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Academic performance improves at age 11-16 thanks to physical activity: mainstream media broadcasts BJSM OnlineFirst paper

24 Oct, 13 | by Karim Khan

It’s no secret we are exercise advocates. And we love media coverage that provides the general public with even more incentive to be active. One profiled study on social media and language links sports with greater emotional stability. Even more notable, are the numerous international news outlets (including articles from Australia, India, the US, and the UK) covering the work of Dr. Booth and colleagues. Dr. Booth et al.’s research suggests that moderate-vigorous intensity physical activity predicts higher academic achievements in adolescence, or in the words of Australian reporters: “exercise is brainfood for teens.”

girls soccerBooth’s research team base their findings on a representative sample of almost 5000 children who were all part of the Children of the 90s study, also known as the Avon Longitudinal Study of Parents and Children (ALSPAC). This is tracking the long term health of around 14,000 children born in the UK between 1991 and 1992 in the South West of England. They conclude: “If moderate to vigorous physical activity does influence academic attainment this has implications for public health and education policy by providing schools and parents with a potentially important stake in meaningful and sustained increases in physical activity.”

Read Booth et al’s (open access) article, Associations between objectively measured physical activity and academic attainment in adolescents from a UK cohort (2013), HERE.

Working with Young Athletes in Football – it’s not JUST kids play, but that helps.

22 Jun, 13 | by Karim Khan

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series

By Sam Blanchard, @SJBPhysio_sport

Head of Academy Physiotherapy at Brighton & Hove Albion FC. South-East representative for ACPSEM 

Recently I stumbled across one of those rare beauties of a course that grips you from beginning to end, where everything relates to previous clinical experiences. I sat for hours absorbed by Sid Ahamed, nudging my colleague with a grin on my face – “that’s what we saw”, “that makes sense now” the whole time she was replying “shhh, I want to listen to this bit!”

kids soccer

The course itself was based on musculoskeletal conditions in young athletes, something that I have “fallen into” in my career.  I never set out to work solely with kids and I think this is something that is reflected in the profession of physiotherapy as a whole. It is not taught in any detail at university, and there is a distinct lack of specific CPD courses on MSK Paeds. I always thought working with children would be a stepping stone to working with elite athletes. It is only since working with young athletes however, that I have discovered the unique challenges and variations in conditions that you would not necessarily see in skeletally mature athletes.

The ‘Worst Case Scenario’ Approach

I teach my staff to consider an 8 year old, a 14 year old and a 21 year old footballer as 3 different species all together. Ahamed says “They are not just mini-adults” and this is a great mind-set to have when assessing and diagnosing. The “easy” diagnoses that we see commonly in the treatment room are the enthesopathies that everyone associates with paediatrics & football – Osgood-Schlatters and Severs – both forming the cornerstones of our injury audit each year. However, the more tricky pathologies that often get missed are the ischial tuberocity apophysisitis, presenting as a proximal hamstring tendinopathy in the “bigger species”. Or the Slipper Upper Femoral Epiphysis (SUFE) going undiagnosed as “it’s probably just overuse, or a sportsman’s groin”.

The approach we now take within our academy is to think worst case scenario first – what’s the most traumatic thing this presentation could be? What bony landmark does this muscle group attach? Lesser trochanter of femur? Well it’s probably an avulsion then, not a psoas tendinopathy.

If a player in the under 14s suffers an inversion mechanism of the ankle, we always treat as a fractured fibula until proven otherwise. Even with a negative X-Ray, it’s worth considering the weakest link in all of the structures involved and for most pubescent athletes, that’s the soft, cartilaginous epiphysis (2-5 times weaker!)  rather than the strong tensile ligaments and tendons (Caine et al 2006).

