Pediatr Clin N Am 49 (2002) 753 – 767

Sport injury profiles, training and rehabilitation

issues in American sports
Eugene F. Luckstead, Sr, MDa,*, Andrew L. Satran, MDa,
Dilip R. Patel, MDb
a
Department of Pediatrics, Texas Tech Medical School-Amarillo, 1400 Coulter,
Amarillo, TX 79016, USA
b
Pediatrics Program, Michigan State University, Kalamazoo Center for Medical Studies,
1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA

American youth sports continue to thrive and increase by substantial numbers

each year; however, sport-specific injury profiles, training and conditioning
demands, and injury rehabilitation factors associated with youth sports are not
widely known.
Rowland has stated: ‘‘In the area of sport training for children and young
adolescents the need for scientific information is particularly urgent’’ [1]. He
further reminds us that there is ‘‘virtually no research data regarding proper
training schedules and techniques, nutrition, psychosocial stress, injury preven-
tion, and medical monitoring’’ [1].
These issues do affect the safety and physical and emotional health of young
growing athletes. Should we be placing more emphasis on developing basic
motor skills and fitness in the younger athletes and building such fundamental
skills before sport specialization, as advocated by Bompa [2]? He further states
that ‘‘prepubertal young athletes should be focusing on skills such as running,
swimming, jumping, throwing, catching, and tumbling, which allow them to
develop their coordination, flexibility, agility, and fitness and thus preparing them
further development and specialization of their individual talents at an older age’’
[2]. Such skill development will require dedicated years of training and coaching
with a de-emphasis of our current ‘‘winning is everything or. . .the only thing’’
concept for young athletes [2,3,64].
All of these issues involving young athletes clearly are very important;
however, it is also important to understand the capabilities, limitations, and
physiologic adaptability to training and practice demands on the young growing

* Corresponding author.
E-mail address: gene@ama.ttuhsc.edu (E.F. Luckstead).

0031-3955/02/$ – see front matter D 2002, Elsevier Science (USA). All rights reserved.
PII: S 0 0 3 1 - 3 9 5 5 ( 0 2 ) 0 0 0 1 7 - 2
754 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

athlete [1,3 –8]. Excessive sport training regimens in younger athletes increase
the risk of physical injury, emotional stress, and subsequent ‘‘burnout.’’ Have we
replaced our youths’ priorities without proven positive long-term results
[2 –4,6,8]? Training programs designed primarily for adult athletes should not
be considered appropriate for young children and adolescents [2].
Injury prevention and safety concerns should receive the highest priority for
all young athletes. There has been a documented 10% increase in boys’ high
school sport participation between 1988 and 1998, while girls’ sport participation
has increased 40% during that same period [9]. Recurrent injuries and prolonged
recovery times from sport-related injuries remain a challenge for young compet-
itive athletes, coaches, and their medical physicians.
This article provides current information for physicians, young athletes, and
their families to heighten their awareness of sport-related injuries that occur in
certain sports, their training, conditioning, and rehabilitation roles, and expectant
time demands.
This article provides sport-related injury profiles for many American sports.
Injury rates for various sports are noted in Fig. 1, and frequently injured anatomic
sites are summarized in Box 1. Sharing such information is helpful for both the
athletes and their families, particularly because adolescent athletes typically feel
they will not get injured. Sports that involve high velocity and force generally
have a greater possibility of injury, whether or not there is the potential for
collision. Low-static, low-impact aerobic sports such as running or swimming
have a lower risk of injury, unless overtraining occurs. Documentation of

Fig. 1. The risk of injury from data from a wide spectrum of sports (data from Rice [11]). These
are from American sports participation and provide information on young athletes at risk of injury
by sport.
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 755

Box 1. Sport-related injury sites (Note: >>, higher incidence;

>, lower incidence. Data from multiple sources.)

Baseball and softball

Shoulder >> elbow/forearm/wrist, fingers > ankle, hip, back
(softball has less severe injuries than baseball)

Basketball and volleyball

Ankle, knee >> hip/thigh > Achilles tendon, heel, thigh, foot,
back, shoulder, elbow, eye, wrist, fingers (girls’ knee injury rate is
three to four times that of boys)

Football
Knee > ankle > head, shoulder, neck > back, face, wrist/fingers

Hockey

Ice hockey
Head, neck > ankle, knee, shoulder/arm > eye, wrist/hand

Field hockey
Knee, ankle > face/head

Gymnastics
Shoulders > torso/back/hip, wrist > elbow > ankle, head/neck

Roller-blading
Distal forearm/wrist > lower leg > elbow > knee > head
(roller-skating has a similar but less severe injury profile; skate-
boarding has a similar profile, but the injuries are more severe)

