Sports injury
Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport.[1] Of those, about three million athletes age 14 years and under experience a sports injury annually.[1] According to a study performed at Stanford University, 21 percent of the injuries observed in elite college athletes caused the athlete to miss at least one day of sport, and approximately 77 percent of these injuries involved the knee, lower leg, ankle, or foot.[1] In addition to those sport injuries, the leading cause of death related to sports injuries is traumatic head or neck occurrences.[2]
When an athlete complains of pain, injury, or distress, the key to diagnosis is a detailed history and examination. An example of a format used to guide an examination and treatment plan is a S.O.A.P note or, subjective, objective, assessment, plan. Another important aspect of sport injury is prevention, which helps to reduce potential sport injuries. It is important to establish sport-specific dynamic warm-ups, stretching, and exercises that can help prevent injuries common to each individual sport.
An injury prevention program also consists of education on hydration, nutrition, monitoring team members "at risk," monitoring at-risk behaviors, and improving technique. In addition, season analysis reviews, preseason screenings, and pre-participation examinations are essential in recognizing pre-existing conditions or previous injuries that could cause further illness or injury. One technique that can be used in the process of preseason screening is the functional movement screen. The functional movement screen can assess movement patterns in athletes in order to find players who are at risk of certain injuries.[3] In addition, prevention for adolescent athletes should be considered and may need to be applied differently than adult athletes. Lastly, following various research about sport injury, it is shown that levels of anxiety, stress, and depression are elevated when an athlete experiences an injury depending on the type and severity of the injury.[4]
[edit]
Subacromial impingement syndrome is a shoulder joint injury. Baseball players are prone to get affected with subacromial impingement syndrome, as the sport requires an overhead movement of the arms to make a throw. Injury causes mechanical inflammation in the subacromial space – the space above the shoulder's ball and socket joint and the top most shoulder bone. Muscular strength imbalances, poor scapula, and rotator cuff tears are the main causes of subacromial impingement syndrome. Overhead movement of the arms instigates pain.[23]
Falling on an outstretched arm and pulling on the shoulder, repetitive lifting of heavy loads or overhead movement cause rotator cuff tears.
Anterior Cruciate Ligament Injury: common in skiing, soccer, football, and basketball. Immediately after injury the subject will fall to the ground, acute swelling sets in, knee is destabilized, and bearing weight becomes a difficulty. Knee injury in contact sports, and jumping, deceleration, and pivoting in non-contact sports and activities cause anterior cruciate ligament injury.[23]
Collateral Ligament Injury: an injury to a partially flexed knee can damage the medial collateral ligament – the ligament stretching along the inner edge of the knee. A forceful medial blow to the knee can cause collateral ligament injury. A reduction in range-of-motion and pain are symptoms of collateral ligament injury.[23]
Meniscus injuries: acute or repeated injury to the meniscus – the shock absorber of the knee – causes meniscus injuries. A person with meniscus injuries experience difficulty squatting and walking instigates pain.[23]
Runner's knee (Patellofemoral pain): knee joint pain affecting the patellofemoral joint. Pain is a direct consequence of the kneecap rubbing against the end of the thigh bone – "patella" means kneecap and "femur" means a thigh bone. The force the patellafemoral joint has to sustain can be as much as five times the body weight when the knee is fully flexed – when squatting – and three times body weight when the knee flexes to 90 degrees – when climbing stairs. This makes the cartilage that makes up the patellafemoral joint susceptible to wear and tear. The typical pain is also associated with muscle strength and joint flexibility. Repetitive physical activity such as running can trigger pain. Tight hamstrings, tight Achilles tendons, and weak thigh muscles, which are required to stabilize the knee, cause runner's knee.[23]
Inversion Ankle Sprain: landing on an uneven surface sprains the ankle. swelling, localized pain, difficulty bearing weight, and limping are signs of inversion ankle sprain.[23]
Eversion Ankle Sprain: injury related to the ankle turning outward or rotating externally. A typical symptom of eversion ankle sprain is excruciating pain that worsens with weight bearing.[23]
Risk factors[edit]
There are several factors that may put an athlete more at risk for certain injuries than others. Intrinsic or personal factors that could put an athlete at higher risk for injury could be gender. For example, female athletes are typically more prone to injuries such as ACL tears. There are approximately 1.6-fold greater rate of ACL tears per athletic exposure in high school female athletes than males of the same age range.[24] Other intrinsic factors are age, weight, body composition, height,[5] lack of flexibility or range of motion, coordination, balance, and endurance. In addition, biological factors such as pes planus, pes cavus, and valgus or varus knees that can cause an athlete to have improper biomechanics and become predisposed to injury.[25] There are also psychological factors that are included in intrinsic risk factors. Some psychological factors that could make certain individuals more subject to injury include personal stressors in their home, school, or social life. There are also extrinsic risk factors that can effect an athlete's risk of injury. Some examples of extrinsic factors would be sport specific protective equipment such as helmet, shoulder pads, mouth guards, shin guards, and whether or not these pieces of equipment are fitted correctly to the individual athlete to ensure that they are each preventing injury as well as possible. Other extrinsic factors are the conditions of the sport setting such as rain, snow, and maintenance of the floor/field of playing surface.[26]
There are approximately 8,000 children treated in emergency rooms each day for sports-related injures.[36] It is estimated that around 1.35 million children will suffer a sports-related injury per year, worldwide.[37] This is why children and adolescents need special attention and care when participating in sports.
