tag:theconversation.com,2011:/uk/topics/injuries-2151/articlesInjuries – The Conversation2024-03-28T12:21:11Ztag:theconversation.com,2011:article/2243222024-03-28T12:21:11Z2024-03-28T12:21:11ZWhy women’s rugby needs its own injury prevention strategy<p>With the Women’s Six Nation’s Championship underway, there is <a href="https://www.bbc.co.uk/sport/rugby-union/65129693">mounting public concern</a> regarding the <a href="https://www.rugbypass.com/news/long-term-brain-damage-could-be-a-significantly-bigger-issue-in-womens-rugby-than-mens-says-lead-concussion-doctor/">risk of injuries</a> to players. </p>
<p>In recent years there has been a significant rise in the number of women playing rugby. Women now make up <a href="https://www.rugbyworldcup.com/2023/news/836825/global-rugby-participation-increasing-ahead-of-rugby-world-cup-2023">one-quarter</a> of the global rugby playing population. But despite the fact that there are similar injuries in both men and women’s rugby, female players need their own injury prevention strategy. </p>
<p>There is evidence to suggest that gender differences may <a href="https://pubmed.ncbi.nlm.nih.gov/34052518/">influence injuries</a> in team sports in general. </p>
<p>Research shows that lower neck strength may predispose female rugby players <a href="https://pubmed.ncbi.nlm.nih.gov/34463209/">to concussion</a>. Research has shown that females have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582549/">greater head acceleration</a> in response to an applied force than males, which could predispose them to concussion. This may be because females have significantly less isometric neck strength and neck girth. </p>
<p>Anatomical differences in the female pelvis, knee and lower leg can alter lower limb alignment. The resulting <a href="https://www.physio-pedia.com/Valgus_Knee">knee valgus</a>, or “knock knee”, may <a href="https://my.clevelandclinic.org/health/body/24777-knee-joint">increase injury risk</a> to the knee particularly the medial collateral ligament, meniscus and possibly the anterior cruciate ligament (ACL). </p>
<p>Gender differences in <a href="https://www.britannica.com/science/neuromuscular-junction">neuromuscular function</a> (the communication between the brain and muscles) have also been reported to contribute to <a href="https://pubmed.ncbi.nlm.nih.gov/8775118/">ACL injury</a> and possibly <a href="https://pubmed.ncbi.nlm.nih.gov/31092121/">concussion</a>. </p>
<p>While there are such differences, the common types of injuries in male and female rugby are similar. Concussion tops the list as the most common specific injury diagnosis with lower leg injuries to the ankle, knee and hamstring following behind. </p>
<h2>Higher risk?</h2>
<p>Within rugby union, an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659070/">injury is defined</a> as any physical complaint sustained by a player during the game that results in the player being unable to take part in future rugby activities. </p>
<p>At the elite level, <a href="https://www.englandrugby.com/dxdam/d8/d86ddce6-f7d0-4aeb-9897-34ecaed2565d/WRISP_report_20-21.pdf">women’s rugby</a> has an overall injury risk that is nearly 50% lower than <a href="https://keepyourbootson.co.uk/wp-content/uploads/2022/03/PRISP-report-2021-22.pdf">men’s rugby</a>. This equates to about three injuries in every male professional match, and less than two injuries in every women’s rugby match. </p>
<p>In amateur rugby, the landscape is different. Both male and female players face a <a href="https://pubmed.ncbi.nlm.nih.gov/33655802/">comparable risk of injury</a>, albeit a lower overall risk than at the professional level. </p>
<p>Emerging evidence also suggests that the overall burden of injury may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558996/">higher in females than males</a> at this level. Injury burden is a composite measure of injury incidence, or rate, and the days missed that is used by experts to understand the overall impact of injuries.</p>
<h2>Concussion and ACL injuries</h2>
<p><a href="https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594#:%7E:text=A%20concussion%20is%20a%20mild,a%20change%20in%20brain%20function">Concussion</a> is a mild traumatic brain injury, usually caused by an impact to the head or body. The rate of concussion in <a href="https://keepyourbootson.co.uk/wp-content/uploads/2022/03/PRISP-report-2021-22.pdf">men’s professional rugby</a> is more than 30% higher than in <a href="https://www.englandrugby.com/dxdam/d8/d86ddce6-f7d0-4aeb-9897-34ecaed2565d/WRISP_report_20-21.pdf">women’s rugby</a>. Research is limited on this topic, but it could be because of the increased size and speed in male rugby increasing the force of contact to the body and therefore also to the head and neck.</p>
<p>However, gender differences in overall injury risk means that concussion accounts for more than one-third of all injuries for women and less than a quarter of injuries for men. </p>
<p>Also notable is that female players face more adverse consequences than men <a href="https://bjsm.bmj.com/content/57/4/212#ref-21">following concussions</a>, such as double the recovery time. The <a href="https://doi.org/10.1080/17461391.2021.1973573">cause</a> of concussion should also be considered. Whiplash and head to ground contact are substantial factors in female players, and more so than in men. This is due to lower isometric neck strength meaning less control of the head during a tackle.</p>
<p>ACL injuries also plague <a href="https://news.griffith.edu.au/2023/05/25/revolutionising-acl-research-and-recovery-for-female-athletes-will-be-bournes-legacy/">elite women’s soccer</a>. But in elite rugby, they are 20 times higher <a href="https://pubmed.ncbi.nlm.nih.gov/17293461/">for male</a> professional rugby players than their <a href="https://pubmed.ncbi.nlm.nih.gov/36428090/">female counterparts</a>. </p>
<p>Looking at the lower tiers of rugby, it becomes clear that women face a five times higher rate of ACL injuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899911/">compared to men</a>. Similar to concussion, ACL injuries represent a greater injury burden <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558996/#:%7E:text=Anterior%20cruciate%20ligament%20injuries%20presented,fourth%20quarter%20of%20match%20play">for women</a> in comparison to men with 50% longer recovery times.</p>
<h2>Unanswered questions</h2>
<p>Many questions remain to be answered on female rugby injury. For example, as women’s rugby transitions towards professionalism, how will this affect injury risk? </p>
<p>The lack of elite female teams has possibly contributed to women taking up the sport at an older age than men. This may explain the emerging evidence of a link between poorer tackle technique and higher injury risk in female players. </p>
<p>There are many other factors we need to understand better too. For example, does the greater injury burden, often reported in women’s rugby, stem from a lack of adequate medical support for female teams? And is the menstrual cycle related to <a href="https://pubmed.ncbi.nlm.nih.gov/37391203/">sports injury?</a></p>
<p>We also need to better understand breast injuries. These injuries are prevalent in <a href="https://pubmed.ncbi.nlm.nih.gov/29322119/">other sports</a> such as basketball, soccer, softball and volleyball. Nearly half of female athletes in such sports have reported they have sustained a breast injury. But there is very limited research or established guidelines concerning breast protection and breast health in women’s rugby. </p>
<p>Despite these unanswered questions, what is clear is that when it comes to playing contact sports, women cannot be viewed simply as smaller versions of men. Instead of imposing male injury prevention strategies on women’s rugby, it would be more beneficial to redirect attention towards understanding the specific injury risks in the women’s game. Then we can develop tailored injury prevention strategies for female players.</p><img src="https://counter.theconversation.com/content/224322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Owen receives funding from World Rugby. </span></em></p><p class="fine-print"><em><span>Eloise Kirby receives funding from World Rugby. </span></em></p>Despite the fact that there are similar injuries in men and women’s rugby, women should not be viewed merely as smaller versions of men.Julian Owen, Lecturer in Sport & Exercise Physiology, Bangor UniversityEloise Kirby, PhD Candidate, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2206412024-02-09T13:33:00Z2024-02-09T13:33:00ZAds, food and gambling galore − 5 essential reads for the Super Bowl<figure><img src="https://images.theconversation.com/files/574506/original/file-20240208-18-ge9cxl.jpg?ixlib=rb-1.1.0&rect=203%2C54%2C4074%2C2881&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Christian McCaffrey and the San Francisco 49ers will try to stop the Kansas City Chiefs from winning their third Super Bowl in five years.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/christian-mccaffrey-of-the-san-francisco-49ers-rushes-news-photo/1976854646?adppopup=true">Michael Zagaris/Getty Images</a></span></figcaption></figure><p>On Sunday in Las Vegas, the Kansas City Chiefs will be looking to win their second straight Lombardi Trophy, while a San Francisco 49ers victory would give the team its first Super Bowl <a href="https://en.wikipedia.org/wiki/Super_Bowl_XXIX">since 1995</a>, when <a href="https://www.pro-football-reference.com/players/Y/YounSt00.htm">Steve Young</a> was under center.</p>
<p>I didn’t get a pass to media day, so I didn’t get a chance to ask Chiefs head coach Andy Reid about how he tends to <a href="https://www.dailymail.co.uk/sport/nfl/article-12961001/Chiefs-coach-Andy-Reid-mustache-FREEZES.html">his mustache</a>.</p>
<p>But my colleagues and I were able to ask an all-pro lineup of scholars to write about a range of football-related topics, from the partisan food divide to the numbers behind the biggest gambling bonanza in league history.</p>
<h2>1. Flag, you’re it</h2>
<p>The Pro Bowl, the NFL’s version of the all-star game, usually gets scant attention. That’s because it happens the weekend before the Super Bowl – absent many of the stars playing in the big game – and the players seem most concerned about avoiding injuries, not winning the game.</p>
<p>A year ago, league officials decided to shake up the annual showcase. It would no longer be a tackle football game. <a href="https://www.nfl.com/news/nfl-announces-the-pro-bowl-games-to-replace-tackle-game-with-flag-football-skill">It would be a flag football match</a>. The thinking went that if the league’s stars didn’t have to tackle one another, they might play harder, be more likely to showcase their athleticism and, importantly, have more fun. </p>
<p>As West Virginia University sociologist Josh Woods explains, <a href="https://theconversation.com/could-flag-football-one-day-leapfrog-tackle-football-in-popularity-222349">the NFL’s promotion of flag football is a big deal</a>, particularly for an emerging sport that’s somewhat obscure outside of Florida, Georgia and New York, where roughly 80% of high school flag football players live. Its inclusion in the 2028 Summer Olympics will only further bolster its profile.</p>
<p>But Woods points to a gender divide and a political divide that could end up clouding the sport’s future.</p>
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Read more:
<a href="https://theconversation.com/could-flag-football-one-day-leapfrog-tackle-football-in-popularity-222349">Could flag football one day leapfrog tackle football in popularity?</a>
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<img alt="Young man runs holding a football and waving his finger mid-stride." src="https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574505/original/file-20240208-24-e030ed.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Miami Dolphins wide receiver Tyreek Hill runs for a touchdown in the first quarter of the 2024 NFL Pro Bowl in Orlando, Fla.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/tyreek-hill-of-the-miami-dolphins-and-afc-reacts-as-he-runs-news-photo/1985984027?adppopup=true">Mike Ehrmann/Getty Images</a></span>
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<h2>2. X’s, O’s and Z’s</h2>
<p>In 2011, former NFL cornerback Sam Shields was a rookie playing for a Green Bay Packers team that had made the Super Bowl. The night before the big game, he tossed and turned.</p>
<p>“I had stomach aches, using the bathroom, but I didn’t have to use it,” <a href="https://www.si.com/nfl/2019/01/31/super-bowl-2019-nfl-players-sleep-rams-patriots-atlanta">he told Sports Illustrated in 2019</a>. “It felt like Christmas too, when Christmas is the next day you can’t sleep.”</p>
<p>I’ve wondered whether I would get a wink of shut-eye if I were scheduled to pitch in the World Series. Something tells me I’d be a lot like Shields. And as if the Chiefs and 49ers players and coaches aren’t feeling enough pressure, it turns out that getting a good night’s sleep is one of the most important things an athlete can do before a big game, meet or match.</p>
<p>University of Pittsburgh sleep medicine specialist Joanna Fong-Isariyawongse highlights reams of studies showing how <a href="https://theconversation.com/sleep-can-give-athletes-an-edge-over-competitors-but-few-recognize-how-fundamental-sleep-is-to-performance-221403">a poor night’s sleep can effect performance and decision-making</a> while making you more likely to get injured.</p>
<p>In fact, she writes, “Sleep deficits have been linked to decreased performance in every cognitive measure.”</p>
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Read more:
<a href="https://theconversation.com/sleep-can-give-athletes-an-edge-over-competitors-but-few-recognize-how-fundamental-sleep-is-to-performance-221403">Sleep can give athletes an edge over competitors − but few recognize how fundamental sleep is to performance</a>
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<h2>3. Going all in on gambling</h2>
<p>Did you bet on the 49ers to cover the spread? Perhaps you’re <a href="https://www.wikihow.com/Play-Football-Squares">playing squares</a>. Or maybe you’re betting on Reba McEntire’s national anthem <a href="https://www.foxsports.com/stories/nfl/2024-super-bowl-lviii-odds-how-long-will-reba-mcentires-national-anthem-be">to last longer than 90.5 seconds</a>.</p>
<p>If you’ve wagered on some aspect of the big game, you’re one of roughly 67 million American adults who have done the same, according to a Morning Consult survey conducted in early February. That would make another new record, shattering 2023’s record, which shattered the mark from 2022. The country’s gambling mania has been aided, in part, by the Supreme Court’s 2018 ruling that <a href="https://www.nytimes.com/2018/05/14/us/politics/supreme-court-sports-betting-new-jersey.html">overturned a federal ban on sports betting</a>. </p>
<p>Gambling and the Super Bowl have always gone hand in hand. To University of Iowa sports media scholar Tom Oates, what makes the developments of the past few years so remarkable is <a href="https://theconversation.com/the-super-bowl-gets-the-vegas-treatment-with-1-in-4-american-adults-expected-to-gamble-on-the-big-game-222370">the NFL’s stunning reversal on its own attitudes toward betting</a>.</p>
<p>Gone are the quaint days of league officials lobbying Congress to put restrictions and guardrails in place. The NFL has gone all in on its embrace of gambling, <a href="https://sports.yahoo.com/nfl-inks-nearly-1-billion-212312677.html?_fsig=UXLu7VdB0Sg8Wcfmd7USNw--%7EA">forging billion-dollar partnerships</a> with the country’s top sportsbooks.</p>
<p>“But this infusion of extra cash comes with a substantial social cost,” Oates writes. “Gambling addictions are at an all-time high, likely spurred by the ease with which people can place bets from their phones.” </p>
<p>So if you want to get in on the action, gamble responsibly and don’t let your emotions get the best of you. </p>
<p>That being said, a little birdie told me that Reba <a href="https://www.facebook.com/watch/?v=696443244813036">can really hold her notes</a>. </p>
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Read more:
<a href="https://theconversation.com/the-super-bowl-gets-the-vegas-treatment-with-1-in-4-american-adults-expected-to-gamble-on-the-big-game-222370">The Super Bowl gets the Vegas treatment, with 1 in 4 American adults expected to gamble on the big game</a>
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<img alt="Woman with red hair and silver dress holds microphone and smiles." src="https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574593/original/file-20240209-31-9fdvn2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Country music singer Reba McEntire will be singing the national anthem at Super Bowl LVIII.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/reba-mcentire-performs-at-madison-square-garden-on-april-15-news-photo/1482508270?adppopup=true">Theo Wargo/Getty Images</a></span>
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<h2>4. At least they aren’t serving donkey meat</h2>
<p><a href="https://jacobin.com/2022/01/hyper-politics-annie-ernaux-moralism-identity-media-individualization">Everything is politicized</a>, so the lament goes. And even the Super Bowl – <a href="https://thedaily.case.edu/the-super-bowl-is-a-cultural-moment-but-why/">one of the few communal events left</a> in a polarized, atomized nation – can’t avoid the creep of partisanship. </p>
<p>In recent years, some of the country’s most iconic food brands – <a href="https://www.nytimes.com/article/bud-light-boycott.html">Bud Light</a>, <a href="https://www.nytimes.com/2020/07/10/business/goya-boycott.html">Goya</a>, <a href="https://www.businessinsider.com/papa-johns-cuts-ties-with-the-nfl-after-national-anthem-protests-2018-2">Papa John’s</a>, <a href="https://nypost.com/2021/02/23/coca-cola-diversity-training-urged-workers-to-be-less-white/">Coca-Cola</a>, <a href="https://www.vox.com/politics/2023/5/31/23742373/chick-fil-a-boycott-controversy-conservative-backlash">Chick-fil-A</a> – have been excoriated by partisans on both sides of the aisle. </p>
<p>So food spreads can color every Super Bowl party with a tinge of “red team,” “blue team.”</p>
<p>“What you serve at your Super Bowl party, or what the host serves at the event you attend, can now be interpreted, or twisted, through a partisan lens,” write political scientists Joshua J. Dyck and Shanna Pearson-Merkowitz.</p>
<p>One possible way to bridge the divide: Unite in a bipartisan celebration of Taylor Swift. Actually, <a href="https://theconversation.com/why-taylor-swift-is-an-antihero-to-the-gop-but-democrats-should-know-all-too-well-that-her-endorsement-wont-mean-its-all-over-now-222437">scratch that</a>. </p>
<p>Maybe you could just serve salmon – a food that, according to Dyck and Pearson-Merkowitz’s research, is “resistant to partisan cues.”</p>
<p>Grim times, indeed.</p>
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Read more:
<a href="https://theconversation.com/super-bowl-party-foods-can-deliver-political-bite-choose-wisely-222687">Super Bowl party foods can deliver political bite – choose wisely</a>
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<h2>5. ByeDaddy</h2>
<p><a href="https://apnews.com/article/super-bowl-poll-commercials-halftime-1f65969d3ec56a5c3eca3ba386428d6a">According to an Associated Press-NORC Center for Public Affairs Research poll</a>, 22% of Americans planning to watch the Super Bowl are most excited about the commercials.</p>
<p>That’s one reason companies are willing to fork over so much cash for a coveted slot – as much as US$7 million for a 30-second spot. </p>
<p>However, as Auburn University scholars Linda Ferrell and O.C. Ferrell point out, many regulars on the airwaves of the Super Bowl, such as GoDaddy and Ford, are <a href="https://theconversation.com/super-bowl-ads-its-getting-harder-for-commercials-to-score-with-consumers-222269">missing from this year’s lineup</a>.</p>
<p>What gives?</p>
<p>“Gen Z, in particular, is not impressed by Super Bowl ads,” they write, “and complicating the matter is their lack of interest in broadcast TV.”</p>
<p>So as a millennial who’s spent years listening to how <a href="https://knowyourmeme.com/memes/millennials-are-killing">my generation has killed</a> everything from paper napkins to mayonnaise, I take great pleasure in typing: Gen Z killed the Super Bowl ad.</p>
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Read more:
<a href="https://theconversation.com/super-bowl-ads-its-getting-harder-for-commercials-to-score-with-consumers-222269">Super Bowl ads: It's getting harder for commercials to score with consumers</a>
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<p><em>This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/220641/count.gif" alt="The Conversation" width="1" height="1" />
Oh, yeah, and there’s a game, too.Nick Lehr, Arts + Culture EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2137192023-09-22T12:30:44Z2023-09-22T12:30:44ZAaron Rodgers’ season-ending Achilles tear resurfaces questions about player safety on artificial turf<figure><img src="https://images.theconversation.com/files/549613/original/file-20230921-23-1tbdis.jpg?ixlib=rb-1.1.0&rect=4%2C12%2C2780%2C1882&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New York Jets quarterback Aaron Rodgers suffered a torn Achilles tendon after being sacked by Buffalo Bills defensive end Leonard Floyd.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/aaron-rodgers-of-the-new-york-jets-is-sacked-during-the-news-photo/1689810103?adppopup=true">Jim McIsaac/Getty Images</a></span></figcaption></figure><p>In the first quarter of his first game as a New York Jet, quarterback Aaron Rodgers dropped back to pass. Buffalo Bills defensive end Leonard Floyd blew past the offensive line and wrapped up Rodgers, dragging him awkwardly to the ground. Rodgers got up, before falling back to the turf, grimacing in pain. </p>
<p>Just like that, the Jets lost their biggest offseason acquisition <a href="https://www.usatoday.com/story/graphics/2023/09/18/aaron-rodgers-complete-achilles-tear-explained/70853550007/">to a season-ending Achilles tendon tear</a>.</p>
<p>Blame quickly circulated. To some football players, it wasn’t Rodgers’ age – the quarterback will turn 40 in December 2023 – nor was it simple bad luck that caused the injury.</p>
<p><a href="https://www.cnn.com/2023/09/13/sport/aaron-rodgers-injury-artificial-turf-nfl-spt-intl/index.html">It was the artificial turf</a> at MetLife Stadium, where the Jets and New York Giants play their home games.</p>
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<p>Two days after the injury, the NFL Players Association <a href="https://www.orlandosentinel.com/2023/09/13/nfl-players-union-renews-call-for-grass-fields-after-aaron-rodgers-injury/">called on the league to convert all playing fields to natural grass</a>. It joined <a href="https://www.si.com/nfl/2014/05/21/nfl-history-95-objects-artificial-turf">a chorus of players and coaches</a> across sports who, for decades, have blamed artificial turf for injuries ranging from sprains and strains to tendon ruptures.</p>
<p><a href="https://scholar.google.com/citations?user=_AxjgecAAAAJ&hl=en">As a physical therapist, researcher</a> and director of performance and sports science, I help elite athletes minimize injury risk and maximize performance. It’s always difficult to tell whether an injury could have been prevented had someone not been playing on a certain surface - particularly because muscle and tendon strength, pliability and stiffness usually play a much more important role.</p>
<p>However, some studies have linked playing on artificial turf to injury risk, though the risk tends to be limited to a few body parts.</p>
<h2>The grass is always greener?</h2>
<p>In 1966, Houston’s Astrodome became the first major sports venue <a href="https://doi.org/10.1177%2F1941738118793378">to install synthetic turf</a>. It was originally called “<a href="https://www.thoughtco.com/history-of-astroturf-1991235">ChemGrass</a>,” though Monsanto, the company that invented it, later rebranded its product as “AstroTurf” due to its association with the Astrodome.</p>
<p>Not everyone was jazzed about the cutting-edge carpet.</p>
<p>“Imagine that – a [US]$45 million ballpark and a 10-cent infield,” <a href="https://sciencehistory.org/stories/magazine/turf-wars/">groused Chicago Cubs manager Leo Durocher</a>. Players said the surface didn’t have the same give as grass – making <a href="https://www.nytimes.com/1975/10/14/archives/astro-turf-is-looming-as-reds-weapon-astro-turf-looming-as-red.html">diving for balls a risky endeavor</a> – and <a href="https://www.latimes.com/archives/la-xpm-1989-10-17-sp-269-story.html">claimed their knees deteriorated</a> from the daily grind of playing on the harder surface. </p>
<p>The technology has come a long way since then. Today’s synthetic turf systems have shock-absorbing technology and glasslike fibers that essentially mimic natural grass. <a href="https://keystonesportsconstruction.com/10-ways-synthetic-turf-fields-beat-the-competition-grass-fields/">Its proponents argue</a> that they’re low-maintenance, cost effective and more durable. </p>
<p>Some athletes disagree. Not only do they point out that artificial turf is still a lot different to play on than grass, but they also question the league’s commitment to <a href="https://www.foxnews.com/sports/nfl-players-rip-league-artificial-turf-aaron-rodgers-season-ending-injury-profit-over-people">safety over saving money</a>.</p>
<figure class="align-center ">
<img alt="Panoramic view of domed baseball stadium with bright green artificial grass." src="https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549624/original/file-20230921-22-kgyc7o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When Houston’s Astrodome was built, it was dubbed the ‘Eighth Wonder of the World.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/general-view-of-the-astrodome-during-a-houston-astros-game-news-photo/50830647?adppopup=true">Bill Baptist/MLB via Getty Images</a></span>
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<p>So what does the evidence show?</p>
<p><a href="https://doi.org/10.1177/0363546519833925">There have been studies</a> looking at the rate of injury on different playing surfaces. A handful have found that the overall incidence of football injuries is significantly higher on artificial playing surfaces. </p>
<p>However, orthopedic resident Heath Gould – a former college football player – <a href="https://doi.org/10.1177%2F2473011421S00217">led a review of existing studies</a> and found that most studies identified similar rates of injury on natural grass compared with artificial turf. There have even been <a href="https://pubmed.ncbi.nlm.nih.gov/20075177/">a few studies</a> that reported a higher overall injury rate on natural grass. </p>
<p>Interestingly, the incidence seemed to be related to specific body parts. There was a higher rate of foot and ankle injuries on artificial turf – both older versions and newer ones – compared with natural grass. <a href="https://doi.org/10.1016/j.eclinm.2023.101956">And a recent meta-analysis</a> observed that the overall incidence of injuries in professional soccer is actually lower on artificial turf than on grass. It concludes that the risk of injury can’t be used as an argument against artificial turf when considering the optimal playing surface for soccer. </p>
<p>These findings suggest that while playing surface is important to take into account when assessing injury risk, other factors must be considered.</p>
<h2>The human factor</h2>
<p>The human body is a kinetic chain that consists of body segments linked together by joints. Those joints need to work together to create and dissipate forces needed for us to move and perform athletic motions. </p>
<p>Any chain, however, is only as strong as its weakest link. The muscles, ligaments and tendons in our bodies play an important role in supporting those links. </p>
<p>For athletes, the stakes are even higher because of the incredible power and momentum they are able to generate and absorb. <a href="https://theconversation.com/stiff-muscles-are-a-counterintuitive-superpower-of-nba-athletes-116252">They rely on muscle, tendon and ligament stiffness</a> in order to take advantage of the elastic energy they create. Like a spring or rubber band, when a muscle is stretched, its stiffness helps create elastic energy that can then be used with a muscle contraction to help athletes run, jump, accelerate or decelerate. </p>
