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NCAA News Archive - 2007
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Athletic trainers' ISS work charts future directions
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By Jack Copeland
The NCAA News
The NCAA News
In a nod to the volunteer efforts of hundreds of certified athletic trainers, a special issue of the Journal of Athletic Training is focusing this spring on a detailed analysis of data they’ve collected during the past quarter century and submitted to the NCAA Injury Surveillance System.
Organizers of the issue, who unveiled its contents during a May 22 news conference in Indianapolis, celebrated volumes of information that have been collected since 1982 through the ISS — believed to be the largest ongoing collegiate sports injury database in the world.
But they also made clear that the injury surveillance program should continue to help improve student-athlete care and well-being for years to come, and pointed to conclusions and recommendations in the journal’s report that they say “can make collegiate sports even safer.”
The special issue of the journal, published by the National Athletic Trainers’ Association, focuses on information collected in 15 sports during a 16-year period (1988-89 through 2003-04).
The injury surveillance program, which has prompted rules and policy changes in sports ranging from football to ice hockey during its existence and more generally guided the NCAA’s response to such issues as the risk of HIV transmission through bleeding, continues a mission that dates back to the very founding of the NCAA.
“The NCAA was founded more than a hundred years ago out of concern about football injuries resulting from the formation called the Flying Wedge. Every sport has its own Flying Wedge. Every sport has its own risk of injury,” said Randall Dick, NCAA associate director of research responsible for the ISS.
“The Injury Surveillance System creates an awareness of what those risks of injury are, and tries to address them through prevention techniques,” he said.
The data featured in the journal indicate that intercollegiate sports generally are safe — less than 25 percent of injuries are classified as severe (causing the loss of 10 or more days of athletics participation), and the rate of re-injury is low (18 percent).
However, broad implementation of injury-prevention initiatives — whether generally directed at all sports, focusing on specific sports or addressing specific game or practice conditions — can further improve student-athlete safety.
“The truth is that people do get hurt in sports, but there are things we can do to reduce that risk, and these data are very important in that regard,” said Jennifer M. Hootman, an epidemiologist for the Division of Adult and Community Health at the Centers for Disease Control and Prevention, who served as primary editor for the special issue.
She listed several factors that ISS data suggest should be considered in injury-prevention initiatives:
More than half of all collegiate athletics injuries occurred to the lower extremities during the 16-year period; 14 percent were lower ankle sprains.
Preseason practice injury rates were two to three times higher than regular-season injury rates.
Injury rates were higher in competition than in practice. Although game-injury rates overall dropped to their lowest level during the last two years of the period — suggesting that past initiatives may be having a positive impact, especially in women’s gymnastics, field hockey and women’s basketball — collision sports like football and contact sports like wrestling continue to post notably higher game-injury rates than other sports. Even in sports where little or no contact is permitted by rules — women’s ice hockey, men’s and women’s soccer, and men’s and women’s basketball — contact is the primary cause of injuries.
Rates of concussions and anterior cruciate ligament (ACL) injuries increased significantly during the 16-year period — though the higher rates likely are due in part to improved identification of and reporting of the injuries. Still, head injuries are becoming more common in “noncontact” sports like basketball, and concussion rates overall have increased an average of 7 percent per year.
Hootman said findings from specific sports — such as the prevalence of ankle injuries in soccer and women’s volleyball and ACL injuries in soccer — are encouraging better ankle taping and bracing, exercises to improve balance, and neuromuscular conditioning programs. However, efforts must continue to implement effective standards of care.
“If you ask any athletic trainer, when you treat your athletes, do you offer these interventions, they’re going to say yes,” said Hootman, a former athletic trainer. “But we don’t know how well they’re covered across sports at the collegiate level, or how well individual athletes adhere to our recommendations. That’s an area where we can improve.”
Just as athletic trainers are at the center of efforts to improve care, they also are at “the heart of the system” that produced the data featured in the journal, Dick said. Although the ISS was upgraded in 2004 to a Web-based reporting process, athletic trainers submitted data during the years covered by the journal report via meticulously compiled paper reports, devoting significant hours annually to the process.
“They did it because they were dedicated to what they saw we were trying to do with the data — protecting the health of student-athletes,” Dick said, adding that it is appropriate that those efforts are being acknowledged through the Journal of Athletic Training report.
“Everything the NCAA has tried to do with the ISS is for the health and well-being of the athlete, and that’s what we’ve wanted, too,” agreed Robert Howard, head athletic trainer at the University of Connecticut, who discussed practical applications of system data on campuses during the news conference.
With development of the Web-based reporting system, which provides athletic trainers with analytical tools for reviewing data for student-athletes they directly care for, it is now possible to monitor trends year-round.
“We’ve had huge growth in athletics through the years, and if you break it down and look at what athletes do, they probably work out or do something else athletically related 50 out of 52 weeks a year,” Howard said. “Constantly, as athletic trainers, we see injuries pop up all the time.
“We rely on the ISS to monitor our out-of-season conditioning program, or our strength and conditioning program. If all of a sudden we see a spike in injuries in training and conditioning during a certain period of time, we’ll look at that through the ISS, then sit down with our strength and conditioning people and ask, ‘What changed? What’s different? What could be causing these injuries?’
“If we find something, then we’ll try to make an adjustment — trying at the user level to take care of the well-being of the athletes.”
In addition to providing a basis for rules changes adopted by the NCAA through its sports committees and governance structure, ISS data also have been crucial in supporting recommendations about appropriate levels of care for student-athletes, said Dennis Miller, director of sports medicine at Purdue University.
ISS data helped the National Athletic Trainers’ Association shape its Appropriate Medical Coverage for Intercollegiate Athletics recommendations in 2000, and continues to help athletic trainers effectively advocate coverage for the number and type of injuries that ISS data indicate are being recorded in each sport.
