence interval (CI): 0.72, 1.15). However, this slight protective effect was entirely due to kneepad use (for knee injury, RR = 0.44, 95% CI: 0.27, 0.74). Knee brace use and ankle brace use were associated with increased rates of knee injury (RR = 1.61, 95% CI: 1.08, 2.41) and ankle injury (RR = 1.74, 95% CI: 1.11, 2.72), respectively. This could be due to slippage of the brace during use, increased fatigue due to the energy cost of wearing a brace, or bias in the study. Further investigation into the effects of brace use is warranted. Youth sports injury has emerged as a public health problem in the last three decades, with detrimental effects on the health and well-being of young athletes and enormous economic costs to society (1–9). Sports and recreational activities are widely promoted as part of a healthy lifestyle for young people, but the physical and psychological benefits gained from participating in sports may be diminished by injuries (10–14). Approximately two thirds of youth sports injuries occur in organized sports, and such injuries predominantly affect the lower extremities (15–20). Each year, approximately seven million high school students participate in organized sports (21). It is estimated that in an average year, 41–61 percent of football players, 40–46 percent of wrestlers and gymnasts, and 31–37 percent of basketball players sustain an injury while participating in organized high school sports (1, 22). In many sports, particularly sports with full-body contact such as football, protective equipment is an integral component of the game and its use is required by national and state sports associations. In addition, many high school athletes use optional protective equipment that is not mandated by sports rules (though a given coach may require its use by his/her players). This discretionary use of protective equipment was the exposure examined in this study. Although many high school athletes use discretionary protective equipment in an effort to prevent sports injuries, there is continuing debate about whether to recommend the use of certain types of protective equipment and, if so, what would constitute appropriate recommendations (23–28). Most sports injury studies to date have addressed the clinical aspects of injuries rather than prevention strategies (29–31). Very few studies have examined the use of discretionary protective equipment to prevent sports injury. Prior research either has been limited to a specific piece of equipment or has focused on a particular sport (e.g., use of a knee brace in football or a mouth guard in basketball) and often has not distinguished whether the protective equipment studied was mandatory or discretionary (27, 32–34). The populations studied have often involved elite athletes, resulting in findings that may not be applicable to youth populations (35–38). Injury severity has seldom been reported or analyzed (17, 39). The purpose of this study was to determine the relation between use of lower extremity discretionary protective equipment and the rate and severity of lower extremity injury among high school athletes during their participation in organized sports. MATERIALS AND METHODSData and study designIn this study, we utilized data from the North Carolina High School Athletic Injury Study (1996–1999), a 3-year prospective cohort study of a stratified, two-stage cluster sample of North Carolina high school athletes. The study design involved first assigning high schools to 50 strata based on school size and region. Two schools were then randomly selected from each stratum. Second, six team sports in each study school were selected using systematic sampling. A list of existing sport programs in selected schools at the start of the 1996–1997 school year was sorted by season and sport to ensure that the sample spanned all seasons and included both girls' and boys' teams. Finally, all athletes on each selected team were included in the sample as study athletes. Each selected team was followed for 3 years. A detailed description of the study design and methods has been published elsewhere (40). Twelve varsity sports were studied, with six male sports and six female sports. These included boys' and girls' soccer, track, and basketball; boys' baseball, wrestling, and football; and girls' softball, volleyball, and cheerleading. Four questionnaires were used in data collection: the Athlete's Demographic Form and the Coach's Form, which were completed by self-report prior to each season, and the Weekly Exposure Form and the Injury Report Form, which were administered during the season by trained data collectors, who were either athletic directors or athletic trainers employed by the school. MeasurementsIn this study, a lower extremity injury was defined as any new injury sustained between the hip and the toes that occurred in an organized sport and required medical attention or restricted participation on the day after the injury. Information on injury