Physical Education Injuries: 150% Increase

Physical Education Injuries alarm bells

IYCA Member, Mike Howard, sent me a link to this incredible article.


I was floored.




And completely annoyed.


150% increase Physical Education injuries.


Read the article and then be sure to leave me your comments about
why exactly you think this has become such a problem.


I feel very strongly that I know the answer.


And tomorrow I’m going to tell you what it is.


But for now, I want to hear your thoughts.


Here’s the article:



New national study finds increase in P.E. class-related injuries


Annual number of cases increased 150 percent from 1997-2007


Physical education (PE) in schools is one of the main tools used to increase physical activity and to prevent childhood obesity, and PE-related injuries are on the rise. Although increasing physical activity may reduce obesity, it may also increase the risk of injury. While recognizing that PE classes and physical activity are important components in combating obesity, parents and school administrators should remain vigilant for injuries. A recent study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital, found that the number of PE-related injuries to elementary, middle and high school students in the United States increased 150 percent between 1997 and 2007.


According to the study, published in the online issue of Pediatrics, the most common PE-related injuries were lower-extremity sprains and strains (23 percent), followed by upper extremity sprains and strains (14 percent) and fractures (14 percent). Middle school-aged children (11-14 years of age) accounted for the majority of PE-related injuries (52 percent). Elementary school-aged children (5-10 years of age) had almost double the odds of a head injury, compared with other injuries.


Nearly 70 percent of PE-related injuries occurred while children were participating in six activities (running, basketball, football, volleyball, soccer and gymnastics). Injuries were caused by contact with another person, playing surface, equipment, stationary structures, pulled muscles, overuse and activity-related illnesses such as heat stroke.


"The 150 percent increase in PE-related injuries presenting to emergency departments was consistent across gender and age groups. It is unlikely that this increase was attributable to an increase in PE participation," explained study author Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital and faculty member of The Ohio State University College of Medicine. "Identifying patterns of PE-related injuries is the first step toward preventing them. Injury prevention education should be made a priority for all PE activities, especially for those activities with the highest injury rates."


This is the first published study to examine PE-related injuries on a national level. Data for this study were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS dataset provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.


41 Responses

  1. mike says:

    Lack of physical preparedness is definitely the overwhelming reason. I would also bet that in a society that is becoming ever to intolerant of any pain whatsoever, many trips to ER’s and Doctor’s would never have been taken years ago.

  2. Qaiser says:

    Separate from the training and fitness question that Brian asked about, I am going to comment on the study itself (my area of studies for my master’s degree was statistics – about as useless as you can get in the fitness world, except to question research studies).

    Without getting more information, the simple fact that the annual number of cases increased over that decade doesn’t tell us very much. In order to help determine a cause/causes, we would need more information, including:
    -whether the total number of children participating in those classes increased or decreased – if the number of children increased, we would expect to see the number of cases increase as well
    -whether hours of PE over that period of time increased or decreased – if the number of hours of PE increased overall, we would expect to see an increase in cases
    -leading us to any change in the hours/child – same ratinoale as above
    -if the reporting requirements changed – if the injuries are more prone to be reported due to a change or more rigid enforcement of school policy or law, we would expect to see an increase in cases
    -if the legal environment changed – for example, if a lawsuit was more likely if a child was injured and it wasn’t reported, then every little event would be reported in an attempt to ‘CYA’.

    There are many more factors that could be examined, but I wanted to list a few to show that it’s hard to make any supportable conclusion from a single set of raw data numbers. Separate from what I think Brian is getting at, the raw data of a certain increase in cases tells us very little to be able to draw any useful conclusions.

  3. Gary says:

    I would suspect the usual 3 culprits:

    1. Poor Nutrition
    2. Sedentary lifestyle- too much time in front of computer or TV;
    3. Poor quality and/or lack of proper Educational Instruction.

  4. Kevin nichols says:

    I’ve Been an elementary education teacher for 5 years and in my school I can tell you that the problems are
    1: not properly warming up
    2: lack of education among teachers
    3: exercise prescription is not developmentally appropriate.

