By Big Man Mike
Big Man Mike here with something I thought would be a pretty helpful index for everyone who has those thoughts regarding when a player should be benched or dropped due to injury. For a little bit of background, I am currently a senior at the University of Kansas majoring in Exercise Science with a Pre-Med emphasis and will be attending the University of Kansas Medical Center next spring with the hopes of going into Physical Therapy in a sports environment. I also worked as an assistant athletic trainer for a local soccer league, thus familiarizing myself with many of these injuries. This is going to be a series of articles that highlight the different injuries players frequently suffer in order to get a better understanding of the medical aspects of the recovery of the player. As a disclaimer, if anyone is experiencing these injuries please consult an actual doctor and listen to their advice, as everyone’s medical situation is different on a case by case basis and this article is focusing on more blanketed generalizations regarding these injuries. With that being said, let’s jump in with some of the more common injuries facing football players.
An ankle sprain occurs when the ligaments that support movement of the ankle stretch beyond their normal range of motion and suffer tears. The ankle itself has two differing sets of ligaments, the medial and the lateral ligaments. The lateral ligaments are housed on the outside portion of the foot, while the medial ligaments are on the inner foot. The most common part that’s affected in ankle sprains are the lateral ligaments, due to the larger role they play in range of motion comparative to the medial ligaments. These injuries, like many other ligament injuries, have differing levels of severity.
Grade I Ankle Sprain: Mild sprain, stretching and microscopic tears of the ankle ligaments.
Grade II Ankle Sprain: Moderate sprain, partial tear of the ligament. Typically associated with mild discomfort and a sense of loose instability of the ankle joint.
Grade III Ankle Sprain: Severe sprain, complete tear of the ligament. Often comes with severe pain and complete instability of the ankle joint.
Depending on the severity of the ankle sprain, the recovery time could be anywhere from a few days to a several months. Most often when you hear about players playing on a sprain ankle, it is typically a Grade I sprain, as that type of sprain is typically more of a pain tolerance issue that anything else. For Grade I sprains, expect the player to be out a few days or so unless they have a significant history of ankle injuries. In which case, the residual effects might make the recovery time just a bit longer. For Grade II sprains, expect that the player would be out for at least two weeks in order to be fully cautious, as this injury can easily lead to a Grade III sprain if re-injured before completely healing and most teams would not want to take that risk. For a Grade III sprain, expect the player to be sidelined for at least 5-8 weeks at the bare minimum. While the ankle ligaments are not like many other ligaments in which a complete tear does not necessitate surgery, it is still an option that may be on the table. In this situation, the player may be put on IR depending on their level of pain tolerance and the teams trust in their medical evaluators opinions.
The hot button issue of the NFL in modern times is the effect of repeated concussions on the neurological systems in our bodies and the best way to prevent them. While the argument still ranges over whether the worst long term effects are caused by the larger concussions that cause unconsciousness or by the repeated sub concussive blows that players experience daily, it is vital to understand how the brain is impaired by them. As many people know, different areas of the brain are responsible for different actions. As such, many injuries involving the head are typically classified by which portion of the brain they are affecting.
For example, one of the worst injuries I’ve experienced was an occipital concussion after falling on the back of my head playing soccer. In these types of concussion, vision is either blurred or lost based on the severity of the concussion. While these concussions are not as common in football as they are in other sports due to the typical lack of hits from behind. The most common types of concussions that involve football players typically affect the frontal lobe, with occasional temporal or parietal lobe injuries as well.
The symptoms of concussions are virtually nothing like they are portrayed in popular culture. Depsite common belief, a loss of consciousness is only indicitive of a grade III concussion and is not an overarching definition for a concussion. Symptoms include confusion, lack of coordination, slurring of speech, vomiting, behavioral changes, intense headache, sensitivity to outside factors, ringing of the ears, memory loss, and/or difficulty in concentration. While these symptoms do not all have to happen to indicate a concussion, the occurance of more than one is a good sign for further testing.
Much like ankle sprains, concussions are also graded as mild (Grade I), moderate (Grade II) or severe (Grade III). In a mild concussion, the player might feel somewhat symptomatic for a brief time but will typically clear up quickly. While this might encourage a player to get back out into the game, they absolutely should not until cleared by a medical professional. Much like how a cut or bruise might stop hurting after a short while, they are not fully healed and neither is the brain after a traumatic brain injury. In a grade II, the players are symptomatic for a significantly longer time than a grade I concussion without clearing up. Even when the symptoms subside, still consult a medical professional for clearance before returning to sports. A grade III is the most severe, and results in a loss of consciousness. These one are the most likely to have a long lasting affect and need to be handed by a medical professional or a neurological specialist.
