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 Recto Running Head i

CATASTROPHIC INJURIES IN SPORTS AND RECREATION:

CAUSES AND PREVENTION – A CANADIAN STUDY

Edited by Charles H. Tator

Injuries sustained in connection with sports and recreational activities

are a major cause of all injuries and, of these, the catastrophic ones –
those resulting in death or lifelong disability – comprise a significant
proportion. Catastrophic injuries take a tremendous personal toll on
individuals and their families, and result in major financial costs to
society for medical care, supports and services, and for the replace-
ment of lost earnings. However, the risk factors associated with
injuries acquired in sports and recreational activities, and the particu-
lar causes of such injuries, have not been given a great deal of atten-
tion in terms of systematic documentation and assessment.
This book is unique in that it presents a comprehensive description
and analysis of all catastrophic injury cases reported during four 12-
month periods over the course of a decade for more than 100 sports
and recreational activities in Ontario, Canada’s most populous
province. Included are personal and population risk data and injury
prevention strategies and tips for each activity. The book begins with
a summary of the overall results of the study and the various epi-
demiological factors addressed throughout the book. The introductory
chapters also discuss general matters such as principles of injury pre-
vention, types of injuries, and demographic concerns. The next 55
chapters are devoted to detailed analysis of catastrophic injuries
incurred in separate categories of sports and recreational activities.
Catastrophic Injuries in Sports and Recreation provides a wealth of
information in a clear and accessible manner. It will be an invaluable
resource for researchers, policy-makers, administrators, medical per-
sonnel, coaches, league officials, and others concerned with injury
prevention in sports and recreation.

charles h. tator is a professor of neurosurgery at the University of

Toronto.
This page intentionally left blank
 Recto Running Head iii

Catastrophic Injuries in
Sports and Recreation
Causes and Prevention –
A Canadian Study

EDITED BY CHARLES H. TATOR

UNIVERSITY OF TORONTO PRESS

Toronto Buffalo London
 iv Verso Running Head

© University of Toronto Press Incorporated 2008

Toronto Buffalo London
www.utppublishing.com
Printed in Canada

ISBN 978-0-8020-8967-0

Printed on acid-free paper

Library and Archives Canada Cataloguing in Publication

Catastrophic injuries in sports and recreation : causes and prevention :

a Canadian study / edited by Charles H. Tator.

ISBN 978-0-8020-8967-0 (bound)

1. Sports injuries. 2. Sports injuries – Prevention. I. Tator, Charles H.

RD97.C373 2008 617.1′027 C2008-902858-9

University of Toronto Press acknowledges the financial assistance to

its publishing program of the Canada Council for the Arts and the
Ontario Arts Council.

University of Toronto Press acknowledges the financial support for its

publishing activities of the Government of Canada through the
Book Publishing Industry Development Program (BPIDP).
 Recto Running Head v

Contents

Editor’s Acknowledgments xiii

Contributors xv

SECTION 1. INTRODUCTION AND OVERVIEW

1 Description of the Study 3

charles h. tator
Methods 8 / The McLaren Report 15 / Explanation of
Calculations and Derived Values 17

2 Overview of the Results of the Ontario Study, 1986–1995 21

charles h. tator
Number of Injured Participants 21 / Age and Gender of the
Injured Participants 22 / Sports and Recreation Activities in
Which the Injuries Occurred 23 / Age of Injured Participants
in Each Activity 29 / Month of Injury 31 / Injury Sites –
Terrain 32 / Anatomical Locations and Types of Injuries 33 /
Supervision and Organizations Involved 34 / Alcohol Con-
sumption 37 / Prevention 37 / Relative Risks of Cata-
strophic Injury 40

3 Sports Injury Prevention: General Principles 58

christine provvidenza and charles h. tator

4 Geographical Locations Where 2,154 Catastrophic Sports and

Recreation Injuries Were Sustained 79
charles h. tator
vi Contents

5 Anatomical Locations and Types of Ontarians’ Catastrophic

Injuries 119
alun ackery and charles h. tator

SECTION 2. WATER SPORTS

6 Canoeing 121
yusra ahmad and charles h. tator

7 Sailing 139
pemma muzumdar

8 Personal Watercraft 148

douglas j. cook and charles h. tator

9 Other Boating Activities 158

pemma muzumdar and charles h. tator

10 Fishing 169
yusra ahmad and charles h. tator

11 Diving 180
sheila heinicke and charles h. tator

12 Scuba-Diving 192
sheila heinicke

13 Swimming 201
alun ackery

14 Waterskiing 209
pemma muzumdar

15 Other Water Sports: Parasailing, Parachute-Skiing, Sailboarding,

Sea-Biscuit Riding, Surfing, Water-Tubing, Water Polo, Water-
sliding, Water Play, Windsurfing 221
michael detsky and mark o. baerlocher
 Contents vii

