Injury Awareness in American Football

Nov 15 2017

Injuries are a common occurrence in American football, and half way through the current NCAA and NFL football seasons I am sure you have witnessed many injuries. With the growth in TV coverage, social media, and the amount of people participating in fantasy football leagues, people seem to be more aware of the injuries that seem to plague the sport. Player safety has become an integral part of the game, but injuries on the football field are inevitable. While the mechanisms of injury are wide and varied, some injuries are more commonly seen in athletic training rooms and physical therapy clinics across the country.

According to the US Consumer Product Safety Commission, in 2007, there were more than 920,000 athletes under age 18 were treated in emergency rooms due to football-related injuries – with traumatic injuries being the most common.1 Of all traumatic injuries, lower limb injuries are the most common reason of missed playing time (50.4%), followed by upper limb (16.9%), torso/pelvis (11.9%), concussion (7.4%), and finally injuries to head/face/neck (4.3%).2

Of all the lower limb injuries, I am going to highlight a couple injuries that are seen most frequently especially in the knee and ankle. Knee injuries are seen at a high rate in football and most occur during non-contact plays - usually when the player plants their leg to cut and change direction. This mechanism can injure the anterior cruciate ligament (ACL), meniscus, and/or the medial collateral ligament (MCL). Symptoms of any of these injuries can include, but are not limited to, immediate pain, swelling within 24 hours, a feeling of knee instability, decreased range of motion, and/or catching/locking of the joint. The athlete will require immediate care, and possible surgery, to repair or reconstruct the injured tissues.

Aside from the knee, ankle injuries are also a common occurrence.  Many New York Giants fans have seen the effect of what ankle injuries can do to a team – especially when four wide receivers go out with ankle injuries in one game.  Ankle sprains can be graded from mild to severe and can be classified as high, lateral, or medial. High ankle sprains can affect the joint between the tibia and fibula which can delay healing and delay return to play when compared to lateral or medial ankle sprains. Both sprains can be very painful and greatly affect the athlete’s ability to run, jump, and cut. Regardless of whether the knee, ankle, or foot is injured, a player can be sidelined for anywhere from a few weeks to a few months – potentially missing an entire season.

As mentioned above, upper limb injuries – especially shoulder injuries – occur at a high rate in football players. Many times, an athlete will be tackled and land on their side directing high amounts of force to the outside of the shoulder. This impact can cause a sprain to the acromioclavicular (AC) joint – commonly known as a “shoulder separation.” This injury is extremely painful especially when trying to raise that arm overhead, and can keep the athlete sidelined for a couple weeks until the pain becomes manageable. Rarely, surgical repair of the AC joint is needed. Another injury commonly seen is a shoulder dislocation, which can tear the shoulder’s labrum. Shoulder dislocations are painful, and can cause gross instability in the joint. Unfortunately, dislocations are common for offensive linemen, and if the damage is great enough, surgery may be required.

One of the hottest topics – in popular culture and football – is concussions. A concussion is a mild traumatic brain injury (mTBI) that can present with many different symptoms. They can be caused by direct or indirect contact (whiplash) and differ in severity. You do not have to lose consciousness to be diagnosed with a concussion, and long term studies are beginning to show that repetitive low level head trauma may have lasting consequences on mental health. Signs of a concussion include headache, dizziness, nausea, loss of balance, drowsiness, change in mental status, numbness/tingling, difficulty concentrating, sensitivity to light and/or sound, and visual disturbances.Some symptoms may not occur immediately, but can occur hours to days later. If a concussion is suspected, it is recommended to contact your healthcare provider and stop playing until all symptoms have subsided.

Now classified as a “collision sport,” injuries on the football field cannot always be avoided, but there are some steps that can be taken to decrease an athlete’s risk. Every athlete should have a pre-participation physical prior to starting any sport – ruling out any underlying medical condition that may affect the athlete’s ability to participate. Following a physical, the athlete should undergo baseline testing for concussion, as well as baseline testing for functional movement and performance. A movement screen can uncover any underlying physical restrictions or deficits, helping to guide training. Once cleared for participation, athletes should undergo a progressive and graded strength and conditioning program to prepare the athlete’s body for the demands of the season. There should always be a proper warm up and cool down period to support muscular and physiological body functions. Lastly, coaches should provide proper instruction for skills and technique development, especially with tackling. There is currently a big push to institute the “heads up” tackling technique as a way to mitigate risk for head and neck injuries. This initiative is happening at all levels, but especially in youth football – ensuring good technique throughout a player’s entire career.

This blog is not meant to include expansive list of all the injuries that can occur on the football field, but is meant to shine a light on common injuries. At Excel, we have intimate knowledge of all football-related injuries, treating everyone from “Friday night tykes” to Super Bowl champions. We are uniquely positioned between the arenas of sports medicine and sports performance, allowing us to screen for potential injury risks in order guide training and performance programs prior to (and during) the season, as well as to treat any injury sustained on the gridiron. Before starting any new activity, or starting a new season, any athlete should be properly screened, and in good physical health. In the event of an injury, always err on the side of caution and contact your healthcare provider, especially if a head or neck injury is suspected.

 

References

  1. Stop Sports Injuries. American Orthopaedic Society for Sports Medicine. 2010. www.STOPSportsinjuries.com
  2. NCAA Sports Medicine Handbook. Available at www.NCAA.org.
  3. NCAA Concussion Fact Sheets and Video for Coaches and Student-Athletes. Available at www.NCAA.org.
  4. Heads Up: Concussion Tool Kit CDC. Available at www.cdc.gov/TraumaticBrainInjury.
  5. Heads Up Video from the National Athletic Trainers’ Association. www.nata.org/consumer/headsup.htm.
  6. American Academy of Orthopedic Surgeons. Available at https://www.aaos.org/Default.aspx?ssopc=1