Wednesday, August 17, 2016

Practical Tips for Injury Prevention in Fall Sports

By: Michael Ellerbusch, MD with Southlake Orthopaedics Sports Medicine & Spine Center, PC

Fall is not only a time of beautifully changing colors in the trees and the return to school, but it is also a very busy season for various types of sporting activities. Perhaps the most well-known of these sports in the South is football; however, there are many other activities going on including, volleyball, cheerleading, soccer, cross country, and even baseball, softball, and other year-round sports. With all of these sports, there comes a variety of different types of injuries. Most studies will tell you that the highest number of youth related sporting injuries in the fall occur in football. According to the Consumer Product Safety Commission (CPSC) in 2013 in athletes ranging from ages 5-13:

• Approximately 881,700 football-related injuries

• Nearly 434,000 were treated for soccer injuries

• 99,884 were treated for cheerleading-related injuries

• More than 94,000 for volleyball related injuries

Below is a table from the CDC’s website from Kerr, et al, December 11, 2015, looking at various injury rates in popular collegiate sporting activities:

Competition and practice injury rates per 1,000 athlete-exposures and competition/practice rate ratios, by 25 championship sports — National Collegiate Athletic Association Injury Surveillance Program, United States, 5 academic years, 2009–10 through 2013–14

From the CDC table, one typically sees more injuries per exposure in competition, with football leading the way with the highest number of injuries per athletic exposure. These injuries can be broken down into traumatic and repetitive stress (overuse). Traumatic injuries occur due to an external force causing damage or injury to the affected tissue. Repetitive stress injuries occur when there is tissue damage that results from repetitive forces applied to the tissue over a period of time without adequate time for the tissue to recover or adapt. Many factors lead to this associated tissue injury from repetitive stress including:

− a diminished blood flow and oxygen supply to the muscle associated with pain and spasm

− stress on tendons which may cause inflammation or scarring of the tendons

− nerve injury due to pressure or tension on the nerve, possibly leading to ischemic damage

− damage to bone due to repetitive pressure or tension on the bone

Different sporting activities are associated with different types of injuries. Although there certainly can be crossover, contact sports such as football are more associated with traumatic injuries; while non-contact sports, such as cross country and volleyball, typically result in repetitive stress injuries. For these reasons, as with most clinical interactions, it is very important to obtain a thorough history including the possible mechanism of injury and sports played in making an accurate diagnosis. The history and physical examination may lead to various types of diagnostic procedures if needed: including x-rays, CT scans, MRIs and other testing modalities. Once an accurate diagnosis has been made, a proper treatment program including likely activity restrictions/modifications may be necessary.

Now, all of this information is very important after the injury has occurred, but what if we can take steps to prevent the injury from taking place altogether? Although not all injuries can be prevented, we may be able to reduce the incidence of some of these injuries with the 10 steps listed below. These are found on the American Academy of Orthopaedic Surgeons’ Website:


1. Have a pre-season physical examination and follow your doctor’s recommendations.

2. Warm-up and cool down properly with low-impact exercises like walking or cycling.

3. Consistently incorporate strength training and stretching. A good stretch involves not going beyond the point of resistance and should be held for 10-12 seconds.

4. Hydrate adequately to maintain health and minimize muscle cramps. Waiting until you are thirsty is often too late to hydrate properly.

5. Keep an eye out for unsafe play surfaces. Playing grounds should be in good condition.

6. Don’t play through the pain. Speak with an orthopaedic sports medicine specialist or athletic trainer if you have any concerns about injuries.

7. When participating, wear protective gear such as properly fitted cleats, pads, helmets, mouth guard or other necessary equipment for the selected sport.

8. Play multiple positions and/or sports during the off-season to minimize overuse injuries.

9. Pay attention to weather conditions such as wet, slippery fields that can lead to injuries.

10. Avoid the pressure to over train. Listen to your body and decrease training time and intensity, if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out.”

Some experts recommend a dynamic stretching program before activities and reserving static stretching, as listed above, following activities while the muscles are warm. In addition, the importance of the playing conditions cannot be stressed enough to help in the prevention of often devastating injuries. For those who watch the NFL, this was exhibited in the NFL Hall of Fame Game on August 7, 2016, between the Packers and the Colts when portions of the painted surface became hard and slick leading to the cancellation of the game just minutes before kickoff. On this same field in the 2015 Hall of Fame Game, the Pittsburg Steelers’ kicker, Shaun Suisham, sustained a season ending knee injury which he attributed to poor field conditions. These recommendations, along with a preseason conditioning program and proper fitting equipment and other tips as listed above, may be very helpful in the prevention of many on the field injuries. As physicians who treat athletes, we need not only to be well trained in how to treat injuries after they occur, but also to be able to relay information to the athletic trainers, parents, and athletes that may help them reduce the risk of injury before they occur so that they may have a more enjoyable sporting experience.

Michael Ellerbusch, MD Subspecialty Board in Sports Medicine Board Certified Physical Medicine and Rehabilitation Subspecialty Board in Neuromuscular Medicine Southlake Orthopaedics Sports Medicine & Spine Center, PC


  1. Thank you for sharing this. Sports injury happens often and these tips will be helpful. If injury is prevented, the game will go on smoothly.

  2. This takes discipline and sacrifice! Rest/sleep is the least planned and underutilized way to enhance performance and feel better. child injury prevention