By Priya Joshi, Tej Shidhaye, and Nimish Kadam, members of the Georgia Thrombosis Forum
As all of us are aware, many of us, both young and adults, play various sports. These sports range from tennis, table tennis, badminton, soccer, basketball, cricket, track, dance, volleyball, or just exercising. While these sports may be very exciting to participate in, one should understand that they come with some inherent risks. One of the main risks of playing a sport is developing an injury, that may result in the formation of a blood clot, commonly known as thrombosis. Risks of thrombosis may further be increased due to immobility.
We, the 3 members of Georgia Thrombosis Forum (GTF,www.gtfonline.net), an affiliate of North American Thrombosis Forum (NATF, www.natfonline.org), decided to look at the basics of thrombosis, risks of sports-related injuries, as they pertain to the possibility of developing thrombosis, and some tips for prevention of injuries / thrombosis.
So what is thrombosis? Thrombosis is a blood clot that can form inside a blood vessel in different parts of the body. Blood clots can occur in many different locations, including the legs, the heart, the lungs, and the brain, causing a variety of problems depending on the location of the clot. Some common examples of types of thrombosis are Deep Vein Thrombosis, Pulmonary Embolism, Coronary Thrombosis (heart attack), and Stroke.
Thrombosis can occur in anyone, irrespective of gender, race, nationality, and age group. Everyone is susceptible to thrombosis. It is therefore very important to be aware of this condition and try to prevent it from happening.
When a person suffers from thrombosis, the entire family dynamics is affected adversely. Such people need prompt medical attention, and may need to take a few days off from work, and their quality of life gets affected. The family of the afflicted patient sometimes needs to make significant changes to be able to take the patient to hospital, doctor’s visits, getting medications, and getting ready for a financial toll on the family.
Let us look at some data from some commonly played sports in the Indian community.
Tennis: Tennis players have an increased risk of having upper and lower extremity injuries, such as rotator cuff strains and tears, tennis elbow, ligament injuries in the knee, ankle injuries etc. The incidence of such injuries is 0.04 to 3.0 injuries per 1000 hours played. Any injury that requires any period of immobilization of a limb or surgery, puts a person at a high risk of getting deep vein thrombosis in the limb. The risk of injuries in tennis players has been shown to gradually increase with age, from 0.01 injuries per player per year in the 6–12 year age group to 0.5 injuries per player per year in those over 75 years of age.
Increased playing time has been associated with increased incidence of new cases of tennis elbow in recreational players playing more than two hours a day versus those playing less than two hours a day.
Table Tennis: A sample of 68 top Slovenian athletes was studied for the frequency of injuries among table tennis and tennis players, types of injuries and severity of injuries. Table tennis is one of the less risky sports, but the number and level of injuries were quite the same in both sports.
In both games, most of the injuries occur due to lack of proper techniques and training. The majority of injuries occur halfway through a training session or during a competition event, mostly during a competition season. The injuries primarily pertain to muscle tissues; these are followed by joint and tendon injuries. The commonly affected body parts are:
1. Lower back
2. Knee joint
3. Wrist joint
4. Shoulder joint
5. Ankle joint
It appears that the main joints of the arms and legs are most susceptible to injury. This can often be caused by overuse or poor technique. Players with poor technique using lots of shoulder instead of general weight transfer, or playing with a very stiff/tense arm, are much more likely to see these types of injuries.
Badminton: Badminton statistics are similar to those of table tennis, because of the same reasons. Two hundred and seventeen badminton injuries occurred in 208 patients with a mean age of 29.6 years (range 7-57 years), constituting 4.1 percent of all sport injuries. Joints and ligaments were injured in 58.5 percent of the patients, most frequently located in the lower limb and significantly more often among patients younger than 30 years of age. Muscle injury occurred in 19.8 percent of the patients. This type of injury was significantly more frequent among patients older than 30 years of age. Most injuries were minor. However, 6.8 percent of the patients were hospitalized and 30.9 percent received additional treatment by a physician. As the risk of injury varies with age, attempts to plan training individually and to institute prophylactic measures should be made.
