Recreational Injuries

Scope of the Problem

Because most sports and recreational activities are seen as healthy and fun—particularly among children—they are not considered dangerous or risky, even though they can be. It is estimated that more than 6,000 deaths in the United States each year are associated with recreational activities. Mortality data from the National Center for Health Statistics (NCHS) is incomplete for sports injuries in comparison to the information available for many other injury areas.1 Sports are a particularly important source of nonfatal injury and disability as well, but morbidity data are not collected in an organized fashion. The major limitation in working with and evaluating recreational injury data is the large number of incidents that go unreported. The best US estimates on the magnitude of nonfatal sports injuries come from the National Electronic Injury Surveillance System (NEISS) which may capture only 48% of all sports injuries.2  ICD-9 E-codes do not specifically identify many recreational injuries and are useful only in identifying approximately 33% of all sports injuries.3 

Exposure data (i.e., person-hours of participation in informal recreation, practice and competition for youth leagues, junior varsity, and varsity sports) are very difficult to obtain. Even at the collegiate level this information is not collected in a systematic manner across all sports. Injury rates are calculated using several different denominators making it difficult to compare evidence across studies. Many studies report a specific injury (knee for example) as a percentage of the total number of injuries or as the number of injuries per 100 players, but this does not allow for the different number of practices and games across teams, or for players who do not participate in every game and practice. Reporting injuries per 1,000 athlete-exposures (AE) is preferred. One AE is one athlete participating in one game or practice where he or she is exposed to the possibility of being injured. In order to accurately reflect a player’s risk of injury in a practice or game situation it is necessary to calculate injury rates for practices and games separately then calculate the relative risk of injury. An example from collegiate football studies conducted by the NCAA is a good illustration. Data from their surveillance system in 1990 indicated a practice injury rate of 3.99 per 1,000 AE and a game injury rate of 35.45 per 1,000 AE, with a relative risk of injury in a game compared to injury in a practice of 8.9. Reporting that 57% of the injuries occur in practice does not accurately reflect individual risk.4 Definitions of what constitutes injury and classifications of injury severity are not uniform across studies. Loss of practice or game time is a common method of measuring severity. The epidemiological evidence describing the injury profiles for a wide range of sports is nicely summarized in a recent text, Epidemiology of Sports Injuries.5

The majority of the studies have been carried out for competitive sports particularly football, and volleyball. However, if effective, these interventions could be useful in a variety of sports, such as soccer, basketball, ice hockey, and baseball. The evidence for the effectiveness of protective equipment (helmets and face masks for ice hockey) and rules changes in football to prohibit spearing and reduce neck injury will be added to this review at a later date.

Many recreational injuries can be classified under such areas as drowning, bicycling, and falls, and are covered in other sections of these web pages. In this review, we examine the effectiveness of the following interventions:

Prevention Interventions