<p><a href="https://www.doi.org/10.2519/jospt.2018.7192">Research I conducted with colleagues</a> found that injuries can occur when there is too much stiffness or compliance in these tissues. In fact, we’ve found that <a href="https://doi.org/10.1123/jab.2022-0088">Achilles tendon ruptures</a> in professional basketball players tend to occur when the ankle flexes beyond the muscle and tendon’s ability to withstand the forces incurred with certain maneuvers.</p>
<p>Certainly, several other variables factor into injuries: muscular strength, power, flexibility, body type and tissue elasticity.</p>
<h2>What gives?</h2>
<p>Playing surface is another important aspect of this equation. </p>
<p>Think about the contact point between the athlete and the surface that they’re playing on. This represents an additional link in the chain because forces must be exchanged between the player and the ground.</p>
<p><a href="https://www1.grc.nasa.gov/beginners-guide-to-aeronautics/newtons-laws-of-motion/">As Isaac Newton noted</a>, “For every action there is an equal and opposite reaction.” </p>
<p>The playing surface must be firm enough to allow an athlete to push off to accelerate or jump. At the same time, the surface must be compliant enough to be able to absorb forces when a player lands or slows down. There is a sweet spot between the ability for playing surfaces to offer enough resistance and support, but also absorb forces. </p>
<p>Therein lies the question as to whether artificial turf is appropriate and safe enough for athletes. The research might be somewhat hazy, but Rodgers’ Achilles tendon rupture did occur in a part of the body <a href="https://pubmed.ncbi.nlm.nih.gov/35593739/">that is correlated with more injuries on artificial turf</a>. </p>
<p>It’s encouraging that playing surface technology continues to evolve. But replicating mother nature isn’t easy.</p><img src="https://counter.theconversation.com/content/213719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Anloague does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two days after Rodgers’ injury, the NFL players union called on the league to convert all playing fields to natural grass.Philip Anloague, Adjunct Professor of Physical Therapy, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035382023-04-21T12:40:48Z2023-04-21T12:40:48ZKeeping NBA players on the court is no small ‘feet’<figure><img src="https://images.theconversation.com/files/521420/original/file-20230417-16-xu2g2y.jpg?ixlib=rb-1.1.0&rect=546%2C7%2C3302%2C2186&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Boston Celtics center Robert Williams III falls to the court after suffering a toe injury during a playoff game in May 2021.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/robert-williams-iii-of-the-boston-celtics-reacts-after-news-photo/1318749877?adppopup=true">Maddie Malhotra/Getty Images</a></span></figcaption></figure><p>The NBA playoffs provide a stage for some of the biggest and tallest athletes in the world. With an <a href="https://www.hoopsaddict.com/average-nba-players-shoe-size/">average height of 6 feet, 7 inches and an average weight of 225 pounds</a>, players have a lot of skin, bone and muscle to support. </p>
<p>That’s why their feet play such an outsize role – literally and figuratively. </p>
<p>As a <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&user=_AxjgecAAAAJ">physical therapist</a> and <a href="https://www.researchgate.net/profile/Philip-Anloague">researcher</a> who works closely with NBA athletes, I know just how difficult it is to maintain the health of players who are on the higher end of the foot-size spectrum.</p>
<p>And so while fans eagerly anticipate eye-popping dunks and crafty assists, I’ll be keeping an eye on the footwork of players like <a href="https://www.blazersedge.com/2023/3/9/23632448/kevin-durant-injury-news-phoenix-suns-ankle-warm-up-out">Kevin Durant</a>, <a href="https://www.inquirer.com/sixers/joel-embiid-injury-stats-sixers-20220502.html">Joel Embiid</a> and <a href="https://www.sportingnews.com/us/nba/news/lebron-james-foot-injury-timeline-return-latest-updates-lakers/vvvgzwzwzyy85emnklhjrtef">Lebron James</a>, each of whom has had challenges keeping their feet healthy.</p>
<h2>The importance of a strong foundation</h2>
<p>NBA players’ bodies take a beating. </p>
<p>They jump and come crashing down to the court up to 70 times per game, with centers – typically the tallest players on the court – <a href="https://doi.org/10.1123/jab.10.3.222">usually jumping the most</a>. </p>
<p>When players land, the impact on the ground can be as high as <a href="https://doi.org/10.1123/jab.10.3.222">four to six times</a> their body weight. The average player also changes direction <a href="https://theconversation.com/stiff-muscles-are-a-counterintuitive-superpower-of-nba-athletes-116252">every two to three seconds</a>, requiring stopping, turning and accelerating. Together, the jumps, twists, dekes and sprints put immense pressure on players’ foot, ankle and knee joints.</p>
<p>Like a tall building, basketball players need a solid foundation to support their massive bodies and withstand the power that is generated by all of this movement. </p>
<p>This is where the feet come in. The average shoe size of NBA players is close to a <a href="https://www.hoopsaddict.com/average-nba-players-shoe-size/">U.S. size 15</a>. NBA Hall-of-Famers Shaquille O'Neal and Bob Lanier famously wore <a href="https://www.hoopsaddict.com/average-nba-players-shoe-size/">size 22 shoes</a>. Among current players, Kevin Durant (18), Andre Drummond (19), Brook and Robin Lopez (20), Karl Anthony Towns (20) and Tacko Fall (22) lead the pack. The typical <a href="https://www.healthline.com/health/average-shoe-size-for-men#by-height">shoe size</a> for an American adult male is 10.5.</p>
<figure class="align-center ">
<img alt="Man poses with large shoe and championship ring." src="https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521419/original/file-20230417-16-hkye8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Shaquille O'Neal’s massive feet are the stuff of legend.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/reebok-classic-and-shaquille-oneal-launch-the-new-shaq-news-photo/642706244?adppopup=true">Josh Brasted/Getty Images</a></span>
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<p>Having big feet means having big bones that act as levers to create forces needed for athletic maneuvers. The foot’s 26 bones are intricately linked together with a series of 33 joints and bound together by <a href="https://doi.org/10.2519/jospt.2018.7192">soft tissues</a> like muscles, tendons and ligaments. The big toe, the arch of <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=_AxjgecAAAAJ&citation_for_view=_AxjgecAAAAJ:WF5omc3nYNoC">the midfoot</a> and the ankle are the gears that facilitate motion. </p>
<p>The soft tissue that connects these joints acts like a spring. Energy must be transferred from one joint to the other in a leverlike system that allows athletes to propel themselves forward when running and jumping. Likewise, these joints need to work together to absorb the shock of landing, slowing down or changing directions.</p>
<p>If this structure is not sound, the entire process can break down.</p>
<h2>What goes up must come down</h2>
<p>According to sports medicine specialist Mark C. Drakos, <a href="https://doi.org/10.1177/1941738109357303">62% of injuries</a> in the NBA occur below the waist, with foot and ankle injuries accounting for over 22% of them. Ankle injuries are the most common: A player has a <a href="https://doi.org/10.1177/0363546519864678">25.8% chance</a> of incurring one over the course of a season.</p>
<p><a href="https://doi.org/10.1177/1941738117738988">Stress fractures</a>, while less common, can be particularly debilitating, lingering for weeks or months. The most <a href="https://doi.org/10.1371/journal.pone.0201758">common bones</a> in the feet and lower leg to experience stress fractures are the navicular, talus, tibia and fibula. </p>
<p>Orthopedic surgeon <a href="https://surgery.mcmaster.ca/bio/dr.-moin-khan">Moin Kahn</a> conducted a case study and found that <a href="https://www.doi.org/10.1177/1941738109357303">only 30% of the athletes</a> who incurred a stress fracture from 2005 to 2015 were able to return to their previous level of play a year after their injury.</p>
<p>Having big feet doesn’t mean that an NBA athlete is destined to have an injury. But many big men have had their struggles. This list includes former players Bill Walton, Arvydas Sabonis, Yao Ming and Greg Oden, all of whom wore size 19 shoes. </p>
<p>Standing at 7 feet, 3 inches, NBA prospect Victor Wembanyama has already had his fair share of <a href="https://www.sbnation.com/nba/2022/8/3/23289223/victor-wembanyama-injury-history-muscle-psoas-back-nba-draft-2023">health issues</a>, including a fibular stress fracture. He wears a size 20.5 shoe.</p>
<h2>Getting off on the right foot</h2>
<p>Our research team has been studying joint range of motion, arch mobility, and foot and ankle mechanics in NBA players <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&user=_AxjgecAAAAJ">to help athletes mitigate these injury risks</a>. </p>
<p>Part of that work involves building a database that includes the normal clinical measurements for elite basketball players – big toe extension, arch mobility, ankle flexion, hamstring flexibility and hip range of motion. </p>
<p>Understanding normal physical dimensions helps physical therapists and trainers to understand the risk of injury based on vulnerabilities in a player’s physical makeup. </p>
<p>For example, the average range of the big toe’s extension for the general population is 60 degrees. However, <a href="https://scholar.google.com/citations?view_op=list_works&hl=en&user=_AxjgecAAAAJ">our research</a> shows that the average NBA front court player has motion that is about 40 degrees. This means that the typical NBA player has feet and ankles that are stiffer than the average person’s. </p>
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<figcaption><span class="caption">Kevin Durant tears his Achilles tendon during Game 5 of the 2019 NBA Finals.</span></figcaption>
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<p>While this stiffness can be advantageous and work like a coiled spring that helps a basketball player run and jump, physical therapists must constantly work on these muscles to loosen them up. That’s because too much stiffness can cause <a href="https://journals.lww.com/nsca-scj/fulltext/2014/10000/lower_extremity_stiffness__effects_on_performance.12.aspx">bone injuries</a>.</p>
<p>Understanding what is happening during the heat of the action is also important. </p>
<p>We found that <a href="https://doi.org/10.1123/jab.2022-0088">Achilles tendon tears</a> tend to occur when the ankle bends more than 48 degrees. We suspect that this can happen when players’ ankles aren’t stiff enough: The tendon can’t adequately withstand the forces it encounters during game play.</p>
<p>The foot – a complex network of bones, joints and tissue – is ultimately only as strong as its weakest link. And the health of a team’s feet can end up being the one thing standing between them and a championship.</p><img src="https://counter.theconversation.com/content/203538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Anloague does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The gargantuan feet of NBA players are the stuff of legend. But nearly two-thirds of their injuries occur below the waist, and they have a 25.8% chance of incurring an ankle injury every season.Philip Anloague, Associate Provost; Associate Professor of Physical Therapy, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992432023-02-10T22:12:35Z2023-02-10T22:12:35ZWhat to watch for when you are watching the Super Bowl: 5 essential reads<figure><img src="https://images.theconversation.com/files/509546/original/file-20230210-14-t9c1mn.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5380%2C3616&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clash of the tight ends?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/kansas-city-chiefs-linebacker-ben-niemann-tackles-news-photo/1235721523?phrase=kansas%20chiefs%20Philadelphia&adppopup=true">Kyle Ross/Icon Sportswire via Getty Images</a></span></figcaption></figure><p>The Super Bowl – an annual celebration of advertising, calorific bar food, Roman numerals and occasional on-field action – is upon us, again.</p>
<p>At 6:30 EST on Feb. 12, 2023, the <a href="https://www.nfl.com/news/super-bowl-lvii-picks-will-kansas-city-chiefs-or-philadelphia-eagles-win-lombard">Kansas City Chiefs and the Philadelphia Eagles will take the field</a> in Arizona before moments later trundling off for one of the many breaks that are a feature of football. </p>
<p>But there is an upside to all those breaks. It means you can read an article or two from The Conversation’s archive. To that end, below is a selection of stories tackling what is happening in the world of football, but not necessarily on the field.</p>
<h2>A game of wounded warriors</h2>
<p>A specific part of the anatomy of Kansas City star quarterback Patrick Mahomes has been scrutinized in the weeks leading up to the Super Bowl: his right ankle.</p>
<p>You see, despite Mahomes’ being more handy with his hands than with his feet, he still needs to be able to move around with some dexterity to be effective – and Mahomes’ mobility is a key aspect of his game. And on Jan. 21, 2023, the 27-year-old athlete awkwardly fell after a tackle and sprained his ankle.</p>
<p>But what exactly in an ankle sprain? The University of Pittsburgh’s <a href="https://mirm-pitt.net/staff/macalus-v-hogan-md-mba/">MaCalus V. Hogan</a>, a surgeon who specializes in sports-related ankle injuries, <a href="https://theconversation.com/patrick-mahomes-injury-an-ankle-surgeon-explains-what-a-high-ankle-sprain-is-and-how-it-might-affect-mahomes-in-the-super-bowl-199248">explained that they occur</a> when someone rolls an ankle joint, resulting in the stretching or tearing of ligaments that hold the ankle together.</p>
<p>The good news for Chiefs’ fans? Hogan reckons their quarterback will be OK come gametime: “While Mahomes may not be at 100%, given the moderate severity of the injury, his fitness and the high quality of care he is receiving, I expect that he will be ready to play an exciting game come kickoff on Super Bowl Sunday.”</p>
<p>Of much more concern are the life-threatening injuries of the sort that afflicted Buffalo Bills safety Damar Hamlin and Miami Dolphins quarterback Tua Tagovailoa earlier in the season. </p>
<p>Both collapsed to the turf after jarring tackles, Hamlin from heart problems, Tagovailoa from a concussion. As paramedics administered treatment on the field, <a href="https://theconversation.com/sports-broadcasters-have-a-duty-to-report-injuries-responsibly-in-the-case-of-nfls-damar-hamlin-they-passed-the-test-197192">broadcasters faced a dilemma</a>, as <a href="https://comm.osu.edu/people/kraft.42">Nicole Kraft of The Ohio State University</a> explained.</p>
<p>“When disaster strikes on a live sports broadcast, it’s easy to say something wrong, especially in an age where words can be distributed widely, dissected and criticized on social media,” wrote Kraft, noting that broadcasters also have a decision to make over whether or not to show replays of the injury.</p>
<p>In the case of Hamlin, ESPN and others behaved responsibly, Kraft concluded. Instead of filling the air with speculation, broadcasters instead appealed to the NFL to suspend the game.</p>
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Read more:
<a href="https://theconversation.com/patrick-mahomes-injury-an-ankle-surgeon-explains-what-a-high-ankle-sprain-is-and-how-it-might-affect-mahomes-in-the-super-bowl-199248">Patrick Mahomes injury: An ankle surgeon explains what a high ankle sprain is and how it might affect Mahomes in the Super Bowl</a>
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Read more:
<a href="https://theconversation.com/sports-broadcasters-have-a-duty-to-report-injuries-responsibly-in-the-case-of-nfls-damar-hamlin-they-passed-the-test-197192">Sports broadcasters have a duty to report injuries responsibly – in the case of NFL's Damar Hamlin, they passed the test</a>
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<h2>The rise and pitfalls of sports gambling</h2>
<p>A subplot of this year’s Super Bowl advertising rush is the growing presence of betting companies like DraftKings and FanDuel.</p>
<p>It’s only been five years since the <a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">Supreme Court opened up legalized sports betting</a> across the states. Since then, “a whole industry has sprouted up that, for tens of millions of fans around the country, is now just part of the show,” wrote <a href="https://www.bellisario.psu.edu/people/individual/john-affleck">Penn State’s John Affleck</a>. He added: “Betting’s seamless integration into American sports – impossible to ignore even among fans who aren’t wagering – represents a remarkable shift for an activity that was banned in much of the country only a few years ago.”</p>
<p>The damage being done by the explosion of easy-to-bet apps and websites is only just being understood. <a href="https://socialwork.rutgers.edu/node/677">Lia Nower</a>, director of The Center for Gambling Studies at Rutgers University, has been tasked by New Jersey to <a href="https://theconversation.com/data-from-new-jersey-is-a-warning-sign-for-young-sports-bettors-197865">evaluate the impact of sports gambling</a> by interviewing gamblers and analyzing every bet placed online in the state since 2018.</p>
<p>She reported that “those wagering on sports in New Jersey were more likely than others who gamble to have high rates of problem gambling and problems with drugs or alcohol, and to experience mental health problems like anxiety and depression. Most alarming, findings suggest that about 14% of sports bettors reported thoughts of suicide, and 10% said they had made a suicide attempt.”</p>
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<a href="https://theconversation.com/how-legalized-sports-betting-has-transformed-the-fan-experience-194994">How legalized sports betting has transformed the fan experience</a>
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<a href="https://theconversation.com/data-from-new-jersey-is-a-warning-sign-for-young-sports-bettors-197865">Data from New Jersey is a warning sign for young sports bettors</a>
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<h2>It really is time to drop the ‘chop’</h2>
<p>Kansas City fans inside the State Farm Stadium in Glendale during the Super Bowl might at various points during the game engage in what is known as the “tomahawk chop.” Outside the stadium, Native Americans intend to protest. What they want – along with an end to that offensive gesture – is a new name for the franchise.</p>
<p>Such re-branding is not, of course, unheard of. Washington’s NFL team dropped its racist moniker in 2020. And last year, the Cleveland Indians changed its name to the Guardians.</p>
<p>But as <a href="https://www.oxy.edu/academics/faculty/peter-dreier">Peter Dreier of Occidental College</a> noted, <a href="https://theconversation.com/the-cleveland-indians-changed-their-team-name-whats-holding-back-the-atlanta-braves-181662">not all teams are on board</a> with jettisoning their problematic names. The Atlanta Braves are one team that refuses to move on, sticking with its name, along with its “tomahawk song” and accompanying crowd gesture.</p>
<p>“Today, many fans – not to mention many Native Americans – cringe at the music and the chop. To them, it reflects a stereotypical image of Native Americans as violent and uncivilized, similar to those that appeared on TV and in movies for many years,” wrotes Dreier.</p>
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Read more:
<a href="https://theconversation.com/the-cleveland-indians-changed-their-team-name-whats-holding-back-the-atlanta-braves-181662">The Cleveland Indians changed their team name – what's holding back the Atlanta Braves?</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/199243/count.gif" alt="The Conversation" width="1" height="1" />
As the Kansas City Chiefs prepare to take on the Philadelphia Eagles, The Conversation takes a critical look at some of the biggest news stories from the past NFL season.Matt Williams, Senior International EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1971922023-01-05T13:27:38Z2023-01-05T13:27:38ZSports broadcasters have a duty to report injuries responsibly – in the case of NFL’s Damar Hamlin, they passed the test<figure><img src="https://images.theconversation.com/files/503131/original/file-20230104-64877-4qdtfn.jpg?ixlib=rb-1.1.0&rect=7%2C11%2C2542%2C1686&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical personnel attend to Buffalo Bills safety Damar Hamlin after he collapsed on the field during an NFL game in Cincinnati on Jan. 2, 2023.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/BillsBengalsFootball/cb4e320fc1b7472cbe0c692d94d07a6e/photo?Query=damar%20hamlin&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=453&currentItemNo=112">AP Photo/Joshua A. Bickel</a></span></figcaption></figure><p>Injuries are an unfortunate part of any sport – none more so than in the NFL, where players can be felled in front of a TV audience <a href="https://espnpressroom.com/us/press-releases/2022/09/espns-monday-night-football-nabs-nearly-20-million-viewers-in-record-setting-season-opener/">in the tens of millions</a>.</p>
<p>Typically, when a player suffers an injury, the media cuts to commercial and returns with replays of the injury – sometimes running it over and over, using every available camera angle, while analyzing what might have happened and the ramifications for the player and team.</p>
<p><a href="https://www.espn.com/nfl/story/_/id/35368372/damar-hamlin-collapses-field-bills-bengals-temporarily-suspended">But in the case of Buffalo Bills safety Damar Hamlin</a>, who collapsed to the ground after a tackle during the “Monday Night Football” game between the Bills and the Cincinnati Bengals, it quickly became apparent that this was no broken arm or torn ACL. This was a matter of life and death. Paramedics worked to keep him alive on the field before he was transported to a hospital, where he <a href="https://www.cnn.com/2023/01/04/football/damar-hamlin-collapse-bills-status-wednesday/index.html">remains in critical condition</a>.</p>
<p>As the tragic scene played out, ESPN’s broadcasters and studio hosts were left to explain what was happening in real time, with virtually no information.</p>
<p><a href="https://comm.osu.edu/people/kraft.42">I am a professor of sports journalism</a> and spend much of my time teaching students how to cover games. As a sportswriter, I have covered many contests as if they were battles, <a href="https://theconversation.com/the-warspeak-permeating-everyday-language-puts-us-all-in-the-trenches-121356">with the language of war</a> interwoven with feats of extraordinary human accomplishment.</p>
<p>When crisis strikes sports, however, it is left to the media to report in, around, about and through the moment. Some do it well and some fail miserably.</p>
<p>In its coverage of Hamlin’s injury, ESPN was, I believe, a sound and responsible broadcaster during one of football’s darkest on-field moments.</p>
<h2>ESPN’s measured, restrained response</h2>
<p>ESPN’s broadcasting duo of Troy Aikman and Joe Buck, along with sideline reporter Lisa Salters, relayed the scene as it unfolded. But instead of filling the live airtime with rambling commentary and sensationalism, they responded with compassion and care. They avoided speculating about Hamlin’s condition and ultimately <a href="https://www.si.com/nfl/bills/news/damar-hamlin-collapse-injury-buffalo-bills-cincinnati-bengals-ambulance-nflpa-postponement">appealed to the NFL to suspend the game</a>, with Aikman asking, “How do you, as a member of the Buffalo Bills or the Cincinnati Bengals, continue on to play football?”</p>
<p><a href="https://www.washingtonpost.com/sports/2023/01/02/espn-damar-hamlin-bengals-bills/">As The Washington Post noted</a>, “The broadcast was measured, informative and emotional.” </p>
<p>From the studio, former NFL players Booger McFarland and Ryan Clark offered their perspectives on what it might feel like to be a player on the field, in that moment – whether as a member of the Bills or the Bengals. They reminded the audience that players are first and foremost people. McFarland <a href="https://thehill.com/homenews/media/3797278-damar-hamlin-injury-tests-espn-with-terrifying-live-television-moment/">acknowledged the inherent violence of the game</a>, adding, “I think we reached a point where nobody is concerned about football anymore tonight.” </p>
<p>Clark, who himself was hospitalized for a splenic infarction in 2007 <a href="https://www.on3.com/news/ryan-clark-provides-unique-insight-reflection-terrifying-damar-hamlin-injury-collapsed-cpr/">shortly after playing a game for the Pittsburgh Steelers</a>, <a href="https://www.mediaite.com/opinion/espns-ryan-clark-earns-rightful-plaudits-for-powerful-handling-of-damar-hamlins-life-threatening-injury/">acknowledged</a> that part of living an NFL dream is “putting your life at risk.”</p>
<p>“Tonight we got to see a side of football that is extremely ugly, a side of football that no one ever wants to see or never wants to admit exists,” he said.</p>
<p>The gravity of the situation was reflected in ESPN curtailing all commercials for more than an hour to provide uninterrupted coverage. In doing so, the network <a href="https://awfulannouncing.com/nfl/damar-hamlin-collapse-espn-coverage.html">stressed the importance of a player’s life over the game or profit motive</a>. </p>
<h2>When the media misfires</h2>
<p>When disaster strikes on a live sports broadcast, it’s easy to say something wrong, especially in an age where words can be distributed widely, dissected and criticized on social media.</p>
<p>Just ask controversial sports commentator Skip Bayless, who wasn’t even on the air, but nonetheless went viral for all the wrong reasons <a href="https://twitter.com/realskipbayless/status/1610101204687949827">after tweeting</a>: “No doubt the NFL is considering postponing the rest of this game - but how? This late in the season, a game of this magnitude is crucial to the regular-season outcome … which suddenly seems so irrelevant.”</p>
<p>Bayless may have had a point – the NFL must now work out how to address the outcome of this game and the implications for the postseason – but his tone and timing led to <a href="https://www.mediaite.com/sports/skip-bayless-apologizes-after-tweet-on-bills-safety-damar-hamlin-sparks-outrage/">much criticism</a>.</p>
<p>Bayless is far from the only broadcaster to be accused of insensitively following the death or serious injury of sports stars.</p>
<p>The 2020 death of Kobe Bryant and his daughter Gianna was a model for what can go wrong, with TMZ breaking the news <a href="https://thehill.com/homenews/media/480066-tmz-scolded-by-police-for-breaking-news-of-kobe-bryants-death-before-his/">before their family was notified</a>. ESPN relegated the news to ESPN2 <a href="https://www.si.com/extra-mustard/2020/01/27/kobe-bryant-media-coverage-espn-mike-breen-jay-williams">so as not to interrupt Pro Bowl coverage</a>. In their rush to break details from the story, some reporters trafficked in misinformation. <a href="https://www.latimes.com/entertainment-arts/business/story/2020-01-29/abc-news-has-suspended-correspondent-who-said-four-kobe-bryant-daughters-were-on-his-helicopter-matt-gutman">ABC News ultimately suspended a reporter</a> who said on air that all four of Bryant’s daughters were among the crash victims, while the BBC ran footage of LeBron James instead of Bryant.</p>
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<p>Driver Kevin Ward, Jr. was killed during a 2014 sprint car race, but it was Tony Stewart, the man whose car struck him, <a href="https://www.indystar.com/story/opinion/2014/08/11/tony-stewart-crash-coverage-challenge-media/13916449/">who garnered most of the media coverage</a>. The media was quick to lay the blame squarely on Stewart before an investigation absolved the driver and revealed Ward was under the influence of enough marijuana to <a href="https://www.usatoday.com/story/sports/nascar/2014/09/24/column-tony-stewart-grand-jury-no-charges-kevin-ward-jr-death/16165885/">impair him at the time of the crash</a>.</p>