  5. Jerry says:

    I would say that for most of the increase is due to children now days would rather lay around in front of a TV, Computer, or video game than go outside and play tag, kickball or any outdoor activity in general. PE classes for many of them probably is the only real physical activity they do in a week. I would be willing to bet that if there was a way to narrow down these results with a good activity history of each incident-a good majority probably would fit into the above description and not playing different sports/activities year round.
    I also believe parents are working longer hours now days and are more tired when they get home from work and less likely to take the kids outside and play with them. I think this is an unfortunate growing problem in our society.

  6. Chad Eisner says:

    I dont buy the nutrition aspect as a big culprit is such stats. The lifestyle angle can’t account for the time sequence (the activity level in lifestyle between ’97 and ’07 hasn’t changed that much to account for 150% increase).

    I would say it’s budget cuts leading to the employment of under qualified and unqualified PE instructors. Too many school systems have put PE on the back burner to trim budgets and just have the Spanish teacher run the classes. Also, the elimination of reccess where kids get to play around periodically through the day is another good suspect.

  7. Jeff says:

    Gary and Mike both are correct. Kids being heavier and out of shape does create more stress on their bodies & causes injuries.

    But I also suspect more kids are faking it to avoid exercising and to avoid conflict, hassles and liability the school staff does not question their claims.

  8. Chad Eisner says:

    i do like this part though: “Injuries were caused by contact with another person, playing surface, equipment, stationary structures, pulled muscles, overuse and activity-related illnesses such as heat stroke.’

    Or, in other words, all athletic type injuries.

  9. Brandon says:

    Instead of focusing on Locomotive Skills and Stability Skills (Fundamental Movement Skills)most school programs go right in to sports and competition too early (Sport Specific Skills).

  10. David Walencewicz says:

    I do conditioning with youth in baseball and football and i am always amazed how unfamiliar they are with doing basic warm up and body weight exercises and i ask if they are doing this in PE and they all say NO. The PE programs get the kids and set them loose in some activity that they are not ready for. I have heard and seen several kids injured in PE in my son’s eigth grade call.

  11. Grant Hernden says:

    Having taught high school physical education for 28 years I can tell you that most of the injuries were caused by improper warm, poor class management and organization and not using age appropriate activities and instruction. The current obesity rate certainly doesn’t help the problem. Time to have physical education teachers become familiar with IYAC protocol. Keep up the good work Brian.

  12. John Dee says:

    I am a 50. When I entered elementary school my friends (boys and girls) and I were already well on the way to developing a strong movement skill set. We played outside every day.

    Over the past 20 to 30 years there has been a paradigm shift away from play skills towards either inactivity or single sport development both of which are a disaster when it comes to developing movement skills and preventing injury.

    Remember, as well, that prior to cutting P.E. completely from the budget school districts will cut the number of P.E. teachers first and overload the classes. Very difficult to supervise or accomplish anything worth doing.

    I would have to take exception with Kevin’s comment about proper warm up being a cause of these problems in elementary school kids. Maybe I am old school but warm up in my day consisted of pushing your buddy on the ground and running like hell to be first on the jungle gym. Do kids really need to warm up to play?

    Finally “pulled muscles” I don’t ever remember anyone that age having a pulled muscle when I was a kid. Sounds like either severe deconditioning followed by over activity or severe over training followed by poor recovery followed by more over activitiy.

  13. Mark says:

    The first thing to question is the study itself. It is easy to jump on the ‘lack of fitness’ idea here, but, these types of studies can be flawed. The author said the change is unlikely due to increased participation. Where is the basis for that opinion? There has to be more people taking PE now with the growing population. Who financed the study? Do they have an axe ($) to grind? Further, the percentage of reporting injuries in this litigious society has likely increased over that time period between previous and present studies.