was collected at the time the injury occurred (40, 41). The rate of lower extremity injury was one of two outcome variables in this study. The injury rate was calculated as the number of incident lower extremity injuries in a season divided by the total number of athlete-exposures in that season multiplied by 100,000. In this study, attending one coach-directed session of either a game or practice was defined as one athlete-exposure (40). The severity of lower extremity injury, the other outcome variable in this study, was defined as the number of days lost from sports participation due to an incident lower extremity injury (39, 42). Lower extremity injury severity was evaluated for each injury and measured at four levels: “no time lost,” if an athlete lost no time; “minor injury,” if an athlete lost less than 1 week of participation time; “moderate injury,” if an athlete lost 1–3 weeks; and “serious injury,” if an athlete lost more than 3 weeks (43, 44). The analysis of injury severity included only those athletes who sustained lower extremity injuries during a given season. Use of lower extremity discretionary protective equipment, the main exposure variable in this study, was defined as any self-reported usual use of lower extremity protective equipment not required by sports rules (45). For example, rules mandate the use of kneepads in football and shin guards in soccer; therefore, using such equipment in those sports was not classified as use of lower extremity discretionary protective equipment in this study. We assessed use of lower extremity discretionary protective equipment during the preseason by asking athletes, “What protective equipment do you usually use?” The athletes participating in a specific sport were asked to select the protective equipment they used from a checklist of items. The checklist varied by sport and could include the following items: helmet, headgear, face mask, mouth guard, shoulder pads, elbow brace, wrist guard, hip pads, kneepads, shin guards, knee brace, ankle brace, pads, and other. We manually reviewed the written-in responses in the “pads” and “other” categories to determine use of discretionary protective equipment. Because rules vary across sports, the same piece of protective equipment may be required in one sport yet optional in another. We determined whether athletes' use of a given piece of protective equipment was discretionary or mandatory based on the rules governing mandatory protective equipment use in each sport. We limited discretionary protective equipment to the lower extremities because they are the most commonly injured body parts among high school athletes (15, 20). Use of lower extremity discretionary protective equipment was coded dichotomously, with “yes” representing self-reported usual use of any piece of lower extremity protective equipment that was not mandated by the rules across all sports studied. The four types of lower extremity discretionary protective equipment most frequently used by high school athletes in this study were kneepads, shin guards, knee brace(s), and ankle brace(s). However, the subanalyses on use of specific types of lower extremity discretionary protective equipment were limited to kneepads, knee braces, and ankle braces because of small counts for nonmandatory use of shin guards. A history of lower extremity injury, a covariate in this study, was measured during the preseason by asking each athlete whether he or she had previously sustained any injuries. The response categories were presented as a checklist specifying concussion, heat stroke, fracture, shoulder injury, elbow injury, wrist injury, knee injury, ankle injury, and other. Athletes who checked the “other” category were prompted to indicate up to three other injuries; these responses were manually reviewed and classified. In the case of athletes who remained in the study for more than 1 year, we updated the injury history variable to reflect the athletes' known prior injuries. Only athletes with a history of lower extremity injury were classified as having a history of injury. We included four demographic variables in the analysis: sex (male or female), grade (ninth, tenth, eleventh, or twelfth), type of sport (full-contact, limited-contact, or noncontact), and whether the athlete had played multiple sports in the past (yes or no) (45). In this study, we categorized football and wrestling as full-contact sports, basketball, soccer, baseball, and softball as limited-contact sports, and track, volleyball, and cheerleading as noncontact sports, based on the amount of body contact the rules allow an athlete to have with his or her opponent (46). Statistical analysisWe conducted separate analyses for the two outcome variables, injury rate and injury severity. To determine the rate of lower extremity injury, we performed descriptive analyses to characterize the frequency and rate per 100,000 athlete-exposures of lower extremity injury, knee injury, and ankle injury