The Injury Carousel

March 16, 2018


By David Gable

David Gable, MS, LAT, ATC, is Associate Athletics Director for Sports Medicine and Head Athletic Trainer for Football at Texas Christian University. He can be reached at:

When the college football season comes to a close, most football athletic trainers—not unlike their counterparts who cover other sports—will reflect back on the year to evaluate the number of injuries sustained, body parts affected, severity of the injuries, and variables that may have led to certain injuries. Oddly enough, each year seems to paint a different picture in what we often refer to as the “injury cycle.” What I am referring to is the rash of injuries to a particular area of the body that seems to change each year.

Each athletic trainer deals with injuries particular to the sports we cover. You could argue athletic trainers who deal with overhead sports such as baseball or volleyball will deal with more shoulder injuries, while track athletic trainers may deal with more lower extremity, overuse-type injuries. However we are all exposed to injuries throughout the body. 

Of course, the reason for this is that training and competition stress the body. Variables such as warm-up, load, mechanics, fatigue, recovery time, training gear, weather, and length of season can also add to this stress. There are so many variables in sport that are beyond our control. I always tell our recruits they are always welcome in the athletic training room, but we hope to never seen them in there. Unfortunately, most will end up on a table for injury evaluation at some point in their careers—some more than others.

As I discussed briefly in a previous article, one of our main goals as athletic trainers is injury prevention. If I held the secret to truly preventing injuries, I would have written a book by now, retired, and put a lot of my colleagues out of a job. Unfortunately, I have not. You’re welcome.

There are some injuries, whether contact or noncontact, that cannot be prevented regardless of the amount of time you spend on prevention. We all apply prevention programs for our sports, yet our athletes still sustain injuries. There are some excellent ACL injury prevention programs out there, but our athletes still tear their ACLs. Some athletes tape their ankles or wear braces, yet we still have numerous ankle sprains each year. What we cannot put a number on is how many ACL tears or sprained ankles we prevented from happening. Those statistics will never be known.

Pre-participation screenings have become a very popular injury prevention tool lately because we can use them to attempt to identify potential areas of concern, such as flexibility issues, muscular deficits, or mechanical faults. These screenings can go a long way in injury prevention if, once weaknesses are identified, we work with our strength and coaching staffs to correct these issues. Most are not quick fixes but need to be corrected over time and with consistency.

The key is proper education and instruction to the athlete. We have to train them, but they have to put our teachings into practice daily in the weight room or on the court, field, or track. Unless you are training a very small number of athletes, it is very difficult to watch all of them, all of the time. It is important to stress to them how important the injury prevention program is to their health and safety to insure they are as committed as you are to it.

Why injuries tend to cycle is unknown. Reflecting on my career, I remember one year where we had 31 back injuries in one form or another. I also remember a span of 13 months where we had six Jones fractures in the foot after a period of approximately six years without a single one. Another season, we had an inordinate amount of shoulder injuries requiring surgeries. At the end of each year, we sat down and tried to figure out why. What did we do differently? What didn’t we do?

It is important to sit down with your entire staff to discuss injuries at the end of the season and work together to build a well-rounded program. This should include your athletic training staff, strength and conditioning coaches, and equipment staff to begin with, but you need the support of your sport coaches, as well.

When collaborating, you should consider the amount of training that went into practices, the drills performed, and to what extent they were executed. Whether athletes played on a field or court and type and condition of the playing surface should be analyzed, too. In addition, were the athletes getting enough recovery time? Most train and compete year-round, but at what point does inadequate recovery time contribute to the number of injures you see? 

Once you evaluate all these factors, discussing changes with your coaches can sometimes feel very ominous. However, keep in mind that they want the same thing we want—healthy athletes who are available for practice and competition.

Take the time whenever you notice a trend in your injury report to evaluate the whole picture and then work closely with your colleagues to find simple, yet effective solutions to the issues. Just remember: They do not keep track of the number of injuries that never happened, but you can feel good about your efforts and how they contributed to the health and safety of your athletes.

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