<p>Sports media was perhaps never more criticized for incident coverage than it was in 2020, when Danish soccer player Christian Eriksen suffered cardiac arrest on the field. BBC cameras <a href="https://theconversation.com/christian-eriksen-broadcast-the-bbc-and-the-question-of-public-interest-162726">showed not only medical professionals performing chest compressions as Eriksen struggled for life</a>, but also his crying life partner and traumatized teammates. Cameras lingered for a full 15 minutes before cutting to the studio hosts. </p>
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<img alt="Man stands at podium speaking before a mass of reporters." src="https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503156/original/file-20230104-105135-rlymua.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Tony Stewart, front right, speaks to the media three weeks after his car hit and killed sprint car driver Kevin Ward, Jr. during a dirt track race.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/tony-stewart-driver-of-the-bass-pro-shops-mobil-1-chevrolet-news-photo/454335928?phrase=kevin%20ward%20jr&adppopup=true">Jamie Squire/Getty Images</a></span>
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<h2>Prioritizing mourning over moneymaking</h2>
<p>From the tragic deaths of basketball players Hank Gathers and Reggie Lewis, to the deaths of auto racers Dan Weldon and Dale Earnhardt and to Chuck Hughes who, in 1971, became the first and only NFL football player to die in a game, it is the media’s responsibility to navigate a tragedy on behalf of the public.</p>
<p>Research has shown that the <a href="https://journals.sagepub.com/doi/epdf/10.1177/0163443708098251">media is often responsible for modeling appropriate public displays of emotion</a> when traumatic or tragic events occur, be it respect for victims and their families or public mourning. It <a href="https://doi.org/10.1080/17512780701275457">can be argued</a> that the media – especially in the digital age – is a key conduit to community connection amid a tragedy, when people seek to show their support and share their grief.</p>
<p>There is a fine line when it comes to sports and catastrophe, for much of what people love about football is its warlike nature. Players are depicted like gladiators in a coliseum. Media quote athletes saying <a href="https://twitter.com/bethhooleVNL/status/1599313686199345152?s=20&t=_2oFgUiDhSlJgUGe8BGcnA">they will die for their teammates</a>.</p>
<p>But when life and death become all too real, the athlete’s well-being takes precedence over wins and losses. At that point, the media, in my view, has one main job: help remind viewers of the player’s humanity.</p>
<p>As “SportsCenter” <a href="https://ftw.usatoday.com/2023/01/damar-hamlin-bills-espn-salters-ryan-clark-booger">host Scott Van Pelt put it</a>: “Sports is important. And suddenly it’s not.”</p>
<p><em>This article has been updated to correctly identify Skip Bayless.</em></p><img src="https://counter.theconversation.com/content/197192/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Kraft does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>ESPN commentators avoided speculation and struck a compassionate tone.Nicole Kraft, Associate Professor of Clinical Communication, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952702022-12-30T08:22:57Z2022-12-30T08:22:57ZFive ways to avoid pain and injury when starting a new exercise regime<figure><img src="https://images.theconversation.com/files/498996/original/file-20221205-24-nwjy1k.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5455%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Make sure you include a good warm-up.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-athlete-warming-sports-training-walking-1983185762">Drazen Zigic/ Shutterstock</a></span></figcaption></figure><p>Getting in the habit of exercising isn’t easy. Not only is finding the time to exercise a major deterrent for people, the fear of <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-0753-1884">aches, pain and injuries</a> is also a reason that people put off starting a new exercise regime.</p>
<p>But exercise doesn’t necessarily have to lead to pain or injuries. Here are some simple things you can do to avoid these when starting out.</p>
<h2>1. Warm up</h2>
<p>It’s important to warm up before your exercise. Warming up raises the temperature of the working muscles and the whole body. It also prepares your body for the increased stress of exercise. Muscles that have been warmed up are able to <a href="https://journals.sagepub.com/doi/10.1177/036354658301100302?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">exercise for longer</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588693/">suffer less soreness</a> and <a href="https://www.sciencedirect.com/science/article/pii/S144024400600051X?via%3Dihub">reduced injury risk</a>.</p>
<p>Exactly what constitutes an effective warm-up varies <a href="https://link.springer.com/article/10.2165/00007256-200333070-00002">from workout to workout</a>. But in general, you should dedicate at least five to ten minutes of your workout to warming up. Start with large, whole-body movements such as body-weight squats and lunges before progressing to more task-specific actions – such as a walk or jog before running, or lifting light weights before weight training. Your warm-up shouldn’t be too strenuous. Aim to use only about 40-60% of your maximum effort.</p>
<p>Your warm-up might also include a dose of dynamic stretching (moving a limb through its entire range of movement instead of holding the stretch), but stretching alone is not an effective strategy. You may consider using self-massage tools such as <a href="https://theconversation.com/does-foam-rolling-actually-do-any-good-98198">foam rollers</a> instead, as they can help optimise your warm-up. As little as <a href="https://www.frontiersin.org/articles/10.3389/fphys.2019.00376/full">two minutes of foam rolling</a> has been shown to reduce muscle soreness in the days following exercise.</p>
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Read more:
<a href="https://theconversation.com/stretching-expert-explains-how-best-to-do-it-before-and-after-a-workout-137962">Stretching: expert explains how best to do it before and after a workout</a>
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<h2>2. Don’t overestimate what you can do</h2>
<p>A common mistake when starting a new exercise regime is to <a href="https://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx">do too much</a>. This can lead to pain after workouts, and may also increase your likelihood of injury.</p>
<p>When you first begin a new workout plan, it’s important to start gradually and at your own pace. Since everyone is different, avoid following an exercise programme that uses absolute distances or repetitions. Instead, focus on how you feel during a workout and listen to what your body is telling you.</p>
<p>It can take weeks or even months to notice the benefits of exercise, so don’t expect to see your health and fitness improve overnight. It’s also worth noting that progress isn’t always linear – some days you may find it’s difficult to exercise as long or as hard as you did the previous session. Listen to your body and stop when you feel tired, to avoid injury.</p>
<h2>3. Take time to recover</h2>
<p>Taking a day or two off to rest each week is vital for recovery. But you don’t just have to sit and do nothing for your recovery days to be effective. Active recovery is equally effective in helping your muscles recover and helping you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932411/">avoid pain and injury</a>. Active recovery might include lower-effort exercises such as walking or yoga.</p>
<p>While you should take <a href="https://journals.lww.com/nsca-jscr/Fulltext/2008/05000/Recovery_From_Training__A_Brief_Review__Brief.49.aspx">at least one day off</a> between strength training workouts, another strategy to boost recovery is to work different muscle groups on different days. This will stop your muscles from using the same movements over and over, which can lead to <a href="https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-1017-5">overuse injuries</a>.</p>
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<img alt="A man performs a chest press using a machine, while his friend stands and watches." src="https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498997/original/file-20221205-24-n2vrx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Train different muscle groups on different days.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dad-son-training-modern-gym-663132841">Africa Studio/ Shutterstock</a></span>
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<p>While aerobic exercise (such as running or cycling) doesn’t usually require as long a recovery period as strength training, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588896/">mixing up your exercises</a> is still beneficial for avoiding injury. It will provide a <a href="https://pubmed.ncbi.nlm.nih.gov/26101904/">more balanced workout</a> and avoid poor movement technique, or form. Rotating between running, swimming, cycling or whatever takes your fancy will allow your body to recover and will help you achieve your fitness goals.</p>
<h2>4. Learn proper form</h2>
<p>Developing correct form early on is important when starting a new exercise regime to avoid developing bad habits. In the beginning, go slow, try a range of different exercises and don’t add too much weight before you’ve nailed technique. Executing the movements properly <a href="https://www.mdpi.com/1660-4601/19/19/12710">will help you avoid injury</a>.</p>
<p>If you choose to exercise at a gym or fitness centre, ask a trainer for pointers if you’re unsure about your form. If you prefer to work out alone, there are lots of resources available online to guide your training. You might also consider filming yourself so you can see how your form looks.</p>
<h2>5. Invest in the right shoes</h2>
<p>The right pair of shoes can make all the difference to your workouts. It’s particularly important for running, as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740063">comfort and support</a> will help reduce soreness and make your runs more enjoyable. You don’t need an expensive shoe either – just one that provides <a href="https://bjsm.bmj.com/content/49/20/1290.long">appropriate support</a> for your unique gait, which will help protect vulnerable areas of your feet from overuse injuries.</p>
<p>If you’re looking to start weightlifting, look for flat, hard shoes to provide a bit more stability while you lift. Specialised weight training shoes are also an option, as their raised heel will allow you to achieve the <a href="https://journals.lww.com/nsca-jscr/fulltext/2016/04000/Influence_of_Footwear_Type_on_Barbell_Back_Squat.24.aspx">proper ankle, knee and hip angles</a> required for effective lifting. This will let you maintain correct form and reduce risk of injury.</p>
<p>Don’t let the fear of pain or injury put you off from starting a new exercise regime. The benefits of exercise far outweigh the temporary feeling of muscle soreness that can accompany a new exercise regime. Not to mention that as you make exercise a regular habit, you’re less likely to feel sore after each workout.</p><img src="https://counter.theconversation.com/content/195270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lewis Macgregor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Aches, pain and injuries are often reasons people put off exercise.Lewis Macgregor, Lecturer in Sport, Health & exercise Science, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1845802022-07-26T14:51:49Z2022-07-26T14:51:49ZFacial injuries hurt Nigerians’ pockets too: how to reduce the burden<figure><img src="https://images.theconversation.com/files/468721/original/file-20220614-16-8qwx0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Road traffic crashes are the most common cause of facial injuries in Nigeria. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/auto-accident-involving-two-cars-on-a-city-street-royalty-free-image/970958674?adppopup=true">Getty Images </a></span></figcaption></figure><p>Injury to the face – from road traffic accidents, for example – can leave a person with a damaged appearance or functional impairment, like difficulty chewing. Treatment helps to restore facial appearance and function and can give some psychological relief. </p>
<p>In Nigeria, facial injuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329035/">account</a> for one out of every 10 bodily injuries. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721415/">a study of 268 patients in Ghana</a>, motor vehicle accidents were the leading cause of mandibular fractures – 75.4%. Other causes included assault, gunshot, falls and industrial accidents. </p>
<p>The economic burden of treating facial injuries is large, and falls on the state and on those injured. For instance, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020889/">the approximate cost</a> of treating lower jaw fractures of 50 patients in Kano State, north west Nigeria was N3,198,139 around US$7,698 in 2015. The overall health budget for the state <a href="https://drpcngr.org/wp-content/uploads/2021/04/KANO-STATE-HEALTH-BUDGET-PERFORMANCE-ANALYSIS-2015-2020.pdf">in 2015 was N18.75 billion (US$45 million)</a>. The gross national income per capita in <a href="https://www.statista.com/statistics/1291432/gross-national-income-per-capita-in-nigeria/">Nigeria for 2015 was US$2,820</a>. </p>
<p>It’s also a drain on patients and their caring relatives. In Nigeria, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186489/">payment for healthcare</a> is mostly an out-of-pocket expenditure. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05117-5#Bib1">Only about 10%</a> of the population had health insurance in 2020.</p>
<p>In most developed nations, healthcare services are funded by the government and various forms of health insurance schemes. For example, the hospital billing cost for treatment of lower jaw fractures in Seattle in the US was an average of <a href="https://pubmed.ncbi.nlm.nih.gov/22907110/">US$14,221 per patient in 2010</a>. Only one third of the Seattle patients were uninsured and had to individually pay for their treatments.</p>
<p>We carried out a study to determine the treatment cost of lower jaw fractures and methods of payment in Nigeria to evaluate the financial implications of facial injury. In <a href="https://link.springer.com/article/10.1007/s10006-021-01000-7">our study</a>, at least eight out of 10 patients paid between ₦42,900 (US$103) and ₦132,500 (US$319) out-of-pocket. Per capita income in the country for <a href="https://www.statista.com/statistics/1291432/gross-national-income-per-capita-in-nigeria/">2020 was US$2,000</a>. </p>
<p>Unsurprisingly, all the low-income patients were uninsured and were responsible for their treatment. This may result in financial hardship for individual patients and their households. </p>
<p>Measures to curtail this method of healthcare payment must be sought. Nigeria needs a better approach with sustained and massive funding to promote affordable access to quality healthcare.</p>
<h2>Causes and costs</h2>
<p>We collected data from the medical records and hospital billing sheets of 100 patients who were treated for lower jaw fractures. Just over 80% of the injuries were caused by automobile, bike and pedestrian accidents.</p>
<p><a href="https://www.statista.com/statistics/1296025/total-number-of-road-casualties-in-nigeria/#:%7E:text=More%20than%2011%2C800%20road%20traffic,1.7%20thousand%20were%20registered%20deaths.">More than 11,800 road traffic casualties</a> were reported in Nigeria during the fourth quarter of 2021. In the previous quarter, about 8,800 injuries and 1,400 deaths from road traffic crashes were counted in the country. Most road accidents occurring in Nigeria are classified as serious. Violations of rules about speed, road signs or vehicle lights were the <a href="https://www.statista.com/statistics/1296331/main-causes-of-road-accidents-in-nigeria-by-category/#:%7E:text=In%20Nigeria%2C%20road%20violations%20emanating,(SLV)%20caused%20312%20accidents.">leading causes of road traffic accidents</a>.</p>
<p>Assault was the cause of 12% of the injuries. </p>
<p>Only four of the patients in our study were in the low income bracket – possibly because low earners don’t usually go to a university teaching hospital. But 87% of all the patients were uninsured and paid the bills themselves, including all the low-income patients. </p>
<p>Direct treatment cost excludes other expenditure incurred while the patient is in the hospital. Transport fares of patients and their relatives, accommodation of relatives, and loss of income while out of work are among these other variable costs.</p>
<p>The direct treatment costs of broken lower jaws ranged between ₦42,900 (US$103) and ₦132,500 (US$319) as at January 2020. This may vary depending on the period and mode of treatment cost analysis in different health facilities in the country. The lowest treatment cost is still higher than the national minimum monthly wage <a href="https://www.premiumtimesng.com/news/headlines/507087-nigerias-minimum-wage-grossly-inadequate-cant-meet-basic-nutritional-needs-of-an-adult-report.html">of N30,000 (US$71.51)</a>.</p>
<h2>Funding of medical care</h2>
<p>Massive and sustained funding is essential to achieving universal health coverage. The national health insurance scheme was <a href="https://www.researchgate.net/publication/232246860_Nigerian_National_Health_Insurance_Scheme_NHIS_an_overview#:%7E:text=History%20of%20NHIS%20The%20Scheme,have%20been%20accredited%20and%20registered.">officially launched on 6 June 2005</a> to offer affordable and quality healthcare for all Nigerians irrespective of their socioeconomic, political and religious standing through multiple prepayment funds. It commenced operations in September 2005 and covered <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05117-5#Bib1">about 10% of the population as at 2020</a>.</p>
<p>The basic package of Nigeria’s health insurance scheme would pay for some of the care received by patients with facial injuries. This is the minimum benefit available to all enrollees. Individual enrollees could subscribe to a different package with added benefits – and a higher premium – in both this scheme and private health insurance. </p>
<p>Other aspects of treatment not listed in the benefits package must be paid for by the patients. </p>
<p>Most enrollees on the national health insurance scheme are government employees who belong to the middle- and high-income classes. </p>
<p>Community health insurance is a social health insurance programme for the informal sector with <a href="https://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=4;spage=437;epage=444;aulast=uzochukwu">about 1% coverage</a>. Reasons for low coverage include unaffordable premiums, unattractive benefit packages, and <a href="https://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=4;spage=437;epage=444;aulast=uzochukwu">mistrust between policy managers and potential enrollees</a>.</p>
<p>The out-of-pocket model of healthcare financing is prevalent in sub-Saharan Africa and other low- and middle-income countries with poor government healthcare expenditures.</p>
<p>The high incidence of out-of-pocket payment leaves the poor poorer. <a href="https://www.ajol.info/index.php/jcmphc/article/view/194172">Other consequences</a> include delays in seeking quality healthcare and the incentive to patronise unqualified providers. </p>
<p>The gaps in financial risk protection for the economically vulnerable could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370156/">leave</a> households in financial distress. </p>
<h2>Steps to take</h2>
<p>Prevention of injury is one step. Since road traffic crashes are the most <a href="https://journals.sagepub.com/doi/abs/10.1055/s-0034-1384740">common cause</a> of facial injury in Nigeria, the <a href="https://frsc.gov.ng/">Federal Road Safety Commission</a> and other relevant government agencies should educate the public about the importance of seat belts and protective headgear. It has been shown that <a href="https://pubmed.ncbi.nlm.nih.gov/27441732/">these reduce injuries</a>. </p>
<p>Government should also increase health insurance coverage through massive public engagement on the benefits of health insurance. It should provide long-term loans for community and private health insurance schemes in order to make the premiums affordable for more people. <a href="https://pubmed.ncbi.nlm.nih.gov/23339606/">Ghana’s system</a> is a good example.</p>
<p>All health insurance schemes in the country should offer enrollees a basic healthcare package that would be affordable to low-income Nigerians. Claims should receive prompt and transparent attention from the policy managers of insurance companies. This will encourage people to join the health insurance schemes and keep up their payments.</p><img src="https://counter.theconversation.com/content/184580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bamidele Famurewa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More Nigerians should be encouraged to have health insurance to reduce the burden of treating facial injuries.Bamidele Famurewa, Lecturer and Consultant in Oral and Maxillofacial Surgery, Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874362022-07-26T05:32:31Z2022-07-26T05:32:31ZWho’s liable if you’re injured or killed riding an e-scooter?<p>The rental e-scooter craze is sweeping the globe, with millions of the vehicles dotting pavements in <a href="https://assets.ey.com/content/dam/ey-sites/ey-com/en_gl/topics/automotive-and-transportation/automotive-transportation-pdfs/ey-micromobility-moving-cities-into-a-sustainable-future.pdf">more than 600 cities</a>. <a href="https://www.bbc.com/future/article/20200608-how-sustainable-are-electric-scooters">Studies predict</a> there will be 4.6 million shared e-scooters in operation worldwide by 2024. </p>
<p>While e-scooters <a href="https://www.mearth.com.au/blogs/news/why-electric-scooters-are-greener-than-you-think">have been praised</a> as a greener form of transport, they have also caused scores of injuries and even deaths. Australia’s e-scooter fleet is comparatively small at <a href="https://micromobilityreport.com.au/infrastructure/bike-scooter-share/2022-a-year-of-change/">around 10,000 units</a>, yet major hospitals in <a href="https://9now.nine.com.au/a-current-affair/melbourne-emergency-department-sees-escooter-injuries-daily/9cdd73d5-0bee-4546-ab65-2cf650201e5b">Melbourne</a>, <a href="https://www.abc.net.au/news/2021-07-22/electric-e-scooter-e-bike-injuries-brisbane-emergency-department/100313526">Brisbane</a> and <a href="https://www.abc.net.au/news/2022-07-15/warning-issued-to-escooter-riders-in-perth/101242834">Perth</a> are reporting “daily” presentations with e-scooter related traumas to both riders and pedestrians.</p>
<p>Worse, according to media reports at least seven Australians have been killed through falls or collisions since their <a href="https://raine.co/blogs/news/electric-scooter-trials">introduction in 2018</a>, including a <a href="https://7news.com.au/news/qld/queensland-boy-15-dies-five-days-after-suffering-critical-injuries-in-e-scooter-crash-c-7563230">15-year-old Queensland boy last week</a>.</p>
<p>Although the National Transport Commission <a href="https://www.ntc.gov.au/sites/default/files/assets/files/NTC-Decision-RIS-PMDs.pdf">recommended</a> in 2020 that e-scooters be limited to a speed of 10 km/hr on footpaths and 25km/hr on roads or bike lanes, most states have allowed higher speeds on footpaths.</p>
<p>Many riders also shun the helmet requirement imposed by the e-scooter terms of use and the <a href="https://www.legislation.sa.gov.au/__legislation/lz/c/r/australian%20road%20rules/current/2014.205.auth.pdf">Australian Road Rules</a>. It therefore seems that more carnage is on the horizon.</p>
<p>We need a uniform regulatory framework balancing the risks and benefits of e-scooters, and clarifying avenues for compensation.</p>
<h2>Who’s liable for e-scooter injuries?</h2>
<p>The <a href="https://pcc.gov.au/uniform/Australian-Road-Rules-10December2021.pdf">Australian Road Rules</a> empower the states to prohibit e-scooters on public roads and footpaths. Most states have banned them by default, but many local councils have authorised <a href="https://www.vicroads.vic.gov.au/safety-and-road-rules/road-safety-programs/e-scooter-trials-in-victoria">temporary trials</a>, which are still in effect. </p>
<p>Obviously, if you crash due to your own misuse or recklessness, you are personally responsible for your injuries or those you cause to others. </p>
<p>But if the accident is caused by a fault with the e-scooter, that might be different. Some of the e-scooter companies, such as Neuron, <a href="https://www.rideneuron.com/terms-of-service/au/">state that they exclude liability</a> for injury except where it’s caused by their negligence. </p>
<p>Where you’ve crashed due to uneven pavement or damaged road, the disrepair will generally need to be known or otherwise significant to prove the local council breached its duty of care to you. You would then seek compensation through the council’s public liability insurer. You would likely have to try to do the same if you trip over a dormant e-scooter that has been dumped in random locations, as they often are.</p>
<p>Third parties who are injured by an e-scooter rider are in a difficult position. This is because <a href="https://jade.io/article/67447">only parties to a contract</a> can incur rights and obligations under the contract. E-scooter contracts are between the user and the respective company, so those who are struck by e-scooters, or trip over a dormant one, have no contractual rights against the company.</p>
<p>An injured third party would have to sue the rider directly. But attaining the rider’s personal details could be difficult if they drive off or are evasive, and they will <a href="https://attwoodmarshall.com.au/escooter-laws/">likely be unable to pay compensation</a>. </p>
<p>Complicating matters is the fact minors also ride e-scooters. <a href="https://www.li.me/en-au/user-agreement">Lime</a> and <a href="https://www.rideneuron.com/terms-of-service/au/">Neuron</a> forbid minors from using their vehicles, but <a href="https://global-uploads.webflow.com/5b685812f109cf81a7d99e25/61b3143240d08942f78415ce_Terms%20of%20Services%20-%20Beam%20Australia%20(website)%20-%20December%202021.pdf">Beam</a> allows people under 16 to ride with parental consent. E-scooters are colourful, funky, and marketed in a manner appealing to young and likely inexperienced riders.</p>
<p>Each of the e-scooter companies’ terms warn that breaching the terms of use, such as riding as an unauthorised minor, can void insurance entitlements, meaning many unwary parents or caregivers may be left to foot hefty medical and legal bills.</p>
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Read more:
<a href="https://theconversation.com/limes-not-lemons-lessons-from-australias-first-e-scooter-sharing-trial-108924">Limes not lemons: lessons from Australia’s first e-scooter sharing trial</a>
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<h2>Excluding liability through the fine print</h2>
<p>When a user downloads and accesses the relevant app to activate an e-scooter, they agree to the terms of service. <a href="https://jade.io/article/68500">The law states</a> that you’re bound by the terms you sign (physically or digitally), even if you don’t read them – and <a href="https://www.theguardian.com/technology/2017/mar/03/terms-of-service-online-contracts-fine-print">most people don’t</a>. </p>
<p>Australia’s biggest e-scooter companies – <a href="https://www.li.me/en-au/user-agreement">Lime</a>, <a href="https://global-uploads.webflow.com/5b685812f109cf81a7d99e25/61b3143240d08942f78415ce_Terms%20of%20Services%20-%20Beam%20Australia%20(website)%20-%20December%202021.pdf">Beam</a>, and <a href="https://www.rideneuron.com/terms-of-service/au/">Neuron</a> – all have lengthy user agreements, each containing exclusion clauses. These clauses restrict or exclude the companies’ liability if you’re injured while using them.</p>
