The Superbowl is coming up tomorrow night. Auburn’s Cam Newton is trying to cap off an amazing season with the first Superbowl win for the Carolina Panthers (War Eagle!), and Denver’s Peyton Manning is trying to cap off his record-breaking career with one last championship. Carolina’s linebacker Thomas Davis had surgery to fix a forearm fracture 2 weeks ago and might actually play with a brace, while Denver’s safeties TJ Ward (ankle) and Darian Stewart(ankle), and guards Evan Mathis (ankle) and Louis Vasquez (knee) are going to play despite injury. How do we decide when to clear athletes to compete after injury, and what factors do parents need to consider when their child has been hurt but wants to play?
When evaluating an injured athlete, the primary consideration is always the long-term function of the patient. Everyday I see people who have sustained sports-related injuries in their youth and are dealing with the long-term consequences of those injuries. Post-traumatic sports injuries are probably the most common entity seen in a sports medicine practice, and can lead to the need for knee, hip, and shoulder replacement surgery. Our goal is to avoid these consequences by implementing appropriate medical care initially. The first priority when dealing with an injury, therefore, is getting good advice from a trusted and well-trained physician who absolutely places the athlete’s health above other sports-related considerations. For complex injuries or decisions, this should ideally be an orthopaedic surgeon who has fellowship training in sportsmedicine. The physician should be able to educate the patient/family/coach in terms of the seriousness of the injury, what treatment options are reasonable and most effective (surgical and non-surgical), and how long it will take for the injury to be mechanically stable such that activity can be resumed with acceptable/minimal chance of re-injury. A good rule of thumb here is that fractures usually take a minimum of 8 weeks to heal to the point where they are mechanically stable, ligaments 6-12 weeks. This means that
external support (brace/cast) is usually needed during this interval if it is felt that the injury is amenable to rapid return to sport.
This is the critical part of the evaluation. Are you hurt or are you injured? You can bruise/contuse your quadriceps or strain your biceps and keep fighting through the competition or workout with little chance of long-term injury (usually!). You can sprain your ankle and resume sports relatively quickly with appropriate support and low risk for long term consequences 90% of the time, but if you actually have a fracture or cartilage injury this could cause permanent damage. Your child may sprain their finger or bruise their knee and be able to keep playing without risk, but if they actually have a physeal (growth plate) fracture, this could result in growth deformity that might require surgery when this is recognized 6 months later. Actions have consequences, and we want to be educated so we can weigh risks and benefits when deciding on whether an athlete should play or sit for the time being. A reasonable physician or parent/coach will look at all the factors, including the level of competition and relative importance of this in terms of issues such as athletic scholarships, future career, current social integration, and long term health.
Wisdom is the skill of balancing the medical facts as we know them with life considerations such as these in an efficient and discerning fashion. It might (MIGHT) be reasonable for Thomas Davis to play in the Superbowl 2 weeks after surgery to fix his forearm fracture, but the same thing would certainly not be reasonable for your eight year-old son or daughter who has a rec league game this weekend. A wise physician will inform you that the fracture is not healed yet, could re-fracture if by you return to play too soon (see Dallas Cowboys’ QB Tony Romo’s clavicle fracture this year as an example of this), and the benefits of the activity absolutely better outweigh the risks you are taking. A wise parent or coach will value quality advice and make the right decision as to when it is reasonable to get back in the game.
Have a great rest of your weekend and enjoy the game!
-Dr. Robert S. Wolf, MD