Avoiding trampoline-related injuries

It’s fun watching children jumping and doing cute stunts on the trampoline. But if we think trampoline exercise is safe and healthy for children, we’re utterly mistaken. Serious injuries have been reported, especially in children, including fractures, head, cervical spine injuries and vertebral artery dissection.

A recently published updated advisory of the American Academy of Pediatrics (AAP) expressed alarm at the relatively high incidence of trampoline-related injuries. “Home use of trampoline is strongly discouraged,” the AAP advised the public. The advisory was published in a recent issue of the journal Pediatrics.

Previous advisories by the AAP and other concerned medical organizations like the American Academy of Orthopedic Surgeons, the Canadian Pediatric Society and the Canadian Academy of Sports Medicine have pressured trampoline manufacturers to institute various safety measures and clear warnings on the packages, but these have not successfully reduced injury rates.

The trampoline industry has tried to address the problem with voluntary safety standards, which included the following: 1) extending padding to the frame and springs; 2) improving the quality of the padding; and 3) prohibiting inclusion of ladders in the packaging to help prevent young children from accessing the trampoline.

Warnings on the package

In addition, manufacturers print bold warnings on the package. These include warnings to avoid somersaulting, restricting multiple jumpers and limiting trampoline use to children 6 years or older. Adult supervision is also strongly recommended. However, several studies have shown that up to one-half of injuries occurred despite having adult supervision, and several authors labeled this as “supervision complacency.” The problem is simply that adults are not fully aware of the potential injuries that could result, and there is no feeling of urgency to stop risky behavior on the trampoline.

The AAP paper particularly warns against allowing multiple simultaneous users on the mat because this is when most of the injuries happen. When doing it together with other kids, children usually become more unruly and careless, resulting in injuries. “Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips,” it said.

Patterns of injury

Common musculoskeletal injuries that have been reported include ankle sprains, strains and contusions, but “several unique patterns of injury have also been attributed to trampoline use,” the AAP paper explained. There are different patterns of injury depending on the age of the trampoline user, but up to a third of all injuries brought to the emergency room have been reported in children younger than 6 years.

Young children are also at higher risk of fractures and dislocations, and chances are, they will require hospitalization compared to older children and adolescents. In the 6- to 17-year age group, more than one-fourth consisted of fractures or dislocations, as compared with 48 percent in children 5 years and younger.

Sprains, fractures and dislocations of the lower extremity are the most frequently reported injury (up to 50 percent). One-fourth to one-third suffer from upper extremity injury, and of these, around 60 percent are fractures.

Serious injuries

While most injuries are not life-threatening, serious injuries to the head and neck have also been reported in 10 percent to 17 percent of all trampoline-related injuries. Around 0.5 percent or one in 200 of all trampoline injuries is serious enough, resulting in disabling permanent neurologic damage due to a serious injury to the head or spine. The head injuries are usually associated with falls from the trampoline.

We see athletes doing spins, flips and somersaults on the trampoline, and they make it look so easy that some children may try to imitate them. That’s when the problem arises. Serious neck spine injuries can happen with falls and failed somersaults or flips causing hyperflexion or hyperextension of the cervical spine in the neck, and these injuries could be catastrophic or life-threatening, or permanently disabling like lifelong paralysis from the neck down.

Sudden severe stretching of the neck can also cause one of the major arteries in the area—the vertebral artery—to be torn, and this can happen, not immediately, but 12 to 24 hours after a trampoline-induced neck injury. So individuals who suffer from neck injuries may seem all right immediately after, only to succumb to a serious complication or even death 12 to 24 hours later. Hence, some of those injured have to be monitored in the hospital for a day or two following the trampoline injury.

Recommendations

In summary, the AAP gives the following recommendations to prevent trampoline-related injury:

• Only one person at a time should use a trampoline.

• Trampolines should be equipped with protective padding.

• Somersaults and flips should not be allowed.

• An adult willing to enforce safety rules should always be present.

Exercising or playing on the trampoline can be a lot of fun, so long as those using them are not foolhardy to disregard the precautions.