sustained during the sports season. We used Poisson regression to determine the effect of use of discretionary protective equipment on the prospective lower extremity injury rate. We modeled the rates of lower extremity injury sustained in games, in practices, and overall, taking into account game injuries, practice injuries, and all injuries, respectively, and adjusting denominators (games or practices) as appropriate. We excluded injuries that occurred in settings other than games or team practices (e.g., personal workouts) in the analysis because of the absence of time-at-risk (rate denominator) measurements for these injuries in this study. We calculated unadjusted and adjusted lower extremity injury rate ratios from the Poisson regression models with no use of discretionary protective equipment as a referent. The demographic variables included in the adjusted analysis were sex, grade, past participation in multiple sports, and type of sport (45). Athletes who have experienced a previous injury appear to be at increased risk of reinjury and more motivated to protect themselves by using discretionary protective equipment (37, 47). We performed subgroup analyses to compare the effect of use of discretionary protective equipment in participants with and without a history of lower extremity injury. Since most reported lower extremity injuries in this study were knee or ankle injuries, we conducted further analyses to examine the effects of knee brace use on knee injuries, kneepad use on knee injuries, and ankle brace use on ankle injuries. To examine injury severity as an outcome, we limited the scope of the analysis to athletes injured in a given season, characterizing the severity of lower extremity injury among athletes who sustained lower extremity injuries. We used logistic regression to predict the effect of use of discretionary protective equipment on the probability of serious injury (>3 weeks lost) versus nonserious injury (≤3 weeks lost) given an occurrence of injury. The model was adjusted for athletes' demographic characteristics. Odds ratios were estimated with no discretionary protective equipment use as a referent (48). We used SAS-Callable SUDAAN 8.0 computer software for all statistical analyses to account for the stratified two-stage cluster sampling design and for within-subject correlation (49). Data were weighted to account for the sampling design and for nonresponse. RESULTSA total of 19,728 athlete-seasons and 1,104,354 athlete-exposures were included in the data analysis. The demographic characteristics of the study population and their use of lower extremity discretionary protective equipment are presented in table 1. TABLE 1. Demographic characteristics of the study population (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Weighted to account for complex sampling and nonresponse. † LEDPE, lower extremity discretionary protective equipment. ‡ n = 17,882 athlete-seasons; missing values were excluded. TABLE 1. Demographic characteristics of the study population (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Weighted to account for complex sampling and nonresponse. † LEDPE, lower extremity discretionary protective equipment. ‡ n = 17,882 athlete-seasons; missing values were excluded. Injury rateOf a total of 2,698 reported injuries, 1,083 were lower extremity injuries. Knee and ankle injuries accounted for most of the lower extremity injuries. After the data were weighted for the sampling design and nonresponse, ankle injuries accounted for 40.5 percent of all reported lower extremity injuries, followed by injuries to the knee (29.1 percent), the upper leg (9.6 percent), the lower leg (8.9 percent), the foot or toe (8.8 percent), and other lower extremity sites (3.5 percent). Table 2 shows rates of lower extremity injury by athletes' demographic characteristics. The overall rate of lower extremity injury was 117.0 per 100,000 athlete-exposures (95 percent confidence interval (CI): 100.4, 136.4). Athletes injured their lower extremities more often in games (n = 568) than in practices (n = 334), and injury rates were much higher in games than in practices: approximately four times higher for the lower extremities (204.4 vs. 49.2 per 100,000 athlete-exposures), six times higher for knees (66.7 vs. 10.8 per 100,000 athlete-exposures), and five times higher for ankles (85.6 vs. 16.2 per 100,000 athlete-exposures). TABLE 2. Numbers and rates of lower extremity athletic injuries according to athletes' demographic characteristics (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* From hip to toes. † Unweighted number of injuries. ‡ Rate per 100,000 athlete-exposures; weighted for complex sampling and nonresponse. § CI, confidence interval. # n = 17,882 athlete-seasons; missing values were excluded. TABLE 2. Numbers and rates of lower extremity athletic injuries according to athletes' demographic characteristics (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* From