  14. David Egan says:

    I think the problems stem from two fronts: 1. A large majority of our youth are highly de-conditioned, weak and tight from a combination of poor nutrition and lack of proper and effective exercise.
    2. The P.E. teachers may be overzealous in their progression or choice of exercises. Leading to overuse issue. The rapid growth phase is a big factor in flexibility and coordination. Time needs to me spent warming these children up properly and progressing them slowly. For many of them the warm-up will be enough of a work out.

    David Egan, CSCS

  15. Njama says:

    I think you also have to look at the amount of time most PE classes last, most are pressed in between other classes most teachers feel are more vital then PE, so when children go out/in doors, right away they go into the activities. A warm up isn’t stressed, hence most children run around with very little structure. I know the teachers in my daughters school care about the children, but if all they have is a schedule on paper to follow, without the proper education of safety and still how to make things fun and interesting, we may still see injuries that could be prevented.

  16. I agree with Mike that parents are more likely to take their kids to the doctor for things our parents would not have…minor aches/pains, colds, etc. It’s ironic that they are more concerned about these things than the long term consequences of their kids not exercising, not eating well, playing video games, texting, or watching TV.

  17. David says:

    I think Gary got it right.
    Adding to his list, the majority of PE
    classes are way overcrowded.
    I have had as many as 75 kids in one class
    with me and one aide.

  18. David Kamalani says:

    Must start with basic fundamentals like dynamic stretches, isolated warm-ups (for strength and mobility), progressive warm-ups( aerobic type movements-jogging and stopping, etc), games and activities and finish with proper isolated stretches.

  19. Rob says:

    Not surprised. The obvious would be that kids as a group are less active than they used to be, so as a result they are less prepared for physical activity and a larger percentage than ever before are overweight. The other side of that is a group that is too involved in sports with coaches who “train for the win”, do not allow them to rest their bodies, and although in reasonably good condition for kids, they are the ones suffering overuse injuries in gym classes that do not understand how to structure a session with a warmup, stretch, and cooldown.

  20. Jack says:

    Regardless of what you think about a study being “flawed”,or any other excuse, the bottom line is a huge increase in injuries. I agree the biggest culprits would be lack of good nutritional habits, a sedentary life style and educated coaches.

  21. Anton says:

    My 12 year old son broke his wrist in a PE lesson. It was a soccer tackle and he fell badly on astro. I do not believe teachers understand the concept of injury prevention. Accidents do happen, but the common age group tells me teachers need to get some kind of training.

  22. Mike Messer says:

    Like many of the other comments we are not building the base before we start the skills The little things balance stretching warming up Administrators who know nothing come out and eveulate your teaching and want to see the children engaged in a sport or activity without the proper base. I been luckey that I have not had a injury I spend the time on behavior rules warmup and stretching Even the kids with poor
    nutriton and sedentary life style can get throught PE with injury if approached in the proper mannor

  23. Steve Payne says:

    Kids just aren’t exposed, or encouraged to participate, in physically demanding activities the way I was when I was young. (I’m nearly 50)

    I have a youngster (8 years old) I work with who told me 2 days ago he has an Iphone he spends quite a lot of time on. That, at least to me, epitomizes what is tactically wrong with many of the kids I run into today.

  24. Davey C says:

    In my opinion, it is due to the lack of instruction given and ability of the kids. They are thrown into a number of very complex movments without being taught how to carry out the tasks safely. They are also not given a suffcient warm up for the task at hand.

  25. Joesy Exstrom says:

    I see a few keys. I agree about asking questions about the study. That is huge. Aside from that, are kids spending more time in P.E.? I know many schools who only have P.E. twice maybe three times a week, if that. If anything increased injuries are due to lack of P.E. time and poor instruction. A personal experience I had with my p.e. teachers was they were apathetic, just walking through the motions and let us do whatever we wanted.

  26. Doc Wood says:

    Probably a large number of them whine about little boo boos now so they can get out of class.

