Cost of Sports Injuries

Cost of Sports Injuries 
Prepared by  Prepared by: Dr Ralph Richards, Senior Research Consultant, Clearinghouse for Sport, Sport Australia (formerly Australian Sports Commission)
evaluated by  Evaluation by: Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Dr Alex Donaldson, Senior Research Fellow
Reviewed by  Reviewed by network: Australian Sport Information Network (AUSPIN)
Last updated  Last updated: 12 November 2018
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Introduction

Increasing daily physical activity and decreasing sedentary behaviour has many individual and societal benefits. Maintaining an acceptable level of physical activity is linked to a reduction in several risk factors that predict the onset or severity of disease.  Improving the health of the Australian population offers potential saving in future Government health care spending, as well as current and ongoing improvement in the quality of life.

Increasing participation in physical activity and sport, within and across all segments of the population, is a key policy objective of Governments. However, physical activity and sport participation will always carry a risk of acquiring activity related injuries.

The immediate and long-term ‘cost’ of sports related injuries results from:

  • Health care costs for treatment.
  • Health system costs for insurance.
  • Time and productivity lost to employment, school, and home activities.
  • Time lost to future sporting activities.
  • The cost of long-term physical, psychological or emotional damage.
  • Equipment and program costs for rehabilitation and prevention.

However, the immediate and long-term ‘cost’ of inactivity, or insufficient physical activity to stimulate health benefits, has a greater impact upon individuals as well as population-wide health and wellbeing.


Key Messages 

1

The significant cost of sports injuries in Australia must be balanced against the long-term cost-benefit of a healthier population from greater lifelong participation in physical activity and sport.

2

The sport and health-care sectors can reduce the incidence and severity of many sports injuries by implementing appropriate (evidence based) policies, programs and intervention strategies.

3

A comprehensive sports injury surveillance system would provide valuable information for the development of policies and programs designed to reduce injury risks.


The weight of evidence supporting the benefits of physical activity (including sport and active recreation) is substantial. The risk of injury associated with physical activity is real, but can be better managed by: (1) education regarding what is ‘safe practice’; (2) relevant data collection and research to more accurately assess risks and develop mediating strategies; (3) implementation of strategies and programs at all levels of organised sport, and (4) public awareness of the benefits and risks of physical activity, particularly during unsupervised activities.

Problems arise in assessing the true ‘cost’ of sports injuries because not enough is known about the social and personal cost (mental wellbeing) of sports injury. The available evidence concentrates on the clinical and remedial costs of injury treatment and recovery.

The overall cost of injuries sustained during physical activity or sport must also be balanced against the potential benefits and cost savings in future health care expenditure. Comparisons are not simple or straightforward and available data for the ‘injury’ side of the equation is not comprehensive. No standard national sports injury surveillance system exists in Australia. Data is available on the incidence of hospital emergency treatments, but there are limitations in extracting data related to sports and recreational activity. Projects in Victoria, Queensland and Western Australia have added to our knowledge of the incidence and type of sport related injury and these sources are often used as a basis for national estimates.

  • Better data reporting will prevent sports injuries and deaths, Finch C, The Conversation, 11 December 2014. How common are deaths and other injuries? What causes those injuries and what can be done to prevent them? We don’t really know because Australia has no national, or even state-based, monitoring of sports injuries. Sports injury surveillance is the crucial first stage in prevention. We need timely data on what injuries occur, to whom and how often, to indicate which sports people and injury types should be prioritised for prevention. We also need robust information about what caused those injuries to fully understand how to prevent them and identify effective preventive solutions.

The Australian Bureau of Statistics (ABS) and the Australian Institute of Health and Welfare (AIHW) provide data on the incidence of injury, but these reports acknowledge difficulties in specifically identifying the cause(s) of injury and isolating ‘physical activity or sport’ as the primary reason, as opposed to injuries resulting from other pursuits or in other contexts. Various estimates of sport related injuries range from 8% to 16% of all reported injuries, with age and gender being important considerations. 

  • Trends in hospitalised injury, Australia: 1999-00 to 2012-13, Australian Institute of Health and Welfare (2015). This report shows that the rate of injury hospitalised cases in Australia rose from 1999–00 to 2012–13 by an average of 1% per year. In 2012–13, case numbers and rates were higher for males than females for all age groups, up to 60–64 years.

The National Health Survey also estimates that more than half a million persons may carry a long-term condition as a result of a sport or exercise related injury. This represents 24% of all persons affected by long-term conditions. Physical activity injury figures reported in 2001 were similar to work related injury statistics for back pain and joint injuries. [source: National Health Survey: Injuries, Australia, 2001, Australian Bureau of Statistics, Catalogue Number 4384.0 (2001)]

More recent statistics on the incidence of sports injury requiring hospital treatment are reported by the Australian Institute of Health and Welfare, the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) and the Day of Difference Foundation/University of Sydney.

  • A 10-year review of the characteristics and health outcomes of injury-related hospitalisations of children in Australia (PDF  - 1.4 MB). Mitchell R, Curtis K, Foster K., Day of Difference Foundation/University of Sydney, (5 May 2017). A retrospective epidemiological analysis of injury-related hospitalisations involving children aged 16 years or less in Australia during the financial years 1 July 2002 to 30 June 2012 was conducted. Linked hospitalisation and mortality records were used to describe the characteristics of injury hospitalisations. Overall the results indicated that: 
    • 1 in 4 (24.5%) of incidents happened at home. 
    • 8.6% of incidents occurred at sports and athletics areas. 
    • Sporting activities (19.0%) were the most common specified activity performed at the time of the incident. 
    • The data did not indicate whether or not sporting injury incidents occurred at organised (i.e. sports clubs) or unorganised/social (backyard cricket, swimming at the beach etc.) activities. It also did not indicate the principal nature, location, or severity of sporting activity related injuries. 
    • The authors called for strong federal government leadership to create a coordinated evidence-based national response to child injury prevention and the development of a national multi-sectorial evidence-informed childhood injury prevention strategy with defined actions and key performance indicators.
  • Kidsafe WA Childhood Injury Bulletin Research Report: Sporting Injuries (PDF  - 1.0 MB), Kays, A, McKenna, J, Skarin, D., Kidsafe WA, (April 2018). This research report provides a summary of the Injury Surveillance System data collected at Princess Margaret Hospital for Children (PMH) in Perth, Australia,  between July 2007 and June 2017 relating to childhood sporting injuries. Over the 10 year period 39,541 children presented to the PMH emergency department with what was classified as a sports related injury. However, quite a few of these would appear to be related to general physical activity or active transport (e.g. cycling, trampolining, scootering) rather than organised sports activity. However, of the sport specific results: 
    • Australian Rules Football accounted for the most sport-related injuries at 12.6% followed by: soccer 9%, basketball 6.8%, netball 4.6%, rugby 4.2%, cricket 1.4%, hockey 1.3%, and ice skating 1.2%
    • The percentage of injuries from other activities included: cycling 12.6%, trampoline 11.6%, scootering 6.8%, skate boarding 5.8%, swimming 3.7%, motocycling 2.1%The most common location for a sporting injury to occur is ‘other place’ (52.1%, n=20,590) referring to an unspecified location or one that does not fit within another category. Following this is the home (11.6%), school or residential institution (10.9%), and sports area (10.2%) locations.
    • The data did not indicate whether or not sporting injury incidents occurred at organised (i.e. sports clubs) or unorganised/social (backyard cricket, swimming at the beach etc.) activities. 
    • The majority of injuries were classified as semi-urgent (76.5%) or urgent (20.3%), with small numbers of injuries being classified as emergency (2.6%), requiring resuscitation (0.4%), or non-urgent (0.2%). It also did not indicate the principal nature, location, or severity of sporting activity related injuries. 
  • Australian sports injury hospitalisations 2011-12, Kreisfeld R, Harrison J and Pointer S, Injury Research and Statistics Series Number 92, AIHW Catalogue Number INJCAT 168, Australian Institute of Health and Welfare (2014). During 2011-12, over 36,000 people aged 15 and over were hospitalised as the result of an injury sustained while playing sport, spending a total of 79,000 days in hospital, though these numbers are likely to represent a significant underestimate of sporting injuries. This figure represented 8% of all injury hospitalisations during that period of time. Around two thirds of those admitted to hospital for a sport related injury were under 35 years of age, and over three quarters were men. This report includes two types of measures of sport related injury: one based on rates of injury within the total population; and another on rates of injury within the population participating in a particular sport. The first statistic enables comparisons between parts of the Australian population that differ in size, such as age groups by sex. However, since risk factors differ among sports, the second comparison provides a better indication of the risk of hospitalisation for participants in a particular sport. The data indicates that around one-third of all sports injury hospitalisations were associated with playing various codes of football. A large number of hospitalisations were also associated with motor sports and water sports. Motor sports, water sports and football taken together accounted for nearly half (47%) of all sports injury hospitalisations. Australian Rules football and soccer had the highest population-based age-standardised rates of injury hospitalisation (18 and 17 cases per 100,000 population, respectively). The highest rate of hospitalisation based on the number of participants in a sport was for wheeled motor sports (3,574 per 100,000 participants), roller sports (2,305 per 100,000), Australian Rules football (1,319 per 100,000) and rugby (1,292 per 100,000). Injury while cycling was also common (8% of cases), although cycling as a sport is not well distinguished from cycling for other reasons (active transport and recreation) in the hospitalisations data. Three sports presented risks of life-threatening injury – motor sports, cycling, and equestrian activities.
  • Rural v Metro: Geographical differences in sports injury hospital admissions across Victoria, Shee A, Clapperton A and Finch C, Medical Journal of Australia, Volume 203, Number 7 (2015). Recent state-wide data from Victoria show that the public health burden of sports injury, as a particular context for hospitalised injury, has increased significantly. Understanding whether sports injury rates vary by geographic regions in Victoria would inform better health service delivery to redress identified health inequalities across regions and target prevention programs. This study analysed hospital admission data in Victoria from 2003-04 to 2011-12. The cases selected had a principal diagnosis of injury and an activity code indicating sport. The overall annual number of sports injury-related hospital admissions increased by 34% (8,092 to 11,359) during this period. For every year, the population-adjusted rate of sports injury hospital admissions was higher for people residing in rural/regional local government areas than in metropolitan areas. These findings have implications for strategic planning around availability of trained staff in rural/regional health services to meet the demands for sports injuries requiring hospital treatment. There is a need for further research to determine how injury occurrence may be linked to residential location.

