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Hospital for Special Surgery, the official hospital of teams including the Brooklyn Nets, New York Giants, Mets, Knicks and Liberty, is bringing its injury prevention expertise used in professional sports down to youth athletics — where more than two million injuries per year are documented in high school sports and nearly 30,000 result in hospital stays.
The entire cost of these injuries comes to an estimated $5 billion per year in the U.S., which HSS aims to reduce through its new “Move Better Play Better” initiative. The hospital will select 50 U.S. high schools for the upcoming school year to receive free online education workshops and recommended exercise programs focused on preventing musculoskeletal injuries, which are increasing among youth athletes.
“There’s little fluctuations here and there, where we get hopeful that preventive interventions are making a difference, but the general trend is up,” said Joseph Janosky, director of injury prevention programs at HSS. “And when it comes to injuries, obviously, that’s not good.”
Janosky counts improved diagnostics — coaches and trainers being better at identifying injuries — and data collection as reasons for recorded injuries increasing for today’s youth athletes compared to previous generations. Other contributing factors include increased obesity and screen time.
“The general level of fitness and level of kids’ ability to participate in sports with the tools and physical capabilities that they need is going down. We see obesity rates were high before the pandemic and higher now,” Janosky said. “We look at outcomes for the physical fitness testing that occurs in physical education classes, and those scores continue to decline. Limited physical education, lots of screen time, kids not meeting the required levels of physical activity each day or each week, leads us down this path of poor movement quality.”
Schools in the new program will access a learning management system that offers on-demand video modules on how to properly perform fundamental movements. Janosky believes that adaptation of the recommended exercise routines can prevent half of all musculoskeletal injuries and reduce a third of all injuries, including concussions that can be prevented by improved body control.
“We have historically always delivered the content live, face to face, in real time. The pandemic of course changed things and pushed us to do things virtually,” Janosky said. “We’re able to make all of this content available on demand, so that coaches and parents and kids can complete these things asynchronously at their convenience.”
Risks for common musculoskeletal injuries such as ACL tears and ankle sprains can be correlated to an athlete’s movement patterns when they run, jump, land and change directions in ways that put excess stress on their ligaments and muscles. HSS conducted a pilot with about 1,000 children where they recorded video of each performing five movements that are variations of the squat and vertical jump, manually analyzed by biomechanics experts.
“The way our screening works is you are scored on each of these five tasks. A score of five is bad; that means of the five tests, the risk factor was present in all five of the tasks,” Janosky said. “The average score of the pilot group is about 4.2. We are blown away by the fact that if we convert that to a percentage, about 84% of the tasks that are being completed by these kids for the risk factors are present. That’s a really scary number.”
Janosky notes a study from researchers at the U.K.’s Anglia Ruskin University found that screen time for kids ages 6-10 increased 80 minutes per day compared to before the pandemic. HSS’s exercise content will be delivered to kids through screens, but Janosky notes that “passive screen time” such as sitting in a beanbag chair to play video games differs from “active screen time,” such as watching your Peloton instructor during cycling workouts.
“We were in a really bad spot, pre-pandemic, and now we just added 80 minutes of passive screen time to the kids in one day. That’s a huge factor that we have to push back against,” he said. “We can now use technology and active screen time to get kids to be physically active to help protect them against these injuries.”
The hospital plans to launch a mobile motion analysis app later this year that leverages computer vision through a smartphone’s camera to identify signs of injury risks in youth athlete movements. Both the Dari Motion biomechanics analysis AI camera system and the Proteus Motion strength training machine, whose investors include HSS and golf star Bryson DeChambeau, are installed at HSS’s new How You Move Lab at Chelsea Piers in Stamford, Conn. Movement assessments start at $99 per session, and HSS will suggest lab visits for kids interested in further training.
“We’re using markerless motion capture [from Dari Motion] and Proteus, which [measures] power and acceleration in 3D, and getting that technology to feed us information,” HSS exercise physiologist Polly de Mille said at the How You Move Lab. “It will pick up any kind of deviation from sort of ideal alignment as you’re moving.
“Kids now specialize really early and just play their sport. They’re not learning how to jump and land, at least the kids we’ve seen. Nobody’s doing any real strength and conditioning. It’s just the sport all the time,” de Mille said.
If Janosky could speed up time, motion-capture technology used in pro sports is at the top of the list of tools he’d like to see expand to youth sports.
“The technology has now evolved to the point where they can see specific body angles and look at things like kinematics, and look at the angle of the hip, for instance, or the elbow if it’s a baseball player throwing,” he said. “So that technology is mind blowing, the amount of data they generate over a game time. Obviously, we have a long way to go before that’s applied at any lower levels.”
Editor’s note: This story is updated from the print edition.
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