  27. Denise says:

    Wow were to start. LOts of good points about lack of activity, intolerance to injury. Today we are so concious of prevention of injury that we take a lot of exploratinout of our kids lives. “don’t climb the tree, you might fall” And that leads to not developing reciprical patters and upperbody strength. Also much of kids “activity” is structured and does not allow for free play and exploration. I learned to tuck and roll when falling after falling getting hurt.

  28. Mary says:

    I think all these comments are valid and don’t have anything new to add. Not unlike your blog from yesterday, I think it boils down to our kids’ lifestyle today. Look at the sports identified – all of them require some level of cardio ability and coordination. I think this problem is also reflected in our professional athlete talent pool. I mean, yes, we have some superstars here and there. I don’t know if its just me but when I go to a game (in any sport at any level – middle, high school, college), I don’t see the talent I use to see when I was younger (now 46). I’d be curious to find out what lifestyle these exception athletes today lead…are/were they watching tv, etc. or were they outside looking for kids to play with like we use to do. My son was always an outside kid and had a hard time finding other kids outside to play with before getting involved in organized sports. That was the best thing that happened to him because of practices & games. Sad but true.

  29. k says:

    Physical Education has not changed remarkably. The biggest change in society is the competitive nature and number of youth programs kids are involved in OUTSIDE of school. Overuse injuries, the competitive mindset and parental demands to “win” in youth sports are feeding into the way kids interact and perform…even in gym class…

  30. Patricia Hubel, PhD, ATC, CSCS says:

    Interesting find Brian. I think that the data provides an interesting view of one part of a larger picture. Here are concerns I have regarding the results of the data:
    1. Hospitals have better injury tracking mechanisms now than before – so categories on the injuries may have never been there before.
    2. Educators are so scared of lawsuits (who isn’t) that even minor things end up in the ER – and many should not make it to an ER.

    And…then there is the student side of the puzzle:
    1. obesity or at least high body fat
    2. lack of muscle skill due to sedentary lifestyles
    3. poor nutrition
    4. ? size of class in which injury occurs?
    5. qualifications of the instructor – were these new faculty or seasoned faculty? This could be a HUGE part of the problem.

    Good find though…and just another exclamation point to the fact that our healthcare system does need something – it’s not an overhaul that is needed…it’s more money spent on education, instructed/supervised activity, and keeping kids moving!

    If we could get money for qualified/quality instructors who were able to work with youth, it would make a HUGE difference in our healthcare system!

  31. Stephanie says:

    As a trainer I agree proper warm up has been throw away. Even in limited timed care should be given to warm up.
    I also would say that too many kids are inactive more than active….shame on those parents. I’m not saying be a super jock, but at least be aware of the health risks in poor diet and lack of exercise.
    Yes I agree kids today are soft!!!!!!!!!!!!Parents over react to the slightest things! Muscle soreness isn’t bad. Kids fall down, they skin their knees… I am all for “old school” Stop coddling these kids! Be safe and smart!

  32. Maureen says:

    Physical education? What’s that? Most schools in my area seem to be cutting that out. And recess too!

  33. Hey Brian

    I am a PE teacher and have been for 15 years. I can tell what the problem is… when they jam the gym full of 100+ students at a time when the gym is built to hold half that number. I see all my classes 5 days per week. I have 4 teacher assistants. We do our best every class of every day to provide top notch instruction and lessons. Despite this, we have occasional accidents… not at an alarming rate, but occasionally. I have stated my concerns many times in regard to this… having too many students at one time. When the weather is cooperating we can always take them outside… however, this is not the case frequently.

    I’ve read many of the responses here that discuss warmups and ‘proper progressions.’ I can assure these people that the injuries that occur are far less from lack of warmups and progressions and simply because PE has become a dumping area for scheduling so that classroom teachers get more planning time. Blame it on ‘no child left behind’… not the PE teachers!

  34. Rick P. says:

    I think most comments posted have some validity & deserve further investigation on all fronts.

