Risk Management in Sports

By Terrence Chee

May 2023 FEATURE
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NOWADAYS, WE ARE all encouraged to live an active lifestyle, through exercise generally, i.e. any movement that contributes towards our physical and emotional well-being; or through sports, more specifically.

However, an active lifestyle always involves injury risks; injuries can lead to a massive setback. Here, I shall discuss risk management and consider injuries caused by sporting exercises, in particular.

Having served alongside the Penang Floorball Team and the Malaysian Floorball Team from 2013 to 2018, I have observed how an unresolved minor ankle injury can lead to a fracture or how an improper rehabilitation programme can end in recurrent back pains or joint sprains. One should be able to make wise decisions regarding suitable exercises that the body is capable of managing, if we consider these aspects:

·         Present and past medical conditions

·         Physical conditions and limitations

·         Supportive devices

·         The nature of the sport/exercise

Present and Past Medical Conditions

Full-time athletes have professionals supporting them; they have doctors and physiotherapists monitoring their physical progress. The rest of us do not. Those of us who play sports for a good sweat need to be aware of the conditions that can affect our exercise tolerance or run the real risk of damage to our muscles, or worse, our organs. There are some physical conditions we simply need to be aware of just in case a particular repetitive movement or exertion brings more harm than good. One of the most common conditions is diabetes.

Exercising with diabetes requires input from a healthcare professional as this condition affects blood circulation to the arms and legs. It also affects eyesight and alters sensations. Since uncontrolled diabetes can lead to vision loss, it is risky for someone with this metabolic disease to play badminton, for example. In the event that they experience a blackout while not wearing proper footwear, they may slip, causing wounds that may not heal efficiently.

Those with high cholesterol have limited choices of exercises as well. Since this condition affects blood flow and can lead to a heart attack or stroke, it is important for them to keep to exercises that allow full control of their movement and pace at all times. Consider gym exercises with a qualified personal trainer, jogging or swimming. During critical phases of rehabilitation, exercise should only be done in a physiotherapy department in the presence of a physiotherapist.

Another condition to consider is obesity. Obesity can cause structural damage or degeneration, such as deterioration in posture, joint pains and soft tissue injuries. Take a game of badminton for example: jumping, bending over, kneeling and falling will cause unnecessary injuries and degeneration of joints. Similarly, as with high cholesterol and diabetes, obesity greatly reduces the options for safe and responsible sporting. Before progressing to the desired sports, it is wise to solve underlying medical conditions.

Physical Conditions and Limitations

Not to be confused with medical conditions, physical conditions denote structural variations which may make one disadvantaged in a certain sport.

An obvious condition is Morton’s Toe, where the second toe is longer than the big toe. This is a disadvantage to runners as the length of the second toe will put an individual at higher risk for pain and calluses. Another example would be those with flat feet; contact sports or sports that require jumping, like basketball and volleyball, may not suit them.

We may not necessarily know the condition of our bodies but we can give ourselves ample time to find out and deal with potential issues efficiently.  Very often, the proper approach is for us to progress slowly in an exercise or sport that we are interested in, intentionally looking out for uncomfortable spots during and after the exercise. Then, allow our bodies enough time to adapt. Instead of going for a long-distance run, we take slow 30-minute jogs on softer surfaces like on a field instead of hitting the road immediately. Doing this allows us to monitor the behaviour of our muscles before increasing duration or intensity. After that, we should focus on strengthening our muscles.

Supportive Devices

Supportive compressors such as knee guards, ankle guards, wrist supports and elbow guards on joints or muscles can provide much-needed support and additional stability to our limbs, helping us avoid injuries.

External support is necessary for injury recovery and as part of a rehabilitation programme (preferably closely supervised and monitored to serve the purpose as planned). This is never for long-term use and should not be worn once we have achieved the next stage of recovery; we should do our best to avoid high support dependency. Proper recovery requires our muscles to perform their roles up to expectation to meet the demands we require, cognisant of the fact that this is different for everyone. Therefore, prolonged reliance on supportive devices is a big no-no.

Take the knee joint as an example, hikers must take leg strengthening exercises seriously to ensure that the thigh and calf muscles are strong enough to cope with the demands of the terrain. The most common mistake I see amateur athletes do is to stick to their desired sport, without questioning whether their sport of interest benefits them and neglecting personal flexibility, strength, balance and agility in the process.

I always suggest visiting a physiotherapist to get a proper rehabilitation protocol confirmed. There are various causes for joint pain, for example, and one solution for an individual might not be right for another with a similar issue.

Nature of Exercise

Responsible sporting must always start with goals in mind (process goals, performance goals, outcome goals); this makes all the difference. Then, decide what you need help with and from whom. A personal trainer? A doctor? A physiotherapist? Or just a group of supportive friends?

Then, decide if the sport you are pursuing or planning to pursue is a contact sport (football, basketball or rugby), or non-contact (badminton, athletics, hiking or tennis). It helps to have friends supporting your goals and keeping to an intensity that suits your current health status.

I suggest starting with a non-contact sport, which is low in intensity and does not demand quick movements. This approach allows time for you to build a more resilient body for strenuous exercises.

Sporting activities while experiencing pain is also tricky, and leads to the need for other decisions like bracing or seeking therapy. There is such a thing as “good pain” and “bad pain”. The good news is that not all pain indicates problems and needs treatment.

Sport Safely

Taking the above into consideration, the safest way forward involves a thorough understanding of our present health conditions, ailments and current limitations and preferences. It is important that we ensure the exercise we opt for suits our current health conditions and that we do not regard all exercises to have the same effect on our body.

Discuss your goals with your doctor, physiotherapist or trainer: compare your options and always prioritise your physical and emotional wellbeing. Lastly, do seek help early. Visit a physiotherapist you can trust, get your discomfort examined and get your issues solved as fast and as early as possible.

Terrence Chee

a Physiotherapist and founder of Prime Osteo in Penang, has been treating sports injuries since 2010. Being an athlete himself, his area of interest is treating and educating the public on sports and exercise.