Kermit Muhammad, M.D.
During football season I notice something a little more frequently than I do at any other time of the year. I see players that avoid reporting the severity of their injuries so that they can get back on the field. I have also seen zealous parents op out of definitive treatment in favor of temporizing measures that will get their child back in the game quickly. Now, this is not purely a phenomenon related to football parents and players, I see this in all sports. The notoriety and financial benefits of a successful college and pro career in sports is so attractive that it sometimes can cloud the judgment on how to handle a temporary setback with an injury.
Children are encouraged to choose their sport at a younger age and participate at a much more intense level than in past years. This has led to more competitive leagues, travel teams, extra lessons with pros etc. If we really look at it the time and dedication involved in youth sports in general, this is really a semi-professional level of its own; which means that there is a high demand to produce. The next factor is that parents see the payoff usually in the form of a free ride at a four-year college. Every parent knows that this is a big deal. Students in general are saddled with debt and the prospect of bypassing that whole situation leads to a strong motivation to push athletes to the limit.
As an orthopedic hand surgeon, I see a different perspective. I see children and young athletes who’ll clearly have a surgical problem that is not ambiguous and there is a family debate on whether or not it should be fixed or treated now or after the season. Obviously for injuries that make it impossible to play, it’s a no brainer. However, particularly in football, where things can be wrapped and casted and protected to a certain degree it leads to a decision point. As a surgeon, it is always easier to handle a problem in the acute setting rather than kick the bucket down the road. The following scenario is not too uncommon, a player comes in the office with a thumb injury that needs to be set and pinned. The family decides not to have it done because the player cannot play with a pin and they opt for a cast only. From their perspective it might be junior or senior year and there will be scouts at the game from big colleges and this is their opportunity. So, the player may have a poorer performance because of the injury and then after the season is over the player sees that his thumb is not working well and then seeks treatment. It’s possible it may be too late to restore normal function at that point.
In general, if something can be treated acutely it should. When fractures and ligament injuries present late there are often fewer options available to the surgeon. The reconstructive options are generally never as good as the fresh fix. Sometimes the options are so limited and suboptimal that the recommendation is to just leave it alone. Consider the number of football players that you may know, older and younger that have “bent” or “crooked” fingers. Many times, it’s because the injury was neglected or overlooked and options for reconstruction were limited when the player finally sought treatment.
So, the advice I would give to players and parents at all levels is to consider the long game. Take the perspective that fixing things correctly now will help performance down the line and not hurt it. Taking care of your body with treatment and proper rehab will ensure a long sports career. From a practical matter parents and players should have a better idea of when to come in. If a player dislocates his finger and its popped back in on the sidelines and buddy taped to finish the game, he should come in for an X-ray. Simple dislocations can occur, but complex dislocations with fractures need immediate treatment. If a player has to change his style of play to compensate for an injury that should be an indication that an orthopedic evaluation is needed. Along those lines, parents should be observant of these things and if they notice a change in style or level of play because of an injury it should be looked at by an orthopedic surgeon to make sure there will not be long-term consequences. Consider the orthopedic surgeon as part of the team and enlist their help to keep your players playing.