Shoreline Physician Blog Archive

Snow Sports Injury Prevention

Bruce A. Stewart, MD/MBA - February 25th, 2014

We still have 4-6 weeks left in the ski and snow board season. We have seen a number of injuries to both skiers and snowboarders this year. In past years we have kept a running tally of the number of wrist fractures seen with snowboarders compared to skiers and it really isn’t close with the majority of injuries being with snowboarding. Boarders have a much higher rate of wrist injury. Many studies have found that wearing wrist guards decrease your chance of a wrist injury by 50%. A good summary of these studies can be found at http://www.ski-injury.com/specific-injuries/wrist Therefore, snowboarders, especially beginning boarders, should wear wrist guards to decrease the chance of wrist injury.

The most common knee injury with skiing is an MCL sprain. ACL tears are also relatively common. In fact, recreational skiing has the highest risk of ACL tears per hour of activity than just about any other sport. A nice summary of general information about skiing and snowboarding injuries and prevention can be found on this site: http://www.stopsportsinjuries.org/skiing-and-snowboarding-injury-prevention.aspx

But if you are really interested in learning more about all kinds of ski and snow board injuries, one of the most thorough sites I have found is: http://www.ski-injury.com

I hope you enjoy the rest of the outdoor winter sports season. It has been an incredible year for snow here in Michigan, but please be safe.

Preventing and Treating Ankle Sprains

Bruce A. Stewart, MD/MBA - November 13th 2013

The high school basketball season starts this month for both boys and girls. Few things are more frustrating for athletes who have been waiting all year for the start of the season than to miss part of it with an injury. The most common injury in basketball is a sprained ankle. In fact, ankle injuries are more common in basketball than in any other sport. Most sprains occur by coming down from a jump and landing on the foot of another player. An ankle sprain is an injury to the ligaments in the ankle. Ligaments connect one bone to another. Usually, ankle sprains affect the ligaments on the lateral side (outer part) of the ankle. Not all ankle sprains are the same. Some are mild and have a quick recovery; others can be severe and be a season ending injury. They are graded on a scale of 1 through 3, with grade 1 injuries being mild stretching of the ligaments, grade 2 tears being partial tears and grade 3 tears are complete tears of the ligaments.

Fortunately, there is a very effective way to prevent ankle sprains. Some people used to question whether ankles should be braced or taped. However, two studies done in the last few years ended any controversy about this: ankle braces do decrease the risk of ankle sprains in basketball players. One study looked at boys and girls high school basketball players and found that athletes who wore lace up ankle braces cut their chance of an ankle sprain by more than half. A similar study done in football players showed the same results. Both studies showed that while the chance of spraining the ankle is decreased, braces do not reduce the severity of the sprain if one does happen. Since two studies in different sports both showed the same results, it is reasonable to assume that this would apply to sports like soccer and volleyball, and other sports that involve frequent jumping and cutting. Given this evidence, I strongly recommend that athletes involved in these sports wear a lace up ankle brace on both ankles to prevent ankle sprains.

If an ankle injury does occur, it should be evaluated by an athletic trainer or physician to determine if it is a sprain or an ankle fracture. Both ankle sprains and fractures usually have rapid swelling, but the tender spot is usually right below the outer ankle bone in an ankle sprain (lateral malleolus) while ankle fractures are usually tender over the bone itself. Rehab is very important after an ankle sprain to regain normal function and to decrease the risk of repeat injuries. The links to the articles that were mentioned in this post are below. There is also a link to the article about risk of ankle injury by sport and a link to the Stop Sports Injuries site that discusses other basketball injuries and prevention strategies.

http://www.medscape.com/viewarticle/746240
http://ajs.sagepub.com/content/39/9/1840.abstract
http://ajs.sagepub.com/content/early/2011/09/16/0363546511422332
http://www.ncbi.nlm.nih.gov/pubmed/18059994
http://www.stopsportsinjuries.org/basketball-injury-prevention.aspx

Neck Injuries in Football

Bruce A. Stewart, MD/MBA - August 26th 2013

When I came to Holland five seasons ago, the first thing I did was set up a cervical spine training drill for area trainers and team physicians so that we can be ready to treat these injuries if they ever occur. This training drill has expanded each year. This year was our largest and most successful training exercise yet. Hopefully, none of us ever needs to use this training. As medical personnel, we are trained to take care of these injuries, but it is far better to prevent them from happening in the first place. This is the early part of the football season and it is a good time to make sure that all athletes, parents, and coaches are doing everything they can to minimize the risk of catastrophic spine injuries. Some of you may have read about the recent death in Georgia of a high school football player from a cervical spine injury that occurred during a scrimmage. This player, De’Antre Turman, was a highly rated prospect and had already received a scholarship offer to play college football at the University of Kentucky. For an article about this tragedy, click here.

Fortunately, these incidents are rare, but they do still occur. Most of these injuries ARE PREVENTABLE! Proper tackling technique will all but eliminate these injuries. Therefore, it is vitally important that all athletes are getting proper instruction in tackling technique to prevent this injury. The catch phrase is "shoulder down, head up."

A football player should never lead to make a hit or tackle with the helmet. The head and eyes should be kept up at all times and contact should be made with the shoulders. A running back or receiver should never be told, "put your head down and run" or "put your head down and deliver a hit." Not only is this dangerous, but for runners and tacklers you need to be able to see where you are going. So if you are being told to keep your head down, it is not good advice for being successful and seeing the field either. This video is a MUST SEE FOR PLAYERS, PARENTS, AND COACHES.

It talks about the dangers of leading with the helmet and with the head down. It also shows examples of proper technique and explains how to properly tackle a ball carrier. Please take the time to watch this video and make sure you understand it and are being taught this proper technique. If you are not being instructed in this, please talk to your coach. If you are afraid to talk to your coach, please feel free to contact me. You can give my office a call and get in touch with me. I work closely with the athletic trainers at all of the area high schools and Hope College and I know many of the coaches. If you feel that you are not being taught proper technique, I will be happy to have a discussion with your athletic trainer and coach (I won't use your name if you don't want me to). I am on the sidelines every Friday night at an area high school and am there to help take care of any injured athlete for either team. I hate to see any injuries, but the ones that I most fear are cervical spine injuries, so let's make sure we do everything we can to avoid these.

American football has been considered the most dangerous sport for causing spinal injuries. Approximately 819 deaths were directly caused by football from 1931 to 1986, with a peak incidence of 3.4 deaths per 100,000 players in 1968. Because of this, a rule change was made in 1976 for high school and college athletes that made it illegal for a tackler to initiate contact with the helmet (spearing). This rule change is credited with greatly reducing the number of catastrophic injuries to football players. The death rate in high school and college football fell from 3.4 deaths per 100,000 players in 1968 to 0.5 per 100 000 players in 1978, and the number of spinal cord injuries rapidly decreased as well. Not only were deaths from football reduced, but the number of catastrophic spine injuries also decreased. Look at the graph below. It is pretty easy to see that the trend in spine injuries resulting in paralysis dropped significantly after the change in rules in 1976.

More information about the head's up campaign and cervical spine injuries can be found here: http://www.jonheck.com/hdc/head-down.htm For people who are really interested in more details and the proper care of athletes with cervical spine injuries, more information can be found at these sites:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1896065/
http://www.nata.org/sites/default/files/AcuteMgmtOfCervicalSpineInjuredAthlete.pdf (position statement)

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