Snowboarding
Wrist > head >> upper extremity, shoulder, forearm > knee,
ankle, hip, back
756 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

Snow skiing
Lower extremity, leg/knee >> head >> thumb, shoulder,
ankle, wrist, back, neck, thigh

Soccer
Knee, ankle >> shin/foot, hip/thigh >> shoulders, cervical
spine, head (knee injuries are three times more common in girls
than in boys)

Swimming
Shoulder > knee > elbow, head/spine (diving)

Track

Running
Knee, shin (shin splints) > foot, hip/back/thigh

Field
Knee, shoulder, hip/back > ankle, spine, elbow

Wrestling
Shoulder >> knee >> back/neck, foot/ankle, wrist/hand >>
head/ear, torso, elbow

previous injury to the musculoskeletal system or persistence of chronic injuries

will predispose the young athlete to injury risk. Assessment of major joint
flexibility, overall muscle development and strength, and physical maturation is
important in the young growing athlete.
Knee, ankle, shoulder, head, and neck injuries are noted to be common
football-related injuries [3,4,9 – 11,71]. Ankle and knee injuries are also com-
monly noted in basketball and volleyball. Shoulder and elbow injuries are
frequently seen in baseball, softball, swimming, and wrestling. Sport-related
overuse injuries are more likely to be seen in swimming, gymnastics, cheer-
leading, and throwing sports [3,12 – 15].
What injuries should we as physicians, parents, trainers, and coaches antici-
pate in young athletes who participate in sports? What are the risks of injury from
specific sports? How should such sport-associated injuries be treated? Perhaps
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 757

most importantly, how can physicians help young athletes avoid or prevent sport-
related injuries (Box 2)?

Box 2. Measures of injury prevention in young athletes

 Proper conditioning
 Limited training (no overtraining)
 Provision of safe playing environment and equipment
 Complete injury rehabilitation
 Proper supervision
 Rule enforcement, safety, and revision of risk factor priorities
 Proper instruction and coaching techniques
 Proper matching of athletes (maturation level, age, and weight)

Data from Refs. [5,7,15].

The incidence of injury is often presented without knowing the total athlete
exposure to injury or the number of athletes involved [7]. One should state the
percent of athletes on the team who miss practice or games during the season.
Injuries should be considered mild if the athlete is ‘‘out’’ less than 8 days,
significant if out more than 8 days, moderate if out between 8 and 21 days, and
severe if out more than 21 days [7]. Past high school injury studies have reported
overall male sport-related injury rates from 27% [70] to a high of 39% [17]. The
overall rate for females was lower, from 12% to 22%; 25% to 35% had significant
injuries in all sports [7].

Football
Football has consistently had the highest injury rates of all sports for all age
groups [3,5,9,11,15,65,66,71]. The national trainer (NATA) 3-year study pro-
vided data on several high school sports and showed football to have 28% mild,
5.9% moderate, and 3.3% major injury rates [9]. They also noted that surgery
resulted in approximately 70% of major injuries when the knee was involved.
Other injury rates noted in the NATA study were contusions (29%), sprains
(28%), strains (21%), fractures (7%), and concussions or nervous system injuries
(6%). In another study, youths 11 to 14 years of age had a 5.2% injury rate; 28%
of the injuries involved the hand and wrist, 17% involved the knee, and 15%
involved the shoulder and humerus [18]. A prospective two-season junior high
football study of 11- to 15-year olds in Alabama reported a 16% injury rate in
340 players. All athletes had preseason ‘‘Tanner maturity staging.’’ A mildly
surprising finding was that the more mature junior high athletes had higher injury
rates compared with the less mature athletes [19]. Other high school studies
758 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

revealed knee (19%) and ankle (15%) injuries to be the most common football
injuries in high school [17,20]. Both college and high school football players
have high knee (34%) and ankle (19%) injury rates, with approximately 27% of
college athletes having significant injuries. Football had the highest injury rate in
male athletes in the 8-year prospective Hawaii private high school study (grades 7
to 12), and soccer had the highest injury rate in females. Boys and girls had
similar injury rates in 32 sports when football and wrestling data were removed
[20]. A study of overly obese (over 95% of skin folds in triceps and subscapular
areas) high school football players in southern Florida found there was no actual
difference in injury rates, but that larger players (both heightwise and weightwise)
were 2.5 times more likely to incur an injury. Another observation was the
alarmingly high incidence of excessive obesity in this population [21].