<p>But are they watertight?</p>
<p>It depends on wording. Beam’s agreement, for example, states that the company isn’t liable to users “for any death, disability or personal injury […] howsoever caused” arising directly or indirectly in connection with use of its e-scooters. Such statements, though broad, are <a href="https://jade.io/article/65000">generally sufficient</a> to exclude negligence liability. The reference to “indirect” injury also implies a user being injured by a third party (such as an errant rider, driver, or pedestrian) would have no recourse against the company.</p>
<p>However, the courts <a href="https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/1953/2.html&query=(white)+AND+(v)+AND+(john)+AND+(warwick)">have also said</a> that where liability can arise on two or more different bases – such as negligence and breach of contract – then you need to use more specific wording in your exclusion clause. Lime, Beam, and Neuron all mention negligence, so they would likely be covered.</p>
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<h2>Insurance as a panacea?</h2>
<p>Compulsory third-party insurance is <a href="https://www.qbe.com/au/news/ctp-explained">required</a> with motor vehicle registration in Australia. But this isn’t so with e-scooters, as they’re not classified as registrable vehicles. Extending the compulsory third-party insurance scheme to e-scooters might help resolve some of the liability questions that linger.</p>
<p>However, the <a href="https://mylicence.sa.gov.au/road-rules/riding_motorised_scooters">South Australian Government</a> has observed this isn’t possible because e-scooters don’t meet <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/vehicles/vehicle-design-regulation/australian-design-rules">national standards</a> that govern registrable vehicles.</p>
<p>While some home and contents insurance policies may offer some coverage for e-scooter injuries, this hasn’t been tested and young victims almost certainly won’t have this insurance.</p>
<p>Workplace insurance might also apply if the accident occurred on the way to, or during, work. Again, this will depend on the relevant policy and whether the rider was obeying all road rules and the e-scooter’s terms of use.</p>
<p>If a rider is hit by a car, the driver’s compulsory third party insurance would cover any resulting injury or death.</p>
<p>The e-scooter companies have started introducing third party liability insurance schemes which might protect riders from claims brought by, for example, injured pedestrians. However, the policies generally have numerous exclusions, such as where riders breach the terms of use (for example for not wearing a helmet or being underage).</p>
<h2>The need for a unified approach</h2>
<p>Multiple stakeholders are involved in rental e-scooter arrangements. From a regulatory perspective, state and local governments have a duty to consider and protect all members of the community when they allow and control e-scooter trials. The chosen approach can also impact redress mechanisms for those injured by e-scooters.</p>
<p>At the moment, there’s different approaches across Australia. So it’s essential that all levels of government work together to craft a uniform regulatory framework.</p>
<p>Additional safety measures can help curb the injury and death count, such as more precise “geofencing” to restrict e-scooters to certain areas and remote deactivation for breach of safety rules. Ensuring only those with a driver’s licence are authorised to ride e-scooters could also help, and this could be implemented by linking e-scooter app sign-up to state government licence databases.</p>
<p>In the meantime, law enforcement is critical to ensure riders are riding e-scooters in a safe and legal manner.</p><img src="https://counter.theconversation.com/content/187436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Brown is a member of the Greens.</span></em></p><p class="fine-print"><em><span>Mark Giancaspro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We need a uniform regulatory framework balancing the risks and benefits of e-scooters, and clarifying avenues for compensation.Mark Giancaspro, Lecturer in Law, University of AdelaideDavid Brown, Co-Director, Bankruptcy and Insolvency Scholarship Unit, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1832022022-06-27T18:42:03Z2022-06-27T18:42:03ZPrevention is better than cure when it comes to high concussion rates in girls’ rugby<figure><img src="https://images.theconversation.com/files/470099/original/file-20220621-14-veejfi.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C2398&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reconsidering the rules of the game may help prevent concussions and other injuries.</span> <span class="attribution"><span class="source">(John Woods/Rugby Canada)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Popularity and participation numbers in rugby union are growing in Canada, particularly in the women’s game. It’s easy to see why — rugby is fast-paced, highly skilful and provides a hugely supportive team environment.</p>
<p>With the Canadian women’s rugby sevens team <a href="https://www.cbc.ca/sports/olympics/rio2016/rugby/canada-beats-britain-rugby-sevens-bronze-1.3712440">winning an Olympic bronze medal at the Rio 2016 Games</a>, and a women’s World Cup happening this October in New Zealand, it’s anticipated that the rise in participation numbers and overall popularity of the women’s game will continue its upward trend. </p>
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<figcaption><span class="caption">In 2016, Canada defeated Great Britain in women’s rugby sevens to take home the Olympic bronze medal.</span></figcaption>
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<p>This is all good news for the sport. But rugby’s growing popularity means that there is more to consider, especially when it comes to injuries and their prevention.</p>
<h2>Hard-hitting</h2>
<p>When you think of the most hard-hitting, high-risk sports, girls’ youth rugby probably isn’t the first thing that comes to mind. However, <a href="https://doi.org/10.1097/jsm.0000000000000993">in Canada</a> and <a href="https://doi.org/10.1055/a-1327-3009">the United Kingdom</a>, the sport is emerging as having one of the highest concussion rates across all youth sports. </p>
<p>While this is not new in the context of <a href="https://doi.org/10.1136/bjsports-2015-094978">boys rugby</a>, with the emergence of more quality data related to the girls’ game specifically, the rates in this cohort may be higher than in many other sport settings for youth.</p>
<p>Considering how concussions occur, it is well recognized that the tackle is the event that leads to the most injuries and concussions in rugby. When focusing more specifically on which player gets injured however, we see that in the girls’ game, a greater proportion of players instigating the tackle (tackler) are injured compared with the ball carrier (the player being tackled). </p>
<p>Looking at tackles that lead to concussions, the specific mechanism of concussion in women’s and men’s games may also be different. In the men’s game, head-to-head contacts are common, however in the women’s game, early research is showing <a href="https://doi.org/10.1080/17461391.2021.1973573">head-to-ground contact and whiplash are more common mechanisms.</a>.</p>
<p>Unfortunately, this research is currently focused on adult athletes, and requires further investigation with injury surveillance, video analysis and mouthguard technologies in youth to better understand head impacts and concussion rates. </p>
<h2>Public health burden</h2>
<p>As the evidence base continues to grow and highlight the public health burden associated with the youth game, rugby faces significant opposition to its growth. In the U.K., there have been calls for <a href="http://www.sportcic.com/resources/Open%20Letter%20SportCIC%20March7%202016.pdf">removal of the tackle</a> from youth rugby.</p>
<p>Concerns were raised in Canada too when in 2019, the Nova Scotia <a href="https://www.cbc.ca/news/canada/nova-scotia/rugby-federation-cancels-games-1.5120503">high school rugby season was cancelled over safety concerns</a>. (However, the season was later reinstated.) </p>
<p>Neither the calls for a tackle ban nor the cancellation of a season have led to long-term changes in the sport. But as more evidence emerges, we are likely to see more of these concerns raised in the coming years, leading to questions surrounding the appropriate age and level of introduction of contact to the game. </p>
<p>How can these risks be mitigated for both male and female rugby players? Our research team at the <a href="https://www.ucalgary.ca/sport-injury-prevention-research-centre">Sport Injury Prevention Research Centre at the University of Calgary</a> is working on preventing these injuries from occurring in the first place. Based on previous work, we know that three key pillars for injury prevention exist. These include: <a href="http://dx.doi.org/10.1136/bjsports-2016-097452">policy or law change, training programs and protective equipment</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a young woman tackles another standing woman in a gym as a coach watches on" src="https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470122/original/file-20220621-22-hyxlyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tackle training is one of the several avenues being explored for prevention of injuries in the youth game.</span>
<span class="attribution"><span class="source">(University of Calgary)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Training contexts</h2>
<p>Changing game laws and rules by governing bodies can significantly impact all levels of the game. However, easily accessible strategies such as neuromuscular training (NMT) programs — which strengthens the connection between the nervous and muscular systems — currently represent the prevention strategy with the most promising findings to date. This has been demonstrated previously in multiple other youth sports. In rugby, this work has been limited to senior and junior men’s settings. </p>
<p>The use of such programs in rugby is best exemplified in youth male rugby to date using the coach-delivered Activate NMT program which has previously been shown to reduce the risk of injury <a href="http://dx.doi.org/10.1136/bjsports-2016-097434">by 72 per cent and concussion by 59 per cent when implemented three times per week</a>, as recommended.</p>
<p>When translating these findings into the context of the Canadian youth game however, it is important to consider the contextual differences between rugby in the U.K. and Canada. In Canada, the playing season is much shorter and often players enter the game at a later age. Given this, and the somewhat unpredictable nature of the injuries that occur, our prevention efforts should be multi-factorial and may span not only one pillar of prevention, but all three.</p>
<h2>A sport for all</h2>
<p>Rugby has previously been described as a “<a href="https://www.world.rugby/news/632406/world-rugby-launches-a-global-sport-for-all-strategic-plan-2021-25-to-guide-long-term-growth?lang=en">sport for all</a>.” With the rise in interest and participation in girls’ and women’s rugby set to continue in Canada, it’s time to put prevention at the forefront of player welfare in the sport. </p>
<p>This is particularly important as many players, both male and female, return to the sport for the first time in two years following the COVID-19 pandemic. Prevention is better than cure, and nowhere does this apply more than keeping our young players safe and free to enjoy the benefits of this wonderful sport.</p><img src="https://counter.theconversation.com/content/183202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen West does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Girls’ rugby is a sport with higher than expected concussion rates. As the sport grows in popularity, preventing concussions is more effective than treating them.Stephen West, Postdoctoral Research Associate, Kinesiology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777392022-03-30T19:08:58Z2022-03-30T19:08:58ZWe’re two physios who ran away with the circus. Here’s what we learned<p>Circus fuses extreme athletic performance, diverse artists and stunning spectacles with a truly global appeal. </p>
<p>Circus is exciting, although sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.</p>
<p>The task of looking after the health of circus performers is unique. And we’ve been privileged to do that, as physiotherapists treating and helping coordinate artists’ medical care. </p>
<p>We’ve done this in well over 100 cities through 30 countries across North and South America, Europe, Australasia, Asia and the Middle East. While we’ve mainly toured with professional circuses, we’ve also advised junior artists and circus training facilities.</p>
<p>This is what it’s like to work behind the scenes of some of the greatest shows on Earth.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/circus-oz-is-to-close-after-44-years-they-irrevocably-changed-australian-circus-and-brought-it-to-the-world-173586">Circus Oz is to close after 44 years. They irrevocably changed Australian circus, and brought it to the world</a>
</strong>
</em>
</p>
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<h2>A diverse crew</h2>
<p>Circuses and their performers are diverse. Disciplines include ground acrobatics (for instance, tumbling, hand balancing, contortion); aerial acrobatics (trapeze, silks, straps); manipulation (juggling); character (clowning); and music. Rehearsals and performances may feature fire, ice, water, heights or a range of props and equipment.</p>
<p>You could compare the cast of a large show to an Olympic squad, with a variety of ages, body shapes, sizes and injury risk.</p>
<p>At the elite level, performers may come from a range of different countries, languages and cultural backgrounds. This can add potential challenges such as differing belief systems and attitudes about injury cause and management, training and performance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Circus performers, including clown, juggler" src="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452734/original/file-20220317-19-8716b3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Circuses and their performers are diverse, as are their injuries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/circus-226087540">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A diverse set of injuries</h2>
<p>While headline-grabbing falls and catastrophic injuries do occur, they are fortunately rare. Most injuries are chronic (long-term) injuries and less-serious acute ones. </p>
<p>The most commonly reported circus injuries are to the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">spine and ankle</a>. We also see sprains, strains, and sore lower backs and shoulders.</p>
<p>You might be familiar with many of these injuries. However, circus performers have unique skills, and sometimes require extreme ranges of movement, coordination and strength. They need their bodies to function in ways you or I don’t. This influences how we work with performers to get them back on their feet (or hands).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">Hot pack or cold pack: which one to reach for when you're injured or in pain</a>
</strong>
</em>
</p>
<hr>
<p>Circus injury rates are <a href="https://www.ingentaconnect.com/content/scimed/mppa/2017/00000032/00000001/art00008">7.37-9.27</a> per 1,000 artist exposures (the number of training/performance hours, or number of training sessions/shows). Acrobatic injuries are the <a href="https://www.ingentaconnect.com/content/scimed/mppa/2014/00000029/00000004/art00010">most</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445642/">common</a>. </p>
<p>However, the limited research we have on circus injuries suggests
circus is safer then many other sports. That includes having lower injury rates than contact football (rugby, American football and Australian rules), and gymnastics. </p>
<p>In professional circus, <a href="https://journals.sagepub.com/doi/abs/10.1177/0363546508331138">injuries tend to be minor</a>, requiring seven or fewer treatment sessions and resulting in one or no missed shows. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fit woman in exercise wear clutching sore lower back" src="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453796/original/file-20220323-21-11ghbqp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Injuries, such as sore backs, are common, and not always reported.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-sportswoman-sitting-on-mat-1745717915">Shutterstock</a></span>
</figcaption>
</figure>
<p>However, injuries are likely under-reported. Common definitions of injury rely on artists missing training or shows, or seeking formal medical care. Some injuries don’t meet these criteria.</p>
<p><a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">Our research</a> looked at performers’ self-reported lower-limb problems, regardless of whether they missed work or saw a health-care practitioner. We asked them about injuries and/or symptoms such as pain, ache, stiffness, clicking/catching, swelling and instability.</p>
<p>In any given week, we found more than 50% of performers reported problems. In an 18-week period, 86% of performers reported having had at least one week with work-related lower limb problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-from-delicate-teens-to-fierce-women-simone-biles-athleticism-and-advocacy-have-changed-gymnastics-forever-124485">Friday essay: from delicate teens to fierce women, Simone Biles' athleticism and advocacy have changed gymnastics forever</a>
</strong>
</em>
</p>
<hr>
<h2>A diverse range of issues</h2>
<p>Some performers also face barriers to recovering from their injuries. <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">One study</a> found financial constraints and a lack of health-care support were issues.</p>
<p>For instance, full-time artists may have access to travelling medical staff with experience working with circus performers. These artists may also have paid injury leave and comprehensive health insurance. </p>
<p>However, artists performing on short-term contracts or doing gig-based work may need to source their own medical care and are more likely to suffer financial loss if they miss performances. </p>
<p>Other researchers have also reported how aspects of circus culture influence how we manage circus injuries. In <a href="https://www.ingentaconnect.com/content/scimed/mppa/2019/00000034/00000001/art00003">one study</a>, performers said they didn’t always trust health-care practitioners’ knowledge of work demands. This includes circus skill requirements, and training or show schedules. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Athlete's taped wrist and ankle" src="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453795/original/file-20220323-21-1ow1371.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To tape or not? Some performers may prefer colleagues’ and coaches’ advice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/injured-athlete-thumb-ankle-injuries-tape-1481951810">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some performers may prioritise advice from colleagues and coaches over medical recommendations. This may be partly because circus is a historic art form where, in many disciplines, training methods have been passed down through generations of performers. </p>
<p>For health-care practitioners, this knowledge can be valuable. So clinicians need to work with artists to come to a shared understanding of how to manage injuries. </p>
<p>Acknowledging the unique nature of circus training and performance, as well as the lack of evidence base to guide medical decision-making in the field, can also help build rapport and ensure a collaborative approach to managing injuries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-clowns-scary-ha-ha-aaaargh-32492">Are clowns scary? Ha ha aaaargh</a>
</strong>
</em>
</p>
<hr>
<h2>Preventing injuries is the goal</h2>
<p>Circus performers are generally adept at managing their bodies, using strength, flexibility and conditioning training to try to prevent injuries and improve their acts.</p>
<p>We have worked with performers to promote self-management, using techniques from more established fields such as sports and dance medicine.</p>
<p>For instance, we looked at adding self-directed <a href="https://www.ingentaconnect.com/content/scimed/mppa/2021/00000036/00000001/art00008">endurance exercises</a> to a performing, touring show. This was welcomed by many performers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-ice-baths-after-sport-help-recovery-or-improve-results-44829">Health Check: do ice baths after sport help recovery or improve results?</a>
</strong>
</em>
</p>
<hr>
<h2>A lot goes on behind the scenes</h2>
<p>For the shows to go on, much behind-the-scenes work is needed from the artists and dedicated support staff. </p>
<p>For those involved in the care of circus artists, this provides not only a uniquely challenging and fascinating workspace, but an amazing view of some of the greatest shows on Earth.</p><img src="https://counter.theconversation.com/content/177739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Ganderton is a research consultant for the National Institute of Circus Arts. Charlotte was previously employed for Cirque du Soleil in its performance medicine team.</span></em></p><p class="fine-print"><em><span>Michael Henry receives funding from the Australian Government in the form of RTPd fee offset and stipend scholarships. He was previously employed by Cirque du Soleil in its performance medicine team. </span></em></p>Circus is exciting, though sometimes unpredictable. At any moment during rehearsal, performance or travel, injuries can occur.Charlotte Ganderton, Physiotherapy lecturer, Swinburne University of TechnologyMichael Henry, PhD candidate, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1784752022-03-14T17:22:52Z2022-03-14T17:22:52ZRunning injuries don’t happen for the reasons you think – here’s the three best ways to prevent them<figure><img src="https://images.theconversation.com/files/451840/original/file-20220314-18-eeq24d.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6006%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most running injuries happen because of overuse.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/runner-sport-knee-injurywoman-pain-while-395823328">sawaddeebenz/ Shutterstock</a></span></figcaption></figure><p>Running is one of the <a href="https://www.latimes.com/travel/la-trb-fitbit-global-workouts-20150824-story.html">most popular</a> forms of physical activity worldwide. But though it requires little expertise or equipment – and can be <a href="https://www.sciencedirect.com/science/article/pii/S0033062017300488?casa_token=A4F7ppCpKtwAAAAA:UXtyxI8cJDgRHzbl9QXlgktUsB3U6v6DaL0Q3d5b5sgVSwp5dqztbGs0SDGCBnThkfD5-XRC">very beneficial</a> for our health – it unfortunately also comes with a relatively high risk of injury. In fact, one survey found nearly half of all runners <a href="https://www.sciencedirect.com/science/article/pii/S1440244018301798?casa_token=rUcD_hcLHv0AAAAA:DS6BQbUBlO8uk1ahHV0nBPVrdZYH3xdjzSG48_dhhfNuNsr7QidfwdINlvO5frO1bFOSnPCB#abs0005">experience injury or pain</a>. Another study even estimated that runners experience nearly <a href="https://link.springer.com/article/10.1007/s40279-015-0333-8">18 injuries</a> for every 1,000 hours of running.</p>
<p>Novice runners have the highest likelihood of sustaining an injury. The most common injuries they experience are in their lower body (such as in the Achilles tendon, shins or knees) and are often the result of <a href="https://www.sciencedirect.com/science/article/pii/S2095254621000454">overuse</a> – an injury that happens in a muscle or joint due to repetitive trauma, usually as a result of doing more than you’re capable of, or not training with proper technique. </p>
<p>But that doesn’t mean injuries are inevitable. There are many ways you can protect yourself from an injury – so long as you ignore some long held ideas about the best way to do this.</p>
<h2>Injury prevention myths</h2>
<p>One common belief in the running community is that static stretching as part of a warm-up or cool-down can reduce risk of injury. But recent evidence suggests that stretching <a href="https://www.tandfonline.com/doi/full/10.1080/15438627.2016.1258640">does little</a> to prevent injuries. It may even reduce running performance in races less than <a href="https://www.tandfonline.com/doi/full/10.1080/15438627.2016.1258640">60 minutes</a> long.</p>
<p>The belief that footwear is a significant factor in whether or not a person gets injured may also be untrue. While comfortable, properly fitting shoes are important for preventing minor issues <a href="https://www.asics.com/gb/en-gb/running-advice/how-to-prevent-blisters-when-running/#:%7E:text=Running%20shoes%20which%20are%20too,turn%2C%20will%20lead%20to%20blisters.&text=If%20your%20feet%20are%20too,them%20more%20prone%20to%20blisters.">such as blisters</a> and can help with <a href="https://theconversation.com/super-shoes-explaining-athletics-new-technological-arms-race-156265">running performance</a>, there’s little evidence suggesting that footwear alone <a href="https://meridian.allenpress.com/jat/article/55/12/1215/446284/Can-the-Appropriate-Footwear-Prevent-Injury-in">reduces injury risk</a>. </p>
<p>There’s also little evidence that shoes prescribed based on foot posture <a href="https://meridian.allenpress.com/jat/article/55/12/1215/446284/Can-the-Appropriate-Footwear-Prevent-Injury-in">reduce injury</a>. A study using army recruits during basic training even showed there was little difference in <a href="https://www.jospt.org/doi/full/10.2519/jospt.2014.5342">injury risk</a> regardless of the type of support a person’s shoe had. </p>
<h2>Evidenced-based tips</h2>
<p>If you want to run injury free, here are the best, evidence-based ways:</p>
<p><strong>1. Build strength</strong></p>
<p>A recent study of Brazilian runners found that performing an eight-week training programme that focused on foot and ankle strength reduced injury risk by <a href="https://journals.sagepub.com/doi/full/10.1177/0363546520969205">nearly 60%</a> compared to a group who didn’t strength-train.</p>
<figure class="align-center ">
<img alt="A woman in athletic wear performs a squat." src="https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451839/original/file-20220314-24-psl2qq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Weight training may help reduce injury risk somewhat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-young-athlete-squatting-wall-646596646">Artem Varnitsin/ Shutterstock</a></span>
</figcaption>
</figure>
<p>While exercising to prevent injury in runners is a relatively new concept, such programmes have also shown promise in other running-based sports such as <a href="https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-017-0083-z">football</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/02640414.2020.1721255">volleyball</a> where overuse injuries are also common. In general, strength training should be done three to five times a week for at least 15 minutes each session. Exercises should focus on building muscular endurance, coordination and balance – such as lunges and squats.</p>
<p><strong>2. Not recovering between training sessions</strong></p>
<p>Failing to recover between training sessions is shown to lead to chronic fatigue or overtraining – which can cause <a href="https://journals.sagepub.com/doi/pdf/10.1177/1941738111434406?casa_token=dNAxbIh11ewAAAAA:01f4QFlseYa-cqwLx0CVswAWugvlvTAqqnMvUCdXqZkPObjM2Y2d0KBh9evEtxiwr-YN1SvqQV9i">performance decline</a>, low mood and muscle aches. These <a href="https://europepmc.org/article/med/1623894">increase risk</a> of overuse injuries as the body’s muscles and tissues aren’t able to repair and adapt between runs. The amount of time a person’s body needs to recover between runs will vary, though 36-48 hours is typical.</p>
<p>Not getting enough or not getting <a href="https://link.springer.com/article/10.1007/s40279-014-0260-0?fbclid=IwAR1BPqYJynmx-Z5mCslc0J-SvnFJxp44BGwwCOSdFxCWbF3RuGpnW_3cCso">good quality sleep</a> can also lead to overuse injuries, as sleep is important for helping the body to recover and restore itself. This is why it’s important to get around seven to nine hours of sleep each night – <a href="https://www.tandfonline.com/doi/pdf/10.1080/17461390801954794?casa_token=RAv3GSqMuWQAAAAA:s0rqNuo747JNQkxeszXPtGZqWA2V0bS0MC8FsV4SSIOUhzg0tmOf6vWSxPd3ntJ4LflRlis5QByk">alongside adequate nutrition</a>. </p>
