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CITATION:
Drdavidgeier. “Don't Return to Play Too Soon after Injury.” Dr. David Geier - Sports Medicine Simplified, Dr David Geier, 29 Aug. 2017

www.drdavidgeier.com/dont-rush-play-after-injury/.

SUMMARY:
The article on Dr. David Geier’s website suggests that athletes go back to playing before fully ready or fully rehabilitated. The article gives statistics regarding how many athletes play with pain and continue to play before full recovery.  Dr. Grier includes his opinion to take all injuries seriously even if it means going back early.  After his article explained everything and what it would take to be able to go back while not fully recovered, he includes links to other related sources that will help readers fully understand what he is trying to get at.

ANALYSIS:
I genuinely disagree with Dr. David Grier’s opinion on early return from an injury.  After doing all of my research, this is the only source I found that has this take on the rehabilitation process.  I thought I would include this text in my sources because it allows people to expand their thought process and understand that some doctors feel that it is necessary to preemptively return to a sport after being injured.  I also thought it was interesting finding out a different perspective on the topic, I didn’t know people thought of the rehab process that way.

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Dr. David Geier - Sports Medicine Simplified

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More attention has been directed at the health of former college and professionals athletes. Data regarding the use of painkilling medications, the rates of chronic health conditions such as osteoarthritis, and the rates of disability have made many question whether the rush to return to play sports is worth the risk to your health.

Long-term pain and return to play after injuries

Former NFL players are the best example of these concerns. 88% of former NFL players claimed that they had excellent health at the beginning of their careers. That number dropped to 13% after their playing days were over.

93% admitted to dealing with pain on a daily basis, and 83% noted that pain to be moderate to severe pain.

When you look at former college athletes, studies have shown that the long-term quality of life for former athletes is worse than people who exercised or played recreational sports. In fact, 40% of the former Division I athletes developed osteoarthritis later in life.

What is the common theme with college and professional athletes? They often played through pain and injuries.

Also read:
Does fear of getting benched keep players from reporting concussions?
Cortisone might get athletes back in game quicker, but does it send wrong message?

Playing sports with pain or an injury

The Washington Post surveyed over 500 former players. Almost 90% of them said that they played games while hurt, and 56% did so frequently. 70% of the former Division I athletes admitted to competing or practicing with an injury during their college careers.

While it is understandable to want to return to play as quickly as possible, you need to keep your long-term health in mind. Whether you play high school, college or professional sports, and whether you play football, basketball or soccer, you must not try to return to play too soon.

Take injuries seriously

At a minimum, all athletes need to take all injuries seriously. Get appropriate treatment from the team doctors and athletic trainers, or consider getting a second opinion from an outside physician. Take whatever time is necessary to recover fully. Get all of your pain and swelling down. Complete a rehab program that replicates your duties on the field or court. Make sure all bones, tendons, and ligaments have fully healed before you return to demanding activities that will stress them again.

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Don't return to play too soon after injury | Dr. David Geier - Sports Medicine Simplified

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More attention has been directed at the health of former college and professionals athletes. Data regarding the use of painkilling medications, the rates of chronic health conditions such as osteoarthritis, and the rates of disability have made many question whether the rush to return to play sports is worth the risk to your health.

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CITATION:
Maffulli, et al. “Sport Injuries: a Review of Outcomes.” OUP Academic, Oxford University Press, 14 Aug. 2010,

academic.oup.com/bmb/article/97/1/47/358051.

SUMMARY:
This article gives an extensive, in-depth look into the many types of injuries athletes may encounter, from the head to the ankle.  Described in this source was a section showing the author’s literature search which showed their own research process along with what they used to find their information.  After that was a table showing the physical injuries and how each injury lead to a deformity.  Percentages of all different kinds of injuries was provided to the reader next on the site.  After that was the description of the outcomes that came with each and every injury known to sports along with a table to easier understand.

ANALYSIS:
This article was sure a hefty task to read through because it was extremely long and full of knowledge I had no idea about although, it did enlighten me on all new ideas such as the amount of injuries possible of receiving while playing a sport.  This is the article that initiated my second inquiry question which was “How can we change the rehabilitation process to keep athletes mentally stable through the process?”  This article was the one to do that because it showed me truly how effective the rehabilitation process can actually be.

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Abstract

Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

Introduction

Participation in sports is widespread all over the world, with well-described physical, psychological and social consequences for involved athletes. The benefits associated with physical activity in both youth and elderly are well documented. Regular participation in sports is associated with a better quality of life and reduced risk of several diseases, allowing people involved to improve cardiovascular health. Both individual and team sports are associated with favourable physical and physiological changes consisting of decreased percentage of body fat and increased muscular strength, endurance and power. Moreover, regular participation in high-volume impact-loading and running-based sports (such as basketball, gymnastics, tennis, soccer and distance running) is associated with enhanced whole-body and regional bone mineral content and density, whereas physical inactivity is associated with obesity and coronary heart disease. Sports are associated with several psychological and emotional benefits. First of all, there is a strong relationship between the development of positive self-esteem, due to testing of self in a context of sport competition, reduced stress, anxiety and depression. Physical activities also contribute to social development of athletes, prosocial behaviour, fair play and sportspersonship and personal responsibility.

Engaging in sports activities has numerous health benefits, but also carries the risk of injury. At every age, competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve injuries, caused by direct trauma or repetitive stress. Different sports are associated with different patterns and types of injuries, whereas age, gender and type of activity (e.g. competitive versus practice) influence the prevalence of injuries.

Injuries in children and adolescents, who often tend to focus on high performance in certain disciplines and sports, include susceptibility to growth plate injury, nonlinearity of growth, limited thermoregulatory capacity and maturity-associated variation. In the immature skeleton, growth plate injury is possible and apophysitis is common. The most common sites are at the knee (Osgood-Schlatter lesion), the heel (Sever's lesion) and the elbow. Certain contact sports, such as rugby, for example, are associated with 5.2 injuries per 1000 total athletic exposures in high school children (usually boys). These were more common during competition compared with training and fractures accounted for 16% of these injuries, whereas concussions (15.8%) and ligament sprains (15.7%) were almost as common.

Sports trauma commonly affects joints of the extremities (knee, ankle, hip, shoulder, elbow, wrist) or the spine. Knee injuries are among the most common. Knee trauma can result in meniscal and chondral lesions, sometimes in combination with cruciate ligament injuries. Ankle injuries constitute 21% of all sports injuries. Ankle ligament injuries are more commonly (83%) diagnosed as ligament sprains (incomplete tears), and are common in sports such as basketball and volleyball. Ankle injuries occur usually during competition and in the majority of cases, athletes can return to sports within a week. Hip labral injuries have drawn attention in recent years with the advent of hip arthroscopy. Upper extremity syndromes caused by a single stress or by repetitive microtrauma occur in a variety of sports. Overhead throwing, long-distance swimming, bowling, golf, gymnastics, basketball, volleyball and field events can repetitively stress the hand, wrist, elbow and shoulder. Shoulder and elbow problems are common in the overhead throwing athlete whereas elbow injuries remain often unrecognized in certain sports. Hand and wrist trauma accounts for 3-9% of all athletic injuries. Wrist trauma can affect the triangular fibrocartilage complex or cause scaphoid fractures, whereas overuse problems (e.g. tenosynovitis) are not uncommon. Spinal problems can range from lumbar disc herniation, to fatigue fractures of the pars interarticularis, and 'catastrophic' cervical spine injuries.

Thus, in addition to the beneficial aspects related to sports activities, injuries can counter these if an athlete is unable to continue to participate because of residual effects of injury. Do injuries in children, adolescents and young adults have long-term consequences? What are the outcomes of the most commonly performed surgical procedures? The aim of this review is to provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries.

Literature search

An initial pilot Pubmed search using the keywords 'sports', 'injury', 'injuries', 'athletes', 'outcome', 'long term', was performed. From 1467 abstracts that were retrieved and scanned we identified the thematic topics (types of injury, management, area of the body involved) of the current review, listed below:

Then a more detailed search of PubMed, Medline, Cochrane, CINAHL and Embase databases followed. We used combinations of the keywords: 'sport', 'sports', 'youth sports', 'young athletes', 'former athletes', 'children', 'skeletally immature', 'adolescent', 'paediatric', 'pediatric', 'physeal', 'epiphysis', 'epiphyseal injuries', 'hip', 'knee', 'ankle', 'spine', 'spinal', 'shoulder', 'elbow', 'wrist', 'football players', 'football', 'soccer', 'tennis', 'swimmers', 'swimming', 'divers', 'wrestlers', 'wrestling', 'cricket', 'gymnastics', 'skiers', 'baseball', 'basketball', 'osteoarthritis', 'former athletes', 'strain', 'contusion', 'distortion', 'injury', 'injuries', 'trauma', 'drop out', 'dropping out', 'attrition', 'young', ' youth', 'sprain', 'ligament', 'ACL', 'cruciate ligament', 'meniscus', 'meniscal', 'chondral', 'labrum', 'labral', 'reconstruction', 'arthroscopy', 'throwing', 'overhead', 'rotator cuff', 'TFCC', 'scaphoid', 'osteoarthritis', 'arthritis', 'long term', 'follow-up' and 'athlete'. The most recent search was performed during the second week of November 2009.

Physeal injuries and growth disturbance

Residual problems after injury in athletes

Osteoarthritis (OA) in former athletes

Spine problems in former athletes

Knee injury and OA

Ankle ligament injury and OA

Residual upper limb symptoms in the 'overhead' athlete

Outcomes of operative management of common sports injuries

Meniscectomy and OA

Meniscal repair in athletes

Anterior cruciate ligament (ACL) reconstruction and OA

ACL reconstruction in children

Ankle arthroscopy in athletes

Hip arthroscopy in athletes

Operative management of shoulder injuries in athletes (focusing on surgery for instability and labral tears)

Operative management of wrist injuries in athletes (focusing on triquetral fibrocartilage complex, TFCC, injuries and scaphoid fractures)

Given the different types of sports injuries in terms of location in the body, several searches were carried out. The search was limited to articles published in peer-reviewed journals.