Basketball
Basketball has a much higher injury rate than would be suspected. Injury rates
range from 25% to 35%, with males having the higher rates in most but not all
studies. Ankle sprain was the most common injury, followed by knee injuries; all
studies showed female athletes having a higher rate of injury than males [9]. In
basketball, sprains and strains of the lower extremities dominate the injuries.
According to a Texas study [22], female athletes are three to four times more
likely to incur anterior cruciate ligament injuries. Eye injuries, some quite serious,
are also relatively common; eye protection may be needed in this sport (as well as
others) [23]. Volleyball has a similar injury profile, but with more finger and knee
problems than basketball. Use of a grading system for ankle injuries, such as the
West Point Ankle Grading System, can be quite helpful in determining whether
or not a basketball or volleyball player can safely resume play [24].

Baseball
Baseball has an overall injury rate of between 15% and 18% per season [70].
Injuries to the shoulder and elbow are common for pitchers, but eye injuries are
particularly dangerous for all players; protective eyewear is highly recommended
[63]. Jammed fingers are common injuries in baseball and softball players alike.
Most injuries are mild or well tolerated, with minimal time lost from baseball
participation except for pitchers with arm injuries and, on occasion, catchers with
hand injuries. Cardiac problems such as commotio cordis have been documented
more often in recent years [3,27,28]. Sliding injuries and collisions with other
players add to the more common ball-and-bat – related baseball injuries. Break-
away bases in baseball and softball have been shown to decrease sliding-related
injuries [29]. There is an excellent report available on a 10-year national study of
little league baseball injuries involving nearly 2 million participants [6]. Baseball
was the leading cause of sport-related eye injuries in the 5- to 14-year-old age
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 759

group; 25% of the injuries were severe, and there were 13 deaths. Safety concerns
and prevention of injuries are also highlighted in this national study.

Softball
In high school populations, softball is the girls’ sport that is equivalent to
boys’ baseball. Similar injury profiles have been noted in both sports, but a
national study by Powell and Barber-Foss [9] revealed a higher overall injury rate
in girls’ softball (16.7%) compared with boys’ baseball (13.2%). In addition,
there was a lower incidence of major injuries in softball (7.8%) compared with
major injuries in baseball (12.5%).

Gymnastics
Gymnastics have a high injury rate, especially in female athletes; the injury risk
increases with higher skill levels. Past studies described a 40% overall injury rate in
high school and an rate of approximately 70% at college levels [4,17,25]. The
majority of injuries are to the lower extremities (50% to 60%), but injuries also
occur in the upper extremities (25% – 30%) and the torso and spine (12% – 20%).
Overuse injuries are noted in about 33% to 42% of all injuries [25]. More than half
are sprains and strains, and about one third are contusions, dislocations, or fractures
(5% to 12%) [3,25]. Knee, ankle, and elbow injuries are the most disabling, and
elbow and back injuries are potentially career-ending [3,25]. Wrist capsulitis (arm
shin splints) is a common overuse injury resulting from training. Catastrophic falls
resulting in quadriplegia or severe brain injuries are especially a concern in
advanced gymnastic levels [26,30]. Gymnasts can also suffer from eating disorders
similar to those seen in track and swimming athletes who train excessively.

Cheerleading
Since 1980, cheerleading has evolved into an activity with a dual purpose: to
lead cheers from the sideline and to compete as a skilled athlete. Some states
consider cheerleading as a school activity, while others consider it a sport (over
74,000 girls participate in state cheerleading championship competitions). High
school and college cheerleaders currently comprise approximately 50% of
catastrophic injuries that occur to female athletes; the number of emergency room
visits among cheerleaders has risen from 4,954 in 1980 to 16,000 in 1994 [30].
Because cheerleading has assumed the role of a sport, safety guidelines
designed to prevent injuries have been prepared. Several states have already
incorporated safety standards for high school cheerleading programs; the Big
Ten, Southwest, Southeast, and Western collegiate athletic conferences have also
adopted safety certification standards (Box 3) [72,73]. The National Federation of
State High School Associations (NFHSA) states that cheerleading programs serve
760 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

primarily as support groups for other school athletic programs. The NFHSA
adopted or revised 18 rules for cheerleaders in 1993, in which safety is placed as
the highest priority; tumbling over, under, or through objects is prohibited [39].

