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Sports-Related Injuries Prevention in High School Research Paper

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Updated: Feb 12th, 2021


Participating in sports and other physical activities for high school students has been perceived as a wonderful way to utilize leisure time by the students. A lot of benefits are derived from taking part in sports such as improvement of the body shape, improvement of personal coordination, and engagement in health competition (Stark and Bowers, 2010; Maffulli, Longo, Spiezia, and Denaro, 2010).

Further, students participating in sports can form enriching relationships with their teammates and instructors. Also, statistics show that every year about 30 million high school teenagers take part in high school sports and according to 1988 research findings of high school sports injuries, an investigation of 1283 student-athletes who participated in various sports suffered a total of 280 injuries for an overall injury rate of 22 percent (McLain and Reynolds, 1989). According to the same research statistics it was found that the majority of injury rate was reported in football at 61 percent which was followed by gymnastics, wrestling, and finally the boy’s basketball (McLain and Reynolds, 1989).

As the number of high school students participating in the sport grows, sustenance of injury is inevitable and an increasing number of students will fall victim to sports-related injuries (Maffulli, Longo, Spiezia, and Denaro, 2010). What is important is for the concerned stakeholders to look for appropriate ways of curbing the high levels of injuries. Numerous ways as to sports injury prevention have been suggested which for some time numerous institutions have employed in their sports injury management strategies.

But one question that still remains in the minds of many people especially key stakeholders in the sector of education is concerned with how well and what excellent strategies can be used to reduce high school sports injuries. Such concerns will guide this research paper through a working thesis statement that argues effective and proper education and training is the best way of preventing high school sports injuries as compared to other initiatives.

Literature Review

The rate of high school youth participation in sport has been rising steadily for the past forty years and in the year between 1998 and 1999, about 6.5 million high school athletes took part in sports (Weaver, Marshall, and Miller, 2002). At the same time estimates from recorded statistics of students participating in high school sporting activities revealed that about 33 percent of high school athletes succumb to injuries during any sports season where the injury becomes severe forcing the student to take some time off in the particular sport (Weaver, Marshall, and Miller, 2002).

According to the National Federation of State High School Associations, during the years 2008 and 2009 about 7.5 million students took part in playing high school sports, and out of this 400,000 suffered concussions (Williams, 2010). Along the way, many health professionals have assumed the role of providing the active and necessary advice on how sports injuries can be avoided specifically among high school students.

Sports-related injuries in high schools

Despite numerous cited benefits of participation in sports by high school students studies conducted shows that those who participate in athletics represent a student population that is at risk of incurring sports-related injuries where high school athletes constitute 2 million cases of injuries, with almost 500,000 doctor visits and another 30,000 cases of hospitalization every year (Morbidity and Mortality Weekly Report, 2006).

According to high school study research in form of surveillance that was carried out by researchers based at Ohio children’s hospital between 2005 and 2006 it was found out that about 1.4 million high school students suffered from injuries as a result of participating in sports which represented a rate of 2.4 injuries per 1000 athlete exposures (Morbidity and Mortality Weekly Report, 2006). During the same period, another study, the High School Sports-Related Injury Surveillance Study was conducted by the Center for Injury Research and Policy specifically at the Columbus Children’s Hospital in Ohio where studies of injuries among major high school sports were carried out.

The sports found to incur high rates of injuries were categorized as baseball, football, and wrestling popularly among boys; softball and volleyball among the girls; and finally basketball and soccer popular for both genders (Morbidity and Mortality Weekly Report, 2006). The overall results showed that the injury rate in all the categorized sports was 2.44 injuries per every 1000 athlete exposures whereby football was found to be the dominating sport in which a lot of injuries occurred at a rate of 4.36 injuries for every 1000 athlete exposure, then was followed by wrestling at a rate of 2.50 and 2.43 for boys and girls respectively; girls’ soccer at 2.36; girls’ basketball at 2.01, while boys’ basketball, volleyball, baseball, and softball both had an injury rate of 2.0 for every 1000 athlete exposures (Morbidity and Mortality Weekly Report, 2006).

Overall, in the nine sports in which injuries were reported, estimates indicated that about 80 percent of the reported injuries constituted new injuries in contrast to recurrences or complications from earlier injuries (Morbidity and Mortality Weekly Report, 2006).

