Overuse Injuries in Youth Sports: Legal and Social Responsibility

Clinics in Sports Medicine, 2008

BMC sports science, medicine and rehabilitation, 2014

The increased participation of children and adolescents in organized sports worldwide is a welcome trend given evidence of lower physical fitness and increased prevalence of overweight in this population. However, the increased sports activity of children from an early age and continued through the years of growth, against a background of their unique vulnerability to injury, gives rise to concern about the risk and severity of injury. Three types of injury-anterior cruciate ligament (ACL) injury, concussion, and physeal injury - are considered potentially serious given their frequency, potential for adverse long-term health outcomes, and escalating healthcare costs. Concussion is probably the hottest topic in sports injury currently with voracious media coverage and exploding research interest. Given the negative cognitive effects of concussion, it has the potential to have a great impact on children and adolescents during their formative years and potentially impair school achieve...

The Physician and Sportsmedicine, 2010

Physical activity is very important in the physical and emotional well-being of children and young adults. Participation in sports has increased in the past 15 to 20 years in the youth population, with benefi ts of self-esteem, confi dence, team play, fi tness, agility, and strength. Th e starting age of sports participation has also decreased during recent years, and it is common for children to specialize in training in their respective sport at a very young age. A well-designed exercise program enhances the immediate physical, psychomotor, and intellectual attainments of a child. 1 Long-term health benefi ts depend on continuation of the physical activity, thus enhancing a child's well-being and favoring his or her balanced development. 1 Concern over possible growth inhibition eff ects of competitive sports is a source of scientifi c debate, 2 but there is no defi nitive evidence to indicate that training either positively or negatively aff ects growth and maturation in young athletes. Injuries during sport appear to be unavoidable, and up to 30% to 40% of all accidents in children and adolescents occur during sports. 3 Nevertheless, the rate of injury is lower in children than in mature adolescents. 4 Prevention measures have been implemented; however, when considering the large number of participants, health care professionals are oft en confronted by acute and chronic musculoskeletal injuries in young athletes. 5,6 Furthermore, some young athletes participate in athletic activities for Ͼ 18 hours per week. 7 Moreover, some are involved in multiple sports with aggressive over-scheduling of competitive events. Th is may have negative psychological eff ects with associated body image distortions and low caloric intake. When considering these points, it is not surprising that an increasing number of overuse sports injuries are being reported. Injuries can counter the benefi cial eff ects of sports participation at a young age if a child or adolescent is unable to continue to participate because of the residual eff ects of injury. 10,12 Th e incidence of injury diff ers depending on many factors, such as level of competition, type of sport, and standard of surveillance systems. To date, few studies have evaluated the long-term health outcomes of youth sports injury. Th is article assesses the long-term outcome of sports injuries in young athletes, and provides suggestions on how to prevent such injuries.