Box 3. Cheerleader guidelines

1. Medical history and preparticipation examination are

required.
2. Coaches must be trained in gymnastics and partner
stunting, as well as spotting and other safety factors.
3. Conditioning and training in spotting techniques are required.
4. Gymnastic stunt training and qualification certification of
stunt mastery are required.
5. All practices must be coach-supervised and must be
conducted in a safe facility.
6. Mini-trampolines and flips/falls off pyramids are prohibited.
7. Pyramids must be limited to two persons high and be
formed on mats (among other safety precautions).
8. Written emergency medical procedures for physicians and
trainers must be provided to coaches and other staff.
9. A cheerleader exhibiting symptoms of head trauma (eg,
concussion) should be restricted from further practice or
cheerleading until given proper medical clearance.
10. Safety certification (available from American Association
of Cheerleading Coaches and Advisors) are required for
all coaches.

Adapted from Mueller FO, Cantu RC. NCCSI: Eighteenth annual

report National Center For Catastrophic Sports Injury Research, Fall
1982 –Spring 2000 [72]. Mueller FO, Cantu RC, Van Camp SP. Ca-
tastrophic injuries in high school and college sports. HK sport sci-
ence Monographs, Human Kinetics, Champaign, Illinois; p 113 – 4;
1996. [73].

Ice hockey
Ice hockey has a high potential for serious injury. Face and head injuries
common to ice hockey have decreased significantly in youth hockey after the
requirement of helmets and face protection. Despite such protection, a compre-
hensive study of 251 high school hockey players found a 41% injury rate, or 1 injury
per 200 player hours [31]. Concussions were noted in 12%, 34% were dizzy after
contact, and 39% reported hockey-related headaches. Dental trauma, fractures, and
concussions comprised 19% of severe injuries, and 7% had major injuries. The
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 761

head/neck (22%), shoulder (16%), arm/hand (13%) and torso (12%) were the
sites injured most often. Half of the injuries were bruises, contusions, or sprains,
but fractures and dislocations or severe separations were not uncommon [7,31].

Skiing
Skiing (and, more recently, snowboarding) have become very popular with
American youths. Youths between 11 and 16 years of age have the highest injury
rates [7]. Equipment changes have reduced foot and ankle injuries, but knee
injuries and upper extremity injuries remain the same. Sprains comprise more
than half of the injuries, followed by contusions, dislocations, and fractures. Most
often, site injuries are to the thumb (gatekeeper’s or lunar collateral ligament),
lower leg, ankle, and knee. Head injuries are common in all age groups. Knee
injuries comprise about 25% of all ski injuries, with the medial collateral knee
ligament most frequently injured [32]. Deaths continue to be seen from falls,
collisions with trees or people, or accidental causes.

Swimming
Swimming has a preponderance of upper extremity injuries, most of which are
training-related. Shoulder injuries dominate, with 82% complaining of shoulder
pain in one study [13]. Knee problems occur more often in backstroke swimmers
and increased lower back and elbow problems are noted with breaststroke
swimmers. Ankle and foot tendonitis are not uncommon in swimmers [7]. Diving
continues to present dangerous injury scenarios if precautions are not taken either
in sports or recreationally [33]. High-level athletes have been noted to have
‘‘swimmer’s anorexia’’ on occasion from overtraining [3].

Soccer
Soccer is rapidly becoming a popular American sport for both boys and girls at
the high school and college levels. Claims that soccer and American football have
similar injury rates have largely been dispelled by the national NATA study of
10 popular high school sports, where soccer had a much lower injury rate [9].
Female athletes, however, have had a disproportionately higher knee injury rate
in this and other studies. Soccer, because of its international popularity and
origins, is covered in the article by Patel and Nelson in this issue [15].

Track and field

Track and distance running have a fairly high injury rate, with 33% to 35%
noted in male and female high school athletes, respectively [17]. Most track
762 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

injuries are musculotendinous, and 85% occur in the lower extremity. Shin
splints, thigh strains, and knee and lower-leg injuries are commonly noted in
track and running sports. A prospective 15-year study of 23 high schools (199
cross-country teams) in the state of Washington showed an overall injury rate of
16.7/1000 athletic exposures [34]. Female runners had a higher injury rate (16.7/
1000 athletic exposures) than male runners (10.9/1,000); also, higher initial and
recurrent injuries occurred more often in female runners [34]. Shin splints were
most common for both initial and recurrent injuries, followed by hip, knee, calf,
and foot injuries, respectively. Ankle sprains are uncommon in the track and field
athlete. Overuse stress fractures related to running occur as high as 15% in
runners but are usually less than 1% in other athletes [12]. Pole-vaulting, shot put,
discus, and javelin all have high injury rates with the potential for catastrophic
injury [30]. Both male and female cross-country runners should be closely
monitored for ‘‘runner’s anorexia.’’ There are several good reviews concerning
the evaluation, diagnosis, and management strategies for young athletes with hip
and pelvic injuries [28,35,69].

