Built Different: Why Proper Evaluation After Illness & Injury Matters for Athletes

If you are an athlete, it is very likely that this has happened to you before in sports…

While training or competing and subjecting your body to the many 'load' demands and stresses of highly dynamic sports movements you, "tweaked” something.

The result was possibly:
     - an ache in your foot or ankle
     - soreness in your knee or hip
     - a 'pulling' or 'jabbing' sensation in your mid- or lower back

Something happened that made you 'pay attention' in the moment though it was not enough to make you stop participating.

So you shrugged-off the moment of pain and decided to press-on, remembering somewhere it the recesses of your sports mind that someone once told you that there's a difference between being 'sore' and being 'injured'.

But in this moment of discomfort, you chalked it up to 'soreness' and you finished-out the training session or competitive event.

The next day, you soreness persisted, perhaps now with some swelling, and after talking to a teammate or other well-intentioned untrained consultant, you diagnosed yourself as simply being "a little stiff“ prompting you to opt for 'recovery' without evaluation and maybe a quick check-in with the Medscape University of Online Medical Science or the Google Virtual College of Sports Medicine.

Of course, I am joking because neither of these entities exist nor do their information platforms present themselves as medical institutions of higher learning.
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In your mind, you’re thinking that the discomfort, decreased mobility and feeling of dis-ease (un-wellness) will pass, but they don't.

Now, weeks later, you are still “not back to normal“ and “not 100%“ and more concerning, still not able to return to full participation.

You start with a your primary care provider, local urgent care or emergency department only to be told to 'rest' and 'be patient'.

You finally connect with a sports health professional and after a number of sports-specific 'provocative' tests where simulated sports-specific movements and stress to the injured body part produce tell-tale discomfort, and a definitive culprit.

The diagnosis, a significant, performance-altering injury to a bone, ligament or tendon followed by a prolonged recovery that has now been delayed by a month or more, leaving
you wondering, how did this happen, how did I get here?

ATHLETES MUST UNDERSTAND THAT THEY ARE BUILT DIFFERENT
If you are participating in a any highly dynamic sports activity at the elite or sub-elite training and competitive level, or are participating at an intensity level or frequency that higher than normal, you are subjected to repetitive and incredible dynamic forces.

Even if highly trained and optimally physically fit-- even with honed sports-specific movement mechanics, better-than-average nutrition and hydration and an attention to and appreciation for wellness and self-care, we can often talk ourselves out of seeking the care we need after injury or illness.

For some of the hesitancy comes from a place of fear and anxiety regarding the potetial diagnosis.

For others, culture and 'coaching' has encouraged stoicism, implying that pain and discomfort are obstacles to be overcome rather than 'signals' from the body that should not be ignored.

High performing athletes have to understand that they are different and that the physics of their movement is not on their side.  

The physical forces being placed on muscles and joints are enormous and over time, the cumulative effect of these repetitive high velocity/loading forces can compromise joints and tissues.  

The are times where the 'tweak' or the 'pull' is just a 'tweak' or a 'pull', but sometimes the symptoms are a sign of the actual or impending failure of these tissues and structures under the enormous stress of repeated high-velocity movement.

And the answer can rarely be uncovered through an internet search alone.

WHAT ATHLETES CAN AND SHOULD DO
'Listen' to your body within the context of your status as a high-performance athlete-- understanding that the dynamics and circumstances are different because missed or delayed diagnosis can impact your ability to train and compete.    

Any one or combination of the following may be a sign symptoms of a deeper injury that warrants prompt attention from a trained sports health professional:

   - pain that persists or worsens over time
   - discomfort that produces unusual selling or bruising
   - any swelling or bruising while on a 'blood thinning medication as warfarin (Coumadin, Plavix, Xarelto)
   - discomfort that significantly impacts normal movement and/or joint function
   - discomfort associated with numbness/tingling
   - discomfort that produces weakness of an extremity
   - discomfort or un-wellness that is associated with a previous similar injury
   -any illness/injury that may exacerbate (make worse) a current chronic medical condition (like asthma/COPD, irregular heart rhythm, kidney disease, diabetes, seizure disorder)

And perhaps the most important consideration is if you feel unsure or in any way unwell to the point of distraction, seek care-- again from a trained clinical sports health professional.