From a total of 2596 abstracts that were scanned, 1247 studies were irrelevant to the subject and were excluded. The remaining studies were categorized in the topics identified earlier. We excluded from our investigation case reports, letter to editors and articles not specifically reporting outcomes, as well as 'kin' studies (studies reporting on the same patients' population). The most recent study or the study with the longest follow-up was included. In some topics of particular importance, such as the effect of knee injuries (given their frequency), we included long-term studies reporting not only on athletes, but also on the general population (usually in these studies a very high proportion on sports injuries is included). Regarding knee injuries in adults, we included articles with follow-up more than 10 years.

Given the linguistic capabilities of the research team, we considered publications in English, Italian, French, German, Spanish and Portuguese.

Physeal injuries and growth disturbance

A concern regarding children's participation in sports is that the tolerance limits of the physis may be exceeded by the mechanical stresses of sports such as football and hockey or by the repetitive physical loading required in sports such as baseball, gymnastics and distance running. Unfortunately, what is known about the frequency of acute sport-related physeal injuries is derived primarily from case reports and case series data. In a previous systematic review on the frequency and characteristics of sports-related growth plate injuries affecting children and youth, we found that 38.3% of 2157 acute cases were sport related and among these 14.9% were associated with growth disturbance. These injuries were incurred in a variety of sports, although football is the sport most often reported.

There are accumulating reports of stress-related physeal injuries affecting young athletes in a variety of sports, including baseball, basketball, climbing, cricket, distance running, American football, soccer, gymnastics, rugby, swimming, tennis. Although most of these stress-related conditions resolved without growth complication during short-term follow-up, there are several reports of stress-related premature partial or complete distal radius physeal closure of young gymnasts. These data indicate that sport training, if of sufficient duration and intensity, may precipitate pathological changes of the growth plate and, in extreme cases, produce growth disturbance.

Disturbed physeal growth as a result of injury can result in length discrepancy, angular deformity or altered joint mechanics and may cause significant long-term disability. However, the incidence of long-term health outcome of physeal injuries in children's and youth sports is largely unknown.

Based on the previously selection criteria, 20 studies were retained for analysis (Table 1). Injury to the physis can result in limb deformities and leg-length discrepancy, the latter being more common after motor vehicle accidents, rather than sports participation.

Residual problems after injury in athletes

OA in former athletes

Two studies investigated former top-level female gymnasts for residual symptoms (back pain) and radiographical changes. Both studies reported no significant differences in back pain between gymnast and control groups; however, the prevalence of radiographical abnormalities was greater in gymnasts than controls in one study.

Lower limb weight-bearing joints such as the hip and the knee are at risk of developing OA after injury or in the presence of malalignment, especially in association with high impact sport. Varus alignment was present in 65 knees (81%) in 81 former professional footballers (age 44-70 years), whereas radiographic OA in 45 (56%). Others showed that prevalence of knee OA in soccer players and weight lifters was 26% (eight athletes) and 31% (nine athletes), respectively, whereas it was only 14% in runners (four athletes). By stepwise logistic regression analysis, the increased risk is explained by knee injuries in soccer players and by high body mass in weight lifters. A survey in English former professional soccer players revealed that 47% retired because of an injury. The knee was most commonly involved (46%), followed by the ankle (21%). Of all respondents, 32% had OA in at least one lower limb joint and 80% reported joint pain. Another study examined the incidence of knee and ankle arthritis in injured and uninjured elite football players. The mean time from injury was 25 years. Arthritis was present in 63% of the injured knees and in 33% of the injured ankles, whereas the incidence of arthritis in uninjured players was 26% in the knee and 18% in the ankle. Obviously, it should be kept in mind that radiographic studies can only ascertain the presence of degenerative joint disease, which is just one of the features of OA. Clinical examination is always necessary to clarify the diagnosis, and formulate a management plan.

Ex-footballers also had high prevalence of hip OA (odds ratio: 10.2), whereas in another study the incidence of hip arthritis was 5.6% among former soccer players (mean age: 55 years) compared with 2.8% in an age-matched control group. In 71 elite players it was higher (14%). Female ex-elite athletes (runners, tennis players) were compared with an age-matched population of women, and were found to have higher rates (2-3 fold increase) of radiographic OA (particularly the presence of osteophytes) of the hip and knee. The risk was similar in ex-elite athletes and in a subgroup from the general population who reported long-term sports activity, suggesting that duration rather than frequency of training is important. An older study is runners associated degenerative changes with genu varum and history of injury. A cohort of 27 Swiss long-distance runners was at increased risk of developing ankle arthritis compared with a control group. Similarly elite tennis players were at risk of developing glenohumeral OA, whereas handball players of developing premature hip OA, and former elite volleyball players had marginally increased risk for ankle OA. Interestingly a study that investigated the health-related quality of life (HRQL) in 284 former professional players in the UK found that medical treatment for football-related injuries was a common feature, as was arthritis, with the knee being most commonly affected. Respondents with arthritis reported poorer outcomes in all aspects of HRQL.

In summary, OA is more common among former athletes, compared with the general population. The lower limb joints are commonly affected, in association with high impact and injury.

Evidence from follow-up studies on spine of former athletes

Heavy physical work and activity lead to degenerative changes in the spine. Studies on different athletic disciplines and heavy workers have given variable degenerative changes and abnormalities in the lumbar spine. Even though sporting activity is regarded as an important predisposing factor in the development of spinal pathologies, there are few studies on the late spinal sequelae of competitive youth sport. Any comparison in terms of back pain between top athletes and the general population is difficult. Experience of pain may be influenced by factors such as susceptibility, motivation and physical activity. Minor pain may be provoked by vigorous body movements that hamper athletic performance, thereby ascribing the pain a greater impact than in the general population. On the other hand, a well-motivated athlete may ignore even severe pain to maintain or improve his/her athletic performance. Also, varying rate/prevalence of osteophytosis has been reported in players associated with various disciplines of sports.

Efforts should be made to understand the aetiology of injuries to the intervertebral discs during athletic performance and thereby prevent them.

Based on the previously selection criteria, seven studies were retained for analysis (Table 2). In summary, spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Degenerative changes in the athlete's spine can occur, but they are not necessarily associated with clinically relevant symptoms of OA. Therefore, it cannot be determined whether it threatens the athlete's career, or whether it has a worse impact on athletes compared with the general population.

Knee injury and OA in athletes

A population-based case-control study investigated the risk of knee OA with respect to sports activity and previous knee injuries of 825 athletes competing in different sports. They were matched with 825 controls. After confounding factors were adjusted, the sports-related increase risk of OA was explained by knee injuries. Another study leads to the same conclusion: 23 American football high-school players were compared with 11 age-matched controls, 20 years after high-school competition. No significant increase in OA could be demonstrated clinically or radiographically. However, a significant increase in knee joint OA was found in the subgroup of football players who had sustained a knee injury.

A cohort of 286 former soccer players (71 elite, 215 non-elite) with a mean age of 55 years was compared with 572 age-matched controls, regarding the prevalence of radiographic features of knee arthritis. Arthritis in elite players, non-elite players and controls was 15%, 4.2% and 1.6%, respectively. In non-elite players, absence of history of knee injury was associated with arthritis prevalence similar to the controls.

An interesting study involved a cohort of 19 high-level athletes of the Olympic program of former East Germany. They sustained an ACL tear between 1963 and 1965. None were reconstructed, and all were able to return to sports within 14 weeks. Subsequent meniscectomies were necessary in 15/19 (79%) athletes at 10 years and 18/19 (95%) at 20 years, when in 18 of the 19 knees, arthroscopy was performed, 13 patients (68%) had a grade four chondral lesion. By year 2000 (more than 35 years after ACL rupture), 10/19 knees required a joint replacement.

The incidence of radiographic advanced degeneration (Kellgren-Lawrence grade 2 or higher) was 41% in a cohort of 122 Swedish male soccer players (from a total of 154) who consented to radiographic follow-up, 14 years after an ACL rupture. No difference was found between players treated with or without surgery for their ACL rupture. The prevalence of Kellgren-Lawrence grade 2 or higher knee OA was 4% in the uninjured knees.

Similar results were evident among Swedish female soccer players who were injured before the age of 20. The prevalence of radiographic OA was 51%, compared with 8% only in the uninjured knee, 12 years later. The presence of symptoms was documented in 63 of 84 (75%) athletes who answered the questionnaire, and was similar ( P = 0.2) in the two management groups (operative versus non-operative). The presence of symptoms did not necessarily correlate with radiographic OA ( P = 0.4).

In summary, knee injury is a recognized risk factor for OA. Injured athletes develop OA more commonly than the general population in the long term. Approximately half of the injured knees could have radiographic changes 10-15 years later. It is not clear whether radiographic changes correspond to presence of symptoms.

Ankle ligament injuries and OA in athletes

Ankle sprains are common sporting injuries generally believed to be benign and self-limiting. However, some studies report a significant proportion of patients with ankle sprains having persistent symptoms for months or even years. Nineteen patients with a mean age of 20 years (range: 13-28), who were referred to a sports medicine clinic after an ankle inversion injury, were followed for 29 months (average), and compared with matched controls. Only five (26%) injured patients had recovered fully, whereas 74% had symptoms 1.5-4 years after the injury. Assessments of quality of life using the short form-36 questionnaires revealed a difference in the general health subscale between the two groups, favouring the controls ( P < 0.05).

Similar conclusions were drawn from another study, regarding ankle injuries in a young (age range: 17-24 years) athletic population. There were 104 ankle injuries (96 sprains, 7 fractures and 1 contusion), accounting for 23% of all injuries seen. Of the 96 sprains, 4 were predominately medial injuries, 76 lateral and 16 syndesmosis sprains. Although 95% had returned to sports at 6 weeks, 55% reported pain or loss of function. At 6 months, 40% had not fully recovered, reporting residual symptoms. Syndesmosis injuries were associated with prolonged recovery.

The association between ligamentous ankle injuries has been highlighted in a study that, retrospectively, reviewed data from 30 patients (mean age: 59 years, 33 ankles) with ankle osteoarthritis. They found that 55% had a history of sports injuries (33% from soccer), and 85% had a lateral ankle ligament injury. The mean latency time between injury and OA was 34.3 years. The latency period for acute severe injuries was significantly lower (25.7 years), compared with chronic instability (38 years). Varus malalignment and persistent instability were present in 52% of those patients.

