September 2011 - Advanced Physical Medicine
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Most Dangerous Sports

Americans love competition, which makes it no wonder why it is so pervasive in sports. This competition is usually accompanied by a strong desire for maintaining good fitness habits. However, many sports aficionados experience one of the costs of the endeavor to pristine health, sports injuries.

No one likes getting hurt, in the near term it causes us to sit out the game, hold back on our exercise routine for recovery time, and may increase our medical costs. In the long term it may exacerbate arthritic conditions with aging or weaken a body part making it more prone to injury in the future. In the very extreme, it may cause catastrophic injury or death.

This article will hopefully shed some light onto details that can aid in understanding what sports are the most dangerous. What qualifies as the most dangerous sport is a matter of opinion, as it can be measured in a variety of ways.  The approach taken in this case was to generally look at sports most people play and compare them against each other in terms of number of injuries, body parts injuries, ages of those injured, and what types of injuries occurred using the Consumer Product and Safety Commission’s NEISS database .

Overall research paints only one perspective of what qualifies as the most dangerous sport. There are so many other qualitative factors that each individual should consider before determining what sport may be safest for them.  In particular, it is hard to consider the severity of injuries incurred in the research since everyone has different pain tolerances. For example, one could argue that basketball is dangerous since they had the most ankle injuries, however since most injuries would not qualify as a catastrophic injury, it may be an injury risk the sports enthusiast considers worth taking.

Comparing sports is by nature comparing apples to oranges since some sports by design have increased personal contact and can be affected by the level of protection required by the sport. The choice of the player to wear certain optional protection will affect incidence or severity of injury. For example ice hockey is a high contact sport and players wear considerable padding, but the amount of padding depends on the player. Hockey players can choose a face mask to prevent facial injuries, but it is not universally used, rather at the option of the player. That said there are 5 interesting takeaways:

Protect your head! - The most common injuries to occur for all sports in the sample were to the head (8554), mouth (1544), and face/cheek (5927), so protect your noodle. The national estimates translate into a large number of injuries that might be preventable. The national table (Table 1) is presented below:

Table 1

Body Part Estimate of National Injuries by Body Part All Sports % of total Injuries
Head 274454.6392 12.8427%
Ankle 258347.9957 12.0890%
Finger 198413.3141 9.2844%
Face/Cheek 190167.4827 8.8986%
Knee 175504.6617 8.2125%
Shoulder 144895.622 6.7802%
Wrist 126607.2021 5.9244%
Lower Trunk 98564.95811 4.6122%
Lower Arm 88265.69003 4.1303%
Lower Leg 88233.60508 4.1288%
Upper Trunk 86212.2534 4.0342%
Hand 77420.97784 3.6228%
Elbow 74886.267 3.5042%
Foot 66608.3506 3.1168%
Mouth 49539.15863 2.3181%
Neck 35774.71624 1.6740%
Upper Leg-Femur 24512.89974 1.1470%
Toe 17742.97586 0.8303%
Eye 15882.04891 0.7432%
Upper Arm- Humerus 13892.78218 0.6501%
All Parts of The Body 12930.23376 0.6051%
Genitals 8695.020719 0.4069%
Body Part Stated 5005.251779 0.2342%
Ear 4138.958202 0.1937%
Internal 320.849473 0.0150%
Face 32.0849473 0.0015%
2137050 100%

Head protection is becoming more common even in sports such as soccer (due to head on head or head to ground collision) because health officials and players alike recognize the value of injury prevention. Whether on a bike, the ice, or the gridiron, where your head and face protection, and where it properly. Let others worry about the fashion statement a helmet may make while you worry about the scoreboard.

Get a ‘Leg’ up on competitors by taking care of yours – Sample injuries to the Ankle (8052), knee (5470), foot (2076), lower leg (2750), and upper leg (764) comprise many sport participants’ injuries. While often these injuries may not be catastrophic as head injuries, they often lead to health problems as the individual ages. Lack of proper stretching and warm up are often contributors to many over extension injuries. If your team is relying on your legs to make that jump shot or punt kick, rely on proper stretching to help keep you at your best.

Playing by the numbers…- If one defines the ‘most dangerous’ sport by the sport most likely for a participant to become injured, the top 3 would be Basketball, Bicycling, and Football (Table 2). It makes sense since these activities are some of the more popular sports. This definition does not suit everyone since a sport that is more popular is more likely to have more aggregate injuries. If one defines ‘most dangerous’ as the sport with the greatest number of injuries per number of participants then football, skateboarding, and basketball could be considered the most dangerous  (Table 3).

Table 2:

Sport Rank Score Rank
Basketball 0.23829461 1
Bicycle 0.23484527 2
Football 0.22211205 3
Softball 0.09427898 4
Baseball 0.07233591 5
Skateboarding 0.06296347 6
Horseback Riding 0.02973311 7
Golf 0.01216269 8
Ice Hockey 0.01023913 9
Lacrosse 0.00935938 10
Tennis 0.00801652 11
Mountain Bikes 0.00332884 12
Street Hockey 0.00135593 13
Badminton 0.00097412 14

Table 3

Sport sport injury/sport participation rate Rank
Football 0.04859796 1
Skateboarding 0.01868844 2
Basketball 0.01858662 3
Baseball 0.01310488 4
Bicycle 0.01292005 5
Softball 0.01110944 6
Ice Hockey 0.00574515 7
Volleyball 0.00561302 8
Golf 0.00187256 9
Tennis 0.00145902 10
Mountain Bicycle 0.00132625 11

What to play if you don’t want to get hurt- Mountain biking, tennis, and golf where those that scored lowest in terms of injuries per participant. Keep in mind though, that the survey was of hospital visits, so it probably doesn’t include tennis players who go to their medical doctor for tennis elbow.

