Tackling trauma: A play-by-play of football’s common injuries
Published 9:58 am Monday, September 11, 2023
By NOAH WORTHAM | Staff Writer
It was the fifth game of his senior season in 2022 when Pelham standout athlete Darius Copeland jogged on the field for what he thought was going to be a normal kick return. That kick return, however, led to his final play in a Pelham jersey.
His mother, Cynthia, was in the stands and did not realize her son was hurt till she heard his name called.
While in pain, Darius made his way to the sideline to get checked out.
“I went to the sideline with my trainer and he checked me out,” Darius said. “I did some exercises, I went through them 100 percent, and I was still running.”
Not aware at the time of the seriousness of the injury, Darius went back onto the field and kept playing.
After several minutes back in the game, Darius would end up falling once again, this time taking him out of the game and out of the season.
While making a cut on a corner route play, Darius’s cleat got stuck in the turf.
“I hit a little one-two step on the corner route and when I came back on my right leg, my leg just folded and I felt like I broke it at first,” he said. “I really think I just landed on it wrong. I really don’t remember, I just remember feeling like my bone was out of my skin.”
After staying at the game as long as he could to support his team, Darius went to Andrews Sports Medicine that night. Following some tests, he eventually learned that he tore his ACL.
“My mom came in and told me, and I broke down,” Darius said. “I really thought about being done with football after all that, but I had told myself that I was just going to keep my head down and keep working and get back on the field.”
It was a sad end to what was setting up to be a remarkable senior season for Darius, but also part of the reality of playing under the lights on Friday night.
“In the end, football is a full-contact sport,” said Dr. Ricardo Colberg, an orthopedic physician with Andrews Sport Medicine, the medical provider for Shelby County Schools. “It’s not a matter of if it’s going to happen, it’s a matter of when it is going to happen and how bad is it going to be? Being proactive about learning how to prevent these injuries is going to be important to minimize the chance of having a catastrophic injury.”
Dangers of turf
Concerns have been raised in recent years over the use of turf with some arguing that artificial turf poses a greater risk for damage to extremities and, with seven out of Shelby County’s 11 AHSAA schools utilizing turf, it is an important question to explore.
A study in the American Journal of Sports Medicine in 2019 investigated if there was a difference in the rate or mechanism of knee injuries between natural grass and artificial turf.
Out of the sample the study investigated, athletes experienced all knee injuries at a significantly higher rate when participating in competitions versus practice. Athletes were found to have experienced posterior cruciate ligament (PCL) and ACL injuries at 2.94 times the rate as those playing on grass. However, no statistical difference was found in the rate of MCL, medial meniscal or lateral meniscal injuries. It is important to note that these studies were focused on NCAA teams.
“The studies have shown that there is an increased risk of sustaining an ACL injury to the knee. The ACL is the main ligament that stabilizes the knee when you play on artificial turf,” Colberg said. “The artificial turf has a lot more grab on the cleats, and so the foot doesn’t skid or slide as much and if someone does a sharp turn, or change of directions, the cleat may get stuck in the ground.”
Which, according to Darius, is exactly what happened as he played on the turf at Pelham’s artificial turf.
“When I had made the cut, the cleat had actually gotten stuck in the field’s turf,” he said. “It was non-contact.”
However, the negatives of artificial turf do not seem to be the same for every type of injury. The Orthopedic Journal of Sports Medicine in 2019 sought to identify risk factors for NFL concussions and musculoskeletal injuries and found, in one of the results, that the risk of shoulder injuries during team games in the NFL was significantly increased for games played on grass surfaces.
“If we play on regular grass, there is risk and benefits to it, and if we play on turf there’s risk and benefits to it,” Colberg said. “Really, it’s a matter of the athletic trainer and the sports medicine physician covering the games to understand what these are, so then, if an athlete gets injured, they know what are the injury patterns that can happen and that those conditions in that scenario.”
Due to the physical nature of the sport and its tactics such as tackling, it should come as no surprise that concussions are one of the most common injuries within the world of football.
“Concussions have garnered a lot of attention over the last several years, really because they are fairly common, and luckily, most concussions, especially in middle school and high school kids, will resolve over the course of a week or two,” said Michael Patterson, an orthopedic surgeon in Alabaster and the team physician for the four-time defending state champion Thompson Warriors.
Signs of a concussion include, headache, dizziness, nausea, blurred vision, difficulty with vision or hearing and difficulty with sleep.