In summary, ankle ligamentous injuries in athletes can result in considerable morbidity, residual symptoms and arthritis 25-30 years later.

Residual upper limb symptoms in the 'overhead' athlete

Shoulder injuries account for 7% of sports injuries and often limit the athlete in his or her ability to continue with their chosen sport. Repetitive overhead throwing imparts high valgus and extension loads to the athlete's shoulder and elbow, often leading to either acute or chronic injury or progressive structural change and long-term problems in the overhead athlete.

Schmitt et al. examined 21 elite javelin throwing athletes at an average of 19 years after the end of their high-performance phase (mean age at follow-up was 50 years). Five athletes (24%) complained about transient shoulder pain and three (16%) about elbow pain in their throwing arm affecting activities of daily living. All dominant elbows had advanced degeneration (osteophytes).

Elbow intra-articular lesions are recognized as consequences of repetitive stress and overuse. Shanmugam and Maffulli reported follow-up (mean 3.6 years) of lesions of the articular surface of the elbow joint in a group of 12 gymnasts (six females and six males). This group showed a high frequency of osteochondritic lesions, intra-articular loose bodies and precocious signs of joint ageing. Residual mild pain in the elbow at full extension occurring after activity was present in 10 patients and all patients showed marked loss of elbow extension compared with their first visit.

Glenoid labral tears require repair, and shoulder instability is currently approached operatively more often. A review article found that conservative management of traumatic shoulder dislocations in adolescents was associated with high rates of recurrent instability (up to 100%). Therefore, surgical shoulder stabilization is recommended. The outcomes of surgical management are presented in the next section.

A distinct clinical entity is the 'little league shoulder', which is characterized by progressive upper arm pain with throwing and is more commonly seen in male baseball pitchers between ages 11 and 14 years. It is thought to be Salter-Harris type I stress fracture. Activity modification, education to improve throwing mechanics and core muscle training are recommended. It is not known how this condition behaves in the long term, regarding structural damage and development of degenerative changes.

Overhead athletes are plagued by shoulder and elbow injuries or overuse syndromes that can affect their performance and cause degeneration and pain in the long term.

Outcomes of operative management of common sports injuries

Meniscectomy and OA

The association between knee OA and meniscectomy has been well documented. In former athletes it is associated with OA (Table 3). Meniscectomy in children and adolescents has been associated with unfavourable results and radiographic arthritic changes in the long term (Table 4). However, radiographic criteria were not always clearly defined. To assess the long-term outcomes of meniscectomy, we also evaluated studies with a minimum follow-up of 10 years in the adult general population (Table 5). Many of the 'older' studies providing the long-term outcomes represent results of open total meniscectomies. The overall message is that radiographic degeneration is common in meniscectomized knees, and patients are at risk of developing OA. The condition of the articular cartilage is a prognostic factor. However, clinical and radiographic findings do not always correlate. Resection should be limited to the torn part of the meniscus.

Meniscal repair in athletes

Given the long-term problems associated with meniscectomies, preservation of the substance of the meniscus after injury is currently advocated. Based on this concept, arthroscopic meniscal repair techniques have been developed. In the general population, encouraging clinical results with failure rates of 27-30% at 6-7 years follow-up have been reported. One study evaluated 45 meniscal repairs in 42 elite athletes followed for an average of 8.5 years. In 83% of them an ACL reconstruction was performed as well. Return to their sport was possible in 81% at an average of 10 months after surgery. They identified 11 failures (24%), seven of which were associated with a new injury. The medial meniscus re-ruptured more frequently compared with the lateral (36.4 versus 5.6%, respectively).

Mintzer et al. retrospectively reviewed the outcome of meniscal repair in 26 young athletes involved in several sports at an average follow-up of 5 years (range: 2-13.5). No failures were reported, with 85% of patients performing high level of sports activities.

In general, the results of meniscal repairs in the general population, as well as in athletes, are encouraging.

ACL reconstruction and OA

Knee injuries can result in ligament ruptures and/or meniscal tears and are recognized as a risk factor of OA. A systematic review on studies published until 2006 reported on the prognosis of conservatively managed ACL injuries showed that there was an average reduction of 21% at the level of activities (Tegner score evaluation). ACL reconstruction is therefore a procedure frequently performed in athletic individuals, as they desire to maintain a high level of activities. However, does ACL reconstruction affect the incidence of knee degeneration and symptoms in the long term? We identified three studies comparing operative versus non-operative management of ACL ruptures specifically in athletes, in regard to OA.

Two studies from Sweden investigating the prevalence of OA after ACL rupture in male and female soccer players were discussed earlier. Both found no difference in the incidence of radiographic arthritis between surgically and conservatively treated players, more than 10 years after their injury.

A comparative study on high-level athletes with ACL injury showed no statistical difference between the patients treated conservatively or operatively (patella tendon graft) with respect to OA or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Several studies present outcomes of ACL injuries in the general population. A recent systematic review included 31 studies (seven were prospective) reporting radiographic outcomes regarding OA, with more than 10 years follow-up after ACL injury. The prevalence of OA in the injured knee varied from 1 to 100%, whereas in the contralateral knee it was 0-38%. Isolated ACL tears were associated with low OA incidence between 0 and 13%, whereas in the presence of additional meniscal injury, it was 21-48%. Meniscal injury and meniscectomy were the most frequently reported risk factors for OA. The authors scored the quality of the studies and found that studies scoring high reported low incidence of OA. Data extraction indicated that ACL reconstruction as a single factor did not prevent the development of knee OA.

There is lack of evidence to support a protective role of reconstructive surgery of the ACL against OA, both in athletes as well as in the general population.

ACL reconstruction in children

ACL reconstruction in skeletally immature patients is a relatively new trend. The concern is intra-operative epiphysis damage and growth disturbance, a complication which has been avoided in several studies.

The earliest published study compared non-operative versus operative management of ACL ruptures in 42 skeletally immature athletes (age range: 4-17 years) followed for a mean of 5.3 years. They used a composite knee score based on clinical examination and a patient questionnaire and found superior results in the operatively treated patients. Age and growth plate maturity did not influence results. They recommended ACL reconstruction for active athletic children.

One of the early reports showed that there were no growth disturbances at a mean of 3.3 years after surgery in 9 children, however, with two re-ruptures. Those children could not return to athletic activities.

In a series of 57 ACL reconstructions, 15 patients had reached completion of growth when examined at follow-up, none had signs of growth disturbance, whereas clinical scoring was good or excellent in all patients.

Another study compared the outcomes of two management strategies in 56 children with ACL ruptures, namely ligament reconstruction in the presence of open physis, or delayed reconstruction after skeletal maturity. The 'early' reconstruction group had evidence of less medial meniscal tears (16 versus 41%), and no evidence of growth disturbances, at 27 months mean follow-up.

After 1.5-7.5 years follow-up of 19 ACL reconstructions in 20 athletic teenagers (age range: 11.8-15.6 years), all but one had returned to sports, none had tibiofemoral malalignment or a leg-length discrepancy of more than 1 cm, and the modified Lysholm score was 93 out of 95.

Finally, 55 children (ages 8 to 16 years, mean 13 years) were followed for a mean of 3.2 years (range: 1-7.5 years) after ACL reconstruction, with no evidence of growth disturbances. Clinical scores showed normal or almost normal values (higher than 90 out of 100 possible points) and 88% of the patients went back to normal or almost normal sports according to the Tegner score.

Overall, the clinical results are encouraging and iatrogenic epiphysis damage does not seem to be a problem, possibly because physeal sparing procedures were used. The study designs, however, are inadequate to answer the question of whether early or delayed ACL reconstruction results in the best possible outcome in skeletally immature patients.

Ankle arthroscopy in athletes

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. Arthroscopic debridement is currently considered a routine procedure, and chondral lesions are now more frequently identified as causes of ankle pain. Few reports specifically in athletes are available (Table 6). Short-term outcomes only are available. It is not known whether arthritis is a long-term consequence.

Hip arthroscopy in athletes

Only recently has the hip received attention as a recognized site of sports injuries, possibly as a result of the evolution of hip arthroscopy which allowed recognition of intra-articular pathology. Acetabular labrum and chondral lesions can be addressed arthroscopically, and patients' satisfaction rates up to 75% have been reported. One study evaluated the outcome of hip arthroscopy in 15 athletes (mean age: 32 years, range: 14-70) followed for 10 years. Nine were recreational athletes, four high school and two intercollegiate athletes. Diagnoses included cartilage lesion (8), labral tear (7), arthritis (5), avascular necrosis (1), loose body (1) and synovitis (1). The median improvement in the modified Harris hip score was 45 points (from 51 preoperatively to 96, on the 100-point scale), with 13 patients (87%) returning to their sport. All five athletes with arthritis eventually underwent total hip arthroplasty at an average of 6 years. Long-term outcomes regarding progression of joint degeneration after traumatic chondral or labral damage are not available.

Operative management of shoulder injuries in athletes

Labral tears require repair, whereas shoulder instability is currently approached operatively more often. Conservative management of traumatic shoulder dislocations in adolescents is associated with high rates of recurrent instability (up to 100%), whereas recurrent dislocations were reported in up to 12%, at an average of 3 years after arthroscopic stabilization. Shoulder dislocations are particularly common in rugby, the characteristic mechanism of injury being tackling, whereas labral tears are common in the 'overhead' athlete'. Published results in athletes (Table 7) show that operative stabilization of the shoulder is initially successful, but instability and pain can recur in the long term. Results of arthroscopic techniques in the management of intra-articular pathologies are promising, but long-term outcomes are unknown (Table 7).

Operative management of elbow injuries in athletes

Elbow ulnar collateral ligament (UCL) insufficiency is one of the frequently recognized injuries in the overhead athlete, as a result of excessive valgus stress. It constitutes a potentially career threatening injury and requires surgical repair. The use of a muscle-splitting approach, avoiding handling of the ulnar nerve, and the use of the docking technique for stabilization is recommended (Table 8). Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for highly motivated athletes. The results of arthroscopic debridement (Table 7) need to be evaluated in the long term.

