Diagnosing and treating football injuries: High School vs. NFL

My Sundays, in the fall, are spent on the Eagles' sidelines leading the team of physicians that are charged with insuring the safety of the NFL players. What most people are not aware of is that on Fridays I am on the sidelines of high school football games in South Jersey. The injuries that I see at the professional level are not different from the ones I see for the high school athlete. Evaluating those injuries are a bit more challenging at the high school facilities.

Every stadium in the NFL has x-ray available and there are a few venues that have a MRI to aid in making a rapid diagnosis of a sports-related injury. After reviewing these studies, I feel more confident in making a decision whether or not it is safe for that athlete to return to play in that game. We do not have this diagnostic testing at high school fields.

I was covering Joe Flacco-led Audubon High School football game years ago and a "bullet" from Flacco's arm struck the finger of a receiver. The player came off the field holding his painful finger and unable the move the already swollen digit. If this occurred at Lincoln Financial Field, I would have sent the player in for an x-ray and if it was negative for a fracture I would allow the player to return if his motion returned and his pain decreased. Unfortunately, I did not have this luxury and I followed the adage, "When in doubt, keep them out." This particular high school athlete was not happy that I would not allow him to return to play but safety comes first.

Most orthopedic surgeons covering high school football games are the only physician on the sidelines. Even though most sports injuries are orthopedically related; concussions, shortness of breath and chest pain are often seen in these athletes. An orthopedic surgeon is qualified to evaluate these abnormalities but usually not without some anxiety. On the Eagles' sideline during home games we have a team of physicians:

The NFL, in addition, mandates that we have either an ER physician or an Anesthesiologist that can intubate a player that is not breathing (place a breathing tube into the trachea), and a Neurosurgeon to aid in concussion evaluation.

In the State of New Jersey it is not mandatory to have an ambulance and EMTs at every game. There was one game between Cherry Hill East High School and Cherokee High School where a player went down complaining of back pain and transient numbness in his legs. My index of suspicion for a serious spinal cord injury was low; but I was not going to accept the risk of moving this athlete. We had to keep the player from moving while we waited 45 minutes for an ambulance to arrive and properly transport him to a hospital. Individual schools will pay out of their own budget for ambulance and EMT coverage. A NFL game cannot begin unless the EMTs are present.

This came to be very critical in a recent Eagles/Chargers game. A San Diego Charger wideout injured his neck. He complained of neck pain, transient numbness into his upper and lower extremities and right arm weakness. With the help of the EMTs, we were able to properly immobilize the player and rapidly transport him to Thomas Jefferson University Hospital where he underwent diagnostic testing. Fortunately for the athlete there was no serious spinal cord injury and the player returned to the stadium in time to return to San Diego with his team.

The sports medicine physician covering a football game is asked to rapidly evaluate an injury, sometimes without proper diagnostic testing, and make a decision whether it is safe for that athlete to return to play. This decision making process is easier in the NFL and is extremely challenging in high school. Financially, it may not be possible to have x-ray capabilities at high school facilities. However, I would like to see at least one orthopedic surgeon and one family practitioner/internal medicine physician at every high school game. In addition, it should be mandated by the State of New Jersey that an ambulance with certified EMTs be present at every game. Playing football has come under much criticism lately and safety of the athlete should be the primary goal.

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