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High school athletes’ most common injuries – and how to avoid them

Muscle strains
Muscle strains are common early in the season because some young athletes are not quite prepared for the repetitive stress of live action.

Steven B. Singleton, M.D.
Orthopaedic Surgery

For young athletes and the fans who cheer them on, fall is a magical time of year, filled with promise and possibilities for the new season.

But whether you’re blocking and tackling beneath the Friday Night Lights, sliding into second on the baseball diamond, or leaping skyward for a spike on the volleyball court, the potential for a sports injury is as much a part of the game as winning and losing.

As head orthopaedic surgeon for the TCU athletics program and Chief of Sports Medicine at UT Southwestern’s Monty and Tex Moncrief Medical Center in Fort Worth, I see and treat everything from hamstring pulls and shoulder strains to broken bones and ACL tears. Some are unavoidable, but there are preventive steps athletes can take to reduce their chances of having their season sidelined.

For instance, dehydration can play a key role, especially in the excessive heat in North Texas. By decreasing circulation, blood supply, and flexibility in your muscles, significant dehydration can make you more susceptible to a strain. It can also slow down your reaction time – so if a player is coming to tackle you, your brain and nerve endings might not fire quickly enough to signal your muscles to move out of the way.

Even with proper hydration and conditioning, injuries happen in sports. Let’s look more closely at a few of the most common sports injuries for high school athletes, how we treat them, and how best to avoid them.

Lower body injuries

Lower body injuries tend to dominate during the fall because many of the sports, such as soccer, football, basketball, and cross country, all relate to running, cutting, and pivoting. And if a high school athlete hasn’t played their sport for a month or two during the summer, that can lead to muscle imbalance and ultimately an injury.

Hamstring pulls

Hamstring strains and pulls are the most frequent injury we see early in the season, particularly for high school athletes. The hamstring is a combination of three different muscles at the back of the thigh. They attach above the hip joint on the pelvis and then stretch below the knee.

What causes them: The hamstring cross two joints – the hip and the knee – that are both used extensively in running, spreading, and cutting. A lot of force surges through your lower body when you sprint and change directions, so your muscles are constantly being activated during those motions. Early in the season, some legs just aren’t quite ready for the workload of game action.

How they’re treated: About 80% of the hamstrings we treat are strains, not complete tears, and the muscles tend to heal really well because they’re so well vascularized – well supplied with blood vessels. Treatment requires ice to reduce the swelling, then rest, local massage, and eventually some gentle stretching and activation of the muscles again.

Most mild hamstring injuries can take as long as three weeks to heal, and more moderate strains take four to six weeks. Patience is key; if you try to run too soon before the muscles are fully healed, you could reaggravate the hamstring. We see that a lot.

Ankle sprains

Ankle sprains are very common in sports such as tennis and basketball.

What causes them: Ankle injuries are usually the result of an athlete making a sudden cut or stepping wrong. If the muscles that stabilize the joint don’t activate quickly enough, the ligaments can give way. While painful, some ankle sprains can be relatively minor, particularly if the athlete has their ankles wrapped for stability.

How they’re treated: We can usually treat ankle injuries with ice, compression and wraps, physical therapy, and modalities such as ultrasound to get the soft tissues to heal fairly quickly.

diagram of the knee joint and ACL and MCL injuries
Knee ligament injuries have increased in recent years as young athletes have learned to cut more quickly in sports like football, basketball, and soccer.

Knee injuries

As young athletes have gotten bigger and faster in the last 25 years, they’ve also become more susceptible to knee injuries, especially to the medial collateral ligament (MCL) and anterior cruciate ligament (ACL).

The MCL is located on the inner side of the knee, and it connects the bones in the thigh (femur) and shin (tibia). The MCL also keeps the knee from moving side to side.

What causes them: Most MCL injuries occur when an athlete:

  • Jumps and lands awkwardly, such as in volleyball or basketball
  • Gets hit on the knee or makes a sharp cut, as in football or soccer
  • Lifts heavy objects in the weight room
  • Hyperextends the knee, which occurs in many sports, including tennis or gymnastics

How they’re treated: Most MCL injuries heal on their own with rest, bracing, and physical therapy – though it typically takes about six weeks. In rare cases, arthroscopic surgery may be recommended to repair the MCL.

ACL injuries, on the other hand, don’t tend to heal on their own because the ligament, which helps connect the thigh bone to the shin bone, is located entirely inside the knee joint. So when it ruptures, it can’t get the necessary blood supply to promote the healing process.