Australian sports participation peaks during childhood and youth, and these age groups are also associated with certain injury risks. Injuries occurring in-and-around water; injuries involving thermal stress; injuries from falls; and overuse injuries are all more likely to affect young people – and these age groups are also more likely to participate in organised sport activities.

  • Hospitalised injury in children and young people 2011-12, Pointer S, Injury Research and Statistics Series Number 91, AIHW Catalogue Number INJCAT 167, Australian Institute of Health and Welfare (2014). This report provides information about the incidence of hospitalised injury in Australian children and young people, aged 0 to 24 years. Hospital information collected includes: length of stay; threat to life; nature of injury; body region injured; causes of injury; place of injury; activity at the time of injury; location of usual residence, and; Aboriginal and Torres Strait Islander identity. Data is presented by age-groups: infants (less than 12 months); early childhood (1-4 years); middle childhood (5-9 years); late childhood (10-14 years); adolescence (15-17 years), and; young adulthood (18-24 years). General findings indicate the overall rate of hospitalised injury was 1,785 per 100,000 population and the highest rate was among males 18-24 years of age, at 3,298 per 100,000. Rates of injury were higher in rural and remote areas and for Aboriginal and Torres Strait Islander children and young people. Falls, commonly from playground equipment, and drowning were significant risk factors during early childhood. Falls from climbing apparatus were common during middle childhood. Unintentional transport injury (bicycle, skateboard, etc.) during late childhood and motor vehicle injury among young adults were common risks for those age groups. Age and risk of certain types of injury are more closely linked at certain periods of life – for example, early childhood or young adulthood; organised sport participation also peeks at these ages.
  • Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine (PDF  - 240 KB), DiFiori J, Benjamin H, Brenner J, Gregory A, Jayanthi N, Landry G and Luke A, Clinical Journal of Sport Medicine, Volume 24 (2014). This position statement provides a systematic, evidenced-based review to assist clinicians in identifying young athletes at risk of overuse injury. The review also delineates the risk factors that are associated with skeletal immaturity; describes specific high-risk overuse injuries; summarises the risk factors and the symptoms associated with burnout in young athletes, and; provides recommendations on injury prevention. 

More information can be found in the Clearinghouse for Sport portfolios, Water and Snow Safety, Heat Illness in Sport and Exercise, and Sports Concussion and Head Trauma.

Sport related injury within the Victorian Injury Surveillance System data for all unintentional injuries, accounts for about 10% of all hospital admissions and 11% of emergency department treatments.

This report cautions that coding for hospital admissions within the reporting system is poor, as 62% of admissions are identified as ‘unspecified’. Within age groups there are considerable differences in the rate of reported sport related injury; the 0-14 year age group reported 11%, the 15-24 age group 21% and the 25-64 age group 6%. These figures are also influenced by the rate of participation within a sport and whether a sport is associated with significant injury risks.

These reports highlight the fact that many sport injuries are predictable events that can be prevented or better managed. Like other public health and safety concerns; such as sun exposure, water safety, or road traffic safety; sports injury prevention requires greater public awareness and ongoing attention to reduction strategies on many levels. The number of hospital presentations for sports injuries in Victoria, particularly among children under the age of 15 years, is now approximately the same as for road traffic injuries.

Using data collected from Victorian hospital emergency department presentations during 2002-2010, it’s estimated that the annual impact of sports injuries is between $1.65 and $2 billion in Australia. In addition, there is a personal ‘cost’ of sport injuries that is hard to measure. Injuries are a significant reason for dropout (i.e. non-participation in sport) each year, and this impacts upon lifelong physical activity habits. The Victorian Taskforce’s report estimates that in Victoria alone, approximately 4,500 participants are lost to sport each year as a result of injury in five major sports: Australian Football, Basketball, Cricket, Football (soccer), and Netball. Comprehensive injury prevention strategies may help to reduce this figure.

Injury statistics nationally appear to be similar to state-based statistics. A variety of factors have been identified which may increase a person's risk of being injured; these include age, sex, alcohol use, residence location (rural, regional or metropolitan), ethnicity, socio-economic status and occupation.

  • Injury: Extracted from various AIHW reports, Australian Institute of Health and Welfare (2014). This summary report extracts data from other AIHW reports. Injury can cause a range of physical, cognitive and psychological disabilities that may seriously affect the quality of life of individuals and their families. Overall, where the type of activity causing an injury was specified, 10.2% were attributed to playing sports and 6.3% to a work environment. The pattern of injury varied between males and females and by age group, with young males more likely to be injured in sport than females. [source: Hospital separations due to injury and poisoning, Australia 2005-06, AIHW (2010)]

More information about sport participation statistics can be found in the Clearinghouse for Sport portfolio, Sport Participation in Australia.

Australia’s Health 2014 is the fourteenth biennial health report published by the Australian Institute of Health and Welfare. This report identifies risk factors to health and wellbeing as having biomedical, environmental, genetic, demographic, or behavioural origins.

The report states that almost all Australians aged 15 and over had at least one risk factor associated with health; such as not getting enough physical activity or not eating enough vegetables. Comparisons with other economically developed countries show that Australia has one of the highest rates of obesity among both adults and children.

More information can be found in the Clearinghouse for Sport portfolio, Childhood Obesity.

Australia's health care expenditure continues to rise and is now estimated at 9.5% of gross domestic product (GDP). It’s also estimated that the cost of obesity in Australia, not including liabilities due to overweight, is $8.3 billion. Cardiovascular diseases, also related to overweight and sedentary lifestyle, accounted for a further $7.9 billion in health care costs.

Various estimates have been made regarding the potential ‘savings’ in population health care costs that would result from incremental decreases in behavioural health risks, particularly risks associated with overweight, obesity, and physical inactivity. Health promotion programs in Australia are built around the reduction of one or more behavioural risk factors. Participation in sport, active recreation, and physical activity programs is known to have a positive influence on a number of risk factors associated with the onset or severity of many diseases. It is well documented that regular physical activity contributes to a healthier lifestyle.