Sport has been an aspect of human society since the earliest times and sports injuries have probably also been part of human existence from the outset. The contests in ancient sports often led to serious injury or death and athletes were viewed as expendable resources that could be sacrificed in the quest for glory. It would seem that this notion of expendable athletes has remained with us throughout the ages. The old Roman principle of volenti non fit injuria endured through the Middle Ages and today we know it as consent to injury or assumption of the risk of injury. Athletes believe in “no pain, no gain” and regard pain as a necessary by-product of sport. Sports managers rely on the self-motivation of players to push themselves beyond the bounds of normal human endeavour in pursuit of success. Athletes who push on and continue to compete despite excruciating pain are hailed as heroes who put their team or country above their own interests. In addition, sport and state authorities seem to accept that injuries and deaths are inevitable in sport. Almost every sport can erect its own “war memorial” for fallen athletes who have met their fate while training for or participating in sport. The number of serious injuries are even higher and there are innumerable short-term injuries that result in athletes’ sitting out on training sessions. Even in cases where team managers or team crews have pushed athletes to the point of death or compelled racing drivers to compete in unsafe cars, authorities have not taken action against such managers or crews. It would seem that sports federations and clubs can do no wrong. The general message to athletes everywhere seems to be: if you play and get hurt, that is your problem. However, an analysis of the principles shows that the position in respect of liability for sports injuries is not quite as simple as it may appear at first glance. Initially, the courts appeared to be mostly reluctant to hold sports federations, clubs or players liable for sports injuries because of the doctrine of consent to injury or assumption of the risk of injury. It would appear that courts generally submit to the rules of the sport concerned. The reason for this could be that organised sport is played on the basis of a contractual relationship between the sports federation, sports league, sports club, event organiser and players. The terms of this contractual relationship are found, inter alia, in the rules of the sport and players agree to play according to these rules. In this regard it is worth mentioning that, in the law of contract, there is a presumption that the parties intended to conclude a legally valid contract. In the context of sport, this means that there is a presumption that the rules of the sport are also lawful. Courts will therefore assume that the rules of the sport are lawful, unless the contrary is proven. The position might be different where friends or family engage in social sports for recreation or entertainment. Social engagements generally do not give rise to binding contracts. Social participation in sport is therefore not based on contract and participants generally also do not observe the rules strictly. The defence of consent to injury or the risk of injury is problematic in the context of sport. Many claims based on sports injuries have failed because apparently conduct which would otherwise be unlawful, can be excused on the grounds that the participants in the sport concerned consented to the risks inherent in that sport. But participation in sport does not in itself provide an all-embracing defence against all claims based on sports injuries. Firstly, consent to injury is a unilateral juristic act which limits the rights of the party granting consent. Consent to injury therefore binds only the player and does not extend to any third parties. Apart from the injured player, a sports injury can cause harm to other interested parties, such as dependants, the player's club and support staff employed by the player. These third parties could still have valid claims against the wrongdoer if they should suffer loss when an athlete gets injured. Secondly, consent to injury is problematic when children participate in sport. The golden rule when children are involved is that one must always determine what is in the best interest of the child. It is not certain that participation in sport and the corresponding consent to injury is necessarily always in the best interest of the child concerned. Accordingly, a court may refuse to exclude liability on this ground when children are involved. Thirdly, professional players are compelled by their employment to run the risk of sports injuries and therefore it cannot be said that consent is granted freely. Fourthly, it is not clear that parties who participate in merely social sports, as well as beginners, necessarily appreciate the extent to which they run the risk of injury. It also seems that professional players find this aspect of consent to be problematic and it puts further doubt on the validity of any consent which may indeed be granted. Consent must also be lawful. Despite indications that the courts might even in some instances condone wilful violations of the rules if these should lead to injuries, there are several policy factors which require that consent can be a valid defence only if the offender played by the rules. One of these factors is a simple matter of occupational health and safety. Another is the high rate of injury in sport. Statistics show that the risk of injury to professional players is up to 5 000 times higher than the risks to workers in the mining industry. Sports federations should do more to promote the safety of players so that they can avoid claims by retired or current players. Some sports federations, such as Athletics South Africa and the National Football League in the USA, have already felt the brunt of such claims. It is time that all sporting codes got their houses in order.

European journal of sport science, 2017

The present investigation was carried out to examine the incidence and pattern of injuries in adolescent multisport athletes from youth sports academy. Injury data were prospectively collected from 166 athletes during the seasons from 2009 to 2014. A total of 643 injuries were identified, 559 (87.0%) were time-loss injuries. The overall injury incidence was 5.5 (95% confidence interval CI: 5.1-6.0), the incidence of time-loss injuries was 4.8 (95% CI: 4.4-5.2), the incidence of growth conditions was 1.2 (95% CI: 1.0-1.4) and incidence of serious injuries was 0.6 (95% CI: 0.5-0.8) per 1000 h of exposure. The prevalence of overuse injuries was 50.3%. Growth conditions represented 20.0%. Most of the injuries (67.0%) involved the lower extremities, and both foot and ankle were the most predominant injured body parts (22.0%). Knee injuries were mostly from overuse (50 vs. 23, p = .02), whereas foot and ankle injuries resulted from an acute mechanism (94 vs. 31, p < .0001). Minor and m...

