With kids back to school, many are also back on the field for fall sports. For parents who are concerned about the likelihood of injury, Dr. Eric Chehab, Affiliated Orthopaedic and Spine Institute Surgeon, shares his insights into what athletes can expect and how to prevent and address potential issues that occur.

Football season will be starting soon – what are some injuries that you see each year among student athletes?
The most common injuries during the fall season occur to the ankle, knee and shoulder. Ankle sprains are by far the most common among student athletes. Typically, an athlete will “roll” their ankle, and injure ligaments around the ankle. Fortunately, most ankle injuries will heal with time, and physical therapy can help heal the injury more quickly, and reduce the risk of recurrence.

Knee ligament injuries are also more common in the fall. Some of these injuries can heal themselves, again aided by physical therapy to speed recovery. Other knee ligament injuries, such as an ACL injury, will not heal themselves and can lead to chronic instability. That’s where surgery can help restore knee stability.

Finally, shoulder injuries are quite common. These can be from falls to the ground or from contact. The most common are AC joint injuries. The AC joint (or the acromioclavicular joint) is where the end of the collarbone meets the shoulder blade (it’s the prominent bump above the shoulder), and when sprained, can be quite painful. It usually does not lead to long term disability, and once healed, athletes return and do quite well. Shoulder dislocations can be more problematic. This is an injury in which the “ball” slides out of the “socket.” Sometimes it will come back into place spontaneously (subluxation) or other times it will get stuck and require a trip to the emergency room to be put back into place. Shoulder instability can often recur, and when it does, surgery may be the best option.

Do injuries always come from contact?
Not at all. For instance, most knee ACL injuries are in fact non-contact injuries. This injury most commonly occurs without contact, when the foot plants, the body torques, and the knee buckles under the strain. It can also occur in contact, but studies have demonstrated that most ACL injuries occur without contact with another player.

Many injuries do occur in contact…. just not with contact with another athlete, but with the ground. We are always trying to emphasize in youth athletics to “keep your feet” because falls to the ground are the number one injury generator, particularly to the shoulder and upper extremity.

What factors determine whether an athlete will need surgery? Are there any procedures that are fairly common among student football players?
The simplest way to determine whether an athlete will need surgery is if the injury will heal better with surgery. Shoulder instability is particularly common among football players, and even more common among linemen in football. Here, again, the ball comes out of the socket. After it occurs once, it is more likely to occur again. Those athletes who play contact sports have an even greater likelihood of the injury recurring. Because frequent dislocations can lead to dysfunction of the shoulder, usually surgery can be the best course of action for athletes with recurrent dislocations that have occurred due to contact.

ACL injuries are very common among all sports in which running, cutting, and jumping are involved. This is another injury that if left alone and treated non-operatively, has a high rate of recurrent knee instability in the athletic population. Surgery to address ACL injuries will usually cure the instability of the knee.

When a tear or sprain occurs on the field, what are some steps that can be taken at that moment? Is it better to go to the ER or a doctor’s office?
Sometimes it is difficult to determine if something is sprained or broken, so an x-ray can help determine that. That question alone – “is it broken?”- Probably drives most visits to the ER. There are alternatives to the ER, and orthopaedic walk in clinics have become more prevalent in our area fortunately.

Some immediate steps to address the pain that occurs with a sprain can be summarized by the R-I-C-E mnemonic. R=Rest. I=Ice. C=Compression. E-= elevate. These four easy steps can help reduce the pain and inflammation associated with many injuries. Urgent evaluation is required if patients have a deformity (i.e. the joint or bone is crooked) or if there is numbness involved. Many injuries can be seen on a less emergent basis through the doctor’s office. It’s certainly more cost effective if it can wait, but when in doubt, check it out.

How likely is re-injury after surgery? Is there anything an athlete can do to decrease the chances?
Unfortunately, with every surgery, there is always the risk of recurrent injuries. With surgery, our goal is to restore the anatomy that was disrupted by the injury. Once restored, patients incur risk by returning to play. There are fortunately programs that can help reduce that risk. Using therapy, muscle strengthening, and balance training, studies have shown injury risk reduction. One of the most effective is lower extremity neuromuscular training, which can help reduce the risk of knee re-injuries significantly. Nothing we can do currently will completely eliminate the risk of re-injury, but neuromuscular training has proven effective at significantly reducing that risk.

How can coaches and players work to prevent shoulder and knee injuries?
Proper technique for blocking and tackling is critical in preventing shoulder injuries in contact sports. Knee injuries in all sports can be reduced by incorporating neuromuscular training into the warmup periods of practice. If coaches are willing to invest the time, it can help the athletes reduce their risk of injury. It just takes away practice time, so it’s understandable why coaches may be reluctant to “give up” practice time for an extended warm up.

If a player faces the same injury multiple times (like ACL), when is it decided that they may no longer be able to play?
With all injuries, whether first time or recurrent, there is a risk-benefit ratio that must be considered with return to play. If an athlete is sustaining the same injury multiple times despite good and maximal treatment, then clearly the risk begins to outweigh the reward. No one wants to give up on a sport they enjoy playing, and particularly when it is forced by injury and not on their own terms. On the other hand, when one door closes, another can open, so we try to encourage our athletes who have had recurrent multiple injuries to explore other outlets with less risk.