One of the more significanr reasons an athletic trainer will immediately shut a player down for any suspicion of a concussion is the prevention of Second Impact Syndrome. In this affliction, a person who has been afflicted with one concussion is afflicted by another before the first one has completely healed. This prevents the brain from being able to regulate the cerebrospinal fluid that surrounds the brain to provide cushion. This can lead to a severe swelling of the brain into the skull and/or herniation of the brain, even if the second impact was far less significant than the first. While a concussion as a one off injury doesn’t typically yield longterm affects, Second Impact Syndrome typically causes severe longlasting physical and mental disability as a best case scenario, but is frequently fatal.
The timelines on concussions are typically unpredictable and depend very heavily on the person and their history of concussions. I’ve experienced situations where a player with 3 prior concussions gets cleared in a week and a half and I’ve seen players with no prior concussions take 6 weeks to get cleared. There’s really no rhyme or reason with concussion recovery times, but concussion history is typically a good indicator. In these situations, assume the player will be out for a week after suffering a concussion, add another week if there was a concussion the year prior, and another the year prior to that, and shut down for the season if two concussions occur in the same season.
One of the more misunderstood injuries in sports involves the difference between sprains and strains. The simplest way to think about these injuries are that sprains affect that ligaments that hold bones together, while strains affect the tendons that hold muscles to bone. In many instances, muscular injuries are very dependent on what position the player plays. For example a shoulder injury would not affect a kicker all that much in terms of performance, but would absolutely cripple a quarterback.
In virtually every aspect of working out, muscle tears are expected and actually welcomed to happen. When a muscle has microtears, the typical bodily response is to fix the initial microtear and add just a little bit more on top to prevent it from happening again. This is a key principal in the idea of weightlifting, in which you want to find that sweet spot of enough reps and a high enough weight to cause these microtears, but a low enough weight to prevent a higher grade muscular strain.
In order to understand how a muscular strain affects the body and the grading system to determine the severity of the muscular strain, it is important to understand the anatomy behind muscles. Muscles are composed of differing levels of fibrous strands that join up. A myofibril is the basic unit of a muscle cell and are composed of thick and thin filaments. These filaments and the myofibrils are the key components of creating muscle fibers, which in turn group up to form fascicles that group up as well in order to form the skeletal muscles. Whenever a tear occurs, damage is often inflicted throughout every level of organization in the muscles.
Muscle tears shared many of the same classification standards for diagnosing the severity of the injury as ligament sprains.
Grade I Muscle Strain: Few muscle fibers torn or overexterted, muscle is more sensitive and painful than usual but can still maintain essentially the same normal workload.
Grade II Muscle Strain: More muscle fibers begin to become torn or overexerted, often a slight incomplete tear in the muscle. Has significant pain, swelling, inflammation, and sensitivity, as well as a noticeable decrease in strength of the muscle.
Grade III Muscle Strain: Significant complete tear of the muscle. Often will hear or feel a pop in the muscle. Comes with severe pain, swelling, inflammation, discoloration, and disformation. Will most often lead to a complete inability of the muscle to function.
When it comes to football, the two most common muscle strains are often hamstring strains or abdominal strains. Both of these are much more problematic than a muscle strain on the arm as far as long term, as it is easier to not use the reserve usage of the arms when only necessary. Since virtually every movement of the back or legs involved the abdominal muscles or the hamstring muscle, it is often a lot harder to baby that injury. Whenever an injury occurs, it is important to know what the grade of the muscle tear is. Muscles often take a decent amount of time to fully recover, which is why sometimes you feel sore from a heavy workout for up to a week. In most situations, a Grade I muscle strain will often lead to a player missing most of the weeks practice and being a 50/50 gametime decision based on the players injury history and their level of pain tolerance, with the potential of missing several weeks. In a Grade II muscle strain, The player will often be out for 4-6 weeks as the training staff attempts to prevent the injury from becoming a Grade III strain by nursing the actions of the player. In a Grade III muscle strain the player is almost certainly shut down for the season and surgery will be required in order to repair the muscle.
That’s it for this round of the Football Injury Glossary. Next time I’ll be going in depth on ligament tears in the knees, complications, and how it can affect a player coming back from injury. Hope you enjoyed the article, and feel free to leave a comment below. See ya!