According to the Centers for Disease Control and Prevention (CDC), many sports-related injuries are predictable and preventable.[38] Some prevention techniques are listed below.
Sports injury prevalence[edit]
Sports that have a higher incidence of contact and collision have the highest rates of injury.[41] Collisions with the ground, objects, and other players are common, and unexpected dynamic forces on limbs and joints can cause sports injuries. Soccer is the sport leading to most competitive injuries in NCAA female college athletes. Gymnastics, on the other hand, has the highest injury rate overall. Swimming and diving is the NCAA sport that has the lowest injury rates.[42] Injury rates were much higher for NCAA women's sports during competitions rather than practices except for volleyball, indoor track, and swimming and diving.[43] For eight of the NCAA sports, many injuries acquired during competition require at least seven days recovery before returning to the sport. In general, more females are injured during practice than in competition.[44] NCAA athlete injury rates are higher in men's ice hockey, basketball, and lacrosse.[45] NCAA athlete injury rates were significantly higher in women's cross country than men's cross country.[46] The NCAA injury rates are roughly the same for soccer, swimming and diving, tennis, and both indoor and outdoor track and field, regardless of gender.[47]
Costs[edit]
Interventions targeted at decreasing the incidence of sports injuries can impact health-care costs, as well as family and societal resources.[48] Sports injuries have direct and indirect costs. The direct costs are usually calculated by taking into account the cost of using healthcare resources to prevent, detect, and treat injury. There is a need for research about how healthcare is used and the expenses that coincide with it. Included in these expenses are how different injuries may have different prognoses. Indirect costs may be taken into account as well, when an injury prevents an individual from returning to work it may hinder the economic benefit to themselves and others.[49]
For collegiate athletics, the estimated cost of sport injuries ranges from $446 million to $1.5 billion per year.[50] For high school athletics, the yearly estimated cost of sport injuries ranges from $5.4 billion to $19.2 billion.[50] Medical costs in the United States for sports injury related emergency department visits exceeded $935 million every year.[51]
[edit]
Sport involvement can initiate both physical and mental demands on athletes. Athletes must learn ways to cope with stressors and frustrations that can arise from competition against others. Conducted research shows that levels of anxiety, stress, and depression are elevated following sports injuries.[52] After an occurrence of an injury many athletes display self-esteem issues, athletic identity crises, and high levels of post-traumatic distress, which are linked to avoidant coping skills.[52][53]
Each year in the United States, 3.5 million athletes are injured; therefore, it is important to understand how injury can impact anxiety.[54] Athletes are exposed to a culture that focuses heavily on success, and injuries can hinder the athlete from reaching their full potential.[55] Because of this reliance on achievement, many players are unlikely to stop performing because of pain they face. An injury could not only impact an athlete's ability to train and compete, but also influence their psyche and mental health. The external pressure by coaches, teammates, fans, and the media on athletes to endure pain and injury instead of refusing to play when hurt have prompted athletes to believe that accepting physical risks is their only choice.[55] This will in turn lead to both physical and mental struggles for the athlete to endure simultaneously and could lead to a worse outcome if not treated appropriately.
