DR. VONDA WRIGHT
Greater than 1.5 million young men participate in American football across all levels in the United States. They will sustain more than 1.2 million football-related injuries this year. Injury is an inherent part of football, a product of the game’s brutal nature and the alternate side of the coin that is American football. From a fantasy football perspective, injuries are the easiest way to end up in the bottom of the standings. Though it is nearly impossible to avoid them, knowing the trends, treatments, and the likely time out of the lineup can help you navigate the ups and downs of a fantasy season.
Older athletes, understandably, have a greater risk for injury than their up and coming counter parts. However, a more experienced coaching staff produces a lower injury rate. Injuries occur during training 51% of the time with contact practices result in injury almost 5x’s more often than controlled practices. High levels of preseason conditioning reduce in season injury rates as do wearing shorter cleats and prophylactic knee bracing.
Overall, lower extremity injuries accounted for 50% of all injuries (with knee injuries accounting for up to 36%). Upper extremity injuries accounted for 30%. In general, sprains and strains account for 40% of injuries, contusions 25%, fractures 10%, concussions 5%, and dislocations 15%. Cervical spine injuries have the potential to be catastrophic, but they have declined dramatically due to the impact of rule changes modifying tackling and blocking techniques as well as improved fitness, equipment and coaching.
From head to toe, the following list is sure to be part of this year’s line up:
In the last few years acute concussion and the long term sequlae of cumulative career hits have been all over the news. Getting hit in the head is now understood to be more than simply “getting your bell rung” but actually represents a metabolic mismatch in the brain as the trauma of your soft grey brain hitting against the hard bone of your skull causes a rapid and profound shift in the brain’s chemical balance. Until the chemical imbalance is corrected, the brain is in a vulnerable state of being starved for energy and unprepared for additional trauma.
Concussion can present simply as the athlete feeling “fuzzy” but more commonly it also presents with disorientation, sensitivity to light, headache, visual changes, memory loss, or motor imbalance. Trainers and coaches are now compelled by the standard of care and the law, in many states, to remove any player suspected of suffering a concussion from play until their baseline neurocognitive testing, such as the ImPACT test, return to pre-injury levels. Time to return to sport varies per player and can be as short as 1 week or can be career ending.
When a defensive lineman reaches out to tackle the ball carrier or falls onto his outstretched arm it can dislocate out the front of his socket. The same holds true with the repetitive blocking of an offensive player who pushes his arm out the back of his socket. In either case the player comes off the field holding his arm to the side then after a sideline or locker room relocation is placed in a sling. Players usually undergo several weeks of rehab if in season and then surgical repair in the off season. Recurrent dislocations are common, making this injury a nuisance to both the player and fantasy football owner.
While usually a less serious injury than dislocation, shoulder separation or dislocation of the collarbone from the acromial portion of the shoulder blade (AC separation) can be painful and take several weeks to heal. Minor separations with no ligament damage can be recovered in 1-2 weeks. More serious separations may require surgery.
ACL (anterior cruciate ligament) injury
ACL rupture is a common injury in many sports and can occur even without contact from another player. If you see your player come off the field with an ACL injury, check him off your roster for the season. One of four ligaments in the knee, the ACL connects the femur to the tibia and prevents the two bones from sliding across one another. On the sidelines the trainer will examine, then brace the leg and place the player on crutches to await a speedy MRI and reconstruction in the coming weeks. Return to play from an ACL reconstruction is usually 6-9 months. See you next season!
From the Greek for crescent, the medial meniscus serves as a cartilage pad between the joints of the thigh and shin bones. Meniscus tears are most likely caused by twisting or turning abruptly, usually with the foot in place while the knee is bent. Symptoms associated with meniscus tears include pain, swelling, giving way, and locking of the knee. Because football players need continuous stability in their knees, those with meniscus tears often undergo surgery. Sometimes the tear can be repaired or in other circumstances the torn portion of the meniscus is removed. Return to play may occur as soon as 4 weeks for a tear that is removed or as long as 6 months for a meniscus tear that was repaired.
These are common sports injuries often associated with sprinting or jumping. Fatigued athletes and those with poor flexibility are especially at risk. Pain and swelling are typical symptoms. Hamstring strains occur when one of the three hamstring muscles is partially or completely torn, causing athletes to experience pain, a pop, or a tearing sensation. Because they vary in severity, a return can be made in as little as a few days or as long as several weeks. Common treatments include rest, ice, compression, elevation, and rehabilitation.
Also called dead leg, a contusion happens after a direct hit to a muscle— causing pain, muscular injury, and intramuscular bleeding with hematoma ( bruise) formation. These are usually the result of a direct impact to the front of the thigh (typically by a helmet). An ice bag wrapped with an Ace bandage is often applied to the affected area immediately. Ice and compression are continued to reduce the risk of developing a large hematoma. Early range of motion exercises help to prevent stiffness. While minor contusions may not sideline a player for an extended period of time, more severe contusions can keep a player out for 3 weeks.
