Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Perspective: Avoiding injury

There are easy ways to reduce the odds of suffering a life-changing injury, says Sara Klaas.

Estimates show that between 238,000 and 332,000 people in the United States have a spinal cord injury (SCI), and there are approximately 12,000 new injuries each year. Each one is a life-changing event. As well as the physical, social and possible psychological effects, such an injury carries a great economic burden. The annual healthcare and living expenses associated with an SCI vary considerably according to the level of injury, but the estimated average lifetime costs — not including indirect costs, such as loss of wages — range from US$1.1 million to $4.6 million. The combination of personal and financial losses makes SCI a high priority for prevention, given the wide-ranging and long-term effects of such injuries.

The Prevention Institute, which is a non-profit organization based in Oakland, California, reports that prevention programmes are extremely cost-effective. Investment of $10 per person in prevention programmes could save nearly $3 billion in healthcare costs in two years in California alone. Healthcare workers have of course focused primarily on treating the effects of SCIs, rather than on preventing the injuries in the first place. But we must keep in mind that safer behaviour decreases the odds of experiencing an SCI.

We know a high quality of life is possible after a spinal cord injury, but it is better to prevent as many of these injuries as possible from occurring in the first place.

The US National Spinal Cord Injury Statistical Center in Birmingham, Alabama, has listed the most frequent causes of SCIs. The most common cause is motor-vehicle crashes, which are responsible for just under 40% of all SCIs, with falls causing almost 30% and acts of violence about 15%. Around 10% of SCIs are caused by sports-related incidents, and the remaining injuries are from unknown or other causes. Understanding what causes SCIs can help campaigners to identify which behavioural changes will make people safer. At Shriners Hospitals for Children, we are committed to making prevention a priority. Along with our collaborators at the American Spinal Injury Association, we strongly believe in the power of rehabilitation: we know that a high quality of life is possible, even probable, after an SCI. But we know it is even better to prevent as many of these injuries as possible from occurring in the first place.

Alert driving

Motor-vehicle crashes are perhaps one of the areas that are most amenable to SCI prevention from changes in behaviour. We have all seen someone swerving while talking on a mobile phone. The 2011 US National Occupant Protection Use Survey — produced by the National Center for Statistics and Analysis of the National Highway Traffic Safety Administration — reported that “approximately 660,000 drivers are using cell phones or manipulating electronic devices while driving” at any time during the day in the United States. Moreover, the National Safety Council, which is a non-profit organization based in Itasca, Illinois, estimates that approximately 25% of all motor-vehicle crashes involve the use of mobile phones.

The complexity of driving requires drivers to keep their eyes on the road, their hands on the wheel, and their brains fully focused on the task at all times. Drivers who talk on their phones — even if they have a hands-free kit — are choosing to be distracted. This distraction causes most problems for young drivers. One study of drivers who have been involved in a crash or near-crash found that those aged 18–20 reported the highest percentage of mobile-phone use1, followed by those who were 25–34 years old.

Keeping your balance

Falls, which cause more than one-quarter of SCIs, can also often be prevented. They tend to occur most in older people: the US Centers for Disease Control and Prevention (CDC) found that people over 75 years of age are most likely to fall.

For older people — even people only in their 60s — the CDC recommends several steps to reduce the risk of falls. First, take regular exercise to keep your legs strong. Second, review your medication with your physician to reduce the chance of a side effect that causes dizziness. Third, make sure your eyesight is as clear as possible, mainly by keeping the prescription in your glasses updated. Finally, run a safety check of your home to look for potential trip hazards. Some of the more obvious hazards can be avoided by a few simple changes, such as tucking electrical cords out of the way and using grab-bars in bathrooms and showers. There are also some less obvious solutions: replace any carpets that have torn edges, for example, and avoid using throw rugs in your house.

Minor changes in behaviour — from knowing when to put down your mobile phone to getting your eyes checked — can have a big impact on reducing the risk of SCIs. Please share this information with your family, friends and community (for more on this, visit the ASIA website:


  1. 1

    Tison, J., Chaudhary, N. & Cosgrove, L. National Phone Survey on Distracted Driving Attitudes and Behaviors. Report no. DOT HS 811 555, National Highway Traffic Safety Administration (2011).

    Book  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Sara J. Klaas.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Klaas, S. Perspective: Avoiding injury. Nature 503, S18 (2013).

Download citation


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing