Preventing football injuries is a team effort

By DR. MICHAEL ROSEN
Guest Columnist

Football’s physical nature means injuries will occur, but many can be prevented or minimized through a proactive approach to player safety.

With high school, college, and NFL football seasons underway, Parkview orthopedic surgeon and sports medicine specialist Dr. Michael Rosen reviewed some of the most common football injuries you might see on the field or hear in the injury report this year.

No sport comes without risk of injury, but the high-strength, high-speed, high-agility action of football is especially rough on an athlete’s body. When injuries occur, proper evaluation, treatment and recovery time are essential. That can be challenging for athletes eager to return to the field, but it plays a critical role in preventing further injury.

“When we’re talking about football, good coaching, proper equipment, conditioning, medical supervision and communication with parents can all make football a lot safer and more enjoyable for everyone,” Rosen said. “The relationship between athletes, their families, coaches, our athletic trainers and orthopedists is key to diagnosing and properly treating injuries to keep athletes healthy and in the game.”

Parkview Sports Medicine’s in-school athletic trainers – who are embedded in more than 50 high schools and universities in Indiana and northwest Ohio – serve as a first line of response when on-field injuries occur. Trainers can help connect injured athletes to a specialist like Dr. Rosen as needed, and in turn, Rosen can relay instructions and rely on trainers to help supervise recovery.

“Athletic trainers build a tremendous amount of trust because they’re with the athletes so much,” Rosen said. “They’re really on top of that and a good communication bridge between athletes, parents, coaches, therapists and sports medicine doctors and surgeons.”

Of course, some injuries like bone fractures or ligament tears will require orthopedic care. But if an athlete experiences persistent or increasing pain, swelling, weakness or numbness from an injury that seemed minor at first, that’s a signal to make an ortho appointment for further assessment, Rosen advised.

That follow-up will start with an X-ray and a detailed physical exam to home in on the exact problem, said Rosen, who practices in both Steuben and DeKalb counties. Depending on the type of injury, doctors might order an MRI or CAT scan to get more details about possible structural damage, he said. Since many games (even high school) are recorded and televised, Rosen said it’s common for families to come with a video clip showing when the injury happened, which can give doctors further context around the incident.

“We know athletes want to get back in the game as soon as possible after an injury, but many sports injuries can be recurring if they don’t get complete care,” Rosen said. “Getting the right rehab and taking the appropriate amount of time to let the body heal is important not just to recover from one injury but to reduce the risk of reinjury.”

Whether you’re an athlete, parent or just a fan who wants to better understand what the weekly injury report means, Rosen explained five common football injuries, how they happen and how they’re treated:

Cramps

Muscle cramping is not the most serious injury a player can suffer, but it’s the most common and can be intensely painful.

Dehydration and electrolyte loss, particularly during prolonged exercise or hot conditions, can disrupt nerve signals from the brain to the muscles, causing them to involuntarily spasm. Cramps can be treated in the moment by an athletic trainer who will help stretch and loosen the muscle. Sometimes players can rehydrate on the sideline and get back in the game, but once hit with cramps, they can recur and keep a player down.

“When you’re depleted and trying to exert yourself, the muscle can spasm or contract against your wishes,” Rosen said. “That’s what a cramp is, just an involuntary contraction of that muscle. It’s a severe and very intense contraction.”

Drinking water or sports drinks before and during the game is important, but good hydration should start well before, Rosen said. Hydrating throughout the week leading up to game day can help prevent cramps.

Concussion

Because of the high-speed impact play of football, concussions are common and can be extremely dangerous for players.

A concussion occurs when a forceful hit causes the brain to move and contact the inside of the skull, Rosen said. Concussions are traumatic brain injuries and can range from mild instances that daze a player to debilitating hits that can cause a loss of consciousness.

Concussions cause symptoms in the moment – dizziness, disorientation, sensitivity to light or loss of consciousness – but lingering impairment can last for days or weeks after. From prep leagues to the pros, athletes must follow a “concussion protocol” to have a doctor evaluate and make sure they’re recovered before clearing them to return to play.

“We try to never rush somebody back after a head injury,” Rosen said. “We want symptoms to be completely resolved for a significant duration. There is a protocol and the athletic trainers help us out a lot with that.”

Teaching good tackling techniques, proper fitting helmets and enforcement of rules that reduce contact to the head all help protect players and reduce concussion incidence.

ACL injuries

The anterior cruciate ligament, or ACL, is one of the connective tissues that hold the knee in place, but football is especially hard on knees due to the strong, fast cuts and direction changes players make.

ACL tears often occur without a player even getting hit, Rosen said, but can happen when a runner plants their foot to turn, but the pushing and twisting forces are too much for the knee to absorb.

“When an athlete goes to cut, if they land awkwardly or go to push off and that ligament is unable to handle it, it can cause strain. Given the velocity, strength and technique of that movement, it often leads to failure and the ACL just shreds,” Rosen said.

ACL tears are season-ending injuries and require surgical reconstruction followed by extensive rehab to rebuild strength around the knee. Athletes who have had one ACL injury are more likely to suffer another.

Although ACL injuries occur unexpectedly, players can reduce their risk of ACL injuries by practicing footwork and body control, specifically to reduce the force placed on their knees while running.

Shoulder dislocation

When a quarterback draws back to throw, his arm is vulnerable if it takes a hit during the throwing motion.

Shoulder dislocations occur when an impact causes the ball joint to slip out of alignment, and while quarterbacks are especially at risk, it can potentially happen to anyone who takes a wrenching hit to the arm or shoulder.

“Your shoulder joint is like a golf ball on a golf tee,” Rosen explained. “The tee is flat and the ball is much larger than the socket it’s sitting on. A dislocation can occur when the ball slides off that socket.”

Dislocation can stretch or tear surrounding muscles and cartilage and even damage the bone of the shoulder joint. A trainer can pop the shoulder joint back into place in the moment after it happens, but recovery is a much longer process.

Worse, Rosen noted, is that incidence rates after a first-time dislocation are very high, sometimes approaching 80 to 90 percent in the highest risk groups.

Muscle strains

Strength is a given for football players, so muscle strains are especially common when a player pushes their body too far.

Two muscle groups frequently injured in football are hip flexors at the leg joints and hamstrings, the big, meaty muscles on the rear of the leg. Again, due to the size, strength and speed of players, the stress placed on the legs during running, jumping, and tackling can overextend and damage those muscles, Rosen said.

Muscle strains are nagging injuries that take a long time to heal. Players will often return to play after feeling like they’ve recovered, only to reinjure the same area because it wasn’t fully healed.

“Those can last the entire season because to really rehab that and recover, you’re not going to be able to compete,” Rosen said. “It takes a period of rest, stretching and allowing it to heal itself.”

Michael Rosen, DO, is an orthopedic surgeon at Parkview Health.