Injury prevention in sport: not yet part of the game?

Background: There is a saying in sport that "injury is just part of the game". In other words, injury in sport is seen as inevitable. Objective: To examine progress toward reaching the contrary position that "injury prevention is just part of the game". Methods: The four steps of van Mechelen's "sequence of prevention" model provide a structure for examining progress. Results: What is known about the size of the problem (step 1)? Most is known about more serious injuries and about injuries in elite and professional sport. Least is known about less serious injuries, injury in community level and amateur sport, and injury occurring in recreational activities. What is known about risk factors (step 2)? Despite calls for analytic studies since the early 1980s, few such studies have been reported in the literature. What is known about the effectiveness of preventive measures (step 3)? Few randomized controlled trials have been reported in the literature. Are there systems in place to monitor sports injury (step 4)? Examples are given of systems in North America, Europe, and Australasia. Conclusions: With a few exceptions, progress has not gone beyond step 1 in van Mechelen's model. Challenges for the future include: deciding where research efforts should be Placed, standardization of definitions and methods of data collection and reporting, identification of risk factors and mechanisms of injury, and the evaluation of interventions. Finally, if the field of sports injury prevention is to advance, multidisciplinary collaboration will be required, along with the involvement of the sports community.