Driving home is usually an uneventful conclusion to a day's work. But for former National Football League quarterback Chris Miller, who had been knocked around the field for three hours on this Sunday, the 30-minute trip home became utter confusion. After two hours of driving, he still hadn't found his house, and finally he called home to his wife for directions. The reason: One of the many hits he took during the game had caused a concussion.

Professional athletes risk injury every time they train, practice, and compete. Like any manual-labor field, pro sports has its own industrial injuries. Only an athlete, for example, will experience turf toe, pitcher's elbow, or a sports hernia. Getting hurt is a part of sports, but today injuries play a larger role -- and receive more attention from teams and the media alike -- than at any time in sports history.

The '90s saw injuries increase in three major US sports: the National Football League (NFL), major league baseball, and the National Hockey League. With this has come a more vigilant, proactive approach to preventing players from getting hurt, as well as a larger emphasis on keeping athletes healthy once their playing days are over.

A sport in which most plays end with someone being tackled is bound to have its share of injuries. A Los Angeles Times study showed that 364 NFL players sat out a combined 1,061 games due to injury during the 1999 season. Football's hazards are receiving a lot of attention these days -- concussions in particular. San Francisco 49er Steve Young, in fact, retired after doctors warned him that any more concussions could cause serious brain damage.

The attention to concussions has led manufacturers to modify the helmet itself to absorb the impacts players take to the head. The National Operating Committee on Standards in Athletic Equipment (NOCSAE) continuously investigates ways for helmet manufacturers to improve helmets, such as thicker outer shells, softer inner padding, and air-filled compartments, which shape and move with a player's head to distribute the force of an impact. Officials are also strictly enforcing rule changes prohibiting helmet-to-helmet contact and striking an opponent above the shoulders. Stiff penalties, fines, and suspensions accompany violations of these rules. Still, concussions remain a problem, possibly because today's athletes are bigger, faster, and stronger than in previous years. Linebackers these days run as fast as running backs and receivers, and weigh roughly 230 to 250 pounds, creating more vicious collisions and thus more injuries.

The "turf monster," which has been known to reach up with its fuzzy, green, stiff-carpet grip to end a player's game or season, is another nemesis of football players. Artificial surfaces are infamous for causing injuries when a player hasn't even been tackled. Among its victims is Jamal Anderson, the star halfback of the Atlanta Falcons, who was planting his foot to make a cut on artificial turf when he blew out the anterior cruciate ligament in his right knee.

League dynamics, such as expansion and a salary cap, have put the spotlight on such injuries. Expansion has watered down talent across the league, and the salary cap has limited the number of "big money" players on a given squad. These factors are responsible for teams carrying fewer veteran or talented backup players, which has made rosters more vulnerable in the event of injury. If a key player goes down, such as Young in San Francisco and Anderson of Atlanta did in 1999, the teams go down with them -- the 49ers' 4-12 and Falcons' 5-11 records can attest to that. With those players active the season before, the teams finished 12-4 and 14-2 respectively, and squared off in an NFC Divisional Playoff Game.

To help prevent injuries, Oakland Raiders head trainer Rod Martin recommends training and conditioning specific to the sport. "For football, we train for the angles and direction changes that come with the sport," Martin says. "Often players will just train by running sprints and long distances in a straight line, but that's not the way the sport is played." The most common injuries Martin sees are hamstring and groin pulls and strains. He recommends athletes train on the surface they play on and to wear proper shoes when they practice. "We primarily play on grass, and therefore we have the players practice on it in their cleats to avoid leg muscle pulls and strains," he explains. According to Martin, keeping properly hydrated by drinking plenty of water during training and before games is one of the most important things a player can do. "This will reduce more than cramps," he says. "It will reduce muscle fatigue which decreases the chance for injury."

The change to a proactive rather than a reactive system for dealing with injuries is evident in successful sports franchises. The St. Louis Rams were the eighth-most injured team in the NFL in 1998 and finished the season 4-12. During their 13-3 championship season in 1999, they were the second-least injured team the league. In particular, the Rams took special care of Isaac Bruce before the Super Bowl season to prevent another hamstring injury to their top wide receiver. In Bruce's first two seasons as a full-time starter, he amassed 3,119 receiving yards, but over the next two seasons, he missed 13 games. During training camp before the 1999 season, Bruce was held out of more rigorous drills and told to run others at three-quarter speed. He played all 16 games that season and returned to his all-star form.

As in football, injuries in baseball are on the rise. According to former San Francisco Giants head trainer Stan Conte*, major league baseball's injuries increased 3 percent every year between 1989 and 1999. By July 2000, there were 96 players in the National League and 72 players in the American League on their team's injury lists.

Some teams have made a turnaround, however. In 1997, the Giants had enough of being one of baseball's most injured teams. When the Giants promoted Brian Sabean to general manager before the 1997 season, he made changes to help the team escape its history of injuries. He promoted Conte from assistant to head trainer, urging him to improve the team's strength and conditioning program to curb the team's injuries. Since Conte revamped the program, the number of players that have gone on the disabled list has plummeted and the team won three division titles and a National League pendant. A lot of players, coaches, and fans often blame injuries on bad luck. Conte agrees some injuries are unavoidable, but if a team manages to reduce them, he says, "It's not luck, it's preparation."