  • Australia: the Healthiest Country by 2020 (PDF  - 836 KB), Australian Government, National Preventative Health Taskforce (2008). This document outlines the Federal Government’s health strategy. Obesity and cardiovascular disease are health concerns that are prominent in the long-term estimates for health care expenditure. Several strategies have been shown to reduce the risk of overweight related diseases through basic lifestyle changes, including an increase in daily physical activity.

More information can be found in the Clearinghouse for Sport portfolio, Preventive Health, Sport and Physical Activity.

In 1990 the estimated annual cost of sports injury in Australia was approximately $1 billion, and this estimate does not appear to have been substantially reviewed or updated regularly. Successive Federal Ministers for the Health portfolio have emphasized that, 'Accidents and injuries put unnecessary pressure on hospitals' [source: 1998 Press Release]. Determining an accurate current estimate of the cost of sports injuries remains problematic.

Nevertheless, accepting the Victorian estimate of the national cost of sports injuries at $2 billion annually, and recognising that even this figure may be understated, the net cost-benefit of a healthier population (i.e. due in part to increased participation in physical activity and sport) is substantial. The preventive health benefits of increased physical activity and reduced sedentary behaviour across the population, and particularly within ‘at risk’ segments of the population, appear to be many times the estimated cost of sports injuries.

More information can be found in the Clearinghouse for Sport portfolios, Childhood Obesity, Preventive Health, Sport and Physical Activity, and Active Transport

The dearth of detailed and up-to-date information on the true cost of sports injuries has thus far hampered efforts to establish more comprehensive sports injury prevention measures. Furthermore, building the case for increased expenditure on injury prevention programs becomes more difficult if we do not know the full extent and impact of sports injuries. The leverage that can be applied to governments and sporting organisations to address perceived or identified problems on a national basis will require a system-wide approach.

  • Sports Injury Surveillance Systems: A review of methods and data quality (abstract), Ekegren C, Gabbe B and Finch C, Sports Medicine, published online (30 September 2015). This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness. The literature search found a total of 15 sports injury surveillance systems; most of these systems existed within professional and elite sports settings. Validation of system data was undertaken by only four systems. This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings

A recent report by Victoria’s Sport Injury Prevention Taskforce provides insight on what can be done to improve awareness/education and program/policy implementation.

  • Sports Injury Prevention Taskforce, final report (PDF  - 1.8 MB), Government of Victoria, Department of Transport, Planning and Local Infrastructure (March 2013). The Victorian Government’s Sport Injury Prevention Taskforce released a comprehensive report that examines the sports injury related barriers that prevent people from leading a more active lifestyle. The report provides advice on improving risk management strategies and sports injury prevention and recommends that five key strategies be implemented: (1) build public and sport sector awareness and increase acceptance of how injury prevention and management positively impact on performance and participation; (2) support coaches by implementing a more systemic approach to injury prevention and management; (3) utilise the role and influence of coaches to build a positive culture around sports injury prevention and the management of injuries to increase participation and improve performance; (4) ensure sports injury prevention is actively supported by policies and practices, reward and recognition systems, and; (5) use facility lease agreements and future funding guidelines to influence improvements in medical emergency preparedness and sports injury prevention, planning, and practice. 

Australian Centre for Research into Injury in Sport and its Prevention (ACRISP). ACRISP conducts research across a range of sports, sports injuries, and injury prevention projects. The aim of this research is to ensure that sport and physical activity is safe, with minimal risk of injury. ACRISP is recognised as the leading sports injury prevention research centre in Australia and is one of nine such centres internationally to be recognised by the International Olympic Committee (IOC) and is a member of the IOC Medical Research Network.

Victorian Injury Surveillance Unit, Monash University. The Victorian Injury Surveillance Unit (VISU) has been analysing, interpreting and disseminating data on injury deaths, hospital admissions and emergency department presentations across Victoria, nationally and internationally for more than 20 years. The VISU provides quality injury surveillance data having immense research potential to governments, sporting organisations, health organisations, education institutions, and research groups for the development of effective injury prevention and safety promotion.

  • Victorian Injury Surveillance System (PDF  - 39 KB), Service Standards and Guidelines (2008). This document outlines the scope of its research activities, which include: (1) identify and describe injury issues and emerging problems; (2) monitor injury trends in the population by gender, age, and cause; (3) identify priorities for prevention and countermeasures to injury; (4) support policy developments, planning and evaluation of injury prevention programs, and; (5) generate research hypotheses. The system was introduced as an initiative of the Victorian Health Promotion Foundation (VicHealth).

New South Wales Injury Risk Management Research Centre (IRMC). This is an independent research centre of the University of New South Wales that collaborates with the University’s faculties of Engineering, Medicine, and Science to develop research and inter-disciplinary links. The IRMC is recognised as an expert source of information on risk management.

Queensland Injury Surveillance Unit. Since 1988 the Queensland Injury Surveillance Unit (QISU) has continuously collected urban injury data from seven hospitals located in Brisbane's south side as well as periodically collecting rural data. In 1998 QISU expanded and upgraded its surveillance activity to collect data from 17 hospitals in Queensland from four sample regions: metropolitan (Brisbane); regional (Mackay and Moranbah Health Districts), tropical northern coast (Atherton, Mareeba, Tully and Innisfail), and remote (Mt Isa). Sports injury data is only part of the information collected by the QISU. The QISU issues media releases and reports on topics of interest.

Western Australia Data Linkage System. The WA Data Linkage System was established in 1995 to connect all available health related information for the WA population. Information has been used for health and medical research in WA and the System's activities are now coordinated, a collaborative partnership exists between the Department of Health Western Australia, the University of Western Australia, the Telethon Institute for Child Health Research, and Curtin University.

  • Injury in Western Australia: A review of best practice, stakeholder activity, legislation and recommendations for selected injury areas (PDF  - 529 KB), Arena G, Cordova S, Gavin A, Palamara P and Rimajova M,Government of Western Australia, Department of Health, Injury Research Centre, section 5 ‘Falls in Children’ (2002) - Children in the 5 to 9 years age-group and the 10 to 14 years age-group have similar risk profiles for fall-related injuries. Falls were most likely to occur from play equipment including trampolines, bicycles and small wheeled equipment, tree climbing and sporting activities. In these age groups, injuries are more likely to be to the forearms, and in the 10-14 age group fractures to the lower limbs were also common.
  • Western Australian sports injury study (PDF  - 59 KB), Stevenson M, Hamer P, Fitch C, Elliot B, and Levitan M, Western Australia Department of Public Health, Injury Research Centre, and the University of Western Australia (1997-98) - Injury data in four sports, Australian Football, Basketball, Hockey, and Netball was collected and analysed.

Sports Medicine Australia (SMA). This non-government, multidisciplinary organisation is committed to enhancing the health of all Australians through safe participation in sport and physical activity. SMA offers information and resources, provides training on injury management and prevention, and supports research into sports injury causes and their prevention.

SportSafe: Australian Sports Injury Data Dictionary (PDF  - 265 KB), Australian Sports Injury Prevention Taskforce (1998). This publication was developed to provide guidelines for injury data collection and classification for the prevention and control of injury in sport and recreation. The dictionary is written to assist sport and recreation organisations, researchers, sports medicine professionals, first aiders, and individual clubs in their collection of information on sports injury; so that data can be accumulated in a consistent manner.

In recent years there has been a dramatic increase in the number of publications, including research, on the subject of concussion and head trauma in sport. All major football codes, as well as many sports likely to involve body collision or head trauma, have adopted policies to help practitioners identify and treat concussion. Our knowledge about the immediate and long-term effects of brain injury continues to evolve, and this area of sports injury has assumed a high priority. It should be noted that the science of brain injury and its current paradigms for identification, treatment and recovery are under continual review.

More information can be found in the Clearinghouse for Sport portfolio, Sports Concussion and Head Trauma.

The Australian Institute of Sport (AIS) and the Australian Medical Association (AMA) have also developed a website on Concussion in Sport. This AIS/AMA website brings together the most contemporary evidence-based information for athletes, parents, teachers, coaches and medical practitioners.

