it’s just a sprain…not

Monday, August 12, 2013

It’s a common scenario in football. A player lay injured on the field while trainers run to his side, assess the injury and either allow the victim to hop up and hobble from the field, or wait for the stretcher to carry him away. The initial evaluation tends to be very conservative since nobody wants to complicate a potentially bad injury. It looked like Kansas City Chief running back, Jamaal Charles, might have had a significant foot injury when he was taken away, but x-rays were negative. This allowed his coach, Andy Reid, to proclaim that it was “just” a foot sprain. And New York Jets rookie quarterback, Geno Smith, was advised to deal with the pain of his ankle sprain, as his coach, Marty Mornhinweg told him: “don’t limp.”

While professional athletes are paid to abuse their bodies and to play through pain, in the real world, a normal x-ray does not equal the absence of injury. Cartilage lines joints, ligaments stabilize them, muscles and tendons attach into bone, arteries and nerves run nearby and all are targets for potential injury. One or all can be damaged even with normal x-rays. Pictures are just one way of assessing the potential for injury. History and physical exam are the keystones of diagnosis and the initial evaluation by the trainer on the field starts the process and perhaps is most important.

On the field, the player can usually describe the mechanism of injury, how his body was hit or twisted, and provide clues as to what injuries might lurk. The ability to examine the player immediately can find potential disasters, like dislocated joints or displaced fractures (remember that fracture, broken or cracked all mean the same thing) where arteries can be stretched and pulses lost. Examining a joint early, before the swelling sets in, may help decide whether a ligament is completely torn or just stretched. Sometimes a dislocated shoulder can be reduced or put back into place on the field before the surrounding muscles spasm.

When it comes to the neurologic system, the initial on field assessment is crucial. Head, neck and back injuries are not taken lightly. Any potential for neck or back fracture will lead to the player being immobilized on a stretcher with their neck in a collar. Power tools are helpful to remove face masks and specific techniques are used to remove the helmet without levering and moving the neck. The fear always exists that the player may have a neck fracture with a normal spinal cord, but manipulating the helmet and shoulder pads would cause the cord to kink, leading to a spinal cord injury.

Physical examination is an art form that is often all that is needed to make a diagnosis, however, the pro athlete is a special breed, who is often is excessively x-rayed, CT scanned and MRI’d to confirm the diagnosis. Identifying the extent of injury can help plan the length of rehabilitation and perhaps helps the general manager and coach more than the player. A player who cannot perform in the short term needs to be replaced for the team to succeed and the CT or MRI can help decide how long that short term might be.

A player will recover as his body allows. No matter how much physical therapy and rehabilitation, body parts need time to regenerate and heal. Muscle, tendon and ligament all heal by the body laying down collagen fibers and bridging the gap between the torn or stretched fibers. Surgery is performed to bring torn ends closer together, making it easier for those collagen fibers to bridge the gap but the time to return to play isn’t set in stone. Some people heal faster, some slower and the range is often measured in days and weeks, not hours.

For the weekend warrior or the person hurt at work or at home, there may not be the need for x-ray and CT with their associated cost in radiation and dollars. The goal of treatment will be the same as the elite athlete; returning to the level of function present before the injury. The physical therapy and exercises may follow the same plan as the elite athlete, but the difference is often frequency, duration and intensity. It is the pro athlete’s job to recover and they will devote hours each day to rehab. The regular person may do home exercises and see a physical therapist a couple of times a week. It’s likely that the pro would recover sooner.

The take home point for mere mortals and pro athletes is that just because it isn’t broken doesn’t mean that it isn’t hurt. Sprains and strains should be taken seriously. A torn knee ACL is a third degree sprain of that knee ligament and takes months to recover from surgery. LisFranc sprains of the foot can take months to heal, with or without surgery. Hamstring strains take weeks to recover.

Andy Reid and Marty Mornhinweg need to remember it’s never just a sprain.

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