WHERE SHOULD I GO TO SEEK EVALUATION?
If you believe that your injury/illness requires “now” evaluation, you may opt to visit an emergency department or urgent care center.

If you believe your injury can 'wait', you should attempt to promptly contact a trained and credentialed sports health professional.  

If you are participating at a level where you have access to a sports health support team (athletic trainer, physiatrist, team clinician),  a member of that team can help coordinate the 'next steps'.

When in doubt, utilize emergency care options and move forward from there.  Do not hesitate to seek care if you feel that you need it urgently or emergently.

THE ROLE OF THE EMERGENCY ROOM
From contusions (bruises) to concussion, emergency departments exist to evaluate, rule out and provide stabilizing care for acute life or limb, threatening injury/ill illness.   In the US, they are open 24/7/365 and must provide all patients with a medical screening examination regardless of insurance, financial or immigration status, etc.

Emergency department staff are highly trained clinical professional with a wealth of clinical knowledge on a wide variety of conditions.  Emergency department staff, in general, are not specifically trained in the care and management of the high performance athlete.

The emergency department can absolutely assess and even diagnose a wide variety of sports-related conditions and provide pain relief, immobilization through splinting, weight-bearing assistance with crutches, and perhaps preliminary imaging if clinically indicated.

Even if you are evaluated and treated by an emergency department clinician with additional sports-specific training, all emergency department visits for all complaints will end with discharge instructions that include a follow-up interval and a recommended follow-up provider/specialty.

For the high performance athlete, if an injury or illness warrants evaluation in the emergency department, the next step is to coordinate care with a properly trained and licensed sports health provider.

If you are 'attached' to a team with sports health and performance support, your follow-up will start there.  Those with health insurance may need to check their insurance network's directory of providers.

When in doubt, before you leave the emergency department, ask for information about sports-specific services that might be available at the hospital/health system where you are being treated.

This is important because sports-focused evaluation and treatment plans can improve recovery time and outcomes for injuries as well as illnesses.

Additionally, in the case of treatment plans that require medication, it is important to involve sports-focused clinical providers to ensure that you are not receiving medication’s that are banned or restricted.

In those cases, depending on your level of participation and/or the organization governing competitive participation, you may require a Therapeutic Use Exemption in order to utilize those medication‘s.

THE SPORTS-SPECIFIC CARE DIFFERENCE
The post-COVID availability of telemedicine and virtual care has expanded the accessibility of all clinical services including sports health related care.

Despite increased access, many athletes still appear reluctant to seek sports-related health services.

Interestingly, data suggest that within youth sports in the United States, less than 5% of total participation-related expenditures are related to health, wellness, and performance.

The bulk of that 5% is spent in the evaluation, diagnosis and treatment of acute illness and injury with very little investment in comprehensive, proactive, prevent preventative, whole athlete care or recovery/rehabilitation.

At the elite performance level, the degree of investment has been studied across many sports, particularly as it relates to injury-reduction and overall player and team performance.

The data suggest that teams that have a more robust investment in these support services, in general, tend to be more successful.

The relationship between the health and wellness of the athlete and performance success is being studied but logically, healthier athletes are better positioned for success in competition.

The estimates suggest that most elite-level/professional teams invest somewhere between 15% and 35% of budgeted expenses on health, wellness and performance support.

Furthermore, this investment has been shown to have a 3 to 6-fold return on investment as measured by both revenue and winss-and-losses.

THE BIRMINGHAM CITY FC STORY
Birmingham City FC competes in The Championship, which is the second tier of English Football).  During the 2024 season, club leadership made a considerable investment of time and capital on improved emphasis in the areas of performance and recovery.  

Using an innovative, evidence-driven platform, the work of the physio team led by Dr. Pete Cummings led to:

   - earlier detect neurocognitive and neuromuscular fatigue
   - prevention of injuries that could player availability and overall team performance
   - personalized, player-specific recovery plans

The result was real time data that staff could use to reduce injury risk and improve recovery.  

The result was a 'breakout season' and the resurgence of a storied English football franchise.