Injury Prevention and Safety Promotion Policy (PDF  - 381 KB), Public Health Association of Australia (2013). On a national scale there is an overall strategy for the reduction of injuries (from all sources) and the promotion of safe environments and practices. The Public Health Association of Australia has published a policy to address safety promotion as one important aspect of injury prevention. Whether intended or accidental, most physical injuries can be prevented by identifying their causes and removing or reducing exposure to risk factors. Environments contribute to many injury risks, so analysis of data can be used to identify suitable safety strategies. Lifestyle and behaviour also influence safety, and they can be shaped by increasing our knowledge about the risk factors. The policy identifies ten principles for effective injury prevention and safety promotion:

  1. Appropriate resource levels for injury prevention and safety promotion. Investment in injury prevention should adequately reflect that injury is a leading cause of death and disability in each of the identified priority population groups.
  2. Leadership in injury prevention and safety promotion. The health sector has a lead role in supporting injury prevention through appropriate action in terms of advocacy, the provision of quality analysis of injury data, coordination, skill development and exemplary policies and standards.
  3. Coordination and integration of effort. Collective action on injury prevention and safety promotion planning and activity is essential to close gaps and minimise duplication of effort. This requires the active participation of all levels of government, community groups, businesses, families and individuals working in partnership.
  4. Informed and capable injury prevention and safety promotion workforce. Strategic planning at federal, state and local levels will ensure that individuals whose work context encompasses injury prevention and safety promotion are sufficiently informed and skilled to undertake best practice in the prevention of injuries.
  5. Access to quality data and its analysis. The health sector has a major role to play in providing quality data and its analysis for use in injury prevention and safety promotion planning, monitoring and evaluation by its partners. Through the use of quality data and its analysis, programs can appropriately anticipate and respond to changes in injury patterns, exposure to risks and population trends.
  6. Commitment to equity of access. Planning and delivery of injury prevention and safety promotion activities will aim to reduce inequalities in injury outcomes within and between groups, and to remove cultural and economic barriers to the uptake of interventions, by creating equity of access to information, services and products to those groups at greatest risk of injury.
  7. Evidence-based planning. Injury prevention and safety promotion activity will be based on evidence of effective interventions and, where possible, good information about the political and social context in which interventions will be introduced.
  8. Supportive legislation and policy. Sustainable changes in behaviour and the environment to reduce the risk of injury can be facilitated by supportive laws, policies and regulations operating at federal, state, local and community levels. Furthermore, supportive environments, created by policies and legislation, can on their own sometimes lead to behaviour change.
  9. Monitoring, research and evaluation of initiatives. Identifying and implementing interventions that make the best use of resources (both organisational and financial) will be assisted by systems and infrastructure that ensure the ongoing monitoring and evaluation of interventions. Such systems should be designed to identify what works or what doesn’t, the contextual factors that influence the uptake of interventions and outcomes, and emerging knowledge about proven or promising interventions.
  10. Sustainability of injury prevention and safety promotion initiatives. Creating lasting change is most feasible if it is developed within the context of appropriate policies or legislation, the creation of safer products and environments, and the development and maintenance of intersectoral networks and sharing of resources and purpose.

There continues to be limited evidence regarding how sports injury interventions are formally trialed and evaluated, their effectiveness, or the cost-benefit analyses associated with their implementation. Almost all National Sporting Organisations (NSOs) have some type of education or information program to help them manage the risk of injury in their sport. Programs may vary, depending upon the risks associated with likely injuries.

Smartplay. Sports Medicine Australia manages a number of programs that are meant to promote optimal health and wellbeing. Smartplay aims to reduce the incidence and severity of sport and recreation injuries and carries the slogan ‘Warm Up, Drink Up, Gear Up’ which represent simple yet important injury prevention practices for all sports participants, coaches and administrators.

Youthsafe. This is a New South Wales based, independent, not-for-profit organisation dedicated to preventing serious injury in young people aged 15 to 25 years. Sport is one of several areas of interest for Youthsafe. Programs have been partnered with the NSW Government, as well as State Sporting Organisations.

Review & evaluation of Victorian Sport Risk Management strategies, policies and programs (PDF  - 290 KB), Otago L, Swan P and Garnham J, Department of Victorian Communities and Australian Sports Commission (2006). This project aimed to investigate how and to what extent sport clubs and associations adopted their State Sporting Association (SSA) SIRM plan into their everyday operations. To adequately explore this, the project was conducted in five phases: A review of SSA SIRM policies for clubs, an interview with a key SSA person, the development and implementation of a survey for clubs and associations, and finally there was an observation phase of SIRM at selected sports training and competition. Whilst the research was segmented into five phases, the objectives of the project could only be attained through an integrated analysis of all phases. Overall, the findings of the five phases support the need for a practical SIRM process at club level. Generic risk management protocols have their place but clubs need to know what is expected of them, and how they should implement SIRM and what the benefits of undertaking the practice are. Currently half the clubs surveyed across sports regard much of the material they receive from SSA as not being practical to implement. A policy cannot be effective if is not implemented. Currently a patchy and inconsistent situation exists with fewer than half the clubs surveyed adopting SSA SIRM plans and even fewer adopting practices related to these policies.

National Guidance for Australian Football Partnerships and Safety (NoGAPS). This project represents a collaboration between the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) and Australian Football to identify factors that influence lower limb injury. It provides evidence regarding the effectiveness of injury prevention strategies and injury-prevention exercise training programs specific to Australian Football. The FootyFirst (PDF  - 1.4 MB), NoGAPS project report (2014) appears in Sport Health.   

How a national sports injury body could work in Australia (PDF  - 298 KB), Orchard J, Coates J and Moorhead G, Sports Injury Prevention, Volume 25, Issue 4 (2007). The authors estimate the cost of sports injuries to Australia's health system at $2 billion annually. On this basis, there is a strong argument for Australia to implement a government body with responsibility for monitoring and preventing sports injuries. What is less clear is how such a body would be structured. This article looks at systems used in other countries, particularly New Zealand. The New Zealand system has been functioning successfully for 20 years and has demonstrated the cost effectiveness of a national injury prevention strategy. Irrespective of the powers and structure of a national sports injury surveillance and compensation system, the authors suggest that establishment of a working party to study the issue should be a priority.

Canada

Canadian public health statistics for 2009-10 report that 66% of injuries among adolescents were linked to sports. [source: Canadian Community Health Survey]

The Active and Safe Injury Prevention Initiative of the Public Health Agency of Canada was a two year pilot program conducted from April 2011 through March 2013 aimed at decreasing the incidence of sport and recreation related injuries in children and youth to the age of 19 years. A public campaign was conducted to improve community awareness and collaboration between the Agency and sport and recreation stakeholders. A total of 18 projects were funded, particular interest was concentrated on concussion, fractures, and drowning; although the scope of projects included a wide range of sports injuries.

  • Evaluation of the Active and Safe Injury Prevention Initiative, Public Health Agency of Canada (2014). This report concluded that unintended injuries resulting from sports and recreational activities are a leading cause of injury among Canadian children and youth. The most common sports injuries were head injuries and fractures, with drownings being less common but of significant concern. In addition to the negative health outcomes from injuries, there is an economic burden for Canada as these injuries may place additional demands on the health care system. Consequently, there is an ongoing need to address this important public health issue. The Initiative was efficient in producing the desired outcomes as it supported solutions that were already proven effective (e.g., combining education, policy formation, equipment and engineering standards) in preventing injuries. On an operational level, the 18 funded projects all used cost-savings measures to ensure that outputs were produced efficiently (e.g., use of volunteers, online technology, etc.). Finally, performance measurement data were collected for individual projects in support of future program decisions. Several opportunities were identified with potential to build upon current investment.

The University of Calgary’s Sports Injury Prevention Research Centre (SIPRC) is one of nine international research centres supported by the International Olympic Committee.

