Athletic injuries: causes, prevention, and treatment

¶ … athletic coach I have garnered a wide variety of skills, as well as an extensive understanding of the standard practices and procedures an individual in the field of exercise science should possess. My past experiences have provided me with substantial knowledge of the principles involved in the prevention and care of athletic injuries. With the following, I hope to illustrate that my experiences and subsequent research have provided me with a broad awareness of typical athletic injuries and treatments as they apply to exercise science.

When a member of my dance squad sprained her ankle it became necessary for me to tape it as to provide additional support. I employed the traditional Gibney basket weave procedure. This consists of an interwoven network of stirrup strips "which cover the plantar surface of the hindfoot and extend proximally on both the medial and lateral aspects of the leg, and horseshoe strips, which are applied perpendicular to the stirrup strips on the hindfoot." (Journal of Athletic Training 2002). Although I recognized that this could not be a permanent solution, it did provide her with a slight amount of external support for her ankle. I advised her avoid testing its limits so it could heal more readily. This proved to be sound advice because she was back to regular activity within the span of two weeks.

During my time as a coach for distance runners I came to realize that a large percentage of running-related injuries could be prevented with the universal use of arch supports. Through my research I found that shin splints, tibial stress syndrome, tibial stress fractures, Achilles tendonitis, heel pains, and arch pains can all not only be treated by using arch supports but can also be prevented with arch supports (Levy 183). Accordingly, I made some form of supports mandatory for my distance squad as a preventative measure. The move paid-off, because none of my athletes suffered from any major arch related injuries that season.

In my years as a cheerleading coach I have found that cheerleaders experience injuries similar to those suffered by gymnasts. Additionally, they experience high levels of groin pulls as a result of performing splits, as well as shin splints from extended activity on hard floors. Of course, the greatest risk in associated with pyramids and other types of lifts. These sorts of stunts must be planned with the utmost attention to safety. Awareness of possible injuries like whiplash dislocation of cervical vertebra, although rare, is necessary.

From my time as a swim team coach I have always felt that it is best to remain aware of the most dangerous injuries that sometimes occur. Diving accidents are infrequent, but one mistake can be extremely costly. Among the more common ailments are swimmers ear, irritated eyes, swimmers shoulder, collarbone pain, and swimmers knee. Fortunately, I was never required to treat any injury more serious than irritated eyes -- which can easily be treated with better goggles.

Distance runners, however, can experience a myriad of injuries from repetitive activity. Many of them can be treated with better arch supports, or better shoes. Stress fractures and hamstring pulls are not uncommon. I have found that lower back pains and knee problems can also arise. Many of the injuries associated with distance running can best be treated with rest.

A parent once asked me exactly what I kept in the bag I brought to competitions, and this forced me to identify the equipment that was most essential to a coach. The following is a list of items that most coaches or trainers should carry regardless of the particular sport as compiled from my own experiences and research (Boyle 103):

Suture materials: superglue, needle holder, scissors.

Inhaled bronchodilator, for treating asthmatics.

Injectable adrenaline, for asthma or insect stings.

Blood pressure cuff.

Stethoscope.

A cake icing, for diabetics suffering from an insulin reaction.

Splints.

Screwdrivers.

Fluorescein dye, to test for corneal abrasions.

Saline, for rinsing eyes.

Eye patches.

Moleskin.

An otoscope and ophthalmoscope, for looking into eyes and ears.

Alkali solution, for cleaning lost teeth.

A cell phone, to call 911 if necessary.

Although most minor injuries can be treated by a trainer -- with the aid of these materials -- it is important to recognize when emergency medical assistance is required. Skull, neck, and spinal injuries should warrant an immediate call for assistance from the nearest medical facility, regardless of apparent severity. In the case of an unconscious person CPR should be performed, but a rescue squad should also be called. Even injuries of this nature that appear minor should be treated with utmost caution, before the individual is allowed to return to competition (Boyle 35).

Broken bones or dislocations of extremities should also warrant a call to 911 if the pulse is weak or the limb begins to turn cold -- this could be a limb threatening injury. Also, trainers or coaches involved in contact sports should be aware of potential injuries to the spleen. "Always consider the possibility of a splenic when a player complains of lower rib pain, and call 911 if there is any suspicion of this injury." (Boyle 58). Essentially, my research into the necessity of emergency calls has resulted in the theory that an athlete who has sustained a serious injury should be checked for a clear airway, breathing, and circulation. A failure in either one of these warrants a call to 911.

