Philly.com
Sports Doc
Posted: Tuesday, September 15th, 2015

It’s that time of year. Fall sports are in full swing. Hopefully you had a productive pre-season that prepared you for the fall. Here are some tips to keep players safe and injury free this fall.

Fitness: If you weren’t in shape going into pre-season, hopefully you survived it without any injuries. If you did sustain an injury in pre-season, make sure you address it now as it will only linger and will likely get worse during the season. Next summer, make sure you get in shape prior to pre-season in order to avoid the same problems.

Overuse Injuries: Stress fractures, shin splints, tendonitis, etc These all occur because of ramping up intensity too quickly. Two and three a day practices on hard fields or indoor courts after a summer off is a recipe for disaster for overuse injuries. If you sustained an injury during pre-season, you need to be evaluated by your athletic trainer as playing through it never works and almost always makes the injury worse and prolongs recovery.

Heat Illness: This is hot topic. The myth of hydrating is finally being dispelled. You should drink when you are thirsty and not be forced to drink excessive fluids. But, you also need to be allowed to drink freely and coaches cannot restrict fluid intake either. And sports drinks, they’re not really needed. Water is the best along with meals that include some salty food to replace the electrolytes lost during training. For players with cramping, sweat testing can be done to assess the cause and how to replace fluids and electrolytes appropriately. The Heat Institute at West Chester University is a local facility that can perform sweat testing with the appropriate replenishment recommendations.

Concussions: I don’t think we need to talk too much about concussions as we all know the significance of these injuries. Any concussion should be taken seriously and needs to be evaluated by your team’s athletic trainer and a physician who specializes in concussion evaluation and management. The current medical guidelines from the most recent consensus statement say “no return to play on the day of concussive injury should occur.” And the “athlete would take approximately 1 week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise.”  Please take concussions seriously as athletes can suffer lifelong post-concussive symptoms if not managed appropriately. 

Best of luck to all of the athletes and their teams this fall. Hopefully we only see you in the newspaper and not in the athletic training room or physician’s office.

Philly.com Sports Doc
Posted: Monday, April 28, 2014

Injury statistics

A 2007 study by Dick et al in the Journal of Athletic Training looked at injury rates for the women’s lacrosse using the NCAA injury surveillance system from 1988-2004.

The results show the game injury rate was twice the rate for practice (7.15 versus 3.30 injuries per 1000 athlete-exposures [A-Es]). Preseason practice injury rates were almost twice as high as regular-season practice rates. More than 60% of all game and practice injuries were to the lower extremity.

Approximately 22 percent of all game injuries and 12 percent of all practice injuries involved the head and neck. In games, ankle ligament sprains (22.6%), knee internal derangement (14.0%), concussions (9.8%), and upper leg muscle strains (7.2%) accounted for the majority of injuries.

In practices, ankle ligament sprains accounted for the largest proportion of all injuries (15.5%), followed by upper leg muscle strains (11.7%) and knee internal derangements (6.1%).

Participants had almost 5 times the risk of sustaining a concussion or a knee internal derangement during a game compared with practice and 3 times the risk of sustaining an ankle ligament sprain during a game. The greatest proportion of game injuries (44.3%) resulted from no direct contact. A total of 35.9 percent of game injuries were associated with other contact (primarily stick or ball) and 18.6 percent with player contact. The majority of practice injuries (62.0%) involved a non-contact mechanism. A total of 22 percent of game and 24 percent of practice injuries were severe enough to restrict participation for at least 10 days. In games, knee internal derangements accounted for almost half of all severe injuries, followed by ankle ligament sprains. Head injuries represented 7 percent of the severe game injuries. In practices, lower leg stress fractures, knee internal derangements, and ankle ligament sprains were the primary severe injuries.

Lower Extremity

Lower extremity injuries account for over 60 percent of all collegiate women’s lacrosse injuries. The majority of these injuries can be divided into the following diagnoses: ankle sprains, knee internal derangements, upper leg strains, and lower leg stress injuries.

Ankle sprains account for 22.6 percent of game and 15.5 percent of practice injuries. These are primarily lateral ankle sprains which are caused by the ankle rolling inward during cutting and pivoting. Most ankle sprains are minor and players can return quickly to practice and competition. These injuries should initially be evaluated by your team’s athletic trainer. Depending on the severity, players with minor injuries may return immediately with taping or bracing. More severe injuries may require time away from the sport and more substantial treatment including evaluation by a sports medicine physician and subsequent rehab. There may be a period of immobilization and limited weight bearing depending on the extent of the injury. Rehab involves regaining range of motion and flexibility, strength, and balance with a gradual progression to full sports activities.

Knee internal derangements account for 14 percent of game and 6.1 percent of practice injuries. The two most common diagnoses are ACL tears and meniscal tears. In women’s lacrosse, ACL injuries account for a great number of knee internal derangement due to the significantly higher rate of ACL injury in female athletes compared to males. Both meniscus tears and ACL tears are serious injuries and should be evaluated by a sports medicine physician. Although most of these injuries require surgery, there are some players who can finish the season. If an athlete is to finish the season with one of these injuries, she needs to undergo a structured rehabilitation program and meet specific objective goals before being cleared to return to sports.

Upper leg strains account for 7.2 percent of games; 11.7 percent of practice injuries. These injuries are primarily hamstring strains. Hamstring injuries can be difficult to treat and there is still debate on the best course of treatment. In my experience, the initial phase of treatment focuses on reducing pain and inflammation while regaining flexibility. The second phase involves regaining strength in the injured and initiating lower level sport specific activities. The final phase involves higher level sport specific activities and a structured return to sport progression.

6.5 percent of practice injuries involve lower extremity stress injuries. These can include stress reaction or exertional compartment syndrome, which combined are commonly called shin splints, as well as stress fractures. Lower extremity stress injuries are almost always due to repetitive overload stress. This can be caused by increased training loads in under conditioned athletes, overtraining, lower extremity biomechanical issues, or a combination of all three. The first treatment is to reduce the volume and/or intensity of training. At times, athletes need to be shut down depending on the severity of symptoms.

These injuries should be evaluated by both the athlete’s athletic trainer and a sports medicine physician to rule out more serious diagnoses such as a stress fracture. The athlete should also have a biomechanical analysis performed to help correct any underlying dysfunction that may be contributing to the problem such as over pronation or weak gluteus medius.

Concussions

Concussions are the 3rd most common game injury and 6th most common practice injury in collegiate women’s lacrosse. In this study, concussions resulted in 7 percent of all injuries requiring greater than 10 days of missed time. This correlates with concussion research showing that that most concussions resolve within that time frame. As we have learned from contact sports such as football and hockey, concussions are serious injuries and should be treated as such. An evaluation by a sports medicine clinician trained in concussion assessment should be performed in order to develop an appropriate treatment plan. This may include time away from the classroom as well as from the playing field.

Upper Extremity Injuries

Upper extremity injuries in women’s lacrosse account for less than 1 percent of all injuries and therefore were not tabulated in this study. This is likely due to the rules that prohibit checking in women’s lacrosse.

As you can see, ankle sprains and knee internal derangements (ACL tears and meniscus tears) are the two most common injuries followed by upper leg muscle-tendon strains (hamstrings) and concussions. Upper extremity injuries are uncommon in women’s lacrosse. Any injury should be evaluated by your athletic trainer to assess the severity of the injury and determine the appropriate plan of care.