How to Handle an Athletic Injury
How to Handle an Athletic Injury
Level 2: Rookie
Welcome Players! Everyone sustains an injury at some point in their athletic career. Instead of moping around or hoping it doesn’t happen the best thing you can do is prepare by educating yourself on the sports medicine healthcare system and establishing a plan for if and when a musculoskeletal injury to either you or a loved one occurs. Establishing relationships with sports medicine professionals before they’re needed, understanding the levels of escalation for an injury, and thoroughly evaluating your options at every step will guarantee you give yourself the best chance for a quick and full recovery.
Contents:
Prevention
Preparation
Acute Injury, GO!
Your Responsibility
The Warm-Up: Important Terms
A musculoskeletal injury is one in which either there is structural damage to:
An acute injury is one that occurs with a sudden or rapid onset, while a chronic injury is one that stems from persistent or unaddressed issues.
The process for a normal person (vs. an athlete participating in an organization) is long, arduous, and full of many uncertainties. It involves multiple healthcare practitioners, appointments, opinions, and each step of the way you’re left to fend for yourself by putting all the pieces of the puzzle together. You may feel unprepared or overwhelmed, and this psychological toll not only will inhibit healing but can also lead you to make the wrong decision about your treatment options!
This process, for lack of better words, sucks.
So, where should we start?
Prevention
The most +EV thing you can do to improve outcomes of an injury is to protect yourself from potential injury by maintaining good cardiovascular shape, baselines of strength & endurance, and eliminating or minimizing musculoskeletal imbalances in the movements that you repeat often.
The better your baseline, the more resilient you are to injury and the quicker your rehabilitation will be should you need one. Nutrition also plays a large role in this as the food you eat largely determines the rate at which your immune and lymphatic systems can clear out inflammation and allow your tissues to regenerate.
To better understand the concept of your health contributing to your performance, you can read:
If your sport/activity has high rates of a certain type of injury, like soccer players and hamstring strings / ACL tears, then your injury prevention efforts should be focused on that. In general, the greater your level of fitness the better off you’ll be.
Preparation
You need to have a game-plan should an injury occur.
“Failing to plan is planning to fail.”
Forming relationships with a few different local professionals is extremely valuable:
A Certified Athletic Trainer for acute-injury management and referrals
An Orthopedic Surgeon for advanced diagnosis, imaging and treatment
A Physical Therapist for rehabilitations and chronic injuries
Your most complete solution will be to find an independent and skilled Certified Athletic Trainer (ATC). An independent ATC is most suited to dealing with acute musculoskeletal injuries and ensuring the proper diagnosis and treatment route. Forming a positive relationship with an ATC that offers concierge services gives you someone to call when you need instant feedback or an in-person evaluation. They are experts at identifying diagnosis possibilities and will have a referral network of specialists should you need it. In traditional settings they fill this role for professional and collegiate athletic organizations, and as an independent will have the knowledge and resources to treat you like they would an athlete: quickly and efficiently. They are also beyond capable in rehabilitation, although for cost purposes it is usually better to see a physical therapist through insurance.
Building a relationship with an orthopedic surgeon is highly recommended. It’s worth scheduling some appointments (covered by insurance) to establish trust and improve your standing for scheduling should you need to be seen quickly. Bring up minor issues you’re having along with your full history and say you want to make sure you treat your physical body with the utmost importance so they take you seriously. You should be thoroughly evaluating them as they are you; if you don’t like them or their approach, find someone else! The last thing you want to do is end up at an orthopedic you don’t trust with no other options.
A competent Physical Therapist (PT) can ensure any rehabilitation needs stemming from the injury are in good hands. Steer away from traditional PT clinics as you’ll be thrown into the roulette of 15-minute evaluations and any rehab work done by a PT aid. You’ll want to do your research on independent or cash-based PT practices. It’s more expensive out of pocket, but worth the investment if you seriously care about your physical health. You should look for long (60 minutes or more) individualized sessions with a board-certified PT, a thorough evaluation process that includes development of a treatment plan, and then said treatment carried out fully hands-on the whole time and utilizes a combination of manual therapy AND MOVEMENT. Do not pay for someone to put a hot pack and electrical stim-pads on you. You didn’t get hurt on a table, you won’t heal on a table. You may have to go to multiple practices before you find someone who is both skilled and has the capacity to care about you. PT’s will be good to have on hand for a chronic injury that you’ve been dealing with for a long time, but in an acute-injury scenario will not be of much help.
Coaches note: I am a licensed & certified ATC, and I present this info without bias. ATC’s are more useful as a complete musculoskeletal care provider than orthopedics or physical therapists especially when dealing with period between initial injury and diagnosis. They are experts at emergency and catastrophic injury management, have ample experience in evaluations, and are trained exclusively as the first-responder in a all major athletic competitions at every level. Having someone with these credentials can save you thousands of dollars in treatment costs and are priceless at improving quality of care for you. With that said using the right professional for the right service is paramount to ensuring YOU receive the highest quality of care.
Acute Injury Happens, GO!
