Sports Medicine

We've all seen it. In a mad scramble for the ball, several players go down. They get up, one by one, but one remains prone, grimacing in pain, clutching an ankle, a shoulder, a knee, a wrist. A coach or trainer trots out and takes a knee next to the stricken player, conducts a brief exam, and the player, unable to continue in the game, is helped from the field or the court. X-rays, treatment, possibly even surgery, and then rehabilitation will follow, all with the idea of getting the player back in the game.

Could this injury have been avoided? Well, possibly. But participation in sports carries a substantial risk of injury. Part of the appeal of sports competition, like it or not, is the idea that the participants are pushing limits and taking risks. In sports such as boxing, MMA or UFC, it could be argued that the whole point is to weaken an opponent by inflicting injury, or at least by inflicting pain, which makes injury likely. A knockout, the outcome that advances careers and brings cheers from an audience, is often the result of a brain injury. Duk Koo Kim, a Korean boxer, went down in a knockout in a bout with Ray "Boom Boom" Mancini. Kim never got up, becoming one of professional boxing's most notorious fatalities.

The most common sports injuries usually result from collisions – players collide with each other, with equipment and with the ground. It's part of the game. Athletes train to maximize their agility and strength, because this is what helps them to compete and win. But it also helps them avoid injury, which is a big concern for any athlete contemplating a career in sports. Injuries shorten or even end careers.

Each sport has its own particular hazards. Coaches, managers, trainers, athletic directors and school principals are well aware of this and take advantage of the burgeoning body of knowledge known as sports medicine to minimize the risk of injury and help injured athletes recover. Sports injury is all but unavoidable, especially for professional or semi-pro athletes who have long careers. Older athletes are especially susceptible to injury. Parents of young athletes want to be assured their children will be safe, but the risk of injury lurks in even the gentlest and most carefully monitored competition. There can be no guarantees against injury; there can only be preparation, vigilance and adequate precautions.

Brad Walker, author of the book "Anatomy of Sports Injuries," writes that one in 17 "participants in sport and exercise suffer a sports injury playing their favorite sport. This figure is even higher for contact sports... However, the truly disturbing fact is that up to 50 percent of these injuries may have been prevented. " Soft tissue injuries are the most common sports injuries, and sprained ankles are the most common soft tissue injuries. Each day about 25,000 Americans suffer ankle sprains, according the American Academy of Orthopaedic Surgeons.

Mike Valenzuela, Athletic Development Director for Mountain View Christian School, says his school's program tries to strike a balance between strength and flexibility training to prevent injury.

"When you improve muscular strength, you improve the strength of connective tissue, tendons and ligaments," Valenzuela said. "That can help avoid injuries to the ACL (anterior cruciate ligament in the knee), MCL (medial cruciate ligament in the knee), which are a big problem with youth sports."

Strength and weight-bearing training also help improve bone density, which improves overall stability. Improved stability means improved resistance to injury.

There is no single best approach to injury prevention, Valenzuela said.

"It depends on the specific demands of the sport and on an individual's goals," he said. "The best thing is to develop a good foundation, work on flexibility and strengthen the core stabilizer muscles."

Valenzuela says he wants his young athletes to focus on "total body exercises" -- complex, or compound movements -- that involve entire groups or several groups of muscles and build overall functional strength. His football, basketball and baseball teams perform bodyweight calisthenics such as burpees, a demanding drill that builds strength and provides cardiovascular conditioning. In addition, they perform overall strength movements such as Hise shrugs, which strengthen the back, especially the upper back, and stabilizing muscles. Bear crawls build strength, agility and overall conditioning. They also do lots of standard pushups.

Athletes at MVCS also do sport-specific conditioning. Valenzuela said the football players perform power cleans, an Olympic powerlifting movement that builds total-body strength and explosive power in the hips and legs.

Some athletes are more susceptible to injury than others. Young female athletes, particularly basketball players, can be plagued with knee injuries. Their hips are often wider than their knees, which can lead to instability.

Matt Smith, a Las Vegas physical therapist whose practice includes rehabilitation, injury prevention and sport-specific training at 17 clinics, says these knee injuries can be common in younger female athletes because of an increased q-angle. The q-angle is formed by a line drawn from the anterior superior iliac spine (a part of the iliac crest of the pelvis) to the central patella (kneecap) to the tibial tubercle, an elevation on one of the bones of the lower leg, just below the knee. An increased q-angle can mean increased shearing stresses placed on the knee during certain activities, which can lead to injury. This is relatively common among females, but Smith says the injuries occur in younger female athletes because they haven't learned to address the stability issues caused by an increased q-angle.

The solution, Smith says, is for athletes, whether young, old, male, female, professional or amateur, to learn to move correctly according to the demands of their sports, and to develop the appropriate strength and flexibility through a training program adapted to both the individual and the chosen sport.

Michael Gunter, M.D., a family practice physician who does nonoperative sports medicine, personalized preventative medicine and acupuncture, says only 5 percent of sports injuries require surgery.

Like virtually all other sports medicine physicians, Gunter recommends strength training. He also emphasizes proper shoe fit.

"If your biomechanics are off, shoes that don't fit right will just make it worse," Gunter said. "Runners need to replace their shoes rather than continue to run in worn-out shoes. Orthotics, sometimes even off-the-shelf orthotics can help a lot in eliminating foot, ankle and knee pain."

Gunter says he sees a lot of shoulder injuries, especially rotator-cuff injuries.

"Most people don't strengthen the shoulder to do baseball, volleyball," he said.

Most shoulder injuries respond well to active rest and improving rotator cuff strength, Gunter said.

"Ninety-five percent or more of the shoulder injuries I see don't need surgery," he said.

All active people, professional and amateur, should take the time to become knowledgeable about their activity, Gunter said.

"Even weekend warriors," Gunter said. "Get the proper equipment, knowledge of the sport. Get with a group, like a running club, and learn from them."