Operative management of wrist injuries in athletes

A review of the literature shows that 3-9% of all athletic injuries occur in the hand or wrist, and are more common in adolescent athletes than adults. In this article, we focused on TFCC injuries and acute scaphoid fractures in athletes.

TFCC injuries are an increasingly recognized cause of ulnar-sided wrist pain, and can be particularly disabling in the competitive athlete. Advances in wrist arthroscopy made endoscopic debridement and repair of the TFCC possible. McAdams et al. treated arthroscopically TFCC tears in 16 competitive athletes (mean age: 23.4 years). Repair of unstable tears was performed in 11 (69%) and debridement only in 5 (31%). Return to play averaged 3.3 months (range: 3-7 months). The mean duration of follow-up was 2.8 years (range: 2-4.2 years). Clinical scores (mini-DASH and mini-DASH sports module) improved significantly. No long-term outcomes are available.

Operative management of scaphoid fractures in athletes, even if undisplaced, is recommended if early return to sports is desired. One study followed 12 athletes treated operatively for a scaphoid fracture. They were able to return to sports at 6 weeks. At an average follow-up of 2.9 years, 9 of 12 athletes had range of motion equal to the uninjured side, and grip strength was equal to the unaffected side in 10 of 12 athletes.

Discussion

Participation in sports offers potential benefits for individuals of all ages, such as combating obesity and enhancing cardiovascular fitness. On the other hand, negative consequences of musculoskeletal injuries sustained during sports may compromise function in later life, limiting the ability to experience pain-free mobility and engage in fitness-enhancing activity. Increasingly, successful management of sports-related injuries has allowed more athletes to return to participation. The knee is the joint most commonly associated with sports injuries, and therefore is most at risk of developing degenerative changes. It is not clear whether radiographic OA always correlates with symptoms and reduced quality of life. Furthermore, even effective management of meniscal or ACL injury does not reduce the risk of developing subsequent OA. OA in an injured joint is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcomes involves not only the exact type of injury (e.g. ACL rupture with or without meniscal damage), but also additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity and reinjury. A better understanding of these variables may improve future prevention and treatment strategies.

In many of the long-term studies (the majority being retrospective case series), several methodological flaws have to be highlighted. A recent systematic review on OA after ACL injuries suggested that some studies may overestimate the prevalence of long-term OA. The authors in several studies mention that a proportion of the index group of injured athletes were available for follow-up or consented for radiographic examination. One can argue that these patients were the ones with symptoms, therefore the prevalence of OA (after ACL rupture for example) may appear higher than it really is. Presentation of outcomes was not always based on robust criteria. Different clinical scores and radiographic classifications have been used, and therefore results between studies are not directly comparable. In the majority of the studies, it was not clarified whether radiographic appearance correlated with symptoms, and how important these were for the quality of life of the patients. Disabling arthritis requiring intervention may actually be delayed for more than 20-30 years. Furthermore, long-term studies present outcomes of older techniques, not used any more in clinical practice (e.g. primary ACL repair or total meniscectomy). Evolution in surgical or rehabilitation techniques might have improved outcomes of certain injuries. Therefore, currently known 'long-term outcomes' may only reflect the results of techniques used in the past and not what we should expect in the future. Increasing awareness of athletes and trainers, new diagnostic and musculoskeletal imaging modalities, improved surgical and rehabilitation methods, but also analysis of injury patterns in different sports and development of injury prevention strategies might be beneficial to minimize the effects of sports injuries in the years to come.

What is the true incidence of arthritis in the long term? Will it be a disabling condition for the former athlete, in the coming decades? Currently, joint preserving procedures (e.g. microfractures, mosaicplaty, autologous chondrocyte implantation, realignment osteotomies and implant arthroplasties) have evolved and allow middle aged or older patients to live without pain and maintain an active life style. Meniscal transplantation shows encouraging results. Should therefore an increased risk for developing musculoskeletal problems prevent children and adults from being active in sports? Do the benefits of participating in sports outweigh the risks?

A survey in Sweden showed that 80% of former track and field athletes with an age range of 50-80 years felt they were in good health, compared with 61% of the referents, despite higher prevalence of hip arthritis in former athletes. Low back disorders were similar in the two groups, shoulder and neck problems were lower in former athletes, and knee arthritis was similar in the two groups.

No definite answer can be given to the previously addressed questions, based on available evidence. Future research should involve questionnaires assessing the HRQL in former athletes, to be compared with the general population.

Conclusions

Physical injury is an inherent risk in sports participation and, to a certain extent, must be considered an inevitable cost of athletic training and competition. Injury may lead to incomplete recovery and residual symptoms, drop out from sports, and can cause joint degeneration in the long term. Few well-conducted studies are available on the long-term follow-up of former athletes, and, in general, we lack studies reporting on the HRQL to be compared with the general population. Advances in arthroscopic techniques allow operative management of most intra-articular post-traumatic pathologies in the lower and upper limb joints, but long-term outcomes are not available yet. It is important to balance the negative effects of sports injuries with the many social, psychological and health benefits that a serious commitment to sport brings.

References

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Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries.

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CITATION:
Quinn, Elizabeth. “Smart Ways to Confirm You're Ready for Exercise Again After an Injury.” Verywell Fit, Verywellfit, www.verywellfit.com/when-is-it-safe-to-return-to-sports-after-an-injury-3119404.

SUMMARY:
In this article, ways to speed up an athlete’s recovery time is provided to the reader. Quinn explains many safe ways to make sure an athlete gets back into the swing of things as soon as possible without causing any unnecessary injuries.  While explaining these ways, she ties the proper conditioning aids, phases and guidelines for faster recovery.  Along with all of these topics, she includes readers responses on how they enjoyed the article and if it helped at all.

ANALYSIS:
This source is extremely helpful to many athletes and athletic trainers around the world because it shows very effective ways to speed up the long-lasting recovery time of the rehabilitation process.  I enjoyed being able to take my original topic and branch of into this very important, necessary subtopic that helps the reader understand the majority of rehab.  Many people will look at this source and believe there is not any way to speed the process but after many different sources of research, a conclusion was made that this source knows effective ways on faster treatment.

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If you have had a recent injury one of your main concerns may be how soon you can return to sports. The answer to this question is not always easy because each athlete and each injury are unique. Returning too soon can increase your risk of re-injury or developing a chronic problem that will lead to a longer recovery. Waiting too long, however, can lead to unnecessary deconditioning.

Proper Conditioning Aids Injury Recovery Time

One thing that can improve your recovery from an injury is a high level of conditioning prior to the injury. Not only will being in great shape reduce your risk of injury and lessen the severity of an injury, but it also has been shown to reduce recovery time.

How to Speed Injury Recovery Time

Phases of Injury Recovery

During the acute recovery phase, you should be following the R.I.C.E. principles (rest, ice, compression, and elevation), limiting your activity, allowing yourself time to heal. Depending on the type and severity of your injury, treatment may also include medical care, surgery, various taping, bracing, or physical therapy treatments.

While your injury heals, try to maintain overall conditioning if possible. Try alternate forms of training such as water running, swimming, cycling, rowing or weight training of the non-injured parts.

Regaining range of motion and strength should be started as soon as possible as directed by your physician or therapist. Use discomfort as a guide and avoid movements that cause pain. Once muscle strength and flexibility return you can slowly get back into your sport, working at about 50 to 70 percent max capacity for a few weeks. During this re-entry phase, functional drills for balance, agility, and speed can be added as tolerated.

Guidelines for Safe Return to Sports

You are pain-free. If it still hurts, don't use it.

You have no swelling. Swelling is a sign of inflammation. If you still have swelling, it is too early to return to sports.

You have full range of motion. Compare the injured part with the uninjured opposite side to see if you have regained range of motion.

You have full or close to full (90 percent) strength. Again, compare with the uninjured side to see if strength has returned.

For lower body injuries - you can perform full weight bearing on injured hips, knees, and ankles without limping. If you are limping, you are still not ready to return to sports. An altered gait can lead to further pain and problems.

For upper body injuries - you can perform throwing movements with proper form and no pain

Keep in mind that even when you feel 100 percent you may have deficits in strength, joint stability, flexibility or skill. Take extra care with the injured part for several months.

These are guidelines only; you should follow your physician's advice regarding return to sports.

Thanks for your feedback!

What are your concerns?

Other Inaccurate Hard to Understand

Article Sources

Return To Play Criteria. The American Orthopaedic Society for Sports Medicine.

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Smart Ways to Confirm You're Ready for Exercise Again After an Injury

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If you have had a recent injury one of your main concerns may be how soon you can return to sports. The answer to this question is not always easy because each athlete and each injury are unique. Returning too soon can increase your risk of re-injury or developing a chronic problem that will lead to a longer recovery.

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CITATION:
“Every Injured Athlete Has One Main Goal: Returning to Play His or Her Sport.” Wtbjc.com, wtbjc.com/our-practice/newsletter-stories/sports-medicine/returning-to-sport.php.

SUMMARY:
The website newsletter for West Tennessee Bone & Joint claims it is important for an athlete to heal and get back to their passion. The article describes common sports injuries and explains how physical therapy is essential for an athlete’s recovery.  Also noted in this article were recovery plans that showed how athletes could recover as fast as possible.  Pearce includes many cations to be aware of while entering the rehabilitation process, one specifically being the chance of full recovery. That chance is only set at 70% - 75% by Doctor Pearce.

ANALYSIS:
Doctor David Pearce’s website source was well appreciated in this process of research because he gives actual numbers and facts to help with assurance.  During the research process, I like to have things laid out in factual form and this source does that, in a clean way even.  This source connects to the topic because it describes how fatal a research process could be to an athlete’s career.  Such things include: failure to return, failure to recover fully, etc. I enjoyed researching on this website because it lead me to new pathways throughout the topic such as the percentage of return.

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888-661-9825 Two locations in Jackson Bolivar * Brownsville Dyersburg * Lexington * Martin Paris * Parsons * Ripley Selmer * Trenton * Union City

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CITATION:
Advanced Solutions International, Inc. “Youth Sports Injuries Statistics.” Statistics, www.stopsportsinjuries.org/STOP/Resources/Statistics/STOP/Resources/Statistics.aspx?hkey=24daffdf-5313-4970-a47d-ed621dfc7b9b.