Fractures account for one quarter of all serious football injuries (i.e. injuries that require hospital care). Fractures commonly occur in the finger, wrist, and leg. Players often experience pain, swelling, tenderness, warmth, bruising, and/ or deformity in the affected area. X-rays and sometimes CT scans or MRIs are used to diagnose broken bones. The treatment for a broken bone depends on the location of the fracture, how out of place the bone fragments are, whether the bone breaks the skin, and whether or not surrounding structures such as nerves or blood vessels are damaged. If the bone fragments are out of place, a doctor will need to put them back in place through manipulation or surgery. The fracture will also need to be immobilized using methods such as splints, casts, or braces. Fractures that will not stay in place through the use of these methods often require surgery. Depending on their severity and location, fractures can sideline a player from 4 weeks to a year or more.
Turf toe is an injury to the base of the big toe. Often caused by running or jumping on hard surfaces such as artificial turf, the big toe is bent back under increasing forces. Athletes with turf toe often experience pain, swelling, and bruising. There are 3 grades of turf toe injuries. Most turf toe injuries can be treated with taping, activity modification, and a support placed inside the shoe. Return to play usually occurs in 2 to 4 weeks when symptoms resolve. Severe turf toe injuries require a cast to immobilize the toe and may sideline a player 6 to 8 weeks or more.
Williams has been sidelined multiple times
due to ankle sprains, including a severe one
which cost him 10 games in 2010.
Ankle sprains are one of the most common injuries that football players experience. They involve stretching and tearing of the ligaments that keep the ankle stable and most often result from a buckling at the ankle because a player came down on the outside of his foot. Symptoms often include swelling and tenderness. Ankle sprains are graded 1-3, based on severity. In the case of severe sprains, a player may not be able to put weight on the affected foot and ankle and it may feel unstable. Less severe sprains are often easily managed with rest, ice, compression, elevation, and exercises. Athletes can return to play within several days to weeks following a less severe ankle sprain. Football players can also sustain “high ankle sprains,” also referred to as syndesmotic sprains; these are more severe and require casting for a short period of time. Return to play following these injuries is often 6 weeks or more.
ABOUT THIS TIME EVERY YEAR, WHEN WE ARE IN THE long dog-days of summer football camp with temperatures on the turf above 100 degrees and players getting banged up multiple times a day, parents begin asking me whether I would ever let my sons play football. I suppose they ask because they know as a Sports Orthopaedic Surgeon and former team doctor for the Pittsburgh Panther football team, I’ve seen both the glory and the gore of the football field.
Fact is, I love taking care of football teams for both the glory and the gore. There simply is nothing like being on the field under the bright lights with the fans screaming, the team pumping, the band blaring, and feeling the electric anticipation in my players as they wait to get started. Also nothing is as tense as seeing one of the guys, the warriors of sport, drop on the field or get up too slowly. My doc senses kick in and I instantly jump into action, determining whether this is just a kid who took a hard hit or if a serious injury is going to take him out. In that moment pinpoint focus takes over, the crowd noise is hushed in my ears and I know the buck stops with me.
Fortunately, in most practices and games, the alarm is short lived. After a quick evaluation we send the player back to do his job, a little bruised but none-the-worse. There are, however, those real game changing injuries that take the player out for the game, a few weeks or the season.
Two years ago, during the Pitt vs. Miami game, one of these game- changing injuries happened. Late in the 3rd quarter our middle linebacker, #40 Dan Mason, was playing hard and pushing the limits as usual. He planted his right leg in the turf to throw down his man. In that instant the Miami player landed across Dan’s knee. We all watched as if in slow motion; Dan’s leg bent in the wrong direction and his foot dangled at the end of this leg. The crowd moaned then went silent. Our medical team sprung into action with on field assessment—stabilizing his leg then rapidly transporting him to the hospital and performing the first of 5 surgeries during the night. Despite Dan’s numerous football accomplishments, this perhaps was his finest hour. He never flinched. He gave a thumbs up to the crowd as we drove him off the field to the waiting ambulance. His knee dislocation ranks with cervical spine injury and femur fracture as some of football’s most serious injuries. Yet, after 5 surgeries and nearly two years of intense and torturous rehab at the hands of myself as well as Pitt’s athletic training staff and strength coaches, together with an exhibition of profound mental fortitude and faith on Dan’s part, we expect him to take the field again this year.
Dan’s display of the shear will to heal and play again, thought a more serious situation, is the same drive I’ve seen in other former Pitt and now NFL players Scott McKillop, Nate Bynam, Mike McGlynn, and soon to join them, Andrew Taglianetti to name a few of the many I’ve had the privilege to care for. They take injury as one more hit and do whatever it takes to return to the field. They are the primary reason I loved being a football doc.
This season, hopefully we will not see injuries like Dan’s across all fields but we can be guaranteed to see many less serious ones.
ABOUT THE AUTHOR
Vonda Wright served as team doctor for the University of Pittsburgh football team for 5 years. She currently cares for Pitt Soccer, Basketball, Baseball, Softball and the Pittsburgh Ballet Theatre. Dr. Wright is an orthopaedic surgeon at the University of Pittsburgh Medical Center’s Center for Sports Medicine and the author of Fitness After 40: How to Stay Strong at Any Age and Dr. Vonda Wright’s Guide to Thrive: 4 Steps to Body, Brains and Bliss. For more information, visit her website at www.vondawright.com.