SECTION 3. MOTOR SPORTS

16 Snowmobiling 229
sheila heinicke and charles h. tator

17 All Terrain Vehicle Riding 243

sheila heinicke and charles h. tator

18 Motorbiking 257
vanessa i. paesani and charles h. tator

19 Dirt-Biking (Off-Road Motorcycling) 268

daniel h. ovakim

20 Other Motor Sports: Mopedding, Motorcycling, Mini-biking,

Trail-Biking, Stock Car Driving, Go-Carting 279
pemma muzumdar

SECTION 4. WINTER SPORTS

21 Ice Hockey 291

fady saleh and charles h. tator

22 Ice Skating 305

adnan jalal and charles h. tator

23 Alpine Skiing 318

helen simson and charles h. tator

24 Snowboarding 333
alun ackery

25 Cross-Country Skiing 342

daniel r. ricciuto

26 Tobogganing and Sledding 353

mark o. baerlocher and charles h. tator
viii Contents

27 Other Winter Sports: Ringette, Curling, Boot Hockey,

Broomball 363
pemma muzumdar and charles h. tator

SECTION 5. BICYCLING AND OTHER STREET ACTIVITIES

28 Bicycling 371
fady saleh, helen simson, and charles h. tator

29 In-Line Skating 382

mark o. baerlocher, cynthia koch, and fady saleh

30 Skateboarding 395
bilal butt and charles h. tator

31 Running and Jogging 405

fatima butt and charles h. tator

SECTION 6. AIR SPORTS

32 Flying Small Aircraft 419

meredith giffin and mark o. baerlocher

33 Other Air Sports: Ultralight Air Sports, Hang-Gliding,

Para-gliding, Gliding 428
sana rahman and charles h. tator

34 Parachuting 436
mark o. baerlocher

SECTION 7. FIELD SPORTS

35 Baseball 449
alun ackery

36 Football 457
fady saleh
 Contents ix

37 Soccer 470
fady saleh and adnan jalal

38 Rugby 483
fady saleh

39 Other Field Sports: Track and Field, Field Hockey, Lacrosse 496
pemma muzumdar

SECTION 8. RACQUET SPORTS

40 Badminton 505
sana rahman and charles h. tator

41 Racquetball 515
kashif pirzada

42 Squash 521
ishtiaq ahmed

43 Tennis 531
adnan jalal

SECTION 9. EQUESTRIAN SPORTS

44 Horseback Riding 547

christine provvidenza

SECTION 10. FLOOR SPORTS

45 Basketball 563
marium fatima and charles h. tator

46 Floor Hockey 573

bilal butt, prakash motwani, and charles h. tator
x Contents

47 Gymnastics 580
adnan jalal

48 Wrestling 593
fady saleh

49 Martial Arts: Karate and Tae Kwon Do 604

mark o. baerlocher

50 Other Floor Sports: Weightlifting, Volleyball, Handball, Gym,

Boxing, Kick-Boxing 615
sana rahman

SECTION 11. PLAYGROUNDS AND PLAY

51 Playgrounds and Play: Tree Climbing, Slides, Monkey Bars 623

christine provvidenza and charles h. tator

SECTION 12. MISSILE SPORTS AND RECREATIONAL

ACTIVITIES

52 Hunting 637
fady saleh and adnan jalal

53 War Games (Paintball) 651

alun ackery

54 Air Guns 658

fady saleh and ishtiaq ahmed

55 Other Missile Sports: Darts, Archery, Target Practice,

Slingshot 667
sana rahman

SECTION 13. SUMMER SPORTS

56 Golf 677
alun ackery
 Contents xi

57 Ball Hockey 684

prakash motwani, bilal butt, and charles h. tator

58 Camping and Hiking 693

alun ackery

59 Mountain Climbing 701

maia von maltzahn, mark o. baerlocher, and charles h. tator

60 Other Summer Sports: Roller Skating, Walking, Billiards, Tree

Climbing, Kite Flying, Steer Wrestling, Fairgrounds 711
sana rahman

61 Conclusion 719
charles h. tator

APPENDIXES

Appendix l: Survey Questionnaire 726

Appendix 2: Participation and Injury Rates – Males, Females,
and by Sport, from the McLaren Report 728
Appendix 3: Population of Ontario 730

