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

Key Points:

  • Part of the reason for rules in sports is to help ensure the safety of the athletes playing the sport
  • It?s estimated that perhaps 10% of the injuries in youth and high school sports are the direct result of fouls or other illegal activity.
  • Rules changes and stricter enforcement of rules could have a positive effect in reducing injury rates and youth sports, however, it can be difficult to implement this from the practical standpoint

Rules of competition exist in all sports mainly to satisfy two needs. First, the rules are in yellowcard-2place to ensure as reasonably as possible that all competitors have a fair chance at winning. And secondly, the rules are in place to help ensure the safety of the participants.

Over the last several years national governing bodies in many sports have been asking serious questions about rules changes necessary to improve the safety of their athletes. To name just a few, the US Soccer Federation enacted sweeping rules changes regarding heading of the ball for younger players designed to reduce the risk of concussion. USA Hockey has an age restriction below which it is illegal to perform body checking. And football at all levels from peewee up through the professional ranks now has fairly stiff penalties in place for targeting.

Is it possible to estimate how many injuries actually occur from fouls or illegal play? As it turns out the question is fairly complicated and there is not a lot of research for us to look at.

There is one published study from Collins and colleagues in the journal Injury Prevention published in 2008 that sheds a little bit of light on the issue.

Injuries related to fouls and other illegal activity in sports

The authors used RIO (Reporting Information Online), an injury surveillance system, to collect data on injuries in high school sports in the United States. For the 2005?06 and 2006?07 academic years, they captured injuries in boys? football, soccer, basketball, wrestling, and baseball and girls? soccer, volleyball, basketball, and softball. They attempted to compare differences between sports (boys? and girls?) for injury rates, and in particular, the proportions of those injuries related to illegal activities and fouls.

There were some interesting results:

The authors estimated that 98,066 injuries occurred nationwide during those years as the result of an action that was ruled illegal activity by a referee/official or disciplinary committee. They calculated an injury rate of 0.24 injuries related to illegal activity per 1000 athletic competition-exposures. Boys? and girls? soccer had the highest rates of injury related to illegal activity. Girls? volleyball, girls? softball, and boys? baseball had the lowest rates of injury related to illegal activity. ?Boys? and girls? sports overall had similar rates of injuries related to illegal activity. Of all injuries in these sports, 6.4% were related to illegal activity. The highest proportions of injuries related to illegal activity were found in girls? basketball, girls? soccer, and boys? soccer (in that order). ?The lowest proportions of injuries to illegal activity were found in girls? softball, boys? football, and girls? volleyball.

Furthermore, these injuries resulting from fouls were fairly severe. About 6% required surgery and about 10% required the athlete to hold out from play for a year.

This study shows that at the high-school level, injuries from fouls and illegal activity caused more than 10% of all injuries in four of the nine sports (boys? soccer, girls? soccer, boys? basketball, and girls? basketball). The authors argue ? and I agree with them ? that any risk factor that causes such a high percentage of injuries should be examined for ways to modify that risk.

In that sense, better rule enforcement and punishment of players guilty of fouls andSideLineSportsDoc other illegal activity might actually decrease a sizable portion of youth sports injuries. Since over 5% of these injuries needed surgery and 10% were season-ending injuries, it seems to be an especially important effort.

In theory, cutting down on injuries related to dirty play and fouls makes sense. As a practical matter it is harder to actually achieve. But better rule enforcement and punishment by referees and education of athletes, parents, coaches, and referees by sports medicine healthcare providers might be a much needed first step.

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