hip to toes. † Unweighted number of injuries. ‡ Rate per 100,000 athlete-exposures; weighted for complex sampling and nonresponse. § CI, confidence interval. # n = 17,882 athlete-seasons; missing values were excluded. Male athletes had higher rates of injury to the lower extremities, knees, and ankles than did female athletes (table 2). Playing full-contact sports and being seniors were also associated with an increased rate of lower extremity injuries. The overall rates of lower extremity injury in the highest-risk sports (soccer and football) were approximately 4–5 times higher than in the least risky sports, boys' baseball and boys' wrestling (table 2). Both the unadjusted and adjusted rate ratios indicated that a history of injury was positively associated with prospective lower extremity injuries (table 3). Athletes with a history of lower extremity injury had almost double the rate of lower extremity injuries compared with those without a history of injury (rate ratio (RR) = 1.96, 95 percent CI: 1.62, 2.37). Athletes with a history of knee or ankle injury had an approximately three times' greater rate of prospective knee injury (RR = 2.92, 95 percent CI: 2.09, 4.09) or ankle injury (RR = 3.42, 95 percent CI: 2.44, 4.80). TABLE 3. Prospective rate of and rate ratio for lower extremity athletic injury among participants with a history of prior injury in the same body part (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of injuries. † RR, rate ratio; CI, confidence interval. ‡ Adjusted for sex, grade, past participation in multiple sports, and type of sport. § Reference category: no history of lower extremity injury. # Reference category: no history of knee injury. ** Reference category: no history of ankle injury. TABLE 3. Prospective rate of and rate ratio for lower extremity athletic injury among participants with a history of prior injury in the same body part (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of injuries. † RR, rate ratio; CI, confidence interval. ‡ Adjusted for sex, grade, past participation in multiple sports, and type of sport. § Reference category: no history of lower extremity injury. # Reference category: no history of knee injury. ** Reference category: no history of ankle injury. Use of discretionary protective equipment tended to be associated with a 9 percent decrease in the overall rate of lower extremity injury (RR = 0.91, 95 percent CI: 0.72, 1.15) and a 19 percent decrease in the rate of game injury for all athletes (RR = 0.81, 95 percent CI: 0.57, 1.16) (table 4). The protective effect of use of discretionary protective equipment seemed to be stronger during game sessions, possibly because of an elevated intensity of competition in the game settings, particularly for athletes with no history of lower extremity injuries (RR = 0.74, 95 percent CI: 0.49, 1.09). TABLE 4. Prospective rate of and rate ratio for lower extremity athletic injury among participants who used lower extremity discretionary protective equipment (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of lower extremity injuries. † RR, rate ratio; CI, confidence interval. ‡ Reference category: no use of lower extremity discretionary protective equipment. § Adjusted for sex, grade, past participation in multiple sports, and type of sport. TABLE 4. Prospective rate of and rate ratio for lower extremity athletic injury among participants who used lower extremity discretionary protective equipment (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of lower extremity injuries. † RR, rate ratio; CI, confidence interval. ‡ Reference category: no use of lower extremity discretionary protective equipment. § Adjusted for sex, grade, past participation in multiple sports, and type of sport. Subgroup analysis by equipment itemAnalysis of the injury rate according to specific equipment item revealed that the overall 9 percent decrease was an amalgam of two separate effects: a protective effect for kneepad use and an increase in the injury rate associated with brace use. Kneepad use was strongly associated with a reduced rate of knee injury in both game and practice sessions, with the exception of practice injuries among athletes with a history of knee injury (table 5). After adjustment for athletes' demographic characteristics, the overall knee injury rate was 56 percent lower for athletes who used kneepads (RR = 0.44, 95 percent CI: 0.27, 0.74). This protective effect was stronger during game sessions and for athletes with no history of knee injury. The rate of knee injuries in games was 67 percent lower for athletes who reported using kneepads (RR = 0.33, 95 percent CI: 0.16, 0.67). For athletes with no history of knee injuries, kneepad use was associated with a 59 percent reduced rate of knee injury (RR = 0.41, 95 percent CI: 0.23, 0.74). TABLE 5. Rate ratio for knee or ankle injury according to use of braces or pads (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of injuries. † RR, rate ratio; CI, confidence interval. ‡ Reference category: no brace or pad use. § Adjusted for sex, grade, past participation in multiple sports, and type of sport. TABLE 5. Rate ratio for knee or ankle injury according to use of braces or pads (n = 19,728 athlete-seasons), North Carolina High School Athletic Injury Study, 1996–1999
