As the dog days of summer wind to an end and students return to their respective competitive fields and courts, sports injuries most assuredly will begin to fill the local orthopaedic offices. High school athletics often play a vital role in many students’ lives. Injuries can be physically as well as mentally devastating to these young athletes. The passion exhibited by the athletes is no less than that seen on collegiate and professional levels. I thought it might be a good time to review some of the more common injuries and medical problems encountered by these young athletes.
Concussions
Concussions have been in the cross-hairs of the national sports media over the last few years. Incidence of concussions has possibly been on the rise due to a number of factors: increased vigilance in diagnosis, poor tackling techniques and larger, stronger athletes with increased physical play.
Concussions are defined as a transient impairment in neural functions such as alterations of consciousness, disturbance of vision and equilibrium due to mechanical force1. It may be as minor as a low grade headache and seeing stars, or it may involve complete loss of consciousness. Diagnosis of a concussive event is imperative so that proper treatment can be rendered to the injured player. If a concussion is missed and a player returns too quickly to athletic play, then severe sequelae ranging from increased susceptibility to repeat concussions all the way to possible death as a result of second impact syndrome may occur.
Treatment involves removal from competitive play with periodic neurological examination. No athlete should return to competition until all symptoms have been resolved completely. Florida High School Athletic Associations (FHSAA) requires a physician to clear the athlete before they are allowed back into competition. Multiple concussions may be a reason to completely remove the athlete from contact sports.
Incoming data from multiple studies have demonstrated the long term problems – such as headaches, memory loss and dementia – from multiple concussions. The medical community has redoubled their efforts in educating both the student athletes and coaches in an effort to identify and treat concussions.
Heat-Related Injuries
This topic is an especially relevant topic to Florida. Climate plays a major role in both performance and well-being for an exercising individual. There are a variety of heat-related injuries from simple muscle cramps to actual heat stroke.
Heat cramps are common in high school football players during the months of Aug., Sept. and Oct. It occurs with excessive loss of fluids, salts and other minerals. The athlete is unable to replace the lost fluids. Cramping of the actively exercising muscle with an inability to use the affected extremity is common and may last for several minutes. On-the-field management consists of replacing fluids, electrolytes, stretching the involved muscle group and rest. Massaging the area may help. Players are encouraged to drink liberally. The brain’s “thirst mechanism” is not adequate enough to hydrate players, so forced water breaks are often needed during practice. Cold water is the drink of choice, but one may use a diluted glucose suspension (50% Gatorade, 50% water) for athletic activity of longer than one hour. Intravenous fluids are given for severe cases.
Heat stroke represents the most lethal form of heat injuries. It can be associated with death if not treated rapidly. Symptoms usually present themselves when an athlete has been performing exercise in a hot, humid environment. Symptoms include high body temperature of 101 to 107 degrees and dry skin. Weakness, dizziness, confusion and even coma may occur. Time is of the essence. The athlete should be plunged, if possible, in an ice bath and given rapid transportation to the emergency department. Every year, there are a number of these tragic preventable deaths.
Prevention is rooted in education of athletes and coaches. Athletes need a period of acclimation to the environment. Workouts should be held in the early morning or late afternoon. Daily body weights when training in extreme heat are important as are enforced water breaks during practice to promote active hydration. The use of salt tablets is not recommended. Pickle juice is often used by players, but no studies support its use, and players may salt their foods liberally.
ACL Tears
The knee is the most injured joint in athletic play. It is supported externally by large muscle groups in the front with the back of the leg. Internally, thick ligaments do the work to provide stability. The anterior cruciate ligament (ACL) prevents the tibia from moving forward on the femur. This is vitally important when athletes are involved in cutting with twisting maneuvers.
The majority of ACL tears happen without contact. The player may plant his foot or pivot and hear an audible pop. Usually, there is an immediate swelling to the knee with difficulty bearing weight. A diagnosis is often made on the field or in the office with simple maneuvers. The diagnosis is then confirmed with an MRI study.
Treatment in a young athlete is almost always surgical. The ligaments are replaced with either patient’s tissue or a cadaveric allograft. This is a most successful surgery with most players able to return to their pre-injury level at six to 12 months. If the knee is not surgically reconstructed, the player is at risk for meniscal tearing (cartilage) and recurrent giving way of the knee. The risk for osteoarthritis is higher in ACL deficient knees. Knee bracing is of limited value, and usually, patients are instructed to avoid sports like tennis or basketball.
I have just reviewed a few of the sports injuries and illnesses that are prevalent as high school sports activities begin this fall. Education goes a long way towards prevention. Once the player is injured, quick diagnosis and a review of the treatment plan with the player, coach and parents is helpful to get everyone on the same page. I am looking forward to a great high school sports year.
**********************
James W. Berk, M.D. is Board Certified in Family Practice and Sports Medicine, with a Certificate of Added Qualifications in Sports Medicine. He attended medical school at the University Of Florida College Of Medicine and completed his residency at the Carolinas Medical Center. Additionally, he obtained his fellowship training in Sports Medicine at the Miller Orthopaedic Clinic in Charlotte, North Carolina and is a member of the Sports Medicine Advisory Board for FHSAA. Dr. Berk practices out of The Orthopaedic Institute’s Alachua facility.
1. Congress of Neurological Surgeons 1966