Ok, so shit hit the fan. Whether it’s at your rec basketball game, during your training session, or a freak-accident during the day, someone somewhere just suffered an injury. Whatever the scenario is, you’ve got to act!
Step 1: Determine if it’s life or death
This may sound a bit extreme, but it’s true. The first thing you should try to determine is if you need to call 9-1-1 or not. Is there bone sticking out? Blood spewing from an artery? Is the person still conscious? Are they breathing? I recommend everyone take a CPR/First-Aid course regardless of profession. You never know when you might need it and it could save a life.
Step 2: Breathe. Evaluate your options.
Ok, so the person isn’t dying. That’s good. This is when you’ll want to take a second and try and calm yourself and the injured person down so you can attempt to determine severity. How bad is it? Did they fall down and just really hurt their arm, or is that arm potentially broken? Your level of escalation here should be somewhere in the range of “Do I need to drive them to the emergency room, urgent care, or can it hold off until tomorrow?”.
This is where having an ATC or another professional to call comes in real handy. I’ve answered quite a few calls that go something like, “[Train Like a Pro] I’m sorry for calling but [this just happened to me or a loved one]. What should I do?” My guidance not only ensures that person is cared for properly, but also brings immense measures of relief to a scared family. You cannot put a price on peace of mind when a loved one is hurt.
Step 3: Pain control, re-evaluate options.
It’s bad but you don’t think they need to be taken to immediate medical attention. That’s a good sign. But it still hurts a hell of a lot. Ice, Ice, baby.
Ice is a powerful analgesic, as well as acts significantly to reduce rates of inflammation. This can be enormously helpful in the first hours to days following an injury.
Coaches note: There was a popular anti-ice movement a few years ago. I’m not sure if it’s still a fad, but I’ll dedicate an entire article in the future to clarifying the science surrounding cryotherapy. For now: Yes, your body needs inflammation to heal. No, it’s not good to have enormous amounts of swelling around the site immediately following injury. No, ice does not completely eliminate this inflammation. Yes, ice is beneficial in most cases following an injury. Yes, there are exceptions.
Ibuprofen (Advil) and Acetaminophen (Tylenol) are two very powerful OTC drugs that can aid in pain control, with two very different mechanisms and as such different purposes. In general:
Ibuprofen is an NSAID whose best use cases are in musculoskeletal injuries that induce any forms of swelling.
Acetaminophen best use cases are for pain control that do not involve swelling, fevers, or as an alternative to ibuprofen.
It’s very difficult to diagnose an injury when there is excessive swelling present especially without knowing the mechanism of the injury. This is to say that if you show up to the ER with a mega-swollen knee and can’t tell them how it happened, they are going to first triage to make sure nothing is life-threatening, then prescribe you pain meds as necessary probably combined with an anti-inflammatory and tell you to come back when the swelling is down so they can take an accurate image. They might X-ray you there to make sure nothing is broken, but an MRI with excessive fluid is impossible to read accurately.
If you’re abrasive to using OTC drugs, fair enough. Some scientifically-proven homeopathic remedies to reduce pain and inflammation include: 1 2
While there may be more that fight inflammation, few are as well researched and readily available as the above. Use whichever remedies you are most comfortable with and make sure to always DYOR (do your own research!)
Step 4: Enact Your Preparation Plan!
This is why the preparation came first! By now you’ve avoided severe or catastrophic injury, have determined the severity does not require immediate medical attention, and have made the injury tolerable enough via natural or OTC pain control. Now it’s time to call up those resources you set up in preparation for this moment. Whether it’s an ATC, PT, or Orthopedic, you should be seeking out a sports medicine professional to accurately evaluate and diagnose the injury.
The earlier you can be seen the better. Some injuries (such as an achilles tear) have the best outcomes when they are diagnosed and operated on quickly. Others, such as ACL tear, actually require waiting until almost all swelling has subsided before surgery is even possible. Even though you will wait for surgery, the sooner you can reduce unnecessary swelling and begin pre-habilitating the better outcomes you will have.3 4
This actually happened to my father a few years ago. He was traveling and suffered a calf injury. He called me within a day of the injury, after telling me what happened I was 95% sure he had torn his achilles. He was going to finish his travels before going to the doctor, but after I took over the situation he was able to get seen at an orthopedic while at his travel destination, confirm a complete achilles rupture, and had surgery scheduled in his hometown for when he returned. All this within 10 days. He made a full recovery, partially because of the response to the initial injury.
Each step from this point on will be on an *IF NECESSARY* basis. Injuries are complex and that is why having a professional evaluate and treat is your best chance at a quick and effective recovery.
Step 5: Imaging
If your sports medicine professional escalates your injury to requiring medical imaging, it’s important to be prepared for the consultation with the orthopedic as they review the report made by the radiologist. The first thing you should do is request the report directly from the medical office. They might be reluctant, but be insistent and demand that you receive a copy not only for your records but also so that you can start your due diligence. They will inevitably have to release the report to you, and you should pass this on to your initial sport medicine professional whom you trust to partially interpret these findings. They can act as a lens to inform what your possible treatment options should look like before hearing the orthopedics recommendation.
