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Quarterly Institute Update

The Institute for Preventative Sports Medicine

July 1999

Now that summer has finally arrived, we hope that all of you are remembering to Play It Safe! Summer is the prime season for activity related injuries, and all of us must remember that prior to activities we need to institute a comprehensive warm up program. In addition, at the conclusion of activities, a cool down period should also be implemented. We hope all of you have a very safe and enjoyable summer season!

Research Update

Members of the Institute's Board of Directors and Advisory Council have continued to produce leading edge research on the fronts of injury prevention and health care cost containment. Between 1990 and 1997 over 300,000 golf injuries were sustained by the American public. Over the past year alone, over 39,000 individuals presented to emergency rooms with significant injuries related to golf. Forty-two percent of these injuries were sustained to the head and face, and most of the injuries in golf occurred in the 5-14 year age group. In addition, 84 individuals died due to golf related injuries in 1997 alone. When the mechanisms of injuries are reviewed, approximately 37% of all golf emergency room visits are due to a club impact, and another 28% of injuries are due to impact of the ball to the individual. Therefore, we were very excited when we were approached by Golf Digest and, in particular, by Mr. Scott Smith, to analyze golf related injuries that are occurring throughout the United States. Golf Digest awarded the Institute a grant to investigate the impact of these golf-related injuries. Our research team, Mr. Brian Czach and Ms. Beth Kedroske, traveled to California to work with the engineers from Golf Digest magazine to analyze the issue. The Institute was identified by the editors of Golf Digest magazine as being on the leading edge of injury prevention issues within golf and, in particular, as it relates to impact mechanisms.

Those of you familiar with the Institute are well aware of our ground breaking research on head and chest impact injuries as they relate to the sports of softball, baseball and, most recently, soccer. In our current golf study, we utilized the Hybrid III Crash System, which we have utilized in our previous studies in softball, baseball and soccer to evaluate the forces of impact as it relates to the club and the ball impacting an individual’s head, chest and leg.

Four tests were completed under the auspices of Mr. Czach, Ms. Kedroske, and the Golf Digest engineers. A 9 driver was initially used at a swing speed of 105 MPH and the ball was driven into the chest of the Hybrid III Crash Model from 35 yards. In addition, the driver was used from 35 yards impacting the Hybrid III Crash Model’s head and, finally, the Crash Model’s leg was impacted by a ball from 8 yards and by a club into the head of the crash model. The results of our study reveal that the risk of a fatal chest impact injury was approximately 1/10th of the impact of a body into a steering wheel in a head-on fatal automotive collision. The risk of life threatening brain injury from a golf ball to the head from 35 yards was less than a 1% risk. The forces generated upon impact of the Crash Model’s leg with a golf ball from roughly 8 yards led to forces which could result in a tibia fracture. Finally, the test of the Crash Model’s head being impacted by a club revealed a less than 1% risk of a life threatening brain injury. I have enclosed a copy of the Golf Digest article for your review which ran in the June issue. Needless to say, we have had a very positive response from this feature article, and we truly appreciate the involvement of Golf Digest in this study. Needless to say, without their help and support, this study would have not come to fruition.

The conclusions of this particular study was that in Pro-Am events the crowd needs to be moved away from the tee box in order to avoid significant potentially fatal impacts that are occurring. In addition, when children are playing, both practicing around their home or in a driving range or golf course setting, an adequate area of clearance needs to be maintained around each participating child so that impacts are not occurring either with the ball or with the club.

As I outlined in our last Quarterly Update, we have completed two other studies. The first is entitled A Laboratory Analysis of a Preventive Intervention for Softball and Baseball: Standard Versus Breakaway Bases. The study was co-authored by Dr. Janda, Ms.Cindy Bir and Ms. Beth Kedroske. We continue to wait on word of a publication date of this particular study. The findings of this laboratory analysis revealed that all breakaway bases are not created equal and do not have an equal effect in reducing injury. The models which we found to be the most effective at reducing the forces of impact and, therefore, the highest potential reduction of injury were the Roger’s Breakaway Bases, which had previously been utilized in our field studies throughout North America.