Conte says the Giants changed their conditioning program to feature functional exercises specifically designed to prevent baseball injuries: "Before, pitchers were conditioned with slow cardiovascular training, because pitching was always compared to a marathon. But it's not." Conte explains that pitching is a series of short, explosive movements done repetitively. For this reason, he changed the pitchers' training and conditioning to rapid-movement drills to reduce throwing injuries, which make up 48 to 50 percent of the injuries he treats. The change was also intended to reduce the leg injuries that can occur when pitchers kick out one of their legs during delivery, and the sudden shift from pitching delivery to fielding. This kind of conditioning can also help pitchers dodge screaming line drives up the middle, which can be extremely dangerous. In a frequently replayed, gruesome incident, Boston Red Sox pitcher Bryce Florie was hit in the face by a batted ball in September 2000, suffering a broken eye socket, a nasal fracture, and retinal damage.

The Golden State Warriors were the most injured team in the National Basketball Association (NBA) in the 1999-2000 season. Nine Warrior players spent time on the injured list, and the team used 32 different starting lineups. The Warriors finished 19-63, tying a franchise record for losses in a season. Team head trainer, Tom Abdenour, was kept busy primarily with ankle sprains and overuse injuries, otherwise known as tendinitis or "jumpers' knee." These are very common in basketball, even among weekend warriors on the playground, and are especially hard to prevent in the NBA, with teams playing an 82-game season, plus practice and off-season play. Abdenour and the American Orthopedic Society for Sports Medicine (AOSSM) recommend preventing jumpers' knee through strengthening and increasing flexibility of the quadriceps muscles, and by resting when the pain becomes too intense. But when tendinitis does occur, Abdenour and AOSSM recommend rest, strengthening, and neoprene sleeves and braces to keep the injured area warm. The AOSSM also recommends heating the area before activity and icing it for 20 to 30 minutes afterwards.

Contrary to Hollywood myth, trainers do not drug or "shoot up" a player to get them out and win the big game. "I've never known that to exist in my years as a trainer," Martin says. "That would ruin the good-faith relationship between player and trainer, and they would no longer have confidence in their medical staff."

Martin prefers a player come to him as soon as he feels something is wrong. He knows, however, veteran players can often figure out whether they need assistance or whether an injury is minor enough that they can take care of it themselves, and prevent it from becoming serious. Athletes, especially veterans, are in tune with their bodies, and they tend to know the difference between being just sore or worn down and when they are injured. It's not wise to let an injury linger, so an athlete should seek medical attention from his or her trainer or a sports physician to immediately prevent it from worsening. "There's nothing like experience," Martin says. "If an athlete has had an injury before, they know what to expect. They can feel when they need medical attention and are less uncertain about what will happen next."

But there are times when a player's competitive fire gets the best of him, and that's when Conte says he takes matters into his own hands. "Much like a football trainer takes a player's helmet to keep him from sneaking back into the game, I'll take a guy's glove," he says. "When a player is on the field injured, neither he, nor his team benefits."

How a pro athlete mentally approaches the constant specter of injuries -- some potentially career-ending -- is very important to avoiding them. "If a player is worried about getting injured and trying to not get hurt is their main goal," says Abdenour, "then they play timid and are too conscious of getting hurt, and that's when there is an increased chance for injury."

But experienced athletes also realize that serious injuries can sideline them. "That is their motivation for strength and conditioning," Martin says. "Athletes are extremely motivated people, and they know they must train properly to lower their chance for injury."

Recovering from an injury requires the proper mentality as well. If an athlete remains in low spirits and feels there is no hope to return after an injury, he may not rehab properly. Conte describes the thought process: "After the initial disappointment and depression an athlete goes through during a serious, rehab-requiring injury, they usually accept it. From there they focus on rehabilitating and getting back to the form they were in. This is the pattern for those who dedicate themselves and rehabilitate well."

Turf injuries, concussions, broken bones: some injuries may be unpreventable. But coaches and trainers agree that proper training and precautions can help prevent a promising athletic career from being cut short. Thanks to a proactive and preventive training approach, other players like Ram wide receiver Isaac Bruce will be able to celebrate championships, not on crutches and in street clothes, standing on the sidelines, but on the field, in uniform, competing and doing their jobs.

* Stan Conte resigned from the San Francisco Giants in 2006, after this story was first published.

-- Tim Fitzgerald is an editorial assistant at Consumer Health Interactive.

Further Resources

American Orthopaedic Society for Sports Medicine

http://www.aossm.org

American Academy of Orthopedic Surgeons

Provides a guide on injury prevention. http://www.aaos.org

National Operating Committee on Standards for Athletic Equipment

http://www.nocsae.org

American and National Leagues

http://www.majorleaguebaseball.com

National Football League

http://www.nfl.com

National Basketball Association

http://www.nba.com

First published October 20, 2000
Last updated April 28, 2008
Copyright © 2000 Consumer Health Interactive