European Union

The burden of sport injuries in the European Union (PDF  - 1.6 MB), Kisser R and Bauer R, European Network for Sports Injury Prevention (2012). The European hospital based injury surveillance system provides data on the circumstances of an injury event, the activity involved, the place of occurrence, and products involved. In 2008 only 11 countries in the European Union (EU) were collecting data, but the sample is sufficiently large to extrapolate figures on sport injuries for the European Community as a whole. Rough estimates of other forms of treatment can be made through national health surveys. Based on the injury database, it is estimated that almost 6 million persons (all ages) annually need treatment in a hospital due to an accident related to sports activity, 10% require hospitalisation for one day or more. Regarding the economic costs of sport injuries, there are no comprehensive and comparable estimates available at EU-level. In practice only the number of days of in-hospital treatment is available as a cost indicator, and so; based on the average cost of a day in hospital, the estimated economic burden of sports injuries would be at least $2.4 billion Euro. For the long-term consequences of sport injuries (i.e. disabilities), there are also no comprehensive and comparable estimates available at EU-level. One estimate has been made of about 30,000 life-long disabilities as consequence of a sport injury. The burden of sport injury is substantial; but from a public health point of view, refraining from sport might place an even greater burden on the health system due to increased chronic disease (e.g. obesity, diabetes and cardio-vascular diseases). It is therefore a more desirable option to prevent sports injuries. The two public health strategies of promoting physical activity while also promoting safety need to become more strongly interconnected in order to provide maximum health gains.

Injuries in the European Union: Summary of injury statistics for the years 2008-2010 (PDF  - 4.2 MB), European Association for Injury Prevention and Safety Promotion, EuroSafe (2013). According to EU estimates, 7.5 million adolescents between 15 and 24 years of age seek treatment for an injury (all sources) each year in EU hospitals. This represents 19% of all hospital treated injuries; however, adolescents represent only 12% of the total EU population. For some injuries the significant differences between boys and girls reflect behavioural preferences leading to different exposure patterns. In sports, for example, there are clearly more European boys than girls participating in sport, 71% compared to 50% respectively. This means that the likelihood of sports injury for boys should be higher than for girls. Unfortunately, the usual health statistics poorly cover the incidence of sports injuries; although it is safe to say that the number of sports injuries is increasing and that the number of girls injured while participating in sport is increasing.

Injury rate and socioeconomic costs resulting from sports injuries in Flanders: data derived from sports insurance statistics 2003 (abstract), Cumps E, Verhagen E, Annemans L and Meeusen R, British Journal of Sports Medicine, Volume 42, Issue 9,pp767-772 (2008). This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders, Belgium. 72 out of 82 Flemish sports federations participated in this study. The total direct medical cost was extrapolated for the number of Flemish sports participants and was estimated to be 0.07% to 0.08% of the national healthcare budget. The indirect cost was extrapolated for Flemish sports participants and was about 3.4% of the costs arising from absenteeism from work. The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures

The Faculty of Sport and Exercise Medicine (FSEM) in the United Kingdom is leading the call for the creation of a National Sporting Injury Register. There is a need for comprehensive national sports injury data in order to identify activities that may pose injury risks. Such a register would also provide key data for governing bodies to help them assess the effectiveness of their injury prevention strategies; including, when necessary, changes to the rules of a sport. The current lack of comprehensive injury statistics means sports clubs and governing bodies are not guided by the best possible evidence. Sport related hospital-treated injuries are five times more common than road traffic injuries for children aged 15 years or younger in the UK. While road traffic injury prevention has been well-resourced by public funding, no parallel sports injury identification and prevention system is in place. 

New Zealand

The New Zealand government has established the Accident Compensation Corporation (ACC) as a means of providing no-fault personal injury cover, injury prevention education programs and strategies. A number of national sporting federations have jointly developed and branded injury prevention programs with the ACC; including Rugby, Netball, Football, Rugby League, Snow Sports, and Mountain Bike.

  • ACC SportSmart -This is a ten-point action plan for sports injury prevention: (1) screening; (2) warm-up, cool-down, stretch; (3) physical conditioning; (4) technique; (5) fair play; (6) protective equipment; (7) hydration and nutrition; (8) injury reporting; (9) environment, and; (10) injury management.

United States

The US Centers for Disease Control and Prevention (CDC) is committed to preventing all types of child injury by supporting solutions that will save lives and help children live to their fullest potential. The National Action Plan for Child Injury Prevention was developed by CDC along with more than 60 stakeholders. The overall goals are to: (1) raise awareness about the problem of child injury and the effects on the nation; (2) highlight prevention solutions around a common set of goals and strategies, and; (3) mobilise action on a national level through coordinated efforts to reduce child injury.

Stop Sports Injuries (SSI) - This organisation is dedicated to the prevention of sports injuries, it has a number of founding member organisations supporting its work, including the American Orthopaedic Society for Sports Medicine; American Academy of Orthpaedic Surgeons; American Academy of Pediatrics; American Medical Society for Sports Medicine; National Athletic Trainers Association; National Strength and Conditioning Association; Pediatric Orthopaedic Society of North America; and Save Kids USA. SSI provides a range of information resources, advocacy, and program support to sports injury prevention initiatives.

Issue Brief: Common Sports Injuries: Incidence and average charges (PDF  - 200 KB), U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (2014).

Youth Sports Safety Statistics (PDF  - 158 KB), Youth Sport Safety Alliance (2013).
National Action Plan for Sport Safety: Protecting America’s student athletes (PDF  - 1.2 MB), Youth Sport Safety Alliance (2013).

A Guide to Safety for Young Athletes (PDF  - 69 KB), American Academy of Orthopaedic Surgeons (AAOS), fact sheet.

National Electronic Injury Surveillance System (NEISS), U.S. Consumer Product Safety Commission. Patient information is collected from each NEISS hospital for every emergency visit involving an injury associated with consumer products. Sports-related injuries made up about 20% of all injury-related emergency department visits among children age 6 to 19 years. 


Where possible, direct links to full-text and online resources are provided. However, where links are not available, you may be able to access documents directly by searching our licenced full-text databases (note: user access restrictions apply). Alternatively, you can ask your institutional, university, or local library for assistance—or purchase documents directly from the publisher. You may also find the information you’re seeking by searching Google Scholar.

Information Resources

  • Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP).  ACRISP and Federation University collaborate with academic/research institutions, sporting organisations and other stakeholders to investigate the causes of sports injuries and develop management/education and prevention strategies.
  • Burden Calculator. Burden Calculator is a simple and open analytical tool that can be used to estimate the burden of injuries in a population using data on the incidence of deaths and non-fatal injuries. The tool aims to simplify earlier methodology, while retaining the features most important for evidence-based estimation of the burden of injuries. The tool will evolve through contributions and collaborations of the injury statistics community. Users are encouraged to provide better input parameters, conduct validation studies, perform cross-country comparisons, and to contribute their results and modifications to the project website.
  • Injury Fact Sheets, Sports Medicine Australia. The Sports Medicine Australia website contains a number of ‘fact sheets’ that can be downloaded.  Titles include: Achilles Tendon Injury; Acromioclavicular (AC) Joint injury; Ankle injury; Anterior Cruciate Ligament injury; Asthma management; Dental injuries; Eye injuries; Exercise and breast support; Gastrocnemius (calf) strain; Hamstring strain; Meniscus injury; Plantar Fasciitis; Quadriceps Contusion (cork thigh); Shin pain; Soft tissue injuries.
  • Injury Update. This website provides information about player injuries in the professional football codes in Australia, including the A-League (soccer), AFL (Australian football), NRL (rugby league), and Rugby Union. It also provides general information about common injuries experienced by players.
  • Preventing musculoskeletal sports injuries in youth: A Guide for parents, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, United States of America. More than 38 million children and adolescents in the United States participate in organised sports each year and still more participate in informal recreational activities. Although sports participation provides numerous physical and social benefits, it also has a downside – the risk of sports-related injuries.
  • SmartPlay Safety Guidelines for Sporting Clubs, Associations, and Facilities (PDF  - 867 KB), Sports Medicine Australia (2000). The development of sport safety plan is an extremely important component for sport and recreation clubs, associations and facilities in providing a safe and healthy environment for participation. This resource incorporates a number of existing preventative medicine and safety policies.
  • Sport Fact Sheets, Sports Medicine Australia. Through its involvement in the SmartPlay program, SMA has prepared a series of sport-specific fact sheets that discuss ways to prevent injury, advice for taking care of junior players, and how to deal with common injuries. Sport titles include: Aerobics; Australian Rules Football; Baseball; Basketball; Cricket; Cross-Country Skiing; Downhill Skiing; Football (Soccer); Golf; Artistic Gymnastics; Gymnastics (Aerobic, Acrobatic & Cheerleading); Gymnastics (Trampolining); Hockey; In-Line Skating (Rollerblading); Lawn Bowls; Netball; Rugby League; Rugby Union; Running; Snowboarding; Softball; Squash; Surfing; Tennis; Volleyball; Walking.
  • Sports Injury Tracker (PDF  - 367 KB). This template for reporting sports injuries has been developed by Sports Medicine Australia and Sport and Recreation Victoria to assist community sport managers. It enables organisations to record, store and analyse sports injury information.
  • What are Sports Injuries? (PDF  - 597 KB), U.S. Department of Health and Human Services, Fast facts Series.

