Dr Di­a­lo-Rudolph Brown

The peak of the sea­son for high school track and field ath­letes and the “mid­dle” of the sea­son for se­nior ath­letes is a time when ath­letes are more like­ly to re­port “nig­gles” and pains, es­pe­cial­ly dur­ing com­pe­ti­tions. Dur­ing com­pe­ti­tions and cham­pi­onships, we may watch as ath­letes “pull up” dur­ing a race, leav­ing them and their sup­port per­sons to ask, “What hap­pened?”, “What caused that in­jury?” and “How soon can they com­pete again?” 

 In sports med­i­cine, we de­scribe in­juries as hav­ing “ex­trin­sic” and “in­trin­sic” risk fac­tors. “Ex­trin­sic” risk fac­tors are “ex­ter­nal” to the ath­lete and may in­clude some things they have lit­tle or no con­trol over. These in­clude the phys­i­cal en­vi­ron­ment, such as the train­ing sur­faces avail­able, sport­ing equip­ment and ac­ces­sories (e.g., the qual­i­ty and fit of footwear or pro­tec­tive gear), and train­ing and com­pe­ti­tion sched­ules. As ath­letes of­ten en­counter back-to-back com­pe­ti­tions dur­ing the sea­son, we must ask: Are they get­ting enough re­cov­ery time be­tween events and meets? Are they com­pet­ing un­der dif­fi­cult phys­i­cal con­di­tions and with sub-stan­dard equip­ment? 

“In­trin­sic” or “in­ter­nal” risk fac­tors, on the oth­er hand, are “with­in” the ath­lete and can in­clude: 

• Mus­cu­lar weak­ness­es and im­bal­ances—for ex­am­ple, weak ham­strings rel­a­tive to very strong quadri­ceps mus­cles in a sprint­er (a com­mon cause of ham­string in­jury in sprint­ers), or mus­cles that were not prop­er­ly con­di­tioned to with­stand the rigours of high-lev­el com­pe­ti­tion; 

• Faulty run­ning or play­ing tech­niques;  

• One of the most sig­nif­i­cant is a his­to­ry of pre­vi­ous in­jury, es­pe­cial­ly one that was not ful­ly re­ha­bil­i­tat­ed. 

Every in­jury in­ci­dent usu­al­ly has mul­ti­ple po­ten­tial “caus­es” or con­tribut­ing risk fac­tors. Al­though we can­not pre­vent all in­juries, we can strive to min­imise the risks and man­age the in­jury as ef­fec­tive­ly as pos­si­ble. 

When an ath­lete “goes down” dur­ing train­ing or com­pe­ti­tions, or even when there is mere­ly a per­sis­tent pain or “nig­gle,” it is im­por­tant that they are ad­e­quate­ly as­sessed and di­ag­nosed by a clin­i­cian such as an or­thopaedic sur­geon, sports med­i­cine physi­cian, phys­io­ther­a­pist or ath­let­ic train­er. Prop­er and time­ly as­sess­ment and di­ag­no­sis are cru­cial when mul­ti­ple in­jury risk fac­tors, in­jury pos­si­bil­i­ties, and “looka­likes” (such as mus­cle strain ver­sus a cramp) are present.  

De­pend­ing on the na­ture of the in­jury, a sports physi­cian may or­der one or more types of imag­ing, such as X-rays (for bone prob­lems, like a sus­pect­ed frac­ture), ul­tra­sound, or an MRI (for soft tis­sue prob­lems, like mus­cle strains). A phys­io­ther­a­pist/cer­ti­fied ath­let­ic train­er will con­duct a com­pre­hen­sive, sport-spe­cif­ic phys­i­cal and func­tion­al as­sess­ment to de­ter­mine how the ath­lete’s func­tion is af­fect­ed by the in­jury and to be­gin plan­ning the re­ha­bil­i­ta­tion pro­gramme.  

