Essay: Injury prevention in young people—time to accept responsibility

Abstract

Many children undertake intensive sports training at a young age or take part in a range of sporting activities, so exposing themselves to the risk of injury. Prevention of sports injuries in youth has great potential health gains: in the short-term, the absolute number of sports injuries falls, and, in the longer term, the risk of injury recurrences and chronic damage is prevented. Prevention of injury also promotes a physically active lifestyle from childhood into adulthood.Measures to prevent sports injuries in young people should be based on knowledge of the incidence and likely severity of the particular injury, causal factors, and mechanisms that contribute to the risk of sustaining sport-related injuries. Once identified, preventive measures should be implemented and assessed, preferably in randomised trials.To date, little has been published about sports injuries in young people, especially those associated with growth, such as growth plate fractures, epiphyseal fractures, osteochondrosis dissecans, and traction apophysitis. Nevertheless, there is one crucial factor that is known to have an important role in injury prevention: an understanding of the behaviour of children, and their parents and sports instructors.An active child is growing, learning, and developing skills. From 6 to 12 years the nature of physical activity evolves from joyful play into competitive sport. Everything a child of this age learns about ways to avoid injury, the capabilities of their body, safe play, and fair play will be carried forward and will affect the way they take part in sport for the rest of their life. Unfortunately, coaches and parents often consider their youngsters mini adults and potential Olympic athletes, and enforce the children to value performance over enjoyment. This pressure encourages children to copy their professional role models. Especially during periods of growth, in team sports such emulation can lead to risky situations in which there are great differences between children in, for example, body size, degree of skill, and strength. In individual sports, excessive training and incomplete rehabilitation after injury can lead to injuries associated with overuse and subsequent growth problems.Between the ages of 12 and 18 years, children's behaviour is the main cause of injuries. Most children take part in competitive sports, and need to be made aware of their behaviour and whether it is putting themselves or others at risk. For instance, proper protection in inline skating is rare in this age group, since wearing a helmet is not thought cool. Another example comes from football, where children do not always see the danger of certain forms of tackling. If taught good values at a younger age, while sport is still more about play than competition, fair play in adolescence will represent a natural progression.The published work provides us with evidence-based preventive measures that reduce the risk of sports injuries. An intervention programme aimed at changing or adapting behaviour in children has yet to be developed, however, even though the data on the cause of injuries are sufficient to back such a programme. The findings of the only study done to date to assess prevention of sports injury in children showed that, in those aged 12–18 years, knowledge about injury prevention was improved. The investigators noted that the subsequent improvement in attitude should have a favourable effect on risk of injury, though this hypothesis has yet to be proven.Sports injuries in children are a public-health concern. Yet, for the most part, they are avoidable through changes to the behaviour and attitudes of children and the adults who influence them. The responsibility for instituting this change lies with the parents, trainers, coaches, teachers, and health professionals involved with the young sports person.