Care and Prevention of Sports Injuries to Athletes with Disabilities

Haley Danner Gayle McDonald KIN 327 Care and Prevention of Athletic Injuries November 17, 2011

Danner 2 It takes educating yourself and thinking outside the box, but serving athletes with disabilities can be an extremely rewarding challenge (David Hill, former Assistant Editor at Training and Conditioning). When most people think about an athlete with a disability their first thought is usually somebody in a wheelchair or someone with special needs. However, not all disabilities are physical, they may also be developmental or intellectual. In order to work with athletes with disabilities you first have to learn as much about the disability as you can. You should get to know your athletes strengths and weaknesses with his/her disability and how their disability could affect their performance. Athletes with disabilities are a very diverse group so this could become very challenging if working with multiple athletes with different disabilities. Certain disabilities are more prone to certain injuries. People with Down syndrome for example, are more prone to joint laxity, which can cause sprains. They are also unable to gain strength as quickly as other people so rehabilitation or strength training for them will be different and/or longer than other athletes with disabilities. Lori Glover, Community Sports Medicine Manager for the Institute for Athletic Medicine in Eden Prairie, Minn., suggests talking to the athletes parents, guardian, caregiver, or physician to learn as much as you can. They can tell you what is normal or not normal for their child, if something happens all the time or what might happen under certain conditions. This communication can be especially useful if the athlete cannot tell you himself or herself what is going on. A minor injury for most athletes is usually no big deal but for athletes with disabilities a small injury may affect their everyday life. If a deaf athlete injures their finger or hand they can no longer communicate because they do not have their hand or fingers to speak for them. An athlete in a wheelchair who injures one or both arms no longer has self-

Danner 3 mobility. This is why care and prevention of sports injuries to athletes with disabilities is very important and challenging, yet rewarding at the same time. Caring for athletes with disabilities is diverse based on the different types of disabilities. It can also be very different than caring for the able-bodied athlete who has no physical, mental, or developmental hindrances. There are many articles and publications addressing the care and prevention of injuries for the able-bodied athlete but little information is found about injuries that occur to the disabled athlete. A survey conducted by Paraplegia found that there are around 4000 to 5000 people with disabilities who are involved in athletic competitions in the United States. Before they can begin competing it is necessary to conduct pre-participation evaluations to find out as much as possible about their disability. This evaluation will help develop ways to prevent injury and how to care for these injuries when and if they occur. The survey conducted by the International Medical Society of Paraplegia was to determine athletic injuries that were commonly experienced during wheelchair sports participation and injuries linked with training methods. They sent out 1200 surveys but only got 128 respondents (101 men and 27 women). The survey consisted of questions about the participants disability, which wheelchair sport they participated in, the history of injuries sustained, and the use of protective gear. The age of the respondents ranged from fourteen to fifty-three. Most of the disabilities reported were spinal cord injuries (65%), followed by post-poliomyelitis (13%), congenital disorders (9%), amputations (3%) and other musculo-skeletal and neuromuscular disorders (10%). There were thirtytwo different sports reported by the respondents. The majority of the athletes participated in track (79%), followed closely by basketball (71%), swimming (61%), field events (60%)

Danner 4 and road racing (57%). Other sports listed were archery, weight lifting, table tennis, bowling, tennis, billiards, boating, and a few others. The average participation of both male and female athletes was four days a week. The training times ranged from zero to twentyfive hours a week. The majority of the respondents reported wearing protective gear during competition. The protective gear they listed included safety glasses, gloves, or helmets. The most common injuries sustained by the 128 wheelchair athlete respondents were soft tissue trauma (33%), blisters (18%), lacerations/abrasions (17%), and joint disorders. Other injuries also listed were decubitus, fractures, head injuries, and dental injuries. Over 70 percent reported at least one injury from participation and some even reported up to 14 injuries from the beginning of their career in wheelchair athletics. There were a total of 291 injuries listed by 93 athletes. The soft tissue trauma injuries included sprains, strains, tendonitis, muscle-pulls, and bursitis. These injuries were most commonly found in the hands, wrists, elbows, and shoulders. A low number of these athletes sought medical treatment and preferred to use self-treatments. Most of the injuries came from track, basketball, and road racing. Blisters on the hands and fingers are a big problem in road racing, basketball, track, and tennis because the athletes have to use their hands so much to push their wheelchair around as fast as they can. This is where the use of protective gloves can play a big part in prevention of some blisters. A high correlation was found between sport participation and number of injuries. The athletes that were involved in more sports events usually had more injuries and are at a higher risk for injuries to occur. A higher number of injuries were also found in those athletes who spent a higher number of hours training per week.

Danner 5 Most of the strength used by wheelchair athletes comes from their arms. When these athletes are involved in sports that require a lot of repetitive hand and arm movements they usually develop overuse injuries such as tendonitis or bursitis. If not treated properly, these overuse injuries could develop into chronic problems. The treatment for injuries such as these is the same as any overuse injury: ice, compression, elevation, and rest. However, rest for an athlete in a wheelchair probably means something different than for an able-bodied athlete. The individual in a wheelchair may not be able to completely rest their injured area because they still need to use it for everyday use of getting around. Instead, they have to come up with ways of modifying the motion they use to move their wheelchair or in some fortunate cases use an electric wheelchair, where all they have to do is push the lever forward to move them around. Rehabilitation of wheelchair athletes injuries is very important. If they try to begin competing again before they are ready it could cause them to be reinjured and that could result in an even more serious injury. At the same time, its important to start rehabilitation as soon as possible so they can resume to their normal life activities. The best thing to do for rehabilitation is seek attention from a professional and start a program that allows progressive effort, training and endurance. The best way to avoid injuries is to use prevention methods. Since the most common injuries of wheelchair athletes are soft tissue injuries, blisters, and lacerations its critical that these injuries try and be prevented. Some ways of preventing soft tissue injuries, such as physical contact or overuse, is to do a warm-up and cool-down with thorough stretching of the muscles you will be using. Protecting old injuries by taping or splinting, using a progressive training program and proper treatment of previous injuries