Carrying out another research on high school injuries during the 2008 and 2009 period, the Center for Injury Research and Policy of the Research Institute at Nationwide Children’s Hospital concluded that about 95 percent of high school injuries involved fractures (Anonymous, 2010, par.2). When fracturing took place generally it resulted in, “costly diagnostic imaging, including X-rays, MRIs and CT scans, and 16 percent required surgical repair” (Anonymous, 2010, par.2). Apart from incurring the high cost of medication fractures at the same time were found to result in more time being lost by being out of the competition as compared to other injuries.

For instance, statistics showed that 34 percent of injuries resulted in about three weeks or more being lost out of the competition while another 24 percent of the time was lost due to medical disqualification from participation (Anonymous, 2010, par.3). Describing the severity of fractures Dawn Comstock, a doctor, and researcher at the Center for Injury Research and Policy at Nationwide Children’s Hospital noted that, “fractures are a major concern for U.S. high school athletes, where they can severely affect the athletes’ ability to continue sports participation and can impose substantial medical costs on the injured athlete’s families” (Anonymous, 2010, par.3).

Sports injury prevention initiatives

Abundant research literature exists on high school sports injuries but little similar literature exists on the effective prevention strategies to undertake to avoid high school sports injuries. Much of the recommendations on high school sports injury intervention measures tend to center on the appropriate use of sports equipment and improvement of the physical environment where the sports take place. In other words, most of these interventions operate on the conviction that injuries in high school sports are a result of poor playing environments and lack of protective helmets. Therefore little is done to equip high school students with adequate training and educational programs concerning sports injuries which on aggregate can be the best mechanisms for tackling high school sports injuries.

Renstrom and IOC Medical Commission observe that there are five major types of preventive interventions that are normally exercised in sports. The interventions include rules or policy change, equipment, education, exercise, and preparticipation evaluation (Renstrom and IOC Medical Commission, 1994). At the same time, effective sports injury prevention programs have been composed of injury surveillance systems.

The system usually functions through a systematic process of monitoring and categorizing sports injuries by injury site, severity, and factors related to the injury which may include player position, stage in the game, or practice (Renstrom and IOC Medical Commission, 1994). Injury surveillance systems have been seen to be important in sports that exhibit high risks of death or catastrophic injury to the head or spine (Renstrom and IOC Medical Commission, 1994) mostly involves body contact sports.

Christoffel and Gallagher (1999) argue that numerous studies in form of researches that have been undertaken suggest that altering certain sports rules with aim of discouraging particular dangerous practices; requiring protective equipment and ability grouping can reduce the occurrence of sports injuries. At the same time the author postulate and salute the role of medicine in sports injury prevention by noting that medicine can oversee conditioning practices and ensure adequate emergence response when injuries take place (Christoffel and Gallagher, 1999).

Liller (2006) argues that interventions can be categorized into three main groups that include: behavioral, environmental, and policy. Behavioral interventions constitute those that involve those participating in sports to make necessary changes with the aim of decreasing risks. Such changes may include improving the conditioning, wearing protective gear appropriately, and always choosing activities or locations that are safer to minimize risks of injuries (Liller, 2006).

On the other hand, environmental interventions include all those activities that are aimed at altering the environment in which those students taking part in the sport operate. This may include for example improving field conditions, building bike paths, or removing the obstacles that are found in areas of play (Liller, 2006). Lastly, the policy changes generally involve broad changes that aim to reduce injury risks and these policy changes may be limited to a specific and particular team, group, or school (Liller, 2006).

Behavioral interventions

Accordingly, the author argues that behavioral interventions normally occur at the individual level and those participating in various sports can decide to adopt them or not. These interventions always become effective specifically when the decision-making process is influenced by key stakeholders such as the parents, coaches, social norms, education campaigns, policies, and legislations. Other proven behavioral interventions include the use of certain protective equipment and this is effective in recreational activities or other unorganized sporting activities where relevant policies and regulations may be absent.

