CHANGING

OUR PREVENTING SPORTS INJURIES IN HIGH

CULTURE: SCHOOL ATHLETES
NATHAN SMITH | 4/16/17

INTRODUCTION:
In the early 20th century, high school athletics was unheard of. The
FAST FACTS: number of opportunities for organized sport was low, as was the number
of sports injuries. However, competitive sports today have overtaken
our culture. As of 2007, 30 million kids under 18 compete in organized
sports1.
Sports With the
Athletics have become an integral part of American high schools.
Highest Injury Schools invest millions of dollars into facilities for their students to
Rates: compete at a high level, while student-athletes invest countless hours
4 into disciplined training.
Injuries per 1,000 Exposures

3.5
However, with this shift in prominence has come the fact that high
3 school athletes sustain two million sports-related injuries per year. By
2.5 letting these injuries propagate to such an extent, the safety of these
2 athletes is compromised, which in turn makes sports programs a
dangerous environment. Sports and injury rates are inherently tied. As
1.5
the importance of sports has increased in our culture, so has the need
1 for coaches, athletic directors, and athletes to begin focusing on sports
0.5 injury prevention.
0
Recovery vs. Prevention

Two years ago, I tore my meniscus playing volleyball for my high

Information provided by the
National High School Sports-
Related Injury Study2
school. When I met with a surgeon, he and his staff ensured me that they
would dedicate themselves to my full and fast recovery so that I could
get back on the court as soon as possible. I believe every athlete
deserves the best treatment that they can get so that they can have such
a recovery. However, every high school athlete also has a right to
compete and train in an environment with the lowest possible risk of
sustaining an injury.
 CHANGING
OUR
CULTURE:
Warming Up:
When I talked to some of my
peers about their high school
experience, they cited that
often times they did not warm
up at all before practice. As a
collegiate athlete, I couldnt
imagine competing without a
warmup. On game days, we
will spend over an hour
drilling to build our bodies up
to peak performance. It is
important and cannot be
ignored.
PREVENTING SPORTS INJURIES IN
HIGH SCHOOL ATHLETES
NATHAN SMITH | 4/16/17
Despite this, high school athletic teams have very few structures
put in place to prevent injuries. Many athletes do not even put a strong
emphasis on warming up before practice and stretching afterwards.
More often than not, these are just motions run through by the athletes
with no real sense of purpose, even though they are integral to
preventing injury.
Furthermore, in American sports culture, there is an emphasis on
pushing past limits and an idea that enduring pain shows dedication.
This atmosphere propagates overtraining, which, in turn, leads to
injuries. Injuries are painful, a barrier for athletic improvement, and
emotionally taxing. They can also be a severe financial burden on the
families of the injured. Over 480 million dollars per year is spent on
hospital fees for athletes under 18 in the United States, and every year
the cost is increasing3.
For these reasons, changes must be made to make high school
athletics a safer environment. Athletic directors must make injury
prevention a priority in their programs. Coaches and athletes
everywhere need to be provided resources so that they understand
what causes injury, and they must dedicate themselves to learning
training methods to prevent them.
HOW CAN WE PREVENT INJURIES?
Part of the lax emphasis on warming up, stretching after practice,
and other injury prevention methods may stem from not only a
misunderstanding of how training methods are tied to injuries, but also
from a stigma that most injuries are not preventable. Wasting precious
time before or after practice can be quite the ordeal when all an athlete
wants is get right into competing, and are already on a busy student-
athlete schedule.
However, injuries are usually the result of a muscle, ligament, or bone
being burdened past the point it can sustain, either through trauma,
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fatigue, or overuse5. By training a way that allows muscles to carry

Practice:
As a team captain in high
school, it was very difficult to
get my team to focus on
having a good warmup. They
wanted to get right into
playing.
more of a load, take less impact, and have less fatigue, a large portion of
sports injuries can be prevented. Furthermore, in many sports, there are
a large percentage of injuries that result from no direct contact with
another athlete. For example, according to a study done by the NCAA,
62% of all injuries in womens lacrosse occur without collisions6. Even in
boys football, the archetypical contact sport, 15 percent of the injuries
occur without contact with another player7.
Injuries that occur in this manner are within the control of the athlete
that is injured because they are the only one in control of their motion.