Unique management strategies for young athletes

But so what? How does the management of these conditions, with very similar presentations between adults and children, differ? The first thing is the patience and over-cautious approach to the initial assessment. If you see what you would suspect to be an MCL strain in an adult, and you know that a skeletally immature patient is weakest at the bony attachments, would you still perform a lateral stress test? You know the mechanism of injury, you can see effusion, you have noted pain on palpation of the medial femoral condyle – stop there! Go straight to the POLICE (Bleakley, C; Glasgow, P & McAuley, D. 2012) (New PRICE guidelines available HERE). By performing a stress test, the only thing you may learn is the stability of the potential avulsion fracture of the medial femoral condyle. And by determining this stability, you won’t change your treatment. The clinical decision now is whether or not to refer for imaging. At some clubs, in some sports, this may be a very routine practice. At others this may require a very good relationship with the local A&E.

The second difference would be the decision of when to progress exercises. Again, what may present as a tendinopathy in an adult is probably an apophysitis or avulsion in a young athlete. Rather than considering eccentric exercises to load the tendon, you are more likely to completely offload the structure (See “OL” of POLICE). This quickly leads to the third challenge in managing an injury in a young athlete – how do you keep a kid entertained while they are injured?!  This is where working in sport with young athletes is at its most brilliant, its most challenging and I think is the secret to keeping young (don’t let my stray grey hairs fool you). Your exercise programs need to be varied day to day. Your demeanour needs to be energetic and your banter needs to be awful. Being injured shouldn’t be a punishment, for most of these kids not playing football is the biggest punishment they could be given. Instead, as physiotherapists, we need to use this injury period as an opportunity! All those hours you put into assessing and screening at the beginning of the season now seem worthwhile as you have motive and opportunity to address movement patterns that ultimately will aid the athletes on their return. The injury itself needs to heal, but no reason why you can’t work the contralateral leg, or the lumbo-pelvic dissociation issues, or the X-Box posture that all teenagers have these days.

Final Reflections

I have now settled on my “stepping stone”, built a jetty and set out my rod. I see enough challenges and variety in this unique environment to keep me occupied for many years, plus it means I don’t have to grow up too quickly.

Register now! Prevention of Sudden Cardiac Death in the Young. CME course (January 17 & 18, 2013)

3 Dec, 12 | by Karim Khan

Nick of Time Foundation invites you to a continuing medical education course (CME) titled “Prevention of Sudden Cardiac Death in the Young” to be held at the Fairmont Olympic Hotel in Seattle, WA on January 17 & 18, 2013.

Sponsored by the University of Washington School of Medicine, Dept. of Family Medicine and Office of Continuing Medical Education. In Collaboration with: Parent Heart Watch and the American Medical Society for Sports Medicine.

Who Should Attend?

Primary care providers – including family physicians, pediatricians, internists, nurse practitioners, and physician assistants – as well as sports medicine physicians, cardiologists and others who conduct pre-participation sports physicals or have an interest in cardiovascular disease in athletes or children and preventing sudden death.

Course Objectives

At the conclusion of this activity, participants should be able to:

  • Define the leading causes of sudden cardiac death (SCD) in children and young athletes
  • Recognize warning symptoms and physical examination findings suggestive of intrinsic cardiovascular disease in the young
  • Describe the added value of electrocardiogram (ECG) as a screening and diagnostic tool in the cardiovascular care of young athletes
  • Apply specific ECG criteria for distinguishing physiologic adaptations in athletes from abnormal ECG findings associated with conditions at risk for sudden death
  • Outline the appropriate evaluation of abnormal ECG findings and the management of identified cardiac disorders

Follow the link for more course and registration details:

Register early as space is limited!


FIFA’s 11 for health programme launched in Asia

12 Nov, 12 | by Karim Khan

We wanted to share more news about the expansion of FIFA’s global initiative to improve health. Keep up the great work Prof Jiri Dvorak and team!

(Story originally posted in Healthcare Asia via FIFA)

On October 22, Football’s stalwart association, Switzerland headquartered Fédération Internationale de Football Association (FIFA) has launched the first-ever ‘FIFA 11 for Health’ programme in Asia, which encomapsses health education projects, among other activities.

Myanmar haa been chosen to host the said programme because it is a “football country”, according to a FIFA insider.

“It’s not a coincidence that Myanmar is the first Asian country in which we have implemented the ‘FIFA 11 for Health’ programme,” said FIFA’s Chief Medical Officer, Prof Jiri Dvorak. “Myanmar is a football country, and as such we are trying to use the power of our sport to tackle some concrete health issues. Both the Myanmar Football Federation and the country’s authorities have shown a consistent interest in our medical and health initiatives as they are convinced about the positive effect of football can have on health education and prevention.”

