Research Focus Areas

Musculoskeletal and head injury prevention, treatment, and rehabilitation are significant contributors to optimal health and quality of life, and based on University of Michigan strengths, the BJIPRC has identified the following specific research focus areas:

Each year in the United States, more than 30 million children and adolescents participate in organized sports, and more than 150 million adults participate in non-work-related physical activity and recreation. Obviously, the positive health benefits of physical activity can be enormous, but injury is always a possibility. The Centers for Disease Control and Prevention (CDC) estimates that more than 4.3 million nonfatal sports- and recreation-related injuries are treated in US hospital emergency departments. The injury rates vary by sex and age and are highest for boys 10–14 years. For persons aged 0–9 years, the leading injuries are playground and bicycle related. For males aged 10–19, football, basketball, and bicycle related injuries are most common, while basketball related injuries rate highest for females 10–19 years. Basketball related injuries are leading, as well, for 20–24 years, and rank highest for men aged 25–44 years. Exercise (e.g., weight lifting, aerobics, stretching, walking, jogging, and running) is the leading injury-related activity for women older than 20 years, and rank among the top four types of injuries for men older than 20 years.

Interventions to reduce the risk for sports- and recreation-related injuries can be put into three categories: personal countermeasures (e.g., use of safety gear-wearing helmets reduces risk for head injury by 85%), behavioral interventions (e.g., proper conditioning), and environmental modifications (e.g., use of break-away bases in baseball and softball reduces sliding related injuries by 95%).

The CDC and others agree that significantly more research is needed to identify effective interventions for many sports and recreational activities. The national health objectives for 2010 and The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity highlight the importance of physical activity for health, but the prevention of injury, appropriate treatment, and effective rehabilitation are key for achieving optimal health.

Notably, military personnel and veterans frequently experience training- and combat-related injuries, and for both male and female veterans returning from Iraq and Afghanistan, 70% of the war-wounded have injuries affecting the musculoskeletal system, as reported at the 2007 annual meeting of the American Academy of Orthopaedic Surgeons. In particular, the current conflicts manifest unique war wounds, predominantly from high energy exploding ordnance such as mortars, rocket propelled grenades, and IEDs (improvised explosive devises). Explosive injuries and military gunshot wounds are often associated with severe bony and soft tissue injuries and can frequently involve the extremities. Both basic biomedical and clinical research efforts are needed to investigate optimal prevention, treatment, and rehabilitation approaches.

As many as 3.8 million sports- and recreation-related concussions happen in the United States each year; of the 2.4 million sports-related emergency department visits for children and adolescents ages 5-18, 6% (135,000) involved a concussion. For males, football accounts for more than 60% of concussions, while for females the leading cause of high school sports concussion is soccer. Among children and adolescents, 5–18 years of age, the five leading sports or recreational activities that account for concussions are bicycling, football, basketball, playground activities, and soccer. Significantly more research is needed in the area of sports- and recreation-related concussion, but intriguing findings are surfacing. For example, high school athletes’ recovery times for a sports concussion are longer than college athletes’ recovery times, high school athletes who sustain a concussion are three times more likely to sustain a second concussion, and lack of proper diagnosis and management of concussion may result in serious long-term consequences, or risk of coma or death.

Concussion (MTBI) from IEDs has become a signature injury of the wars in Iraq and Afghanistan, where more than 1.5 million US troops have served. Reports have stated that at least an additional 20,000 US troops who were not classified as wounded during combat in Iraq and Afghanistan have been found with signs of brain injuries, according to military and veterans records. The data were accumulated from the Army, Navy, and Department of Veterans Affairs and showed that about five times as many troops sustained brain trauma as those officially listed by the Pentagon. The Congressional Brain Injury Task Force stated that as many as 150,000 troops may have suffered mild to moderate brain injuries, commonly from exposure to blasts. Among the sequelae of trauma are depression, post-traumatic stress disorder, and somatic (musculoskeletal) pain—which are prominent diagnoses in many men and women veterans.

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