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Managing Athletic Injuries For OU Football
By: Jordan Brogley Webb
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It’s safe to say the season is in full swing for Ohio football after the team notched six wins in its first six games.
With a full slate of games and practices, it is a busy time for not only players, but the team’s medical staff as well.
Recent coverage highlighting the risks of sports related injuries to college athletes has cast the spotlight directly on those responsible for their care.
Today there is a greater and more urgent demand for better management of sports related injuries, and Ohio University is out to prove its up to the task.
From athletic trainers to strength and conditioning coaches, to team physicians, surgeons, and even nutritionists, when an athlete gets injured, there are multiple levels of defense.
A Year-Round Commitment
The Bobcats weren’t graced with unlimited time to enjoy their Famous Idaho Potato Bowl win in December, and just as soon as the 2011 season came to a close, the 2012 campaign began.
For eight weeks in the winter, the strength and conditioning staff got the players into what is known as the heavy-build phase, as they try to build strength and power and add body mass. They had a three-week break that encompasses spring break before they return for spring practice.
For the duration of spring practice, the players were in a maintenance phase. In addition to practicing three to four days per week, the team lifted weights twice per week on off days.
“They are not trying to tear tissue down, but it’s not atrophy either,” said John Bowman, the head athletic trainer for the Bobcats football team.
After spring practice ended, the team spent about five days per week in weight training, working on building strength through lifting for the first hour and a half typically and then for the remaining 45 minutes of practice working on speed and agility.
This training regimen was not significantly altered for summer workouts, but a greater emphasis was placed on the running program. The goal was to sustain a certain level of intensity in practice without players getting hurt.
In June and July, the athletic training staff worked hard to improve players’ cardiovascular health by working with them outside in the heat in order to get them acclimatized to conditions that will be present in August.
In August practice level are ratcheted up again and players were exposed to heat in full pads for two a day practices lasting five hours total.
That kind of summer workout program is commonplace for competitive college football teams today, but Bowman said that it wasn’t always like that at Ohio University.
When Bowman was working at the university in the 1990s he said that the school lacked resources to keep all of the players on campus throughout the summer. Workouts were on a volunteer university so in August, the team would consistently have 15 to 20 players out consistently with injuries.
Problems like heat exhaustion, muscle cramps, hamstring, groin, and hip flexor pulls were highly prevalent.
Bowman said that when head coach Frank Solich came to Athens he said about the summer program, “This is crazy, we never had anything like this at Nebraska.”
As a part of his deal with the university, Solich said in order to build a winning program, he needed to have a commitment to a summer program.
“It’s been essential for injury prevention and performance. Practice is very hard, but the players are able to sustain themselves at that level for the most part,” said Bowman.
Coach Solich also has speakers come to Athens once or twice per year to talk to the team about the importance of healthy eating.
Unlike larger programs like those at Ohio State and the University of Southern California, who have a nutritionist on the football staff, Ohio University has one nutritionist for the entire athletics program.
Bowman said that the team ideally would like to do more with nutrition, but they have invested more of their resources into academic study tables and injury care.
Injury Play-By-Play
Once a player goes down on the practice or game field, Ohio University has a complex network of medical staff ready to spring into action.
John Bowman is usually always the first responder to any injury suffered during a game or a practice. Accompanied by another trainer or graduate assistant Bowman will evaluate and assess the athlete on site before making a recommendation.
In addition to the athletic training staff, a team physician, and the team surgeon, Dr. Raymond Tesner, is often on hand for the more significant practices and all games.
Dr. Craig Chappell is one of two team physicians for Ohio University athletics and he sees all athletes in men and women’s sports. Chappell studied osteopathic medicine at Pikeville College in Kentucky and specializes in non-surgical orthopedics.
When an injury is not severe, Chappell leaves the assessment to the discretion of Bowman, and generally speaking will not interfere unless asked by the athletic training staff. For more serious injuries however, Chappell and Dr. Tesner will go directly onto the field to attend to the athlete.