SUMMARY:
The article from stopsportsinjuries.org shares statistics from the U.S. Centers for Disease Control (CDC) in relation to athlete injuries.  This source gives factual evidence to injuries from youthful athletes.  It gives a breakdown of each sport and what percent each of them have of kids getting injured.  Also noted in this source is a few popular injuries whether its head injuries or limb or body injuries and what percent of athletes end up receiving an injury like them.

ANALYSIS:
This article was my favorite article out of all my sources because it was very easy to understand, it was very easy to read and it was not over my head, it was on my level of vocabulary and knowledge.  Again, I enjoyed reading this source because it broke down facts by bullet points and was not too long of an article because it got to the point quick.  Including real numbers and percents really helps the reader quickly understand what is being said.

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CITATION:
“Psychological Rehab After Sports Injury.” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/blog/the-power-prime/201512/psychological-rehab-after-sports-injury.

SUMMARY:
This article discusses how an athlete is not only physically affected by an injury but also mentally. After an injury, athletes begin to physically rehabillate, but his/her mind also needs to be reassured that they will be able to overcome the injury.  This requires him/her to keep perspective, stick to the program, redirect the negative energy, and stay involved in the sport they have loved. The words from an experienced psychologist who shares experiences from real patients and their outcomes is very important.

ANALYISIS:
This source was a great source to use for many reasons, the first one would be that it takes the mental half of my research and blows my mind.  It shows a great understanding of how the psychological part takes an even role with the physical part of the rehabilitation process.  Another reason would be because it comes from a psychology doctor and in the article he states that he doesn’t know the exact facts but from his work in psychology he realizes how athletes may be affected in plenty different ways.

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Every day when you read the sports page of a newspaper or online, you hear about injury after injury after injury. Whether the NFL, NBA, MLB, NHL, NCAA, professional soccer, tennis, and golf, or down to the high school ranks, men and women athletes all over the world are seeing their seasons (and sometimes their careers) ending with a serious injury.

Given the steady flow of injuries that occur to athletes, I thought it timely to return to a topic that is near and dear to me, namely, the role of the mind in responding to an injury and its impact on a quality rehabilitation and a timely and effective return to sport.

Though I don't know the statistics on knee injuries in sports, I'm going to figure that a substantial portion of athletes sustain a serious injury at some point in their careers. Also, as the author of two books on the psychology of injury, I regularly work with athletes of all sorts helping them recover and return to their sport better than ever. Finally, having avoided serious injury during my own career as an internationally ranked ski racer (just a partially torn ACL and two broken wrists), I tore up and had surgery on my shoulder a few years ago while working with a group of ski racers in Chile and finally learned first hand how difficult recovering from a serious injury is.

The sad reality of sports is that many young athletes either have so far or will this year hurt themselves so seriously that it will end their seasons. The good news is that surgical and rehabilitative technology has become so advanced that a full physical recovery from an injury that a few decades ago might have been career-ending is now commonplace.

But another reality of physical injuries is that the mind gets damaged too, but little attention is paid to how the absence of "mental rehab" can prevent athletes from returning to or improving on their pre-injury level of performance. As a result, I thought I would share some ideas I have about how injured athletes can ensure that their minds recover as fully as do their bodies.
Keep Perspective
Accept that getting hurt sucks and you will feel bad at times, especially early in your recovery when you're more disabled than recovering. You will not be able to do the normal things to which you are accustomed. You will be in pain. You'll feel frustrated, angry, and depressed. You'll want to curl up in a ball and withdraw from life. These reactions are normal and, to some degree, healthy, as you have to allow yourself to grieve for your loss.

At the same time, if you allow yourself to stay in that funk for too long, you will surely slow your recovery. So, after a short time, get over your "pity party" and get your mind on your recovery; keep focused on the present ("What can I do now to get healthy?") and the future ("I will heal and get back better than ever!").

Another part of keeping perspective is that your injury seems like a big deal now, but, when you look back on it in a few years, it will probably be just a blip in your sports career and life. I'm working with a European athlete who missed two years with a back injury, but he never gave up his dream and is now healthier and better than ever.
Stick with Your Rehab Program
A simple reality I learned in recovering from my shoulder injury was that if you follow your rehab program, you will get better (and if you don't you won't). The problem is that rehab hurts (a lot!), is boring, tiring, monotonous, in other words, it gets old fast. That's why so many injured athletes end up either shortening or skipping rehab sessions, or not putting in their best effort. The result: slowed or incomplete recovery.

There is also a subset of injured athletes who have the belief that more is better, so they do more sets and reps on more days than recommended by their rehab team. Unfortunately, this "more is better" mentality often results in overuse injuries and other complications, and a slowed rather than accelerated recovery. My recommendation here is very straightforward: Do exactly what your rehab people tell you to do, no more and no less.
Become a Better Athlete
I have seen careers saved by serious injuries. How's that possible, you might ask. Getting injured can teach you to be tough, endure hardship, and really find your motivation for sports. Injuries can also enable you to focus on areas of our sport that have been weaknesses, but you simply haven't had time to work on them. Yes, a knee injury, for example, can prevent you from doing a lot. But it's also an opportunity to figure out ways you can improve as an athlete working around your knee, for instance, strengthen your core and upper body, improve your flexibility, and increase your stamina. The goal is for you to return to your sport a physically better athlete than you were before.
Redirect Your Energies
One of the most difficult aspects of an injury is that you can't do what you normally do and are often at a loss how to expend the energy that builds up in you every day. Another downside is that you have lost something that has been a source of self-esteem, validation, meaning, satisfaction, and joy in your life.

Your best path is to find something toward which you can direct your energy and that will provide you with what sports used to for you. It can be anything, for example, learning a musical instrument, cooking, reading, school, whatever. The important thing is to find something you can care about and throw yourself into it just the way you threw yourself into your sport. Not only will it bolster how you feel about yourself, but it will also take your mind off of the disappointment of your injury and the difficulty of the recovery.
Stay Involved in Your Sport
The chances are that much of your life revolves around sports and being injured can cause you to feel isolated and at a distance from the sport you love. This separation from sports can also hurt your motivation because you aren't experiencing many of the good things that you get from sports; the excitement, inspiration, fun, and camaraderie of your teammates.

So, look for ways to stay connected with your sport. For example, become an apprentice coach (this will help you learn more about technique) or help out at practices and competitions. Do your physical conditioning (around your injury) during regular team fitness sessions. I realize that this might be difficult because you may be "jonesing" to be out there and you may not like seeing your teammates or competitors moving ahead of you. At the same time, both the connection and seeing others having fun and getting results will further motivate you to rehab and get back on the field, court, course.
Watch Video and Sports on TV
Imagine if, while sidelined with an injury, you just sat on the sofa all day. Obviously, your muscles would atrophy, you'd get really out of shape, and you wouldn't be ready to return to your sport when your injury healed. The same applies to your mind. If you don't keep it sharp, it too will get soft and out of shape.

One way to keep your mind in shape is to watch video of yourself and televised competitions of your heroes. You can use video and TV to "rehab" your mind and keep it focused and "in the game" during your recovery. Watch video of yourself three time a week for 10 minutes to keep a clear image of how you perform in your sport. Watch televised competitions of your sport and videos of your favorite athletes. You will learn about technique and feel inspired watching them (while recognizing that many of these athletes you are watching have returned from serious injuries as well).
Develop a Mental Imagery Program
There is nothing more important to your mental recovery than mental imagery. Imagery is not just something that goes on in your head. In fact, it connects your mind and your body and, amazingly, activates muscles in the same way as when you are actually performing in your sport (though not with the same intensity). Mental imagery, in a way, fools your body into thinking that you are really performing in your sport.

Imagery has huge benefits to recovery from injury. Research has shown that you can improve your skills without actual training by engaging in regular mental imagery. So, by doing imagery regularly, you can maintain or maybe even better your sports skills. Seeing and feeling yourself continuing to practice and compete (in your mind's eye) will keep your motivation up (because you'll be inspired to get back to your sport), your confidence high (because you'll regularly see and feel yourself performing well), and your mind focused (because you'll be exercising your mental muscles and, as a result, they will stay in shape for your return to sport). Importantly, imagery will make you feel like you're still progressing as a athlete.
Bottom Line
When you get seriously injured, it is a real bummer. But what is an even bigger bummer is not returning fully or as quickly as possible to your sport. For you to return to sport as good or better than you were before your injury, you need to do everything possible to facilitate your recovery. That means, of course, following your physical rehab program to the letter. But it also means developing and following a mental rehab program as well, so that your body and your mind are fully recovered and prepared for the rigors of sports from the very first time to return to practice.

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Every day when you read the sports page of a newspaper or online, you hear about injury after injury after injury. Whether the NFL, NBA, MLB, NHL, NCAA, professional soccer, tennis, and golf, or down to the high school ranks, men and women athletes all over the world are seeing their seasons (and sometimes their careers) ending with a serious injury.

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CITATION:
Brewer, Britton W. “Psychological Responses to Sport Injury.” Oxford Research Encyclopedias, 11 Nov. 2018, oxfordre.com/psychology/view/10.1093/acrefore/9780190236557.001.0001/acrefore-9780190236557-e-172.

SUMMARY:
Written in this article from Britton W. Brewer, was multiple different reasons why the psychological portion of the rehabilitation process is important to athletes and everybody caring for them.  Brewer explains in this article that emotions in athletes tend to change from a depressed and worried feeling to a more positive one as they progress nearer to recovery.  Also touched on was the fact that patients in the rehab process tend to cope by isolating themselves, carrying on with their normal lives, etc.

ANALYSIS:
Brewer’s article is a valid source for use in this project and topic because it describes in key detail how these affected athletes feel while going through the process.  It truly helped me get a grasp on what really goes on mentally and basically tied all of the psychological half of the process together as i finished my research on the subtopic.  I enjoyed reading what Brewer had done research and experiments on because it was like he was doing the exact same project as I was and had everything I needed to know.  Even though it was a great source, it was quite over my head in vocabulary and context because I had to do extra research on what some of the content was trying to portray.

