The Centers for Disease Control and Prevention, taking account of existing surveillance systems and relevant federal data collection efforts, should establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions, including those in youth ages 5 to 21. The surveillance data collected should include, but not be limited to, demographic information (e.g., age, sex, race and ethnicity), preexisting conditions (e.g., attention deficit hyperactivity disorder, learning disabilities), concussion history (number and dates of prior concussions), the use of protective equipment and impact monitoring devices, and the qualifications of personnel making the concussion diagnosis. Data on the cause, nature, and extent of the concussive injury also should be collected, including
Sport or activity
Level of competition (e.g., recreational or competitive level)
Event type (e.g., practice or competition)
Impact location (e.g., head or body) and nature (e.g., contact with playing surface, another player, equipment)
Signs and symptoms consistent with a concussion
Sports injuries in young athletes are a public health issue which deserves special attention. Effective prevention can be achieved with training programmes originating from the field of physical therapy and medicine.
Sources of data
A systematic literature search on injury prevention in youth sport was performed in the MEDLINE database.
Areas of agreement
For prevention programmes to reduce sports injuries, critical factors must be considered, such as training content, duration and frequency, as well as athlete compliance.
Areas of controversy
Home-based programmes could be inferior to supervised training, but are efficient if compliance is high. So far prevention programmes have focused on team sports and their efficiency in individual sports remains to be proven.
Active prevention programmes focusing specifically on the upper extremity are scarce. Initiatives enhancing the awareness of trainers, athletes and therapists about risk factors and systematic prevention measures should be encouraged.
sports injuries, young athlete, prevention strategies, compliance, risk factors
Promotion of a physically active lifestyle is encouraged worldwide, particularly with regard to the many health benefits.1 In children and adolescents, regular sports practice facilitates the development of fundamental movement skills,2 helps prevent obesity and its long-term consequences3 and has long-lasting benefits on bone health.4 Unfortunately, increased intensity and volume of sport practice lead to a higher rate of acute and overuse injuries. For the young athlete, the consequences of sports injuries could be numerous, ranging from re-injury to career-ending.5 Long-term impacts of sports injuries are frequently found in adulthood, such as an accelerated development of osteoarthritis.6
In addition to the potentially long-term outcomes of sports injuries on later life, the related healthcare costs constitute a substantial economic burden. In a recent study, Cumps et al.7 showed that the ensuing total direct medical costs of sports injuries in Flandren (i.e. rehabilitation, medical care, hospitalization, medication, bandages, transport, crutches) amounted to 15 027 423.00Є, which represents 0.07–0.08% of the total budget spent on health care. In the USA, the estimated total hospital charges for sports injury hospitalizations among 5–18-year-olds were $485 million over a period of 4 years, with a steady increase each year.8 The highest medical costs are mostly found for knee injuries, especially for anterior cruciate ligament (ACL) injuries.7,8 The costs for one ACL surgery plus rehabilitation were estimated to up to $17 000. Gianotti et al.9 analysed knee ligament injuries in New Zealand and found that the mean treatment costs were $885 for non-surgical knee injuries, $11 157 for ACL surgeries and $15 663 for other knee ligament surgeries. The socio-economic impact should also be viewed under the light of indirect costs of sports injuries, such as absence from work and long-term health consequences, which add to the direct costs.7
Reduction of only a moderate proportion of all sports injuries is of significance for the young athletes' health and could have a long-term economic impact regarding health-care costs.10 It is therefore important to convince medical doctors, physical therapists, trainers and coaches, as well as the athletes themselves, of the necessity to implement active prevention measures into their therapy and training programmes, thus decreasing the (re-)injury rate and enhancing athletic performance. Indeed, recent scientific literature based on a systematic injury prevention approach suggests that well-designed programmes do have positive effects, provided that a number of conditions are fulfilled.
Van Mechelen et al.11 proposed a general four-step model (Fig. 1) for sports injury surveillance. The first step comprises the description and the extent of the injury problem. In a second phase, the aetiology and mechanisms of sports injury are being investigated. A third stage concerns the introduction of preventive measures, which will then be assessed regarding their effectiveness by repeating step 1. The purpose of this paper is to review the state-of-the-art knowledge on injury prevention in child and youth (<19 years) sports based on that model. In the first part, the incidence and frequency of particular sports injuries will be briefly recalled, highlighting the specificities of the young age group related to biological maturation. The second part will discuss intrinsic risk factors of that population, with special emphasis on those which are modifiable and can be targeted by intervention. In the last part, active prevention programmes will be critically presented regarding their implementation, characteristics and efficiency. This analysis will make it possible for practitioners of different areas to draw relevant recommendations for their work.
Search strategy and methods
A systematic search of relevant publications was performed for the section on active prevention strategies via the MEDLINE database (1966–May 2009). The keywords used were adolescent OR youth AND sports injury AND prevention, yielding a total of 1953 hits. Additional searches were performed in the authors' personal databases. Relevant papers were selected on the basis of the following criteria: Figure 2 provides an overview of the search strategy used. On the basis of these selection criteria, 14 studies were retained for further analysis.
exclusive focus on organized sports;
separate results for young athletes under the age of 19 years;
longitudinal studies: only prospective designs;
major focus on intrinsic risk factor;
intervention studies using active prevention programmes;
search limited to English papers only.
Flow-chart illustrating the search strategy used for investigations dealing with active prevention strategies.