Chappell sees any injuries, illnesses, medical conditions, and takes care of the players two days a week at Peden stadium. He covers all of the games and largest practices and travels with the team when they go on the road.
Types of Injuries
Football is by its nature a violent sport and injuries are expected. Players move at a high velocity and collisions are inevitable, thus football tends to have the highest rates of injury. According to the National Journal of Athletic training, football injuries in practice and games occur more often than in any sport.
The medical staff sees a variety of contact and noncontact injuries. Of the least severe injuries, Chappell said that they most commonly see strains and sprains of hands, fingers, and feet. There are also a number of stress fractures of ankles and arms, and dislocations of shoulders. Some of the more serious injuries Chappell sees are more serious leg fractures, as well as internal knee derangements, and concussions.
Treatment is often case specific and the kind of treatment varies based of a player’s previous injury history. As far as players with nagging injuries go, Chappell said that if they can play safely with a lingering problem, then the medical staff will do its best to fit them with a brace and provide palliative care in order to get the player onto the field.
If the injury is affecting the player adversely however, Chappell will place them in the appropriate rehabilitation program or make surgical recommendations. For Chappell, the ultimate goal in treating athletes is the same for anyone who suffers an injury.
“The recommendations I make are the same as I would make for a 64 year-old person in my office who wants to climb up on the roof and hang Christmas lights,” Chappell said. “Hopefully we don’t put them at risk.”
Concussions
For Chappell, the rule changes and mandates that have resulted from concussion research have had a trickle down effect. “There are 1,600 players on NFL rosters on any given Sunday. After that there are 64,000 college players and 1.3 million high school football players. Who should we really be concerned with? It’s all about numbers,” he said.
The NFL has made rule changes based on the Zurich Guidelines of 2008. In November of 2008, the Third International Conference on Concussion in Sport was held in Switzerland. From this conference came a consensus statement on concussions outlining their management, evaluation, prevention, and future investigations.
The NCAA and the Ohio High School Athletic Association have followed suit. According to the 2007 study in the Journal of Athletic training, concussions represent the fifth most common injury in college football, but they have the potential for the most catastrophic results.
Both governing bodies have mandated that an athlete that suffers a concussion can only return to play after they have to have been cleared by the appropriate medical personnel. This mandate came from the NCAA went into effect in 2010, but John Bowman said that this practice has been implemented at Ohio University for four seasons prior to that.
The mandate has created a more objective process for management of mild traumatic brain injuries. Concussions differ from other types of injuries because they are treated with cognitive and physical rest. An estimated 55 percent of sports head injuries are football related. Also 90 percent of concussions resolve in 3 to 10 days.
Yet there is still so much that we do not know about concussions. Researchers are starting to find out that head injuries are worse in certain populations, especially young people. Younger individuals are more likely to develop migraines, psychiatric disorders, and anxiety.
“From research being done at Boston University we are learning that in former players who had chronic traumatic encephalopathy, there is an excess accumulations of Tau proteins, but can we develop a way to measure that in living people? Do Tau protein accumulations occur in non-symptomatic people? Are you genetically predisposed to developing these problems after a concussion? There is still so much to learn,” said Chappell.
Chappell hopes to begin working with the school of Osteopathic Medicine this summer for his own research. Chappell and a team of researchers hope to study the aftermath of whiplash, by looking at people who develop balance problems and treating them with vestibular rehabilitation and manipulation.
“We want to look at impacts outside of the head as well. In terms of football, could a serious of non-head related impacts over a stretch of time be just as devastating as a concussion? These are things we want to look into,” he said.
Ultimately it’s impossible to totally protect the brain from being injured while playing football. Improved helmets and equipment can be used to help dissipate the force of hard hits, but nothing can prevent the brain from hitting the inside of the skull, which is how a concussion occurs.
The NCAA has tried to combat this with rule changes, most recently on Feb. 24 the NCAA mandated kick offs would be moved from the 30-yard line to the 35 and touchbacks on free kicks would be moved to the 25-yard line.
Both Chappell and Bowman agreed that more penalties are being called for unnecessarily violent hits, but they are unsure what effect the latest rule change will have from a medical standpoint.