Facility Resources

  • Ground conditions and injury risk: implications for sports grounds assessment practices in Victoria (PDF  - 1.6 MB), Otago L, Swan P, Chivers I, Finch C, Payne W and Orchard J, University of Ballarat, School of Human Movement and Sport Sciences report (2007). This report provides a body of evidence for sporting bodies and councils to assess the suitability and safety of their grounds as a way of preventing or reducing the risk of sports related injuries.
  • Natural grass vs synthetic turf surfaces study: final report, Government of Western Australia, Department of Sport and Recreation. The perceived increase in injury risk on synthetic turf, compared to natural grass, has been debated for many years.  Recently, the potential harm from heat-related exposure and toxicity has become a major focus of attention. This report presents the current knowledge and evidence on the differences between natural grass and synthetic turf in terms of injury risk, and heat-related issues.
  • Skate Facility Guide (PDF  - 2.0 MB), Government of Victoria, Department of Planning and Community Development, Sport and Recreation (2001). This guide focuses primarily on the provision of facilities for skateboarding but it also includes information about in-line skaters and free-style BMX riders as they may also use skate parks. It is aimed at providing information for a variety of interest groups, professional planners, and designers. The guide may also be used as a resource for community organisations as they make their way through the complex design, development and approvals processes necessary to create a skate facility.
  • More information can be found in the Clearinghouse for Sport portfolio, Sports Facility Planning and Use.

