Sports Medicine: Just the Facts

involves cord compression either through hyperflex-

ion or hyperextention of the neck. An episode of CCN

is not an absolute contraindication to return to foot-

ball. It is unlikely that athletes who experience CCN

are at risk for permanent neurologic sequelae with

return to play. The overall risk of a recurrent CCN

episode with return to football is approximately 50%

and is correlated with the canal diameter size. The

smaller the canal diameter the greater the risk of

recurrence.

PREVENTION

• Banning spearing-tackling and teaching players to
  play “heads up” ball with no contact on the top of the
  helmet has dramatically reduced the incidence of per-
  manent cervical quadriplegia.


• The development of a safety standard for the football
  helmet by the National Operating Committee on
  Standards for Athletic Equipment (NOCSAE) has
  also been a significant factor in reducing head and
  neck injuries.
  •Training medical personnel to understand on-field
  management of athletic head and neck injuries and
  guidelines for return to contact or collision sport after
  an injury.

POLE VAULTING

EPIDEMIOLOGY

• Pole vaulting is a unique sport in that athletes often
  land from heights ranging from 10 to 20 ft. Pole vault-
  ing has one of the highest rates of direct, catastrophic
  injuries per 100,000 participants for all sports moni-
  tored by the NCCSIR (Boden et al, 2001).


• The vast majority of catastrophic pole vaulting
  injuries are head injuries in male athletes. The overall
  incidence of catastrophic pole vault injuries is two per
  year, while the incidence of fatalities is one per year.
  Most injuries occurred at the high school level (Boden
  et al, 2001).

MECHANISMS OFINJURY

• Three common mechanisms of injury have been
  described (Boden et al, 2001). The most common mech-
  anism occurs when a pole vaulter lands with his body on
  the edge of the landing pad and his head whips off the
  pad, striking the surrounding hard surface (in most cases
  either concrete or asphalt). The second most common
  mechanism occurs when the vaulter releases the pole
  prematurely or does not have enough momentum and
  lands in the vault or planting box. The third most
  common mechanism occurs when the vaulter completely

misses the pad and lands directly on the surrounding

hard surface.

PREVENTION

•As of Jan 2003, both the NCAA and NFHS decided to

increase the minimum pole vault landing pad size

from 16′× 12 ′to 19′ 8 ′′ × 16 ′ 5 ′′. Because the majority

of injuries are a result of athlete’s either completely or

partially missing the landing pad, this rule change has

the potential to significantly reduce the number of cat-

astrophic injuries.

•Any hard or unyielding surfaces such as concrete,

metal, wood, or asphalt around the landing pad must

be padded or cushioned.

•A new rule has been adopted placing the crossbar far-

ther back over the landing pad. This should reduce the

chance of an athlete landing in the vault or planting

box.

•A coach’s box or painted square in the middle of the

landing pad is being promoted. This zone would help

train athletes to instinctively land near the center of

the landing pad. Other safety measures include mark-

ing the runway distances so athletes can better gage

their takeoff, and prohibiting the practice of tapping or

assisting the vaulter at takeoff.

• Pole vaulting is a complicated sport requiring exten-
  sive training. Certification by coaches is encouraged.


• The value of helmets in reducing head injuries in high
  school pole vaulters is controversial. Without conclu-
  sive data as to their protective effect, the use of hel-
  mets is optional for athletes at this time (www.
  skyjumpers.com).

SOCCER

EPIDEMIOLOGY

• Injuries to the head, neck, and face in soccer account
  for between 5 and 15% of all injuries. Most head and
  neck injuries occur when two players collide, espe-
  cially when jumping to head the ball.
  •Fatalities in soccer are usually associated with either
  movable goalposts falling on a victim or player
  impact with the goal post (Janda et al, 1995). The
  CPSC identified at least 21 deaths over a 16-year
  period associated with movable goalposts (www.
  cpsc.gov).


• The incidence of concussions in high level soccer ath-
  letes is approximately one per team per season (Boden
  et al, 1998). There is a 50% chance for a professional
  athlete to sustain a concussion over a 10-year span.
  Most concussions occur as a result of contact with an
  opposing player, not with the soccer ball.

26 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE