September 7, 2007

The onset of football season triggers a laundry list of athletic injuries as severe as they are prodigious.

At the University of Buffalo (New York), after only a few days of practice, Marc Fineberg, MD, chief of sports medicine in the University at Buffalo School of Medicine and Biomedical Sciences, gave a staggering tally of injuries to the school's football team: "We've had three players with ACL injuries, a medial collateral ligament tear, a dislocated shoulder and a dislocated elbow."

University sports medicine doctors serve as team physicians for the Buffalo Bills, the Buffalo Sabres and Western New York's major collegiate football teams -- the UB Bulls, the Buffalo State Bengals and the Erie Community College Kats. They also treat many of the area's high school teams.

While team medical personnel and staff emphasize the importance of injury prevention, those efforts can be stymied when offered to large, highly charged males engaged in bodily contact. Injuries can appear inextricably linked to the gridiorn culture. Knee and ankle sprains are the most common injuries treated during football season, Fine berg says. Concussions and shoulder sprains also compose the laundry list of nicks and dings that plague players.

The knee injury most common in football is a sprained medial collateral ligament, according to Fineberg. Such injuries, which usually occur during a tackle or block can heal on their own without surgery, Fineberg adds.

Less common, but more serious is a torn anterial cruciate ligament, described as unraveling like a braided rope. Torn anterial cruciate ligament injuries are less common but affect players more seriously, they frequently result from a quick change of direction. Their impact is sweeping: requiring surgery and routinely sidelining a player for an entire season, Fineberg says.

Though results vary in effectiveness, Fineberg says measures can be taken to prevent season-ending injuries.  "MCL injuries may be reduced by wearing a double-hinged knee brace," he says. "Using them remains controversial, but we think they provide added protection against MCL injuries. On the other hand, no brace has been proven to protect the ACL."

Getting players into top condition and developing strength, flexibility and agility may help to reduce ACL injuries, along with replacing outdated field covering with newer, more forgiving surfaces and wearing the right shoes, Fineberg notes. "Shoes with really long cleats grip better for increased performance, but may also put a player at greater risk of tearing an ACL."

Athletes and medical professioinals are also recognizing concussion as a serious threat to players' health, particularly at the professional level. Concussions remain underreported, however, particularly among high school players, for whom the injury occurs most frequently and with potentially fatal effects, Fineberg says. Educating players to avoid head-on tackling and wearing properly fitted helmets can help young athletes avoid this type of injury.

With few outward signs of injury -- no swelling or broken bones -- identifying the subtle signs of concussion is crucial, because a high school player who has an undiagnosed concussion and sustains a second blow to the head is at risk of second-impact syndrome, which studies have shown can result in sudden death.

 "If a coach or trainer suspects a player has had a concussion, he or she should take the helmet away, and put that player on the 'doctor's team,'" stated Fineberg. "There must be complete resolution of the injury before the athlete is allowed to play again, and that decision is not the player's, not the parents', not the coach's; it's the physician's."

 Signs to look for include dizziness, headache, aversion to light, nausea and a dazed or blank stare. If one pupil is dilated, the player needs to get to the emergency room pronto, he said.

 Shoulder injuries, the third most common group of orthopedic injuries in football, occur most often to backs and receivers. Quarterbacks are usually "off-limits" in practice, but are particularly vulnerable in games if they get slammed to the ground. Wide receivers are at risk when they go up for a pass and come down shoulder-first, usually hitting the turf under a much bigger and heavier player.

 Common shoulder injuries include "AC joint" sprains --– a separation at the bump on top of the shoulder which marks the junction between the shoulder blade and the collarbone. Proper-fitting shoulder pads may help avoid these injuries, which rarely require surgery.

 Another common problem is a dislocated shoulder, which occurs when the labrum, the cartilage around the socket, tears. Training focusing on rotator cuff conditioning may help prevent these tears. Players other than quarterbacks can wear a harness to support a shoulder weakened by a labral tear. These tears often require arthroscopic surgery to eliminate the painful episodes of instability, said Fineberg.

 Everyday maladies aside, the most catastrophic injury a young football player can sustain is to the neck or spine. "We saw a rapid decline in neck injuries when spearing -- using the head as a weapon -- was outlawed [it now garners a 15-yard penalty]," he said. "Players now are trained to tackle with the head up." Improving neck strength and flexibility may help protect against this type of injury, along with good coaching, he noted.

 "Football is a dangerous game," commented Fineberg. "The only thing we can do is try to minimize the risks by providing the safest environment possible. That involves the players, coaches, officials, parents, trainers, doctors, even the people who maintain the field. It's everyone's responsibility."


Source: University of Buffalo