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How do elite athletes deal with their sports injuries?
Summary
Champions bounce back after injury with the help of physiotherapists, sports biomechanics specialists and other expertsNeeraj Chopra won the javelin silver at the Paris Olympics two weeks ago, and last week, he won a silver with his last throw at the Diamond League in Lausanne in Switzerland. Through all this, Chopra has been carrying a minor niggle for a few months now, and is likely to get it addressed later this year. According to reports, the injury bothering the champion athlete is with his adductor muscles around the groin.
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A professional athlete’s injury is not the same as a normal person’s, according to sports medicine and sports science experts. For example, when the new Manchester United centre back Leny Yoro fractured his metatarsal, he was taken to surgery where his affected toe was operated upon. Normal humans like you or I would have either been given a cast or a splint and advised not to put any weight on the affected foot. Owing to the nature of demands sports makes on athletes’ bodies, they need to recover quicker and more thoroughly than us, which makes their course of treatment very different.
So, how exactly is an elite sportsperson’s injury treated? Biomechanical issues and overuse injuries are common across all sports, and a majority of the injuries are related to shoulder and knees. Muscle strains like hamstring injuries, ankle injuries, low back pain and groin injuries are also common in sports involving multidirectional movement such as cricket, football and hockey.
After picking up a niggle or an injury, an athlete’s first point of contact is a sports physiotherapist, says Vaibhav Daga, head of sports science and rehabilitation and a consultant for sports medicine at the Kokilaben Dhirubhai Ambani Hospital in Mumbai. “It starts with the expertise of the sports physios who can assess each injury at an advanced level," adds Ashutosh Nimse, a sports medicine consultant at the same hospital’s Center for Sports Science and Rehabilitation. “It is usually a sports physiotherapist because they are in close contact with the athlete. In some cases, it might be a sports medicine doctor or another specialist depending on the situation," says Daga.
Once the sports physio assesses the injury during the clinical examination, they come up with their diagnosis of the injury. After this, the athlete is sent for medical investigations such as MRI scans, X-rays and other imaging and scanning facilities to confirm the diagnosis and determine the extent of the injury. Based on confirmed findings of the investigations, a course of treatment is proposed to the athlete and their personal sports physiotherapist. The treatment could be surgical or non-surgical depending on the nature and severity of the injury, and whether the player can take time off from the season.
Sports injuries are graded from levels one to three depending on their severity. Grade 1 and 2 injuries can be managed with rehab or external support. For example, if an injury can be managed with external support such as a brace or minor treatment, the athlete could choose to continue playing till the end of the season or competition gets over. This is how Chopra continues competing despite his injury. More serious injuries such as hamstring pulls and lower back sprains, are still not severe enough for surgery. These injuries can be treated with a tailor-made rehabilitation protocol and athletes can return to play within eight weeks to six months. Grade 3 injuries are serious. These include ACL tears, fractures and elbow and shoulder ruptures, all of which require surgery before a player can return to the sport.
Phases of rehabilitation
After surgery, the next stage of recovery is rehabilitation. Rehab is broken down into three stages: early recovery, which is basic restoration of movements; intermediate recovery (strengthening); and final recovery, which is sport-specific drills. The first phase of rehab is mainly the protection phase, focusing on reducing swelling and pain, restoring range of motion, and ensuring the athlete doesn’t lose overall conditioning, says Nimse. “After this, we conduct further tests to see if they are ready for the next stage. We perform return-to-play tests, including strength assessments, hop testing, isokinetic testing, and balance testing, to find symmetry between limbs and determine if the athlete is ready to start sports activities," explains Nimse.
There is a lot of specialised equipment to assess and aid an athlete’s’ return to full fitness. “A sports rehabilitation facility usually has electrotherapy equipment, blood flow restriction apparatus, and an aqua treadmill for early-stage movement and faster recovery. We also use sports science equipment such as isokinetic devices for measuring strength differences, force decks for jump-based assessments, and a node board for hamstring strength assessment. These give us accurate data to tailor rehabilitation programmes," Nimse adds.
During rehab, players are tended to by teams of specialists, including those who specialise in biomechanics and strength and conditioning.
“The sports biomechanics specialist analyses the athlete’s movements to provide feedback for injury prevention and performance improvement. The strength and conditioning coach helps the athlete regain strength in the affected region," says Daga. While almost every athlete undergoes post-operation early rehab at the sports medicine facility, some choose to continue the subsequent phases of recovery with their personal physios and strength & conditioning coaches. In each case the athlete and their team are made aware of the full course of treatment in detail complete with procedures, possible risks, likely outcome and timelines. “The final decision rests with the athlete," says Daga.
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.
