| WHAT COACHES SHOULD KNOW |
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| BRIEF INJURY DEFINITIONS |
| Strain: The excessive stretching and tearing of a muscle, or of tendon fibers. |
| Sprain: When the bones that form a joint are forced beyond their normal range of motion as a result of tearing of ligaments. |
| Dislocation: A displacement or separation of a bone from its normal position at a joint. |
| Fracture: A cracked or broken bone. |
Strains, sprains, dislocations, and fractures are common football injuries. Usually, only a trained medical professional can tell the difference between them. It is not important to know which kind of injury it is to provide immediate care.
Strains
A strain is the excessive stretching and tearing of a muscle, or of tendon fibers. It is sometimes called a "muscle pull" or "tear." Because tendons are tougher and stronger than muscles, tears usually occur in the muscle or where the muscle attaches to the tendon. In athletes who have not physically matured, which pertains to most high school athletes and younger players, a piece of bone may be pulled from the muscle attachment.
Generally, muscle strains occur when a player has not properly stretched before practice or a game. Muscles are also more susceptible to injury in a setting of prolonged intense activity. Good conditioning and common sense can help avoid muscle strain injuries. Most muscle strains are not severe, and a player can return to the same level of play after recovery. Though there are not any long-term effects, muscle strains must completely heal and be rehabilitated or they are likely to recur.
Stretching regimens and slow warm-up exercises have been shown to reduce the occurrence of muscle strain injuries. This allows the muscles, tendons, and ligaments to adjust to increased intensity in activity levels. Muscles most commonly involved in strains are the hamstrings and quadriceps (thigh muscles) and gastrocnemius (calf muscle). If a severe strain is suspected, activate the Emergency Action Plan and contact EMS for the transport of the athlete to a medical facility.
Sprains
A sprain usually results when the ligaments that hold the bones forming a joint are stretched too far or torn. The bones can then be forced beyond their normal range of motion. The more ligaments that are torn, and the more complete the tear, the more severe the injury. The sudden violent forcing of a joint beyond its limit can completely rupture ligaments and dislocate bones. Severe sprains may also involve a fracture of the bones that form the joint.
When dealing with young athletes, particularly between the ages of 8 and 15, coaches should be aware that severe sprains can result in avulsion fractures that involve the growth plate. This type of injury can have long-term effects.
The sprain must be allowed to heal and the area rehabilitated. Severe sprains or sprains that involve a fracture usually cause pain when the joint is moved or used, and are recognized as serious.
Often, a sprain is more disabling than a fracture. When the fractures heal, they usually leave the bone as strong as it was before. It is unlikely that a repeat break would occur at the same spot. On the other hand, once ligaments become stretched or torn, the joint may become less stable. A less stable joint makes the injured area more susceptible to reinjury.
The most common sprains in football occur at the ankle, knee, and shoulder joints. Coaches should be able to recognize signals of a sprain and provide the immediate care until a physician can examine the athlete. X-rays may be required to rule out a fracture or widening of the joint.
| A physician should be consulted if the athlete: |
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If a severe sprain is suspected, activate the Emergency Action Plan and contact EMS for removal of the athlete to a hospital.
Dislocations
A dislocation is a displacement or separation of a bone from its normal position at a joint. The injury requires immediate care, and if it goes unnoticed such as by slipping back into place, it may be incorrectly treated. Such a misdiagnosis can lead to longterm problems for the athlete. Therefore, it is important for a coach to be able to recognize the signals of this type of injury and get the athlete the appropriate treatment.
Dislocations are generally obvious because the joint appears deformed. The displaced bone end often causes an abnormal lump, ridge, or depression. Also, an injured person is unable to move a joint freely that is out of place.
Some dislocations tear the skin and become an open dislocation. If the skin is broken, a responder should place a clean bandage over the wound to keep it from becoming more contaminated. Open dislocations require immediate medical care. If any dislocation is suspected, activate the Emergency Action Plan and contact EMS for removal of the athlete to a medical facility.
Fractures
Fractures are among the more serious injuries sustained in sports. The signals of a bone fracture can be easy to detect. Athletes often complain of hearing or feeling a "snap." The most consistent complaint is tenderness or pain, usually localized to a specific area of the body. It is usually difficult for the person to move the injured part and not further damage the fracture. There may be bruising and swelling, although this may not occur immediately. In completely displaced fractures, there may be an obvious deformity.
| Call 9-1-1 or the local emergency number for the following situations: |
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Coaches' Response
For strains, sprains, dislocations, and fractures, activate the Emergency Action Plan and follow the emergency action steps, Check-Call-Care. Check the scene for safety and check the athlete, Call 9-1-1 or the local emergency number when needed, and Care for the player until EMS personnel arrive. Immediate care should be provided in the following manner:
- Avoid any movement or activity that causes pain.
- Apply ice or a cold pack to the injured area for about 20 minutes to control swelling and reduce pain. To prevent cold injury, place a towel or cloth between the source of the cold and the skin.
- Splint the arm or leg only if the athlete must be moved or transported and if you can do so without causing more pain and discomfort to the athlete.
- To minimize shock, keep the athlete from getting chilled or overheated.
Splinting is a method of immobilizing an injured body part to keep it from moving. It may also help reduce pain, making the injured athlete more comfortable. Splint only if the athlete must be moved or transported and if you can do so without causing more pain and discomfort to the athlete.
| The following guidelines should be followed when applying a splint or sling for immobilization: |
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Check for warmth and color of the skin below the site of the injury before and after splinting. Make sure that circulation has not been restricted by applying the splint too tightly. Loosen the splint if the athlete complains of numbness or if the limb turns blue or cold.
Because in most cases only a trained medical professional can tell the difference between a strain, sprain, dislocation, or fracture, the injured athlete should consult a physician. If an injury appears severe, do not move the player; activate the Emergency Action Plan and transport the athlete to a hospital immediately. X-rays may be needed to determine the extent of the injury. Immediately consulting a medical professional is important to establish the correct method of treatment, rehabilitation, and return to play guidance.
| For less severe injuries, a prompt visit to a physician may result in advice for the athlete to: |
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The prescribed rehabilitation program may be started a few days after the injury when the swelling is reduced. Early range of motion and strengthening exercises may be prescribed to promote recovery and protect from recurrent injury. Taping and bracing for support may help prevent re-injury.
Some injuries such as fractures, dislocations, and sprains or strains may require further medical treatment as well as an extended rehabilitation and recovery period. Following a strain, sprain, dislocation, or fracture, return to play should be guided by a physician's recommendation.
MORE READING
Andrews, J., Clancy, W.G. Jr., & Whiteside, J.A. (Eds.). (1997). On field evaluation and treatment of common athletic injuries. St. Louis, MO: Mosby.
Schenck, R. (1999). Athletic training and sports medicine, (3rd ed.). American Academy of Orthopedic Surgeons: Rosemont, IL. American National Red Cross. (2001). Emergency response. Boston, MA: StayWell.
American National Red Cross and the United States Olympic Committee. (1997). Sport safety training. San Bruno, CA: StayWell.
Ankle sprains: How to speed your recovery. AOSSM Sports Tips. American Academy of Orthopedic Surgeons: Rosemont, IL.
The evaluation of any athlete, whether as a part of health evaluations prior to activity or as a diagnosis of an injury as the consequence of sports activities, is specific to that individual and the history and current state of the individual presented. Advice, diagnosis and treatment is individualized according to numerous factors, including patient health and age information, medical history and symptoms. All athletes should be cleared by a physician or other appropriate medical professional before engaging in physical activities and, after injury, diagnosis and treatment, for return to play.