Most sports with an organized component have recommended or require protective gear where the encouragement is that those participating in sports should be encouraged to wear. The gear in its capacity and functionality should be relevant to the sport and player position, kept in good condition, fit the player correctly, and used consistently (Liller, 2006). In the same measure behavioral intervention has constantly encouraged skill training which has evolved to become an important aspect of injury prevention. For example, researchers have found out that football coaches who instruct in proper technique, are older, have advanced degrees, have collegiate playing experience, and are assisted by assistant coaches, their teams have been found to have lower injury rates (Liller, 2006).

Environmental interventions

The author argues that environmental interventions result in a decrease in injuries by changing how a participant encounters his or her surroundings. Environmental interventions have been found to reduce injuries in organized sports for instance break-away bases are effective in reducing sliding injuries in male and female athletes at the recreational, collegiate, and professional levels (Liller, 2006).

Other necessary interventions include ensuring that the playing fields and courts are free from holes, obstacles, or other tripping hazards; ensuring that goal posts are padded and secured and providing a space between the legal field of play and seats, bleachers, fences, walls, and other obstacles. Further strict refereeing is important to ensure compliance with rules developed to decrease injuries. Studies that have been done in football have indicated the benefits and important role of rules in preventing spearing, face tackling, and butt blocking, and in hockey, studies show that prevention of checking from behind and many players, coaches, and spectators are always encouraged to ensure strict adherence to rules of fair play.

Other environmental interventions are related to heat-illness prevention especially when the play environment is regarded as hot or to be humid. For example, among US high school athletes, heat illness has been rated as the third most leading cause of death and any systematic gradual acclimation to hot or humid environments can result in a reduction of the effects. Therefore there has been an emphasis on attention to hydration and appropriate dressing. Lastly, importance has been attached to the need to alter or cancel practice or participation in high-risk conditions where organized sporting schools and other groups need to develop necessary guidelines for practices and competitions under high-risk conditions (Liller, 2006).

Policy and legislation interventions

Policy and legislation have been identified to aid in ensuring particular groups’ schools included conform to injury prevention recommendations without any flouting. The policy formulation occurs at different levels where appropriate rules and policies are implemented and require participating with recreational teams and activities to comprehensive legislation requiring certain specific behaviors under penalty of law ().

In essence injury prevention policies and legislation are powerful tools to change the social norm regarding injury prevention behaviors. Further studies have shown that policy and legislative actions should be accompanied by education and enforcement. Also, it has been found that state and local legislative mandates, school and community are important where currently about 99 percent of high schools have policies in place regarding the appropriate use of gear in interscholastic sports and activities while another 79 percent of middle schools and 86 percent of high schools have the same policies that largely cover similar sports when played in a physical education class (Liller, 2006).

Examination of sports injury data has been vital in the successful formulation and implementation of policies whereby rules sometimes have been changed and necessary age-appropriate limitations instituted. Such rule limitations propagated by policy and legislative requirements include the elimination of spearing, clipping, and grabbing the facemask in football, rear checking in hockey, age limitations on heading in soccer and checking in hockey, and restrictions on pyramid height and certain stunts in competitive cheerleading (Liller, 2006). Lastly, there is a need for consistent and rigorous examination of injury information and research into circumstances of common and severe injuries which is vital in informing future decisions regarding rules and changes.

Education and Training programs to reduce sports injuries

The American College of Sports Medicine has maintained that “up to one-half of all injuries that are sustained by children and adolescents while playing organized sports are likely preventable” (Gullotta and Bloom, 2003, p.625). Thus observation made is that injury and re-injury prevention should be an integral feature of school sports and physical education programs and students should perceive the programs to be intrinsic components that largely seek to improve their physical well-being. Education has been regarded as the primary prevention strategy of high school sports injuries whereby it has been regarded to constitute capabilities of reducing the occurrences of injury-producing events.

Education programs are perceived to be a logical and direct way approach to injury problems whereby providing necessary instructions to high school students of what they are required to do in case a particular sport seems to possess risks is important in ensuring injuries are detected and prevented in advance. Further researches have indicated that to be effective in functional education programs for sports injury prevention must result in permanent, fundamental changes in children’s behaviors (Gullotta and Bloom, 2003).

