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Establish a Preseason “Chain Of Command” About Youth Sports Injuries

By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

• A recent survey was published by Safe Kids Worldwide highlighting important aspects of the culture surrounding youth sports injuries
• Youth coaches at club and high school levels must be properly educated in basic injury recognition
• It’s very important to have a discussion with parents prior to the club season to establish a decision process for dealing with on-field injuries

There are some really great points exposed in this recent survey from Safe Kids Worldwide regarding the culture of youth sports injuries. Here are the most relevant points I took away from the survey:


• Survey was comprised of 1,000 young athletes (seventh through 10th grade), 1,000 coaches and 1,000 parents.

• 42% of players report that they have hidden or downplayed an injury during a game so they could keep playing; 62% say they know someone else who has done so.

• 54% say they have played injured and 70% of those kids say they told a coach or parent that they were hurt. Top reasons given for playing injured: it wasn’t that bad (18%); couldn’t let the team down (13%); didn’t want to be benched (12%).

• 33% say they have been injured as a result of dirty play from an opponent; 28% agree that it is normal to commit hard fouls and play rough to “send a message” during a game.

• 53% of coaches say they have felt pressure from a parent or player to put an athlete back in a game if the child has been injured.

• 80% of parents favored their child’s youth sports coach receiving certification or at least training in injury recognition.

• But less than half of coaches responded that they had received any injury training.

The numbers above are interesting but what I’d really like to point out to you are that the numbers of players with injuries dealt with on the field of play by the coach and parent who do not end up seeing a physician are staggeringly large. We know with good certainty that there are about 1.2 million visits annually to the Emergency Room for youth sports related injuries; we also know with good certainty that about another 2 million visits take place annually to the pediatrician or sports medicine specialist for youth sports injuries. But the real number that is under publicized is that at least 3 times that number are dealt with each year by the coach without involving a physician. That’s about 10 million injury incidents annually.

Many of those 10 million are really minor bumps, bruises, etc. What if they’re not? And will you as a coach know if it’s something that should be looked at by a skilled professional?

In the preseason it’s really important for the coach and parents of club teams to have an open and honest discussion to lay down some ground rules, what I like to refer to as a “chain of command”. First, the coach must be educated in basic injury recognition. Then, there needs to be a clear understanding that if the coach feels a child should not return to play due to injury that the coach is backed on his/her decision without pressure from parents or players to have the child continue playing. At the high school level there needs to be an understanding that the ATC (or if available the team physician) has the last word on play or no play for injured athletes during a game, and the coach should not have authority to override the professional opinion of the ATC.

Injuries are going to happen. Let’s make sure we have the right education for the coaches and the processes in place to deal with the issues properly. Have the key discussions before the start of the season.

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