Non-Contact Injury Prevention

Non-contact injuries stem from various inconsistencies in balance,

lack of flexibility and strength8. Fortunately, because they are
dependent on factors within the athletes control, they are preventable
with the proper training.
Throughout the country there are various programs that have been
created to help athletes train their bodies to be less injury prone. For
example, it is possible to decrease the occurrence and severity of ankle
sprains through strengthening of the area around the ankle, increasing
flexibility through stretching, and improving balance9. By
understanding the causes of this and other injuries, athletes and coaches
can include simple sessions, exercises, and regimens to their normal
training routine that prevent the injuries that re-occur on the team. Not
only would this be beneficial to individual athletes, but to the
performance of the team as a whole. For example, the ability for the
team to perform would suffer greatly if a star player went down in
practice because he didnt warm up sufficiently and pulled a hamstring.

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Tendonitis:
Tendonitis is one of the more
common overuse injuries
present in volleyball. Almost
everyone I know who plays it
has said they have
experienced either knee or
shoulder tendonitis. With such
prevalence, it is a wonder why
there isnt a huge push to
attempt to prevent it every
single practice because it is a
preventable overuse injury.
Sports Fatigue:
The Same trend in football can
be seen in many other sports.
Only 15.2 percent of
basketball injuries occur in the
first quarter, while 29.7
percent occur in the second
quarter. Girls soccer injuries
skyrocket from 27.5 percent of
injuries occurring in the first
hour of practice to 70 percent
in the second hour!
PREVENTING SPORTS INJURIES IN
HIGH SCHOOL ATHLETES
NATHAN SMITH | 4/16/17
Overtraining
It is also important to note that overtraining is another prominent
cause of injury that is easily preventable. Something romanticized in
Hollywood is the ability for athletes to persevere through pain, like a
boxer fighting through a cracked rib and a black eye or Daniel-san
winning a Karate tournament despite attempts of his opponent to
incapacitate him by injuring his leg in Karate Kid. However, a paper
from the American Orthopedic Society for Sports Medicine highly
encourages resting when you are favoring one side of your body, you
cannot put weight on a muscle, or have acute pain of any sort throughout
the body in order to prevent debilitating injuries, many of which
develop over time11. No one should ever be encouraged to play through
pain. These overuse injuries occur when tears occur in joints and
muscles from repeated stress, causing great amounts of discomfort and
swelling. Many of us must know of athletes who have had to end their
season early because of their injury became too swollen and painful. In
addition to proper rest, overuse injuries can be limited by proper
warming up to prepare muscles for activity, and stretching to limit stress
on the joints by loosening muscles. These are simple things that should
be incorporated into every training regimen.
In addition to the risk of overuse injuries, overtraining puts the
body into a state of fatigue. According to the findings of Dr. Matt Greg in
a study on athletic injuries, being put into this compromised
biomechanical position is a huge factor in determining occurrence of
traumatic injury12. This can be further seen in the in a study done by the
National High School Sports-Related Injury Study documenting high
school sports injuries in 2015, where it was found that only 31 percent of
injuries in football happen in the first half hour of practice, while 56.8
percent occur in the second hour13. It is difficult for an athlete to find a
balance between pushing boundaries and exceeding them, however,
disrupting this balance can be extremely unproductive.
Preventing these sports injuries depends solely on the dedication
of athletes, coaches, and athletic directors. Despite how simple it can be
to incorporate, most of my athletic career I have not experienced
programs geared for injury prevention. I have only received treatment
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for injuries. It is time for initiatives to be taken by those involved in high

school athletics in order to create a safer environment to compete.

WHAT SHOULD BE DONE?