According to Gullotta and Bloom (2003), they assert that sports injury prevention has effectively been carried out using education programs where these programs largely appeal to young people and in essence are inexpensive while at the same time able to reach a large group of students. Analyzing the role of education in reducing the effects of concussion in high school students, Hyde and Gengenbach, (2007) observed that education is an important injury prevention strategy and that effective education for instance may contribute a positive role in dissuading an athlete from returning to play too soon (Hyde and Gengenbach, 2007).

For example, in a study carried out by Kant and colleagues, they found out that more than 25 percent of athletes continue to participate in sports activities while still experiencing symptoms of concussion (Hyde and Gengenbach, 2007). Accordingly, the majority of these athletes were unaware of the symptoms related to concussions. The recommendations made by Kant and his team was that athletes, coaches, health care providers, and family members of high school athletes need to be trained to identify the signs and symptoms related to concussion. It is important to educate coaches, trainers, athletes, and other relevant officials concerning the dangers of improper and hazardous techniques of playing and which may result in injury (Hyde and Gengenbach, 2007).

At the same time, Kant and the group, reveal that numerous educational strategies aimed at preventing high school sports injuries exist that also include videos and Web-based resources (Hyde and Gengenbach, 2007), where again a thorough and comprehensive explanation of the sport along with the possibility of injury, should be rendered to players together with their parents before the athletes begin to play.

At the same time, numerous continuing research is underway that aims at investigating the effectiveness of educational interventions strategies in reducing head injuries and one such program that is becoming effective is the ThinkFirst Canada Smart Hockey program which has shown that sports participants increase their knowledge related capacity about concussion especially about body checking-related penalties among the players who took part in the program as compared to control subjects (Hyde and Gengenbach, 2007).

Effective training has also evolved as a strategy being emphasized by sports experts to contribute to the reduction of sports injuries. One such effective training program is the Proprioceptive Neuromuscular Training which was first carried out in Germany and findings showed that it was the effective training approach responsible for preventing sports injuries (Chiro Access, 2010, p.1). According to the study conclusion,” based on the results of seven high-quality studies, this review showed evidence for the effectiveness of sports injuries among adolescent and young adult athletes during pivoting sports” (Chiro Access, 2010, p.1).

In accordance pivoting sports comprises basketball, hockey, handball, volleyball, soccer, and floorball. The article asserts that “multiple high-quality studies now support the use of training programs to improve proprioception and the research further supports that this proprioceptive improvement translates to a reduced risk of sports-associated injuries” (Chiro Access, 2010, p.1). The benefits of the program have been found to work more adequately among high school sports participants with a history of sports injury (Chiro Access, 2010, p.1).

The article summarizes his observation of this training program by concluding that, “the proprioception neuromuscular training programs varied but included strategies using balance platform devices, wobble boards, single-leg stance, stretching, core stability exercises, plyometrics, strength training, and agility training” (Chiro Access, 2010, p.1). At the same time suggestions have been made for the incorporation of effective training exercise programs that in turn are seen to be able to contribute to the reduction of sports injuries. According to this published article,

“exercises that help develop neuromuscular control and increase functional joint stability are critical in conditioning and programs designed for injury prevention in sports where at the same time information regarding joint movement and joint position provided by the skin, muscles, tendons, ligaments, and joints should be taught to high school students where a further combination training manual to be taught to the students regarding joint input from the vestibular and visual systems to maintain neurologic input or improperly processing that input at the spinal, brain stem, or cognitive centers” (Chiro Access, 2010, p.1).

Education in high school sports injury prevention has also been favored as many stakeholders believe that sport and exercise education is relevant in informing the widest possible sports audience of how well to understand sports performance, causes of injuries, injury prevention strategies, sport and exercise equipment, and the physical effects of the environment in which sporting activities takes place. This kind of education at the same time can benefit a wide group of people including coaches, and performers at all standards, teachers, medical and paramedical practitioners, exercise and health professionals, leisure organizers and providers, national governing body administrators,s and also the media.

In hockey, for instance, the availability of an education and training program known as, Heads Up Hockey’ has resulted in tremendous results in preventing injuries. The program is largely designed to provide information to both players and coaches on how to reduce the risk of head and neck injuries (Castaldi et al., 1989). The program has been structured into five sections that address: head injuries are preventable and how spinal cord and head injuries occur in hockey, incorporating Heads Up Hockey into the game, through practice, protective hockey equipment, getting the team in shape, and what to do in a player gets hurt (Castaldi et al., 1989).

