by David H. Janda, M.D.
Institute for Preventative Sports Medicine, Ann Arbor, Michigan

"Injury is probably the most under recognized major public health problem facing the nation today, and the study of injury represents unparalleled opportunities for reducing morbidity and mortality and for realizing significant savings in both financial and human terms - all in return for a relatively moderate investment (2)."

The above statement, now four years old, continues to ring hollow in most medical research facilities in North America. All causes of injury have been estimated to kill more than 142,000 Americans each year and cause more than 62 million persons to require medical attention annually (3). The United States Consumer Product Safety Commission has reported five million medically treated injuries associated with fifteen of the most popular sports in a one-year time period (6). Injuries are the greatest single killer of individuals from ages 1-44 and cost the nation approximately $133.2 billion each year (3). Thus, it is an understatement, that injuries are an enormous public health problem that continue to usurp our limited health care financial resources. In North America, the vast majority, if not the entirety of the training programs for sports medicine personnel including physicians, focus on the treatment and rehabilitation of the injured individual. Little, if any, attention is given to teaching the skills required to evaluate a problem from a preventive approach and the development of a preventative approach to a problem is consequently under emphasized or even nonexistent. Such is currently the case with sport medicine, a field where prevention can take the form of modifications in training, preventive equipment, and in the elimination of unsafe practices.

Several published research papers emphasizing the preventive approach within the sports medicine field have yielded an enormous reduction in injury rates as well as an enormous reduction in health care costs. Peterson's 1970 analysis of injury rates in football led to the elimination of cross-body blocking and a substantial reduction in football in juries (5). The institution of passive preventive measures as recommended by the research of Pashby et al. involving protective eye wear during racquet sports, has led to a significant diminution in eye injuries and associated health-care costs (4). An in dependent analysis by the Centers for Disease Control with regard to our research on the utilization of breakaway bases within recreational baseball indicates a projected prevention of 1.7 million injuries per year in the United States alone with an estimated savings in health care costs of $2 billion per year nationally (1).

On the one hand, research directed towards documenting the efficacy of preventive measures in sports seems to be logical, straightforward, and relatively simple. Unfortunately, this is not the case at present. Even with well substantiated studies, the enforcement of protective rules and utilization of protective equipment continues to be shunned by the athletic community at large. Tradition has been one of the major obstructions to introducing new rules or equipment to prevent injuries. Implementing equipment changes such as breakaway bases may offend the traditionalist, and undermine traditional aspects of the sport. In addition, other obstacles such as ignorance or lack of recognition of safety measures can delay or block instituting preventive measures. Unfortunately, the general public may be misled in regard to prevention, if unethical promotion of products by the business community is allowed. Further, implementation of some protective equipment may be expensive and resisted by communities, schools and organizations, since they must absorb the additional cost without benefitting directly from reduced insurance premiums.

It is of paramount importance that citizens, organizations, and most importantly physicians, re searchers, and other health care professionals maintain persistent pressure on all organized sports groups, school leagues, city leagues, professional sports, and college sports to consider and promote improved equipment, safer techniques, and preventive measures. It is obvious that without this leadership by physicians and health-care personnel, the necessary changes will not be instituted and, there fore, injury will continue to drain our already over burdened health care systems.

Thus, prevention is two-pronged. First, well designed research studies must document the safety of products and, secondly, the medical community must lobby for change. In order for prevention to come to the forefront of health-care cost containment, physicians and other health care personnel must bring scientific, not anecdotal, research to light in the public forum. This can be accomplished through lectureships, the media, and by enrolling the support of local, state, and national government representatives in increasing the public's awareness of preventive measures. It has been found that governmental agencies can act to increase public awareness, thereby making sports organizations consider alternatives and safer playing methods and conditions. In addition, the media can have an enormous and immediate impact upon disseminating the necessary information to the public. It is our contention that an informed public will, therefore, be come a safer public.

It is also imperative that we enlist the support of corporate North America to fund the development and implementation of appropriate measures in order to reduce our health-care expenditures. To date, many corporations speak of prevention but very few in actuality support the concept. One of the reasons may be that treatment is capable of immediate results, whereas the impact of preventive strategies is realized over the long term. To circumvent this difficulty, institutional-based researchers must expand their influence from the domains of pure research and work together with industry, fostering a collaborative relationship that will promote the applied research which will reduce sport injuries.

In summary, it is the responsibility of every health-care provider within the field of sports medicine to make the practice of prevention the rule and not the exception. If we are serious about reducing morbidity, mortality, and the health-care dollars spent on sports injuries, we, individually and collectively, must emphasize the development of preventive techniques that would.lead to a significant reduction of injuries. This approach is the "next frontier" for sports medicine.

REFERENCES

1. Janda DH, Wojtys EM, Hankin FM, Hensinger RN, Sacks J. Softball sliding injuries in Michigan 1986-1987 MMWR 1988;37: 169-70.
2. National Academy of Sciences. In: Injury Control. Washington, DC: National Academy Press, 1988:7.
3. The National Committee for Injury Prevention and Control. Injury prevention: meeting the challenge. The American Journal of Preventative Medicine 1989 (suppl):I.
4. Pashby TJ , Bishop PJ, Easterbrook WM. Eye injuries in Canadian racquet sports. Canadian Family Physician 1982;28:967-71.
5. Peterson TR. The cross body block, the major cause of knee injuries. JAMA 1970;211:211-4.
6. Rutherford GE, Miles R. Overview of sports related injuries. Washington, DC: United Safety Consumer Product Safety Commission, 1981.

This article was published as:
"Prevention Has Everything to Do with Sports Medicine"
Clinical Journal of Sports Medicine
Vol. 2, 1992, pp. 159-60
Janda DH

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