Florida public health review, 2019

The purpose of this study was to identify the injury rates and mechanisms of sports injuries among 5-11-year-old athletes, and to provide preliminary guidance for decreasing injuries in this population. A total of 1511 athletes ages 511 playing football, soccer, baseball and softball participated in our research. One certified athletic trainer (ATC) used Reporting Information Online (RIO) to collect the data on athletic exposure, injuries and injury mechanisms weekly during the 2016-2017 season in Hillsborough County, Florida. A total of 18 injuries occurred in practices or competitions. Football had the leading rate of injuries for both competitions and practices (1.18 and 0.68, per 1000 athlete-exposures respectively). Most injuries occurred during competition (66.7%) and the leading types of injuries were concussions (22.2%) and fractures (22.2%). The leading injury mechanisms were contact with another person (33.3%) and playing apparatus (33.3%). It is advantageous to have ATCs ...

Sport has been an aspect of human society since the earliest times and sports injuries have probably also been part of human existence from the outset. The contests in ancient sports often led to serious injury or death and athletes were viewed as expendable resources that could be sacrificed in the quest for glory. It would seem that this notion of expendable athletes has remained with us throughout the ages. The old Roman principle of volenti non fit injuria endured through the Middle Ages and today we know it as consent to injury or assumption of the risk of injury. Athletes believe in “no pain, no gain” and regard pain as a necessary by-product of sport. Sports managers rely on the self-motivation of players to push themselves beyond the bounds of normal human endeavour in pursuit of success. Athletes who push on and continue to compete despite excruciating pain are hailed as heroes who put their team or country above their own interests. In addition, sport and state authorities seem to accept that injuries and deaths are inevitable in sport. Almost every sport can erect its own “war memorial” for fallen athletes who have met their fate while training for or participating in sport. The number of serious injuries are even higher and there are innumerable short-term injuries that result in athletes’ sitting out on training sessions. Even in cases where team managers or team crews have pushed athletes to the point of death or compelled racing drivers to compete in unsafe cars, authorities have not taken action against such managers or crews. It would seem that sports federations and clubs can do no wrong. The general message to athletes everywhere seems to be: if you play and get hurt, that is your problem. In part 2of this article, an analysis of the principles shows that the position in respect of liability for sports injuries is not quite as simple as it may appear at first glance. Initially, the courts appeared to be mostly reluctant to hold sports federations, clubs or players liable for sports injuries because of the doctrine of consent to injury or assumption of the risk of injury. It would appear that courts generally submit to the rules of the sport concerned. The reason for this could be that organised sport is played on the basis of a contractual relationship between the sports federation, sports league, sports club, event organiser and players. The terms of this contractual relationship are found, inter alia, in the rules of the sport and players agree to play according to these rules. In this regard it is worth mentioning that, in the law of contract, there is a presumption that the parties intended to conclude a legally valid contract. In the context of sport, this means that there is a presumption that the rules of the sport are also lawful. Courts will therefore assume that the rules of the sport are lawful, unless the contrary is proven. The position might be different where friends or family engage in social sports for recreation or entertainment. Social engagements generally do not give rise to binding contracts. Social participation in sport is therefore not based on contract and participants generally also do not observe the rules strictly. The defence of consent to injury or the risk of injury is problematic in the context of sport. Many claims based on sports injuries have failed because apparently conduct which would otherwise be unlawful, can be excused on the grounds that the participants in the sport concerned consented to the risks inherent in that sport. But participation in sport does not in itself provide an all-embracing defence against all claims based on sports injuries. Firstly, consent to injury is a unilateral juristic act which limits the rights of the party granting consent. Consent to injury therefore binds only the player and does not extend to any third parties. Apart from the injured player, a sports injury can cause harm to other interested parties, such as dependants, the player's club and support staff employed by the player. These third parties could still have valid claims against the wrongdoer if they should suffer loss when an athlete gets injured. Secondly, consent to injury is problematic when children participate in sport. The golden rule when children are involved is that one must always determine what is in the best interest of the child. It is not certain that participation in sport and the corresponding consent to injury is necessarily always in the best interest of the child concerned. Accordingly, a court may refuse to exclude liability on this ground when children are involved. Thirdly, professional players are compelled by their employment to run the risk of sports injuries and therefore it cannot be said that consent is granted freely. Fourthly, it is not clear that parties who participate in merely social sports, as well as beginners, necessarily appreciate the extent to which they run the risk of injury. It also seems that professional players find this aspect of consent to be problematic and it puts further doubt on the validity of any consent which may indeed be granted. Consent must also be lawful. Despite indications that the courts might even in some instances condone wilful violations of the rules if these should lead to injuries, there are several policy factors which require that consent can be a valid defence only if the offender played by the rules. One of these factors is a simple matter of occupational health and safety. Another is the high rate of injury in sport. Statistics show that the risk of injury to professional players is up to 5 000 times higher than the risks to workers in the mining industry. Sports federations should do more to promote the safety of players so that they can avoid claims by retired or current players. Some sports federations, such as Athletics South Africa and the National Football League in the USA, have already felt the brunt of such claims. It is time that all sporting codes got their houses in order.