“Does the change favor the kicking team or the receiving team? I’m not sure. On one hand the offense will get better field position, but that could encourage the kicking team to kick it higher and shorter, which could actually increase injuries,” Chappell said.
In order to emulate NFL players, both men said it was important to emphasize hitting other players in a safe way that doesn’t utilize using the head as a weapon.
“On one hand we are trying to eliminate these dangerous hits, but we are doing that by not only changing the rules, but building bigger, stronger, and faster athletes. That could have an inverse effect though because getting hit by a stronger athlete at a greater velocity could increase the injury rate,” Bowman said.
Knee Injuries
According to the 2007 study published in the Journal of Athletic Training, internal knee derangements are the most common kind of injury suffered by football players in games and both fall and spring practices.
The medial collateral ligament is the ligament that is injured the most, while the anterior cruciate ligament accounts for the longest rehabilitation process and most chronic problems.
MCL injuries are often not repaired surgically and a typical strain will keep a player on the sidelines for about six weeks. MCL tears occur four times more frequently than ACL tears. They are treated typically with periods of rest and immobilization that allow them to heal.
In football MCL injuries almost always occur as a result of contact. Due to this factor, offensive linemen often wear braces that prevent a lot of MCL injuries, however; they do not protect the ACL.
Chad Starkey is an associate professor of athletic training at Ohio University. A 2009 inductee into the National Athletic Trainer’s Association Hall of Fame, Starkey has been studying knee injuries in NBA players for more than 25 years.
“Ankle sprains happen 30 to 40 times more frequently than ACL injuries, but with the ACL you have to worry about significant time loss the most,” he said.
ACL tears result from rotation of tibia on the femur that creates a functional instability. The winding of the ACL and the accompanying posterior cruciate ligament are what allows for walking.
For ACL tears an MRI is the diagnostic test of choice in order to determine the extent of damage. When the ligament fibers are torn, the ligament doesn’t heal but muscles around the joint can strengthen to compensate.
The ligament actually restricts joint motion Starkey said. When ligaments are torn, the muscles have to prevent further damage. The hamstrings become more involved without the ACL.
Today an ACL tear is arthroscopically repaired, and since the ACL is composed of many individual fibers, most of the time the surgeon will take a tendon graft from the hamstring, patella, forearm, or an artificial graft to replicate ACL. The practice used to be fairly invasive, but now it only requires several small incisions, and recovery time is much faster.
“Once the graft heals, it’s all about re-educating the muscles around the knee and your brain telling where your knee is and how fast it is going,” Starkey said.
Some physicians will wait until the patient can contract their quadriceps and get leg into extension as soon as possible, even hours after surgery. Very diligent care is required in first few weeks to protect surgical wounds and grafts, and once initial healing is done the focus shifts to strengthening range of motion and controlling swelling.
If more than the ACL is torn that affects long-term prognosis said Starkey. A knee dislocation is determined by tearing two of the three major ligaments. When this occurs, it is generally the ACL and either the MCL or lateral collateral ligament. PCL tears are generally fairly uncommon as the PCL is the stouter of the two cruciate ligaments.
Very few musculoskeletal injuries are 100 percent preventable said Starkey and most ACL injuries in football are noncontact injuries.
All of the causes of ACL injuries are not clearly established, Starkey said. “We have examined everything from hormonal influence, biomechanics, skill level, and anatomy. It could be a combination of all of these factors but it’s not definite.
Most football players don’t wear a brace after ACL surgery, said Starkey. “It’s always give and take. If you put a brace on a knee, it is going to restrict range of motion and possibly harm other muscles,” he said.
Knee and head injuries are injuries that account for the most significant time loss and can be devastating to a player’s career. The injuries outlined above however are not an exhaustive list of all kinds of sports injuries. There is no way to keep an athlete totally injury free, but the idea is to minimize the damage.
Jordan Brogley Webb is an Ohio University Honors Tutorial Student. This is the third of a four-part weekly series focusing on athletic injuries.