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PRINTED FROM the OXFORD RESEARCH ENCYCLOPEDIA, PSYCHOLOGY (oxfordre.com/psychology). (c) Oxford University Press USA, 2018. All Rights Reserved. Personal use only; commercial use is strictly prohibited. Please see applicable Privacy Policy and Legal Notice (for details see Privacy Policy and Legal Notice).

Subscriber: null; date: 29 November 2018

Summary and Keywords

In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes. Consistent with contemporary models of psychological response to sport injury, aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, and behavior. Part of the fabric of sport and ubiquitous even among "healthy" athletes, pain is a common consequence of sport injury. Postinjury pain is typically of the acute variety and can be exacerbated, at least temporarily, by surgery and some rehabilitation activities. Cognitive responses to sport injury include appraising the implications of the injury for one's well-being and ability to manage the injury, making attributions for injury occurrence, using cognitive coping strategies, perceiving benefits of injury, and experiencing intrusive injury-related thoughts and images, increased perception of injury risk, reduced self-esteem and self-confidence, and diminished neurocognitive performance. Emotional responses to sport injury tend to progress from a preponderance of negative emotions (e.g., anger, confusion, depression, disappointment, fear, frustration) shortly after injury occurrence to a more positive emotional profile over the course of rehabilitation. A wide variety of personal and situational factors have been found to predict postinjury emotions. In terms of postinjury behavior, athletes have reported initiating coping strategies such as living their lives as normally as possible, distracting themselves, seeking social support, isolating themselves from others, learning about their injuries, adhering to the rehabilitation program, pursuing interests outside sport, consuming alcohol, taking recreational and/or performance-enhancing substances, and, in rare cases, attempting suicide. Psychological readiness to return to sport after injury is an emerging concept that cuts across cognitive, emotional, and behavioral responses to sport injury.

Keywords: psychology, sport injury, rehabilitation, consequences, responses, adherence, psychological

Inherent in sport participation is the risk of injury. Although the physical effects of sport injury (e.g., tissue damage, initiation of healing processes, increased body mass index and body fat percentage) are especially salient (Myer et al., ; Prentice, ), sport injury can also have psychological consequences. Aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, behavior, and readiness to return to sport. These aspects can be considered in terms of theoretical, empirical, and practical perspectives.

Theoretical Perspectives

To describe and explain how athletes respond psychologically to injury, researchers have borrowed and, in some cases, adapted theories and models from other areas of psychology. For example, the most comprehensive attempt to represent psychological responses to sport injury and their antecedents conceptually-the integrated model of psychological response to sport injury (Wiese-Bjornstal, Smith, Shaffer, & Morrey, )-is based largely on principles from the literature on stress and coping (Lazarus & Folkman, ) and is an extension of several previously adapted models (e.g., Gordon, ; Weiss & Troxel, ). In the integrated model, sport injury is conceptualized as a stressor that athletes interpret (or "appraise") in terms of its impact and their ability to deal with its effects. This cognitive appraisal process is thought to be influenced by a multitude of personal and situational factors. Personal factors include injury characteristics (e.g., severity, type) and individual difference variables in the psychological (e.g., personality, motivation, identity), demographic (e.g., age, gender), and physical (e.g., health status, eating behavior) domains. Situational factors pertain to aspects of the sport (e.g., level of competition, time of the competitive season), social (e.g., family dynamics, social support), and physical (accessibility to rehabilitation, comfort of rehabilitation sessions) environments. The resulting cognitive appraisals are posited to influence cognitive, emotional, and behavioral responses to sport injury, which are themselves proposed to be dynamic, reciprocally related, and potentially influential on injury recovery outcomes (Wiese-Bjornstal et al., ). Research has provided consistent support for predictions generated from the integrated model (for a review, see Brewer, ). Although the integrated model does not include pain and psychological readiness to return to sport, it could easily be expanded to do so.

Another group of models has adapted the widely known ideas of Kübler-Ross () regarding adjustment to terminal illness to psychological responses to sport injury. Such grief-based "stage models" hold that athletes proceed through an invariant, predictable sequence of stages after injury. For example, several authors (Astle, ; Rotella, ) proposed that athletes display denial, anger, bargaining, depression, and, finally, acceptance after they become injured. Although athletes have exhibited grief-like reactions to serious injury (Macchi & Crossman, ) and tended to display more favorable psychological responses over time after injury (e.g., McDonald & Hardy, ; Smith, Scott, O'Fallon, & Young, ), the notion of an invariant series of psychological reactions to sport injury has not been supported by research (Brewer, ). As with the integrated model, stage models do not address pain and psychological readiness to return to sport.

Focused on the types of pain that athletes might encounter both before and after injury, Addison, Kremer, and Bell () developed a model of sport-related pain that incorporates ideas from the gate control theory of pain (Melzack & Wall, ), the parallel processing model of pain (Leventhal & Everhart, ), and the literature on cognitive appraisal processes in stress and coping (Lazarus & Folkman, ). As specified in the model, which neatly dovetails with the integrated model of Wiese-Bjornstal et al. (), athletes experience postinjury pain when they interpret physiological sensations as indicating a threat to their health and ascribe the sensations to injury. Individual differences in age, attention to bodily symptoms, fitness, and physiology are thought to influence the detection of physiological sensations. Both intrinsic factors (e.g., affect, cognition, pain tolerance, personality) and extrinsic factors (e.g., culture, prior experience, social/situational context) are proposed to affect the appraisal process. The model holds that when athletes with injury appraise physiological sensations as pain due to their injury, their responses (e.g., reducing physical activity, seeking assistance, implementing a coping strategy) are subject to the influence of factors such as culture and motivation. Although the model is of potential utility in understanding pain after the occurrence of sport injury, research support for the model is scant.

One particular behavioral response to sport injury-adherence to sport injury rehabilitation-has been examined from a variety of theoretical perspectives. Because adherence to medical regimens has been a widely studied topic for many decades (Meichenbaum & Turk, ), investigators of adherence to sport injury rehabilitation have had numerous theories and models of adherence available to guide their research. Among the perspectives that have been applied in studies of sport injury rehabilitation are, in addition to the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., ), personal investment theory (Maehr & Braskamp, ), protection motivation theory (Prentice-Dunn & Rogers, ), self-determination theory (Ryan & Deci, ), the transtheoretical model (Prochaska & DiClemente, ), and an adaptation of the theory of planned behavior (Levy, Polman, & Clough, ). In general, the perspectives have strong cognitive and motivational components, which is not surprising given the effort and persistence that adherence to sport injury rehabilitation programs can require.

Although psychological readiness to return to sport is a concept that is still being defined, it has not been completely atheoretical. In particular, it has been suggested that self-determination theory (SDT; Ryan & Deci, ) offers a viable explanation for why athletes might or might not be psychologically ready to return to sport after injury. Podlog and his colleagues (e.g., Podlog & Eklund, , ; Podlog, Lochbaum, & Stevens, ) have provided empirical support for the contention that, consistent with SDT, athletes can be considered less psychologically ready to return to sport when their basic psychological needs for competence, relatedness, and autonomy are not being satisfied than when those needs are being met.

Empirical Perspectives

Although the first empirical study on psychological responses to sport injury was conducted by Little () more than a half-century ago, it wasn't until the 1990s that a steady stream of empirical investigations began to appear in the literature. Over the past quarter-century, a sizable body of research on the topic has accumulated. The primary foci of scientific studies have varied over time, but pain, cognition, emotion, behavior, and readiness to return to sport have all been examined by investigators.

Pain

Pain is ubiquitous in sport. It not only can signal the occurrence of sport injury and feature in its aftermath, but it also can be a central aspect of sport training and competition. Reflecting the prominent role of pain in sport, scholars have investigated multiple aspects of the phenomenon in the context of sport. Research has progressed along four main lines of inquiry. One line of research has examined pain from a sociological perspective, yielding the important finding that sport is a culture in which athletes can be reinforced (or even glorified) for ignoring, denying, and playing through pain and injury (e.g., Hughes & Coakley, ; Nixon, ). Pain, therefore, appears to be a socially charged psychological response to sport injury that athletes may be discouraged from expressing, even to those responsible for treating the conditions that precipitated it (Safai, ; Walk, ).

A second line of research has compared athletes and nonathletes on laboratory measures of pain tolerance and pain threshold. Results of a meta-analysis of 15 studies indicated that (1) athletes had higher pain tolerance than nonathletes for cold, electrical, heat, ischemic, and pressure stimul; and (2) athletes had higher pain threshold than nonathletes for cold and pressure stimuli (Tesarz, Schuster, Hartmann, Gerhardt, & Eidt, ). The relevance of these findings for pain in response to sport injury, however, is not clear.

Cognition

As noted in the general section on theoretical perspectives, the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., ) and earlier models emanating from the Lazarus and Folkman () approach to stress and coping (e.g., Gordon, ; Weiss & Troxel, ) ascribe a temporally primary role to cognitive appraisals of the impact or personal relevance of sport injury in determining the cognitive, emotional, and behavioral responses that follow. In light of the physical damage induced by injury and the ramifications of that damage for subsequent sport participation, it is not surprising that interpretations of sport injury as threatening or involving harm or loss are common (Clement & Arvinen-Barrow, ; Ford & Gordon, ; Gould, Udry, Bridges, & Beck, ). Cognitive responses beyond the primary appraisals of the injury can be grouped into three potentially overlapping categories of cognitive content (i.e., injury-related, self-related, and coping-related) and one general category of cognitive processes.

