Injury prevention programs not widely used in high schools, study shows

CORVALLIS, Ore. - Injury prevention programs can help reduce ankle, knee and other lower extremity injuries in sports, but the programs are not being widely used in high schools, a new study from Oregon State University has found.

Researchers surveyed 66 head soccer and basketball coaches from 15 Oregon high schools and found that only 21 percent of the coaches were using an injury prevention program, and less than 10 percent were using the program exactly as designed, said the study's lead author, Marc Norcross, an assistant professor of exercise and sport science in OSU's College of Public Health and Human Sciences.

"We know these programs are beneficial to the athletes," Norcross said. "If I were to recommend something to coaches, it would be to adopt one of these programs and follow it."

In 2013-14, more than 1.7 million students competed in high school soccer and basketball in the United States. During that period, about 335,000 of the athletes had a lower extremity injury that required medical attention and kept them from participating for at least one day.

The more serious injuries, such as an ACL tear, can require months of recovery and rehabilitation and can lead to early onset of arthritis. But even minor injuries such as an ankle sprain can have significant consequences, Norcross said. Ankle sprains, for example, increase the risk of arthritis developing in the joint.

Injury prevention programs are designed to help reduce lower extremity injuries that occur during play or practice but aren't as a result of contact with another player. Among the better known-programs are PEP, developed by the Santa Monica Sports Medicine Foundation; and FIFA 11+, developed in conjunction with the world soccer organization.

While they can vary in structure and content, most injury prevention programs include often include similar activities, such as strength exercises, cutting/jumping drills and balance exercises with a focus on using proper technique.

In their study, OSU researchers wanted to find out whether high school coaches were aware of existing injury prevention programs, if they were using a program, and if not, why not. They focused on soccer and basketball because lower extremity injuries are common in those sports and they are not usually caused through direct contact with another player.

They found that about half of the boys and girls coaches surveyed were aware of existing injury prevention programs. Coaches of girls' teams were more likely to be aware of the programs than coaches of boys' teams. Also, less than half of the coaches perceived lower extremity injuries to be a problem for their team.

The findings were published recently in the Journal of Science and Medicine in Sport. The research was funded by a grant from the Oregon School Activities Association Foundation. Co-authors of the study are Samuel Johnson, Viktor Bovberg and Mark Hoffman of OSU and Michael Koester of the Slocum Center for Orthopedics and Sports Medicine in Eugene.

While most coaches surveyed were not using a formal injury prevention program, about two-thirds of the coaches, or 65 percent, reported that they use activities similar to those found in such programs. That may be one reason they aren't adopting a specific program, Norcross said.

But there hasn't been any research yet to determine what, specifically, works about the injury programs. Researchers don't know if it is specific components of the programs that lead to fewer injuries, or if it is the combination of several things.

"When a coach says, 'I already do most of those things, isn't that enough?' - the answer is, we don't know," Norcross said. "Maybe that is good enough. We need to find that out."

OSU researchers are now working on a related study that will examine high school athlete injury data in relation to coaches' injury prevention practices. That should help researchers understand whether specific practices, or injury prevention programs as a whole, are helping to reduce injuries, Norcross said.

"For too long, we've been waiting for the perfect program to be developed," he said. "There's more we don't know than we do. But we should use the little we do know while we continue to learn more."

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