Wrestling
Wrestling has a high risk of injury [68]. An Ohio study involving 458 male
wrestlers at 14 different high schools for a season had an overall injury rate of
52%, and 6 injuries occurred in every 1000 exposures [36]. More than 63% of
injuries occurred during practice, but the rate was higher in matches. Hard
wrestling accounted for 68% of practice injuries, with 23% during drills and 9%
during conditioning. The takedown position was most often involved in 68% of
the injuries, and the older, more advanced athletes were at greater risk. Ear
injuries persist because wrestlers do not keep headgear on during practice
situations [16,37,67]. The 3-year national high school study by Powell and
Barber-Foss [9] noted a 10.5% mild traumatic brain injury rate that was second
behind football. All 10 popular high school sports that were surveyed had athletes
with mild traumatic brain injuries [9]. Dangerous weight-cutting techniques
continue to be exercised by wrestlers. Wisconsin has used a minimum weight
program determined by percent of body fat and nutritional education to advantage
to decrease unhealthy high school practices [38].

Strength training
Strength training of young athletes extends beyond increased muscular
strength. It should be viewed as an important part of conditioning, but one must
respect safety rules and inherent injury in the weight training of all young athletes
(Box 4) [3,39 – 41]. Qualified instruction, proper supervision, and realistic age-
and peer-related weight-training guidelines for young athletes training for
selected sports should be mandatory. For young athletes, the most pragmatic,
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 763

safety-conscious, and effective approach is to begin with very light weights and
high-repetition sets (10 to 15 repetitions) with a slow progression of increased
weight over time [39,40,42– 44]. Guidelines from the American Academy of
Pediatrics, American College of Sports Medicine, American Orthopedic Society
for Sports Medicine, and the National Strength and Conditioning Association are
available for more detailed guidance for young athletes [39,42,45,46]. Sport-
specific weight training programs are described elsewhere and are available for
coaches, parents, and young athletes [3,41,43,44].

Box 4. General principles of youth strength training

1. Qualified adult instruction and supervision (eg, spotting)

should be provided.
2. Participant goals should be outlined and mutually under-
stood by the athlete and the coach.
3. Warm-up and cool-down periods should be enforced (eg,
light aerobics and stretching).
4. Light weightlifting with 10 – 15 repetitions and 8 – 10
balanced exercises should be performed.
5. Proper technique should be emphasized; the maximum
weight should be discouraged.
6. Each athlete’s progress should be reviewed and reinforced
using a card and chart system.
7. Sessions should be limited to two or three per week.
8. Alternate with aerobics on ‘‘off weight’’ days.
9. Increase weight (resistance) gradually as strength improves
(usually by increments of 5 to 10).
10. Incorporate weight training and other conditioning (eg,
stretching, aerobics).

Adapted from Refs. [3,40,41].

Roller-blading
In-line skating, more commonly known as roller-blading, has emerged during
the 1990s as a popular form of exercise and recreation. In 1995, it was estimated
that 22.5 million people in the United States were roller-blading [47]. Research in
exercise physiology has revealed that the aerobic benefits of roller-blading are
comparable to running, but without the same shock impact on joints [48,49]. Not
surprisingly, roller-blading causes more injuries than skateboarding, hockey,
lacrosse, or rugby [50]. The estimated annual cost of treatment for these injuries
in the United States was 4 billion dollars in 1997 [50]. Although this sport is
764 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

