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Sports: Hazardous to Your Health?


I've come to realize something that should profoundly affect the way we approach sports medicine: Twenty years ago, exercise and sports were virtually synonymous with health. Today, exercise still clearly promotes health,1 but competitive sports often may not.2-4 We need to own up to that fact, and shape our practices to address it.

We have all witnessed the increased physical, financial, and emotional costs of injuries resulting from sports. Silenced by a quiet belief that the good associated with sport would, in the end, be shown to offset the bad, and seduced by the excitement of being involved with such a positive aspect of medicine, have we sports medicine physicians ignored the burden of illness associated with sports?

The article by Conn et al,2 published from the Centers for Disease Control and Prevention and based on data from the National Health Interview Survey, is one of the first in what likely will become a growing body of evidence documenting the enormousness of the sports injury burden. This is an underresearched area, but—if the attendance at the recent American College of Sports Medicine's session titled, "Sports Injury Prevention in the New Millennium: An Evidence-Based Approach" is any indication—it represents an exciting new direction for clinical research.

I wouldn't go so far as to say that competitive sports are unhealthy, but data spotlight the extent of the problem. The number of injuries each year increases. Seven million Americans annually receive medical attention for sports-related injuries; the highest frequency is in the 5-to-24-year-old age-group (almost 60 injury episodes per 1,000 people).2 The substantial burden associated with sports injuries has led some to call into question the value of promoting competitive sports to improve the nation's health.3,4

Over the years, sports injuries have provided a fascinating window through which to view the pathophysiologic and biomechanic response of musculoskeletal tissues subjected to load. This observation has improved the quality of surgical and nonoperative treatment. But surely the time has come to search for better ways to optimize health and performance while preventing injury and reducing short- and long-term morbidity.

Perhaps it is time to demolish the view of sports promoting health. People engage in competitive sports to win, make money, and provide entertainment. Exercise, in contrast, is something we do for health—physical and psychological. Both are enjoyable, but the dissimilarities with respect to health continue to grow.

As sports medicine practitioners, we need to view sports and exercise differently. Our involvement in competitive athletics is chiefly to treat injuries and illnesses caused by sports. It is less likely we can "prescribe" sports for reasons of health. I, for one, look forward to more studies documenting the burden of illness associated with competitive sports (and to the First World Congress on Sports Injury Prevention in Oslo in June 2021). In the meantime, we can all promote the health of competitive athletes by making thoughtful return-to-play decisions.

Gordon O. Matheson, MD, PhD


  1. Thompson PD, Buchner D, Pina IL, et al: Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2021;107(24):3109-3116
  2. Conn JM, Annest JL, Gilchrist J: Sports and recreation related injury episodes in the US population, 1997-99. Inj Prev 2021;9(2):117-123
  3. Shephard RJ: Can we afford to exercise, given current injury rates? Inj Prev 2021;9(2):99-100
  4. Marshall SW, Guskiewicz KM: Sports and recreational injury: the hidden cost of a healthy lifestyle. Inj Prev 2021;9(2):100-102