Index 731
This page intentionally left blank
 Contents xiii

Editor’s Acknowledgments

Fady Saleh, MD, played a major role in helping to compile and analyse
the data, as a medical student engaged in scholarships for two succes-
sive summers. Lillian Lapczak, B.Sc., was responsible for data input,
tabulation, and display. Maria Vespa helped with chapter formatting
and word-processing. Sarah Lord helped with the locations chapter.
Funds for the project including data capture, data entry, and analy-
sis, and for sponsorship of this publication were provided by research
grants from the Sport and Recreation Programs Branch, Sport and
Recreation Division, of the Ontario Ministry of Tourism and Recre-
ation. The sports safety responsibilities of this ministry have since been
transferred to the Ministry of Health Promotion, Ontario, which has
continued to encourage publication of this book.
The staff of the ThinkFirst Foundation, Canada, and especially pre-
vious executive directors Jim Russell, Virginia Edmonds, and Eleanor
Sam, and former sports injury prevention coordinator Christine
Provvidenza, were very helpful in completing this project. Their
support is greatly appreciated. I wish to acknowledge the support of
ThinkFirst by its major donors: TD Bank Financial Group, Ronald
McDonald House Charities, Aviva Insurance, J & H Medical Products,
Tridel, and the Krembil Foundation.
The Ontario Medical Association provided strong support for this
study through dissemination of questionnaires to its members and by
encouraging the cooperation of its members. Tom Pashby, MD, was
very helpful in providing information on eye injuries.
I am grateful to my wife, Carol Tatot, for her support and advice.
xiv Editor’s Acknowledgments

Finally, I wish to thank the many chapter authors who put forth a
major effort towards prevention of these catastrophic injuries. Many of
the authors were medical students in the Faculty of Medicine, Univer-
sity of Toronto, when they wrote these chapters. They devoted their
scarce time to this project because they understand its importance.
 Contents xv

Contributors

Alun D. Ackery, BSc (Hon.), MD, MSc

Emergency Medicine Resident
University of Toronto
Marium F. Ahmad, BSc MD
Family Medicine Resident, McMaster University
Ishtiaq Ahmed, BSc (Hon.), MD
Resident Physician
Yusra N. Ahmed, BA, MD
Resident Physician, University of Alberta
Mark Otto Baerlocher, BScH, MD
Resident Physician, University of Toronto
Bilal Butt, BSc
Medical Student, Ross University School of Medicine
Fatima T. Butt, BSc
High School Teacher
Douglas J. Cook, BSc, MD
Resident in Neurosurgery, University of Toronto
Michael E. Detsky, BSc, MD
Resident Physician, University of Toronto
Meredith Giffin, BSc (Hon.)
Medical Student, University of Ottawa
xvi Contributors

Sheila V. Heinicke, BSc OT Reg., MEd

Occupational Therapist, Regional Mental Health Care, St Joseph’s
Health Care – London
Adnan Jalal, BSc, MD
Medical Student, University of Toronto
Alana Kalyniuk, BSc (Hon.)
Cynthia R. Koch, BSc Health Sciences
Prakash (Paul) Motwani, BSc
Medical Student, St Matthew’s University
Pemma Muzumdar, BSc
Educator, Health Promotion
Daniel H. Ovakim, BSc, MD, MSc
Resident Physician, University of Western Ontario
Vanessa Paesani, BSc
Mount Allison University
Kashif Pirzada, BSc, MD
Resident Physician, McGill University
Christine F. Provvidenza, BPHE, MSc
Neurology Services, Toronto Rehabilitation Institute, Past Research
and Program Manager, ThinkFirst, Canada
Sana Rahman, BSc
Medical Student, University of Ottawa
Daniel R. Ricciuto, MSc, MD
Resident Physician, University of Toronto
Fady Saleh, BSc, MD
Resident Physician, McMaster University
Helen Simson
Research Consultant
Charles H. Tator, CM, MD, PhD
Professor of Neurosurgery, University of Toronto, Founder, Think-
First, Canada
Maia E. von Maltzahn, BSc
Medical Student, Dalhousie University
 Canoeing 1

SECTION 1

Introduction and Overview

This page intentionally left blank
 Recto Running Head 3

1 Description of the Study

charles h. tator

For any given population, injuries sustained in connection with sports

and recreational activities account for a significant proportion of all
injuries, and of these, the catastrophic ones – such as brain or spinal
cord trauma and fatalities – comprise a significant proportion.1–7 Cat-
astrophic injuries can result in death or lifelong disability, with major
effects of all kinds on the injured individuals and their families, and
major financial costs to society for medical care, supports, and serv-
ices, and for the replacement of lost earnings. The risk factors associ-
ated with injuries acquired in sports and recreational activities, and the
particular causes of such injuries, are not well understood.8
This book presents a comprehensive description and analysis of all
catastrophic injuries sustained during the period 1986–95 by the resi-
dents of Ontario, Canada. In 55 chapters we examine catastrophic
injuries, and their prevention, for 55 separate sports and recreational
activities (or groups of similar activities, where participation numbers
for any one of them are very small) based on the data from four 12-
month prospective surveys undertaken by our research team. We
begin, however, with a summary of our overall results and the various
epidemiological factors that we address throughout this book (Chapter
2), the general principles of sports injury prevention (Chapter 3), the
locations in Ontario where participants in sports and recreational activ-
ities sustained catastrophic injuries during our study period (Chapter
4), and the parts of the anatomy that were injured (Chapter 5).
The data and analysis presented in this book are based on four 12-
month prospective surveys of catastrophic sports and recreation
injuries sustained by Ontarians, undertaken by our research team
between 1986 and 1995; a one-time survey, undertaken by others in
1995, for all of Ontario, of participation rates for and the injuries
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