Teachers and coaches from 18 pilot schools have gathered in Yangon (Myanmar’s former capital before it has been superseded by Naypyidaw in 2005) for training sessions supervised by Dvorak. An additional three-day course on emergency medicine and anti-doping for member association doctors was also conducted.

The ‘FIFA 11 for Health’ is an innovative programme that promotes 11 simple messages aimed at reducing communicable and non-communicable diseases. The initiative is based on an analysis of risk factors by the World Health Organisation(WHO).

After Botswana, Colombia, Ghana, Kenya, Malawi, Mauritius, Mexico, Namibia, Solomon Islands, South Africa, Tanzania, Tonga, Zambia and Zimbabwe, Myanmar has become the 15th country in which the ‘FIFA 11 for Health’ has been organised.

“Given the fact that HIV, malaria and tuberculosis, to mention just a few examples, represent fundamental threats to public health in Myanmar, we have a concrete chance to make a valuable contribution to the country by conveying some of the key messages of our ‘FIFA 11 for Health’ initiative, such as ‘protect yourself from HIV’, ‘respect girls and women’, ‘avoid drugs, tobacco and alcohol’, ‘wash your hands’, ’and ‘drink clean water,” added Dvorak.

According to recent figures released by UNAIDS, about 216,000 people live with HIV in Myanmar, with the overall population being 55 million. AIDS-related illnesses, tuberculosis and malaria are among the ten leading causes of death in the country.

With an estimated base of over a million active players, Myanmar used to be a football stronghold in South-East Asia in the 1960s and 1970s, although the country has performed less well in international football since then.

Over the past two decades, FIFA has been actively promoting the development of football in Myanmar through a variety of initiatives, including the Goal Programme, the Financial Assistance Programme (FAP) and the PERFORMANCE Programme.

FIFA President Joseph S. Blatter visited Mandalay and Yangon in March 2011 to open Myanmar’s Goal project II (Mandalay’s football academy) and to lay the foundation stone for Goal IV (upgrading the stadium at the national youth academy). A total of four Goal projects have been implemented to date in Myanmar, and the construction of a fifth – an academy building at the National Football Training Center – was recently approved (HCA)

FIFA and education representatives join forces to combat childhood obesity and improve health

29 Oct, 12 | by Karim Khan

Congratulations to Mexican public schools representatives and FIFA, for leading the Latin American development of a joint initiative to combat childhood obesity and implement programs in schools to improve health.

FIFA’s 11 for Health was launched in Mexico in summer of 2011:

The “11 for Health” programme complements the Mexican government’s “5 Pasos por tu Salud”  (“Five Steps for Your Health”) and “Mídete, cuida tu peso” (“Measure Yourself, Watch Your Weight”) campaigns to harness the full potential of using football to promote health. Studies show that playing football, competitively or just for fun, reduces the risk factors for many diseases indicated by the World Health Organization (WHO). Based on these findings, F-MARC decided to combine the direct health effects of the game with its unique power in education and prevention to create this comprehensive health programme, using top players such as Mexico’s Carlos Vela and Javier “Chicharito” Hernández, Argentina’s Lionel Messi and Portugal’s Cristiano Ronaldo, to name just a few, to deliver health education messages to young people.

                                    -FIFA’s press release July 7, 2011

In Mexico City last week, Ministers and Vice-Ministers of education from 31 countries, along with representatives from international organization met to discuss the program’s further implementation into educational curricula.

The specific aims for Mexico (the first country outside of Africa to implement the program), includes a phased plan with targeted objectives to both ‘train-the-trainers,’ and ‘train-the students.’ A preliminary goal is to reach 22,100 of Mexico’s public secondary schools by 2014-2015.

Mexico’s Health Minister, Dr José Ángel Córdova Villalobos underscores the importance of action to improve the health of Mexican youth. He states that the average age when youth start smoking and consuming alcohol is 13.7 years — younger than in previous years.  Youths’ unhealthy consumption habits, combined with sedentary behaviour pose a great public health risk for Mexico which has a relatively young demographic.