Consensus Statements

Research and Reading

  • Adult sports injury hospitalisations in 16 sports: the football codes, other team ball sports, team bat and stick sports and racquet sports (PDF  - 2.7 MB), Cassell E, Kerr E, and Clapperton A, Hazard, Edition 74 (2012). This issue of Hazard investigates the frequency, incidence, trend and pattern of adult sports-related injury and hospitalisations in four groups of popular sports: football codes (Australian football, combined rugby union & league, and soccer), other team ball sports (basketball, netball and volleyball), team bat and stick sports (combined baseball & softball, cricket and hockey) and racquet sports (badminton, table tennis, combined squash & racquetball and tennis).
  • Hospital Care for Australian Sports Injury 2012–13 (PDF  - 1.6 MB), Australian Institute of Health and Welfare and Flinders University (2017). This report analyses Australian hospitalisations data for 2012–13 to provide an insight into the impact of sports injury on 1 part of the Australian health system, and to improve understanding of the types of sport-related injury conditions for which people are admitted to Australian hospitals. In particular, the report focuses on the acute care services provided by hospitals for sports injuries.
  • Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. M L Alosco, A B Kasimis, J M Stamm, et.al., Translational Psychiatry, Volume 7, (published online 19 September 2017). This research examined the association between age of first exposure (AFE) to football and behavior, mood, and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Results indicate that there was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.
  • Applying implementation science to sports injury prevention (abstract), Donaldson A and Fitch C,British Journal of Sports Medicine, Volume 47, published online (16 March 2013). A key challenge for future sports injury prevention is to reduce the ‘research to practice’ gap.
  • The causes of injuries sustained at fitness facilities presenting to Victorian emergency departments - identifying the main culprits, Gray S and Finch C, Injury Epidemiology, Volume 2, Number 6 (2015). Fitness facilities provide an avenue for people to engage in physical activity. The ‘fitness industry’ is often considered part of the larger ‘sport and recreation’ industry in Australia, albeit with a decidedly commercial focus. This study aimed to identify the specific causes of injuries sustained at fitness facilities and the activity being participated in, to aid in the development of injury prevention strategies. Analysis of routinely collected emergency department case-series data were obtained from Victorian hospitals covering the period July 1999 to June 2013. Overall, 2,873 cases were identified that specified the exact cause of injury that occurred at a fitness facility. Injuries due to overexertion were most common overall, 36.2% of all cases. Injuries related to general free weight activities and group exercise classes were most commonly associated with equipment. Crush injuries due to falling weights were common for all free weight activities. Falls and awkward landings were common causes of injuries during group exercise classes. Trips and falls were common throughout gym facilities and were often related to cardiovascular exercise equipment. The authors recommend that facility management should implement risk management strategies to reduce injury risk among their clientele, based on the identified major causes of injury in this study.
  • Child fall injuries: an overview (PDF  - 330 KB), Ashby K and Corbo M, Hazard, Edition 44 (2000). The article draws on the extensive previous work undertaken by the Monash University Accident Research Centre and utilises available sources to provide an update of the child fall data. A large proportion of child fall occur on playground equipment.
  • Child injury due to falls from playground equipment, Australia 2002-04 (PDF  - 203 KB), Helps Y and Pointer S, Australian Institute of Health and Welfare, National Injury Surveillance Unit, and Flinders University (2006). Key findings from this report: (1) 12,091 cases of playground falls injury in the 0–14 years age group resulted in hospitalisation, (2) children aged 5–9 years were hospitalised at 3 times the rate of 0–4 year olds, and at four times the rate of 10–14 year olds, (3) climbing apparatus accounted for 33% of hospitalised playground fall injuries, followed by trampolines (24.6%), (4) fractures were the largest injury type (85.2% of cases).
  • Coaching our kids to few injuries: a report on youth sport safety (PDF  - 1.4 MB), Safe Kids Worldwide (April 2012). This report provides the findings of a survey conducted in the United States in 2012; data on 516 children and adolescents ages 8 to 18 who play a variety of sports, 750 parents and 752 coaches. Key findings about coaches' attitudes: (1) they want and need more sport safety training; (2) some hold disconcerting beliefs, and; (3) nearly half had experienced pressure from parents. Key findings about parents: (1) about half (49%) reported their children had been hurt playing team sports and were treated by a coach or adult at the site of the game; (2) only 38% of parents know or express concern about coaches’ safety training; (3) 75% of parents worry about their child being injured while playing sports; (4) parents generally over-estimate their own competence about sports injuries, and; (5) a majority of parents report having taken some steps to protect their child. Key findings about athletes: (1) 70% had reported some type of injury; (2) most children receive injury specific advice from their coach; (3) 42% reported having been injured badly enough that a coach or adult made them take a break until they felt better.
  • Consumer product-related injury: playground equipment and trampolines (PDF  - 384 KB), Clapperton A and Cassell E, Hazard, Edition 61 (2005). This edition highlights the frequency of hospital treatment as a result of playground equipment and trampolines and makes recommendations for injury prevention.
  • A cost-outcome approach to pre and post-implementation of national sports injury prevention programs, Gianotti S and Hume P, Journal of Science and Medicine in Sport, Volume 10, pp436-446 (2007). In New Zealand the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention program. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention. Each form of economic analysis deals with costs but differing in the way that the consequences of programmes are measured and valued. While the model chosen will depend on what is being measure, the approach taken in this paper is aligned to a cost-outcome description since it is unable to undertaken a full comparison of alternative programs.
  • The economic burden of time-loss injuries to youth players participating in week-long rugby union tournaments, Brown J, Viljoen W, Lambert M, Readhead C, Fuller C, Van Mechelen W and Verhagen E, Journal of Science and Medicine in Sport, Volume 18, Issue 4 (2015). Rugby Union, 'rugby', is a popular sport, but carries high injury risk. The aim of this study was to describe the monetary cost associated with youth rugby injuries of players at the South African Rugby Union Youth tournaments in 2011/2012. A health insurer used player treatment and other associated costs resulting from injury to calculate a total cost. Legal guardians of the 421 injured players were contacted on a weekly basis following injury, until they returned to play. Treatments costs were estimated in South African Rands based on 2013 insurance rates and converted to US$ for reporting purposes in this study. Of the 3652 players, 2% (n = 71) sought medical care after the tournament. For these players, average treatment costs were US$731 per player. Bone fractures were the most expensive type of injury. Players with medical insurance had higher costs (US$937 on average) than those without insurance (US$220). Although a minority of players sought follow-up treatment after the tournaments, the cost of these injuries was high. Players without medical insurance having lower costs may indicate that these players did not receive full treatment for their injuries. Injury prevention strategies and programs should give consideration to the type of injuries associated with high costs, and the treatment of players without medical insurance.
  • Emergency visits for sports-related injuries (abstract), Burt C and Overpeck M, Annals of Emergency Medicine, Volume 37, Issue 3 (2001). This study estimates the effect and magnitude of patients with sports-related injuries presenting to hospital emergency departments in the United States and examines the differences in patient and visit characteristics between sports and non-sports-related injuries. There were an average annual estimated 2.6 million emergency visits for sports-related injuries by persons between the ages of 5 and 24 years. They accounted for over 68% of the total 3.7 million sport injuries presented to emergency departments by persons of all ages. As a proportion of all kinds of injuries, sports-related injuries accounted for more than one fifth of visits by persons 5 to 24 years old. The sports-related injury visit rate for male patients was more than double the rate for female patients. Visits from sports-related activities for this age group were more frequent for basketball and cycling compared with other categories (eg, baseball, skateboarding, gymnastics). Compared with non-sports-related injuries for this age group, sports-related injuries were more likely to be to the head, upper and lower extremities. Patients with sports-related injuries were more likely to have a diagnosis of fracture and sprain or strain and less likely to have an open wound. They were also more likely to have diagnostic and therapeutic services provided, especially orthopedic care.
  • Epidemiology of overuse injuries among high-school athletes in the United States, Schroeder A, Comstock R, Collins C, Everhart J, Flanigan D and Best T, The Journal of Pediatrics, Volume 166, Issue 3 (2015). This descriptive epidemiologic study looked at high school athlete injuries. Data was collected from a large national sample of US high schools participating in the High School Reporting Information Online Study from 2006 to 2012. Reporting of information was done by certified athletic trainers. Of the 20 sports studied, overuse injuries were more likely to occur in practice sessions than competition in all sports except boys' baseball and ice hockey. Overall, the proportion of overuse injuries were evenly distributed across athletes' year in school (freshman 25.6%; sophomore 25.3%; junior 24.9%, and; senior 24.3%). However, there were distinct patterns by sex; in boys, the proportion of overuse injuries increased from 20.7% (freshman) to 28.5% (senior), and in girls the proportion decreased with athletes' year in school from 30.7% (freshman) to 19.8% (senior). Although patterns of overuse injury varied by sport, the most commonly injured body sites overall included lower leg (area between the knee and the ankle), knee, and shoulder. One-half of all overuse injuries resulted in a time loss from training and competition of less than one week, with few injuries causing the athlete to miss more than three weeks or resulting in medical disqualification for the season. An important finding of this study was that girls not only have greater overuse injury rates than boys, but a greater proportion of their overuse injuries occurred earlier in their high school careers, as compared with boys. Overuse injuries made up a large proportion of all injuries in athletes participating in sports requiring repetitive movements and the body sites affected most were sport specific. Identifying high school athletes at risk of overuse injuries is a recommended first step in injury prevention strategies.
  • Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007-2001 (PDF  - 183 KB), Fridman L, Fraser-Thomas J, McFaull S and Macpherson A, BMC Sports Science, Medicine & Rehabilitation, open access (2013). This study provides the descriptive epidemiology of sports-related injuries treated in emergency departments for children and youth aged 5 to 19 years.
  • Game Changers: Stats, stories and what communities are doing to protect young athletes, Safe Kids Worldwide (August 2013). This report analysed data from the United States Consumer Product Safety Commission’s National Electronic Injury Surveillance System to better understand the characteristics of children’s sorts related injuries and make recommendations on what can be done to prevent them. In 2012, more than 1.35 million children ages 19 and under were seen in emergency departments for injuries related to 14 commonly played sports. Based on the Safe Kids research, four recommendations are made to parents, young athletes, and coaches to avoid preventable sports injuries. The report labels these recommendations ‘game changers’: (1) get educated about preventing serious sports related injuries and share that knowledge among parents, athletes, coaches and officials; (2) learn skills to prevent injuries while playing sports; (3) encourage athletes to speak up about injuries, and; (4) support coaches and officials in making decisions to prevent serious injuries.
  • The impact of sport and active recreation injuries on physical activity levels at 12 months post-injury, Andrew N, Wolfe R, Cameron P, Richardson M, Page R, Bucknill A and Gabbe B, Scandinavian Journal of Medicine & Science in Sports, Volume 24, Number 2, pp377-385 (2014). Changes between pre-injury and 12 month post-injury physical activity was assessed for 324 patients, 98% were followed up at 12 months. Education level and occupation group were the only variables independently associated with changes in physical activity levels post-injury. These results highlighted that sport and active recreation injuries lead to significant reductions in physical activity levels. Hence, the prevention of sport and active recreation injuries is important when considering promotion of activity at a population level.
