Sports Medicine Corner

Dr. Don Kirkendall

I am not a physician. I’ve just had the good fortune to work and watch a number of really great sports medicine docs at work on the sideline, in the clinic, performing surgery, doing research.

I’ve asked some of them what they wish the public knew or understood about sports injury that might help them get the athlete back on the field more quickly. Their responses usually fall into one or more of four categories.

Recognize and act accordingly. The longer one is involved in a sport, the more one learns about what constitutes an injury and what doesn’t.

Some are pretty obvious: visible bleeding, exposed bone or obvious evidence that a fracture has occurred, the unconscious player (who is NOT to be moved), audible responses to extreme pain. All of those require medical attention (i.e., call 911).

In soccer, a lot of players experience contact and fall, but that doesn’t necessarily mean an injury has occurred. Watch carefully to see the immediate reaction. A grim face while rubbing a shin might just indicate a minor contusion and the player gets back up and in the play.

If the surrounding activity continues, however, ignoring the surrounding play is a good indication that something has happened that is more important than what’s going on around the player. Now what? Is the problem a sprain (ligament injury), strain (muscle injury), contusion (bump or bruise), abrasion (scraped skin)?

In general (there are some exceptions) the first treatment is the same: PRICE-Protect, Rest, Ice, Compression, Elevation.

Protect might be just getting off the field or it might mean unweighting (e.g., crutches). Rest means don’t return to play. Ice is the main modality of treatment. This could be a commercial cold pack, an ice cup (water frozen in a paper or Styrofoam cup), ice (cubed, crushed), or even a package of frozen vegetables.

All (except the ice cup) can be tightly wrapped using a elastic bandage. Finally, if the injury is to a limb, Elevate the limb above the heart to reduce the hydrostatic pressure that can make swelling worse. One thing to remember: when using some form of an ice bag, ice water is colder than all ice and ice water ‘molds’ around the surface better than ice alone.

What About Heat?

The reasons behind why heat as a first treatment is not advisable have to do with the body’s immediate responses. The injured tissue sends out messengers that damage has occurred. One of the body’s responses is a surge of inflammatory agents that are drawn to the site of injury. Now some inflammatory cells are good, but too much can extend the duration of the immediate post-injury period and extend the time lost.

Adding heat allows more blood in the area and more inflammatory agents. Cold limits this excess blood flow leading to less of the inflammatory agents. Some believe that heat should be reserved for mostly overuse injuries (no single identifiable injury) or even later in the rehab process of an acute injury (but there is no consensus on this application).

Seek Medical Evaluation For An Injury

Don’t self-diagnose. See a physician, preferably a sports physician. If there is no physician present, don’t make any conclusion about the extent or nature of the injury. What might appear to be a minor ankle sprain might be fully torn ligaments, a fracture, cartilage damage, a high ankle sprain. Any of those could involve nerve or tendon damage, too.

Then there is the whole concept of rehabilitation and when to return to play. Let the MDs do their job. So what if it costs you a co-pay.

Remember the mechanism. One of the most important parts of the appointment at the doctor’s office is the Q/A about how the injury happened. Injury mechanisms are the bread crumbs that lead the doctor to specific injury and helps focus attention on whether any extra tests are needed (e.g., imaging), what other things might be causing the same signs (what the doctor sees) and symptoms (what the patient experiences), and what’s the best course of treatment.

Doctors frequently start out with a litany of possible options and the Q/A allows the physician to toss out possibilities, narrowing in on the actual diagnosis. Remember as many details as possible on how the injury occurred.

Realistic rehab expectations. Most injured athletes have entirely unrealistic expectations regarding return to play. Ankle sprain? Out a week. Knee sprain? Maybe a couple weeks. Concussion? Day or two at the most.

As Lee Corso says on ESPN’s football GameDay, “Not so fast.” The doctor and therapists are best positioned to determine when an injury has healed. For many injuries, expect to be out longer, doing rehab for longer, and maybe wearing some protection for an extended period after feeling fine.

Were you aware that an ankle sprain should be supported for up to six months after returning to play? Or that a substantial proportion of injuries in any season are re-injuries of incompletely rehabed earlier injuries? And Adrian Peterson’s remarkable return to form after ACL surgery did physicians no
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