Why Athletes are More Susceptible to Injuries Amid the Pandemic—and How to Prevent Getting Hurt

Orthopedic surgeon and sports medicine expert Dr. Nicole Belkin shares winning tips to help athletes safely return to team and competitive sports.

Cleated shoe kicking a soccer ball
Cleated shoe kicking a soccer ball

As athletes look ahead to returning to peak performance when the coronavirus pandemic subsides, the proverb rings true: Slow and steady wins the race.

In the wake of the COVID-19 outbreak — which has shaped a “new normal” that changed how people live their daily lives and interact with one another — athletes at all levels have been advised to adopt a more measured training regimen that builds over time as they are able to return to competition, especially if there are disruptions in the training schedule due to fluctuating infection rates.

“Restarting sports is a marathon, not a sprint,” says Dr. Nicole Belkin, chief of orthopedic surgery and rehabilitation and regenerative medicine at NewYork-Presbyterian Hudson Valley Hospital.

In fact, rushing back into sports after a prolonged layoff without proper training or preparation can lead to more injuries, according to a paper published in the International Journal of Sports Medicine.

“We’ve seen typical sports-related injuries at increased rates and in different age groups,” says Dr. Belkin, who is also an assistant professor of orthopedic surgery at Columbia University Vagelos College of Physicians and Surgeons. “We’ve seen an awful lot of stress fractures, shin splints, and shoulder and elbow injuries because of the lack of a gradual return to sports, less practice before the season, and overzealous practice schedules due to condensed preparation.”

A more conservative reintroduction to training is especially important for athletes who have recovered from COVID-19. “Athletic trainers and coaches should know that students who had an infection or tested positive for antibodies should spend their first week returning to athletic participation in a very controlled manner with graduated exertion,” adds Dr. Belkin.

Dr. Belkin spoke with Health Matters about how COVID-19 changed the game in competitive sports training and offers winning strategies to avoid injuries.

What kinds of injuries have you seen?
In youth athletes, meaning adolescents through high school, baseball ramped up quickly, so we’ve seen shoulder and elbow injuries. Typically, only young athletes who pitch would have these injuries. But this year we’ve seen some of those conditions in the other players, like shortstops, outfielders, and third-base players because when they throw, they throw hard.

Soccer and track and field have also restarted. This is where we’ve seen a majority of shin splints, which is inflammation where the muscles of the lower leg attach to the bone. We also see stress fractures in the shin bones, hips, and feet in our runners more than anybody else, especially the youth runners, because they typically are not as regular about their year-round training and may increase their mileage faster than they should.

How can people avoid these types of injuries?
The most important thing is to slowly build up your return to sports to reduce the risk of an overuse injury. For example, if you’re a gymnast, and in your first session back you’re doing all the same stunts and tricks you did nine months ago but haven’t had the same training, that’s when we run into problems with stress fractures and other injuries.

The American College of Sports Medicine, an organization representing various occupations within the sports medicine field, recommends the 10 percent rule when it comes to training. The 10 percent rule means you should resume any activity that you do at 10 percent intensity or duration level than what you can do at your highest performing state. In other words, a runner who can run 10 miles when they’re fit will run just 1 mile in a session. There’s a recovery period recommended between training sessions, and then you should increase your intensity or duration by no more than 10 percent per session or week, depending upon the activity. This rule can be applied to everything from running to rowing to weightlifting, and it’s good for athletes of all ages and skill levels, not just high school and college.

What other strategies are recommended?
If it’s necessary to practice every day, consider making every other day not as strenuous and monitor your intensity by keeping a journal. Focus on strategy, execution, and skill, as opposed to being as physically intense as you would normally be and add more rest intervals between training sessions. Also, make sure your equipment is in order. For example, if you’re a runner, check your shoes for signs of uneven wear. Overall, set realistic goals, have a plan, and don’t be too aggressive right away.

Dr. Nicole Belkin

Dr. Nicole Belkin

What should trainers and coaches look out for with athletes who have had COVID-19 and are getting back into sports?
For athletes who had COVID-19 and were asymptomatic, there is a possibility that they had some asymptomatic inflammation of the cardiac muscle during their infection. The American College of Cardiology recommends that these athletes be monitored more closely than you would typically monitor an athlete who is returning to team training after a long absence. These athletes may be exhibiting some shortness of breath that they attribute to being out of shape, but could indeed be a symptom of the cardiac effects of the virus that they’re not aware of.

Young athletes who were symptomatic with COVID-19 and are resuming activity need to be monitored closely by coaches, doctors, athletic trainers, or anyone who can keep an eye out for signs of distress, so much so that we follow what’s called the myocarditis return-to-play guidelines. We use these same guidelines if a patient had mononucleosis or another infection that was severe and they are returning to play. This sometimes includes getting tests like EKGs and echocardiograms or doing blood work and monitoring what would appear to be a healthy, athletic, young person.

If the coach is on the sideline of a practice and a kid who they know recovered from COVID-19 comes over winded more than usual, that might trigger someone to put a stethoscope on their chest and listen as opposed to giving the kid a water bottle and telling them to sit one play out and then go back in. If there is no one on the sideline who knows how to use a stethoscope, the athlete should go see their pediatrician. Recreational athletes who might not have a coach or trainer could use wearable technology like a smartwatch to monitor for signs of an elevated heart rate.

Whether you’re on a school team or a recreational athlete, if you have recovered from COVID and you experience either an elevated heart rate or shortness of breath while exercising, a medical provider should be consulted.

What are some general steps schools can take to reduce the risk of COVID-19 transmission among student athletes?
We have to recognize that wearing masks is something that everyone should participate in and take to heart 100 percent. That’s easy. Schools should do temperature checks because it’s easy. And if it helps you identify one asymptomatic carrier, it stops transmission. There needs to be essentially the same “see something, say something” education about why it’s not OK to deny symptoms and come be around your teammates and other students.

Lastly, athletic trainers and coaches should be educated that students who had COVID-19 or were otherwise asymptomatic but test positive for antibodies should spend their first week returning to athletic participation in a very controlled manner. We shouldn’t let our return to sports be jeopardized because we’re not doing everything that we can. There’s a lot we can do to keep our young athletes safe.

Nicole S. Belkin, M.D., is the chief of orthopedics at NewYork-Presbyterian Hudson Valley Hospital and an assistant professor of orthopedic surgery at Columbia University Vagelos College of Physicians and Surgeons. She is a sports medicine specialist with expertise in non-operative and operative treatment of injuries and conditions affecting the knee, shoulder, elbow, and hip. Dr. Belkin provides individualized, state-of-the-art care to athletes of all descriptions. She has served as an assistant team physician for the New York Giants, an associate team physician for Iona College Athletics, and an orthopedic consultant to the New York-based Public Schools Athletic League. She is the head team physician at Pace University.

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