“If those symptoms are present, it’s critical that the player is in constant communication with the sports medicine team,” said Nate Bower, owner of Uncommon Physical Therapy.
Multiple concussions can lead to Second Impact Syndrome, which can have severe and permanent consequences on a player’s life.
“What we’re really trying to prevent is what’s called Second Impact Syndrome,” Patterson said. “(When) they’re still having symptoms and they return to the sport and they get another hit to their head or neck area, which in of itself may have not been a big deal, but because they already have concussions, it then makes those symptoms worse. Those sometimes have a prolonged recovery and sometimes even some long-term issues.”
According to Bower, many times, initial concussions go undiagnosed because the player may not report the symptoms they are experiencing to an athletic trainer, coach, the team or a physician.
“A lot of times, if you’ve sustained a second concussion, you are at more risk to sustain another one down the road,” he said. “It is imperative for athletic training staff, team physicians, coaches and parents to be very aware if they’re noticing any unusual signs or symptoms from that athlete.”
A major way to prevent players from sustaining concussions is through learning a proper tackle method.
“Learning proper tackling techniques is going to be the most crucial aspect,” Colberg said. “When you’re tackling, you’re tackling with your chest and shoulders and you’re not tackling with your head. You should be able to keep your eye on the opponent at all times, you should not be putting your head down at any point when you’re engaging a player for a tackle.”
Sprains, strains and tears
Perhaps the most common injury seen on the field, aside from minor ones such as bruises, contusions and scrapes, are sprains and strains.
“I think the primary injuries we see, whether it’s athletic training, physical therapy or some of the off-field positions, it’s probably more of your acute sprains and strains,” Bower said. “It could be a knee or an ankle, sometimes wrist, elbow and shoulder.”
Fortunately, however, sprains and strains are typically the most easily treatable injury from football.
“Most of those will respond to some therapy, icing, anti-inflammatory medications, sometimes braces are required, for the most part those don’t cause long term disability,” Patterson said.
However, tears are also fairly common, especially an Anterior Cruciate Ligament (ACL) tear. The ACL is a ligament in the knee that stabilizes the tibia to the femur and stops the tibia from shifting forward as the player cuts or pivots.
“When your ACL is torn, when you try to make a turn or cut or pivot, that knee will buckle or give on you,” Patterson said. “By doing so, you then damage other structures in the knee, and so, that’s why, most of the time, ACLs require surgical treatment to restabilize the knee.”
ACL tears usually occur as a direct contact injury from a player colliding with another player in which they are forced into a position which disrupts the ACL or in a non-contact situation in which the player is accelerating and immediately has to change direction and the knee buckles under that force due to friction. There are some cases in which an MRI is needed to detect the injury.
Surgery can be anywhere from between a week to two after the onset of the injury or could be delayed up to four to six weeks depending on the severity of the swelling. ACL tears are a season-ending injury and can take a significant amount of time for the player to recover and return to the field.
Often, when a player is falling, the instinctual action is for them to use their arm to break their fall, but this can lead to a variety of injuries, particularly for the shoulders and elbows.
“Another thing we see commonly is shoulder dislocations or shoulder instability,” Patterson said. “That is generally where you tear what’s called the labrum in your shoulder, which is a little cushion that helps stabilize that ball and your shoulder joints. When that’s torn, it allows increased motion in your shoulder. The tendency, especially in younger athletes, is for that shoulder to come in and out and if you do that, it damages other structures around your shoulder.”
Often, depending on the position, team physicians will employ a brace to help the players get through the season.
“A lot of athletes attempt to rehab those (shoulder dislocations) non-operatively,” Bower said. “In which case, I would see them in the clinic and put them through a fairly comprehensive program addressing any need that they may have.”
Players can work to avoid shoulder dislocations through learning correctly how to fall by rolling.
“That actually helps prevent a lot of injuries,” Colberg said. “I do see a lot of injuries, particularly for elbows and shoulders, where they’re actually trying to break the fall as they’re falling with their arm and then they have the weight of a lineman on them and the shoulder ends up dislocating when ideally they should have tucked in and rolled and then you actually avoid an injury by learning how to fall.”
Although less common, fractures are also an unfortunate injury that can occur during games and practice. Upper extremity fractures usually occur when a player lands on an outstretched limb and lower extremity fractures come from contact.