embraced by athletes of all ages, children 10 to 14 years old account for 60% of
the injuries [50]. One Swedish study showed an annual injury rate of 1.7 per 1000
males in the population aged 10 to 19 years old [51].
The speeds encountered in roller-blading combined with the relative unsteadi-
ness of the roller blades predisposes skaters to injury. Cruising speeds of 10 to
17 mph (compared with 13 mph for recreational cyclists) and sprint speeds of
30 mph contribute to the incidence and severity of the injuries [47]. Fractures
account for 45% of the injuries in patients who require emergency room
treatment [52]. The most commonly injured site is the distal forearm, usually
as a result of a fall on an outstretched hand; this injury accounts for 66% of all
fractures [52]. Significant elbow injuries (6%), knee injuries (6%), and lower leg
injuries (9%) are also common [52,53]. Five percent of children incur head
injuries; 2.5% of all children require hospital admission [52,54]. Although
collisions with cars accounted for only 5% of emergency visits [55], they
represented 96% of the 28 deaths reported in a 5-year period [56]. One small
study discovered that among patients with wrist fractures, almost half were
novices with less than 4 weeks experience [57].
With all of the injuries in roller-blading, it is surprising that there is such poor
compliance with the recommended use of protective equipment. A recent large
study of roller bladers in Boston reported that 60% of skaters wore wrist guards,
but only 5.7% wore helmets [58]. Elbow pads were used 10% of the time, and
knee pads were used 23% of the time [58]. Beginners and advanced skaters have
better compliance than average skaters [58]. Unfortunately, the use of protective
equipment in children under 16 is much lower than in adults [59]. Because wrist
guards and elbow pads have been shown to reduce injury by 87% and 82%,
respectively, the American Academy of Pediatrics (AAP) recommends the
routine use of protective equipment [53,60]. Although knee pads may decrease
the incidence of abrasions, they were not shown to significantly reduce the
incidence of knee injuries requiring emergency room treatment [53].
Traditional roller-skating has a similar injury profile to roller-blading. While
the roller-skating injury rate is three times higher than that of roller-blading, the
injuries are much less severe [49,54,61]. Skateboarding, on the other hand,
produces more severe injuries than roller-blading.
The use of helmets, wrist guards, knee pads, and elbow pads are strongly
recommended to decrease the large number of significant injuries seen in roller-
blading. Because the most common reason for not wearing safety equipment is a
lack of perceived need [62], health care workers can play a significant role in
reducing injuries.

Summary
The injury profiles and possibilities for the sport-specific injuries associated
with the major American youth sports have been reviewed in this article.
Guideline concepts for physicans, athletes, and their families are noted.
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 765

Weight-training general concepts are suggested for the younger athlete. Strong
consideration should be given to include cheerleading as a sport to promote safety
and reduce cheerleading-related injuries. A special appendix section updates
current information on the popular sport of roller-blading.

References
[1] Rowland TW. Pediatric exercise science: so what? Ped Exerc Sci 2001;13:205 – 13.
[2] Bompa TO. Total training for young champions. Champaign (IL): Human Kinetics; 2000.
[3] Luckstead E, Greydanus DE. Medical care of the adolescent athlete. Los Angeles: PMIC
Press; 1993.
[4] Dyment PG, et al. Sports medicine: health care for young athletes. 2nd edition. Elk Grove
Village, IL: American Academy of Pediatrics; 1991.
[5] Goldberg B. Injury patterns in youth sports. Physician and Sports Medicine 1989;17:175 – 86.
[6] Mueller FO, Marshall SW, Kirby DP. Injuries in little league baseball from 1987 to 1996:
implication for prevention. Physician and Sports Medicine 2001;21:41 – 8.
[7] Risser W. Epidemiology of sports injuries in adolescents. Adolesc Med 1990;2:109 – 24.
[8] Rome ES. Sports-related injuries among adolescents: when do they occur, and how can we
prevent them? Pediatr Rev 1995;16:184 – 7.
[9] Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA 1999;282:
958 – 63.
[10] Davis PM, McKelvey MK. Medicolegal aspects of athletic cervical spine injury. Clin Sports Med
1998;17:147 – 54.
[11] Rice SG. Risks of injury during sports participation. In: Sullivan JA, Anderson SJ, editors. Care
of the young athlete. American Academy of Orthopedic Surgeons and American Academy of
Pediatrics; 2000.
[12] Boden BP, Osbahr DC, Jimenez C. Low-risk stress fractures. Am J Sport Med 2001;29:100 – 11.
[13] Ciullo JV. Swimmer’s shoulder. Clin Sport Med 1986;5:115 – 37.
[14] Landry GL. Sports injuries in childhood. Pediatr Ann 1992;21:165 – 8.
[15] Patel D, Nelson TL. Sports injuries in adolescents. Med Clin NA 2000;84:983 – 1007.
[16] Martin WR, Margherita AJ. Wrestling. Phys Med Rehabil Clin N Am 1999;10:117 – 40.
[17] Garrick JG, Requa RK. Injuries in high school sports. Pediatrics 1978;61:465 – 9.
[18] Goldberg B, Rosenthal PP, Robertson LS. Injuries in youth football. Pediatrics 1988;81:255 – 61.
[19] Linder MM, Townsend DJ, Jones JC, et al. Incidence of adolescent injuries in junior high school
football and its relationship to sexual maturity. Clin J Sport Med 1995;5:167 – 70.
[20] Beachy G, Akau CK, Martinson M, Olderr TF. High school sports injuries. A longitudinal study
at Punahou School: 1988 to 1996. Am J Sports Med 1997;25:675 – 81.
[21] Kaplan TA, Digel SL, Scavo VA, Arellana SB. Effect of obesity on injury risk in high school
football players. Clin J Sport Med 1995;5:43 – 7.
[22] Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas high school basketball:
a prospective study among male and female athletes. Am J Sport Med 1999;27:294 – 9.
[23] American Academy of Pediatrics Statement. American Academy of Ophthalmology Committee
on Eye Safety and Sports Ophthalmology. Pediatrics 1996;98:311 – 3.
[24] Hockenbury RT, Sammarco, GJ. Evaluation and treatment of ankle sprains: clinical recommen-
dations for a positive outcome. Physician and Sports Medicine 2001;29:57 – 64.
[25] McCauley E, Hudash G, Shields K, et al. Injuries in women’s gymnastics: the state of the art. Am
J Sport Med 1988;16(Suppl 1):S124 – 31.
[26] Torg JS, Corcoran TA, Thibault LE. Cervical cord neurapraxia: classification, pathomechanics,
morbidity, and management guidelines. J Neurosurg 1997;87:843 – 50.
[27] Dickman GL, Hassan A, Luckstead EF. Ventricular fibrillation following baseball injury. Physi-
cian and Sports Medicine 1978;6:85 – 6.
766 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767