Injury-related content

Given that sport injury is the kind of event that elicits the psychological responses addressed in this article, it is logical to expect the cognitive content of athletes with injuries to reflect their experiences and pertain at least partially to the injuries themselves. The unexpected nature of sport injuries may prompt athletes to engage in attributional thinking (Wong & Weiner, ) in which they attempt to identify the cause (or causes) of their injuries. A trio of studies identified behavioral factors (San José, ; Tedder & Biddle, ) and mechanical/technical factors (Brewer, ) as common explanations given by athletes for injury occurrence. In addition to cognitions about the causes(s) of their injuries, athletes have reported experiencing recurrent, distress-producing, recurrent, intrusive thoughts and images of the injury event (Newcomer & Perna, ; Shuer & Dietrich, ; Vergeer, ). Later, after the immediate impact of injury has passed, athletes have shown a propensity for experiencing more positively tinged cognitive content, reporting perceptions of benefits they have accrued as a result of their injuries (e.g., Ford & Gordon, ; Podlog & Eklund, ; Tracey, ; Udry, Gould, Bridges, & Beck, ; Wadey, Evans, Evans, & Mitchell, ). Common themes of the injury-related benefits identified by athletes include personal growth, psychologically based performance enhancement, and physical/technical development (Udry et al., ). After experiencing injury, athletes may also harbor negative cognitive content about their prospects with respect to future injury, reporting less confidence in their ability to avoid injury and higher levels of perceived risk of injury and worry about sustaining an injury than athletes without a recent injury (Reuter & Short, ; Short, Reuter, Brandt, Short, & Kontos, ).

Self-related content

For many athletes, injury threatens their involvement in a self-defining activity that serves as a significant source of self-worth (Brewer, Van Raalte, & Linder, ). Consequently, it is reasonable to expect that injury might have an impact on self-related cognitive content. Consistent with this notion, athletes have reported decreases in self-esteem after injury (Leddy, Lambert, & Ogles, ), increases in self-confidence and self-efficacy over the course of rehabilitation (Quinn & Fallon, ; Thomeé et al., ), and decreases in self-identification with the athlete role (Brewer, Cornelius, Stephan, & Van Raalte, ). Substantial changes in self-definition, which reflects how athletes think about themselves, have been reported by athletes with severe injuries (Vergeer, ).

Coping-related content

In taking an active role to deal with the adverse physical and psychological effects of injury, athletes have reported that they sometimes initiate cognitive coping strategies. Among the common themes of the cognitive content used by athletes to cope with injury are acceptance of injury, disengagement from injury, imagery, positive thoughts, and recovery (Bianco, Malo, & Orlick, ; Carson & Polman, , ; Gould, Udry, Bridges, & Beck, ; Ruddock-Hudson, O'Halloran, & Murphy, ; Tracey, ; Udry et al., ). It appears that the cognitive strategies deployed by athletes are at least in part influenced by the specific qualities of the injury-related stressors (e.g., physical symptoms, rehabilitation requirements) with which they are dealing, as the use of various coping strategies fluctuates over the course of rehabilitation (Johnston & Carroll, ; Udry, ) and differs as a function of whether athletes have chronic or acute injuries (Wasley & Lox, ).

Processes

The literature suggests that, in addition to affecting cognitive content, sport injury has an adverse effect on cognitive processes such as attention, memory, processing speed, and reaction time (Moser, ). Postinjury impairment of cognitive functioning has also been found for musculoskeletal injuries in one study (Hutchison, Comper, Mainwaring, & Richards, ), but not in another (Mrazik, Brooks, Jubinville, Meeuwisse, & Emery, ). Presumably, the intrusive images of injury occurrence (Shuer & Dietrich, ; Vergeer, ) noted in the section on injury-related content occupy some of the cognitive resources that would otherwise be devoted to processing other information and, along with postinjury emotional disturbance, may partially explain how musculoskeletal injuries might produce impaired cognitive functioning.

Emotion

The largest share of research on the psychological consequences of sport injury has been devoted to emotional responses. Findings from an abundance of qualitative and quantitative studies have converged to produce a rich description of how athletes respond emotionally to injury and identify a variety of personal, situational, cognitive, and behavioral factors associated with those responses.

Behavior

The behavioral response to sport injury that has garnered the most attention from investigators is adherence to rehabilitation. Considered vital to the success of sport injury rehabilitation programs (Fisher, Domm, & Wuest, ), adherence in this context refers to the extent to which athletes follow the prescribed course of treatment. The specific behaviors involved in adhering to rehabilitation vary substantially across the range of injuries that athletes incur, but some of the more common behavioral requirements of sport injury rehabilitation programs include "attending and actively participating in clinic-based rehabilitation appointments, avoiding potentially harmful activities, wearing therapeutic devices (e.g., orthotics), consuming medications appropriately, and completing home rehabilitation activities (e.g., exercises, therapeutic modalities)" (Brewer, , pp. 39-40). Although athletes engage in some of the rehabilitation behaviors in supervised clinical settings, they complete other of the behaviors at home, away from the direct oversight of rehabilitation professionals. The considerable variation in average adherence levels reported in research investigations (ranging from 40 to 91%, as reported in a review of the literature [Brewer, ]) is not surprising in light of the vast array of injuries, rehabilitation programs, clinical settings, and methods of assessment (e.g., self-report, practitioner rating, attendance log) that have been examined. Further complicating the estimation of adherence in the context of sport injury rehabilitation is that some highly motivated athletes may "overadhere" to their rehabilitation program by engaging in rehabilitation activities to a greater extent than recommended by the sports health care professional treating them (Niven, ; Podlog, Gao et al., ). Although such behavior is technically nonadherent, it is fundamentally different from failing to complete one or more aspects of a rehabilitation program.

Psychological Readiness to Return to Sport

The lack of a universally accepted definition of psychological readiness to return to sport after injury has not prevented researchers from investigating the topic through two main approaches. One approach involves comparing athletes who return to sport after injury with those who do not return to sport after injury on psychological variables measured during or after rehabilitation. The other approach involves asking athletes who have returned to sport after injury to describe their experience of returning. Reviews of research in which the two approaches have been implemented have yielded a consistent set of psychological factors associated with athletes' return to sport after injury (Ardern, Taylor, Feller, & Webster, ; Czuppon, Racette, Klein, & Harris-Hayes, ; Podlog & Eklund, ). Specifically, the empirical findings of prospective and retrospective studies have dovetailed, suggesting that factors involved in psychological readiness to return to sport after injury include a lack of fear or anxiety regarding reinjury, confidence in the injured body part and in one's ability to perform, and intrinsic motivation to return to sport.

The consequences of an absence of psychological readiness to return to sport are not fully understood. Beyond being less likely to return to sport in the first place, athletes who are not psychologically ready to return to sport but do so anyway may be at increased risk for such consequences as injury (or reinjury), poor sport performance, and a lower quality sport experience. Prospective longitudinal research is needed to investigate these possibilities.

Practical Perspectives

From an applied standpoint, numerous interventions have been implemented to affect athletes' psychological responses to sport injury. Common treatment approaches for pain differ somewhat from those for problematic cognitive, emotional, and behavioral responses, and treatments designed to enhance psychological readiness to return to sport have not been evaluated explicitly. Consequently, interventions to treat pain and improve psychological readiness to return to sport are discussed separately from the other three main types of psychological response and from each other.

Cognitive, Emotional, and Behavioral Responses

Psychological Readiness to Return to Sport

As an emerging construct, psychological readiness to return to sport after injury has received minimal attention from researchers attempting to evaluate the effectiveness of interventions designed explicitly to foster psychological readiness in athletes resuming sport participation after injury. Nevertheless, interventions that have produced increases in confidence (e.g., Maddison et al., ) and decreases in anxiety (e.g., Cupal & Brewer, ; Ross & Berger, ), for example, may have enhanced the readiness of the athletes receiving the interventions to return to sport with or without the intention of actually doing so. As a fuller understanding of the composition of what it means to be psychologically ready to return to sport emerges, inquiry into the effects of interventions developed to enhance readiness is likely to ensue.

Conclusions

Sport injury can affect athletes both physically and psychologically. Pain, cognition, emotion, and behavior are primary areas of psychological functioning affected by injury. Psychological responses to sport injury tend to be strongest in close temporal proximity to injury occurrence and fluctuate over the course of rehabilitation. Psychological readiness to return to sport after injury is an emerging concept that incorporates aspects of cognition, emotion, and behavior, including anxiety, confidence, motivation, and postreturn expectations. A variety of theoretical perspectives have been used to guide a body of research on psychological responses to sport injury. Relatively few controlled investigations of interventions designed to influence psychological responses to sport injury have been conducted.

References

Brewer, B. W. (1999b). Adherence to sport injury rehabilitation regimens. In S. J. Bull (Ed.), Adherence issues in sport and exercise (pp. 145-168). Chichester, U.K.: Wiley.Find this resource:

Brewer, B. W. (2004). Psychological aspects of rehabilitation. In G. S. Kolt & M. B. Andersen (Eds.), Psychology in the physical and manual therapies (pp. 39-53). Edinburgh: Churchill Livingstone.Find this resource:

Brewer, B. W. (2007). Psychology of sport injury rehabilitation. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology (3d ed., pp. 404-424). New York: Wiley.Find this resource:

Clement, D., & Arvinen-Barrow, M. (2013, October). Psychosocial responses during different phase of sport injury rehabilitation: A qualitative study. Paper presented at the annual meeting of the Association for Applied Psychology, New Orleans, LA.Find this resource:

Garnham, A. (2007). Pharmacological agents in sport and exercise. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 541-557). Edinburgh: Churchill Livingstone.Find this resource:

Gordon, S. (1986, March). Sport psychology and the injured athlete: A cognitive-behavioral approach to injury response and injury rehabilitation. Science Periodical on Research and Technology in Sport, 1-10.Find this resource:

Kolt, G. S. (2004). Pain and its management. In G. S. Kolt & M. B. Andersen (Eds.), Psychology in the physical and manual therapies (pp. 141-161). Edinburgh: Churchill Livingstone.Find this resource:

Kolt, G. S. (2007). Pain. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 133-148). Edinburgh: Churchill Livingstone.Find this resource:

Kübler-Ross, E. (1969). On death and dying. New York: Macmillan.Find this resource:

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. NewYork: Springer.Find this resource:

Leventhal, H., & Everhart, D. (1979). Emotion, pain, and physical illness. In C. E. Izard (Ed.), Emotions in personality and psychopathology (pp. 263-299). New York: Plenum.Find this resource:

Maehr, M., & Braskamp, L. (1986). The motivation factor: A theory of personal investment. Lexington, MA: Lexington Books.Find this resource:

Meichenbaum, D., & Turk, D. C. (1987). Facilitating treatment adherence. New York: Plenum.Find this resource:

National Collegiate Athletic Association. (2012). National study of substance abuse trends among NCAA college student-athletes. Retrieved from http://ncaapublications.com/p-4266-research-substance-use-national-study-of-substance-use-trends-among-ncaa-college-student-athletes.aspx.