I have found that athletic trainers, on the high school level, are responsible for much more than just ensuring the safety of the athletes. In fact, it has often become necessary for me to inform the athlete's parents of my capabilities and reassure them of their child's safety. This is frequently the case because parents are regularly more concerned for their young athlete's physical security than the children themselves. Therefore, I feel that it is essential for athletic trainers to, not only be prepared for any potential mishaps, but also to exude a professional and calm persona.

I believe that there are two primary ways by which someone can gain the qualifications necessary to be a capable athletic trainer. The first is the traditional method, and the way I came into the practice: apprenticeship or internship structure, where the primary focus is on attaining practical skills to provide service for athletes. I gained the majority of my skills through direct experience and observation.

However, it has been increasingly more common for athletic trainers to begin their learning in an academic setting, with a more rigorous and organized method. I believe that in the future a clinical education model will be the standard by which trainers learn their trade. Currently, both paths are acceptable and both types of athletic trainers can be equally competent. In fact, I feel that the vast majority of topics that are covered in my classes I have already encountered in my own experiences.

An athletic trainer is responsible for the prevention and care of athlete's injuries, as well as introducing programs that may produce the greatest gains in performance. This includes strength training, cardiovascular, flexibility exercises, and equipment recommendations. Although the specifics of day-to-day responsibilities may vary from place to place, these are the essentials of the position.

In addition to the supplies that I carry in my medical bag to each event, I also find it necessary to have full access to a treatment facility during the regular working day. This way, when an athlete sustains an injury during the course of a practice or workout it is possible for me to assess their injury and suggest a treatment. I always keep in this facility many of the larger supplies that I may be unable to transport to ever single sporting event. These supplies include: crutches, leg braces, slings, ankle braces, bandages, as well as pain relievers. Of course, all of the emergency materials that are kept in the medical bag should also be available in any other treatment facility.

I have found that one of the most common injuries that can potentially become serious generally occurs when an athlete is poked in the eye. A corneal abrasion can often occur; I always test for this immediately if an athlete complains of eye pain. A member of my distance squad during a practice run had her eye poked by a hanging tree branch. She was in extreme pain and tested positive for a scratched cornea. I thoroughly rinsed her eye with saline and covered it with a protective patch before instructing her to visit a doctor. This turned out to be the correct course of action because the doctor confirmed the abrasion, and no further complications were sustained.

From my time as a distance runners' coach I have investigated the mechanics behind the most common types of injuries associated with running. Subsequently, I have learned that "95% of these problems are due to the foot striking the ground improperly." (Levy 199). Generally speaking, three specific types of problems are most common in runners: a pronating foot, a Morton's foot, and a supinating foot. "A pronating foot rolls toward the inside. A supinating foot rolls toward the outside. A Morton's foot is a combination of these two abnormalities." (Levy 199).

A pronating foot can result in knee problems from the joint being repeatedly twisted. I have found that most people with a pronating foot can be treated with a simple arch support, but naturally, this is not the right answer for everyone. I have learned that, "For 10% of runners, an arch support provides too little lift, and for another 10% an arch provides too much lift. These 20% of runners need a custom-made shoe insert, or orthotic device." (Levy 200). This is why -- for my distance team -- although I require every member to use an arch support, if they cannot become accustomed to it, I allow them to return to what they are most accustomed to.

Obviously, the most common ailment I have encountered in my years as a coach is muscle soreness. "This soreness, or more specifically 'delayed onset muscle soreness (DOMS),' usually peaks between 24 and 36 hours after the exercise bout." (Brown 3). It is predominately the lengthening portion of the muscular activity that causes tiny tears in the muscle fibers, and thus soreness. An additional cause can be prompted by the body's natural response to send lactic acid to overworked muscles. I have always found that there are three general ways to reduce muscle soreness.

First, stretching and warming-up of the muscles is essential. Obviously, this prevents more injuries than just muscle soreness and should be done by everyone before and after exercise. Second, since soreness usually occurs when an athlete performs an activity that is in some way new to their muscles, they should repeat this activity until their muscles can "adapt." (Brown 3). Third, following a rigorous workout I always insist that my athletes complete a gentle "cool down" run. This can help to flush out some of the first lactic acid on the scene that the body initially sends to the muscles.

