Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)
The British Journal of Sports Medicine (BJSM) Volume 48, Issue 3 is devoted to physical activity promotion and “Exercise as Medicine”. However, as the deliberately provocative title of this particular cross IP-BJSM Blog indicates, there is nothing in any of the papers in this particular BJSM issue that links injury prevention to physical activity promotion. Even a paper on how the built and social environment influences people choosing inactive lifestyles, ignores the extensive literature on how to make such settings safer and more useable because injury hazards are removed. So could it be that the title of this blog is true. But I would challenge any reader of this blog to provide evidence to support such a stance. Given the lack of papers directly related to injury prevention in this particular BJSM issue to discuss, I am going to take this opportunity to explain why this aforementioned fact is, in fact, fiction.
As long ago as 2003, separate Editorials by Ray Shepherd I and Marshall & Guskiewicz in Injury Prevention argued for the importance of linking promotion of exercise/physical activity (PAP) to injury prevention (IP) to ensure that health and fitness goals. Even earlier, I published a paper that outlined the nexus between physical activity promotion and injury prevention. These are not the only commentaries to have discussed the links between the two, but I am left wondering why there remains such a gap. Which sector, physical activity promotion or injury prevention, benefits the most from the gap?
At its most basic, on a per exposure basis, sports (including exercise, fitness, physical activity) related injuries only occur when people participate in such activities. By definition, and if nothing is concurrently done to actively encourage safe participation, more people being encouraged to be physically active (by physical activity promoters) means that more people will be exposed to the risk of injury (even if small). And more people will present with injuries needing medical treatment or with lifelong disability outcomes.
Ok – this may be good for injury prevention professionals because we have larger numbers of cases to document, prevent and treat. But it also seems to me that this scenario is a WIN (for PAP) -WIN (for IP) for both physical activity promoters (because more people will be active) and for injury/injury prevention professionals (because there are more injuries for us to deal with). But it would also lead to increased burden on our medical delivery systems due to the need to deal with injury management and repair. Injury prevention could prevent this poor population health outcome.
We also know that many people who are injured have to stop their physical activity for some time to recover and a significant number do not return to their pre-injury activity levels. This is, in a sense, a LOSS (for PAP) – WIN (for IP) scenario because fewer people will remain active, but there will still be lots of injuries and injury consequences to deal with. Moreover, an increasingly larger number of people will not take up physical activity because they are fearful of injury. Reductions in physical activity levels at the population level will lead to an increased chronic disease burdens that will need to be met by our healthcare systems. Still not being proactive about sports injury prevention, will mean that fewer people remain active.
Overall, it seems to me that the physical activity and sport promotion sector has much more to lose from ignoring injury prevention strategies than we do the other way around. By not incorporating injury prevention principles as standard practice into their activates, and by continuing to largely ignore the injury prevention literature around issues that are directly relevant to supporting and enabling physically active populations, there is every likelihood that injury rates and their public health burden will increase whilst participation rates will stabilise or further decline.
It is clearly a myth that “Physical activity promotion has nothing to gain from injury prevention”. If we injury prevention professionals are doing our jobs properly, there should be fewer injuries for us to concern ourselves with, not more of them. In essence, over time, we should be doing ourselves out of a job. We should be sharing our injury prevention strategies with the physical activity promotion professionals, especially those operating at the broad population level.
Is it the injury prevention or physical activity promotion professionals who are most to blame for the two not to be linked?
From one viewpoint, it could be argued that many of the current physical activity promotion and “Exercise is Medicine” activities are doing everything possible to ensure that this outcome is not achieved. They do not even mention “injury risk” or “safety strategies” in many of their resources and programs. But equally, it could be that the injury prevention sector is not doing enough to engage with those who are most concerned about other health issues and so have not convinced them of our integral relevance to them.
No matter the reason for not currently linking the two health promotion issues, it seems to me that there will be plenty of sports and physical activity related injuries for me and my colleagues to keep on preventing for a very long time! BUT even I can see that this is NOT a good thing for the health of all.
Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) 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 the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.