[28] Maron BJ, Wang PJ, Estes NAM. Clinical profile of commotio cordis: an under-appreciated
cause of sudden death in the young during sports and other activities. J Cardiovasc Electro-
physiol 1999;10:114 – 20.
[29] Janda DH, Woitys EM, Hankin FM, et al. Softball sliding injuries. JAMA 1988;259:1848 – 50.
[30] Mueller FO, Cantu RC. Catastrophic injuries and fatalities in high school and college sports, fall
1982 – spring 1988. Med Sci Sports Exerc 1990;22:737 – 41.
[31] Gerberich SG, Finke R. Madden M, et al. An epidemiological study of high school ice hockey
injuries. Clin Nerv Sys 1987;3:59 – 64.
[32] de Loes M. Epidemiology of sports injuries in the Swiss organization ‘‘Youth and Sports’’
1987 – 1989. Injuries, exposure and risks of main diagnoses. Int J Sports Med 1995;16:134 – 8.
[33] Schmitt H, Gerner HJ. Paralysis from sport and diving. Clin J Sport Med 2001;11:17 – 22.
[34] Rauh MJ, Margherita AS, Rice SG, Koepsell TD, Rivara FP. High school cross-country running
injuries: a longitudinal study. Clin J Sports Med 2000;10:110 – 6.
[35] Browning KH. Hip and pelvic fractures to runners: careful evaluation and tailored management.
PSM 2001;29:23 – 34.
[36] Pasque CB, Hewett TE. A prospective study of high school wrestling injuries. Am J Sports Med
2000;28:509 – 15.
[37] Schuller DE, Dankle SK, Martin M, Strauss RH. Auricular injury and the use of headgear in
wrestlers. Arch Otolaryngol Head Neck Surg 1989;115:714 – 7.
[38] Opplinger RA, Landry GL, Foster SW, Lambrecht AC, et al. Wisconsin wrestling minimum
weight program reduces weight-cutting practices of high school wrestlers. Clin J Sport Med
1998;8:26 – 31.
[39] American Academy of Pediatrics Statement. Strength training, weight and power lifting and
bodybuilding by children and adolescents. Pediatrics 1990;86:801 – 3.
[40] Faigenbaum A. Strength training for children and adolescents. Sports Injuries; Diagnosis. Man-
agement and Prevention. Clin Sports Med 2000;19:593 – 619.
[41] Webb DR. Strength training in children and adolescents. Pediatr Clin NA 1990;37:1187 – 210.
[42] American Orthopedic Society for Sports Medicine. Proceedings of the Conference on Strength
Training and the Prepubescent. Chicago: American Orthopedic Society for Sports Medicine; 1988.
[43] Faigenbaum A, Westcott W. Strength and power for young athletes. Champaign (IL): Human
Kinetics; 2000.
[44] Kraemer W, Fleck S. Strength training for young athletes. Champaign (IL): Human Kinetics; 1993.
[45] Faigenbaum A, Micheli L. Current comment on youth strength training. Indianapolis: American
College of Sports Medicine; 1998.
[46] Faigenbaum A, Kraemer W, Cahill B, et al. Youth resistance training: position statement paper
and literature review. Strength and Conditioning 1996;18:62 – 75.
[47] Thompson RS, Rivara FP. Protective equipment for in-line skates. NEJM 1996;335:1680 – 1.
[48] Mahar AT, Derrick TR, Hamill J, Caldwell GE. Impact shock and attenuation during in-line
skating. Med Sci Sports Exerc 1997;29:1069 – 75.
[49] Wallick ME, Porcari JP, Wallick SB, Berg KM, Brice GA, Arimond GR. Physiological re-
sponses to in-line skating compared to treadmill running. Med Sci Sports Exerc 1995;27:
242 – 8.
[50] Tan V, Seldes RM, Daluiski A. In-line skating injuries. Sports Med 2001;31:691 – 9.
[51] Bjornstig U, Bjornstig J, Boman H. Inline skating – high fracture risk. Lakartidningen 2000;97:
4998 – 5000.
[52] Powell EC, Tanz RR. In-line skate and roller-skate injuries in childhood. Pediatr Emerg Care
1996;12:259 – 62.
[53] Schieber RA, Branche-Dorsey CM, Ryan GW, Rutherford Jr. GW, Stevens JA, O’Neill J. Risk
factors for injuries from in-line skating and the effectiveness of safety gear. NEJM 1996;335:
1630 – 5.
[54] Schieber RA, Branche-Dorsey CM, Ryan GW. Comparison of in-line skating injuries with roller-
skating and skateboarding injuries. JAMA 1994;271:1856 – 8.
[55] Adams SL, Wyte CD, Paradise MS, del Castillo J. A prospective study of in-line skating:
 E.F. Luckstead et al / Pediatr Clin N Am 49 (2002) 753–767 767

