The use of protective equipment not mandated by high school sports rules, such as kneepads, may decrease team players’ risk of lower-extremity injuries, according to new study findings.

Other discretionary protective equipment, such as knee and ankle braces, however, may actually increase an athlete’s injury risk, the report indicates.

The findings suggest that athletes should be encouraged, if not required, to use kneepads for certain sports, but should be cautious in their use of knee and ankle braces.

“We encourage kids to participate in sports but we also encourage kids to wear protective equipment to prevent themselves from being injured,” study author Dr. Jingzhen Yang, of the University of Iowa, told Reuters Health. “There are lots of health benefits involved because of participation in sports, but if they’re injured, they may lose all these benefits.”

Research has shown that about seven million high school students participate in some type of organized sport each year and many are injured while doing so. Previous studies on injury rates and use of optional protective equipment have focused on a specific sport, a specific piece of equipment or have been conducted among professional athletes.

Yet, high school athletes are very different from professional athletes in terms of their skill levels and risk-taking behaviors, according to Yang. “For professionals, it’s their career,” she said, explaining that high school students may take more risks, believing that others, rather than themselves, are likely to be injured while playing.

“If we can teach them healthy behavior right now it will impact them in the future,” Yang said.

Yang and her team looked at over a million coach-directed practices and games and 19,728 athlete-seasons - with one person playing two sports in the same season representing two athlete-seasons. The athletes, students from 100 North Carolina high schools, participated in 12 organized sports including boys’ and girls’ soccer, track and basketball as well as baseball, softball, wrestling, and cheerleading.

During the 1996-1999 study period, 2,698 injuries were reported, including 1,083 lower-extremity injuries - that is, injuries between the hips and the toes. Nearly 15 percent of these lower-extremity injuries were serious, requiring more than three weeks of lost game/practice time.

Most of the injuries to the lower extremity were to the ankle, which accounted for about 41 percent of such injuries, and to the knee, (approximately 29 percent).

Overall, there were 117 lower-extremity injuries per every 100,000 practices/games. However, the rate of game injuries was 19 percent lower among athletes who used discretionary protective equipment than in those who did not use such equipment, Yang and her colleagues report in the American Journal of Epidemiology.

This lower injury rate was found to be wholly due to the use of kneepads. Kneepad use was actually associated with a 67 percent lower rate of knee injuries in games, the report indicates.

The athletes’ use of knee and ankle braces, on the other hand, was associated with a 61 percent and 74 percent increased rate of knee and ankle injury, respectively.

The reason for this is unknown, but Yang speculates it may be because some athletes who get hurt simply put on a recuperative brace to stabilize their ankle or knee and continue to play, thereby increasing their risk of injury.

“When you have an injury, you need to fully recover before you go back,” she said, adding that this message applies not just to athletes, but to their coaches and parents who may also be eager for the athlete to return to the game.

In other cases, Yang added, athletes who regularly wear protective braces may play more aggressively, thinking that they are protected “but putting themselves at a greater injury risk.”

Kneepad use was the highest among boys who played baseball and girls who played softball, sports that incidentally also had the lowest rates of knee injury, the researchers note.

“Since so many players used kneepads voluntarily and seemed to benefit, we recommend that the National federation of State High School Associations review the rules for baseball and softball with a view to requiring kneepad use,” Yang and her team write.

SOURCE: American Journal of Epidemiology, March 15, 2005.