* Unweighted number of injuries. † RR, rate ratio; CI, confidence interval. ‡ Reference category: no brace or pad use. § Adjusted for sex, grade, past participation in multiple sports, and type of sport. Use of knee braces or ankle braces, on the other hand, was associated with increased rates of knee and ankle injury, respectively (table 5). The use of knee braces was associated with an elevated rate of knee injury among athletes with no history of knee injury, with an adjusted injury rate ratio of 2.24 (95 percent CI: 1.35, 3.71). Ankle brace use was similarly associated with a higher rate of ankle injury among athletes with no history of ankle injury, with an adjusted injury rate ratio of 2.29 (95 percent CI: 1.24, 4.24). Injury severityOf 1,083 reported lower extremity injuries, 14.8 percent (95 percent CI: 10.7, 18.8) were serious injuries. More time was lost due to knee injuries than to ankle injuries, and the proportion of serious (>3 weeks lost) knee injuries was approximately four times higher than that of serious ankle injuries (27.5 percent vs. 6.5 percent). We used logistic regression to examine the association between use of discretionary protective equipment and the severity of lower extremity injury among injured athletes. After adjustment for sex, grade, type of sport, and past participation in multiple sports, use of discretionary protective equipment tended to be associated with 22 percent lower odds of sustaining serious injury in injured athletes with a history of lower extremity injury (odds ratio (OR) = 0.78, 95 percent CI: 0.41, 1.49) and with 46 percent lower odds for those with no history of lower extremity injury (OR = 0.54, 95 percent CI: 0.26, 1.10). A history of lower extremity injury seemed to be associated with increased odds of sustaining serious injury (OR = 1.34, 95 percent CI: 0.76, 2.37), and a history of knee injury tended to be associated with greater odds of sustaining a serious knee injury (OR = 1.57, 95 percent CI: 0.77, 3.17). However, a history of ankle injury was not associated with increased odds of sustaining a serious ankle injury (OR = 0.90, 95 percent CI: 0.28, 2.91). DISCUSSIONIn this study, we determined the rate and severity of lower extremity injuries among athletes in 100 North Carolina high schools participating in 12 organized sports and examined the effect of use of lower extremity discretionary protective equipment. Our findings provide an empirical basis for future research on the effectiveness of discretionary protective equipment and have implications for future intervention strategies. In particular, the finding that kneepad use was associated with a reduced rate of knee injury suggests that consideration should be given to developing and implementing effective intervention strategies to promote kneepad use in high school sports. However, the finding that knee brace use and ankle brace use were associated with increased rates of injury was surprising. Further research is needed to examine this result in more detail. Use of discretionary protective equipment and injury rateConsistent with previous research (23–27, 50), the findings from our study indicated that use of lower extremity discretionary protective equipment was associated with a reduced rate of lower extremity injury, as well as with a reduced proportion of serious injuries. The protective effects seemed to be more apparent during games and for athletes with no history of lower extremity injury. However, the positive effect of discretionary protective equipment was largely due to the use of one item, kneepads. Pads can minimize the effects of direct contact by dissipating impact forces and reducing the force transmitted to soft and hard tissue (30, 31, 36). The highest usage of kneepads was in boys' baseball and girls' softball, sports in which more than 80 percent of players reported having used kneepads (45). Interestingly, these sports also had the lowest knee injury rates. Since so many players used kneepads voluntarily and seemed to benefit, we recommend that the National Federation of State High School Associations review the rules for baseball and softball with a view to requiring kneepad use. The effect of wearing a brace on the risk of injury is complex and probably depends on the design of the brace, the physical conditioning and dynamic movement characteristics of the athlete, the type of footwear worn, and environmental conditions such as surfacing and weather. A number of studies have found that braces may minimize knee or ankle injuries (25, 28, 35). However, the evidence for efficacy is generally considered too weak to recommend universal prophylactic