“We can go back to our bosses, back to the university, and say this is what it takes to provide quality health care for the student-athlete,” Miller said.
Organizers of the issue, who unveiled its contents during a May 22 news conference in Indianapolis, celebrated volumes of information that have been collected since 1982 through the ISS — believed to be the largest ongoing collegiate sports injury database in the world.
But they also made clear that the injury surveillance program should continue to help improve student-athlete care and well-being for years to come, and pointed to conclusions and recommendations in the journal’s report that they say “can make collegiate sports even safer.”
The special issue of the journal, published by the National Athletic Trainers’ Association, focuses on information collected in 15 sports during a 16-year period (1988-89 through 2003-04).
The injury surveillance program, which has prompted rules and policy changes in sports ranging from football to ice hockey during its existence and more generally guided the NCAA’s response to such issues as the risk of HIV transmission through bleeding, continues a mission that dates back to the very founding of the NCAA.
“The NCAA was founded more than a hundred years ago out of concern about football injuries resulting from the formation called the Flying Wedge. Every sport has its own Flying Wedge. Every sport has its own risk of injury,” said Randall Dick, NCAA associate director of research responsible for the ISS.
“The Injury Surveillance System creates an awareness of what those risks of injury are, and tries to address them through prevention techniques,” he said.
The data featured in the journal indicate that intercollegiate sports generally are safe — less than 25 percent of injuries are classified as severe (causing the loss of 10 or more days of athletics participation), and the rate of re-injury is low (18 percent).
However, broad implementation of injury-prevention initiatives — whether generally directed at all sports, focusing on specific sports or addressing specific game or practice conditions — can further improve student-athlete safety.
“The truth is that people do get hurt in sports, but there are things we can do to reduce that risk, and these data are very important in that regard,” said Jennifer M. Hootman, an epidemiologist for the Division of Adult and Community Health at the Centers for Disease Control and Prevention, who served as primary editor for the special issue.
She listed several factors that ISS data suggest should be considered in injury-prevention initiatives:
More than half of all collegiate athletics injuries occurred to the lower extremities during the 16-year period; 14 percent were lower ankle sprains.
Preseason practice injury rates were two to three times higher than regular-season injury rates.
Injury rates were higher in competition than in practice. Although game-injury rates overall dropped to their lowest level during the last two years of the period — suggesting that past initiatives may be having a positive impact, especially in women’s gymnastics, field hockey and women’s basketball — collision sports like football and contact sports like wrestling continue to post notably higher game-injury rates than other sports. Even in sports where little or no contact is permitted by rules — women’s ice hockey, men’s and women’s soccer, and men’s and women’s basketball — contact is the primary cause of injuries.
Rates of concussions and anterior cruciate ligament (ACL) injuries increased significantly during the 16-year period — though the higher rates likely are due in part to improved identification of and reporting of the injuries. Still, head injuries are becoming more common in “noncontact” sports like basketball, and concussion rates overall have increased an average of 7 percent per year.
Hootman said findings from specific sports — such as the prevalence of ankle injuries in soccer and women’s volleyball and ACL injuries in soccer — are encouraging better ankle taping and bracing, exercises to improve balance, and neuromuscular conditioning programs. However, efforts must continue to implement effective standards of care.
“If you ask any athletic trainer, when you treat your athletes, do you offer these interventions, they’re going to say yes,” said Hootman, a former athletic trainer. “But we don’t know how well they’re covered across sports at the collegiate level, or how well individual athletes adhere to our recommendations. That’s an area where we can improve.”
Just as athletic trainers are at the center of efforts to improve care, they also are at “the heart of the system” that produced the data featured in the journal, Dick said. Although the ISS was upgraded in 2004 to a Web-based reporting process, athletic trainers submitted data during the years covered by the journal report via meticulously compiled paper reports, devoting significant hours annually to the process.
“They did it because they were dedicated to what they saw we were trying to do with the data — protecting the health of student-athletes,” Dick said, adding that it is appropriate that those efforts are being acknowledged through the Journal of Athletic Training report.
“Everything the NCAA has tried to do with the ISS is for the health and well-being of the athlete, and that’s what we’ve wanted, too,” agreed Robert Howard, head athletic trainer at the University of Connecticut, who discussed practical applications of system data on campuses during the news conference.
With development of the Web-based reporting system, which provides athletic trainers with analytical tools for reviewing data for student-athletes they directly care for, it is now possible to monitor trends year-round.
“We’ve had huge growth in athletics through the years, and if you break it down and look at what athletes do, they probably work out or do something else athletically related 50 out of 52 weeks a year,” Howard said. “Constantly, as athletic trainers, we see injuries pop up all the time.
“We rely on the ISS to monitor our out-of-season conditioning program, or our strength and conditioning program. If all of a sudden we see a spike in injuries in training and conditioning during a certain period of time, we’ll look at that through the ISS, then sit down with our strength and conditioning people and ask, ‘What changed? What’s different? What could be causing these injuries?’
“If we find something, then we’ll try to make an adjustment — trying at the user level to take care of the well-being of the athletes.”
In addition to providing a basis for rules changes adopted by the NCAA through its sports committees and governance structure, ISS data also have been crucial in supporting recommendations about appropriate levels of care for student-athletes, said Dennis Miller, director of sports medicine at Purdue University.
ISS data helped the National Athletic Trainers’ Association shape its Appropriate Medical Coverage for Intercollegiate Athletics recommendations in 2000, and continues to help athletic trainers effectively advocate coverage for the number and type of injuries that ISS data indicate are being recorded in each sport.
“We can go back to our bosses, back to the university, and say this is what it takes to provide quality health care for the student-athlete,” Miller said.
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