Keeping Them on the Field

M usculoskeletal injuries are an integral part of many sports. Contact sports seem to produce the most, with football, hockey, soccer, and basketball leading the way. As athletes compete and push themselves to improve, sprains, strains, contusions, and other injuries become part of the daily routine. Those often attending to these athletes with regular aches and pains are athletic trainers, physical therapists, and physicians. Such sports medicine teams are there to emphasize prevention, treat injuries, and keep athletes on the field or court. This last objective produces the following dilemma: Where is the line between allowing injured athletes to play and restraining them to prevent further injury? Who draws the line? When is further competition harmful? How much can athletes withstand, and at what point does the sports medicine team say, " It's time to rest " ? Up to the high school level, the medical team can rely on parents in the decision-making process, for it is they who—above all the hype, hoopla, and excitement—can keep the best interests of their sons and daughters in mind. When the future health of athletes is jeopardized or when there is a real chance of further injury, most parents can and do make the right decision with the help and guidance of the sports medicine team. Parents occasionally lose sight of the big picture and become blinded by their offspring's athletic stardom. Coaches can also become irrational and shortsighted. This situation can make the life of a team physician very challenging. Thankfully, at the high school level, this usually does not happen, often making the job of the medical team straightforward. When athletes are good enough to advance to the collegiate level, the complexity of these situations expands as expectations and demands increase. In big-time revenue sports, such as football, hockey, and basketball, the pressures mount for the athletes to play through pain and injuries. The success or failure of college coaches who are commanding million-dollar salaries is often determined by a bunch of teenagers who were promised an education in exchange for subjecting themselves to the rigors of college sports. The bounty for the successful teams is impressive: stadiums and arenas full of grateful, adoring alumni willing to support the institution. Bowl games, successful recruiting, and bonuses are the spoils for those who are victorious and maintain an edge over traditional rivals. However, for those coaching regimes that do not make …