knee brace use (28, 50, 51). To our knowledge, this study is one of the first to have examined brace use in high school athletes. There are at least two plausible mechanisms through which brace use may increase injury risk for the high school athlete. Wearing a brace can increase the athlete's energy expenditure (28, 51, 52). In treadmill tests, oxygen consumption and heart rate were 3–8 percent higher when using a knee brace while running (53). It is therefore plausible that brace use may increase fatigue, which may lead to an increased risk of injury. The plausibility of this mechanism depends upon the weight of the brace and the physical fitness of the athlete; these factors vary greatly between athletes. A second potential mechanism, particularly for knee braces, is slippage or migration of the brace during use. Maintaining the correct position of a knee brace is problematic (26), and some types of knee braces exhibit migration up and down the leg during running (54). Slippage will diminish the protective function of the brace and could conceivably increase injury risk through contact with the hard surfaces of the brace or inappropriate restriction of range of motion. However, the elevated injury rate we observed with brace use may also be the result of bias from one or more sources (28). First, skilled football players (receivers, kickers, and running backs) may avoid routine brace usage, fearing that braces will limit their speed and agility. Those football players who wear knee braces most frequently may actually be at greater risk for injury (offensive and defensive linemen) (26). Second, many players use knee braces inconsistently. Often, they wear braces in practices but not in games. Third, we examined only “self-reported” use without knowing whether the brace was used on one leg or both. When only one leg is braced, differences in injury risk may affect both the braced leg and the unbraced leg. Albright et al. (28) have noted that an athlete wearing a knee brace may face a higher risk of injury to the unbraced knee. Fourth, players recovering from injury may return to play earlier if they feel that braces afford protection. Thus, some brace users may be injured players who would not otherwise play. Any or all of these factors could have confounded the association observed in this study. Future research is needed to investigate the relation between brace use and knee and ankle injury, as well as more effectively control for these sources of bias. Use of discretionary protective equipment and injury severityOur findings suggest that use of lower extremity discretionary protective equipment was associated with decreased odds of sustaining serious injury to the lower extremities. Although high school sports injuries are seldom severe enough to require hospitalization, the direct medical costs of outpatient treatment and the indirect cost of lost productivity can be high (7, 55). Therefore, modest reductions in injury severity, such as we observed here, may translate into a greatly reduced burden on the health care system and society. Injured athletes' suffering may also be reduced. LimitationsAlthough the North Carolina data allowed us to examine the relations between high school athletes' use of discretionary protective equipment and the rate and severity of lower extremity injuries, these data have several limitations. First, the use of discretionary protective equipment was self-reported and might have been subject to social desirability bias. Second, an athlete's exposure measured in this study used the number of coach-directed game or practice sessions, regardless of the athlete's actual playing time. Because the duration and intensity of each session may vary both within a team and across teams, our assessment of exposure could have been imprecise, particularly for those athletes who “sit on the bench” during game sessions (56). Third, the effect of using discretionary protective equipment may potentially be confounded by behavioral biases: Athletes who choose to use discretionary protective equipment may also adopt other safety behaviors (e.g., warm-ups or stretching) that may reduce their risk of injury. In contrast, users of discretionary protective equipment may believe they are less vulnerable and play more aggressively during games, which may increase their risk of injury. Finally, data on the laterality of use were not collected. In practice, athletes often wear kneepads bilaterally, but they generally wear knee braces and ankle braces unilaterally. ConclusionsThis study found that use of lower extremity discretionary protective equipment tended to be associated with reduced rates of lower extremity injury and reduced odds of serious lower extremity injury. The protective effect of discretionary equipment use was particularly apparent during game sessions and among athletes with no history of lower extremity injury. We found that kneepad use reduced the rate of knee injury, but use