Most would agree that students deserve to compete in their sport

safely. In order for this to happen, there needs to be a shift in the
structures that are currently set in place. Furthermore, these structures
must cater to the variation of needs of different sports due to the
variation in their types of common injuries.

Most Common Injuries by Gender and Sport, Information provided by The National
High School Sports-Related Injury Surveillance Study of 201514.

Sports Injuries:
Looking at the most
common injuries by sport
and gender shows why it is
important to gear injury
prevention programs
towards specific sports:
Each sport has very
different ratios of different
kinds of injuries.

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Solution 1: Athletic Trainers, Shifting Roles

Only 55 percent of athletes at public secondary schools have

access to a full-time athletic trainer according to the National Athletic
Trainers Association(NATA), and just 37 percent of public secondary
schools have one15. Hiring more athletic trainers is a critical step to
Pros: decreasing injuries in high schools. Athletic trainers fulfill the role in
high schools of providing direct care to athletic injuries, ensuring that
Injury Prevention athletic equipment is safe to use, and helping athletes rehabilitate from
Programs Created any injuries that might occur. More importantly, trainers have the
by a Certified knowledge and expertise to create programs to prevent specific
Professional injuries should they be reoccurring in an athlete or on a team. A school
Athletic trainers are can hire an athletic trainer as a full-time position for an average wage of
already integrated 51,000 dollars a year16. An athletic trainer is not only an investment in
in many Schools childrens safety, but towards the cost of injury as well. One ACL
Strengthens tie surgery could cost a family over ten thousand dollars, multiple thousand
between Athletic coming directly out of pocket17. In addition to this is the cost of physical
trainers and Sports therapy. After I tore my meniscus, it cost 110 dollars per hour plus many
teams fees to rehabilitate my atrophied leg.
Athletic trainers provide care and expertise that cannot be
replicated through any other means. If we want to stop injuries from
Cons: occurring, more athletic trainers need to be hired. However, when I was
Costly to hire an in high school, our athletic trainer was constantly busy in the training
athletic trainer/ room attending to athletes who were doing ankle rehabilitation, or
multiple athletic needed tape for various joints. He was not utilized for his expertise in
trainer if one isnt injury prevention because he was focused on injury treatment. In order
already available for athletic trainers to be used to their full potential, schools that have
Athletic Trainer them must shift their role from greater injury recovery to greater injury
may be prevention. This will partially eliminate the need for them to help injured
overburdened if athletes recover down the road, as well as could save athletes the pain
expected to fill too of such a recovery. It is up to the coaches and athletes to seek this
many roles, information out of the athletic trainers, and work with them to create
especially at big specific programs for their sports team. A program to prevent injuries
schools. on a basketball team where the most common injuries are ankle sprains
will need to be different than a field hockey team that is experiencing an

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abnormally high rate of ACL tears. This is the biggest challenge of

utilizing athletic trainers: it requires the cooperation and dedication of
both the coaches, athletes and trainers themselves. However, if this can
be achieved, teams will each have highly specialized programs backed
by the expertise of a certified professional to prevent them from
injuries.

Solution 2: Education Programs

Pros:
Coaches can play a If an athletic trainer is not affordable for a school district, or a
bigger role in trainer is unable to fulfill a role of preventing injuries because he/she is
creating injury overtaxed, then other means must be employed to create injury
prevention prevention programs and educate coaches and athletes in injury
programs prevention. One alternative to athletic trainers being responsible for
Less costly than injury prevention are the various, relatively inexpensive training
hiring an Athletic programs that have been developed across the country to effectively
trainer decrease injuries on sports teams. Some organizations will even provide
Builds coaches them for free. For example, the company Maximum Training Solutions
expertise/ has created an injury prevention course that can be taken by coaches
Responsibility for that is designed to educate them on how to assess body movements and
Injury prevention exercises to correct poor form and ensure proper exercise selection.
Scientifically The program cites a 25% decrease in athletic injuries for athletes that
backed participate in their program in relation to other comparable teams18. In
addition, there are similar such programs that created for specific
injuries such as ACL tears or shoulder sprains. These programs would
Cons: be easy to integrate as they usually consist of simple, but effective
exercises. From this, if the same basketball team mentioned earlier is
Coach must commit suffering from a large amount of ankle sprains, a school could find a
to this role program that specifically trains for ankle stability. If schools could invest
Coaches are not in these programs for their coaches and players to attend, it would be a
trained to build huge first step towards preventing injuries.
these programs, As individual teams continue to gain experience with injury
need to be prevention, coaches will better be able to gauge the needs of their
dedicated athletes, and know exactly what programs that they need in order to
prevent injury. The biggest challenge is having the dedication to
commit to the programs every day, even though they seem to be too

