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Horseback Riding
O– Horseback riding can be safe for people with bleeding disorders,
depending on how they participate.
R– The risk associated with horseback riding varies with the type of riding
performed. For example, therapeutic horseback riding or going on a
trail ride with trained staff carry less risk. Alternatively, galloping across
rugged terrain, racing or jumping carry higher risks of injury. Most
horseback riding injuries occur when a rider falls or is thrown from
a horse. Serious injuries may also result from horse kicks. The most
common injuries are ankle sprains, wrist injuries to bones and/or
ligaments, and head injuries, including concussions.
S– To promote safety, stables should be well maintained and staffed with
trained professionals who provide proper horse care (feeding, shoeing,
etc.). Riders should never walk behind a horse or make sudden movements
or loud noises. They should not ride horses with unknown temperaments.
Riders should always be supervised by trained staff. A trained professional
should safety check all equipment prior to riding, including the girth or
cinch, stirrup leathers, stirrups and reins. Stirrup length should be adjusted
to fit each rider. A hard, well-fitting helmet should always be worn. Helmet
use has reduced the rate of traumatic brain injuries by 40%-50%. Sturdy
riding boots should have a short heel and cover the ankle.
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Hockey, Field/Ice/Street
O– Hockey is a team sport, played on various surfaces, such as ice rinks,
and on grass and pavement.
R– Often, hockey played as a younger child carries less risk of high-impact,
high-collision injuries. However, there is still a risk for traumatic injuries
from the puck or ball, as well as collisions with rink barriers, hockey sticks
or players, or the ground. The rate of injury increases along with the size
and the speed of players, and when checking is part of the game.
S– Hockey carries less risk at a lower competitive level when participants
wear the proper safety gear and play under supervision. If you choose
to play, always wear a helmet, padding and appropriate safety gear.
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Hiking
O– Hiking typically involves a long walk on dedicated paths or trails that may have sharp inclines or varied, rugged terrain. Walking is one of the lowest impact activities, allowing the cardiovascular benefits of other aerobic activities, without the stress, strain and pounding that come with high-impact activity. Hiking can be a good social experience when done in groups, and it is an excellent lifetime activity. Equipment needs vary according to the duration, distance, terrain and the environment. Equipment can include hiking boots and walking poles.
R– Aerobic effort, impact, balance and muscular workout increase with more challenging terrain and weight carried in a backpack.
S– While overall risk is low, make sure to only hike on terrain that is appropriate for your ability.
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High Intensity Functional Training (Incl. CrossFit®) Class
O– These programs have been shown to significantly improve
cardiovascular fitness, while decreasing the percentage of body
fat. HIFT includes programs like CrossFit®, a core strength and
conditioning program composed of movements that are constantly
varied at high intensity.
R– Injury rates are variable, just as the style of training is variable.
However, injury rates have been reported as high as nearly 75%.
Power lifting and Olympic lifting exercises, two main components
of the CrossFit® program, have high risk of injury.
S– Participants are less likely to be injured when coaches are monitoring
and correcting form. As with any strengthening program, proper form
is key to injury prevention. Learn the skill before adding any weight.
Use modifications as needed, especially with activities that may stress
areas of previous injury or bleeds.
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Gymnastics
O– Participating in gymnastics can help improve strength and flexibility.
R– Young gymnasts whose bodies are still growing and developing are at
increased risk of injury due to their immature bones and joints, as well
as the stress associated with repeated twisting, flipping and landing.
The more difficult the routine (jumping dismounts or aerial moves), the
higher the risk of injury. Injuries most commonly occur in the low back,
ankles, feet, knees, wrists, hands, often from overuse. Of greater concern
for people with bleeding disorders is the inherent risk of traumatic injury,
concussion and/or a bleed resulting from a blow to the head during a fall.
S– Maximize safety by using proper technique and wearing recommended
safety gear, such as wrist guards, hand grips, footwear and knee/elbow/
heel pads. Make sure all equipment is in good working condition. Use
safety harnesses and spotters when learning new skills. Look for a wellsupervised
setting that includes proper instruction and good spotting.
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Frisbee®, Ultimate
O– Ultimate is played by two teams of 7 players with a flying disk on
a field with end zones, similar to a football field. Players score by
catching a pass in the opponent’s end zone. Ultimate is a limitedcontact
team sport that can be played recreationally or competitively.
Participants run, cut, guard, jump, throw, catch and dive in order to
catch the disk.
R– Frequent cutting moves, physical contact and jumping are risk factors
for injury. Jumping, cutting and diving maneuvers carry the highest
injury risk, especially for the knee and ankle.28
S– To improve safety, players should train for aerobic conditioning to
support the need for constant running during a game.
