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.