In addition, the influences of personal and situational factors can directly impact an athlete's perceptions about their injury. Personal factors include the characteristics of the injury, the athlete's own approach to their injury, and their identity.[55] Situational factors include the nature of the athlete's sport, social influences, and the rehabilitation environment.[55] For example, stressful events such as divorce or employment instability can increase the likelihood of experiencing an injury.[54] An athlete's response to an injury is influenced by a variety of stressors they encountered before the injury and the coping skills they used to overcome previous struggles. Therefore, it is important to utilize an integrated model in the rehabilitation process to account for the cognitive, emotional, and behavioral needs of the athletes.
In the rehabilitation process, athletes may experience anxiety as a result of the injury as well as their underlying personal and situational issues. As mental trainer Jeff Troesch mentions, "recovering from injury can be one of the toughest psychological challenges any athlete faces."[56] All of the uncertainty surrounding the injury and lacking full control over one's body can lead to more anxiety and stress on the athlete. Studies have shown that higher anxiety scores are commonly associated with other comorbidities including depression.[57] In addition, athletes with higher ratings for career dissatisfaction also exhibited higher anxiety scores compared to those who were career satisfied with their career.[57] From these studies it can be inferred that injured athletes experience an increase in anxiety levels as a result of psychosocial factors. Hence, taking these influences into account may assist sports medicine practitioners when planning for the psychological management needs of injured elite athletes.
When addressing psychological readiness during the recovery process, rehabilitation facilities should encourage confidence-building and provide social support to the athletes. Developing confidence in returning to sport includes "having trust in the rehabilitation provider, satisfaction of social support needs, and achievement of physical standards/clinical outcomes."[58] Social support can operate as a buffer for the amount of anxiety and stress associated with an injury by positively affecting the athlete's psychological and emotional wellbeing. In turn, this support can improve the athlete's motivation and coping skills during the rehabilitation process.[59] In addition, research suggests that emotional social support, which prioritizes "empathy, love, trust, and caring" can benefit injured athletes psychologically as they recover.[59] With greater emphasis on the psyche, athletes will be more motivated to envision their injury recovery as a new competition or task, rather than a roadblock that hinders them from achieving their dreams.
To accommodate psychosocial factors in recovery, services must be accessible to the athletes. Although many universities provide psychological services to their students, these employees may not be trained in handling athlete-specific factors, and thus may not be able to address the particular needs of injured athletes.[59] Therefore, certified athletic trainers who work with athletes on a consistent basis can be an important resource for providing emotional social support to injured athletes.[59] In previous studies, athletes who were content with the social support they received by their athletic trainers were 87% less likely to report symptoms of depression and anxiety.[59] Thus, such athletic trainers involved in the athlete's regular activities can be effective in facilitating psychological interventions during the rehabilitation process.
Currently, mental health struggles are often surrounded by stigma and can be seen as a weakness for high-level athletes. When discussing Kara Goucher's openness to sharing her difficulty with negative self-talk and confidence, the author acknowledged that this example is rare in the world of athletics because such struggles are usually considered a weakness.[60] If more athletes like Kara Goucher communicate about their mental health, others will feel more inclined to discuss their own issues instead of keeping it to themselves. Therefore, de-stigmatizing and engaging in conversations about mental health can encourage athletes to enlist help for their internal struggles throughout their sports career and during an injury. Mindfulness-based interventions that integrate the mind and body have begun to address mental health needs among high-level athletes. Not only has mindfulness been shown to positively impact general well-being and improve performance, but it could also be utilized as a "protective factor to stress and stress-related psychological issues."[54] The stigma associated with mental health as a weakness is a common barrier impeding help-seeking behaviors for athletes whose primary goal is to achieve perfection and success in their sport.
Elite athletes dedicate an immense amount of time and effort and can suffer from both physical and mental roadblocks. Therefore, it is important that rehabilitation programs account for mental health as a strong component of the recovery process for athletes, so that they are better prepared to manage not only the physical burden but also the psychological effects of their injury. Understanding the injured athlete experience from a physical, psychological, and social perspective is essential for athletes to return to their sport when they are both physically and mentally prepared and perform at their optimal level.[55]
Many student-athletes do not seek mental health support. Research suggests that only 10% of college athletes with mental health conditions seek support.[61] This means that out of approximately 500,000 college athletes,[62] only 50,000 seek help. Awareness is another challenge of support. In a survey evaluating mental health support for college athletes, 60% of male athletes and 55% of female athletes were not aware how to find or access mental health support. [63]