The hope is that through football – “the world’s most popular language” – FIFA and their allies will communicate positive health messages that result in long-lasting behaviour change.

For more on the 11 for health program go here

Sudden Cardiac Death screening: notes of caution

31 May, 12 | by Karim Khan

By Lynley Anderson & Lynne Bowyer
Bioethics Centre, University of Otago

In his guest post on the BJSM Blog entitled ‘Call for NHS to review its policy on screening of young people at risk of sudden cardiac death’ Dr Steven Cox laments the decision of the National Screening Committee not to offer screening to young athletes (14-35 years). The National Screening Committee’s decision is in direct conflict with the position advocated by the organisation ‘Cardiac Risk in the Young’ (CRY) which is to offer screening to all young athletes.

We support screening where such screening is robust and can offer valuable and accurate information to young people and their families in making decisions about participation in sport. Unfortunately the current screening programme is not adequately robust and accurate. This is also a concern of the National Screening Committee 2009 stating that: ‘Owing to the multiple causes of SCD and the ambiguity of data collection, the accurate estimation of the incidence of death from these conditions is extremely difficult and unreliable.’As we have stated in our recent article on this issue, ‘death is not inevitable for those diagnosed with a SCD-linked condition, nor will abstaining from competitive sport ensure survival’. Despite the lack of definitive science, Cox wishes to establish a national screening programme on the grounds that prevention is central to a national health system. If CRY were to achieve its aims, it is important to consider the implications of adopting such a programme. Among the issues for consideration are concerns about consent, confidentiality, and what to do in the event of a positive result.



If screening is offered to all athletes, who decides whether any particular individual shall be screened? In the case of the younger athlete, should that decision be made by parents or the young person, and what should happen in the event of a disagreement? Although CRY advocate that screening should be offered and therefore left to the discretion of the athlete, how will this level of voluntariness be maintained? Could a club insist that all athletes are screened, and what could be the consequences of withholding consent in this situation?



Once a screening result is available who will have access to that information? Would the results be provided solely to the athlete, or in the case of the younger athlete will they also be given to parents? Will coaches, sporting bodies and team doctors also be provided with the results? The athlete needs to be fully aware of who will receive the results prior to undertaking screening.


Decisions about whether to continue to play

What are the next steps once a positive test is discovered? There is perhaps a perception that once discovered, the athlete will decide to discontinue, but what actions might be imposed if that person wishes to continue to play? Should that person be permitted to play where risk factors exist, and who gets to make that decision? We argue that mandatory exclusion of positive testing athletes is not a defensible option.


Setting aside the debate regarding the science underpinning SCD screening, any implementation requires a full consideration of its complexities and ramifications. Although a screening programme is beneficent in its aims, we need also to recognise that there are limits to the ways in which we can intervene in the lives of others.



Lynley Anderson is a Senior Lecturer at the Bioethics Centre/Te Pokapū Matatika Koiora, Division of Health Sciences, University of Otago.


 Lynne Bowyer is a PhD Student at the Bioethics Centre, University of Otago.


Safer bicycling. Better roads? More helmets? Increased legislation and enforcement?

23 May, 12 | by Caroline Finch


Last month in a BMJ blog, Domnhall Macaulay stated “Cyclists deserve our support; we need to address the risks of riding on the road and make cycling safer.” In one of my earlier BJSM blogs, I also pointed out that bicycling safety has long been a research and action goal of many injury prevention experts. The April 2012 issue of Injury Prevention contains several new papers, from Canadian injury prevention researchers, that each address some aspect of bicycling safety and injury.

Mecredy et al report data from a national survey of Canadian school-aged children about their injury experiences. The survey included a particular focus on the built environment and street connectivity close to the neighborhoods where they lived. A key finding was that children living in neighborhoods with poor connectivity reported more injuries and this was largely attributable to bicycling injuries. In fact, more than half of all physical activity related injuries that occurred on streets were associated with bicycling. The authors use these findings to argue for the design of safer streets, with more consideration given to separating bicycles from other forms of traffic.

