Health Evidence Bulletins - Wales
Team Leader: Dr. Ronan Lyons

Date of Completion: 02.04.98

5:Sports Injuries

This document is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation

The Statements The Evidence
5.1 Water Safety
5.1a. Garden ponds and domestic swimming pools pose a large threat to infants and children. Adequate fencing regulations and public education have reduced the risk in other countries. There is evidence from observational studies that pool access barriers in private homes can reduce the risk of child drownings by about 75% i,ii.
(Health Gain Notation- "likely to be beneficial")
i. Preventing unintentional injuries in children and young adolescents. Effective Health Care Bulletin. Vol. 2 No. 5. University of York: NHS Centre for Reviews and Dissemination, 1996.
(Type IV evidence - observational studies)
ii. Thompson DC, Rivera FP. The evaluation of the effectiveness of pool fencing to prevent drowning in children. Cochrane Database of Systematic Reviews Cochrane Library 1998, Issue 2.

(Type I evidence - systematic review)
5.1b. No study has assessed the association between the ability to swim and drowning i.
(Health Gain Notation - 4 "unknown")
i. Nieves JL, Fuller L, Buttacavoli M et al. Childhood drowning: Review of the literature and clinical implications. Paediatric Nursing 1996; 22(3): June 1996.
(insufficient data for recommendation)
5.1c. Adult supervision of public swimming pools improves safety. There is observational evidence that lifeguards reduce drownings in public swimming pools i,ii.
(Health Gain Notation - 2 "likely to be beneficial")
i. Health promotion in childhood and young adolescence for the prevention of unintentional injuries. Health Promotion Effectiveness Review - Summary Bulletin 2. Health Education Authority, 1996.
(Type IV evidence - observational studies)
ii. Kemp A, Sibert JR, Drowning and near drowning in children in the United Kingdom: lessons for prevention. British Medical Journal 1992; 304: 1143-6.
(Type IV evidence- observational studies).
5.1d. Avoiding alcohol before water sports will save lives. There is observational evidence of recent alcohol use in 25-50% of drowned persons i.
(Health Gain Notation - 1 "beneficial")
i. Alcohol and aquatic activities - U.S. 1991. Morbidity and Mortality Weekly 1993; 675: 681-683.
(Type IV evidence - observational studies)


5.2 Sports Facilities and Environments
5.2a. Rule changes in contact sports resulting in less axial loading have been associated with reduced cervical spine injuries. The value of rule changes in other situations has not been demonstrated i,ii .
(Health Gain Notation - 2 "likely to be beneficial")
caveat: Following rule changes in American Football which banned tactics involving charging head first, related cervical quadriplegic injuries fell by 85%. There is uncertainty whether rule changes in rugby have, or can, reduce the incidence of spinal cord damage. Further epidemiological studies are required.
i. Torg JS,Vegso JJ, Sennett B et al. The National Football Head and Neck Injury Registry, a 14-year report on cervical quadriplegia, 1971-1984. Journal of the American Medical Association 1985; 254: No.24.
(Type IV evidence - observational studies)
ii. Noakes T, Jakoet I. Spinal cord injuries in rugby union players. British Medical Journal 1995; 310: 1345-1346.
(Type IV evidence - observational studies)
5.2b. There is strong observational evidence that the use of mouthguards during contact sports significantly reduces dental injuries (see Oral Health Bulletini) ii,iii.
(Health Gain Notation- 2 "likely to be beneficial")
i. Health Evidence Bulletins. Health Evidence Bulletins - Wales: Oral Health. Cardiff: Welsh Office, 1998.
(Summaries of evidence classified according to type)
ii. Jennings DC. Injuries sustained by users and non-users of gum shields in local rugby union. British Journal of Sports Medicine 1990; 24: 159-164.
(Type IV evidence - observational studies)
iii. McNutt T, Shannon SW, Wright JT, et al. Oral trauma in adolescent athletes: a study of mouth protectors. Paediatric Dentistry 1989; 11: 209-213.
(Type IV evidence - observational studies)
5.2c. More active encouragement in wearing horse-riding helmets will result in fewer head injuries. Lightweight multipurpose helmets could also be used by children and adolescents in many sports. There is observational evidence that helmets worn by horse riders result in less injuriesi,ii but a formal evaluation of this and other equestrian safety manoeuvres is required. There is also evidence that the introduction of mandatory use of helmets and face masks has reduced head and eye injuries in ice-hockey playersiii.
(Health Gain Notation - 2 "likely to be beneficial")
i. Preventing unintentional injuries in young people. Effective Health Care Bulletin. Vol. 2 No. 5. University of York: NHS Centre for Reviews and Dissemination, 1996.
(Type IV evidence - observational studies)
ii. Watt GM, Finch CF. Preventing equestrian injuries - Locking the stable door. 1996; 22(3): 187-197.
Type IV evidence - observational studies)
iii. Franklin FH,William T, Melton J et al. Ice hockey injuries. American Journal of Sports Medicine 1987; 15(1): 30-40.
(Type IV evidence- observational studies)


5.2d. Polycarbonate eye protectors reduce eye injuries in racket ball and squash. Polycarbonate provides much higher protection than other materials. Such eye protection is mandatory in the military and official championships in the United States i.
(Health Gain Notation-1 "beneficial")
i. Eastbrook M. Eye protection in racket sports. An update. Physician and Sports Medicine 1987; 15(6): 180-192.
(Type V evidence - expert opinion)
5.2e. External ankle supports can prevent about 50% of ankle sprains during sports i.
(Health Gain Notation - 1 "beneficial")

Prophylactic ankle taping reduces ankle sprains in  basketball. ii.
i. Quinn K, Parker P, De Bie R, Rowe B, Handall H. The prevention of ankle ligament injuries. Cochrane Database of Systematic Reviews, Cochrane Library 1998, Issue 2.
(Type 1 evidence- systematic review)
ii. Garrick JG, Requa RK. Role of external support in the prevention of ankle sprains. Medicine and Science in Sports 1973; 5(3): 200-203.
(Type II evidence - randomised controlled trial)
5.2f. A package of preventative measures substantially reduce leg injuries during soccer. There was a 75% reduction in injuries in soccer teams randomly allocated to an intervention which involved enhanced warming up, extended shin guards, and prophylactic ankle taping in players with previous sprains.i It is not clear which aspect of the intervention was the most effective and further research is required.
(Health Gain Notation- 2 "likely to be beneficial")
i. Ekstrand J, Gillquist J, Liljedahl ST. Prevention of soccer injuries - Supervision by doctor and physiotherapist. American Journal of Sports Medicine 1983; 11(3): 116-120.
(Type II evidence - randomised controlled trial)
5.2g. Wrist protectors can prevent the vast majority of wrist fractures among in-line skaters and rollerskaters. In a case-controlled study in America the wearing of wrist guards was associated with a 90% reduction in injuries to the wrist i.
(Health Gain Notation - 2 "likely to be beneficial")
i. Scheiber RA, Branche-Dorsey CM, Ryan GW, Rutherford GW, Stevens JA. Risk factors for injuries from in-line skating and the effectiveness of safety gear. New England Journal of Medicine 1996; 335: 1630-1635.


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