Clinical Pediatrics, 2010

Purpose. To evaluate relationships between seasonal patterns of athletic participation and overuse injuries in high school athletes. Methods. Self-reported survey of sports played and injuries sustained during the preceding 12 months administered anonymously to 9th-12th graders in school. Results. Females suffered more overuse injuries than males. Overuse injuries increased slightly with age and with seasons of sports played per calendar year. Students who played sports all year long had 42% increased risk of overuse injury compared to those who played fewer than 4 seasons. Conclusions. Reducing the number of sport seasons played by high school athletes could decrease their rate of overuse injuries, with the greatest gains potentially achieved by taking at least one season off from sports entirely each calendar year.

Applied Physiology, Nutrition, and Metabolism, 2008

An increase in the physical activity of individuals has many health benefits, but a drawback of an increase in physical activity is the risk of related injuries. To reduce the short-and long-term effects in terms of social and economic consequences, prevention of physical activity injuries is an important challenge. A sequence of prevention model has been proposed that aims to prevent physical activity injuries in different steps. The model includes (i) identification of the problem in terms of incidence and severity of physical activity injuries, (ii) identification of the risk factors and injury mechanisms that play a role in the occurrence of physical activity injuries, (iii) introduction of measures that are likely to reduce the future risk and (or) severity of physical activity injuries, and (iv) evaluation of the effectiveness of the measures by conducting a randomized controlled trial (RCT). This review describes what is currently known about all of the various aspects of the sequence of prevention in children (steps i-iv).

International Journal of Environmental Research and Public Health

The present study aimed to determine the epidemiology of sport-related injuries in amateur and professional adolescent athletes and the incidence of different risk factors on those injuries. Four hundred ninety-eight athletes aged 14 to 21 voluntarily participated in this prospective injury surveillance, conducted from 1 January 2019 to 31 December 2019. The information collected included: personal data, sports aspects, characteristics of the injuries, and lifestyle. Forty point four percent of the participants suffered an injury in 2019 (39% of them in a previously injured area). The average injury rate was 2.64 per 1000 h. Soccer presented the highest rate (7.21). The most common injuries were: lumbar muscle strains (12.24%), ankle sprains (11.98%), and bone fractures (9.31%). Ankles (36.12%), knees (19.32%), and shoulders (6.47%) concentrated the highest number of injuries. Fifty-nine point twenty-eight percent of the injuries occurred during practices, and 40.72% during competit...