DH recently sustained a signfiicant shoulder injury playing hurling.  In fairness, after decades of playing the sport, he was probably due an injury.  But since I’m currently the sole designated family chauffer, sports injuries are on my mind.   Summer is a great time:   we are more likely to be outside and active.  Which is great for our health!  But with that comes the risk of injury.

So, how do we look after sports injuries?  This is a huge topic, so I’ll just focus on a few of the most common things that come up in my practice:  Prevention, first aid, “Is it broken?”, Return to play, Concussion, and child/teen sport injuries.

Prevention

Prevention doesn’t include avoidance.  Physical activity is healthy for us, and injuries can happen:

1. Safety first: Check the weather if it’s an outdoor sport. Wear the proper footwear and gear for your sport. This can include sunscreen, hi vis,  or lifejackets for watersports.

2. Wear a helmet if your sport should have one. There is a lot of misunderstanding about the role of a helmet. One of it’s important features is not just protecting the brain – but the face!  Helmets worn correctly greatly reduce facial injuries.

3. Stretch it out. Warm up and stretch before exercise, especially sports with bursts of movement like sprinting, quick turns, or jumps.

4. Know your limits. If you’re new to exercise or going back after a long period away from sport, start slow or consider joining a programme in your community like a couch-to-5K. Stay in your depth if you aren’t a strong swimmer. If you’re unsure about your health or limits because of a health conditions just as asthma, heart condition, or arthritis, check in with your GP or a chartered physiotherapist.

Who you gonna call?

Okay, you did everything right and now you are in pain:  Ideally, someone near you has done their community first aid course. (Seriously, it’s a lifeskill.  I’m a huge advocate that everyone should know the basics!) First aid kits should be regularly checked and stocked and readily available, for example pitch side for teams, golf club houses, onboard small craft, and in hill-walkers’ backpacks.

If you are injured and worried it might be serious (see more below), get professional medical advice from GP, HSE injury unit, private urgent care, or ED.  An HSE injury unit can save you both time and money, so check to see if there is one near you and the opening hours. You can also review what ages your nearest injury unit sees, and what types of injury qualify they treat. Something else that comes up quite a lot lately:  Some injuries are straightforward. But some injuries may require repeat examination, chartered physiotherapy, or additional imaging including a second interval xray 7-10 days later (especially in kids). So if follow-up is recommended, make sure you are clear on what’s needed – ask before you leave ED/urgent care. This is important to consider if you are going to use a private option:  can you afford- or happy to pay for – any additional follow-up that may be needed?

But is it broken?

Can Google – or urban myths – help you decide if your injury is a broken bone?  Let’s ‘break’ down some common urban myths:

• “If you can move it, it’s not broken” FALSE! You may be able to move a limb even if broken. Though if you can’t move it, that is definitely a concerning sign and seek medical advice from a professional.

• “If you can walk on it, it’s not broken.” FALSE. Not necessarily. People can definitely walk on some broken bones (painfully), though if you can’t walk it, that is concerning and you should seek medical advice from a professional.

• “You can tell it’s broken by looking at it.” FALSE. Swelling and bruising might be worse for some people than others for many reasons. A broken bone might not always look too impressive from the outside. But if there is obvious deformity, that is concerning and you should seek advice from a professional.

• “A broken bone is the worst pain ever.” FALSE. How someone experiences pain is affected by many, many things. But if your pain is very severe, seek medical advice from a professional.

• “If it isn’t broken, you don’t need to worry because it’s ‘just’ soft tissue.” FALSE. Some soft tissue injuries (Achilles tendon, knee ACL, wrist TFCC…) can be serious and need treatment.

• “Never take pain killers before going to the doctor/ED/injury unit.” FALSE. It will not “mask” anything. Also always do the first aid while you are waiting to go: ice and elevation, as appropriate. This will make you more comfortable for waiting, exam, xrays and can even speed things up.

• “Xray was OK so it’s fine.” MAYBE. Some injuries are straightforward. Some injuries may require repeat examination or additional imaging including a second interval xray 7-10 days later (especially in kids).

• “I heard a ‘crack’ so it’s bad.” NOT ALWAYS. Joints in your body can make a cracking or pop sound when pushed beyond normal range of motion in injury. It can be caused by that same phenomenon that makes that sound when you crack your knuckles (or that one friend you know who can crack every joint as a party piece.) But again, cracks can be bad so if concerned, seek medical advice from a professional.

• “It’s better to wait to see if it gets better first.” FALSE. (This one, like much of our bad online health misinformation I suspect circulates from US where cost of healthcare is prohibitive for many.) For significant injuries, prompt diagnosis and early treatment usually lead to better patient outcomes.

• “You’d know if you broke something.” FALSE. Not always.

Concussion:

If an athlete – of any age – has sustained a head injury, they should be removed from play and assessed. Any suspicion of concussion – that includes even the fact they had a significant impact even with no symptoms at the time – should mean no return to play that day.

 In the case of children, watch your child carefully (symptoms can change) and no sport for at least 24-48 hours. Any concerns? Don’t crowd source an opinion for this one – get qualified medical assessment at an urgent care or ED. Docs commonly use SCAT or Child SCAT (for under 12s) which is a painless clinical test asking about the injury and symptoms, a physical exam and asking the patient to remember things and do certain movements to test parts of the brain.

All sports in Ireland have written head injury #ReturnToPlay guidelines. If your child plays a sport, do you know these guidelines? They are available to read and review online on the website of your child’s sporting organisation. Many also offer free courses or online training on head injury on their websites.

Signs of a more serious head injury: loss of consciousness (no matter how brief), neck pain, or more than one vomit.

When to Seek Help With Head Injury

You should see medical care with your head injury if the person has: been knocked out but have now woken up, been vomiting since the injury, has a headache that does not go away with painkillers, a change in behaviour,  problems with memory, has been drinking alcohol or taking drugs just before the injury, has a blood clotting disorder  or take blood-thinners, or has had brain surgery in the past. Symptoms usually start within 24 hours but sometimes may not appear for up to 3 weeks.

Players with these symptoms of any age require urgent medical assessment.

Head injuries – especially in children and teens – need to be taken seriously. I commonly counsel my adolescent athlete-patients and their parents about the important role of the parent as an advocate for their child’s health when it comes to injury and sport. Especially concussion. Teach your child to tell someone immediately if they have sustained an head injury, to be a good teammate and call for a stop play if someone else is injured, and that they can trust you to help them not be pressured to “shake it off and get back out there.”

Sports Injuries in Children

I’ll share some child sports injury tips I share with my adolescent patients and their families:

1. It’s okay not to be okay. If it hurts, stop playing. Teaching your child/teen to listen to their body is a great skill. They will learn in time to “shake it off.” If they are crying, let them come off the pitch. (Look, if it’s a simple skinned knee, the drama quickly passes, and they will want to go right back on anyway.)

2. Overuse injury is a problem for all athletes, including child and adolescent. Make sure they have at least one day off a week from training.

3. Don’t rush return to play if there is still pain: Pressuring an athlete of any age to return to play can increase their risk of sustaining a second injury. In one study, as much as 15% of athletic injuries are “second injuries”, that is they occur as a direct (example: re-twisting a weakened ankle) or indirect (example: wrist injury because fall due to a lingering ankle injury). “Second hit syndrome” in head injury is a rare, but devastating injury.