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simple to have any effect. Although they would not come with the other
benefits of having an athletic trainer at hand, sports injury prevention
programs could eventually be utilized to have the same level of
specificity to various sports, and be backed by science.

Solution 3: Self Education

If there is absolutely no funding available, it is still feasible to have
Pros: injury prevention be part of any high schools athletic culture. With no
Costs Next to funding at all, if athletes and coaches dedicate themselves to preventing
Nothing injuries, they can find several resources online to prevent specific
Builds knowledge injuries. From YouTube videos to websites, there are countless places
in athletes that they where they can find exercises that can be integrated into practice daily.
can use the rest of One of the most prominent organizations where free, quality resources
their lives can be found is STOP Sports injuries, whose mission is to limit
Makes injury preventable sports injuries for athletes across the country. On their
prevention a more website are countless pdf documents that outline the causes of specific
widespread topic in injuries and how to prevent them. They even have resources available
an athletic for specific sports that describe common injuries and how to prevent
program, which them. These range from explanations on which muscles must be
furthers the culture strengthened and stretched if traumatic injuries are common in the
of injury prevention sport, to how to schedule training in order to prevent overuse injuries if
overtraining is the most prominent cause of injury in the sport.
Cons: Furthermore, if there is a local university, athletic directors could invite
No real experts students studying kinesiology to help educate their athletes and
involved coaches.
May not be as Although a self-education method does not have the level of
effective as other individualized expertise that comes with a scientifically backed
methods biomechanics program, or a certified specialist, putting athletes and
May be too much to coaches in charge of educating themselves in injury prevention is an
expect from accessible, realistic method of injury prevention. To do so, however,
Students/coaches/ athletic directors and coaches must make it a priority to ensure that
Students/coaches athletes are training safely, and make it well understood throughout
may not believe in their entire athletics department how important and achievable injury
themselves enough prevention is. If this occurs, and there is widespread belief in the
to find educating importance of injury prevention, then the dedication to being educated
about sports injuries will come by itself.

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themselves is
worthwhile.
CONCLUSION:

No matter what the situation at a high school is, it is possible

to decrease the amount of injuries that athletes experience. Any of
the methods or a combination of them could be used to effectively
limit athletic injuries in a high school athletics setting. Coaches
need to demand that their athletes stretch and warm up properly,
perform exercises that prevent injury, and drill the importance of
these into the culture of their sport team. If coaches and athletic
directors show their dedication to preventing injuries, I believe
that athletes will begin to exhibit a dedication to their own
personal injury prevention as well. From this, the culture of
athletics will change to highlight injury prevention, and be much
safer as a result of it.
However, for this to occur there needs to be accessible
information that can be incorporated into the routines of various
sports teams. For schools that can afford athletic trainers, the
resource is readily available, it is just a matter of taking an
initiative. For less affluent schools, athletic departments will have
to take initiatives in other ways, either through less costly injury
prevention programs or self-education. No matter which route is
taken, the biggest thing preventing limiting injuries in high school
sports is a commitment to it. If the dedication to injury prevention
propagates, more and more general knowledge of sports injury
will be spread across athletic programs across the country. It will
become commonplace to know which exercises limit which
injuries, and that they must be done before practice. Or having an
attitude that warming up before practice and stretching
afterwards are something that absolutely cannot be skipped.
Some injuries may unavoidable, but it is our duty as coaches,
athletic directors, and athletes to prevent the ones that are.