<p><strong>3. Avoid doing too much too soon</strong></p>
<p>Runners are often also advised to follow the “10% rule” when training to avoid injury, meaning they shouldn’t increase their training load (the volume and intensity of their running) by more than 10% each week. Yet research shows that the 10% rule is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253751/">no better</a> at reducing injury risk than increasing your training load by a <a href="https://journals.sagepub.com/doi/full/10.1177/0363546507307505?casa_token=2Y4rOhNnNiwAAAAA%3A3ONPQgOopOGHyMX8IPno7NatAiLOLp60F8suMlX2s9IOcnwzPB4sqyM38kYuCMRhC_eJhGU0DGI">greater degree</a>: increasing by <a href="https://pubmed.ncbi.nlm.nih.gov/17940147/">up to 24%</a> each week has no greater risk of injury for novice runners. </p>
<p>On the other hand, increasing running volume by <a href="https://www.jospt.org/doi/pdfplus/10.2519/jospt.2014.5164">around 30%</a> each week is linked to greater risk of injury in novice runners. In practical terms, this would mean increasing your running load from 10km per week to 28.5km per week over a four-week period. </p>
<p>Given that injuries are typically the result of a combination of factors – including age, gender, experience and injury history – growing evidence suggests that the best way for runners to avoid injury is to learn how to <a href="https://bjsm.bmj.com/content/bjsports/early/2017/08/17/bjsports-2017-098113.full.pdf">listen to</a> their bodies. A recent study showed that having an obsessive passion for running was associated with an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057706/">increased risk</a> of injury – this is likely due to runners ignoring their bodies and avoiding the early warning signs of injury. </p>
<p>Being able to listen to your body improves with experience. But two studies have shown that people suffering from both knee and <a href="https://journals.sagepub.com/doi/full/10.1177/0363546515584760">achilles injuries</a> were still able to run without significantly worsening their pain or injury so long as they listened to their body and <a href="https://bjsm.bmj.com/content/bjsports/early/2017/08/17/bjsports-2017-098113.full.pdf">modified their running style</a> slightly. </p>
<p>It’s unlikely a person can avoid getting injured altogether – though following these strategies may help reduce the risk and severity of injuries somewhat. If you do get injured, the best thing to do is consult a professional. But pain permitting, you may still be able to do <a href="https://journals.humankinetics.com/view/journals/ijsnem/31/2/article-p135.xml">other types of exercises</a> in the meantime (such as cycling or using an <a href="https://www.youtube.com/watch?v=E15Q3Z9J-Zg">elliptical</a> or even <a href="https://theconversation.com/three-reasons-runners-should-start-lifting-weights-178453">strength training</a>) to help as <a href="https://link.springer.com/article/10.1007/s40279-021-01547-1">you recover</a>. And, as you become <a href="https://www.sciencedirect.com/science/article/pii/S1440244018301798?casa_token=rUcD_hcLHv0AAAAA:DS6BQbUBlO8uk1ahHV0nBPVrdZYH3xdjzSG48_dhhfNuNsr7QidfwdINlvO5frO1bFOSnPCB#abs0005">more experienced</a> as a runner, you may actually suffer fewer injuries than you did at the start.</p><img src="https://counter.theconversation.com/content/178475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Running injuries don’t have to be inevitable.Nathan Liddle, Lecturer in Physiotherapy, Teesside UniversityJonathan Taylor, Lecturer in Sport and Exercise, Teesside UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1700762022-01-04T13:07:12Z2022-01-04T13:07:12ZThe promise of repairing bones and tendons with human-made materials<figure><img src="https://images.theconversation.com/files/438835/original/file-20211222-120394-wx89va.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8093%2C5464&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Musculoskeletal injuries can cause severe pain and lead to greater problems. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shot-of-a-young-woman-holding-her-shoulder-in-pain-royalty-free-image/1359197542?adppopup=true">PeopleImages/E+ via Getty Images</a></span></figcaption></figure><p><em>Brittany Taylor is a biomedical engineer and assistant professor who <a href="https://scholar.google.com/citations?user=KOS4i7AAAAAJ&hl=en">studies novel ways to improve bone and tendon healing</a> after injuries. She is exploring drug delivery systems and temporary artificial tissue replacements to promote healing of tendons and the interface with bones and muscle. Millions of musculoskeletal injuries each year cause pain and reduce people’s quality of life. Here, she answers questions about the <a href="https://www.bme.ufl.edu/dept-member/brittany-taylor-ph-d/">benefits of using composite materials</a> – biological materials like tissue from animals or synthetic materials – to improve repair outcomes. Many of the techniques are still in the experimental stages and have been tested in animal models.</em></p>
<h2>At least half a million bone grafts a year are performed in the United States. Why do doctors and patients need an alternative to using real bone in these surgeries?</h2>
<p>Musculoskeletal complications due to disease, traumatic injury or repetitive activity are major problems worldwide. Current treatments to repair these injuries rely on harvested or donated tissue. For example, doctors take bone from the iliac crest, the curved portion at the top of the hip, then mold it to fit the area needing the bone replacement. But donation sites for bone are limited, and there is a risk of tissue death where the bone is extracted. </p>
<p>When <a href="https://journals.lww.com/jaaos/fulltext/2005/01000/the_biology_of_bone_grafting.10.aspx?casa_token=MHJAoIBIQwMAAAAA:Yiq53pMIWz2_abzPfC-3eTTW3rzgf2QlI-AV_2HjIetqN6zzTS8LxAcT7CPah7BpTQZaoezJ031gOEd7suOVWplK">another patient or a cadaver provides bone for such repairs</a>, it can transmit disease. Harsh detergents and sterilization methods to remove any disease can also affect the bone’s strength.</p>
<p>The use of composite material <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=KOS4i7AAAAAJ&citation_for_view=KOS4i7AAAAAJ:IjCSPb-OGe4C">overcomes the risks and problems of real bone</a>. </p>
<h2>What kinds of materials work best to help injured bones regenerate?</h2>
<p>Composite materials that have a combination of metals, ceramics and polymers – human-made substances – appear to work best for bone regeneration. They <a href="https://www.researchgate.net/publication/288050539_Recent_Advances_in_Bone_Graft_Technologies">provide mechanical support and also a matrix</a> for tissue development. Biomaterials – engineered materials designed to interact with real body tissue – can regenerate tissues and help healing. </p>
<p>The biomaterial should be compatible with the body. It should not set off an immune response, and it should match tissue’s structural and mechanical properties. Biomaterials used for bone tissue engineering should be as tough as bone and allow for tissue to grow into the structure. Natural materials <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jbm.b.33622">such as collagen from cows</a> or pigs can also be integrated into the bone scaffold to promote bone repair. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7Q3S6q97FiU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">This short video from the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health introduces nonscientists to the process of tissue engineering for healing.</span></figcaption>
</figure>
<h2>You study tendons and their limited ability to regenerate when torn. Why don’t tendons heal themselves easily?</h2>
<p>Tendons do not regenerate well because they have low cellularity – fewer clusters of cells than other parts of the body – and fewer blood vessels. Tendons also form scar tissue as they heal and therefore have limited functionality. Surgically repaired tendons can also easily retear, which reduces a person’s quality of life and lead to prolonged complications. Therefore, researchers are working on tissue engineering strategies to augment healing.</p>
<h2>What kind of engineered materials can help tendons heal?</h2>
<p>Tendons are fibrous tissues that transmit energy loads from muscles to bones. They are “highly aligned,” which means they orient along the direction of the load they transmit. Any engineered biomaterial that replaces a tendon should mimic its mechanical force and allow cells to attach and grow on them, as real tendons do. Therefore, polymer-based biomaterials are the best materials to engineer tendon tissue. Engineers make the experimental polymers with techniques such as electrospinning, which uses an electric field to draw a nanosized polymer strand from a solution, making nanofibers. </p>
<p>Nanofibers can be combined with other materials to engineer tendons, as they have a large surface area-to-volume ratio and are porous. Cells easily adhere to these materials.</p>
<h2>You have worked on developing stronger scaffolds that act like real bone in the body. What do scaffolds do, and why do they need to be made stronger?</h2>
<p>Biomaterial scaffolds for tissue engineering are similar to scaffolding used in construction: a temporary framework that supports the structure and provides a platform for the builders to climb and place materials in their appropriate location. Once the construction is complete, the scaffolding is removed and the newly built structure remains.</p>
<p>The same process works in the human body. Cells attach to the scaffold, proliferate and migrate throughout the scaffold. As the cells “climb” they start to deposit biological factors that promote tissue formation.</p>
<p>The scaffold degrades over time as the new tissue regenerates. Mechanical supports can be added to the scaffolds to make them stronger. My colleagues and I included ceramic posts made out of naturally occurring bone mineral, hydroxyapatite, in the three-dimensional composite bone scaffold for load-bearing applications. The posts were similar to beams added to a structure.</p>
<h2>As a Black scientist, you have advocated for <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=KOS4i7AAAAAJ&citation_for_view=KOS4i7AAAAAJ:5nxA0vEk-isC">good mentors</a> to help other scientists of color.</h2>
<p>I have had to overcome several societal and academic challenges. As a Black first-generation college graduate and female biomedical engineer, I am underrepresented at every level of academia. The obstacles I conquered and the knowledge I gained along this journey contribute to the diverse perspective I bring to the field as a culturally competent educator, well-rounded scientist and strong mentor.</p>
<p>My vision for diversifying scientific research is to continually influence members of the next generation as they work their way through their studies. I mentor scientists, transparently share my experiences and encourage trainees from all backgrounds.</p>
<p>I strongly believe a significant part of being successful in academia is the ability to mentor and be mentored throughout the academic pipeline. I am grateful for the many mentors throughout my journey who opened doors for new opportunities and provided access to the necessary spaces to get me to where I am now. And I am committed to doing the same for others.</p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-favorite">Weekly on Wednesdays</a>.]</p><img src="https://counter.theconversation.com/content/170076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brittany Taylor receives funding from the University of Florida and Burroughs Wellcome Fund.</span></em></p>A biomedical engineer explains how human-made materials inserted in the body hold hope to repair painful injuries more efficiently than bone grafts.Brittany Taylor, Assistant Professor of Biomedical Engineering, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1594632021-04-23T12:52:16Z2021-04-23T12:52:16ZGoing back to the gym: how to avoid injuries after lockdown<figure><img src="https://images.theconversation.com/files/396768/original/file-20210423-15-v2ycyo.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5982%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tendon and muscle injuries are the most common.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-fit-woman-man-running-on-1836367948">DuxX/ Shutterstock</a></span></figcaption></figure><p>After months in lockdown, gyms in England reopened on April 12. Many have already eagerly returned with plans to get back to their old fitness routines. But while it may be tempting to go straight back to what you used to do, this could result in an injury – which is why it’s better to ease into training after months off.</p>
<p>Injuries happen when training load <a href="https://link.springer.com/article/10.1007/s40279-015-0459-8">exceeds tissue tolerance</a> – so basically, when you do more than your body is capable of. Fatigue, muscle-tendon strength, joint range of motion, and previous injury to the tissue can all increase the <a href="https://bjsm.bmj.com/content/37/5/384">likelihood of sustaining an injury</a>.</p>
<p>The most common injuries associated with excessive training loads are tendinopathies and strains. Tendinopathy describes when tendons – the tissue connecting your muscles to your bones – have failed to repair properly from previous damage. Common tendinopathies occur in the <a href="https://link.springer.com/article/10.1007/s40279-015-0336-5">buttock</a>, <a href="https://bjsm.bmj.com/content/45/13/1026">proximal hamstring</a> (thigh) and <a href="https://bjsm.bmj.com/content/45/13/1026">Achilles</a>, while the most common muscle strains happen in the <a href="https://www.sciencedirect.com/science/article/pii/S1356689X16000400">shoulder</a> and <a href="https://link.springer.com/article/10.2165/11594800-000000000-00000">knee</a>. But understanding of how our body changes in response to training can help us reduce injury risk when we return to the gym.</p>
<p>Exercise is stressful to our body. As such, a training session “<a href="https://www.nature.com/articles/138032a0">alarms</a>” various body systems (including the muscular-skeletal and cardio-respiratory systems), disturbing the body’s normal state. These systems subsequently respond to the stress by developing resistance and adapting beyond their current capacity – often referred to as <a href="https://link.springer.com/article/10.2165/11319770-000000000-00000">supercompensation</a>. Essentially, this process leads to us becoming stronger or fitter.</p>
<p>Importantly, adaptation occurs after training and requires time. If the body is unaccustomed to the type of training or has not adequately recovered from a previous training session, then this can lead to injury or illness. This is why it’s key to increase training stress gradually over time and ensure you are well recovered between training sessions.</p>
<p>It’s also important to remember that after a long break, even if you can still do the same amount of training as before, the stress on your body could much greater. So for example, let’s say you were able to perform a 20-minute run of the treadmill at 10km/hour prior to lockdown with an average heart rate of 125 beats per minute. Enthusiastically, you complete the same run after lockdown – but your current heart rate now beats an average of 160 beats per minute. </p>
<figure class="align-center ">
<img alt="Man wearing a face mask checks his heart rate using his smart watch." src="https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396770/original/file-20210423-23-vloz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your fitness levels may have decreased during lockdown.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-mask-protection-corona-virus-1735019585">Ranta Images/ Shutterstock</a></span>
</figcaption>
</figure>
<p>This shows us that while the <a href="https://www.researchgate.net/publication/330198549_Internal_and_External_Training_Load_15_Years_On">external training load</a> (the exercise, as described in your training plan) is the same as it was pre-lockdown the body’s response to the training, the <a href="https://www.researchgate.net/publication/330198549_Internal_and_External_Training_Load_15_Years_On">internal training load</a> is much greater. In this case a higher heart rate indicates greater stress on your cardio-respiratory system. So, the same session has become more tiring.</p>
<p>And if you’ve moved less throughout lockdown, it’s possible your lower limb strength and coordination has suffered. This means you’ll be less able to cope with the impact of running, placing greater stress on your joints, muscles, and bones. Without better or longer recovery, this accumulation of stress could lead to injury within a few weeks of training.</p>
<h2>Reducing risk</h2>
<p>To help avoid common injuries a cautious approach to high-impact activities such as jumping may be beneficial, as well those that require muscle lengthening, such as lowering a weigh. While these activities benefit muscular and skeletal health and should be encouraged for most people, they are still challenging to perform and you should spend time developing proper technique before lifting heavier weights or doing more vigorous exercises. </p>
<p>Here are a few other things you can do to avoid injuries as you return to the gym:</p>
<ul>
<li><p><strong>Warm-up</strong>
Warming up has been consistently shown to <a href="https://link.springer.com/article/10.1007/s40279-015-0376-x">improve performance</a> and <a href="https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-017-0083-z">reduce injury</a>. A good warm-up should steadily raise your heart rate and prepare your body for the exercise you are about to perform. Consider including exercises that mobilise key joints and that engage your major muscle groups, such as body weight squats and lunges. </p></li>
<li><p><strong>Monitor how your training feels</strong>
Monitoring your internal load – your body’s response to a training session – is a great way to help you avoid doing too much. You can use ratings of perceived exertion (RPE) scales, such as <a href="https://www.researchgate.net/profile/Gunnar-Borg/publication/20809955_Psychophysical_scaling_with_applications_in_physical_work_and_the_perception_of_exertion/links/558c17b508ae1f30aa80905e/Psychophysical-scaling-with-applications-in-physical-work-and-the-perception-of-exertion.pdf">Borg’s</a> CR-10 scale, which measures exertion on a scale from one to ten. This way you can rate your overall exertion for different training activities to help you determine how hard your have trained.</p></li>
<li><p><strong>Do high-intensity interval training (HIIT)</strong>
Short, intense workouts are popular and can be a safe and effective way of improving health and fitness. While they are <a href="https://theconversation.com/not-enough-time-to-exercise-high-intensity-training-can-fit-into-your-daily-life-122228">high intensity</a>, they’re also low in duration, so the overall training load is usually easily managed. However, consider choosing a low-impact option initially (such as cycling), as high intensity – and high-impact – exercises could increase injury risk after some time off. </p></li>
<li><p><strong>Do strength training</strong>
Doing strength training, such as lifting weights, <a href="https://www.acsm.org/blog-detail/acsm-certified-blog/2019/07/31/acsm-guidelines-for-strength-training-featured-download">two to three times</a> each week can prepare our tissues for more complex activities, as well as having a wide ranging health benefits such as improving mental health, preventing falls and <a href="https://www.researchgate.net/publication/233738795_Muscular_strength_in_male_adolescents_and_premature_death_Cohort_study_of_one_million_participants">reducing mortality</a>.</p></li>
</ul>
<p>Other tips include staying hydrated, wearing appropriate clothing and footwear, and taking enough time to recover – with a focus on sleep and <a href="https://www.bda.uk.com/food-health/food-facts/adult-food-facts.html">good nutrition</a>. Recovery strategies like foam rolling, compression garments and even cold water therapy might help for some people, but the best way to recover is to focus on sleeping and eating.</p>
<p>Of course, you shouldn’t let the risk of injury put you off exercising. Taking things slowly at first will ensure you’re less likely to develop an injury. Most importantly, enjoy exercise, and develop a routine which benefits your lifestyle.</p><img src="https://counter.theconversation.com/content/159463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Top tip: take it slow when you get back to training.Matthew Wright, Lecturer in Biomechanics and Strength and Conditioning, Teesside UniversityMark Richardson, Senior Lecturer in Sports Rehabilitation, Teesside UniversityPaul Chesterton, Associate Professor, Sports Therapy and Rehabilitation, Teesside UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1560292021-02-25T04:52:20Z2021-02-25T04:52:20ZTiger Woods’ car crash injuries explained, according to a trauma surgeon<p>Tiger Woods’ medical team has <a href="https://twitter.com/TigerWoods/status/1364447580520738820/photo/1">released a statement on Twitter</a> to explain the injuries he sustained <a href="https://edition.cnn.com/2021/02/23/us/tiger-woods-car-accident-intl-spt/index.html">in his car crash</a> earlier this week.</p>
<p>The statement was from the Harbor-UCLA Medical Center, a trauma centre, where golfer Woods was taken for emergency treatment after the <a href="https://www.espn.co.uk/golf/story/_/id/30951717/tiger-woods-hospitalized-vehicle-rolls-crash">single-vehicle accident</a>.</p>
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<p>I’m a practising orthopaedic surgeon specialising in trauma surgery and I lecture nationally and internationally on the orthopaedic treatment of fractures. </p>
<p>Here’s my explanation of some of the technical terms in the statement, and what this might mean for Woods’ recovery.</p>
<h2>What were his injuries?</h2>
<p>It appears from the statement his injuries were confined to his right lower leg. This may appear surprising to many who have seen the footage of the accident and heard that his vehicle rolled over. </p>
<p>However, it is common these days to have people admitted after bad car accidents with only injuries to their lower leg. This is because of seat belts, airbags and vehicle construction. These have done a lot to prevent the previously common facial injuries (from windscreens and steering wheels) and head, chest and abdominal injuries.</p>
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Read more:
<a href="https://theconversation.com/smallpox-seatbelts-and-smoking-3-ways-public-health-has-saved-lives-from-history-to-the-modern-day-128300">Smallpox, seatbelts and smoking: 3 ways public health has saved lives from history to the modern day</a>
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<p>The statement says he had “comminuted open fractures affecting both the upper and lower portions of the tibia and fibula”.</p>
<p>Let me break that down. “<a href="https://medlineplus.gov/ency/imagepages/1096.htm">Comminuted</a>” means the bones had broken into many fragments, the opposite of a “simple” fracture where the bone breaks into two parts. </p>
<p>The “upper and lower portions” suggests he has what is called a “<a href="https://pssjournal.biomedcentral.com/articles/10.1186/s13037-015-0086-1/figures/13">segmental</a>” fracture, where the bone is broken in two separate locations.</p>
<p>The comminuted and segmental nature of the injury is not unexpected after high-energy injuries like car accidents and doesn’t change the treatment too much.</p>
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<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-have-bones-90246">Curious Kids: Why do we have bones?</a>
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<p>People place a lot of importance on how many pieces bones are broken into, but as long as the bones heal, they all end up in one piece regardless of how many pieces there were to start with. </p>
<p>The fact that it was a bad fracture, however, means it might be harder to get it to heal and that it might take longer. </p>
<p>“<a href="https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/">Open</a>” fractures mean the skin overlying the broken bone was broken. The main concern is that having an open fracture increases the risk of infection. However, given Woods remained in the vehicle (he had to be broken out of it with special equipment), there is unlikely to be any dirt or highly contaminated material involved.</p>
<h2>How did doctors treat his injuries?</h2>
<p>The tibia and fibula are the two bones that link the knee to the ankle, the tibia being the much larger, main bone. His tibia and fibula were “stabilized by inserting a rod into the tibia”. </p>
<p>It is routine to treat fractures like this with a rod inserted inside the bone from top to bottom to line it up. The rod only needs to go into the tibia because the fibular usually follows the tibia into alignment, as the two bones are connected.</p>
<p>The statement also said that trauma to the soft-tissues of the leg required “surgical release of the covering of the muscles to relieve pressure due to swelling”. </p>
<p>This refers to a procedure called a <a href="https://www.ncbi.nlm.nih.gov/books/NBK556153/">fasciotomy</a> which is performed for actual or impending “<a href="https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/">compartment syndrome</a>” — a build-up of pressure in the leg.</p>
<p>We do not have information on whether the muscle was damaged as a result of the increased pressure (in which case there could be permanent weakness) or whether the muscle is intact. If the fasciotomy was done early and adequately, it is likely there will be no permanent muscle damage.</p>
<h2>Will he recover?</h2>
<p>The interesting thing about Woods’ injuries is that, while the “open” and “comminuted” fractures of the tibia and fibula sound very bad, if he can avoid the early problem of infection, these injuries on their own do not necessarily mean that he will have any permanent problems. </p>
<p>Once healed, the leg can potentially be just as straight and strong as it was before. Muscles can be strengthened and skin and bones usually heal.</p>
<p>The point of most concern relating to his long-term function is the part of the statement that said: “additional injuries to the bones of the foot and ankle were stabilized with a combination of screws and pins”. </p>
<p>Injuries that involve the joints — the parts where one bone joins another bone — are the ones that commonly lead to long-term problems. This is especially the case in the foot and ankle, as these joints take our whole body weight when walking. And these joints allow us to not only walk normally, but also swing a golf club. </p>
<p>If, for example, he has fractures that involve the ankle joint or any of the foot joints, this can result in permanent loss of flexibility and pain on walking.</p>
<h2>Did Woods get special treatment?</h2>
<p>People may be wondering if Woods got <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC315491/">special treatment, or was even overtreated</a>, which is something that can occur with famous people, and when people seek treatment and have the resources to pay for it. </p>
<p>With trauma though, particularly the type of trauma in this case, the treatment usually follows fairly standard practice. Although some surgeons and hospitals vary in exactly how they treat certain injuries, the management of these lower limb injuries is fairly uniform. So it is unlikely he was treated differently to any other patient who would present to that hospital.</p><img src="https://counter.theconversation.com/content/156029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Harris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Once his leg fracture heals, his leg can potentially be just as straight and strong as it was before. But his foot and ankle are more of a worry.Ian Harris, Professor of Orthopaedic Surgery, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1515952020-12-08T02:24:41Z2020-12-08T02:24:41ZNo more than 10 standard drinks a week, or 4 on any day: new guidelines urge Aussies to go easy on the booze<figure><img src="https://images.theconversation.com/files/373476/original/file-20201208-15-150kbo.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2822%2C1706&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The National Health and Medical Research Council (NHMRC) has today released <a href="http://www.nhmrc.gov.au/alcohol">new guidelines</a> to reduce health risks from drinking alcohol. Under the new recommendations, healthy adults should drink no more than ten standard drinks a week, and no more than four on any one day.</p>