of braces was associated with an increased rate of knee or ankle injury. Prospective, well-controlled epidemiologic studies are needed to better address the numerous complex factors underlying the effectiveness of knee braces and ankle braces in high school athletes. This study was supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01/AR42297) and the National Center for Injury Prevention and Control (R49/CCR402444) to the University of North Carolina Injury Prevention Research Center. The authors express their appreciation to Dr. Nancy Weaver, Dr. William D. Kalsbeek, John Sideris, Brian Sutton, and the advisory board of the North Carolina High School Athletic Injury Study, particularly Richard Knox and William E. Prentice, Jr. The authors acknowledge the invaluable contribution of the high school athletic trainers and athletic directors who participated in this project. They also thank Patrick Inman for editing an early version of the manuscript. References1. Aaron DJ, LaPorte RE. Physical activity, adolescence and health: an epidemiological perspective. In: Holloszy JO, ed. Exercise and sport sciences reviews. Baltimore, MD: Williams and Wilkins, 1997 :391–406. 2. Bijur PE, Trumble A, Harel Y, et al. Sports and recreation injuries in US children and adolescents. Arch Pediatr Adolesc Med 1995 ; 149 : 1009 –16. 3. Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med 2001 ; 37 : 301 –6. 4. Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the US population. Inj Prev 2003 ; 9 : 117 –23. 5. Ni H, Barnes P, Hardy AM. Recreational injury and its relation to socioeconomic status among school aged children in the US. Inj Prev 2002 ; 8 : 60 –5. 6. Pate RR, Pratt M, Blair SN, et al. Physical activity and health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995 ; 273 : 402 –7. 7. Miller TR, Lestina DC, Galbrainth MS, et al. Medical care spending, United States. MMWR Morb Mortal Wkly Rep 1994 ; 43 : 581 –6. 8. Shephard RJ. Economic benefits of enhanced fitness. Champaign, IL: Human Kinetics, 1986 . 9. Nonfatal sport- and recreation-related injury treated in emergency departments—United States. MMWR Morb Mortal Wkly Rep 2002 ; 51 : 736 –40. 10. Shephard RJ. Can we afford to exercise given current injury rates? Inj Prev 2003 ; 9 : 99 –100. 11. Marshall SW, Guskiewicz KM. Sports and recreational injury: the hidden cost of a healthy lifestyle. Inj Prev 2003 ; 9 : 100 –2. 12. Leddy MH, Lambert MJ, Ogles BM. Psychological consequences of athletic injury among high-level competitors. Res Q Exerc Sport 1994 ; 65 : 347 –54. 13. McGowan RW, Pierce EF, Williams M, et al. Athletic injury and self diminution. J Sports Med Phys Fitness 1994 ; 34 : 299 –304. 14. Crossman J, Quackenbush N. Injured athletes: a study of emotional responses. J Sport Behav 1994 ; 17 : 178 –89. 15. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med 2003 ; 33 : 75 –81. 16. Zaricznyj B, Shattuck LJ, Mast TA, et al. Sports-related injuries in school-aged children. Am J Sports Med 1980 ; 8 : 318 –24. 17. Garrick JG, Requa RK. Injuries in high school sports. Pediatrics 1978 ; 61 : 465 –9. 18. Powell JW. High school injury epidemiology: The NATA High School Injury Study. In: Proceedings of sports injuries in youth: surveillance strategies. Bethesda, MD, 8–9 April 1991. Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases, 1991 . 19. Backx FJ, Beijer HJ, Bol E, et al. Injuries in high-risk persons and high-risk sports: a longitudinal study of 1818 school children. Am J Sports Med 1991 ; 19 : 124 –30. 20. Maffulli N, Baxter-Jones AD. Common skeletal injuries in young athletes. Sports Med 1995 ; 19 : 137 –49. 22. Mclain LG. Reynolds S. Sports injuries in a high school. Pediatrics 1989 ; 84 : 446 –450. 23. Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Med Sci Sports Exerc 1973 ; 5 : 200 –3. 24. Anderson G, Zeman SC, Rosenfeld RT. The Anderson knee stabler. Phys Sportsmed 1979 ; 7 : 125 –7. 25. Sitler M, Ryan J, Hopkinson W, et al. The efficacy of a prophylactic knee brace to reduce knee injuries in football: a prospective, randomized study at West Point. Am J Sports Med 1990 ; 18 : 310 –15. 26. Albright JP, Powell J, Smith S, et al. Medical collateral ligament knee sprains in college football: brace wear preferences and injury risk. Am J Sports Med 1994 ; 22 : 2 –11. 27. Marshall SW, Anna EW, Randall WD, et al. An ecologic study of protective equipment and injury in two contact sports. Int J Epidemiol 2002 ; 31 : 587 –92. 28. Albright JP, Saterbak A, Stokes J. Use of knee braces in sports. Sports Med 1995 ; 20 : 281 –301. 29. Kraus JF, Conroy C. Mortality and morbidity from injuries in sports and recreation. Annu Rev Public Health 1984 ; 5 : 163 –92. 30. Francisco AC, Nightingale RW, Guilak F, et al. Comparison of soccer shin guards in preventing tibia fracture. Am J Sports Med 2000 ; 28 : 227 –33. 31. Bir CA, Cassatta SJ, Janda DH. An analysis and comparison of soccer shin guards. Clin J Sport Med 1995 ; 5 : 95 –9. 