Sep. 3, 2007 Football Fever is upon the nation once again. The soaring of the pigskin signals the start of the "busy" season for cheerleaders, marching bands, and inevitably, sports medicine physicians.
"After only a few days of practice at UB we've had three players with ACL injuries, a medial collateral ligament tear, a dislocated shoulder and a dislocated elbow," said Marc Fineberg, M.D., chief of sports medicine in the University at Buffalo School of Medicine and Biomedical Sciences.
University Sports Medicine doctors serve as team physicians for the Buffalo Bills, the Buffalo Sabres and Western New York's major collegiate football teams -- the UB Bulls, the Buffalo State Bengals and the Erie Community College Kats. They also treat many of the area's high school teams.
Prevention is the primary goal of everyone involved in the sport, but when large, highly charged males engage in bodily contact, injuries are inevitable. Knee and ankle sprains are the most common injuries treated during football season, followed by concussion and shoulder sprains, said Fineberg.
The knee injury most common in football is a sprained medial collateral ligament, or MCL, one of four ligaments that support the knee joint. MCL injuries, which usually occur during a tackle or block -- sometimes because of an illegal hit -- heal on their own without surgery, said Fineberg.
Less common, but more serious is a torn anterial cruciate ligament, described as unraveling like a braided rope. A torn ACL happens most often during a quick change of direction, requires surgery and takes the player out for the season, stated Fineberg.
How to prevent knee injuries? "MCL injuries may be reduced by wearing a double-hinged knee brace," he said. "Using them remains controversial, but we think they provide added protection against MCL injuries. On the other hand, no brace has been proven to protect the ACL."
Conditioning players to be stronger, more flexible and more agile may help to reduce ACL injuries, along with replacing old Astroturf with newer, more forgiving surfaces and wearing the right shoes, noted Fineberg. "Shoes with really long cleats grip better for increased performance, but may also put a player at greater risk of tearing an ACL."
Concussion is gaining recognition as a serious injury, particularly at the professional level. Concussions remain underreported, however, especially at the high-school level, where they are most frequent and potentially fatal, Fineberg said. Prevention, by not tackling head-on and wearing properly fitted helmets, is the best way to "treat" this injury.
With few outward signs of injury -- no swelling or broken bones -- identifying the subtle signs of concussion is crucial, because a high school player who has an undiagnosed concussion and sustains a second blow to the head is at risk of second-impact syndrome, which studies have shown can result in sudden death.
"If a coach or trainer suspects a player has had a concussion, he or she should take the helmet away, and put that player on the 'doctor's team,'" stated Fineberg. "There must be complete resolution of the injury before the athlete is allowed to play again, and that decision is not the player's, not the parents', not the coach's; it's the physician's."
Signs to look for include dizziness, headache, aversion to light, nausea and a dazed or blank stare. If one pupil is dilated, the player needs to get to the emergency room pronto, he said.
Shoulder injuries, the third most common group of orthopedic injuries in football, occur most often to backs and receivers. Quarterbacks are usually "off-limits" in practice, but are particularly vulnerable in games if they get slammed to the ground. Wide receivers are at risk when they go up for a pass and come down shoulder-first, usually hitting the turf under a much bigger and heavier player.
Common shoulder injuries include "AC joint" sprains --– a separation at the bump on top of the shoulder which marks the junction between the shoulder blade and the collarbone. Proper-fitting shoulder pads may help avoid these injuries, which rarely require surgery.
Another common problem is a dislocated shoulder, which occurs when the labrum, the cartilage around the socket, tears. Training focusing on rotator cuff conditioning may help prevent these tears. Players other than quarterbacks can wear a harness to support a shoulder weakened by a labral tear. These tears often require arthroscopic surgery to eliminate the painful episodes of instability, said Fineberg.
Everyday maladies aside, the most catastrophic injury a young football player can sustain is to the neck or spine. "We saw a rapid decline in neck injuries when spearing -- using the head as a weapon -- was outlawed [it now garners a 15-yard penalty]," he said. "Players now are trained to tackle with the head up." Improving neck strength and flexibility may help protect against this type of injury, along with good coaching, he noted.
"Football is a dangerous game," commented Fineberg. "The only thing we can do is try to minimize the risks by providing the safest environment possible. That involves the players, coaches, officials, parents, trainers, doctors, even the people who maintain the field. It's everyone's responsibility."
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