Mul­ti­ple op­tions ex­ist when seek­ing the ap­pro­pri­ate pro­fes­sion­als to ad­dress sport­ing in­juries, in­clud­ing sports physi­cians, phys­io­ther­a­pists, and cer­ti­fied ath­let­ic train­ers, some of whom have grad­u­at­ed from the Uni­ver­si­ty of the West In­dies Fac­ul­ty of Sport. The goal is to avoid in­ap­pro­pri­ate or in­ad­e­quate man­age­ment of sports in­juries by vis­it­ing the prop­er per­son­nel. 

Once a course of in­jury man­age­ment is un­der­way, there are a few “rules” to fol­low to op­ti­mise re­sults: 

Do your ‘home­work!’  

If you are “con­scious and awake” and re­ceiv­ing phys­io­ther­a­py, you WILL get “home­work” (ex­er­cis­es to do at home be­tween treat­ment ses­sions). The re­ha­bil­i­ta­tion process pre­dom­i­nant­ly oc­curs out­side the phys­io­ther­a­py of­fice/clin­ic; there­fore, what you do—or don’t do—in be­tween ses­sions will af­fect your progress. Par­ents of youth ath­letes should ide­al­ly in­vest in this process by en­sur­ing their young­sters do their re­ha­bil­i­ta­tion home­work. 

Phys­i­cal fit­ness and ac­tiv­i­ty dur­ing re­ha­bil­i­ta­tion 

Un­less spe­cif­ic med­ical cir­cum­stances ex­ist, “com­plete” rest from all train­ing is not rec­om­mend­ed. Main­tain­ing fit­ness with­in safe lim­its for the in­jury can help re­duce the over­all re­cov­ery time and fa­cil­i­tate a quick­er re­turn to sport. As part of the sports med­i­cine team, a cer­ti­fied strength-and-con­di­tion­ing pro­fes­sion­al is well-qual­i­fied to work along­side re­ha­bil­i­ta­tion clin­i­cians and sports coach­es to ad­just ath­letes’ train­ing pro­grammes, main­tain­ing fit­ness and strength while al­low­ing prop­er heal­ing of the in­jured area. To main­tain fit­ness, ad­e­quate high-qual­i­ty nu­tri­tion and sleep are cru­cial to max­imis­ing the body’s nat­ur­al heal­ing process­es. 

Stay the course—trust the process

A ma­jor in­trin­sic risk fac­tor for re­peat or new in­juries is the in­com­plete re­ha­bil­i­ta­tion of a pre­vi­ous in­jury. A com­mon mis­con­cep­tion among many ath­letes and oth­ers is that once there is seem­ing­ly mi­nor or no pain with gen­er­al ac­tiv­i­ty, they must be “OK.” They of­ten stop be­fore com­ple­tion of the ad­vanced stages of re­ha­bil­i­ta­tion and, im­por­tant­ly, be­fore their ther­a­pist thor­ough­ly tests their readi­ness for re­turn to sport. Do­ing so, un­for­tu­nate­ly, leads to a high risk of re-in­jury or wors­en­ing of the in­jury. In some cas­es, a dif­fer­ent in­jury can oc­cur due to over­com­pen­sa­tion by oth­er body ar­eas.  

Com­plet­ing the re­ha­bil­i­ta­tion process and test­ing readi­ness for re­turn to sport is vi­tal to min­imis­ing the risk of re-in­jury. Work­ing with the re­ha­bil­i­ta­tion and strength and con­di­tion­ing team is vi­tal for op­ti­mal re­cov­ery and re­turn to sport. 

Dr Di­a­lo-Rudolph Brown is a Sports Phys­i­cal Ther­a­pist and Cer­ti­fied Strength and Con­di­tion­ing Spe­cial­ist at The Uni­ver­si­ty of the West In­dies Sports Med­i­cine Clin­ic, Mona. Con­tact: di­alob.rpt.cscs@gmail.com