Injuries favor the young – The vast majority of injuries occur within the 10 to 15 age group, with the 15 to 20 age group a somewhat distant second. The peak injury age, that is the age at which the greatest number of injuries is recorded below for each sport (Table 4). While the peak age differs between sports, all are a relatively young age. If you’re a parent concerned about your youngster’s health in sports, this is especially important. Children are not only learning how to play these new sports, but are also learning to play in their growing bodies. Instilling proper warm up and stretching technique is even more imperative. If contact sports concern you, see if there are intramural sports are available, which can teach sports and healthy activity while avoiding some overly competitive nature that may lead to increased injury incidence. It’s always a good idea to consult your doctor as well as sports injury professionals on prevention methods and devices such as sports goggles, knee or elbow supports.

Table 4

Sport Peak Injury Age
Basketball 16
Football 14
Lacrosse 15
Softball 15
Baseball 12
Golf 7
Volleyball 15
Field Hockey 15
Badminton 16
Street Hockey 15
Bicycle 13
Mountain Bikes 11
Ice Hockey 15
horseback riding 13
Tennis 16

In short, what qualifies as the most dangerous sport is anyone’s guess because it depends on the person who’s guessing. Every individual must first ask themselves what their definition of what qualifies as ‘most dangerous’ and what risk they wish to take in pursuing healthy sports activities.  The important take away is that since every sport has different tendencies for injuries. If you know what sport you want to play, then the best way to protect yourself is to understand the most common injuries of your sport and use preventative injury techniques accordingly.  Lastly, have fun! (As safely as possible).


Formula 3 is now offered by Dr. Bender at Advanced Physical Medicine
Last week's blog focused on fungal toenails or onychomycosis.  This week, we will discuss a new topical treatment option that is only available from podiatrists, Formula 3.  This medication employs a very old drug, tolnaftate, but the company that created the product was able to make tolnaftate oil soluble, so that it penetrates the nail better.  The oil used to make this possible is jojoba oil.  Formula 3 is active against a variety of orgnaisms (including the most common fungi that infect toenails):  T. rubrum, T. mentagrophytes, Candida Albicans, and others.
This product is applied daily to the infected toenails.   There are NO side effects to the drug.  Fungal toenails require at least 9 months of application of the medication to clear out the fungus.  Topical solutions have been reported to be 50 percent effective for fungal nails.
Formula 3 is available from Dr. Bender at Advanced Physical Medicine for $30 (U30 USD). 

Additionally, the company that makes Formula 3 offers a no questions asked money back guaranttee if you are not satisfied with the product. 
If you are interested in this product, please make your appointment today!

Mary Ann Bender, DPM
Foot and Ankle Specialist

What to Eat for a Better Workout

Believe it or not, what you eat before and after your workout has an impact on your overall performance and energy level. In order to perform and feel your best while exercising, it is important to incorporate a variety of healthy foods into your diet.

Planning your meals before and after you exercise can help you get in a good workout without feeling drained. Here are some tips on what to eat to maximize your workout.

Balance your meals

Two to three hours before your workout, eat a meal that contains a mix of carbohydrates, fat and protein. This mix of macronutrients will give you energy and keep you from feeling hungry shortly after eating. Try a turkey burger with Swiss cheese on a whole grain bun or chicken pasta salad with grated Parmesan cheese.

Go for energy packed snacks

Snacks that will keep you fueled during your workout consist mostly of carbohydrates with a little protein. These snacks should be consumed no less than an hour before your workout and are also ideal to eat post-workout. Yogurt with granola or crackers with peanut butter are two good choices.

If you’re hungry immediately before

Easily digestible snacks like crackers or applesauce are what you should eat if you’re hungry immediately before your workout. Sugary snacks such as candy or fruit juice are a good option if you’re planning on doing a cardio session such as kickboxing, running or swimming.

So practice these tips and eat well for a better workout.

Fungal Toenails or Onychomycosis

Why are my toenails thick, discolored, and crumbling?

What is it?

A fungal toenail often appears thick, discolored (brown, black, yellow, white), crumbly, loose, and/or distorted in shape. It can involve one nail or multiple nails on the feet.


Fungi normally inhabit all of our shoes and socks because the warm, moist environment allows the fungi to thrive. The most common causes are the following: trauma or injury to the toe, athlete’s foot infection of the surrounding skin, pedicures, certain diseases which affect the body’s immune system, and genetics. In some cases, it is not known why a toenail develops a fungal infection. Pedicures and injuries of the nails or toes can both cause tears in the cuticle (a protective barrier for the nail plate), and this readily allows the fungus to enter. Athlete’s foot is an invasion of the skin by fungus, causing blistering, scaling, and itching. The same fungus enters the nail plate. Certain diseases that affect the immune system, such as diabetes, cancer, and others, can also weaken the body’s ability to fight of a fungal infection. Finally, some research shows that genetics can play a role in fungal toenail development.


There are two ways to treat fungal toenails: topical or paint on treatments and oral treatments. The topical treatments typically work fifty percent of the time and require 9-12 months of daily applications. The oral option is a three month course and has a success rate between 75 and 85 percent. This treatment requires analysis of the patient’s blood work prior to treatment, as the drug is broken down by the liver. There are benefits and weaknesses of both treatment options, so it is important to schedule an appointment to see which is best for you. Also, it is important to know that there is not a treatment available for fungal nails that is 100 percent successful.

Dr. Bender is a podiatrist at Advanced Physical Medicine, with Oak Park and Chicago locations. She is also an instructor for William Scholl College of Podiatric Medicine.

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