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Football, Tackle
O– Football encourages teamwork. Playing football has cardiovascular
benefits and can improve agility.
R– Football is a high-contact, high-collision sport with potential for
serious traumatic injury to the head, neck, spine and extremities.
Overuse injuries can occur. However, traumatic injury and concussion
are by far the most common. Traumatic injury in a person with a
bleeding disorder can be life-threatening.
S– If you choose to play, speak with your healthcare providers prior to
starting the activity. Wear protective gear and avoid playing positions
with heavy tackling.
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Football, Flag or Touch
O– Flag and touch football are alternative options to tackle football
and carry less risk. Playing flag football and touch football has
cardiovascular benefits and can improve agility.
R– Although the sport does not include tackling, there is still a risk for
collision between players, and injuries from light contact or falls.
S– Improve safety by participating in flag football or touch football
in a supervised setting.
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Fishing
O– Fishing types are variable and can include; saltwater fishing, such as
deep sea fishing or surf fishing; freshwater fishing, such as boat fishing
or fly fishing; and ice fishing. Each type of fishing may require different
knowledge, and provides a different experience.
R– Because fishing is practiced in different environments (pier, boat, ocean,
rocky coastline, ice, river), risk will be different for each specific location.
S– Think about safety precautions each time you decide where to fish.
These include: protection from the elements and insects, and appropriate
clothing and shoes. Use safe handling techniques with fishing knives, and
when baiting, removing hooks and handling fish. Carry emergency/safety
gear, use life jackets and follow boating safety procedures. In case of a
storm, head to shore if you can.
Remember, you need a license even for catch-and-release fishing. Each state
has regulations about fishing licenses and daily limits.
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Elliptical Machine (Training Equipment)
O– This machine is a combination of an exercise bike, stepper and ski
machine, with some treadmill attributes. Some have poles to add
an upper body workout. Elliptical trainers provide a low-impact and
cardiovascular workout, while lessening stress on the joints.
R– Minimal risk.
S– Practice proper form by keeping correct posture: shoulders back,
head up, chin straight, abdominals tight and arms relaxed. Rest hands
lightly on the handrails to help with balance (or use the workout bars
if available). Try not to lean forward or grip the bars tightly. If needed,
lower the resistance level.
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Diving, Recreational
O– Diving may help improve flexibility, strength, balance and
overall fitness.
R– Recreational diving injuries often result from diving into shallow water.
S– Safety tips to minimize risk include never diving into shallow water or
water that isn’t clear enough for you to see obstacles. If you’re unsure,
always jump in feet first. Also, only allow one person on a diving board
at a time.
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Diving, Competitive
O– Diving may help improve flexibility, strength, balance and
overall fitness.
R– Competitive diving is a high-collision sport with potential for serious
head and neck injury. A diver on a 10-meter platform enters the water
at about 40 miles per hour. Injuries can occur from hitting the board/
platform and from overuse injuries, such as frequent jumping, back
arching, trunk flexion and back twisting. They can also occur when
divers enter the water.
S– If diving competitively, diving from a lower platform improves safety.
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Dance
O– Dance may involve participation in a structured class with an instructor
or can be done individually. There are a wide range of dance styles that
can be done for exercise, recreation and/or performance.
R– Injury risk varies greatly from very minimal risk in ballroom dancing or
beginner ballet all the way to very high risk associated with head-spinning
during breakdancing. Injuries tend to be the result of overuse, rather than
trauma, and can include stress fractures, tendon injuries, sprains
and strains.
S– To improve safety, get instruction and follow proper technique.
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Circuit Training
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Cheerleading
O– Cheerleading provides the opportunity to work on a team, and participate
in high-energy exercise.
R– Basic cheers and jumps present minimal risk. The risk for injury increases
with pyramids, lifts and throws, especially in competitive squads. The
most common injuries are sprains/strains, usually occurring during
stunts. However, cheerleaders do have a small risk of catastrophic
injuries, such as head and spine injuries.
S– Proper spotting is essential to minimize risk. Aerial moves are not
recommended. Safety precautions that include technical skills, such as
pyramids, mounts, tosses and tumbling, should not be performed on hard,
wet, uneven surfaces or on obstructed surfaces. No cheer events should
take place on dirt, vinyl floors, concrete or asphalt. Pyramids and partner
stunts should only be performed with spotters on a spring floor or with
a landing mat, on either a traditional foam floor or grass/turf. Pyramids
should not be more than two people high.
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