Changing sport rules to improve safety
Prof. Lars Engebretsen, IOV Head of Medical Scientific Activities
Sports injuries are a significant concern
—for the injured athlete, for sports organizations, and society
Beijing London Vancouver*
Sochi (per Feb 22)
Injuries per 100 athletes (5)
10 13 11 11
Time-loss (%)
0 days 50 65 43 65
1-7 days 30 23 16 21
8-28 days 14 8 11 4
>28 days 6 5 4 10
Injury incidence + severity
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* Severity missing for 26% of all injuries in Vancouver
• Rugby – scrum and high tackles • Icehockey – Canadian youth- no body checking • Football- tackling from behind and elbowing • Volleyball – where change was made with a negative effect • Freestyles skiing – to show the challenges • Boxing – will removal of head guards make a difference? • Concussion – new rules of detection- give the physician time!
Can rule change make a difference? Here are a few examples…..
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Preliminaryanalyses(PeeWee–ages11-12)
Bodychecking
Nobodychecking
IncidenceRatesforPeeWeegameinjuriesinAlberta(BodyCheckingallowed2011-2012)versusAlberta(NoBodyCheckingAllowed2013-14)
Head injuries in football • 4-20% of all acute injuries in
football are head & neck injuries (Lohnes et al.94)
• Concussion, facial fractures and tooth injuries most common
• Incidence of concussion men: 0.6/1000 practice/match women: 0.4/1000 practice/match
(Boden et al. 98)
Andersen et al. BJSM, in revision
HeadElbow
Arm/hand Foot BallShoulder
KneeGround
GoalpostOther
% of
inci
dent
s
0
5
10
15
20
25
30
35N=198
What hits the head?
HeadElbow
Arm/hand Foot BallShoulder
KneeGround
GoalpostOther
% of
inci
dent
s
0
5
10
15
20
25
30
35N=198
Conclusion n 4 of 10 head incidents occurred from
elbowing or the use of arm n Only 1/4 of these led to a free kick or a
yellow/red card
Consequence - prevention n Change of the rules regarding elbowing n Improved & focused referee training
n Video review by the match referee n Stress the fair play-perspective for both
players & coaches
Bahr R et al. Scand J Med Sci Sports, 7: 166-171, 1997; NVBF Div. Iⅈ 92-93; n=48
Risk factors & injury mechanisms 1) Recent old injuries risk factor for reinjury
2) ½ of all injuries occur in conflict zone under the net with blocker landing on opposing attacker’s foot
3) ¼ of all injuries occur after two-man block when player lands on teammate’s foot
4) Technical errors: Improper movement and take-off technique in block and attack
Bahr R. Int Volley-Tech, 2 (June): 14-19, 1996
Net line rule
Prop
ortio
n of
rally
term
inat
ions
(%)
0
3
6
9
12Ordinary ruleNew rule
Bahr R et al. Scand J Med Sci Sports, 7: 172-177, 1997 No. of sprains0 5 10 15 20 25 30
Opponent
Teammate
Movement
Landing
Other
During (93-94)Before (92-93)
After (94-95)Injury mechanisms
Bahr R et al. Am J Sports Med 22: 595-600, 1994
Phase
Athlete
Rules
Equipment
Pre-crash
Skill Neuromuscular
function
Net line rule
-
Crash
-
-
Tape/brace
Post-crash
Rehabilitation
-
-
Prevention strategies - volleyball
Injuries in sports – all athletes
ALL ATHLETES Snowboard Cross: 35% Bob: 20% Freestyle Aerials: 19% Freestyle Cross: 19% Ice Hockey: 18%
• Head and knee most common and most severe injuries (45% of all injuries in skiing and snowboarding) • 20 concussions (7% of athletes)
Injuries in sports – female athletes
FEMALE ATHLETES Snowboard Cross: 73% Freestyle Aerials: 26% Freestyle Cross: 23% Bob: 24% Ice Hockey: 23%
Overall injury risk -World Cup disciplines
Seasons
06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16
Injurie
s per
100 a
thlete
s
10
20
30
40
50
60 Alpine WCFreestyle Snowboard
Time-loss injuries (n=2456)
• Venue standard-guidelines? • Equipment – helmets,boots, bindings, skis, boards? • Epidemiologi- new sports in the Olympics: Big Jump • Epidemiology surveillance- combining data • Mechanisms of injury – videoanalyses • Longitudinal studies in schools • Judging rules- changes, restrictions? • More biomechanical field studies/lab studies- technique changes:
more flexion inleading knee when landing? • Binding study- placement of rotation- in the lab?
Important research questions in freestyles:
• The International Boxing Association (AIBA) has recently instituted a set of rules which, among others, involve removing the headguard in competition
• The AIBA Medical Commission has provided the IOC with data from AIBA boxing competitions that suggest that boxing without headguards does not lead to an increased risk of injuries to the head or to the face
Background
1. Systematic literature review of rule change and protective equipment and injury risk in boxing: showed no benefit of HG
2. Video analysis of the injury rates and characteristics in boxing with and without headguards: Less hits to the head
3. Boxing Headguards and Gloves Biomechanics Project: HG is effective
4. Neuropsychological testing of boxers: a phd thesis in Sweden shows changes in the spinal fluid after bouts
The expert group were asked to do:
THE SIX ”R”S OF CONCUSSION 1. RECOGNIZE 2. REMOVE 3. RE-EVALUATE 4. REST
• (REHABILITATION) 5. RECOVER 6. RETURN TO SPORT
CHILD SCAT3!
Developed by Child SCAT3 subcommittee - Davis, McCrea, G. Gioia, Purcell, Ellenbogen, C. Vaughan, Guskiewicz, Kutcher, Meeuwisse, McCrory
SCAT3!
Developed by SCAT3 Subcommittee - Meeuwisse, McCrory, Dvorak, Echemendia, Guskiewicz, Iverson, Johnston, McCrea, Putukian, Raftery, Schneider
• Rugby – scrum and high tackles • Icehockey – Canadian youth- no body checking • Football- tackling from behind and elbowing • Volleyball – where change was made with a negative effect • Freestyles skiing – to show the challenges • Boxing – will removal of head guards make a difference? • Concussion – new rules of detection- give the physician time!
Rule changes make a big difference!
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