What causes them: Most ACL tears or strains are caused by a sudden pivot or cut and may happen in a non-contact setting. Soccer, football, volleyball, and basketball players are at risk for ACL injuries, which can also occur when an athlete lands awkwardly from a jump or gets hit on the knee.

How they’re treated: Most ACL tears require surgery to reconstruct the ligament. Nonsurgical treatments, including rest, anti-inflammatories, bracing, and rehab are options for older patients, but for a young athlete who wants to return to play, ACL surgery is usually recommended. The surgeon will reconstruct the torn ligament with a tissue graft that the body remodels into a new ligament.

Recovery is typically anywhere from six months to a year and requires intense physical therapy and rehabbing of the knee. At UT Southwestern, the sports medicine and physical therapy teams see patients throughout the process, which includes:

  • Recovering full range of motion
  • Strengthening the muscles around the knee
  • Returning to light jogging, followed by running and sprinting
  • Beginning to jump, pivot, and move laterally
  • Returning to sport testing, which makes sure the patient is ready for competition

Related reading: 12 concussion myths debunked

Upper body injuries

Prominent among athletes who play baseball, volleyball, and tennis, shoulder tightness and tendonitis typically affect the pitcher who throws 90 mph fastballs or a top-level tennis player who serves at 120 mph. Swimmers are also susceptible to shoulder and elbow tendonitis.

Shoulder tightness and tendonitis

What causes them: We call these conditions repetitive stress injuries, and they usually occur because the rotator cuff, capsule joint, and biceps tendon are being asked to take on an increased workload, which can cause inflammation and swelling. Improper technique can also lead to shoulder tendonitis.

How they’re treated: Shoulder tendonitis is typically treated with ice, rest for three to five days, and ibuprofen to reduce swelling around the joint. Physical therapy to restore range of motion is also key. In rare cases, we may recommend a cortisone injection to relieve painful symptoms.

Elbow tendonitis

Elbow tendonitis typically emerges inside the elbow, in the medial epicondyle, and it’s a common injury in baseball, volleyball, and tennis.

What causes it: The pronating motion athletes make when they’re spiking a volleyball or snapping their arm to throw a baseball is the primary culprit.

Young athletes typically don’t experience what’s been called “tennis elbow,” which is more degenerative in nature and typically affects older athletes on the outside of their elbows, or the lateral epicondyle.

How it’s treated: Elbow tendonitis is treated much the same way shoulder tendonitis is – with ice, rest, and ibuprofen, followed by physical therapy.

Shoulder dislocation

The shoulder is the body’s most flexible joint, which makes it the most likely to dislocate. Vulnerable in contact sports such as football, a dislocation occurs when the ball of the upper arm bone pops out of the cup-shaped socket. The shoulder can dislocate forward, backward, or downward.

What causes it: When a player extends his arms to make a tackle or break a fall, blunt force can make the ball pop out of the socket. Dislocations can also occur when a player is blocking, and his arms are locked and an opposing player pushes back with extreme force.

How it’s treated: Shoulder dislocation can be extremely painful because your bones have moved out of their standard position. A trainer or doctor will perform a closed reduction, making gentle maneuvers to move the bones back into their proper position. That should relieve the immediate pain.

We’ll immobilize the joint with a sling for about three weeks, which will give any labral tears in the shoulder joint time to heal. We’ll also do range of motion physical therapy and strengthening before letting the player get back onto the field, usually with a brace.

If the ball and/or socket fracture, surgery may be recommended to repair the bones. Or if the injury recurs, we may suggest surgery to repair the stretched ligaments.

Steven Singleton, M.D., is head orthopaedic surgeon for the TCU athletics program and Chief of Sports Medicine at UT Southwestern’s Monty and Tex Moncrief Medical Center in Fort Worth.

Stretch before and after practice

One way to limit sprains and strains is to stretch before and after you exercise. I tell my young patients – and their parents ­– to consider it part of their “job.”

If you’re playing an organized sport, most coaches will require stretching before practice. But it’s just as important to stretch for about 15 minutes afterward. It will help prevent muscle pulls and strains throughout the season.

Of course, anybody who has ever played sports knows it’s impossible to avoid all injuries. Try not to play tentative or worry too much about getting hurt. And the good news is that our bodies are extremely resilient, so if you get proper care for an injury from a health care professional or orthopaedic specialist, you should soon be back to playing the sport you love.

If you or a loved one needs to see an orthopaedic doctor at our Fort Worth location, you can call 817-882-2585 or request an appointment online.

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