Danner 6 are also ways of preventing soft tissue injuries. Heather Pennington, Strength and Conditioning Specialist for the Lakeshore Foundation in Birmingham, Alabama, says, the more I can get them to do pulling and rowing motions, such as lat pull-downs, the more I can protect their shoulders from injury. I emphasize back strength areas nearly two-to-one compared to chest muscles. Blisters can be caused by the friction of the hands pushing on the rim of the wheelchair or can be caused on a persons back because seat position or seat material. Therefore, to prevent blisters, the formation of calluses should be encouraged, taping fingers, wearing gloves and having a padded seat should all be measures taken. Common skin abrasions and lacerations occur because of finger contact with brake, armrest socket, or rim, scraping inner arms on the wheels and trapping fingers between the wheelchairs. To prevent these skin abrasions or lacerations from happening hazardous wheelchair parts should be removed or padded, arm guards should be worn on the upper and lower arms and camber wheels should be used on the wheelchairs. In addition to all these preventive measures it is also very important that the athlete and coach be properly educated in the causes of injury and the preventive methods of all possible injuries not just the most common ones. This can help ensure the best performance possible without the high risk of injuries. One advantage of working with athletes with physical disabilities is that they know their bodies very well. They are able to easily communicate with medical professionals and help them in assessing their injuries. One of the main disadvantages of working with athletes with disabilities also comes during injury assessment. In most cases you can compare the injury to the uninjured side of the body, but with individuals with amputees that is not the case. This makes it harder to assess the degrees of injury. Safety and

Danner 7 balance also require a lot of extra attention during strength work and rehabilitation. If a person does not have use of their lower body parts they will need extra spotting to help maintain balance. Andrea Kushman, Athletic Trainer for the New England Bruins sled hockey team, had an athlete with an amputee and a prosthetic leg. She wanted him to practice single leg-squats to strengthen his hips but when he did the squats against a wall he sagged to one side. To help him not fall over she put him in a corner where he could use his hand to push against the wall when he was leaning. Small modifications such as this can make all the difference for disabled athletes. Core strengthening is very important for wheelchair athletes because these muscles have most likely been ignored or unused. Most wheelchair athletes started out being inactive once they were confined to their wheelchair. Heather Pennington also suggests taking a closer look at how the athletes body already compensates and works before designing a rehabilitation or strength program. Another dimension that needs to be considered when working with disabled athletes is their emotions. Studies have shown that individuals with disabilities are more influential on the participation of other individuals with disabilities. If a person on a team gets injured it could be very detrimental to them because now they have not only lost time spent with their disabled friends but also an important aspect of their daily life. Sometimes it may take a lot of patience to get that athlete back to where they were before they were injured. Working with athletes with mental disabilities also requires a lot of patience. It may take a lot of explaining and a lot of repetition. It is important that the person working with the athlete knows their level of cognitive ability. If they injure themselves and tell you their pain level is a ten, you have to make sure they understand how much pain that is supposed

Danner 8 to feel like. Another example would be an individual that does not feel pain like they should. People with autism usually have a sensory impairment so if they get injured really badly they may barely feel it. When trying to assess an injury you might have to adjust the special tests to accommodate their cognitive abilities. If you suspect that an athlete has a concussion a typical test would be to have them count backwards by threes or sevens, but for a mentally disabled person they may not have the ability to do that anyway. Some autistic children also dont like to be touched because of their imbalanced sensory system. If you need to palpate an injured area its very important they know what youre going to do before you do it. You may have to wait for them to calm down and move slowly when doing the assessment. It will also help if they have a familiar person there with them that they trust. In a recent study, athletes with autism had an injury rate five times higher than the rate of other athletes with mental disabilities. Individuals with seizures also had a high rate of injury two and half times the rate of other athletes. No matter what the disability may be, physical or mental, working with disabled athletes requires a lot of trial and error and patience, but the end results will be more than rewarding for you and the athlete. Most of the time the athletes just appreciate the time and attention that is put in for them. Linda Platt Meyer, Associate Professor in the Duquesne University Department of Athletic Training, says, speaking selfishly, we get so much more out of it than we can ever imagine delivering.

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Works Cited Cooper, Rory A. Wheelchair racing sports science: A review. Journal of Rehabilitation Research and Development. Vol 27. Nov. 3, 1990. 295-312. http://www.rehab.research.va.gov/jour/90/27/3/pdf/cooper.pdf. Curtis, Kathleen A, and Deborah A. Dillon. Survey of Wheelchair Athletic Injuries: Common Patterns and Prevention. Parapelgia 23 June 1985. 170-175. International Medical Society of Paraplegia. http://www.nature.com/sc/journal/v23/n3/full/sc198529a.html. Hill, David. Ready to Serve? Training and Conditioning. Issue 15.08. Nov. 2005. http://www.training-conditioning.com/2007/03/09/ready_to_serve/index.php. Ramirez, Marizen, et al. Sports Injuries to High School Athletes With Disabilities. Pediatrics. Vol. 123 No. 2. Feb. 1, 2009. 690-696. http://pediatrics.aappublications.org/content/123/2/690.full. Vanlandewijck, Yves. Sport Science in the Paralympic Movement. Journal of Rehabilitation Research & Development. Vol. 43. Nov-Dec. 2006. http://go.galegroup.com/ps/i.do?id=GALE%7CA204209917&v=2.1&u=tel_a_freehu &it=r&p=GPS&sw=w.