In life, there are numerous factors in any given situation – context, background, timelines, conditions, goals, etc. that all need to be considered. This is no different than decisions needing to be made in sports medicine with regards to returning an athlete to their sport. In my last post, there were some assumptions made that we could work in an ideal scenario with the luxury of time and resources. More often, there is the reality where those things are not always practical, or even possible, for that matter.
So, that leaves us with the dilemma of how to move forward with an athlete who has “in-season” considerations and would like to return ASAP. Well, everyone wants to be better yesterday & no one ‘has time’ to be hurt. That said, some situations may change the decision-making process. Imagine any of these scenarios: it’s the last game of your senior year, your team made the playoffs, there will be scouts at the game to see you, if you don’t play you may get replaced by your back up, etc.
Does that change your approach? What circumstances should allow the sports medicine community to medically clear an athlete to play? What’s the risk? How bad is the injury: A broken bone? A torn muscle? A sprained ligament? What about function: Can they run, cut, jump, land, kick/throw a ball? Any pain with that? Does taping it up or bracing it help? Pain meds?
Ultimately, we have to acknowledge the areas where we DO NOT have good insight – where there is an information gap, so to speak. There are unknowns. Uncertainties. This is where we can do our best work…
In-season decisions need to be made with as much objective insight and knowledge as possible – the same as what we discussed in the previous post with off-season athletes. The major difference is the concessions that must be made oftentimes. We all seem to make exceptions. We draw upon personal experience, situational circumstances, and amount of time that has past since the original injury (thus assuming a given level of biological healing).
All of this is well-intentioned; however, the medical community should have situations that are more concrete and tangible – like what one would consider “against medical advice”. If an athlete/coach/parent wishes to return to their sport, they STILL need to be informed of the possible injury risk. Beyond that, there should be situations where returning to sports is not only not recommended, but is actually prohibited. What should these consist of? This is where future research is needed, but is already happening with concussions in the NFL. Concussion protocols were developed to minimize risk of re-injury to the neurological system (brain, primarily), but could be considered a good model for the musculoskeletal system.
No one can predict who will get hurt/injured, just like no one can say who will not. We all must understand and accept this. The same is true for other health-related issues. “You may have heard that smoking, excess weight and high blood pressure are risk factors for heart disease. That doesn’t mean that someone who smokes, is overweight, and has high blood pressure is going to have a heart attack. It does mean that having those factors places that person at an increased risk when compared to someone who doesn’t have them.” 1
I am not trying to eliminate toughness and perseverance in the face of pain/injury/adversity. I am trying to better utilize objective information instead of “professional opinion” and “expertise”. Have you ever seen a court case where 2 or more “experts” debate? How do you know who is right if they are both experts with loads of experience and using sound science to defend their positions? My point here is that everyone has opinions. Opinions (even “expert” ones) are subject to influence and bias…as such, they are not as ideally reliable as objective data. Deciding to play while injured should be more informed than that.
Now, if no one played through an injury, we wouldn’t have these spectacular sports stories:
- Kirk Gibson’s 1988 walk off World Series homerun with 2 injured knees
- Michael Jordan’s 1997 Game 5 of the NBA Finals with the Flu
- Tiger Woods winning the 2008 U.S. Open with stress fractures and a partially torn ACL
- Patrice Bergeron playing through a punctured lung, cracked rib, torn rib cartilage and a separated shoulder in Game 6 of the 2013 Stanley Cup Finals
- Rajon Rondo playing after dislocating his elbow in Game 3 of the 2011 Eastern Conference Semifinals
So, I am not saying let’s make sure we don’t ever play if injured…We simply need to own our limitations, attempt to minimize our knowledge gaps & gather as much objective/tangible information as possible. Let’s fight to do better and utilize informed risk (even if that means an athlete returns to their sport before it is ideal) to guide our decisions.
Save Your Hands: Ch 3: Risk Factors for Musculoskeletal Disorders. Pgs: 18-22.