Our second study which was submitted for publication is entitled An Evaluation of the Cumulative Concussive Effect of Soccer Heading in the Youth Population which is co-authored by Dr. Janda, Ms. Cindy Bir, Ms. Angela Cheney and Ms. Leslie Lange. This continues to be under review by a peer reviewed medical journal. We await the publication date of this particular study. As we have outlined in the past, the findings of this study are significant. At the conclusion of the second group of seasons studied, we found in one of our cognitive function tests that there was a diminution, at a low level of statistical significance, of information processing and memory ability as the amount of heading increased. Therefore, it is our recommendation that a lighter mass ball be utilized in soccer heading drills and the possibility of a helmet could also be entertained as a means of reducing the force of impact on a repetitive basis.

In addition, our chest impact research as it relates to the sport of baseball has continued to gain significant attention and, in fact, the Physician in Sports Medicine journal will be including the Institute’s series of studies over the past several years on this issue in their August edition.

In a subsequent study, as it relates to chest impact injury in baseball, we have now completed the statistical analysis of our chest protector research and, in fact, we are in the process of writing up this particular study to be presented for peer reviewed publication in the future. Our study reveals there are no current chest protectors on the market which significantly protects athletes from chest impact injury and/or fatality at all levels of play and ball speed. In fact, some of the chest protectors reduced the potential risk of injury at certain speeds, but as the speed increased, the beneficial effects of that particular chest protector dissipated to below statistical significance. At this point, the chest protector manufacturers still need to be in search of a "better mousetrap" in order to prevent the chest impact fatality scenario.

Included in this Quarterly Update is an order form for the new parent’s handbook entitled Head Up, Eyes Forward: Guide to Preventing Football Injuries. This handbook was developed through the Governor’s Council on Health Fitness and Sports. Dr. Janda served as the chairman of a 22 member organization advisory group which developed a position paper entitled The Prevention of Injuries in Amateur Football. This has been included in our previous Quarterly Update and was the basis for the handbook. This 32 page handbook is inclusive as it relates to football injuries and the prevention of these same injuries. If you are so inclined please see the order form enclosed in this update to obtain a copy.



Members of the Board of Directors and Advisory Council have continued to present information throughout North America on our injury prevention and health care cost containment approach. Dr. Janda had the opportunity of being the featured Abrams Lecturer at the University of Maryland. In addition, he was the keynote speaker at the University of Maryland Shock Trauma Center. It was truly an honor to be selected as the Abrams Lecturer and his presentation focused on the Institute’s injury prevention and health care cost containment approach. In addition, the lectureship at the University of Maryland-Shock Trauma Center introduced the concept of the role of injury prevention within health care reform. The Institute’s work on the injury prevention front was also the focus of this presentation and the application of our research as a means of preventing health care need as the most beneficial method of reducing unnecessary health care expenditures. We truly appreciate the relationship that we have developed with the University of Maryland and, in particular, Dr. John Herzenberg.

Dr. Janda has also been selected as the keynote speaker at the North Carolina Medical Society Annual Meeting which will be occurring in July. Dr. Janda will be presenting the Institute’s injury prevention approach to sports medicine with the added application of the Institute’s work to health care reform proposals. This is the second opportunity we have had in the State of North Carolina to present to a distinguished group of medical providers, and we look forward to our ongoing relationship that we have developed with our colleagues in North Carolina.



The Institute has continued to garner significant print and electronic media coverage as it relates to our injury prevention and health care cost containment approach. Over the past 3 months, the diversity of our exposure to the public has continued to grow on both a national and international basis. In the print media, the Institute’s work was featured in the LA Times, Keeping Well magazine, Canadian Living magazine, Men’s Health magazine, as well as the feature article in Golf Digest magazine. The electronic media has also featured the Institute’s work, in particularly on CBS Evening News, who focused on our head impact injury prevention research. This particular segment was also re-broadcast on CBS This Morning. CNN, under the direction of Dr. Steve Salvatore and Mr. Alan Statsky, presented research on golf injuries to the American public. This particular segment featured Golf Digest, as well as the Institute and the study that is highlighted in your supplement. This particular segment ran on CNN several times, as well as on their health show hosted by Dr. Steve Salvatore. In addition, the piece ran on CNN Headline News, CNN International, CNN FN and on the CNN Airport Channel. In addition, well over 100 station affiliates associated with CBS, NBC, ABC, Fox and Paramount re-broadcast the CNN piece on their local evening news channels. We have had a very positive response from the public throughout the United States and internationally on the CNN segment. Finally, the Institute’s research was discussed on radio in the Detroit area by Dr. Dick Purtan on WOMC radio. Mr. Purtan is a member of our Advisory Council and is the Marconi Award winner for Radio Personality of the Year in the United States. All of us at the Institute truly appreciate the media’s interest in our research.


