Athletic Training and Sports Health Care

Editorial Free

There’s More to Sports Medicine Than Concussions and ACL Injuries!

Thomas W. Kaminski, PhD, ATC, FACSM, FNATA

The author has disclosed no potential conflicts of interest, financial or otherwise.

My most recent travels have taken me to the great northwest, to Portland, Oregon, where I participated in the 4th World Conference on Science and Soccer. This is the second such meeting I have attended (the last was in Ghent, Belgium, in 2012) and a refreshing change from my usual attendance at hard core “sports medicine” meetings. Although my presentations at this meeting have focused on the topic of concussions and soccer heading, I’ve come to realize that the rest of the world is not so focused on the same issues that seem to have engulfed the sports medicine community here in the United States. In fact, it is this observation that I wish to address in this editorial and the premise that there are many more areas of concern that sports health care professionals are dealing with than just sport-related concussions and anterior cruciate ligament (ACL) injuries.

An area of interest gaining traction in the sports medicine community involves injuries to our youngest athletes—the buzzword that seems most appropriate is pediatric and adolescent injuries! As more and more children participate in sports and recreational activities, acute and overuse injuries have increased; this translates into increased costs for medical care and attention. In fact, the number of injuries in this population is staggering, with estimates of more than 2.5 million each year in the United States alone.1 Physical and physiological differences exist between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability (compared with adults) include children’s larger surface area-to-mass ratio, children’s larger heads proportionately, that children may be too small for protective equipment, that children’s growing cartilage may be more vulnerable to stresses, and that children’s motor skills needed for certain sports are less complex until after puberty.2 Because of the many differences that exist between these young athletes and their adult counterparts, treatment plans must be adjusted to produce favorable outcomes.

However, the level of knowledge with regard to these types of injuries has improved substantially over the past decade, and properly trained sports health care professionals are now involved to provide the best care and to help to speed a safe return to competition. There is still room for improvement, and additional resources in the form of funding allocations, as well as advanced research, are needed to improve the athletic and sporting experiences of this most precious of athletic populations.

Hamstring injuries are a growing concern, especially in professional sports. Of particular concern are soccer-related hamstring injuries. With the world’s attention focusing on the summer 2014 World Cup competition being held in Brazil, these types of injuries could prove costly to a team’s chances of winning the ultimate prize in the world’s most popular sport! Hamstring strains are among the most common muscle strains in athletes3 and are common in sports that require sprinting, cutting, and jumping. Despite the prevalence and long-term disability associated with these injuries, little attention is given to them, especially here in the United States. In fact, the Athletic Training Research Laboratory at the University of Delaware conducted a survey of attendees at last year’s National Athletic Trainers’ Association meeting in Las Vegas with regard to their own treatment interventions involving hamstring injuries, and the results were presented at this year’s meeting in Indianapolis, Indiana. Perhaps what we gleaned most about this research effort is that clinicians are thirsty for new insight, knowledge, and advice on how to treat hamstring injuries and improve successful outcomes. Like many sport-related injuries, predisposition to subsequent injury rises drastically following hamstring strains, increasing the likelihood of a lifetime of disablement associated with such injuries. Although the topic is not especially fashionable with research-funding agencies, the problem is nonetheless widespread and deserves more research and insight to improve clinical practice guidelines and patient care.

As baseball season is in full swing, it has been hard not to notice the number of Major League Baseball players on the disabled list with elbow-related injuries. It seems as though scars associated with ulnar collateral ligament reconstruction, aka “Tommy John” surgery, is the true badge of honor in pitching circles. Major League Baseball commissioner, Bud Selig, said recently that he is personally concerned about the recent spate of ulnar collateral ligament reconstruction surgeries and other injuries experienced by major league pitchers. The reasons for the alarming increase in injuries to the medial elbow joint region are complicated and numerous and cannot be traced to one specific cause; however, the fact that the problem most likely begins in baseball pitchers at a young age is frightening. In addition, the “need for speed” and the mindset to increase ball velocities in excess of 90 mph without time for rest and recovery take a toll on the human arm. Although pitch count policies are in place in many sanctioned youth baseball leagues throughout the United States, the lack of such policies in effect as players move past their early playing days has created a “win at all cost” type of environment that directly impacts pitchers who log many innings with high pitching velocities.

I believe that it is imperative for the sports medicine community to take a hard look at the specific causes of these serious elbow injuries and to improve our prevention efforts to halt the disturbing increase in elbow injuries in this population of pitching athletes.

In this digital age of information sharing, we are bombarded with a constant message about certain health-related topics that are hot button issues. It seems as though the constant attention on sport-related concussions and ACL injuries in athletes has not waned in recent years, similar to many other sport-related injury trends of the past. As with most important social issues of our time, we, as health care professionals, must take time to pause and offer a rebalance and refocus for the good of our clients—the athletes!


  1. Centers for Disease Control and Prevention. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged =19 years—United States, 2001–2009. MMWR. 2001;60(39):1337–1342.
  2. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33(1):75–81. doi:10.2165/00007256-200333010-00006 [CrossRef]
  3. Petersen J, Hölmich P. Evidence-based prevention of hamstring injuries in sport. Br J Sports Med. 2005;39:319–323. doi:10.1136/bjsm.2005.018549 [CrossRef]


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