Changing sport rules to improve safety

Prof. Lars Engebretsen, IOV Head of Medical Scientific Activities

Sports injuries are a significant concern

—for the injured athlete, for sports organizations, and society

Injuries in the Olympic Games:

From Beijing through Rio

Data through the IOC surveillance project

Injuries and illnesses in 5 consecutive Olympic Games

Beijing London Vancouver*

Sochi (per Feb 22)

Injuries per 100 athletes (5)

10 13 11 11

Time-loss (%)

0 days 50 65 43 65

1-7 days 30 23 16 21

8-28 days 14 8 11 4

>28 days 6 5 4 10

Injury incidence + severity

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* Severity missing for 26% of all injuries in Vancouver

•  Rugby – scrum and high tackles •  Icehockey – Canadian youth- no body checking •  Football- tackling from behind and elbowing •  Volleyball – where change was made with a negative effect •  Freestyles skiing – to show the challenges •  Boxing – will removal of head guards make a difference? •  Concussion – new rules of detection- give the physician time!

Can rule change make a difference? Here are a few examples…..

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AWARENESS PROGRAM - NZ PRESENTATION TITLE

Day Month Year 7

LAW CHANGES 2012 - SOUTH AFRICA

8

YouthIceHockey

Preliminaryanalyses(PeeWee–ages11-12)

Bodychecking

Nobodychecking

IncidenceRatesforPeeWeegameinjuriesinAlberta(BodyCheckingallowed2011-2012)versusAlberta(NoBodyCheckingAllowed2013-14)

Researchinformedpolicychange!PartnershipsandKnowledgeTranslaEon

Head injuries in football •  4-20% of all acute injuries in

football are head & neck injuries (Lohnes et al.94)

•  Concussion, facial fractures and tooth injuries most common

•  Incidence of concussion men: 0.6/1000 practice/match women: 0.4/1000 practice/match

(Boden et al. 98)

Andersen et al. BJSM, in revision

HeadElbow

Arm/hand Foot BallShoulder

KneeGround

GoalpostOther

% of

inci

dent

s

0

5

10

15

20

25

30

35N=198

What hits the head?

HeadElbow

Arm/hand Foot BallShoulder

KneeGround

GoalpostOther

% of

inci

dent

s

0

5

10

15

20

25

30

35N=198

Andersen et al. BJSM, in revision

A

C

B B

C

High active elbow

Conclusion n  4 of 10 head incidents occurred from

elbowing or the use of arm n  Only 1/4 of these led to a free kick or a

yellow/red card

Consequence - prevention n  Change of the rules regarding elbowing n  Improved & focused referee training

n  Video review by the match referee n  Stress the fair play-perspective for both

players & coaches

Bahr R et al. Scand J Med Sci Sports, 7: 166-171, 1997; NVBF Div. Iⅈ 92-93; n=48

Risk factors & injury mechanisms 1)  Recent old injuries risk factor for reinjury

2)   ½ of all injuries occur in conflict zone under the net with blocker landing on opposing attacker’s foot

3)  ¼ of all injuries occur after two-man block when player lands on teammate’s foot

4)  Technical errors: Improper movement and take-off technique in block and attack

Bahr R. Int Volley-Tech, 2 (June): 14-19, 1996

Net line rule

Prop

ortio

n of

rally

term

inat

ions

(%)

0

3

6

9

12Ordinary ruleNew rule

Bahr R et al. Scand J Med Sci Sports, 7: 172-177, 1997 No. of sprains0 5 10 15 20 25 30

Opponent

Teammate

Movement

Landing

Other

During (93-94)Before (92-93)

After (94-95)Injury mechanisms

Bahr R et al. Am J Sports Med 22: 595-600, 1994

Phase

Athlete

Rules

Equipment

Pre-crash

Skill Neuromuscular

function

Net line rule

-

Crash

-

-

Tape/brace

Post-crash

Rehabilitation

-

-

Prevention strategies - volleyball

Freestyles in Vancouver and Sochi:

Injuries in sports – all athletes

ALL ATHLETES Snowboard Cross: 35% Bob: 20% Freestyle Aerials: 19% Freestyle Cross: 19% Ice Hockey: 18%

•  Head and knee most common and most severe injuries (45% of all injuries in skiing and snowboarding) •  20 concussions (7% of athletes)

Injuries in sports – female athletes

FEMALE ATHLETES Snowboard Cross: 73% Freestyle Aerials: 26% Freestyle Cross: 23% Bob: 24% Ice Hockey: 23%

Overall injury risk -World Cup disciplines

Seasons

06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Injurie

s per

100 a

thlete

s

10

20

30

40

50

60 Alpine WCFreestyle Snowboard

Time-loss injuries (n=2456)

•  Venue standard-guidelines? •  Equipment – helmets,boots, bindings, skis, boards? •  Epidemiologi- new sports in the Olympics: Big Jump •  Epidemiology surveillance- combining data •  Mechanisms of injury – videoanalyses •  Longitudinal studies in schools •  Judging rules- changes, restrictions? •  More biomechanical field studies/lab studies- technique changes:

more flexion inleading knee when landing? •  Binding study- placement of rotation- in the lab?

Important research questions in freestyles:

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•  The International Boxing Association (AIBA) has recently instituted a set of rules which, among others, involve removing the headguard in competition

•  The AIBA Medical Commission has provided the IOC with data from AIBA boxing competitions that suggest that boxing without headguards does not lead to an increased risk of injuries to the head or to the face

Background

1.  Systematic literature review of rule change and protective equipment and injury risk in boxing: showed no benefit of HG

2.  Video analysis of the injury rates and characteristics in boxing with and without headguards: Less hits to the head

3.  Boxing Headguards and Gloves Biomechanics Project: HG is effective

4.  Neuropsychological testing of boxers: a phd thesis in Sweden shows changes in the spinal fluid after bouts

The expert group were asked to do:

PHYSICIAN RULES !

THE SIX ”R”S OF CONCUSSION 1.   RECOGNIZE 2.   REMOVE 3.   RE-EVALUATE 4.   REST

•  (REHABILITATION) 5.   RECOVER 6.   RETURN TO SPORT

CRT!

CHILD SCAT3!

Developed by Child SCAT3 subcommittee - Davis,  McCrea, G. Gioia, Purcell, Ellenbogen, C. Vaughan, Guskiewicz, Kutcher, Meeuwisse, McCrory

SCAT3!

Developed by SCAT3 Subcommittee - Meeuwisse, McCrory, Dvorak, Echemendia, Guskiewicz, Iverson, Johnston, McCrea, Putukian, Raftery, Schneider

•  Rugby – scrum and high tackles •  Icehockey – Canadian youth- no body checking •  Football- tackling from behind and elbowing •  Volleyball – where change was made with a negative effect •  Freestyles skiing – to show the challenges •  Boxing – will removal of head guards make a difference? •  Concussion – new rules of detection- give the physician time!

Rule changes make a big difference!

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Thank you