observational series and survey of active in-line skaters—injuries, protective equipment, and
training. Acad Emerg Med 1996;3:304 – 11.
[56] Pudpud AA, Linares MY. In-line skating: a deadly pediatric activity? Pediatr Emerg Care 1997;
13:376 – 9.
[57] Mitts KG, Hennrikus WL. In-line skating fractures in children. J Pediatr Orthop 1996;16:640 – 3.
[58] Osberg JS, Stiles SC. Safety behavior of in-line skaters. Inj Prev 2000;6:229 – 31.
[59] Beirness DJ, Foss RD, Desmond KJ. Use of protective equipment by in-line skaters: an obser-
vational study. Inj Prev 2001;7:51 – 5.
[60] American Academy of Pediatrics. In-line skating injuries in children and adolescents. Pediatrics
1998;101:720 – 2.
[61] Osberg JS, Schneps SE, Di Scala C, Li G. Skateboarding: more dangerous than roller skating or
in-line skating. Arch Pediatr Adolesc Med 1998;152:985 – 91.
[62] Young CC, Seth A, Mark DH. In-line skating: use of protective equipment, falling patterns, and
injuries. Clin J Sport Med 1998;8:111 – 4.
[63] Vinger PF. A practical guide for sports eye protection. PSM 2000;28:49 – 69.
[64] Fagard J. Skill acquisition in children: a historical perspective. The Child and Adolescent
Athlete. Bar-Or O, editor. London: Blackwell Science; 1996. p. 74 – 91.
[65] Feinberg JH, Nadler SF, Krivickas LS. Peripheral nerve injuries in the athlete. Sports Med 1997;
24:385 – 408.
[66] Feinberg JH. Burners and stingers [review]. Phys Med Rehab Clin N Am 2000;11:771 – 84.
[67] Giffin CS. Wrestler’s ear: pathophysiology and treatment. Ann Plast Surg 1992;28:131 – 9.
[68] Jarret GJ, Orwin JF, Dick RW. Injuries in collegiate wrestling. Am J Sports Med 1998;26:
674 – 80.
[69] Mares SC. Hip, pelvic and thigh injuries and disorders in the adolescent athlete. Adol Med
1998;9:551 – 68.
[70] McLain LG, Reynolds S. Sports injuries in a high school. Pediatrics 1989;84:446 – 50.
[71] Sallis RE, Jones K. Prevalence of headaches in football players. Ed Sci Sports Exerc 2000;32:
1820 – 24.
[72] Mueller FO, Cantu RC. NCCSI: Eighteenth annual report National Center For Catastrophic
Sports Injury Research, Fall 1982 – Spring 2000.
[73] Mueller FO, Cantu RC, Van Camp SP. Catastrophic injuries in high school and college sports,
HK sport science Monographs, Human Kinetics, Champaign, Illinois; p 113 – 4; 1996.