Tuesday, July 28, 2015

Scholastic sports injuries: Track & field

In the last of this series for spring sports, Justin looks at each event and the common injuries to befall its competitors.

Scholastic sports injuries: Track & field


Common injuries in scholastic spring sports: Track and field

Unlike other collegiate sports, there have been no studies published on track and field injuries using the NCAA injury surveillance system. Therefore, we will look at the few studies that analyze injury prevalence in track and field.

A 2005 article published by Zemper in the journal Medicine and Sports Science suggested that 70-80 percent of all track and field injuries are the result of running events. 75 percent of all injuries are to the lower extremity and the overwhelming majority of injuries occur during practice. A 2011 article by Jacobsson et al in the American Journal of Sports Medicine showed a strong dominance of overuse-related conditions such as tendinopathies and stress fractures in track and field athletes.

These overuse injuries account from 60-90 percent of injuries in various published papers. An article by Alonso et al in 2012’s British Journal of Sports Medicine looked at track and field injuries during the period of the Daegu 2011 IAAF World Championships. Sprint events accounted for 27.7% of all injuries followed by long distance at 17.3%, and jump events at 14.1%.

Let’s look at the some of the different events and the injuries that go along with them.

Sprints and Relays

The most common injury in sprint events is muscle strain, specifically hamstring strain. The mechanism of hamstring injuries is still being debated.  These include neuromuscular inhibition, eccentric overload, over-striding, and decreased muscular endurance to name a few. To simplify hamstring injuries, these can be broken down into acute and chronic injuries.

Acute hamstring injuries are the result of a distinct injury such as a sprinter pulling out of a race. These usually involved a tear of the hamstring muscle. These can be minor or more serve where bruising, swelling, and a defect are noted. Hamstring injuries can result in significant time away from training and competition, and early return frequently results in re-injury. Treatment involves management of pain in the acute phase of injury followed by rehabilitation to regain ROM, strength, and eccentric control prior to initiating a running program.

Chronic hamstring pain can be due to a variety of underlying causes. These include incomplete rehabilitation from a previous hamstring injury, overuse injury, and referred pain from other areas such as the lumbar spine. A thorough evaluation from an athletic trainer or physical therapist is needed to determine the underlying cause and to develop an appropriate rehab program.

Middle Distance

Middle distance injuries are a combination of sprint injuries and distance injuries. The event distance and the training methods will dictate which type of injury is more likely to occur. As with any injury, the athlete should be evaluated by the team’s athletic trainer in order to develop an appropriate rehab program.

Long distance

Unlike sprints, long distance injuries are primarily overuse and repetitive stress injuries. These include sprains, strains, and tendinopathies as well as stress fractures, shin splints, and exertional compartment syndrome. Treatment should not only focus on resolving the symptoms but also include a thorough biomechanical evaluation to correct the underlying cause. This should include assessment of footwear, lower extremity alignment, and lower extremity flexibility and strength. This may also include modification of the athletes training program with decreases in frequency, intensity, and/or duration.

Hurdles and Steeple Chase

Hurdles and steeple chase have injuries similar to the above running events but also include more traumatic injuries. With hurdles, injuries can occur from hitting the hurdle or from catching a hurdle resulting in a fall or awkward landing. Steeple chase injuries can occur from stepping onto the obstacle, not clearing the obstacle, or landing from/over the obstacle.

Traumatic injuries can include contusions, ligament sprains, knee internal derangements (meniscus tear, ACL injury) and fractures. These injuries should be evaluated by the team’s athletic trainer and treated accordingly or referred to a sports medicine physician for more serious injuries. These more serious injuries usually require significant time away from training and competition.

Long jump and triple jump

Long jump and triple jump are horizontal jumping events with specific associated injuries. These injuries can be broken down into overuse and traumatic. Overuse injures include tendinopathies and repetitive stress injuries as seen in other events and should be treated as noted previously. Traumatic injuries occur either at takeoff or landing and can include fractures, acute muscle tears, dislocations, serious ligament sprains (such as ankle sprains), tendon ruptures, and knee internal derangements. These more serious injuries should be evaluated by your team’s athletic trainer and referred to a sports medicine physician for appropriate care. These more serious injuries usually require significant time away from training and competition.

High Jump and Pole Vault

High jump and pole vault are vertical jumping events with similar injuries to horizontal jumping events. These injuries can also be broken down into overuse and traumatic. Besides the traumatic injuries noted for long and triple jump, pole vault accounts for almost all of the catastrophic injuries (fatal, non-fatal but causing permanent severe functional disability) and serious (no permanent disability, but a severe injury). These more serious injuries should be evaluated by your athletic trainer and referred to a sports medicine physician for appropriate care. These injuries usually require significant time away from training and competition.

Javelin, shot put, hammer, and discus

Throwing events account for the vast majority of upper extremity injuries in track and field. These include injuries to the rotator cuff and shoulder labrum as well as abdominal injuries from the rotational throws, and lower extremity injuries from planting during a throw. One injury specific to the javelin is an ulnar collateral ligament tear (Tommy John injury).

UCL injuries in javelin are due to the throwing motion and the stress incurred at the elbow, similar to baseball. Throwing injuries need to be evaluated by the team’s athletic trainer and either treated conservatively through rest and rehabilitation or referred to a sports medicine physician when more a more serious injury occurs such as an ulnar collateral ligament tear.

Exertional heat illness

Lastly, environmental factors can cause heat related illness in track and field athletes. Athletes, coaches, and medical staff need to be aware of the environmental conditions (heat and humidity) and monitor athletes for any signs or symptoms of heat illness. Heat illness is an urgent and sometimes emergent issue and needs to be address by the event’s medical staff. Signs and symptoms can include finding it hard or impossible to keep playing, loss of coordination, dizziness or fainting, profuse sweating or pale skin, headache, nausea, vomiting or diarrhea, and stomach/intestinal cramps or persistent muscle cramps.

To truly evaluate an athlete for heat related injury, an accurate core body temperature needs to be assessed by a trained medical professional such as an athletic trainer. Cooling measures should be implemented with the best method being ice immersion. For those athletes with a core temperature over 104° and showing signs or symptoms of heat illness, immediate cooling should be implemented and emergency response should be initiated as heat stroke is likely.

The National Athletic Trainers Association has an excellent web page on How to recognize, prevent, & treat exertional heat illness: http://www.nata.org/nr072606

As you can see, not only do we see lower extremity injuries in track and field, we also see upper extremity injuries and environment injuries such as exertional heat illness. Although most of the injuries are minor, there are urgent and emergent injuries in track and field and these are best managed by the team’s athletic trainer and medical staff.

Read more Sports Doc for Sports Medicine and Fitness.
Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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