Drawing from the same experience Canadian schools are first adopting the Canadian Hockey Safety Program, which puts more emphasis on injury prevention and safety through risk management and education. The objectives of the program are to provide injury prevention education and training goals to every team through a qualified Safety Person and who in particular works with players in the field ensuring the safety of the players (Castaldi et al., 1989).

The program provides training opportunities to Course Conductors who in turn train their local team Safety Persons based in schools and later bring the messages and education directly to the players. Safety Persons receive diverse training in numerous issues that include: Emergence Action, Risk Management, Abuse and Harassment, Protective Equipment, and Injury Prevention Techniques (Castaldi et al., 1989).

The role of an education program in preventing sports injury

Doll and Haas (2008) noted that schools constitute an ideal place where teaching and advocating for safer behaviors in sports for youth can take place. Most education programs that have been designed with aim of addressing sports injuries in schools have been designed based on safe physical education, sports, and other related recreational activities, that further include actions schools are supposed to take to develop, teach, implement, and enforce safety rules in spots (Doll and Haas, 2008).

Therefore, the basic question that enthralls many policymakers and stakeholders is how well should a school education program for sports injury prevention strategies look like? Answer to this question needs consideration of multivariate factors that join together to influence the possibilities of specific or particular sports resulting in injuries among the high school students.

In essence, an effective education program should be able to: develop, teach, implement and enforce safety rules; promote unintentional injury prevention and nonviolence through physical education and physical activity program participation; promote knowledge know-how of ensuring that spaces and facilities for physical activity meet or exceed recommended safety standards for design, installation, and maintenance; suggest the need to hire physical education teachers, coaches, athlete trainers, and other physical activity program staff members who are trained in injury prevention, first aid, and CPR and provide them with ongoing staff development (Doll and Haas, 2008).

Further, the education and training program should be able to accomplish the following features: require a physical assessment before participation; provide developmentally appropriate activities to the students; ensure the students and other stakeholders have adequate training in proper conditioning; provide student instruction regarding numerous sports injuries; provide adequate information and instruction about appropriate match participants according to size and ability; provide a conducive training environment for students to adapt more quickly to the rules of sports and how well to use protective equipment; modify rules to eliminate unsafe practices; ensure that injuries including concussions are healed before allowing further participation; establishing criteria, including clearance by a health care provider, for reentering play after an injury; and lastly should avoid excesses in training (Doll and Haas, 2008).

Lastly, the authors observe that training of high school sports participants should be the principal initiative undertaken to ensure cases of sports-related injuries are reduced. And to facilitate effective sports training there is a need for the training to be well planned since some studies have shown that overtraining increases the likelihood of injury occurring and less improvement in performance is noted (Doll and Haas, 2008). Specific training programs have been identified to be particularly beneficial in improving balance, flexibility, strength, and neuromuscular control.


To reduce most high school sports injuries it has been suggested that there is a need for modification of personal behaviors and related environmental conditions. Further, more protection of these injuries has resulted from the appropriate use of protective gear during the play while helmets have become effective in providing protection in sports activities that involves cycling, in-line skating, skateboarding, horseback riding, and other winter sports.

This does not end here for at the same time appropriate physical fitness and conditioning have been discovered to be another important factor in sports injury prevention. Nevertheless, on a large scale, high school students participating in different kinds of sports have been urged to undertake effective training in their particular chosen activities and avoid taking part in those sports activities they are not well prepared for.

Advocacy for better and improved safety measures in high school sports and other recreational activities continues to heighten where incorporation of both key stakeholders of schools, parents, students, community, and the government has become vital. All these efforts are aimed at formulating and implementing what can be regarded as effective safety measures for high school sports. The paramount concern for these various advocacy groups should be to articulate the need for schools and other key stakeholders to recognize the importance of education and training programs in curbing sports-related injuries.

Through education sports-students, parents, teachers, coaches, and other sports instructors will be empowered to have adequate and beneficial knowledge with concern to sports; sports rules, policies and legislation; sports injuries; and how well to address the sports injuries in their pre and post-state. Training will further ensure that students participating in various sports are fit enough to live up to the challenges of the sport they are taking part in.


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