There are varying approaches towards encouraging or supporting the use of cycling helmets globally. These range from mandatory road rules to educational campaigns aimed at voluntary uptake to little or no focus. In Toronto, legislation requires all cyclists under the age of 18 to wear helmets but older cyclists can choose whether or not to wear one themselves. It is not surprising, therefore, that the observational study by Page and colleagues has reported an overall bicycling helmet wearing rate of only 50%. Of course, children were much more likely to wear helmets than adults were (but not exclusively so). But females were also more likely than males to do so and helmet wearing rates were also highest in commuter cyclists. (The researchers also observed other types of recreational riders and found the use of helmets to be even lower in people who used scooters, inline skates and skateboards.) The authors recommend that the mandatory cycle helmets laws be extended to adults to increase helmet-wearing rates and that the legislation be more enforced across all age groups.

Irrespective of whatever actions are implemented to improve the environments or safety behaviors of bicyclists, high quality, reliable data is needed to evaluate the impact of these preventive strategies. Many bicycling-related injuries are treated in emergency departments (EDs) and therefore injury surveillance conducted at this place of treatment has the potential to contribute to ongoing population-level evaluation efforts. As demonstrated by Karhaneh et al, the use of International Classification of Disease (or ICD) codes specifically developed for bicycling injuries can be used reliably and accurately in the ED setting, confirming the value of ED data for bicycling injury surveillance. Unfortunately, the same could not be said for the other group of physically-active road users, the pedestrians.

There is no doubt that bicycling is a very healthy active pursuit that is to be encouraged. However, as with all other forms of physical activity, if injury risks are not kept to a minimum then bicycling will be unsustainable as a long-term population physical activity promotion strategy, particularly in countries which do not have the road infrastructure to support safer cycling. In terms of active road users, bicyclists have received the greatest safety research attention to date and are likely to still do so. But this is still good news, because strategies to improve safety for cyclists (particularly improved road infrastructure and driver behaviors) are also likely to benefit other non-motorised users of roads (pedestrians, runners, skateboarders, in-line skaters and the like) too.



Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Institute, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch

Call for NHS to review its policy on screening of young people at risk of sudden cardiac death

11 Apr, 12 | by Karim Khan

Guest blog by Dr Steven Cox (from CRY – Cardiac Risk in the Young

The UK’s National Health Service (NHS)  policy – that “screening should not be offered*”  is currently discouraging young people who may be at risk of sudden cardiac death from having simple, non-invasive and potentially life-saving tests.

The National Screening Committee need to review its position which is out of date

It is the view of the charity Cardiac Risk in the Young (CRY) that:

  • All young people (14-35 years old) should be offered the option to have cardiac screening
  • Cardiac testing should only be conducted by specialist cardiologists with the necessary skills and expertise to ensure accurate interpretation of the investigations.
  • The National Screening Committee policy should widen the remit to consider all cardiac conditions that can cause young sudden cardiac death
  • The National Screening Committee policy directly contradicts with the general NHS policy of “prevention”

Can anyone do these tests?

Cardiac screening needs to be overseen by a cardiologist with expertise in this specialist area of cardiology, including; athletes heart, ethnic differences in cardiac adaptation to exercise, and structural/electrical cardiac conditions. Professor Sanjay Sharma is a leading sports cardiologist and CRY’s consultant cardiologist who gives his time to oversee the CRY screening programme.

When a specialist cardiologist conducts the tests the number of false positives and false negatives significantly decrease (i.e. fewer people are told they may have a problem and are subjected to further investigations when they do not have a problem, and fewer people with a problem are given an all clear).

Could the NHS handle so many people wanting testing?

In the current economic era the answer is probably not. Moreover the NHS does not have the infrastructure, including the facilities or the expertise, to immediately implement a national screening programme for ALL young people.

However, CRY is leading the way in training specialist doctors, conducting research and providing educational resources so this will be possible in the future.

Although the implementation of nationwide screening is hampered at this point due to the economic constrains and lack of infrastructure and expertise that does not mean that screening should not be recommended. On the contrary, these limitations should prompt the development of a collaborative scheme between the Government, NHS, charity organisations such as CRY and sporting bodies to provide an initiative to offer cost effective screening.

