Hey Doc, When is it Safe to Get Back in the Game?
February 02, 2006
By: Stephanie Riesenman for Shoulder1
Athletics is big business today, with an ever-growing fan base that has created celebrity athletes and multi-million dollar professional salaries. The higher expectations by the public and the business of sport, means athletes at the professional as well as the collegiate and high school levels must be more competitive and more prepared to return to play following an injury. And though medical treatment has become more advanced, it still cannot eliminate the inherent risk for injury that athletes face as they keep up with the increasing pressure to perform at higher and higher levels. Balancing the pressure to return to play and the requirements for recovery becomes an equation in which there are many factors.
The recognized sports related injuries are musculoskeletal, neurological and cardiac in nature. Though studies have shown that an adolescent is about twice as likely to be killed by lightning and a 1,000 times more likely to die in an auto accident, there are still 10 to 13 cases of undiagnosed fatal heart disease among the millions of teenage athletes in the United States each year. Most of these cardiac problems are not identifiable by history and physical exam. Hypertrophic cardiomyopathy is characterized by a dramatic thickening of the left ventricle. The risk of sudden death from this condition is increased by sports play. Those identified with having this condition are restricted from sports competition. Adolescents with coronary artery abnormalities are also restricted.
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|Hints from Dr. Edward Craig, MD, orthopaedic surgeon at Hospital for Special Surgery|
Before you get on the field:
Think of your soft tissues (muscles and tendons) like taffy -- if you bend it and it's cold it will snap. Warm it up and then bend it, it will twist.
Run in place or do any other low-impact activity that raises the heart rate and increases blood flow to the muscles.
On the field:
Use it or lose it - Muscles that aren’t conditioned get atrophied and are more prone to injury.
Keep up with strength training.
Aerobic exercise can help keep the muscles in shape.
Thomas W. Rowland, MD, who writes about these conditions in one of several articles on sports injuries in the November 2005 issue of the Clinical Journal of Sports Medicine, says consequently a high level of anxiety has been raised whenever symptoms of chest pain, dizziness or abnormal heart rhythms occur. He says in the great majority of these cases symptoms are non-cardiac and not of significant concern. Chest pain, according to Dr. Rowland, is most often a sign of exercise-induced asthma or gastroesophageal reflux.
Among the more common sports-related injuries only concussions have consensus guidelines about how to treat an athlete and when they should return to play. A mild concussion, which is defined by no disorientation or loss of consciousness, would allow for an athlete to return to play after a 20-minute break. A second mild concussion would pull an athlete out for one week, and a third would lengthen the return to play time to three months. Moderate concussions, those that result in some amnesia, require an athlete to rest for one week before returning to play. A second moderate concussion would require at least one month of recovery, and a third would pull the athlete for the remainder of the season. A severe concussion that results in loss of consciousness would require at least one month recovery before returning to play, and a second would finish the athlete’s season. A third severe concussion comes with the recommendation that the athlete not return to contact sports.
The broadest category of sports-related injuries is that of the muscles, bones, tendons and ligaments – both at the competitive and recreational levels. According to Edward Craig, MD, attending orthopaedic surgeon at Hospital for Special Surgery in New York City, bone injuries are typically the easiest to diagnose and treat. He said bones take six weeks, on average, to heal. An orthopaedist will look to see a complete reduction in tenderness at the fracture site, and the patient should be able to demonstrate normal range of motion at the site of injury. An X-ray will confirm that the fracture has healed.
Unlike the characteristic one-time event that results in a snapping fracture of a bone, stress fractures are considered “a fatigue failure of bone and result from the accumulation of microdamage that occurs with repetitive loading of bone,” writes Christopher Kaeding, MD in the Clinical Journal of Sports Medicine. The injury starts in an area of concentrated stress; if it is not repaired, and repeated stress occurs, the microdamage accumulates until eventually the bone has become a full-blown stress fracture. These injuries are categorized as either high or low risk.
Low risk stress fractures typically heal with rest (about 4-8 weeks) and an athlete may even be able to continue playing on the injury using pain as a guide. High-risk fractures, according to the authors of the article, require at minimum, immobilization and restriction form weight-bearing. An athlete is allowed to return to their sport once an exam shows the bone looks normal and the pain has dissipated. For an athlete to return to activity too soon increases the risk of improper bone healing or the injury progressing to complete fracture.
Muscles strains – the battle cry of the weekend warrior – have the highest recurrence rate of all the common sports injuries. These injuries pose a treatment challenge for doctors treating both the professional and recreational athlete. Dr. Craig said typically his patients, no matter what the injury, want to know what they can do to feel better and when they can go back to their sport.
“There are two separate identifiable things I try to clarify for people,” said Dr. Craig, “that is are you doing damage by continuing to play, versus is it painful to play.”
For example, Dr. Craig said 50-60 percent of collegiate swimmers develop shoulder pain during the season. Because swimming is a short season, often these athletes will swim with the pain as long as doing so does not cause further damage to the shoulder muscles.
Muscles strains are typically treated with rest, ice and anti-inflammatory medications. Return to play is usually dependent upon the absence of pain and the ability to compete or play comfortably.
Injuries that affect ligaments and tendons are also common and have been known to end careers when not managed properly. Common upper extremity injuries of the throwing athletes are dislocated shoulders, rotator cuff tears, and elbow dislocations. Depending on the extent of the injury, sports medicine experts recommend a return to play anywhere from three weeks to one year. Factors such as whether surgery was required to repair the injury and the sport to which the athlete is returning impact the length of time to return to play. Again, an orthopaedic surgeon will look to see that strength and range of motion have returned to pre-injury levels and that the athlete is free of pain.
Doctors understand the high stakes of competitive athletics these days, and most do all they can to get an athlete back in the game as quickly as possible. Rehabilitation depends on the type of injury, how quickly an individual heals, and the sport to which the athlete will return.
Last updated: 02-Feb-06