A quick note on Orthopedic Surgeons: As their title suggests, orthopedic surgeons are trained in the science of medicine specifically as it relates to the diagnosis and management of orthopedic injuries. Their most practiced and refined skill which makes them so valuable is their ability to perform surgery. They are trained extensively in surgical operations, so much so that they often can become blind to any other treatment option. Orthopedics are also not trained extensively in rehabilitation or movement therapies. This is the role of an ATC or PT. “When all you have is a hammer, everything looks like a nail” applies greatly to most orthopedics who diagnose an injury and think, ‘which surgery can I do to fix this?’ Especially a more traditionally trained orthopedic will rarely see benefit in holistic or non-surgical approaches, and if they do, they often will not be the best provider to carry out such a treatment plan. Keep this in mind throughout your visits with them.
When you do finally consult with the orthopedic to review your images, you should come prepared with a list of questions. Writing them down helps you maintain confidence as it’s normal to feel pressure not to question or disagree with the professional opinion of a doctor. Remember, YOU are the client! You have to take accountability and responsibility for your own health at all times, and this means making sure the orthopedic has considered all possibilities. The doctor will give you the layman’s version of the injury and their suggested treatment plan, which you should then take the opportunity to ask your list of questions. Some suggested tracks to ask about:
What confidence level do they have that the injury they diagnosed is actually what has occurred?
If they were to be wrong about the diagnosis, what would the other top differential diagnoses be?
Understanding what their recommended treatment plan is, what other forms of treatment are available?
Is this considered an aggressive or conservative treatment plan? What does the other one entail?
What are my likelihoods of full recovery to doing X activity?
Would other treatment plans give me a greater chance of returning to X activity more completely?
How long is the expected treatment plan?
What risks are associated with this treatment plan?
These should give you a good starting point, but make sure to DYOR from your imaging report and ask relevant questions.
Step 6: Weigh your options
With your images and reports, the orthopedics recommendation, your independent sports medicine professional (ATC/PT/Ortho) opinions, you now have almost all of the information necessary to make an informed and educated decision on how to move forward with the treatment of your injury. You should have a firm understanding of the severity of the injury, short and long term implications, the treatment options and associated risks, and potential repercussions should you choose not to follow the recommended treatment.
If you have any questions or concerns, this is the time to ask them directly and clarify your understanding. If you feel unsure about your options, you have every right to get a second opinion. Even in time-sensitive cases there is usually a way to receive secondary medical counsel without potentially risking the treatment outcome.
From here it’s important to realize you have a team of professionals to advise you, but there job is really to present you an unbiased view of the information so that you can make an educated decision on what’s best for you. It can very well be a decision between two not-so-great options, but at the end of the day YOU are the one that’s going to have to live with the results so you need to take accountability for understanding the situation to the best of your ability and deciding which risks you are most willing to endure.
Take Responsibility Back
The most common failure of the healthcare system comes at the lack of responsibility from the patient who unjustly assumes it is the medical professionals job to make the right decision for them. This is false. The moment you mentally assign the responsibility of your health to someone else you will continue to play the blame-game when things go wrong. The job of a medical professional is to provide you with all the information necessary, as well as obvious medical expertise and advised course of action, but you have to be the one who pulls the trigger. When things go right, YOU made the decision. If things go wrong, YOU also made that decision. It is a shared responsibility, yes, but you cannot write-off your duties to your own health to someone else.
The risk of infection at the surgical site following an operation is somewhere between 1-3%. If the doctor advises you to get surgery, and the odds fall against you and you end up with an infection, is that the doctors fault? You may think so, but you signed the consent form (hope you paid attention), and if you weren’t comfortable with that risk you should not have proceeded with the operation. This may be a hard truth, but if you want to get the most out of the western medical system you have to take an active role, not a passive role.
I believe it’s vitally important for every individual to be the #1 champion for their own health. When you understand the pitfalls of the medical system; how doctors are overworked, overbooked, understaffed, how medical sales are designed to prioritize money and not efficiency of solutions, how the entire opioid crises came to be (re: Purdue pharma, the Sackler family), you should realize that the medical system is designed for something for you to USE, not go through.
It’s not like getting on a ride at the amusement park, where you strap in at the beginning, hold on tight while the roller coaster makes all the turns and twists for you until the end where you’re helped off with a smile. It’s like driving through the wild safari. You get a guide, a good vehicle, and then you’re out on the adventure with an expert. They can recommend which way to go, where the best sights are, how to best protect yourselves from the lion, but at the end of the day you share the responsibility for what happens on that trip, unlike a roller-coaster. You might get stuck in quick-sand and blame it on the tour guide, but you’re the one who said you wanted to go see the chimpanzees and would take the risk of getting stuck.
The more you educate yourself on how to take advantage of the medical system and not let the medical system take advantage of you, the more in-charge of your health you’ll be and the better outcomes you’ll get.
Have a question or want to share your experience with the community?
Disclaimer: This is not medical advice. The content is purely educational in nature and should be filtered through ones own lens of common sense and applicability.