Why doctors are concerned about injuries — not just COVID — upon prep sports return

Beyond the masks, the disinfectant, the logistical nightmares of this shortened spring season, there’s one more thing eating at the minds of many high school coaches in California. How will they protect their players from injuries after a year or more away from the playing field?

The time sidelined could lead to an uptick in overuse injuries as well as more serious acute-traumatic ones, like tears to the anterior cruciate ligament, said Dr. Kevin Shea, the Director of Sports Medicine at Stanford Children’s. Dr. Nirav Pandya, a pediatric orthopedic surgeon at UC San Francisco, said injuries would be the “inevitable consequence” of bringing back sports so quickly.

In response, many Bay Area football teams have adapted their training routines and taken other measures, such as limits on playing time — steps that could help limit the risk, the doctors agreed.

“I think the concerns are legitimate,” Shea said. “When people ramp up their activity, they’re more likely to have overuse injuries — tendonitis, aches, pains, other things . ... but also acute injuries — things that are more likely to be more severe, you miss more playing time, you might be in the emergency room, you might even have to have surgery. Those two areas are certainly of concern.”

When the Saratoga Falcons took the field for the first time last week, coach Tim Lugo said it looked more like a spring practice — months away from competition with little contact — than one only weeks away from the start of play.

Players didn’t wear any protective gear besides their helmets until after the first day of practice, Lugo said.

A gradual ramp up is one of the most effective ways to prevent injury after a long layoff, Pandya said. Pandya said six weeks would be the ideal to prepare for the season. Instead, most teams will have about half that time to fit in an entire slate of preseason practices.

“The first couple days, we’re just getting kids used to wearing a helmet again and putting a mouthpiece in their mouth,” Lugo said. “I treat this like traditional spring practice . ... The only problem is in May, we have two-and-a-half months before we play. Now, we have two-and-a-half weeks.”

Already, Shea and Pandya said they have noticed an increase in visits to their clinics since the first practices began last month.

In a normal year, Pandya said he operates on about 10 to 15 ACL tears per month but that number fell to only about one every month while sports were down for the past year. Just last week, Pandya had five new patients come in with ACL tears, he said.

Pandya, a former collegiate track athlete, learned first-hand the effects of a long layoff. After his freshman year at the University of Chicago, Pandya took time off to study for medical school. The following year was marred by injuries, he said.

“I think that at a certain level, you need a base that you can build on to really train. If that’s not there, it’s hard in real-time to catch that up,” Pandya said. “The most important thing I think for coaches and athletes to know is just to recognize that and to modify based on that . ... Trying to translate what you were doing before is going to lead to problems.”

At De La Salle High in Concord, a training staff led by Kent Mercer will be closely monitoring each athlete’s level of conditioning as they prepare for their season opener this weekend. The Spartans plan to limit players to one side of the ball, Mercer said, meaning no one will play on offense and defense in the same game.

As a private school, De La Salle has been in session since October. Players have been able to lift weights in a converted batting cage and hold conditioning workouts since the summer, Mercer said. At Saratoga, the football team transported their weight-lifting equipment outside to the softball field.

Without the luxury of extra preparation, Mercer said he would have reservations about such an accelerated timeline to play.

“If we were just starting up, I wouldn’t feel comfortable sending kids out there to play a sport like football,” Mercer said. “The sport doesn’t change. You have to make sure the kids are ready. There are challenges with that. It’s a short season and we want to give them as much as we can, but we also have to make sure they’re safe.”

Even for athletes who have been able to train throughout the pandemic, some aspects of the game can’t be replicated, Pandya cautioned. Not every public school has a dedicated athletic trainer, either.

“If kids aren’t ready to respond in real-game speed, that’s where the risk occurs,” Pandya said. “One thing we do know is when you suffer these injuries is when your muscles aren’t strong enough and they get fatigued . ... Your form breaks down and you twist or you lose that balance in your leg and you tear your ACL. We’re going to start seeing those traumatic injuries, and I’ve even already started to see it a little bit.”

In the NFL, more players suffered ACL and MCL injuries during practice prior to the 2020 season than either of the previous two years. But the number of serious knee injuries was about in line with the average since 2012, according to the NFL’s health and safety data.

Certain exercises can reduce an athlete’s risk of harmful knee injuries by as much as 50%, said Dr. Andrew Pearle, who specializes in ACL injuries as the Chief of Sports Medicine at the Hospital for Special Surgery in New York City. Getting coaches to convince kids to adopt the time-consuming and often boring routine, though, he compared to having a vaccine that people refuse to take.

“We can prevent half these injuries, almost like a vaccine can prevent a virus,” Pearle said. “But people don’t take the vaccine or people don’t do the exercises.”

Planks, squats, hamstring curls — with proper form — can all help minimize the risk of injury by strengthening the core and the hips as well as improving balance, all of which helps mechanics of sharp cuts and awkward landings, Pearle said, two motions that commonly lead to ACL tears.

At Hillsdale High in San Mateo, coach Mike Parodi said some players have already taken time off to nurse tight hamstrings, though, “knock on wood,” he added, “I think it’s just a normal start to the season.”

After a year away from the practice field, Parodi said he wasn’t in peak form either.

“Shoot, my voice is cracking all the time,” he joked. “I’m not used to coaching on a full field.”

While athletes in sports like football, basketball and soccer may be at a higher risk for severe injuries, Pandya and Shea noted, endurance athletes may be more plagued by those of the overuse variety, like stress fractures and tendonitis, that can also derail a season.

However, a growing number of programs are becoming smarter about the way they train, Shea said, which can help reduce the risk.

“I think many more coaches are recognizing that and becoming a little bit more scientific and a little more responsive to the athletes with their training,” Shea said.

He also said not to discount the psychological benefits for kids who are able to play sports for the first time since last March.

As for the risk of COVID versus the risk of injuries, Pandya said the latter should be of more concern as high school sports return to California.

“If you think about the high school athlete, they’ve had really no access to training. They haven’t had contact with their coaches, for the most part,” Pandya said. “I think as long as they’re doing the right stuff outside of the game, the injury risk is much higher for these kids than the COVID risk.”