<p>I’m chair of the Alcohol Working Committee that for the past four years has worked on revising the Australian drinking guidelines.</p>
<p>These replace the previous version published in 2009, and come at the end of a year upended by a pandemic, and just before the festive season. That might sound like a curious time to release the alcohol guidelines, but it actually makes sense.</p>
<p>During the pandemic, some people have been drinking less because they are going less often to pubs. Others are drinking more at home. Of these, some have turned to drinking for stress relief and run into <a href="https://theconversation.com/worried-about-your-drinking-during-lockdown-these-8-signs-might-indicate-a-problem-136289">major strife</a> with it.</p>
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Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
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<p>But these guidelines are not just for the pandemic year. They are to help all Australians make informed decisions about how much they drink, at any time.</p>
<p>Alcohol contributes to a major health burden in Australia. Harms related to drinking result in more than <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EDeaths%20due%20to%20harmful%20alcohol%20consumption%20in%20Australia%7E4">4,000 deaths</a> and <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/drug-related-hospitalisations/contents/content">70,000 hospital admissions</a> every year. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Alcohol guidelines graphic" src="https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=629&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=629&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=629&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=790&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=790&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373466/original/file-20201208-17-1mu78yk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=790&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The new NHMRC alcohol guidelines.</span>
<span class="attribution"><span class="source">NHMRC</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Alcohol is a key cause of injuries, including road trauma, falls, burns, violence and self-harm. It contributes to drownings and other short-term harms. But much of the damage alcohol causes is less visible, and less immediate.</p>
<p>In the past decade, international research has shown even low levels of consumption are linked with an increase in <a href="https://www.wcrf.org/sites/default/files/Alcoholic-Drinks.pdf">several common cancers</a>, including those of the breast and bowel. And we’ve known for a long time that alcohol consumption can contribute to high blood pressure, liver disease and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13757">many other conditions</a>. The risk increases as more alcohol is consumed.</p>
<p>So, in line with its mission to provide robust evidence-based health advice, NHMRC has now released a set of three guidelines so Australians can make informed decisions about their health.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Standard drink graphic" src="https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=629&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=629&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=629&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=790&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=790&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373467/original/file-20201208-15-1ydkuan.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=790&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Healthy adults should have no more than ten standard drinks per week.</span>
<span class="attribution"><span class="source">NHMRC</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>What do the new guidelines say?</h2>
<p>The first guideline recommends healthy adult men and women consume no more than 10 standard drinks a week, and no more than four on any given day.</p>
<p>The less you drink, the lower your risk. If this advice is followed, there is a less than one in 100 chance of dying from an alcohol-related condition across your lifetime.</p>
<p>Guidelines <a href="https://www.nhmrc.gov.au/health-advice/alcohol">two and three</a> concern people under the age of 18, and women who are pregnant, trying to become pregnant, or breastfeeding. In all these cases, the recommendation is to drink no alcohol at all.</p>
<p>The guidelines were developed by a group of 14 health experts, including clinicians, public health professionals, researchers, and consumer representatives.</p>
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<a href="https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="1 in 100 graphic" src="https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=628&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=628&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=628&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=790&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=790&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373468/original/file-20201208-23-nvv9tc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=790&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you follow these guidelines, evidence suggests you’d have a less than 1% chance of dying from an alcohol-related condition.</span>
<span class="attribution"><span class="source">NHMRC</span>, <span class="license">Author provided</span></span>
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</figure>
<h2>But doesn’t light drinking have a protective effect? The jury is out</h2>
<p>After a thorough review of research evidence, NHMRC’s Alcohol Working Committee released draft guidelines for public consultation in December 2019. We received many responses, some asserting the guidelines didn’t go far enough, and others claiming they went too far.</p>
<p>Some studies mentioned suggested a possible protective effect of low-level consumption of alcohol, in particular against coronary heart disease.</p>
<p>These issues were scrutinised by our committee. The evidence for a protective effect has been challenged by <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.13757">research</a> in recent years. Some researchers dispute its existence.</p>
<p>But at the least, any protective effect is not as strong as previously thought. Nonetheless, the guidelines do allow for a potential protective effect – if they hadn’t, the recommended maximum would have been far lower! Potential protective effects were balanced against the increased risk of certain cancers.</p>
<p>These guidelines are not trying to tell you what you can and can’t do. Rather, we’re providing advice on how you can reduce your health risks from drinking alcohol. That way, we can all make informed decisions in our daily lives.</p><img src="https://counter.theconversation.com/content/151595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Conigrave is chair of the Alcohol Working Committee of the National Health and Medical Research Council.</span></em></p>The guidelines are informed by a review of the best available evidence. The less you drink, the lower the risk of harm to your health.Kate Conigrave, Senior Staff Specialist and Professor of Addiction Medicine, Royal Prince Alfred Hospital and Sydney Medical School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1440712020-08-11T06:58:25Z2020-08-11T06:58:25ZVictorian emergency departments during COVID-19: overall presentations down but assault, DIY injuries up<figure><img src="https://images.theconversation.com/files/352104/original/file-20200811-20-1vymxs6.jpg?ixlib=rb-1.1.0&rect=50%2C0%2C5627%2C3748&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>COVID-19 restrictions in Victoria have had a marked effect on how and where we spend our time. For many people, home has become the workplace, and for most school-aged children, home is also the classroom.</p>
<p>We compared <a href="https://www.monash.edu/__data/assets/pdf_file/0009/2294919/COVID-19-VISU-May-Bulletin-3.pdf">Victorian emergency department presentations</a> in May 2020 to those in May 2019 and found this extra time at home has affected the rates at which people are presenting to hospital with injuries — and the types of injuries they’re presenting with.</p>
<p>Importantly, overall presentations to the emergency department were down. But some categories saw notable increases, including the number of “unintentional home injuries”, which grew by 21%, and the number of injuries caused by “assault in the home”, which was 48% greater than the same time last year.</p>
<p>Although motor vehicle related injuries decreased, there was an increase in bicycle injuries, particularly among children.</p>
<h2>What we did</h2>
<p>At Monash University’s <a href="https://www.monash.edu/muarc/research/research-areas/home-and-community/visu">Victorian Injury Surveillance Unit</a>, we’ve been tracking injury rates throughout the pandemic.</p>
<p>We get our data from the <a href="https://www2.health.vic.gov.au/hospitals-and-health-services/data-reporting/health-data-standards-systems/data-collections/vemd">Victorian Emergency Minimum Dataset</a>, which holds deidentified clinical records of presentations at Victorian public hospitals with 24-hour emergency departments (currently 38 hospitals).</p>
<figure class="align-center ">
<img alt="The outside of a hospital with large red " src="https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352109/original/file-20200811-16-1sr22k8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Fewer Victorians are presenting to emergency departments during the pandemic.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>We’re also tracking emergency department presentations overall, to determine how much more common different types of injuries are becoming as a proportion of usual emergency department presentations. We call this measure “relative to emergency department caseload”.</p>
<p>So for example, in our <a href="https://www.monash.edu/__data/assets/pdf_file/0009/2294919/COVID-19-VISU-May-Bulletin-3.pdf">most recent bulletin</a>, we took the total emergency department presentations during May 2020. But because we’re looking for the proportion of usual emergency department presentations — that is, outside a pandemic — we excluded presentations directly or indirectly related to the pandemic from the total.</p>
<p>To calculate “relative to emergency department caseload”, we worked out the injuries as a proportion of this total.</p>
<h2>Illness</h2>
<p>Emergency presentations in Victoria were 24% lower in May 2020 than in May 2019 (118,793 versus 156,708 respectively). This decrease should be considered in the context of <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care">steady growth in emergency department presentations</a> in Victoria in recent years. It’s difficult to deny the COVID-19 pandemic is deterring people from presenting to hospital.</p>
<p>Respiratory illness-related presentations (such as asthma or pneumonia) in particular saw a steep reduction. Some 4,748 people presented to Victorian emergency departments with respiratory issues in May — 63% fewer than in May last year, when there were 12,847 such presentations.</p>
<p>Even people with potentially life-threatening conditions were less likely to present to hospital. Heart attack presentations were down 15% compared with the same period one year prior (721 versus 613), and stroke presentations were down 19% (858 versus 693). </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/even-in-a-pandemic-continue-with-routine-health-care-and-dont-ignore-a-medical-emergency-136246">Even in a pandemic, continue with routine health care and don't ignore a medical emergency</a>
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<h2>Injuries</h2>
<p>The overall number of injury presentations to Victorian emergency departments was actually 26% lower in May 2020 than in May 2019 (26,991 versus 36,293). </p>
<p>But breaking this down by the place where the injury occurred shows a marked reduction in injuries that took place in sporting venues and schools, and an increase in injuries that occurred in the home and on farms. </p>
<p>Unintentional home injuries, including DIY injuries, increased from 10,105 to 12,265 (21%) from May 2019 to May 2020. Relative to emergency department caseload, this was a 56% increase. At both timepoints, falls were the most common cause of unintentional home injuries.</p>
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<p>Self-harm injuries did not increase in May 2020 versus May 2019 in terms of the raw numbers (719 versus 773). But relative to emergency department caseload, self-harm injury presentations increased by 20%. </p>
<p>This can be taken with more recent data outside of our research which showed <a href="https://www.theage.com.au/national/victoria/victoria-records-394-new-covid-19-case-17-deaths-20200809-p55jz4.html">a 9.5% rise</a> in the number of overall Victorian hospital admissions for self-harm in the past six weeks.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-not-only-teenage-girls-and-its-rarely-attention-seeking-debunking-the-myths-around-self-injury-120214">It's not only teenage girls, and it's rarely attention-seeking: debunking the myths around self-injury</a>
</strong>
</em>
</p>
<hr>
<p>According to our data, assault in the home increased from 118 presentations in May 2019 to 175 in May 2020: a 48% increase in frequency and a 91% increase relative to emergency department caseload. </p>
<p>Finally, transport injuries overall were not much different in May 2020 compared to May 2019 (1,669 versus 1,766). This was, however, a 22% increase when considered relative to emergency department caseload. While motor vehicle injuries decreased by 30% (833 to 581), bicycle injuries increased 55% from 371 to 576.</p>
<p>For children under 15 years, the rate of transport-related injury presentations to emergency departments increased 78% from May 2019 to May 2020.</p>
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<p><iframe id="qm16y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/qm16y/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
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<h2>Staying safe at home</h2>
<p>The bulletins we previously released for <a href="https://www.monash.edu/__data/assets/pdf_file/0005/2224283/COVID-19-VISU-Bulletin-1-03JUN2020.pdf">March</a> and <a href="https://www.monash.edu/__data/assets/pdf_file/0006/2246604/COVID-19-VISU-Bulletin-2.pdf">April</a>, and the data we’re now collating for June, reflect similar trends in the rates and types of emergency department presentations, as compared to the same time points last year.</p>
<p>Our findings have a few different implications.</p>
<p>First, we should encourage people who are sick and need hospital care to present to hospital — not to stay home for fear of contracting COVID-19.</p>
<figure class="align-center ">
<img alt="Young girl riding her bike." src="https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352111/original/file-20200811-17-ow8avo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children were disproportionately represented in transport-related injuries.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Second, alongside the messaging we’re receiving to “stay home” and “stay safe” from coronavirus, public health messaging should include advice on staying safe at home. </p>
<p>With reduced face-to-face contact with health practitioners, some injury prevention messaging, such as the information provided through child-maternal health services, general practitioners and nurses, should be made available through other channels. These could include social media, radio, television, and telephone consultations. </p>
<p>Improving awareness of cycling safety, including messaging around <a href="https://www.monash.edu/__data/assets/pdf_file/0010/2186956/Hazard87-FINAL.pdf">cycling road rules</a>, would also be pertinent at this time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/there-are-ways-to-reduce-injuries-in-kids-that-dont-involve-wrapping-them-in-cotton-wool-79408">There are ways to reduce injuries in kids that don't involve wrapping them in cotton wool</a>
</strong>
</em>
</p>
<hr>
<p>Finally, trends in self-harm and assault in the home need to be closely monitored, particularly during stage 4 restrictions in Victoria. </p>
<p>The stricter lockdown conditions may result in further increases in violence in the home and compound the effects on mental health, and we need to provide support accordingly.</p><img src="https://counter.theconversation.com/content/144071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Victorian Injury Surveillance Unit is funded by the Victorian Government</span></em></p>Comparing presentations to Victorian hospital emergency departments in May 2020 to those in May 2019 reveals some important differences.Janneke Berecki-Gisolf, Associate Professor, Accident Research Centre, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1313862020-02-17T01:06:39Z2020-02-17T01:06:39ZAussie Rules players risk injuring hands and wrists too<p>When people think about Australian Rules Football injuries, they tend to think about head injuries and the long-term effects of <a href="https://www.abc.net.au/news/2019-03-19/john-barnes-ex-afl-ruckman-joins-planned-concussion-class-action/10915086">concussion</a>. Or they might think of the potentially lengthy recoveries after <a href="http://www.aflcommunityclub.com.au/index.php?id=342">hamstring</a>, shoulder or ankle injuries.</p>
<p>But our <a href="https://www.jsams.org/article/S1440-2440(19)31347-7/fulltext">recently published research</a> found another leading cause of injury serious enough to take players to the emergency department – injuries to the hand or wrist. </p>
<p>These cost one Victorian public health network <a href="https://bridges.monash.edu/articles/Individual_community_and_societal_burden_following_acute_hand_and_wrist_injury/11635335">between</a> about A$250 (for a single emergency department consultation) and about A$5,300 (for surgery and rehabilitation) each time. And many of these injuries can be prevented or better managed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aussie-rules-rules-thanks-to-the-eight-hour-working-day-27630">Aussie Rules rules thanks to the eight-hour working day</a>
</strong>
</em>
</p>
<hr>
<h2>What causes these injuries?</h2>
<p>Australian Rules Football or Aussie Rules involves a mix of physical endurance, high-speed running, frequent changes of direction, jumping, sudden and forceful collisions, aggressive tackling, as well as kicking and ball-handling skills. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/XMZYZcoAcU0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How does Aussie Rules differ from other types of football?</span></figcaption>
</figure>
<p>The sport’s distinctive rules and physical demands exposes players to both unique and uncommon injuries compared to those sustained in other football codes, for instance in <a href="https://www.ncbi.nlm.nih.gov/pubmed/16247262">gridiron football</a> played in the United States and Canada or <a href="https://www.ncbi.nlm.nih.gov/pubmed/22879401">Gaelic football</a> played in Ireland. </p>
<p>Put simply, the 360-degree nature of the game (unlike rugby which is played mainly in straight lines up and down the pitch), can result in fingers, hands and wrists to be pulled, jarred, kicked and crushed. </p>
<p>Players’ hands and wrists can also be injured by other players, when falling on the grass pitch or when in contact with the hard leather ball. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-traumatic-brain-injury-and-how-is-it-treated-34697">Explainer: what is traumatic brain injury and how is it treated?</a>
</strong>
</em>
</p>
<hr>
<h2>More and more people playing around the country</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/8665278">Research published in the 1990s</a> found hand fractures were the second most frequent injury, behind concussion, for amateur Aussie Rules players. </p>
<p>Since then, the game has become much more popular. Nationally, it’s the <a href="https://www.clearinghouseforsport.gov.au/__data/assets/pdf_file/0012/796827/AusPlay_focus_Children_Participation.pdf">third most popular</a> organised sport for children (behind swimming and soccer). </p>
<p>And the number of women playing the amateur game <a href="https://www.theage.com.au/sport/afl/number-of-women-playing-footy-surges-post-aflw-20190429-p51i5j.html">has increased</a> since the introduction of the women’s professional league, <a href="https://womens.afl/">the AFLW</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/growth-of-womens-football-has-been-a-100-year-revolution-it-didnt-happen-overnight-71989">Growth of women’s football has been a 100-year revolution – it didn't happen overnight</a>
</strong>
</em>
</p>
<hr>
<p>This rise in participation at an amateur level is likely to have impacts on the number of injuries presenting to emergency departments.</p>
<p>We weren’t aware of Australian data looking at people with sports and exercise-related hand and wrist injuries who presented to the emergency department. So we decided to establish baseline data so that we could track patterns over time. </p>
<h2>What we found</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=702&fit=crop&dpr=1 600w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=702&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=702&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=883&fit=crop&dpr=1 754w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=883&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/314657/original/file-20200211-146708-17zxie6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=883&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This x-ray shows a complex finger joint injury from a player who came to the emergency department after playing Aussie Rules.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our study used diagnostic codes and billing records at one Victorian public health network. Over a year, we identified and tracked 692 people with a sport and exercise-related admission to the emergency department following a hand or wrist injury.</p>
<p>People playing amateur Aussie Rules were the largest group (20.2%) followed by cyclists (15.9%). </p>
<p>The most common injuries were finger dislocations, with or without fractures, to the <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/proximal-interphalangeal-joint">proximal interphalangeal joint</a> (the middle joint on the x-ray shown) of the little and ring fingers. Next came <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928373/">metacarpal fractures</a> (in the bone below the knuckles).</p>
<p>The total cost of all sport and exercise-related injuries during the year for the health network was A$790,325, with Aussie Rules accounting for close to <a href="https://bridges.monash.edu/articles/Individual_community_and_societal_burden_following_acute_hand_and_wrist_injury/11635335">A$167,000</a> alone.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/get-a-grip-the-twist-in-the-wrist-that-can-ruin-tennis-careers-90318">Get a grip: the twist in the wrist that can ruin tennis careers</a>
</strong>
</em>
</p>
<hr>
<p>As Australia’s national injury database does not capture specific hand and wrist injury data, we cannot compare injury patterns from sports and exercise across states and territories.</p>
<p>But if our study was repeated in New South Wales, for example, where other football codes are more popular, we’d expect to see a different injury profile.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rugby-world-cup-injuries-thats-gotta-hurt-3101">Rugby World Cup injuries: That's gotta hurt</a>
</strong>
</em>
</p>
<hr>
<h2>Could we prevent or better manage these injuries?</h2>
<p>Nevertheless, our finding that Aussie Rules accounts for one in five sport and exercise-related hand and wrist injuries highlights the need for further action.</p>
<p>Preventing these injuries would be challenging for a number of reasons. These include the fast pace of the game, the number of players on the pitch, and the unpredictable bounces that come with using an oval shaped ball. </p>
<p>Yet several strategies might help reduce the frequency and impact of these injuries, as well as their health-care costs.</p>
<p>These include training players from junior grassroots level the <a href="https://doi.org/10.1097/JSM.0b013e31829aa3e8">correct way to tackle, handball and mark</a>. </p>
<p>For example, when tackling, players need to avoid catching their fingers in another player’s clothing as it could lead to dislocation; players can avoid handballing with the thumb in the palm; and they can hold their fingers to the sky and their body behind their hands when <a href="https://www.youtube.com/watch?v=I9Rk7r0V_HI">marking</a> where possible.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/I9Rk7r0V_HI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How to mark in Aussie Rules.</span></figcaption>
</figure>
<p>Clubs could ensure ground conditions are safe, for instance by providing padding on goal posts and avoiding playing on hard, concrete cricket pitches.</p>
<p>And, on the ground, we could ensure there are enough club trainers or health professionals experienced in diagnosing and managing these types of hand injuries. This would reduce the risk of misdiagnosis and exposure to further injury. </p>
<p>Both of us have treated injuries made worse by a well-meaning trainer who has, for example, treated a fracture as a dislocation, leading to further displacement of the bone fragments.</p><img src="https://counter.theconversation.com/content/131386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Running, jumping, tackling, not to mention handling the ball, means Aussie Rules players risk injuries to their hands and wrists serious enough to send them to the emergency department.Luke Robinson, Lecturer, Department of Occupational Therapy, Monash UniversityLisa O'Brien, Associate Professor, Occupational Therapy, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1266302019-11-26T13:37:50Z2019-11-26T13:37:50ZMedical errors still harm too many people but there are glimpses of real change<figure><img src="https://images.theconversation.com/files/303192/original/file-20191122-74572-kfjs22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The U.S. is nowhere near the goal, set 20 years ago, of cutting medical errors in half.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/focus-on-hand-patient-hospital-ward-589302497?src=39815974-b5d4-4f3e-b60a-d4a34539cda5-1-1"> Thaiview/Shutterstock.com</a></span></figcaption></figure><p>In late November 1999, a TV producer called me about an alarming <a href="http://www.nationalacademies.org/hmd/%7E/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf">report</a> that 44,000 to 98,000 Americans were being killed each year by preventable errors in hospitals and another 1 million were being injured.</p>
<p>Could that be true? Based on my research, I replied, the estimate seemed low.</p>
<p>The To Err is Human report from the Institute of Medicine <a href="https://www.ncbi.nlm.nih.gov/pubmed/30395508">has been called a “seminal moment”</a> in the patient safety fight. The public furor sparked by the group’s assertion that medical mistakes were deadlier than breast cancer, auto accidents or AIDS prompted new laws, as well as vows to meet the Institute of Medicine’s goal of cutting medical errors in half in five years. </p>
<p>Twenty years after the report’s release, how safe is our medical care?</p>
