Covering all the bases: school sports and risk mitigation

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In addition to creating great memories, research shows that school sports can instill confidence and raise self-esteem, while teaching important lessons about leadership and teamwork.
A recent Cornell University study showed that youths who participated in high school sports tend to get better jobs and earn higher salaries later in life. A study from the Foundation for Global Sports Development found that school sports programs can have a positive impact on physical health – obesity has been linked to a decline in funding for school sports programs – and can encourage more healthful eating habits.
While their place in education, society and community is beneficial, school sports do create potential injury risks for participants as well as potential liability exposure for school districts and municipal governments. There are several areas where administrators and local leaders can put procedures and best practices in place in order to help mitigate these risks as much as possible.
Player readiness
Being active and participating in sports is safe for most youths, but it is crucial to ensure that each participant’s readiness is confirmed by a third party, namely a physician. The American Academy of Pediatrics recommends that pediatricians thoroughly assess “developmental readiness and medical suitability … to participate in organized sports and assist in matching a child’s physical, social, and cognitive maturity with appropriate sports activities.”
The National Athletic Trainers’ Association and the North American Booster Club Association recommend that all youths receive both a general medical exam, including a check of the heart and lungs, and an orthopedic exam prior to participating in school sports. A suggested medical questionnaire for physicians to use when making assessments is available on the Massachusetts Interscholastic Athletic Association website ( and can be shared with parents.
Concussion prevention
Parental and coach involvement is key, particularly in ensuring player readiness via medical exams, as well as with training regarding potential injuries and associated risks. One key area of concern is the high incidence of concussions in school sports – a topic that has attracted national attention in recent years, as well as mitigation efforts.
The U.S. Centers for Disease Control and Prevention estimates that between 1.6 million and 3.8 million concussions occur each year, and that five to 10 percent of athletes will experience a concussion in any given sports season. At greatest risk are high school football players, who are more than twice as likely to sustain a concussion as college players – and who account for 45 percent of all school sports-related injuries, according to a study from the U.S. Center for Injury Research and Policy.
In Massachusetts, a 2013 study found more than 4,400 concussions or other head injuries during school sports over a one-year period, with most occurring at larger high schools with bigger sports programs.
As part of its “Heads Up” public education initiative, the CDC provides a range of detailed training and informational materials customized specifically for coaches, parents, sports officials, and young athletes, including fact sheets and posters (available at Several different organizations in Massachusetts, including Massachusetts General Hospital, recently partnered to raise awareness about concussions and promote the CDC’s Heads Up program. Through this partnership, Heads Up materials have been distributed to many emergency room directors, trauma center directors, youth sports coaches, and school nurses throughout the Commonwealth. State lawmakers, meanwhile, passed a law requiring coaches, trainers and onsite medical personnel to undergo concussion training.
Other safety hazards
Injuries to the mouth and teeth also put players at risk. Such injuries, however, can be easily prevented in many cases.
The American Dental Association estimates that one third of all dental injuries are sports-related. Interestingly, a pediatric dental study revealed that 75 percent of these injuries occurred when mouth guards were not worn.
The Massachusetts Interscholastic Athletic Association highly recommends that mouth guards be worn during both practice and game situations – particularly in soccer and basketball – and the association provides an education form (for parent signature) that outlines the potential costs of dental injuries.
Other areas where school sports injuries are common include heat-related illness, insect-related issues, and hazing incidents. The MIAA website ( is a resource for educational materials and recommendations related to preseason heat acclimatization (such as a 14-day ramp-up period), tips for preventing and avoiding mosquito-borne illnesses, and a summary of the state’s anti-hazing law.
Continuous education and training is critical for preventing injuries and mitigating municipal risk, but it’s also important to have the proper paperwork on file. Permission slips should always be required and should include waiver language acknowledging that the student assumes the risk for any injuries that result from participation and holds the school harmless.
It is also recommended that youth athletic programs require that a copy of each player’s health insurance card be submitted to ensure that each student has proper medical coverage.