    I would like to add that a friend of mine who is a pediatrition & child fitness exspert has told me & another mutual friend that between the ages of about 11 & 14, children are very prone to sprains, pulls, tares & fractures due to puberty.

    I am not a doctor & I personally have not studied the research in depth.

    However, my doctor friend is very highly regarded within the medical & fitness community in our area.

  35. Shawn Fears says:

    If you put a person, young or old in a situation that they are not accustomed to and have no knowledge of how to perform correctly there is going to be injuries. I am going to go out on a limb here and say that there is probably a correlation between increased video game time and injures during gym during the same time period. Kids just don’t know how to move anymore and when they do, they do it unsafely and incorrectly…that’s the bottom line!

  36. Glenn says:

    As a former physical educator, a licensed physical therapist and owner of a personal training studio it is easy to make the case that it is deconditioned kids or poor exercise progressions that are the cause. Maybe even poor study design. My bet is that it has to do with a dramatic increase in the number of kids in a PE class at one time. In Florida, where I live, that is certainly the case. They only get PE 1 -2 times a week and it’s in huge group settings. Even back in my day as a PE teacher (early 80’s)I had 150+ students at a time. Of course I had 2 – 3 assistants that at least could supervise. With cutbacks PE teachers are lucky if they 1 assistant these days.

  37. Melissa Walker says:

    I think it all goes back to the major issue at hand, pediatric obesity. If kids are overweight and/or de-conditioned to begin with, it makes sense that the # of injuries would increase. I read this article the other day and couldn’t believe that wasn’t addressed.

  38. Robyne Arrow says:

    thanks for sharing the article. Appalling to say the least. Its hard to add anything of great value to the above comments… I too wonder one thing that wasn’t mentioned in the article nor in the comments. It’s not really a comment as much as a question, “What percentage of these injuries were self induced or led from being pushed by another”? Is gym class becoming a place for children to get their frustrations out…

    I mention this because haven’t schools been given grants to provide cushier pavements.. I mean look at all the playgrounds now a days… if these places haven’t been given grants to promote safe havens for children at play someone in the local communities have sponsored money’s allocating for this sort of thing… and why would PE teachers be any less careful with children than years ago… I don’t know but the following is what I’m leaning towards.

    Many years ago I spent 5-7 years working with elementary schools across the country providing them with character education programs as well as training for the teachers. I was able to pay for these programs and trainings by having the local communities give me so much per mile i bicycled whether 200 miles at one time or as far as bicycling across country on 2 separate occasions.. I learned a lot during this time and now a decade later children must be going through a lot of confusion with no other way to release…. but perhaps through the gym activity… just a thought anyway.

  39. Jim says:

    How many of you have decided to help the youth problem by getting your education certificate in Physical Education and getting into the front lines? I work at a school where I coach, teach PE, and run a small weight room. I am also trying to reach out to the teachers who teach health, run the cafeteria and afterschool program. Additionally I send out information to felow teachers, coaches, the AD, the booster club, parent groups, club coaches, and sport performance coaches. There are not enough hours in the day; and you certainly don’t get paid or recognized in a respectable manner. Please create partnerships in times like these, rather than blame. In my lifetime i have personally gone from receiving daily PE to teaching 1 day a week at the elementary level. It is very frustrating to say the least. I challene each of you reading this to reach out to your local PE teacher in a respectable manner. They need help. Many good ones are leaving the profession. To those reading this you have no idea of the impact you could make if you did this. A drowning ship needs many life preservers

  40. tim rudd says:

    Thinking back 20 years ago when I was in high school, my p.e. Teachers
    Taught no movement skills and there were no warmups not even in middle school
    Or grade school. The one difference is we played during recess,lunch and
    After school. So basically much more active. I think the problem now
    Is p.e. Is the only exercise the majority of our youth get.

  41. tim fernandes says:

    I agree with tim rudd, I have been out of school for at least 20 years but I don’t recall warmups or movement skills ever being taught in any of my p.e. classes. P.E. was for being exposed to different sports we dressed out and got right on the field and started playing.

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