<p>Your local hospital is almost certainly much more dangerous than it could be. The latest research says the “<a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0738">frequency of preventable harm remains high</a>,” and danger in the doctor’s office and other outpatient settings is only now starting to be addressed.</p>
<p>But the good news, based on my research in this field, is that almost all hospitals are making some progress, while a small number of institutions have committed themselves to zero harm, providing hard evidence that care can be made far safer.</p>
<h2>Changing a culture</h2>
<p>Over the years, the definition of what constitutes a medical error has become both more precise, as detection methods have improved, and more expansive. The simplest approach to understanding the different types of treatment-caused harm is to look at two categories. The first type of error happens when the doctor or nurse’s intent was correct, but something went wrong – a medication overdose, a preventable infection, a sponge left in the patient’s body after surgery. The second kind of error is one of intent – the wrong diagnosis, for instance. The Institute of Medicine report mostly (though not exclusively) focused on the first kind of error and pointed to the direction hospitals should take. For years, few chose that road.</p>
<p>“When I said I was going to eliminate preventable injuries and deaths, people looked at me like I was a crazy,” a physician leader who started his health system down the “zero harm” path more than a decade ago told me when I interviewed him for this article. “But the whole history of medical progress is doing just that.”</p>
<p>The Institute of Medicine report relied on studies from the 1980s, as did my methodologically cruder estimate of 180,000 deaths <a href="https://www.amazon.com/Demanding-Medical-Excellence-Accountability-Information/dp/0226525880">in a 1997 book</a>. Newer research with varying definitions and measurement methods has produced varying conclusions. The closest to an “official” estimate may be a <a href="https://www.hhs.gov/about/strategic-plan/strategic-goal-1/index.html">statement</a> by the U.S. Department of Health and Human Services in its current strategic plan that “preventable medical errors potentially take 200,000 or more American lives each year.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302294/original/file-20191118-66917-em3dul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are pockets of progress on medical errors, but over 40% of hospitals earned a ‘C,’ ‘D,’ or ‘F’ grade on safety in an annual review.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/archer10/44662897652/">Dennis Jarvis/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Based on that figure, the 346 people killed in the crashes of two Boeing 737 Max jets within six months in 2018 and 2019 is equivalent to those dying from hospital-caused harm in a little over half a day.</p>
<p>Unlike airline crashes, of course, treatment-caused harm is mostly invisible to the public. <a href="https://www.nytimes.com/2019/07/23/us/neil-armstrong-wrongful-death-settlement.html">The occasional newsworthy scandal</a> only leaves the mistaken impression that “bad” doctors and nurses are to blame when something goes wrong.</p>
<p>But as a physician who lost a loved one to medical error <a href="https://www.huffpost.com/entry/how-hospitals-kill-our-loved-ones-and-conceal-it_b_58cbd60fe4b07112b6472c7d">wrote on HuffPost</a>, dangerous care persists because “genuinely caring and often highly expert people” work in a system that “devolves into routine and dangerous dysfunction.” It is the very routineness of that dysfunction that can blind clinicians and staff to its consequences.</p>
<p>“Nobody goes to work in the morning to harm a patient,” is a health care truism. Yet a <a href="https://www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/2018hospitalsopsreport.pdf">national survey of hospital patient safety culture</a> found that 40% of respondents agreed that “hospital management seems interested in patient safety only after an adverse event happens.” Perhaps coincidentally, 43% of hospitals earned a “C,” “D” or “F” grade in the latest <a href="https://www.hospitalsafetygrade.org/about-us/newsroom/display/807485">report</a> from the Leapfrog Group, a nonprofit that publishes patient safety report cards on individual hospitals.</p>
<p>The challenge with regard to patient harm is changing from a culture that sees “inevitability” to one that is passionate about “preventability.”</p>
<h2>Pockets of progress</h2>
<p>The public impact of the To Err revelations receded long ago. Today’s spotlight shines on <a href="https://theconversation.com/why-thousands-are-getting-hit-with-unexpected-medical-bills-117955">surprise medical bills</a>, daunting drug prices and holes in health insurance. Still, 20 years’ time is a generation, and in today’s generation, there are glimpses of significant change.</p>
<p>In contrast to <a href="https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.22.2.103">the silence</a> that persisted for so long, groups such as the American College of Healthcare Executives, the American Hospital Association, the Joint Commission (the nation’s largest hospital accreditation group) and others are explicitly confronting the imperative to eliminate all harm. Hospital collaboratives <a href="http://www.ihi.org/Topics/CMSPartnershipForPatients/Pages/default.aspx">organized by the federal government and others</a> are providing guidance.</p>
<p>Most importantly, in my opinion, hospitals on the zero harm journey are sharing their stories, providing proof that aspiration can become implementation. Their ranks are not large, but they include institutions like Titusville, Florida’s Parrish Medical Center, which has <a href="https://patientsafetymovement.org/news/parrish-medical-center-awarded-patient-safety-movements-first-5-star-hospital-ranking/">not had a death from ventilator-related pneumonia</a> in a dozen years; the Ascension Health system, which has meticulously documented its yearly progress toward eliminating all preventable injuries and deaths in more than 60 hospitals; and St. Louis’ BJC HealthCare, which actually <a href="https://www.sciencedirect.com/science/article/abs/pii/S1553725019301862">did reduce patient harm by over half in just five years</a>, and then by 75% in 10 years, a success that contrasts sharply with the national results.</p>
<p>The leaders of these efforts describe a slow and painful culture change process. But it is nowhere near as painful as watching, as I have, a mother recount how her nine-year-old daughter died from a series of medical mistakes in a hospital where the mom had taken her child to save her life.</p>
<p>For the sake of our families, friends and ourselves, it’s time for community leaders to challenge local hospitals to understand that a different path is both urgent and possible.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/126630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael L. Millenson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Twenty years after a landmark report on preventable deaths and injuries in hospitals, is the medical profession doing better?Michael L. Millenson, Adjunct Associate Professor of Medicine, Feinberg School of Medicine, Northwestern UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1183182019-08-06T13:04:15Z2019-08-06T13:04:15ZThe facts on the US children and teens killed by firearms<figure><img src="https://images.theconversation.com/files/286127/original/file-20190729-43118-14dzx06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Injuries from firearms are a leading cause of death for American children and teens.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/school-sign-banning-drugs-guns-188967872?src=J_fD5-MUYMAAH_Gqa60jzw-1-1&studio=1">Whytock/Shutterstock.com</a></span></figcaption></figure><p>Injury is the leading cause of death for U.S. children and adolescents, accounting for over 60% of all deaths in this group.</p>
<p>Many of these deaths occur during fun, everyday activities, like swimming in the backyard pool or during a family car ride. But a disproportionate and disturbing number of these deaths in the U.S. occur as a result of firearms.</p>
<p>Firearms are the second leading cause of death among U.S. children and adolescents, after car crashes. Firearm deaths occur at a rate over three times higher than drownings. </p>
<p><a href="https://scholar.google.com/citations?user=B9HaG4kAAAAJ&hl=en">We</a> <a href="https://scholar.google.com/citations?user=3xTR4rsAAAAJ&hl=en">have</a> <a href="https://scholar.google.com/citations?hl=en&user=3pd-tcQAAAAJ">dedicated</a> our careers to understanding violence and injury prevention, including how firearm injury and deaths happen and how they can be prevented. </p>
<p>Causes of injury and death due to motor vehicle crashes have steadily declined over the last 20 years, but death and injury due to firearms has remained about the same over the same period.</p>
<p><iframe id="TVsCz" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/TVsCz/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Firearm death rates</h2>
<p>Since 2013, <a href="https://wonder.cdc.gov/ucd-icd10.html">fatal firearm injuries for children and teens</a> have risen unabated. </p>
<p>Rates of death from firearms among ages 14 to 17 are now 22.5% higher than motor vehicle-related death rates. In the U.S., middle and high school age children are now more likely to die as the result of a firearm injury than from any other single cause of death.</p>
<p>For Americans between the ages of 1 and 19, a little over half of 2017 firearm-related deaths are homicides. </p>
<p>Another 38% of firearm-related deaths in this age group are suicides, while the rest result from unintentional injuries or undetermined causes. </p>
<p>What’s more, the U.S. has had 1,316 school shootings since 1970. The numbers of these tragic events have been increasing, with 18% of the total occurring in the past seven years since the Newtown school shooting at Sandy Hook Elementary School. </p>
<p>School shootings are a focus of media attention and raise awareness about the problem of firearm deaths among children and teens. But they remain the smallest proportion of deaths, accounting for 1.2% of all homicides among 5 to 18-year-olds.</p>
<p><iframe id="A8f8p" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/A8f8p/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Death disparities</h2>
<p>African American children and teens are over eight times more likely to die from firearm homicide than their white counterparts. Firearms have been the leading cause of death for African American youth for well over a decade.</p>
<p>Firearm suicide rates are highest among American Indian/Alaskan Native and white children and teens, compared to other racial/ethnic groups. </p>
<p><iframe id="7Z2id" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/7Z2id/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Researchers have limited information on the reasons for <a href="https://doi.org/10.1056/NEJMsr1804754">these racial disparities</a>. We suspect they are likely a result of a number of factors, including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446109/">socioeconomic status</a>, firearm availability and accessibility, and <a href="http://doi.org/10.1001/jama.2015.9260">lack of access to mental health services</a>.</p>
<p>Although firearm-related rates of death for children and teens living in urban, suburban and rural communities are similar, rural rates of firearm suicide are twice as high and unintentional firearm injuries are four times higher than in urban communities. Meanwhile, firearm homicide rates are twice as high in urban than in rural communities. </p>
<p><iframe id="X7fVu" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/X7fVu/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>A uniquely American epidemic</h2>
<p>The U.S. stands out <a href="https://doi.org/10.1016/j.amjmed.2015.10.025">among high-income countries</a>: Over 90% of all the firearm deaths among children and adolescents that occur in industrialized nations occur in this country. </p>
<p>Furthermore, the U.S. has <a href="https://www.washingtonpost.com/news/wonk/wp/2018/06/19/there-are-more-guns-than-people-in-the-united-states-according-to-a-new-study-of-global-firearm-ownership/">more privately owned firearms</a> – not including military firearms – than citizens. </p>
<p><a href="https://www.pewresearch.org/fact-tank/2018/12/27/facts-about-guns-in-united-states/">In a Pew Research Center survey of U.S. adults in 2017</a>, about 30% reported owning a firearm and 42% reported living in a household with firearms. </p>
<p>Two-thirds of households have more than one firearm and almost one-third have five or more firearms. Firearms may have different purposes – deer hunting, shooting competition, target practice and so on – which may explain why so many households own more than one gun. </p>
<p>Pew’s data indicates that 54% of firearm owners with children under 18 living in the home have their firearms <a href="https://www.pewsocialtrends.org/2017/06/22/americas-complex-relationship-with-guns/">locked away</a>. This suggests to us that young children and teens may have relatively easy access to unsecured firearms. </p>
<h2>Digging into the data</h2>
<p><a href="https://theconversation.com/why-is-there-so-little-research-on-guns-in-the-us-6-questions-answered-92163">Research on firearms is limited</a> in the U.S.</p>
<p>Government sponsorship of research focused on firearm has been virtually eliminated by an annual appropriations amendment, first added by Arkansas Congressman Jay Dickey in 1996.</p>
<p>Recently, academics, the National Institutes of Health, state governments and private foundations <a href="https://www.nytimes.com/2019/04/17/upshot/gun-research-is-suddenly-hot.html">have begun to renew the focus</a> on research to prevent firearm injuries and fatalities. This is due largely to changes in public opinion about firearms as mass shootings keep occurring. </p>
<p>Established in 2017 with NIH funding, the <a href="https://www.icpsr.umich.edu/icpsrweb/content/facts/index.html">Firearm Safety Among Children and Teens (FACTS) Consortium</a> is one of these efforts, with a focus on conducting critical firearm injury prevention research while respecting legal and safe firearm ownership. We lead FACTS, in which academics from 14 universities from around the country are involved. </p>
<p>Members of this consortium have <a href="https://www.icpsr.umich.edu/icpsrweb/content/facts/projects.html">begun to investigate key research questions</a>, such as the best methods for health care providers to counsel families about safe firearm storage, interventions to decrease firearm suicide risks among rural teen households, and the effect of state firearm laws on school shootings. </p>
<p>Just as other public health problems have turned to scientific evidence to prevent injuries, we feel that the U.S. should use evidence to inform policies that protect children and teens. Much more can be done to address this vital public health problem. </p>
<p><em>This article has been updated to correct the caption of the graph on rural and urban rates.</em></p><img src="https://counter.theconversation.com/content/118318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc A Zimmerman receives funding from the NIH, CDC, NIH and foundations to do violence prevention work generally and some of that funding is focused on firearm injury and death in particular. The funding does not provide additional profit for me other than covering my time to work on the projects. </span></em></p><p class="fine-print"><em><span>Dr. Patrick Carter receives research funding from the NIH (NICHD, NIDA, NIAAA) and the CDC. This funding is to support research projects focused on violence and injury prevention. </span></em></p><p class="fine-print"><em><span>Rebecca Cunningham receives funding from NIH for firearm injury prevention research, as well as from the CDC for injury and violence prevention.</span></em></p>Firearms are the second leading cause of death among US children and adolescents.Marc A. Zimmerman, Professor of Public Health, University of MichiganPatrick Carter, Assistant Professor of Emergency Medicine, University of MichiganRebecca Cunningham, Interim Vice President Research University of Michigan, Professor of Emergency Medicine and Director of the Injury Research Center, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1074132018-12-13T12:48:44Z2018-12-13T12:48:44ZWhy football’s festive fixture congestion is so bad for injuries<figure><img src="https://images.theconversation.com/files/250436/original/file-20181213-178576-1cyfi2c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tottenham's Kieran Trippier has been struggling with a persistent groin problem.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>For many football fans, the festive football schedule is a highlight of the Christmas break. But for many clubs, the cold conditions and congestion around fixtures can lead to an increase in injuries. In fact, earlier in the year Manchester City boss, Pep Guardiola, <a href="https://edition.cnn.com/2018/01/03/football/pep-guardiola-english-premier-league-fixture-scheduling-killing-players/index.html">said the festive period in English football</a> was “killing” the players. </p>
<p>English football is unique in that it has a high number of fixtures, particularly during the festive period when European teams get a mid-season break. In fact, <a href="https://www.ncbi.nlm.nih.gov/pubmed/30442720">recent research</a> has confirmed that elite football teams that do not have a winter break (England) lose on average 303 more player days per season to injuries than those teams that do (mainland Europe).</p>
<p>These findings may also contribute to explaining the spike in training injuries seen during the month of December in the latest injury audit of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30408703">English professional football</a>. And it’s well known that leagues in <a href="https://www.skysports.com/football/news/11661/11560051/premier-league-and-efl-clubs-suffer-more-severe-injuries-due-to-lack-of-winter-break-study-finds">Northern Europe that play during cold winters</a> are at a higher risk of injury than teams in Southern Europe. </p>
<h2>Increased injury risk</h2>
<p>Of course, some fans might claim that modern football players are simply not made of the same tough stuff as their historic counterparts. But <a href="https://www.ncbi.nlm.nih.gov/pubmed/30408703">recent research</a> published by the Musculoskeletal Health Research Group at Leeds Beckett University appears to suggest that <a href="https://www.ncbi.nlm.nih.gov/pubmed/29071112">injuries in semi-professional and professional football</a> may actually be on the rise in Britain and Ireland. </p>
<p>These findings are contrary to what might have been expected given that sports science and medicine – which aims to reduce injury risk and improve performance – has never been so prominent at football clubs. Indeed, Alex Ferguson once described sports science as the greatest change in the game <a href="https://www.theguardian.com/football/blog/2014/mar/23/ryan-giggs-sports-science-samuel-etoo">during his time as manager</a>.</p>
<p>There are two main risk factors for musculoskeletal injury in athletes: previous injury and sudden increases in training or competition loads. Managers ultimately have the final say on training practices and the number of games a player takes part in. And as a result, management style has an impact on the amount of games a player is exposed to and their risk of injury and subsequent re-injury. </p>
<p>The size of a manager’s playing squad will inevitably influence their decision on who takes part and how soon after injury a player returns. And this could mean that smaller playing squads in lower leagues are at heightened risk of injury. </p>
<h2>Types of footballing injury</h2>
<p>Muscle strains in the thigh region are the most common injuries in professional football. They occur more often in <a href="https://www.ncbi.nlm.nih.gov/pubmed/30408703">matches than training</a> and usually during <a href="https://www.ncbi.nlm.nih.gov/pubmed/29071112">high speed running</a>. These trends further suggest that fatigue associated with consecutive matches and not enough rest between them plays more of a role than the physicality of the game. </p>
<p>Further evidence in support of this theory <a href="https://bjsm.bmj.com/content/47/12/732">comes from research</a> which demonstrates a reduction in ligament injuries but not muscle injuries in professional football. It seems that exercise programs designed to improve strength and balance have had a positive impact on ligament injuries but that exposure to training and match demands – or, more specifically, sudden changes in the amount of training or matches – is the primary factor associated with muscle injury. </p>
<p>It’s worth pointing out, however, that injury can be caused by both genetic and environmental issues and these interpretations are purely suggestions based on the trends observed.</p>
<h2>Tackling the issue</h2>
<p>In the absence of a mid-season or winter break, these findings stress the importance of player management by football clubs and medical teams. </p>
<p>To reduce the risk of injury, clubs should consider reducing or altering the intensive nature of training during periods of fixture congestion – something that has been <a href="https://bjsm.bmj.com/content/50/5/273">shown to be effective in professional rugby</a>. This may be supplemented by increased squad rotation. </p>
<p>So for football fans who are unhappy with their teams points haul this festive period, it might be worth checking to see how many of the players were injured. If the answer is quite a few, the reason may be a lack of player availability rather than underperformance – and ultimately, that buck still stops with the manager.</p><img src="https://counter.theconversation.com/content/107413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Elite football teams that do not have a winter break lose on average 303 more player-days per season to injuries than those teams that do.Peter Francis, Director of the Musculoskeletal Science Research Group, Leeds Beckett UniversityAshley Jones, Senior Lecturer in the School of Clinical and Applied Sciences, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1060682018-11-22T18:49:26Z2018-11-22T18:49:26ZTennis, running, netball: do I really need a specific shoe for a specific sport?<figure><img src="https://images.theconversation.com/files/246357/original/file-20181120-161612-qyma92.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents can fork out big bucks for different shoes for different sports for their children. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/running-children-young-athletes-run-kids-772039159?src=5DS5OducNQY4fwmCHqKwTA-1-15">from www.shutterstock.com </a></span></figcaption></figure><p>Over the past 40 years the “modern” sports shoe has evolved from the all-purpose sneaker to an abundance of sport-specific shoes. Given we have so much choice – and with encouragement from big brands and keen shop assistants – it seems logical to select footwear designed specifically for each activity. </p>
<p>But what does the evidence say? Do we really need to wear a unique shoe for each activity we participate in?</p>
<p>The answer is a little less clear than you might imagine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/children-should-spend-more-time-barefoot-to-encourage-a-healthier-foot-structure-100289">Children should spend more time barefoot to encourage a healthier foot structure</a>
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</em>
</p>
<hr>
<h2>What you want in a shoe</h2>
<p>Before we look at the evidence, let’s think about what we want from our sports shoes. </p>
<p>For me, there are three key considerations that can help guide the shoe selection process: </p>
<ol>
<li>the selected shoe should minimise the risk of injury in light of the sports it will be used for, and with respect to the uniqueness of the person wearing it</li>
<li>our sports shoe should allow us to maximise our athletic performance, but not at the expense of increasing injury risk (let’s face it, if you get injured then your athletic performance is likely to decrease anyway!) </li>
<li>our shoes should be comfortable – this may sound obvious, but some of the world’s most esteemed footwear researchers suggest that increased footwear comfort is associated with <a href="https://bjsm.bmj.com/content/49/20/1290.long">fewer injuries and improved sporting performance</a>.</li>
</ol>
<p>With this in mind, we need to consider the unique physical demands of each sport and what shoe features are required to help prevent injury and maximise performance. </p>
<p>For some sports, the benefits of using a specific shoe are quite obvious. Most would agree that football boots with built-in spriggs will help maintain traction while avoiding a tackle, while a stiff-soled cycling shoe will help power production through bike pedals during a hill climb. </p>
<p>However, the benefits of using a sport-specific shoe during other activities may not be as apparent. For example, is there really that much difference between netball, basketball and tennis shoes? </p>
<h2>Court shoes versus running shoes</h2>
<p>With the exception of basketball shoes typically having a “high-top” upper, all other features of court shoes can be quite similar – they all aim to provide support, cushioning and traction during multi-directional movements. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246366/original/file-20181120-161624-1784hjh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">My high tops sure do look good.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/2xvOUe__syg">Gold Chain Collective/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>To achieve this, common features among court shoes include having a re-enforced toe, a slightly “flared” forefoot, a relatively flat sole, and being made from strong and durable materials in the uppers and outsoles (the base). </p>
<p>In contrast, running shoes are traditionally designed for repetitive straight line movements performed over long distances. So running shoes are generally lightweight and have a highly cushioned midsole – which is intended to dampen impact forces – while also being flexible through the forefoot to assist with propulsion.</p>
<p>These differences in shoe design all sound good in theory, but are they actually effective in reducing injury and maximising performance? </p>
<p>Unfortunately the science on this topic is scarce, but let’s look at what we know. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sustainable-shopping-how-to-rock-white-sneakers-without-eco-guilt-85989">Sustainable shopping: how to rock white sneakers without eco-guilt</a>
</strong>
</em>
</p>
<hr>
<h2>The evidence is scarce</h2>
<p>A clinical trial found using high-top shoes for basketball does not help <a href="https://journals.sagepub.com/doi/abs/10.1177/036354659302100416">prevent ankle sprains</a> – and a separate <a href="https://shapeamerica.tandfonline.com/doi/abs/10.1080/026404197367146#.W_OB8xMzY0p">study</a> found that high-top shoes actually decrease vertical jump height and running performance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246368/original/file-20181120-161612-1w8v4w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some of these shoes may be ok for running - mostly depending on whether you find them comfortable or not.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/collection-various-sport-summer-shoes-56407381?src=MdMmGZHF-gVZbfFk47v0uQ-1-35">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Based on these studies, I rarely recommend that people seek out a high-top shoe for court sports (but I don’t avoid them either). The priority should be on selecting a court shoe that fulfills the needs of each individual (current and past injuries must be considered) and their sport. All court shoes – irrespective of whether they are labelled a tennis, basketball or netball shoe – should be looked at. Much of this process is guided by theory and comfort given the lack of research in this area.</p>
<p>With respect to running, you may be surprised to learn that choice of running shoes for prevention of injury is also still largely theoretical. </p>