  • The importance of injury and illness surveillance in Paralympic athletes (Abstract) van de Vliet P, British Journal of Sports Medicine, Volume 48, Number 7 (2014). Injury and illness surveillance plays an integral role in the prevention of injury and the protection of athletes' health. However, there are few epidemiological studies documenting injury and illness in Paralympic athletes. Daily injury and illness data were obtained from team physicians and through the London 2012 Medical Services, during the full period of the London 2012 Paralympic Games. The incidence rate of injury during the competition period was 12.1 per 1000 athlete-days, with and incidence proportion of 11.6%. Upper limb injuries were most common. Higher injury rates were found in older athletes and certain sports like Football. The most commonly injured region was the shoulder, followed by wrist/hand, elbow and knee. The incidence rate of illness was 12.8 per 1000 athlete-days with an incidence proportion of 10.2%. The incidence proportion was highest in the respiratory system, skin, gastrointestinal and genitourinary system. Athletes in the sports of cycling, table tennis, swimming and athletics reported most frequently for medical care. This study concluded that injury and illness rates at the Paralympic Games are similar to those in other events in able-bodied sports, but patterns of injuries and illness may be different.
  • Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data, Aman A, Forssblad M and Henriksson-Larsen K, Scandinavian Journal of Medicine & Science in Sports, published online (8 April 2015). Monitoring acute injuries in sport is still a problem because limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have mandatory injury insurance for all athletes under the same insurance company and injury data are systematically kept in a national database. The aim of this study was to identify high-risk sports with respect to incidence of acute and severe injuries in 35 sports reporting to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008–2011. Eighty-five percent of all reported injuries were from four sports: football (soccer), ice hockey, floorball, and handball. The highest PMI incidence was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in motor sports, handball, floorball, and football. High-risk sports with numerous injuries and high incidence of PMI injuries were: motorcycle, handball, ice hockey, football, floorball, and other motor sports. This study recommends that high risk PMI sports ought to be the target of preventive actions at national level.
  • Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015, David Zbrojkiewicz, Christopher Vertullo and Jane E Grayson, Medical Journal of Australia, (published online 23 April 2018). This study analysed longitudinal data on ACL reconstructions (July 2000 - June 2015) from the National Hospital Morbidity Database to determine the incidence and demographic features, and determine whether or not the incidence rates had changed over the previous 15 years. The results show an increasing incidence of ACL injuries, particularly in young Australians, with Australia having the highest rate of ACL reconstructions in the world. The authors discuss the potential long term consequences/impacts of this (increased risk of arthritis and future knee replacements; potential early retirement/significant loss of mobility impacting future work/productivity), the need for better data and oversight of the issue, and potential mechanisms to reduce injuries requiring reconstruction (appropriate agility training). 
  • Injury risk is different in team and individual youth sport (abstract), Theisen D, Frisch A, Malisoux L, Urhausen A, Croisier J and Seil R, Journal of Science and Medicine in Sport, Volume 16, Issue 3 (2013). This study compared sports injury incidence in young high-level athletes from various team and individual sports and investigated if sport participation patterns are linked to injuries. The results indicate that injury incidence was significantly higher in team compared with individual sports (6.16 versus 2.88 injuries/1000 hours, respectively) as a result of a higher incidence of both traumatic and overuse injuries. The number of competitions per 100 days was significantly higher in team sports and the number of intense training sessions per 100 days was significantly lower, compared to individual sports. In team sports, the number of competitions per 100 days was positively associated with injuries, while in individual sports the number of competitions per 100 days had a protective effect.
  • Meta-narrative analysis of sports injury reporting practices based on the Injury Definitions Concept Framework (IDCF): A review of consensus statements and epidemiological studies in athletics (track and field) (abstract), Timpka T, Jacobsson J, Ekberg J, Finch C, Bichenbach J, Edouard P, Bargoria V, Branco P and Alonso J, Journal of Science and Medicine in Sport, published online 5 December 2014. Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, the authors have applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field (track and field). An analysis was performed of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics published in PubMed between 1980 and 2013. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data; six consensus statements on athletics injury met the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, provided that firm precautions are taken when comparing studies performed in the different contexts.
  • Physical literacy for reducing injury risk, Play Safe Initiative, Canada, published online (3 August 2013). Developing physical literacy has emerged as a key strategy in promoting physical activity among children and youth, and thereafter through their adult lifespan. There is another practical benefit to physical literacy, the reduction and/or prevention of injury. A 2009 report found that sports equipment related injury cost the Canadian health care system approximately $188 million. Physical literacy helps to reduce injuries because it improves body mechanics and increases awareness of the activity environment. The Play Safe Initiative is led by Canadian Sport for Life, to promote injury prevention through physical literacy.
  • Position statement on reducing the incidence and impact of Childhood injury in Australia (PDF  - 615 KB). Childhood injury is costly, life changing, and importantly, highly preventable. Injury is the leading cause of death in Australian children and each year results in more than twice the number of hospital admissions due to cancer, diabetes and cardiovascular disease combined. For the first time in Australia, we have a comprehensive national profile of all childhood hospitalised injury causes, characteristics, treatment costs and survival. The findings from this 10 year nation-wide study of the 686,409 injury-related hospitalisations of Australian children (aged less than 17 years) commissioned by the Day of Difference Foundation are alarming and require urgent action. 
  • Preventing injury in sport and active recreation (PDF  - 76.2 MB), Cassell E and Clapperton A, Hazard, Edition 51 (2002). This article provides an overview of the available sports injury data held or accessed by the Victorian Injury Surveillance and Applied Research program.
  • Priorities for investment in injury prevention in community Australian Football (abstract), Finch C, Gabbe B, White P, Lloyd D, Twomey D, Donaldson A, Elliott B and Cook J, Clinical Journal of Sport Medicine, Volume 23, Issue 6 (2013). High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football players, as collected through field-based monitoring of injury in teams. The authors conclude that gains in reducing the public health impact of football injuries, and injury-related barriers to Australian Football participation, will only come from substantial investment in large-scale trials at the non-elite level, and a co-ordinated and multidisciplinary approach to dealing with safety and injury issues across all levels of play.
  • A review of field hockey injuries and countermeasures for prevention (PDF  - 308 KB), Sherker S and Cassell E, Monash University Accident Research Centre, Report Number 143 (2002). This report reviews both formal research literature and informal sources that describe preventive strategies and countermeasures to hockey injury. Countermeasures include enforcing rules aimed at preventing dangerous use of the hockey stick, careless play of the ball, modifying rules for children, use of protective equipment, expert training of coaches and officials, adequate pre-season conditioning, pregame stretch and warm-up, prompt access to professional first aid and medical care, and full rehabilitation before returning to play.
  • The role of International Sport Federations in the protection of the athlete’s health and promotion of sport for health of the general population (abstract), Mountjoy M and Junge A, British Journal of Sports Medicine, Volume 47, Issue 16, pp1023-1027 (2013). This study looked at the priorities and activities of International Sport Federations (IFs) with respect to the promotion of health in their sport and for the general population. All 35 IFs participating in Olympic Games in 2014 (Winter) or in 2016 (Summer) were asked to rate the importance of 10 topics, and to report their programmes, guidelines or research activities on 16 health-related topics using an online questionnaire (response rate 97%). With regard to sport injury surveillance programs, FIFA (football) was the first IF to systematically survey all injuries in its competition (1998). During the Olympic Games (OG) in 2004, injuries were recorded in all team sports. The IAAF (athletics) and FINA (swimming) were the first IFs for individual sports to introduce injury surveillance in their World Championships, 2007 and 2009, respectively. The IOC included all athletes in their injury surveillance project at the OG in 2008. The IOC injury surveillance protocol was expanded to also include illnesses in the OG 2010 (Winter) and 2012 (Summer). To standardise and encourage injury surveillance studies in their sports, several IFs have published consensus statements on injury definitions and data collection, such as football, rugby, tennis, horse racing, cricket and athletics.
  • Safe sports report (PDF  - 414 KB), Medibank Private (2006). This report looks at the most popular sports in Australia, peak injury risk periods and comparison of physical activity levels amongst the States and Territories. The intention of this report was to reinforce the importance of injury prevention techniques and private health insurance cover, whether you’re part of a team, exercise alone, or have a social ‘hit’ or ‘kick’ with mates.
  • Self-reported worst injuries in women's Australian football identify lower limb injuries as a prevention priority, Fortington L, Donaldson A and Finch C, BMJ Open Sport & Exercise Medicine, Volume 2, published online (13 April 2016). Increasing participation by women in Australian football has made understanding their specific injury prevention needs a priority. An online survey of 553 participants indicated that 78% had experienced some injury, over half (55%) of injuries were to the lower limbs. Ankle and knee ligament tears or sprains were the most frequent lower limb injuries reported. This study highlights the frequency of lower limb injury among female Australian football participants. A prospective injury study is needed to confirm the causes of lower limb injuries and identify the most suitable prevention strategies.
  • Spiking injuries out of volleyball: a review of injury countermeasures (PDF  - 436 KB), Johnson M, Oxley J, and Cameron M, Monash University Accident Research Centre, Report Number 285 (2009). The overall aim of this report is to critically review the formal research literature and informal sources that describe measures to prevent volleyball injury and to assess the quality of evidence supporting claims of effectiveness.
  • The training-injury prevention paradox: should athletes be training smarter and harder? Gabbett T, British Journal of Sports Medicine, published online ahead of print (12 January 2016). Training loads have been linked to higher injury rates; however, there is also evidence that training has a protective effect against injury. Across a wide range of sports, well-developed physical qualities (e.g. muscular strength, fitness, etc.) are associated with a reduced risk of injury and under-training may increase injury risk. This paper describes the ‘Training-Injury Prevention Paradox’ model; a phenomenon whereby athletes accustomed to high training loads have fewer injuries than athletes training at lower workloads. The Model is based on evidence that non-contact injuries are not caused by training per se, but more likely by an inappropriate training program.
  • Translating Systems Thinking into Practice: A Guide to Developing Incident Reporting Systems, 1st edition, Natassia Goode, Paul M. Salmon, Michael Lenne, Caroline Finch, CRC Press, (September 2018). This book describes how to design a practical, usable incident reporting system based on this approach. The book contains all the information needed to effectively design and implement a new incident reporting system underpinned by systems thinking. It also provides guidance on how to evaluate and improve existing incident reporting systems so they are practical for users, collect good quality data, and reflect the principles of systems thinking.

Clearinghouse Videos

Please note a number of the resources below (as indicated) are restricted to ‘GOLD' AIS Advantage small AIS Advantage members only.
Please see the Clearinghouse membership categories for further information.
  • Exploring new frontiers of Pathway Research, Simon Rogers, AIS/Southern Cross University, Erin Smyth, AIS/University of Canberra, Claire Tompsett, University of Sydney, Winning Pathways Workshop (14 December 2017)
  • Holistic Health and Fitness in the US Army, Michael McGurk, Colonel (ret.), Department of the Army Civilian, Director of Research and Analysis for the U.S. Army Center for Initial Military Training and Dr Whitfield East, Co-lead, Baseline Soldier Physical Readiness Requirements Study, Professor/Department of Physical Education, United States Military Academy, Smart Talk Seminar Series (4 December 2017)
  • Enhancing sporting performance and understanding injury causation through computation modelling, Dr Paul Cleary, research scientist, Computational Modelling, CSIRO, AIS Smart Talk Seminar Series, Australian Institute of Sport, Canberra, (14 August 2014) - The Computational Modelling group at CSIRO have been developing realistic models of elite sporting activities since 2004 to provide otherwise unavailable data for understanding the relationships between technique, performance and injury risk.


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