Is there any evidence from other countries that screening is worthwhile?

In Italy where screening prior to participation in organised sport is mandatory they have reduced the incidence of young sudden cardiac death by 90%. This research has informed international policies that either mandate or recommend cardiac screening prior to participation in organised sport.

The current National Screening Policy is inconsistent with current practice at an elite level in most sports in the UK (including: the Football Association, Lawn Tennis Association, Rugby Football Union, Rugby Football League, Cricket, English Institute of Sport) and the fact that screening is often mandated for athletes when competing outside the UK.

Important Links

Support CRY’s epetition for the UK governement to change their policy on cardiac screening in young people here.

Learn more about the National Screening policy here 

Read Professor Sharma’s team’s response to the most recent National Screening Committee Review here [‘Unlocked’ courtesy of BMJ Group]

Follow CRY on twitter


Dr Steven Cox is the Director of Screening and Deputy Chief Executive of CRY. Unit 7, Epsom Downs Metro Centre

Waterfield, Tadworth, Surrey.


Is high level snowboard too dangerous to allow your children to participate?

1 Mar, 12 | by Karim Khan

Guest blog by Professor Lars Engebretsen

Photo by Aktivioslo, Flickr CC

The recent World Championship in Snowboard in Oslo, Norway led me to the question in this blog’s title. I am a sports doc with extensive experience in treating high level athletes in almost all kinds of sports (except Aussie rules football and cricket).

Since 2000, I have been involved in studies aiming at preventing sports injuries. We have targeted football (soccer), team handball and Alpine skiing and have had some success.  Newer sports however, keep popping up. Almost like the doping hunters  – often being too late to prevent new, effective performance drugs – it seems that we are too late to prevent injuries in some of the new sports.  I was reminded of this during the recent Snowboard Championship in Oslo: new venues for cross, half pipe and slope style situated beautifully in the Oslo countryside. The first days had bad weather and difficult light and there were some serious injuries- not life threatening, but nevertheless serious.

I have noticed a similarity with the last few Olympic games: the venues get bigger, the athletes better trained and with ever increasing abilities. Unfortunately, there is also an increase in injuries. The numbers from Vancouver showed that 35% of snowboard cross and 13% of half pipers experienced injuries.

What can we do to prevent these? We can count injuries, identify risk factors, study how to reduce these and aggressively implement our knowledge. In the meantime, the sporting venues get larger and more challenging and knowledge from our studies become yesterday’s news. I know that the majority of the athletes appreciate the danger, but I am not sure that the top leaders of the sport have the same awareness.

I need ideas to help the athletes operate in a safer environment- any ideas?

Note that the BJSM publishes 4 issues a year dedicated to Injury Prevention and athletes’ Health Protection (IPHP). You can find these issues of BJSM by clicking here. The next IPHP issue will launch in June and will focus on Olympic Sports. IPHP issues are published as part of BJSM’s partnership with the International Olympic Committee.

Nik Zoricik dcath: News story here. (added March 10th). Updated March 15th


Related Articles

Bakken A, Bere T, and Bahr R et. al. 2011. Mechanisms of injuries in World Cup Snowboard Cross: a systematic video analysis of 19 casesBr J Sports Med. 45:1315-1322 Published Online First: 15 November 2011.

Lars Engebretsen L and  Steffen K. 2009. Warm up The importance of sports medicine for the Vancouver Olympic Games. Br J Sports Med. 43:961-962.

J Torjussen J,  and Bahr R. 2006. Injuries among elite snowboarders (FIS Snowboard World Cup)Br J Sports Med. 40:230-234 .

Engebretsen L, and Bahr R. 2005. Injury prevention – Leader An ounce of prevention? Br J Sports Med. 39:312-313.