TO: The Board of Directors, Advisory Council, Contributors and Friends of the Institute for Preventative Sports Medicine

FROM: David H. Janda, M.D., Director

The past 3 months have once again been extremely productive at the Institute, as is evident from the before mentioned review of our quarter. We continue to focus our efforts at the Institute on injury prevention and health care cost containment, and we have truly become the most consistent research organization on this subject on an international basis. Members of our Board of Directors and Advisory Council have continued to be on the leading edge of developing and presenting injury prevention concepts and state of the art research on a national and international basis, which will ultimately benefit our population as a whole in a very positive manner.

Our study on golf injuries which was funded by Golf Digest magazine and given such a prominent role by Golf Digest in their publication, as well as by CNN has opened the eyes of a number of different individuals participating in the sport of golf. As we mentioned in the body of our research, over 300,000 individuals have sought emergency room treatment for their golf injuries over the past 7 years. Our goal is to make individuals more cognizant of the most common mechanisms of injury and therefore, by being more aware of these scenarios, prevention of these injuries will ultimately come to fruition.

It should be noted that without the help of the media, our research would not be benefiting the pubic in such a positive manner. It has been our contention since the inception of the Institute 10 years ago this month, that we can do the best research in the world and win a number of national and international awards; however, if the public whom we are doing the research for is not cognizant of our studies, unnecessary injuries and escalating health care expenditures will continue to be the standard. It has been our finding that with the involvement of the media, our research is delivered to the public’s doorstep and into the public’s living room on an immediate basis. Our most beneficial preventive effects have come from the media’s continued involvement in our research, thereby benefiting the public in an immediate time frame. I truly appreciate the efforts of Dr. Steve Salvatore, Mr. Alan Statsky, as well as Mr. Scott Smith from Golf Digest magazine.

An important aspect of our success at the Institute over the years has been our networking and integration of our efforts with other prestigious organizations. Our affiliation with the American Academy of Orthopedic Surgeons, the Governor’s Council on Health Fitness and Sport, the Center for Disease Control and Prevention, the New South Wales Olympic Organizing Committee in Australia, as well as our recent experience at the University of Maryland are just some examples of the relationships we have built over the years, which have truly been win-win relationships. By utilizing our efforts and our research, which we have accomplished at the Institute, these organizations have been able to further their outreach on the injury prevention and health care cost containment fronts. We look forward to the road ahead with these organizations and hope, that as time progresses, we will continue to be able to build bridges with other organizations by linking our research with the communities that they serve.

We look forward to the Eighth Annual Mid-American Sports Medicine Symposium, as well as the Celebrity Benefit Auction, which will be hosted at the Eagle Crest Marriott on the Lake Conference Center in the Ann Arbor area in Michigan on April 13-15, 2000. Needless to say, the symposium has gained a significant following in the medical community and many of the concepts and techniques that

we present at this course are then utilized throughout North America as it relates to prevention and treatment techniques. In addition, the Celebrity Auction, which has been hosted by Mr. Dick Purtan, has continued to garner significant support from our local community in the Detroit metropolitan area. We hope that all of you will be able to attend next year’s event and, that if you are unable attend, you will be able to donate the necessary items so that we may continue our very innovative and progressive research activities. All of us who are actively involved at the Institute on a day-to-day basis truly appreciate your ongoing support. Have a great and safe summer season!

David H. Janda, M.D.