32. Chapman P. Orofacial injuries and international rugby players' attitudes to mouthguards. Br J Sports Med 1990 ; 24 : 56 –8. 33. Marshall SW, Mueller FO, Kirby DP, et al. Evaluation of safety balls and faceguards for prevention of injuries in youth baseball. JAMA 2003 ; 289 : 568 –74. 34. Finch C. Teenagers' attitudes towards bicycle helmets three years after the introduction of mandatory wearing. Inj Prev 1996 ; 2 : 126 –30. 35. Sitler M, Ryan J, Wheeler B, et al. The efficacy of a semirigid ankle stabilizer to reduce acute ankle injuries in basketball: a randomized clinical study at West Point. Am J Sports Med 1994 ; 22 : 454 –61. 36. Gerrard DF. The use of padding in rugby union. Sports Med 1998 ; 25 : 329 –32. 37. Marshall SW, Loomis DP, Waller A, et al. Usage of protective equipment in a cohort of rugby players. Med Sci Sports Exerc 2001 ; 33 : 2131 –8. 38. Pettersen JA. Does rugby headgear prevent concussion? Attitudes of Canadian players and coaches. Br J Sports Med 2002 ; 36 : 19 –22. 39. Van Mechelen W. The severity of sports injuries. Sports Med 1997 ; 24 : 176 –80. 40. Weaver NL, Mueller FO, Kalsbeek WD, et al. The North Carolina High School Athletic Injury Study: design and methodology. Med Sci Sports Exerc 1999 ; 31 : 176 –82. 41. Finch CF. An overview of some definitional issues for sports injury surveillance. Sports Med 1997 ; 24 : 157 –63. 42. Van Mechelen W, Hlobil H, Kemper HC. Incidence severity etiology and prevention of sports injuries: a review of concepts. Sports Med 1992 ; 14 : 82 –99. 43. Sandelin J, Santavirta S, Lattila R, et al. Sports injuries in a large urban population: occurrence and epidemiological aspects. Int J Sports Med 1988 ; 8 : 61 –6. 44. Powell JW, Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995–1997 seasons. J Athl Train 1999 ; 34 : 277 –84. 45. Yang JZ. Use of discretionary protective equipment and lower extremity injury in high school athletes. (Doctoral dissertation). Chapel Hill, NC: University of North Carolina at Chapel Hill, 2004 . 46. National Federation of State High School Associations. 1999 rules book. Indianapolis, IN: National Federation of State High School Associations, 1999 . 47. Finch CF, McIntosh AS, McCrory P. What do under 15 year old schoolboy rugby union players think about protective headgear? Br J Sports Med 2001 ; 35 : 89 –94. 48. Stokes ME, Davis CS, Koch GG. Categorical data analysis using the SAS system. Cary, NC: SAS Institute, Inc, 2000 :181–203. 49. Research Triangle Institute. SUDAAN user's manual: release 8.0. Research Triangle Park, NC: Research Triangle Institute, 2001 . 50. Hume PA, Gerrard DF. Effectiveness of external ankle support. Sports Med 1998 ; 25 : 285 –312. 51. Kramer JF, Dubowitz T, Fowler P, et al. Functional knee braces and dynamic performance: a review. Clin J Sport Med 1997 ; 7 : 32 –9. 52. MacKean LC, Bell G, Burnham RS. Prophylactic ankle bracing vs. taping: effects on functional performance in female basketball players. J Orthop Sports Phys Ther 1995 ; 22 : 77 –81. 53. Highgenboten CL, Jackson A, Meske N, et al. The effects of knee brace wear on perceptual and metabolic variables during horizontal treadmill running. Am J Sports Med 1991 ; 19 : 639 –43. 54. Greene DL, Hamson KR, Bay RC, et al. Effects of protective knee bracing on speed and agility. Am J Sports Med 2000 ; 28 : 453 –9. 55. Malek M, Chang B, Gallagher SS, et al. The cost of medical care for injuries to children. Ann Emerg Med 1991 ; 20 : 997 –1005. 56. Lindenfeld TN, Noyes FR, Marshall MT. Sports injury research: components of injury reporting systems. Am J Sports Med 1988 ; 16 (suppl 1): S69 –80. American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Topic:
Which of the following is the simplest way to prevent injury to the young athlete?Rest is critical to avoiding injury and seeing gains in your training program. You can not get faster or stronger without allowing your body time to heal and recover.
What type of drugs keep your hand steady?Medications. Beta blockers. Typically used to treat high blood pressure, beta blockers such as propranolol (Inderal, InnoPran XL, Hemangeol) help relieve tremors in some people. ... . Anti-seizure medications. ... . Tranquilizers. ... . OnabotulinumtoxinA (Botox) injections.. Which of the following is a condition in which the bones of the extremities become elongated and enlarged and the bones and soft tissues of the face become thickened?Acromegaly is a rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly. Over time, this leads to abnormally large hands and feet, and a wide range of other symptoms.
Which of the following is an effective way for athletes to manage iron deficiency?7 So the more effective way to increase iron status is by eating animal products such as lean red meat, poultry or fish or liver.
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Protective equipment helps protect a young athlete when participating in adult style games
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