Safety and Preparation for Warm Weather Sports: Part II, Sport-Specific Injury Prevention by Mark B. Levin, M.D. and Louis J. Tesoro, M.D. The Pediatric Group, P.A., Princeton

This is the fifth article in a series written for Princeton Online on summer hazards. Click here for Part I of Safety and Preparation for Warm Weather Sports.

The risk of injury in sports participation varies with the specific sport. Those with the highest rates in the high school age group include football, wrestling and gymnastics. Presumably because of a comparatively smaller bone and muscle mass, adolescent girls have a higher serious injury rate than boys in high school sports, although boys are injured more often. With proper education and preparation any sport can be made safer. You can learn more about preparation and conditioning in our previous article in this series entitled Safety and Preparation for Warm Weather Sports: Part I.

By far, the most common organized summer sport in this country continues to be our national pastime, baseball. With improved practices regarding pitching (having coach pitching for younger children and limiting the number of innings an older child pitches) and catching (protective gear), injuries are less common than in the past. However, even in the major leagues, wild pitches can hit a batter. The younger the pitcher's age, the greater the likelihood of wild pitches. It is no surprise, then, that baseball is the second leading sport to cause eye injuries in the 15 to 24 year old age group (behind basketball), but the leader in children under 14 years old! Batters, at the plate and on the bases, must wear a helmet that is fitted with either a polycarbonate eye shield or a protective cage. The American Academy of Pediatrics Committee on Sports Medicine and Fitness and the American Academy of Ophthalmology Committee on Eye Safety and Sports Ophthalmology also recommend sports goggles with polycarbonate lenses for fielding (two thirds of facial injuries resulting from ball impact are sustained by defensive players who miscatch a hit or thrown ball). This equipment is inexpensive (often less than a baseball mitt and far less than the medical costs of an ocular injury) and readily available.

Boys playing baseball or the ever-popular soccer run the risk of genital injury. A padded cup athletic supporter is a critical piece of equipment, often overlooked by parents of these sports participants. Baseball players and soccer goalies over 10 years old should wear a hard plastic cup supporter. Any sporting goods store and many pharmacies carry these items. All players of both sports would be well advised to wear a mouthguard.

Soccer players are generally otherwise protected by shin guards for all players and hip, thigh and elbow padding for goalies. Soft helmets for soccer goalies, especially in the early years when a child does not yet instinctively know the position of the goal posts, would prevent the rare catastrophic head injury, such as the one that occurred several years ago in northern New Jersey. Unfortunately, these are not readily available. A karate sparring helmet would be an acceptable substitute until a soccer helmet is designed.

Lacrosse is rapidly gaining popularity, especially on the east coast. Boys’ lacrosse, a contact sport, requires substantial protective gear, similar to football. A caged helmet, shoulder pads, padded gloves, rib pads and sometimes hip pads are often provided by the team. The player is usually responsible for his own hard cup athletic supporter and mouth guard. Though permitted in boys’ lacrosse, girls’ lacrosse has penalties for contact and "high-sticking". Unfortunately, parents, coaches and players often labor under the misconception that because these occurrences are against the rules they do not happen. Because girls do not wear helmets, they are subject to a higher frequency of facial injuries than boys. In the absence of rule changes, players of girls’ lacrosse should wear sports goggles with polycarbonate lenses. They should also supply their own mouth guard. Lacrosse gloves, infrequently worn by girls, can provide protection against the finger injuries that are often sustained by lacrosse players. Like lacrosse, the Fall sport of field hockey requires a mouthguard, eye protection and gloves.

Although football is generally considered a Fall sport, many schools begin preseason training at the end of the summer. On hot August days, the grueling double sessions in full uniform can easily cause the heat prostration described in our previous article. Appropriate precautions, as described in that article, must be observed to prevent injury and illness. The more common injuries in football include sprains, cuts, concussions and fractures. Prohibiting "spearing" has reduced, but not eliminated, serious neck injuries that can cause paralysis. Players must be taught proper tackling and blocking techniques and should wear rib pads and foam neck rolls. A mouth guard and a hard cup supporter are mandatory in this sport, as well. There is not yet a satisfactory preventative measure for the frustrating problem of ligament and cartilage injuries of the knee.

While non-contact sports do not as often cause injuries, there are still risks. The tennis player who puts a twist in his or her stroke is as likely as a baseball pitcher to develop tendinitis ("tennis elbow"). Twisted and strained knees are common in tennis. But this sports boasts, along with swimming, one of the lowest rates of serious injury (see our article on The Old Swimming Hole). Tennis players can often avoid even minor injuries with a conscientious program of stretching and conditioning. The ever-present water bottle and rest in a shaded area between matches are as important in tennis as in other warm weather sports.

Competitive (cross country, track) or fitness (jogging) running have common hazards. Overuse syndromes, such as shin splints and tendinitis, are the most common injuries in these athletes. Pre-run hydration, conditioning and stretching are imperative to avoid injury. Preadolescent children should not be running more than 2 to 3 miles at a time and no more than 5 days per week. Running on a rubberized track is best, followed by grass, then asphalt. If running in the street, beware cars. Run toward traffic and know the rules of the road. Mostly, do not run on a road at night. Running on cement sidewalks is a sure way to have leg pain the next day.

Biking has the unique position in the sports world of sharing roads with automobiles. Bikes are required to follow the same traffic rules as cars. Helmets are not only required by law in many states, including New Jersey, they make good common sense. Head injury due to bike accidents are eminently preventable. A bike helmet should be looked upon as essential bicycling equipment--like the wheels, handlebars and seat! Even though New Jersey law only covers children to 14 years old, it is wise for bikers through adulthood to wear head protection. A New Jersey law requiring a helmet for outdoor skating has also recently been enacted. Skaters should not be on the streets and some municipalities have designated skateboard-free areas. See our article on Helmets for more information on brands, costs, proper fit and convincing statistics.

In case of pain, illness or injury, be sure to consult your physician or trainer for proper advice on treatment. Have fun safely.

All Rights Reserved 7/98 The Pediatric Group, P.A.

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Chairman, Department of Pediatrics, Medical Center at Princeton, 1996 to present and Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees, lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.