FOLLOW-UP CARE AFTER INITAL EVALUATION
all sports related injuries in high performance athletes require follow up!

One of the primary goals of this follow-up is to ensure that your recovery returns you to full, competition-level, strength, agility and function.

Some injuries and illnesses that do not impact the non-athlete can still produce subtle changes in movement mechanics, stamina, etc that keep the injured athlete at risk.

Additionally, even small changes and overall movement mechanics in response to an isolated injury can put other joints and muscular systems at risk.

For example, a right ankle injury that is not fully recovered could put unnecessary stress on the hips, lower back or joints of the opposite leg. This would likely go unnoticed in a non-athlete but could manifest as an overuse injury in the high performance athlete— further prolonging recovery, and return to full participation.

IMPORTANCE OF THE “RECOVERY PARTNERSHIP”
Interaction between the athlete and the members of his/her health, wellness and performance support team is best described as a partnership.

The athlete brings personal goals and objectives and an honest self-assessment of strengths, weaknesses, and commitment.

The trained professionals that make up the support team bring knowledge of science and data driven best-practices along with sports health-specific clinical experience.

Within the framework of that partnership, there must also be transparency, open/honest communication and trust.

When the partnership is firing on all cylinders, it produces powerful and performance shifting results.


FINAL ANALYSIS
The human body is incredibly strong and resilient. Trillions of cells under highly complex, physiological and neurological oversight, working together, just to maintain “normal” daily function.

Now insert the intense demands of high performance sports participation.   High performance athletes are 'built' different.

The ability of the body to meet/exceed the demands of these complex, high demand movement mechanics are to be marveled as extraordinary.

Nonetheless, injuries and illnesses do occur and athletes at any level of skill or participation are not exempt.

As a high performance athlete, your body is your instrument that, when finely tuned and functioning, will allow you to separate yourself from teammates with whom you may be competing for match minutes as well as competitors.

Do not underestimate or undervalue the importance of remaining tuned-in to your own body and staying connected to the health and wellness support resources to keep you “in the game” and at your best.

With the amount of time, energy and finance that millions invest each year in high performance sports participation, perhaps athletes should consider leveraging some of that expenditure in a way that encourages health, wellness, well-being and self-care.

At the organized sports level, particularly among youth sports, coaches and organizational boards that desire to create market separation between their “brand” and the competition should consider the role and benefit of a more robust health, wellness, and performance focus.

In the end, where there are sports, there will be competitors and where there are competitors there will be injury.

Perhaps some of this information may help to shape your approach in a way that improves competitive success as well as your level of joy and longevity.

Christopher T. Conti, MD is the Founder and Owner of Steel City Direct Care, LLC., a Pittsburgh, PA-based medical practice specializing in the care of athletes and aviators.  He is an emergency medicine physician with additional training in sports and concussion health.  He is currently a Team Physician for the US Soccer Federation (USSF), U14-U17 Youth National Team player pools, Medical Advisor for the PA West Soccer Association, a local affiliate of the United States Youth Soccer Association and the Medical Advisor for the Woodland Hills School District in suburban Pittsburgh, PA.  Dr. Conti serves as Medical Advisory Board Member for  SportGait and is also a Credentialed ImPACT Consultant (CIC) for sports concussion care.  Dr. Conti is a designated Senior Aviation Medical Examiner (AME) for the Federal Aviation Administration (FAA)

Disclaimer
The information, opinions and content presented do not necessarily represent the policies or opinions of USSF, the FAA, PA West Soccer, USYS, FIFA, ImPACT, SportGait, the Woodland Hills School District or Steel City Direct Care, LLC.  
None of the information presented should be construed as formal medical advice, nor should it be considered an acceptable substitute for a formal virtual or in-person encounter with an appropriately trained and licensed healthcare professional.  None of the above-listed entities, including Steel City Direct Care, LCC, are responsible for any adverse outcome associated with this content.  
If you would like to schedule a virtual or in-person visit with Dr. Conti, please contact Steel City Direct Care

Steel City Direct Care is a Direct Patient Care (DPC) practice that provides targeted & specialized in-person and virtual care for aviators and athletes of every age and level of skill and participation.