<p>Over the past decade there has been an increase in research focused on determining the features of running shoes that are most important for the prevention of injury, but none have investigated how running shoes compare to other <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=logical+fallacies+running+shoe">sport-specific shoes for this purpose</a>. </p>
<p>Although there is uncertainty around the benefits running shoes provide for the prevention of running injuries, we do know that running performance is <a href="https://www.ncbi.nlm.nih.gov/pubmed/28483557">improved as shoes get lighter</a>. As running shoes are generally lighter than all other footwear options, using them will likely result in greater athletic performance compared to non-running shoes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-tech-to-fetish-shoes-in-fairy-tales-are-a-mark-of-status-93948">From tech to fetish, shoes in fairy tales are a mark of status</a>
</strong>
</em>
</p>
<hr>
<h2>Can I buy all-purpose shoes?</h2>
<p>A common question is whether a single all-purpose sports shoe is OK. </p>
<p>Science can’t answer this without the right evidence. But in general terms, an all-purpose shoe (i.e. something branded as a “cross-trainer” in the shops) will generally be fine for someone who participates in an array of activities, particularly if being completed at low intensities. </p>
<p>However, if you’re playing sports at a competitive level, or doing the same activity regularly, then it makes sense to wear sport-specific shoes – although more research is needed to confirm this recommendation. </p>
<p>It’s also worth stating that if you have been injury free in your current sports shoe, and you’re performing at a level you are happy with, then you may already have the right shoes on your feet. </p>
<p>And don’t forget, make sure your shoes are comfortable!</p><img src="https://counter.theconversation.com/content/106068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Bonanno does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’ve been injury-free in your current sports shoe, and you’re performing at a level you are happy with, you may already have the right shoes on your feet.Daniel Bonanno, Lecturer (Teaching and Research) and PhD Candidate, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/987372018-06-28T15:15:15Z2018-06-28T15:15:15ZMen suffer about 70 percent of fireworks injuries – and other 4th of July facts<figure><img src="https://images.theconversation.com/files/224461/original/file-20180622-26576-1dqo9bt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">John Adams believed the fourth of July should be filled with 'illuminations from one end of this continent to the other.'</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Royals-Rangers-Baseball/54dccbc219f44139a966bdf37a8de799/15/0">AP Photo/Richard W. Rodriguez</a></span></figcaption></figure><p>In the eyes of many Americans, the Fourth of July is a day for parades, barbecues and, of course, fireworks. </p>
<p>The tradition got its start at the beginning of our nation’s history after the Founding Fathers met in Philadelphia to write and sign the Declaration of Independence. A day after the Continental Congress adopted the declaration on July 4, 1776, John Adams – soon the second U.S. president – penned a letter to his wife Abigail, <a href="https://www.masshist.org/digitaladams/archive/doc?id=L17760703jasecond">declaring that Independence Day</a></p>
<blockquote>
<p>“ought to be solemnized with pomp and parade, with shews, games, sports, guns, bells, bonfires and illuminations from one end of this continent to the other from this time forward forever more.”</p>
</blockquote>
<p><a href="http://gurukul.american.edu/heintze/fourth.htm#Beginning">One year later</a>, Philadelphia celebrated the anniversary with fireworks – or “illuminations,” to Adams – plus a parade commemorating Independence Day. </p>
<p>So with that in mind, here are four fascinating sets of facts about fireworks.</p>
<h2>Firework use is growing</h2>
<p>Americans shoot off <a href="http://www.americanpyro.com/assets/docs/FactsandFigures/Fireworks%20Consump.%20Figures%202000-17.pdf">almost 1 pound of fireworks</a> each year for every adult. </p>
<p>And this figure has grown rapidly in recent years, from half a pound per adult in 2000. In 1976, the United States’ bicentennial, the figure was just <a href="http://www.americanpyro.com/assets/docs/FactsandFigures/2consumpvinjuriesliberalizationgraph%201976-2016.pdf">one-sixth of a pound</a> annually. </p>
<p><iframe id="Bh9T6" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Bh9T6/5/" height="550px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>A reason for the big increase is the steady reduction in <a href="http://time.com/money/4379859/aerial-fireworks-legal-state-map/">state prohibitions against</a> individuals using fireworks. Today only Massachusetts completely prohibits individuals from owning and using any type of fireworks. <a href="https://www.usfireworks.biz/legal/legal.htm">The other states all allow</a> usage in some form.</p>
<p>The most recent states to allow fireworks are <a href="http://www.americanpyro.com/apa-applauds-nj-legalization-of-consumer-fireworks">New Jersey</a>, <a href="https://delawarebusinessnow.com/2018/06/yes-a-limited-variety-of-fireworks-are-legal-in-delaware/">Delaware</a> and <a href="http://www.desmoinesregister.com/story/news/local/altoona/2017/05/09/communities-respond-new-fireworks-law/101480788/">Iowa</a>, whose new law legalizes fireworks around the 4th of July and New Year’s Eve only.</p>
<p>Fireworks are also illegal in many urban areas, like <a href="http://www.dhses.ny.gov/ofpc/alerts-bulletins/information/documents/2015/sparklers.pdf">New York City</a>.</p>
<p>Because states are now permitting individuals to purchase and possess fireworks, there has been a large shift from professional to amateur use. Back in 2000, roughly one-third of all fireworks were set off during <a href="http://www.americanpyro.com/assets/docs/FactsandFigures/Fireworks%20Consump.%20Figures%202000-17.pdf">professional displays</a>, the kind that light the skies of cities around the world on holidays like New Year’s Eve and national celebrations. By 2017, professional displays comprised less than 10 percent.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176238/original/file-20170629-16053-1pwf0sp.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sparklers cause a large share of fireworks-related injuries.</span>
<span class="attribution"><span class="source">Maria Symchych/Shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Firework prices have fallen</h2>
<p>Just because more regular Americans have been shooting off fireworks doesn’t mean prices have surged. The vast majority of the fireworks shot off in the United States are manufactured overseas, mainly in China. </p>
<p>Each <a href="https://dataweb.usitc.gov/">shipment of fireworks brought into the U.S.</a> includes a detailed invoice that shows the price the importer paid. These invoices show fireworks prices, after adjusting for <a href="http://businessmacroeconomics.com/">inflation</a>, are cheaper today than in the mid-1990s. </p>
<p>In 1996 it <a href="https://dataweb.usitc.gov/">cost</a> about $1.37 in <a href="https://www.bls.gov/data/inflation_calculator.htm">today’s terms</a> to import 1 pound of fireworks. By 2017 the price had fallen to just $1.13 a pound. That means pound-for-pound fireworks are less than half the <a href="https://www.bls.gov/data/#prices">price of the hot dogs</a> many people are grilling this 4th.</p>
<p><iframe id="7sep3" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/7sep3/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Accidents and injuries</h2>
<p>Fireworks are dangerous – hence the reason so many states had banned them previously. </p>
<p>And as we’ve exploded more bottle rockets, firecrackers and Roman candles, <a href="https://www.cpsc.gov/safety-education/safety-education-centers/fireworks">fireworks-related injuries have increased as well</a>, though they are still far below the rates we saw back in the mid-1980s when cities and states <a href="http://articles.latimes.com/1987-06-30/local/me-1174_1_fireworks-bans">began banning their usage</a>. </p>
<p><iframe id="F8RXS" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/F8RXS/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Back in 1986, fireworks injured about 6.6 out of every 100,000 people. Since 1986, injuries have steadily fallen as government regulations made them safer. In 2008, the rate was down to 2.3 people. </p>
<p>But as states have relaxed restrictions, the injuries have started increasing again. The <a href="https://www.cpsc.gov/s3fs-public/2017-Neiss-data-highlights.pdf?3i3POG9cN.rIyu2ggrsUkD1XU_zoiFRP">latest figures for 2017</a> show a rate of 4 people per 100,000. </p>
<p>In addition, there’s also a big gender divide in who suffers the most injuries. Men experienced about <a href="https://www.cpsc.gov/s3fs-public/Fireworks_Report_2017.pdf">70 percent of fireworks-related injuries</a> for the one-month period from June 18 to July 18, 2017. </p>
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<p>Beyond such statistics, however low, every year there are <a href="https://www.cpsc.gov/s3fs-public/2016%20Fireworks%20Fact%20Sheet_0.pdf">horrible stories</a> of both <a href="http://pediatrics.aappublications.org/content/108/1/190">children</a> and adults being maimed and killed. So it’s always important to exercise caution when lighting what amounts to a low-yield missile. </p>
<h2>Fireworks now must meet higher standards</h2>
<p>One reason that injury rates have fallen in the first place is because of the federal government’s <a href="https://www.cpsc.gov/">Consumer Product Safety Commission</a>. </p>
<p>This organization regulates fireworks under the <a href="https://www.law.cornell.edu/cfr/text/16/part-1507">Federal Hazardous Substances Act</a>. It <a href="http://www.americanpyro.com/banned-illegal-explosives">banned the sale</a> of the most dangerous fireworks, such as M-80s and cherry bombs, in the 1960s. </p>
<p>Today, it is working to lower injury rates again by requiring manufacturers to adhere to higher standards. In <a href="http://www.americanpyro.com/assets/docs/CPSCDocs/cpscfireworksnprmfinal.pdf">February</a> 2017, for instance, the commission passed several of what I believe are common sense regulations for firework manufacturers to make their products safer.</p>
<p><iframe id="vNRDl" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/vNRDl/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>For example, faulty fuses have caused many <a href="https://www.cpsc.gov/s3fs-public/FireworksPoster2017.pdf?naw5VgnAOQ1Od_QzjYvZiZXeLk.kOqpt">injuries</a>, such as when some burned rapidly and ignite a rocket too quickly, preventing the holder from moving away in time. Other fuses actually take too long to ignite, leading people to investigate whether it needs to be relit just as the firework explodes in their face. So the commission now <a href="https://www.cpsc.gov/Business--Manufacturing/Business-Education/Business-Guidance/Fireworks/">requires all fuses to ignite</a> fireworks three to nine seconds after being lit.</p>
<p>The commission also now requires fireworks to have bases that are wider and support more weight so they do not tip over after being ignited. This prevents fireworks from firing off horizontally, becoming missiles that bounce along the ground and potentially hit spectators. </p>
<p>It also now bans <a href="https://link.springer.com/article/10.1007%2Fs10661-007-9784-1?LI=true">hazardous materials</a> like lead from the powder inside fireworks. This ensures people downwind from the explosions are not <a href="http://www.sciencedirect.com/science/article/pii/S1352231006008351">poisoned by breathing</a> the <a href="http://www.sciencedirect.com/science/article/pii/S1352231007009685">smoke</a>.</p>
<h2>Common sense</h2>
<p>As more states loosen restrictions on fireworks this Fourth of July, millions more people will follow the exhortations of John Adams and celebrate by shooting off “illuminations.” </p>
<p>But if you do plan to shoot off a few rockets or more advance fireworks, use some common sense, especially if children are around. </p>
<p>Whether you are lighting fireworks, watching them explode above you or just <a href="http://forums.webmd.com/3/anxiety-and-panic-disorders-exchange/forum/4777">hiding from the noise</a>, try to have a fun and safe Independence Day.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/americas-dangerous-love-for-pyrotechnics-4-facts-about-fireworks-80181">article</a> originally published on June 29, 2017.</em></p><img src="https://counter.theconversation.com/content/98737/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay L. Zagorsky does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An economist explores data on injuries, which states ban fireworks and other interesting stats on what President John Adams referred to as ‘illuminations.’Jay L. Zagorsky, Economist and Research Scientist, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947382018-04-11T04:33:27Z2018-04-11T04:33:27ZCommonwealth Games injuries highlight a problematic culture in elite sports<p>New Zealand weightlifter <a href="https://www.theguardian.com/sport/2018/apr/10/weightlifter-laurel-hubbards-career-ended-by-injury-at-commonwealth-games">Laurel Hubbard suffered a career-ending elbow injury</a> during the Commonwealth Games. Australia’s <a href="http://www.abc.net.au/news/2018-04-07/francois-etoundi-commonwealth-games-gold-coast-2018/9629678">Francois Etoundi was also injured</a>, but continued to compete and won a bronze medal. Welsh competitor <a href="https://www.thesun.co.uk/sport/5999815/commonwealth-games-joshua-parry-collapses-weightlifting/">Joshua Parry collapsed</a> during his attempt at lifting 160kg.</p>
<p>These incidents are a symptom of a <a href="https://journals.humankinetics.com/doi/abs/10.1123/ssj.8.4.307">belief</a> that athletes should stop at nothing to achieve success. The idea is that athletes must make sacrifices, take risks, and strive for distinction. </p>
<p>Strict adherence to these values can have negative health outcomes. Yet people who behave in a manner consistent with these values are usually celebrated and held up as role models.</p>
<p>After Etoundi dropped the bar and collapsed in distress, for example, commentator and two-time Commonwealth Games weightlifting champion Michaela Breeze <a href="https://www.youtube.com/watch?v=1SLE8vG9EuM">said</a>: </p>
<blockquote>
<p>Well he is in a fair amount of pain by the looks of it, but you know what, the good news is that was his last attempt – it doesn’t matter…</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-children-and-adolescents-lift-weights-54888">Health Check: should children and adolescents lift weights?</a>
</strong>
</em>
</p>
<hr>
<p>Joshua Parry collapsed violently just before he could lift the weight above his head. Similarly, <a href="https://thewest.com.au/sport/commonwealth-games/commonwealth-games-2018-weightlifter-ivorn-mcknee-the-latest-to-collapse-on-the-gold-coast-ng-b88800603z">Ivorn McKnee collapsed</a> from a lack of oxygen during his lift. </p>
<p>The commentators had mixed reactions on both occasions. For Breeze, the event was normal and she <a href="https://www.youtube.com/watch?v=fyKt2ciLxUY">reassured viewers</a> that the athlete was “absolutely fine”. She explained why the lifters lost oxygen and provided acute recovery advice (take the belt off, feet up, and so on). </p>
<p>In both cases, the lifters were accompanied off the stage by medical staff.</p>
<p>This reflects the kind of values that are promoted and taught to athletes in high-performance sport. In a <a href="https://journals.humankinetics.com/doi/abs/10.1123/ssj.8.4.307">seminal study</a>, researchers Robert Hughes and Jay Coakley coined the term “sport ethic” to refer to a set of criteria necessary to be a “real athlete”. </p>
<p>Athletes are expected to sacrifice other areas of their life and commit themselves fully to their sporting pursuit. They place the demands of the sport or team above their own and are expected to dedicate their lives to self-improvement and push the limits.</p>
<p>There are inherent health risks in sport, but facing up to them voluntarily is viewed as courageous. “Real” athletes are expected not to back down from challenges or external pressure. They take full responsibility for achieving their pursuits and believe anything is possible if they try hard enough. </p>
<p>However, as we have seen with the recent spate of injuries to weightlifters, athletes who compete through pain and refuse to accept limits can put their health at risk. </p>
<p>Media commentary often normalises injuries as part of the sport. Playing through pain and injury is not exclusive to weightlifting; rather, it is common practice in a <a href="http://journals.sagepub.com/doi/abs/10.1177/1012690216640525">range of sports</a> as (aspiring) athletes place the demands of the sport above themselves. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
<hr>
<p>It was <a href="https://edition.cnn.com/2018/03/16/tennis/nadal-tennis-injury-toni/index.html">recently revealed</a> that tennis star Rafael Nadal has been “living with pain and painkillers” for more than a decade. </p>
<p>Nadal’s case shows how injured athletes face considerable pressure to return from injury quickly, or to compete even when hurt.</p>
<p>Ignoring injuries and playing through pain, often with the help of medical strategies, is a major aspect of how athletes are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1525/si.1993.16.3.273">socialised</a> – even if it is at the expense of their long-term health and well-being.</p>
<p>But physical injury is not the only risk of conforming to these values. Athletes who commit solely to their sporting involvement over long periods <a href="https://journals.humankinetics.com/doi/abs/10.1123/ssj.9.3.271">may experience</a> burnout, or fail to develop meaningful ways of interacting with the world and other people. This presents problems for career transitions such as retirement.</p>
<p>While this issue is prevalent in elite sport it is often individualised - we concentrate on specific athletes or events. The result is commentary that merely seeks to describe the incidents without attempting to understand them in light of the broader social and cultural context.</p>
<h2>Values trickle down</h2>
<p>Conformity to the sport ethic starts with children from a young age. Through participation in recreational sport and interactions with others they may adopt certain beliefs, values and behaviours. </p>
<p>As children continue participating and grow older there is an <a href="http://cmy.net.au/publications/participation-versus-performance">increased emphasis</a> placed on performance, even in recreational sport. Sport may have been a venue for play and enjoyment, but the lessons of professional sport have trickled down to children.</p>
<p>Many of the beliefs and values that shape over-conformity to the sport ethic are gradually learned and adopted by those aspiring to become elite athletes. </p>
<p>The Commonwealth Games offer an opportunity to rethink the process of becoming an elite athlete and longer-term health outcomes. Through gaining a greater awareness and understanding of this process we can shape sports as an avenue for developing young people in their entirety, not just for sport performance.</p><img src="https://counter.theconversation.com/content/94738/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ramon Spaaij receives funding from the Australian Research Council</span></em></p><p class="fine-print"><em><span>Jack Hynes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Recent injuries are symptoms of a belief that athletes should stop at nothing to achieve success.Jack Hynes, PhD student, Victoria UniversityRamon Spaaij, Professor, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/940682018-03-28T20:44:16Z2018-03-28T20:44:16ZBaseball teams need to protect fans from foul balls – and US courts need to lift MLB’s special liability exemption<figure><img src="https://images.theconversation.com/files/212507/original/file-20180328-109182-1y0kp1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Close call?</span> <span class="attribution"><span class="source">AP Photo/Morry Gash</span></span></figcaption></figure><p>Tens of thousands of fans are gathering at Major League Baseball ballparks around the country for hot dogs, home runs, their favorite players’ autographs and the <a href="https://www.youtube.com/watch?v=04KQydlJ-qc">fresh grass on the field</a>.</p>
<p>Few fans will consider the possibility that they could be blinded or suffer a serious head injury by a ball or bat leaving the field of play. In reality, such injuries occur much more frequently than many may realize, with a <a href="https://www.bloomberg.com/news/articles/2014-09-09/baseball-caught-looking-as-fouls-injure-1-750-fans-a-year">2014 analysis</a> finding that more than 1,750 fans are hurt each year by batted balls at MLB games. </p>
<p>Who should be held responsible legally when injuries like this occur? </p>
<p>In a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3143732">new paper</a>, University of Georgia business student Zachary Flagel and I argue that it’s time for courts to abolish an outdated rule that has historically immunized baseball teams from liability.</p>
<h2>The ‘Baseball Rule’</h2>
<p>Under a century-old legal doctrine commonly known as the “<a href="http://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=1612&context=sportslaw">Baseball Rule</a>,” U.S. <a href="https://www.si.com/mlb/2017/09/21/new-york-yankees-netting-ballpark-injury">courts have almost uniformly</a> held that professional baseball teams are not liable for <a href="https://www.amazon.com/Death-Ballpark-Comprehensive-Game-Related-Professional/dp/078643435X">these kinds of injuries</a> to fans, who are stuck with the medical and rehab costs. </p>
<p>Specifically, as long as a team takes basic precautions such as putting nets immediately behind home plate and ensuring that there are enough screened seats to meet anticipated demand, then under the Baseball Rule it will not be held legally responsible for fans’ injuries. </p>
<p>Instead, courts have traditionally held that the danger posed by foul balls is sufficiently obvious and that fans legally assume the risk of any resulting injuries. </p>
<p><a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3143732">Our research shows</a> that changes in the way that the sport of baseball is presented to fans, as well as in the underlying law of torts, undermine the courts’ continued reliance on the Baseball Rule. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212508/original/file-20180328-109196-13hf7q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A young fan holds his hands to his face after being hit by a foul ball in 2016.</span>
<span class="attribution"><span class="source">AP Photo/Tony Gutierrez</span></span>
</figcaption>
</figure>
<h2>Closer, stronger, faster</h2>
<p>We found that many changes in the game in recent decades have considerably increased the risks that foul balls pose to fans.</p>
<p>Perhaps most significantly, fans attending MLB games today are now sitting about 20 percent closer to the field than they were even just 50 years ago. Much of this change has occurred over the last 25 years in particular, as a wave of new stadiums have placed fans ever closer to the action.</p>
<p>At the same time, baseball players are throwing and hitting the ball harder than ever before due to better strength and conditioning regimens. As a result, foul balls are frequently hit into the stands <a href="https://twitter.com/CarrieMuskat/status/908145691104628736">at 110 miles per hour</a> or more. Fans may have only a few tenths of a second to react to a particularly fast-moving foul ball, in some cases literally making it <a href="https://www.ncbi.nlm.nih.gov/pubmed/26097821">physically impossible</a> for a spectator to avoid injury.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212513/original/file-20180328-109199-hilays.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Miami Marlins batter Giancarlo Stanton breaks his bat while hitting a foul ball in 2014.</span>
<span class="attribution"><span class="source">AP Photo/J Pat Carter</span></span>
</figcaption>
</figure>
<h2>The role of tort law</h2>
<p>While these changes themselves undercut courts’ continued reliance on the Baseball Rule, the doctrine is also at odds with <a href="https://chicagounbound.uchicago.edu/journal_articles/1875/">recent academic insights</a> regarding the most efficient allocation of liability in tort lawsuits, which involve personal injuries.</p>
<p>Courts and scholars increasingly realize that legal liability should be imposed on the party that is in the best position to prevent the injury on the most cost-effective basis.</p>
<p>In the case of foul balls and broken bats, there is little question that the team itself is best positioned to prevent these resulting injuries. While fans may not be able to react quickly enough to avoid injury, teams easily can protect them through installing more protective netting. </p>
<p>Indeed, at <a href="http://www.kansascity.com/sports/mlb/kansas-city-royals/article27539521.html">US$8,000 to $12,000 per 60 feet</a>, the cost of such additional netting is a drop in the bucket for MLB – with its <a href="https://nypost.com/2017/10/24/yankee-fan-hit-in-the-face-by-foul-ball-loses-injury-lawsuit/">annual league revenues</a> of over $10 billion. In addition, that small expense pales in comparison to the medical costs of a single serious foul-ball injury, which can easily account for $150,000 or more in medical costs.</p>
<p>To its credit, in recent years MLB <a href="https://www.mlb.com/news/mlb-issues-recommendations-on-netting/c-159233076">has encouraged</a> its teams to install additional protective netting to better protect fans sitting near the field. However, the fact that MLB itself has acknowledged that fans sitting in areas beyond those immediately behind home plate are at a heightened risk of injury only serves to underscore how outdated the Baseball Rule has become. </p>
<p>And while MLB’s actions in this regard are laudable, because the league’s teams remain legally devoid of any potential responsibility for spectator injuries, there is no guarantee that they are doing enough to protect all fans sitting in high-risk areas.</p>
<h2>The right incentives to reduce injuries</h2>
<p>The time has come for the judiciary to dispense with the Baseball Rule. </p>
<p>I believe that courts should hold professional baseball teams liable whenever a fan is injured by a foul ball, giving teams a better incentive to provide the most effective level of possible protection. By forcing teams to compensate spectators for their injuries, teams would be more likely to engage in a cost-benefit analysis to decide whether the risk of injury in a particular section of seating outweighs the cost – including potential lost ticket sales – of installing a net between fans and the playing field. </p>
<p>In the highest-risk sections, teams will almost certainly determine that the benefits of additional screening outweigh the costs. In lower-risk sections, however, teams could reasonably decide to accommodate fans preferring an unobstructed view of the field, on the understanding that the team would then be liable in the rare case when a fan sitting in such a section sustains an injury.</p>
<p>This season, more than <a href="https://www.forbes.com/sites/maurybrown/2017/10/02/final-2017-mlb-attendance-dips-below-73-million-for-first-time-since-2002/#48989b72326f">110 million fans</a> are likely to attend a major-league or minor-league baseball game. For several thousand of these fans, an otherwise enjoyable trip to the ballpark will be disrupted by a serious injury inflicted by a foul ball or broken bat leaving the field of play. The judiciary has the ability to encourage baseball teams to take steps to better protect spectators from these injuries. They should do so by discarding the Baseball Rule.</p><img src="https://counter.theconversation.com/content/94068/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathaniel Grow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A century-old legal doctrine has protected MLB teams from liability, when a fans gets injured by a foul ball. New research shows why it’s time that changed.Nathaniel Grow, Associate Professor of Business Law and Ethics, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.