I have always found that athletes, particularly good athletes, seem to feel that they know what is best for their own bodies. I have told athletes suffering from asthma that the most effective way to overcome the problem is to stay active, and they look back at me like I have lost my mind. I repeatedly hear the phrase following certain tidbits of advice, "Ya, but my body is weird." Although this statement may be true in some respects there are many general scientific notions that all athletes can benefit from.

A read a book where basketball great Charlie Ward admitted that for the first portion of his career he was convinced the best way to gain muscle was to eat as much fat as possible (Schlosberg xxvii). Eventually, athletic trainers set him straight. It has become one of my goals to convince my athletes, with a scientific basis, the value of my advice and the things it can help them to achieve.

Flexibility is the best way to prevent most injuries associated with sports. It seems, however, that most athletes do not recognize the importance of stretching before and after a workout. When people who can hardly reach their hands over their head, like Arnold Schwarzenegger and Sylvester Stallone, are idolized in our society this fact is not surprising. Early on as a coach I found it difficult to convince a number of my athletes to stretch extensively, especially after a workout. This became much easier when I began requiring members of the cheer squad to stretch as a team before and after all practices, and always under my supervision.

A preventative measure I have taken with my distance runners is to encourage them to run on the grass on training runs, rather than on the sidewalk or the street. This has the effect of lessening the repeated impact on the lower body. Yet, it is simply not possible for runners to run on grass or dirt all of the time. Fortunately, "Today's shoes are designed to run on asphalt. The idea of the cushioned sole is to make the asphalt as easy on the body as grass. You can even run on concrete in these shoes, but asphalt is much better." (Garrick 257). However, on the high school level it is difficult to supply runners with proper running shoes. So I find that I can only encourage athletes and parents to buy the proper equipment.

Psychogenic, or emotional, factors in sports can be extremely important. Emotions not only influence an individual's performance, but can also cause some physical disorders. By referencing the Journal of Athletic Training I found that psychogenic factor can play significant roles in disorders as serious as seizures. More pertinent, however, is the influence psychological factors can have on an athlete's understanding of an injury. Some athletes seem to constantly believe that they have sustained some type of injury; others will refuse to admit to themselves or the trainer when they are hurt.

One member of the poms squad I coached had me look at one limb or another almost every day. Naturally, I could never find anything seriously wrong but my advice was always the same: I had her sit out of the practice and work on her injury. It is always better to be wrong and be safe, than to insist that an individual partake in an activity that could potentially harm them.

On the other end of the spectrum, one of my best runners on the distance squad suffered from severe blisters covering the entire bottoms of both feet. She never revealed the injury to me because she knew what my reaction would be. Although from a competitive standpoint she was invaluable to the team, competition cannot be a coach's primary concern. When I happened to see her feet after a race I promptly sterilized them, punctured the blisters with a sterile needle, and advised her to cover them with a piece of moleskin. I also had her sit-out of practice for the next three days, despite her vocal opposition, to allow the blisters to heal. When she returned to action her feet no longer bothered her.

A understand that protective equipment is essential in many sports. As a poms coach is was necessary to practice all lifts and potentially dangerous moves on safety mats. Because of proper spotting procedures the mats were merely the last stop in the effort to prevent injury. Clearly, contact sports require much more protective equipment than running, poms, or dance. Helmets, mouth guards, cups, shin guards, kneepads, and similar equipment should all be employed and inspected before any competition.

For a practitioner in the field of exercise science there are an abundance of resources available. Thousands of books on exercise and exercise science have been published, but it can sometimes be difficult to discern what types of sources can be trusted. Therefore, I feel that it is essential to refer to sources that have been peer reviewed and are generally accepted by practicing trainers or doctors. I have made frequent use of the Journal of Athletic Training, because of both its good reputation and the broad range of topics that can be found in it. Additionally, the journal can be located online and searched for a wide variety of topics. I commonly use this as a supplemental resource for crosschecking any information I find in other books, magazines, or others in the field of exercise science.

Exercise science and sports training is an exponentially growing field. Just fifty years ago the best advice most athletes received was from informational movies, encouraging hygiene and stretching. Today, sports trainers are at every school in America, and every major sports team is backed by an equally formidable team of trainers. In the past fifteen years there has been a dramatic transition from apprenticeship type learning to a formal schooling approach to the field. There is an ever increasing demand for qualified trainers who come armed with the latest and most effective techniques to improving athletes' performance. Professional sports teams invest substantial amounts of money in finding the best athletic trainers. As coaches and athletes in more and more sports look to exercise science to improve results, more and more employment opportunities arise.