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ENDNOTES:

1International,
Inc. Advanced Solutions. "Youth Sports Injuries

Statistics." Statistics. STOP Sports Injuries, n.d. Web. 16 Apr. 2017.

2"Statistics on Youth Sports Safety." Statistics. SWATA, n.d. Web. 16 Apr.

2017.
3 Korkmaz, Murat, Blent Kl, and Fatih atkka. "CODEN (USA): EJEBAU

Financial Dimension of Sports Injuries." European Journal Of

Experimental Biology 4.4 (2014): 38-46. Web. 16 Apr. 2017.

4Comstock, R., PhD, D. Currie, MPH, and Lauren Piermont, MS. "NATIONAL

HIGH SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY

2014-2015." (n.d.): n. pag. Http://www.ucdenver.edu. UC Denver. Web.

16 Apr. 2017.
5Mercola,
MD. "Injury Prevention Exercises for Common Athletic

Injuries." Mercola.com. N.p., n.d. Web. 16 Apr. 2017.

6ATC,
Justin Shaginaw MPT. "Scholastic Sports Injuries: Women's

Lacrosse." Philly.com. N.p., 28 Apr. 2014. Web. 16 Apr. 2017.

7Comstock, R., PhD, D. Currie, MPH, and Lauren Piermont, MS. "NATIONAL

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CHANGING PREVENTING SPORTS INJURIES IN
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NATHAN SMITH | 4/16/17
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HIGH SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY

2014-2015." (n.d.): n. pag. Http://www.ucdenver.edu. UC Denver. Web.

16 Apr. 2017.
8
Mercola, MD. "Injury Prevention Exercises for Common Athletic

Injuries." Mercola.com. N.p., n.d. Web. 16 Apr. 2017.

95
Ways to Reduce Your Chance of an Ankle Sprain." Athletico. N.p., 26 July

2016. Web. 16 Apr. 2017.

10When
Play Is Too Much." (n.d.): n. pag. STOP Sports Injuries. AAOSM.

Web.16 Apr. 2017.

11When
Play Is Too Much." (n.d.): n. pag. STOP Sports Injuries. AAOSM.

Web.16 Apr. 2017.

12 Greig, Matt. "The Consideration of Fatigue as a Cause of Injury." News.

N.p., n.d. Web. 16 Apr. 2017.

13Comstock, R., PhD, D. Currie, MPH, and Lauren Piermont, MS. "NATIONAL

HIGH SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY

2014-2015." (n.d.): n. pag. Http://www.ucdenver.edu. UC Denver. Web.

16 Apr. 2017.
14
Comstock, R., PhD, D. Currie, MPH, and Lauren Piermont, MS. "NATIONAL

HIGH SCHOOL SPORTS-RELATED INJURY SURVEILLANCE STUDY

2014-2015." (n.d.): n. pag. Http://www.ucdenver.edu. UC Denver. Web.

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16 Apr. 2017.
15
Pike, Alicia, Riana R. Pryor, Stephanie M. Mazerolle, Rebecca L. Stearns,

and Douglas J. Casa. "Athletic Trainer Services in US Private

Secondary Schools." Journal of Athletic Training 51.9 (2016): 717-26.

Web. 16 Apr. 2017.

16 Lowe,
Russel. "Athletic Training Salaries on the Rise According to Latest

Survey." (n.d.): n. pag. Nata.org. National Association of Athletic

Trainers. Web. 16 Apr. 2017.

17 How Much Does ACL Surgery Cost?" Healthgrades. N.p., 17 Oct. 2016.

Web. 16 Apr. 2017.

18 Injury Prevention." Maximum Training Solutions -. Rocktape, n.d. Web. 16

Apr. 2017.

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