“Let’s say you have a running back who has the ball and he’s making a cut and he gets hit at an angle from another player, you could see a tibia fracture, maybe a fibula fracture,” Bower said. “I’ve only seen a few femur fractures from football. That’s a lot more rare.”
Fortunately, many times, players can still find a way to get back into the game depending on the severity of the fracture.
“Most of those, depending on the severity of that fracture, and even with or without surgery, we can brace or cast those so that they can still play some positions in football,” Patterson said.
Like with any injury to the extremities, fractures can be better avoided if players adjust the method in which they fall and tackle and avoid landing on limbs.
Although it might not be what one’s mind immediately thinks of in regard to sports injuries, heat illness and heat exhaustion is a common danger when it comes to high school football games and practices.
“Heat illness is totally preventable, but there’s still a lot of deaths and sports-related heat illness through the U.S. every year,” Patterson said.
According to the National Center for Catastrophic Sport Injury Research, from 1960 through 2022, there were 157 exertional heat stroke cases that resulted in death, with 51 of them being high school level athletes.
When an average athlete is outside practicing with their full equipment on, their surface body temperature can increase by 30 degrees.
“Their surface body temperature, which is right at the skin, may feel up to 120 degrees,” Colberg said. “That’s why it is so difficult for a football player with all the gear on to be able to withstand a long practice or a long game with the heat that we’re having right now.”
Due to the extreme heat and the nature of the sport, athletes should prepare their body for upcoming games and practices.
“Hydration doesn’t start the day of the game, it starts the day, the week after the last game or the last practice,” Patterson said. “You first have to replace the fluids that you lost from that day’s practice and keep up with that throughout the week. So, that by the time you’re ready to play, you’re not starting from a negative hydration status that puts yourself at an increased risk to not perform well but also some other issues related to stroke or heat exhaustion.”
Sports drinks also make an excellent hydration tool to replenish an athlete’s hydration and energy.
“Once you’re in practice and games, we should be changing from regular water to sports drinks that have electrolytes and will have sugar to help provide the minerals, nutrients and the energy to be able to get through practice,” Colberg said.
Keeping hydrated will not only help protect athlete from heat illnesses, but it also ensures that they are able to perform to the best of their abilities.
“We know that even with a two percent loss of body water, they have a decrease in 15 percent of their sports performance,” Patterson said. “Fluid management is very important for athletes because if they are dehydrated they are not performing at their top level.”
Another way to prevent heat illness is through acclimating one’s self to the environment.
“We talk a lot of about acclimation which is, especially in football or other outside sports this time of the year, when they usually spend the first five days out in the heat, but not necessarily with all the equipment on,” Patterson said. “Your body has to learn how to get rid of that heat in your body, your ability to sweat that off, really to get rid of and control your body temperature. If you haven’t done that, (you) are more prone to heat illness.”
The love of the sport
After a period of roughly six months, Darius was back on his feet and had fully recovered from his ACL injury thanks to the efforts of his coaching staff, physicians and doctors at Andrews Sports Medicine.
“I would rather be with them than anybody in this world,” Darius said. “I would go two times a day, just working on my knee. They helped a lot, not even just my knee, just having them telling me to keep pushing it. They were always there for me even in school.”
Although he never got to play another game for Pelham, Darius committed to Liberty University and has started his new role as a member of the Flames.
“I didn’t really know I was going to be ending up here at Liberty,” Darius said. “The coach up here, Tony Washington, me and him had a good connection. He still had trust in me. He had faith in me that I could still be the player that I am.”
Although injuries are a common occurrence in the world of sports, physicians are sitting on the sidelines ready to help players get back on their feet.
“Our goal as a sports medicine physician is to get people back into that sport they love,” Patterson said. “That’s the enjoyment I think I get out of it—seeing people return back to a sport that they enjoy playing and I enjoy watching.”
Like any other sport, football has its risk for injury but it also has its own lessons and rewards.
“At the same time, there’s a lot of benefits to playing the sport,” Colberg said. “Athletes learn to pull themselves away from the individualism and selfishness and think more about playing as a team. They learn discipline, they learn to follow instructions, they learn about strategy and game planning.”
However, players need to condition their bodies and recognize their own limitations in order to engage in the sport with minimal risk.
“We have to respect our bodies and learn to understand what our body can and can’t do,” Colberg said. “I think if we come to terms with that, we can minimize injuries.”