John C. Richmond, MD
• Medical Director for Network Development at New
England Baptist Hospital
• Vice President of the Arthroscopy Association of
North America
• Team Physician for Merrimack College
This piece is adapted from a previous webinar
featuring Best Doctors Expert…

According to the Center
for Disease Control, more
than half of all sports
injuries in children are
preventable.
The American Academy of Orthopaedic Surgeons http://www.sportsmed.org/uploadedFiles/Content/Media/News_Room/Sports%20Media%20Guide%202011%20Final.pdf

Most organized
sports-related injuries
(62%) occur during
practice.
National SAFE KIDS Campaign and the American Academy of Pediatrics via Johns Hopkins Medicine website.
http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/sports_injury_statistics_90,P02787/

Overuse injuries are
responsible for nearly ½ of
all sports injuries to middle
and high school students.3
Safe Kids USA Campaign Web site. 2009. Via http://www.stopsportsinjuries.org/media/statistics.aspx

Sports medicine was not
developed until the 1960’s.

Sports medicine was not
developed until the 1960’s.
It began with orthopedic surgeons who were
treating collegiate athletes, and subsequently
evolved during the 1970’s and 1980’s.

Sports medicine physicians
concentrate on…
ligaments
cartilage
tendons
muscles

The primary principle restore
the athlete to function…

The primary principle restore
the athlete to function…
so the athlete can get back in
the game, and do so safely.

You can’t prevent sports injuries, but
you can certainly reduce the risk.
The most common injuries really depend on the
sport and to some extent the athlete participating
in them.
Age, exercise history, and prior injury are all
predisposing factors to injury.

&
The most common overuse injuries.
Both are readily decreased by
• proper warm-up
• flexibility programs
• strengthening programs

Additional Ways In Which To Reduce
The Risk Of Having An Overuse Injury
 Gradually increasing mileage
 Using proper footwear
 Cross-training
Cycling
Elliptical machines
Swimming
Rowing

What are the most common problems
associated with overuse injuries?

Overuse injury occurs when your
exercise intensity exceeds your
body’s ability to repair itself.

EXERCISE
+ STRESS ON YOUR BODY

EXERCISE
+ STRESS ON YOUR BODY
micro-injuries

Not listening to your body is the
most common way to lead to an
overuse injury.

Take stress fractures, for instance, which
commonly occur in…
• the legs of runners
• the rib cages of oarsman
• and the spines of gymnasts

They are caused from ignoring pain
and trying to push through it.
The old coach’s moniker of
“No pain, no gain”
is at fault.

Stress fractures do not occur in nature, meaning the rest of
the animal kingdom does not experience stress fractures.
Race horses are the only exception, because they have
been trained to push through the signs of pain.

If a pain persists longer than a few days,
it’s time to recover.
Recovery periods will allow your body
to heal and prevent any pain from
accumulating and developing into a
problematic injury.

Listen to your body!

It is very possible to
cross-train with an injury.
If you have an injury that has required you to
seek medical care, cross-training to maintain
your cardio fitness should be done with
some guidance.

THE BEST GUIDANCE
Make sure you are fully healed
before getting back out there.

Before returning to your sport…
 Make sure the injury is fully healed
 Make sure it is completely rehabilitated
 Make sure it is pain-free
 Make sure that you have regained all flexibility
 Make sure there is no leftover stiffness
Once all of those criteria have been met, design a program
that is able to get your strength back without overloading it.

Advanced imaging techniques,
such as MRIs, can provide
valuable information, but they
are quite expensive and are not
necessarily the first approach to
reaching a diagnosis.

A well done history and physical
examination will oftentimes define
the extent of the injury and whether
there is anything seriously wrong
that might warrant an MRI scan.

Remember…
If there is not a significant traumatic injury, an MRI is usually
not the first test you need. The first test might be an X-ray to
make sure there is not an arthritic joint.
Many orthopedic surgeons are happy to work with primary
care doctors, especially if the primary care physician is unable
to determine the cause of the pain.
An appointment with an orthopedic surgeon is much less
expensive than an MRI scan.

The biggest risks today are found in cutting or
pivoting sports especially is female athletes.
There’s good data that shows women are 2-4 more
times likely to tear an ACL if they’re playing soccer
or basketball or participating in downhill skiing.
Part of the reason is that men and women have
different muscle firing patterns, which means they
use their muscles differently when they cut and turn.

A number of places have identified those
causes and have come up with ways to
reduce the risk of ACL injury in the athlete.

The Vermont Ski Safety Program has a video and
teaching program to reduce the risk of ACL injuries in
skiers.
The Santa Monica Sports Medicine Foundation
(SMSMF) is a great educational resource. SMSMF is a
not-for-profit run by an orthopedic surgeon with a high
interest in soccer. The foundation has a 15-minute
warm-up program you can download from their website
and distribute to your local teams. The program helps
to significantly reduce the risk of ACL tears in cutting
and pivoting sports, particularly for women.

If you are a cross country runner, you expose yourself to other risks, but
are not as likely to tear your ACL as you would if you were involved with
sports that involve cutting or pivoting.
There are ways to reduce that risk by investing time in prevention
strategies like proper strength and conditioning, proprioception
(the conscious and unconscious sense of self and the body’s position),
and a muscle training program.

Consult with your treating physician.
You don’t want to try to treat an injury non-
operatively and then miss a window after which
surgery will no longer help restore you to full
function.
Having said this, a vast majority of injuries
will heal without surgery.

“Will it lead to permanent loss
of function if I don’t have it
operated on?”
If the answer is “no,” then certainly
you can invest in physical therapy.