Prentice, W. E. (2011). Principles of athletic training: A competency-based approach (14th ed.). New York: McGraw-Hill.Find this resource:

Rotella, B. (1985). The psychological care of the injured athlete. In L. K. Bunker, R. J. Rotella, & A. S. Reilly (Eds.), Sport psychology: Psychological considerations in maximizing sport performance (pp. 273-287). Ann Arbor, MI: Mouvement.Find this resource:

Snyder-Mackler, L., Schmitt, L. A., Rudolph, K., & Farquhar, S. (2007). Electrophysical agents in sport and exercise injury management. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 220-235). Edinburgh: Churchill Livingstone.Find this resource:

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Psychological Responses to Sport Injury - Oxford Research Encyclopedia of Psychology

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In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes. Consistent with contemporary models of psychological response to sport injury, aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, and behavior.

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CITATION:
Ahern, Lohr  DK. PSYCHOLOGICAL ISSUES RELATED TO INJURY IN ATHLETES AND THE TEAM PHYSICIAN

SUMMARY:
This document is a concensence statement written by sportsmedicine.org which is a collaboration of professionals in the field of sports medicine addressing the protocol for injured athletes as it relates to the psychological impact of an injury. It is a guide that suggests the effects of physical injury on the psyche of the athlete and what to know.  It is intended for the coaches and the support staff.

ANALYSIS:
This source is somewhat alike to the first one where it shows how athletes may feel during the rehabilitation process.  Although it is intended for the coaching staff, it is noticed by all areas of athletics, as well as people like me trying to understand the topic better.  This helps me distinguish the difference between the physical and psychological halves of rehab.  I believe this source is one of my top sources due to the layout of the paper.  It is set up to where each topic has its own section and it is very noticeable to the reader.

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CITATION:
Britt, Darice. “Physical Therapy Crucial to Sports Injury Recovery.” Pros and Cons of Being an Entrepreneur, source.southuniversity.edu/physical-therapy-crucial-to-sports-injury-recovery-59068.aspx.

SUMMARY:
This source was and article that showed how physical training could be fatal or crucial to recovering from a sports related injury.  In the text, Britt describes most of the common injuries due to athletics and explains what each of them are.  After that, she goes through a treatment portion along with what the treatment consists of.  The prevention paragraphs at the end of the source showed how to stop an athlete from either receiving one of the many explained injuries or to prevent them from reoccurring.

ANALYSIS:
Darice Britt’s descriptions of these sports injuries was very helpful for the task at hand because it put some understanding in my head of how many possible injuries are out there.  It helped me expand the topic by giving me another pathway of conversation besides the basic mental and physical effects.  Sure, it talks about the effects but at the same time it shows how each of those effects are brought up through injuries.  I enjoyed reading through her thought process although, the way the website was not very appealing, it was a very narrow column that I had to keep transferring my eyes from line to line.

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Sports injuries have sidelined many athletes for games, seasons, and worse, careers.

Injuries are common while participating in organized sports, competitions, training exercises, or fitness activities.

Poor training methods, inadequate warm-up, and lack of conditioning are a few of the causes of sports injuries.

"Injuries can be caused by a combination of those things without necessarily being the only reasons," says Apostolos Theophilou, DPT, clinical coordinator of the Physical Therapist Assisting program at South University. "Fatigue and overuse are also significant contributors to an injury, and not excluding also the psychosocial aspects and dehydration that cause athletes to be prone to injuries."

Coping with sports injuries often requires physical rehabilitation. Physical therapy helps people rebuild strength and movement in parts of their body after an injury. Therapy can also help someone manage pain and prevent permanent damage and recurring problems.

Each sport carries its own risk of injury for the athlete.

Physical therapists are trained to help patients recover following an injury. As part of physical therapy, they can teach exercises, stretches, and techniques using specialized equipment to address problems.

"Physical therapists will examine a patient to determine if there are weak or inflexible muscles in the body that could make you more prone to an injury," says physical therapist and athletic trainer Dr. Trent D. Stone, who is the director of rehabilitation at Effingham Spine & Sport in Rincon, Georgia.

Common Sports Injuries

According to the National Institutes of Health, the most common sports injuries include sprains, strains, knee injuries, swollen muscles, shin splints, fractures, and dislocations.

"Athletes participate in a wide spectrum of sports," Theophilou says. "Each sport carries its own risk of injury for the athlete."

These injuries should be appropriately addressed in order to keep the athlete safe. It is useful to examine the biomechanics of an athlete participating in a particular sport, therapists say.

"This is actually very useful for repetitive-motion athletes like golfers, baseball's pitchers, and tennis players," Theophilou says. "These are different sports, although they share similar biomechanical concepts. During their games, these athletes have to constantly go through the same motion, putting the same body structures through the same stress.

"This motion often involves some sort of a loading or pre-swing phase, some sort of swing phase or throwing phase, and finally the 'follow-through' phase."

It is common for these athletes to develop similar injuries such as lateral epicondylitis (tennis elbow), inflammation or pain on the outside of the upper arm near the elbow; medial epicondylitis (golfer's elbow), inflammation or pain on the inner side of the upper arm near the elbow; or "Tommy John" injury for pitchers, which is an injury to the ulnar collateral ligament of the elbow.

The biomechanics of these players need to be very precise during the game to avoid an excessive load of forces distributed to the wrong or same anatomical structure, Theophilou says. For example, pitchers will focus too much on a particular anatomical part, such as the elbow, and neglect to appropriately use their legs. Thus the elbow now has to deal with over-excessive forces. In addition, athletes may neglect or struggle with a particular phase of their motion and expose a specific anatomic structure more.

Sports Injuries and Treatment

Physical therapists need to understand the involved and injured structure and the extent of the injury before treating it.

Rehabilitation of an injured athlete should carefully be evaluated on a daily basis. Injuries are time dependent, which means that the normal healing process follows a pattern of acute phase, subacute phase, and chronic phase.

"Each phase dictates a different treatment approach and it is the physical therapist's responsibility to accurately diagnose which phase and what treatment the patient should receive," Theophilou says.

The acute phase involves the R.I.C.E. (Rest-Ice-Compression-Elevation) principle, which allows for healing to take place and controls inflammation.

"Recently, the letter 'P' was added to this acronym, 'PRICE,'" Dr. Stone says. "The 'P' stands for protection and the 'RICE' principle has been around for quite some time now, but major advancements have been made recently in the area of prevention."

The subacute phase also is a control motion phase, however the athlete may carefully perform active-assisted range of motion exercises and strengthening exercises. And the chronic phase is a return to function phase in which the athlete progressively returns to pre-injury workout routines.

"Through the years, therapists have been successfully able to log the 'steps' for each phase, thus now we have collective treatment protocols that have a complete analysis of what activities and treatments the athlete should be receiving based on his current phase," Theophilou says.

In addition to injuries to muscles, joints, and bones, concussions are a hot topic in sports today. A concussion is a traumatic brain injury that may result in bad headaches, an altered level of alertness, or unconsciousness. It may result when the head hits an object or a moving object strikes the head. Athletes in all sports are at risk of a sports-related concussion, but the most at risk are athletes who participate in football, boxing, hockey, rugby, and snow skiing.

Concussions are one of the most difficult-to-manage injuries in sports today. Dr. Stone says physical therapists are an integral part in the multidisciplinary approach to the identification and treatment of these injuries.

"Being able to understand the signs and symptoms of a concussion, as well as a multitude of other diagnoses, can be vital to a physical therapist as a patient is able to access our services without requiring a referral from a physician," he says. "This is called Direct Access. The physical therapy in this case would be the first line of defense for the patient and can provide the patient with a home exercise program to perform, as well as instruct the patient on things to avoid such as removal from play/activity, decreased workload, limited reading, decreased video game playing, and decreased outside activities that would increase stimulation to the brain."

Prevention of Sports Injuries

Dr. Stone says athletes can prevent some sports injuries with proper warm-up and stretching.

"Seeing a physical therapist prior to an injury becoming very severe can be beneficial as we can examine the patient and find areas that would need to be addressed," he adds.

Physicians, athletic trainers, and physical therapists continue to gain more knowledge in preventing and diagnosing sports injuries. Although some procedures would remain the standards of care, the means to address the injuries could change.

Author: Darice Britt

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Physical Therapy Crucial to Sports Injury Recovery

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Sports injuries have sidelined many athletes for games, seasons, and worse, careers. Injuries are common while participating in organized sports, competitions, training exercises, or fitness activities. Poor training methods, inadequate warm-up, and lack of conditioning are a few of the causes of sports injuries.

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CITATION:
Zakrajsek, R A, S B Martin, and C A Wrisberg. "National Collegiate Athletic Association Division I Certified Athletic Trainers' Perceptions of the Benefits of Sport Psychology Services." Current Neurology and Neuroscience Reports. U.S. National Library of Medicine, May 2016. Web. 27 Nov. 2018.

SUMMARY:
This is an abstract study and its results regarding the willingness of Athletic Trainer to recommend the use of SPCs,  Sports Psychology Consultants, during rehabilitation process from a sports injury.  Basically in this article, results from a survey of Division 1 Athletic Trainers was shown and given back were results on what measures should be taken to improve the way the rehabilitation process should be handled.  Along with the survey, a conclusion was included that described how many people contributed and how much of the survey was valid.

ANALYSIS
This source was very useful although it was out of my league, knowledge wise.  This is why it was very helpful though, it showed me how much more there was to the physical state of an injury.  It also demonstrated how many other people have the same concerns as me or else they wouldn’t have held this survey.  Whenever I come upon a source that has the same passion and topic interest as me, I seem to read further into it and gain more knowledge out of it.  Especially those that are above my knowledge level, they really show me the amount I am not aware of.

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National Collegiate Athletic Association Division I Certified Athletic Trainers' Perceptions of the Benefits of Sport Psychology Services. - PubMed - NCBI