Lars Engebretsen MD PhD is a professor and director of research at Orthopaedic Center, Ullevål university hospital and University of Oslo Medical School and professor and co-chair of the Oslo Sports Trauma Research Center. He is also Chief Doctor for the Norwegian Federation of Sports, and headed the medical service at the Norwegian Olympic Center until the autumn of 2011. In 2007 he was appointed Head of Science and Research for the International Olympic Comittee (IOC). Professor Engebretsen is Editor of the IPHP issues of BJSM (Injury Prevention & Health Protection)

Fitness and health of children through sport: the context for action – Guest Blog Caroline Finch

20 Oct, 11 | by Karim Khan

(follow Caroline Finch on Twitter — @CarolineFinch)

This relates to:

Micheli, L, Mountjoy, M, and Engebretsen, L et al. 2011. Fitness and health of children through sport: the context for action. BJSM. 45:931-936

photo: owenfinn16 via Flickr cc

I read, with great interest, the paper by Micheli et al [1]in the September Injury Prevention and Health Promotion issue of the BJSM,because it outlined  different policy contexts for action.  These contexts are generally consistent with the ecological levels of sports delivery we outlined in the Sports Setting Matrix as a framework for the implementation and evaluation of programs delivered through sport.[2]  It is also consistent with our previous argument that the sports delivery and policy contexts need to be more aligned for global sports safety.[3]

Given that injury is one of the major barriers towards participating in sport,[4] it is surprising that no international policy link for addressing this key factor in children’s sports participation was named in the article.  Many of the organisations named in the paper (e.g. the World Health Organization) have divisions that are concerned with injury prevention as well as NCD (non-communicable disease) prevention, for example. A major way forward to ensuring lifelong participation in sport would surely be to bring together the policy bodies for physical activity/sport promotion together with those concerned with reducing or removing injury risk in such activities.

Whilst there is no doubt that having global policy is a key driver of action and priority attention given to health issues, it is largely practitioners at a more local level who need to implement those policies and to translate them into appropriate acceptable and sustainable programs.  In the sports injury context, we have found a mismatch between what the policy makers want and what the practitioners or implementers need.[5] Moreover, just because there is an international policy/guideline/directive one cannot assume that the desired practice or action at the grass roots level of participation, even at a low level, is achieved.[6]  No matter how much evidence-base there is for a new policy, the end-users will have their own perspectives that will directly influence their readiness to act according to the desired policy result.[7]

Having global, national and local policy responses to fitness and health (including injury prevention) will be crucial for ensuring lifelong participation in sport well into the future.  But not less so than also ensuring both an adequate informed workforce of practitioners to deliver associated programs and end users who are fully receptive to the messages that have been appropriately targeted to reach them.


1.         Micheli L, Mountjoy M, Engebretsen L, et al. Fitness and health of children through sport: the context for action. Br J Sports Med. 2011;45:931-6.

2.         Finch CF, Donaldson A. A sports setting matrix for understanding the implementation context for community sport. Br J Sports Med 2010;44:973-8.

3.         Timpka T, Finch CF, Goulet C, et al. Meeting the global demand of sports safety – the role of the science and policy intersection for sports safety. Sports Med. 2008;39:795-805.

4.         Siesmaa E, Blitvich J, Finch CF. Chapter 1. A systematic review of the factors that are most influential in children’s decisions to drop out of organised sport.  In: Farelli A, editor. Sport participation: health benefits, injuries, and psychological effects: Nova Science Publishers Ltd; 2011. p. 1-45.

5.         Poulos R, Donaldson A, Finch C. Towards evidence informed sports safety policy for NSW, Australia: assessing the readiness of the sector. Inj Prev. 2010;16:127-31.

6.         Hollis S, Stevenson M, McIntosh A, et al. Compliance with return-to-play regulations following mild traumatic brain injury in Australian schoolboy and community rugby union players. 2011;On line First, published on June 24, 2011 as 10.1136/bjsm.2011.085332.

7.         Donaldson A, Leggett S, Finch CF. Community perceptions of a draft policy and training structure for Australian football sports trainers at the community level: a qualitative analysis. 2011;In press. Published online 16 September 2011 as DOI: 10.1177/1012690211422009.


Caroline Finch is an injury prevention researcher specialising in implementation and dissemination science applications for sports injury prevention.  She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group.  Caroline can be followed on Twitter @CarolineFinch

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