Marching band injuries strike a sour note in emergency rooms

NEW YORK, Oct. 20 (UPI) -- Marching bands often put on spectacular shows, but being in one is physically demanding and can cause disabling injuries.

New research indicates that 70% of marching band-related injuries reported to emergency departments during a nine-year period happened to young women of high school age.

Half of the injuries occurred in the lower body, with ankles and knees most often at risk. Sixteen percent of marching band injuries were serious and included mild traumatic brain injury, fractures, dislocations and or heat injury. In this category, mild traumatic brain injury comprised 6%.

The unique abstract, "Marching Band Injuries In Children Presenting to Emergency Departments in the United States, 2012-2021: A Trebling Tale," will be presented Sunday during the 2023 American Academy of Pediatrics' National Conference & Exhibition at the Walter E. Washington Convention Center in Washington, D.C.

Unlike other organized athletics, such as American football, soccer and cheerleading, a lack of evidence exists that details injury trends in marching band members, the abstract's authors noted.

"This is the first nationwide estimate of marching band injuries presenting to an [emergency department]," they wrote.

Staying in tune

"Like their instruments, band members must be in tune with their bodies," Dr. Jacob Coene, a researcher, pediatrician at Brooke Army Medical Center in San Antonio, Texas, and an Air Force captain, said in a new release.

"Coaches and parents should be educated on the risk of soft tissue injury and mild traumatic brain injury to help keep their band members marching to the beat of the drum."

Researchers examined an estimated 20,335 marching band injuries reported to emergency departments between 2012 and 2021, according to data from the National Electronic Injury Surveillance System. Eighty-five percent of marching band injuries occurred in those between age 14 and 18.

Of all marching band injuries, 98% were treated and released from the emergency department.

"Based on the injuries catalogued and the low rate of care escalation required, we theorize that a high proportion of these ED visits could likely be prevented," the abstract said. "The injury patterns described provide an opportunity for targeted public health intervention by sports medicine teams."

Acknowledging the risks, in 2017 the National Athletic Trainers' Association provided timely recommendations aimed at keeping marching band members healthy and well prepared for activity.

Physical exams required

In addition, states like Texas and Oklahoma "have started to mandate pre-participation physical evaluations for marching band members, recognizing that the physical demands and environmental conditions of these students are similar to those experienced by athletes," according to the National Federation of State High School Associations.

"This study is overdue. I think many of us focus on the athletes on the field and the court and can overlook the physical demands of being in the marching band," Dr. Robert Lapus, a UTHealth Houston emergency medicine physician affiliated with Children's Memorial Hermann Hospital, told UPI via email.

"The finding that the majority of marching band injuries occurred in high school-aged females is worth noting and can help guide injury prevention strategies and interventions targeted towards this specific demographic," Lapus said.

"The study also identifies the most commonly injured body parts, such as the ankle, knee, and upper trunk, which can guide efforts to develop protective equipment, strengthening programs to help minimize the risk of these injuries, or even prompt evaluation of the type of footwear used."

Dr. Ryan Stanton, a vice president of the American College of Emergency Physicians, who practices medicine in Lexington, Ky., told UPI in a telephone interview that he was hurt while playing drums in a college marching band.

"I got injured, so I have firsthand knowledge of these injuries," said Stanton, who said he played in marching bands starting in fifth grade.

Stanton said he hyperextended his left knee while running across an artificial turf with his instrument on during the pregame performance. He limped during that show and wore a knee brace for several weeks.

Awkward instruments

Marching band injuries occur "due to movements of dozens to potentially hundreds of young people on the field with some quite heavy and awkward instruments," Stanton said. "Injuries can be quite common just from tripping, falling on uneven surfaces and then hitting each other."

Carrying a heavy instrument such as a tuba prevents a player from holding out his or her arms to fall on the wrists. While this protective mechanism puts the wrists more at risk for injury, it helps prevent head trauma, he said.

Dr. Dennis Cardone, chief of primary care sports medicine for NYU Langone Orthopedics in New York City, told UPI in a telephone interview that there has not been any major data related to marching band injuries before this study.

"It's surprising that the head injury rate is as high as it is being reported in this study," said Cardone, who is also co-director of the NYU Langone Concussion Center.

"This is an important study because it brings attention to this specific population and the amount and type of injuries sustained, and then provides the groundwork for the next step, which is prevention of these injuries."

More studies are needed to determine whether most injuries occur during practice or performance and are related to falls or contact with instruments or other band members, he said.

In addition to musculoskeletal impact and concussions, injuries related to extreme heat or cold often affect marching band members, Dr. Nicholas Cozzi, EMS medical director at Rush University Medical Center in Chicago, told UPI in a telephone interview.

In the winter, participants can get frostbite in their fingers, toes, ears and nose. Wearing layers and keeping the hands and feet warm can help prevent this common occurrence, Cozzi said.