Nothing is more common in childhood athletics
than sprains and strains and soft tissue injuries and in this case, we’ve got a soccer player
who obviously was coming up to try to get the ball, either rolled over the ball or kicked
another one of the players. But regardless, what we know about this mechanism of injury
is that there was a sudden, abrupt stop and the player collapsed to the ground. Now our
first assessment is obviously that he’s awake, he’s conscious, and he’s breathing normally.
He seems to be in a little bit of discomfort or even some mild to moderate pain. But he’s
not in an unstable situation. So immediate activation of EMS or 911 may not be our best
first option. We can do a little bit more of an investigation first. And right now,
what I want to know is, is this an injury that’s going to require this player to go
to the doctor or to the ER or is it actually a bump or a bruise that this player can deal
with and they just want to get back in the game. That’s the real question, isn’t it?
And so here’s how we’re gonna get to the conclusion of that, with a moderately safe and conservative
method of investigation. The first thing I’m gonna do is I’m gonna ask the player, do you
hurt anywhere else, other than, it looks like your knee? Do you hurt anywhere? And he shakes
his head no. This is all that hurts and he grabs his knee. We call this self-splinting.
They’ll do it to their arm. They’ll hold a rib. They’ll hold their knee or their ankle.
And in this case, he’s stabilizing his knee. What I want to do, in this case he’s wearing
shorts, obviously. But if they had pants on, I would take my scissors and I would cut the
pant leg to be able to reveal the injured part. Now what am I looking for? I’m looking
for bruising, swelling, deformity, bone ends possibly poking up through the skin or under
the skin. I’m looking for angulation that’s not normal. And then, I’m looking for, ultimately,
an open bleeding wound that has a bone end sticking out, which is the most serious of
these injuries when it comes to fractures due to infection risk and vasculature and
nerve endings and things like that. But what I’m gonna do is I’m gonna say, hey, could
you just let me take a look at your knee. You don’t have to move it. And you can see
that there’s grass stains and dirt. But I don’t see any of those symptoms that tell
me, this is a serious injury. I see no bruising, the skin color looks pink, and it looks normal.
I could actually take the shoe and the sock off, if it didn’t cause any more harm, and
I could actually look at the toes to make sure there’s good circulation coming to end
of the toes. There’s no blue toenail beds or purple toenail beds. They’re nice and pink.
And then I kinda wait to see, does this player want to get back in the game? Because they
kinda know what’s going on. They know if they’re really hurt or not. And if he starts wiggling
around and watching the other players or checking for mom and dad, that’s starting to indicate
to me that, yeah, it hurt. But it may not be a serious injury. If he stays here, keeps
splinting his own knee, that’s when I’m going to assist, holding the injury, and we’re gonna
activate emergency medical services and have the paramedics or EMS professionals come out
and take a second look. In most cases, if we have this situation going on, we may want
to stabilize it further before we move the injured player. So we don’t injure the knee
worse, we don’t cause any secondary problems with neurological deficit or nerve injuries
and, most of all, we want to make sure that this player is in as much comfort as possible
and we don’t aggravate the injury. Now let’s take a closer look at a real practical question.
Is it okay for them to return to work or play after an injury? And this is a very basic,
but a very common sense question that everybody needs to ask themselves, whether it’s for
school, for work, or for the home. You know, we know that he got hurt initially. But that
happens all the time. They rub it off. It kind of wears off. It wasn’t a serious injury
in the grades of injury. It was more of a shock. It kind of torqued it a little bit,
maybe it hurt initially. But now, as he’s sitting on the ground resting and I’ve asked
the questions, he begins to say, you know, this doesn’t hurt so bad after all. I can
tell that because the patient is starting to move their own limb. Remember initially,
if it’s really serious, they don’t want anybody to touch it. Don’t touch it. Don’t move it.
I’ve got it. So we call this self-splinting. That’s the way I found this player initially.
But now as we’re talking, he’s kinda paying attention to the other players in the background,
checking out the game, maybe looking for mom and dad, starts to joke and laugh with his
friends. And the next thing you know, I see him start to move his leg back and forth,
wiggling it around. And I say to him, hey, is it feeling better to you? He acknowledges
it is. And I say, would you like to try to just stand up for me and see if it hurts when
you try to stand? Just be real careful. You can use my hand if you need to. Take it easy
there. How does that feel, standing up, just standing? If it hurts seriously, then we’re
gonna have him sit back down. And I’m gonna help protect that leg, or we’re gonna get
a chair or a stool, or we might even help assist them off the field. But in this case,
I talked to him and he’s kind of walking around and looking like, yeah, it’s not so bad. Then
I say, well, why don’t you just do a little circle here, just kinda put some weight on
it. How does that feel? He says, feels pretty good. I feel, I don’t feel like it hurts as
bad anymore. And at this point, now time is on our side. And I say, looks like you’re
doing well. If it starts hurting again, then you come off field. And we’ll help you, okay.
Otherwise, go have fun. He takes off, gets back into play, or goes back to work or back
to school. And in the meantime, what we do is we educate parents, we educate the coach,
maybe we are the coach, and we make a note of that. There was an injury. We’re gonna
watch this player, see if it happens again, and if it does, that’s when we’re gonna to
really assess whether this player should be seen at the urgent care center or the hospital.