Soccer: Players who are injured will have a high rate of developing blood clots due to immobility, or if necessary, surgery.
Basketball: Basketball players are quite susceptible to develop clots because of injury and constant travel so the thrombosis rate in basketball players is fairly high.
In a one year period, from January to December 1986 in Denmark, 4303 patients with sports injuries were analyzed. The mean age was 21.6 years (range 7-72 years).
Cricket: Thrombosis is a little more frequently seen in cricket players due to the nature of the game. Balls are bowled fast and fielders can be hurt as well.
A British Council sports survey has reported 2.6 injuries per 10,000 hours played. Among Australian players the figure is reported to be 24.2 per 10,000 hours played. In South African surveys, 49% of all players sustain injuries at some point in the season.
Recent studies show that injuries are on the rise, with 28.4% to 71.6% of cricketerssustaining between 1.61 and 1.91 injuries per season.
Injuries to the lower limbs varied from 22.8% to 50% of total injuries, while upper-limb injuries accounted for 19.8% to 34.1%, with the fingersfound to be the most vulnerable site. Back and trunk injuries accounted for about 18% and 33.3% respectively. Head, neck, and face injuries account for 5.4% to 25%; mainly concussions, contusions and lacerations.
Sports personalities who suffered from thrombotic episodes in their life
We have collected a short list of various sports personalities who suffered from thrombotic episodes in their life:
- Andrew Flintoff, England all-rounder (DVT)
- Brian Vickers, Race Car Driver (PE)
3. Darren Lehmann, Australian Cricketeer (DVT)
4. Joey Sindelar, the Charles Schwab Cup Championship (PE)
5. Katie Hoff, World Champion Swimmer (PE)
6. Kimmo Timonen, theNational Hockey League player (DVT)
7. Lynn Jennings, Long Distance Runner (PE)
8. Navjot Singh Sidhu, Indian Cricketeer, (DVT)
9. Rebecca Bradford, an Olympic sprint skater (DVT)
10. Serena Williams, the US Tennis champion (DVT)
11. Steve Waugh, the former Australian captain (DVT)
12. Tomas Vakoun, the Czech NHL player (massive blood clots)
Injury Prevention / Safety Tips #
Because injuries can cause people not to use a limb or body part for an extended period of time, which can cause thrombosis, it is important for people, especially athletes, to be aware of the following tips for injury prevention and safety.
All sports have a risk of injury. Fortunately, for the vast majority of youth, the benefits of sports participation outweigh the risks. In general, the more contact in a sport, the greater the risk of a traumatic injury. However, most injuries in athletes are due to overuse.
The most frequent types of sports injuries are sprains (injuries to ligaments) strains (injuries to muscles), and stress fractures (injuries to bones). Injury occurs when excessive stress is placed on tendons, joints, bones and muscle. In a growing child, point tenderness over a bone should be evaluated further by a medical provider even if there is minimal swelling or limitation in motion.
To reduce the risk of injury:
1. A sufficient warm-up session should last at least 5-10 minutes, and involves gently stretching and exercising muscles to prepare them for the strenuous activity to follow. It is vital to start the warm-up slowly, and build up gradually to a more brisk and energetic pace. Warm up in this way allows an increased flow of blood to reach the muscles, increasing the flexibility of the muscle fibers and significantly reducing the risk of pulling or straining a muscle. Ideal warm-up exercises include steady walking and jogging. These activities allow you to gradually increase the pace to further prepare your body for strenuous exercise.
2. When you have warmed up, you can undertake some gentle stretches to lengthen the muscles and tendons, further preventing injury. Pay particular attention to stretching those muscles which will be used during your exercise.
3. Take time off. Plan to have at least 1 day off per week and at least one month off per year from training for a particular sport to allow the body to recover.
4. Wear the right gear. Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee, shin), helmets, mouthpieces, face guards, protective cups, and eyewear. Young athletes should not assume that protective gear will prevent all injuries while performing more dangerous or risky activities.
5. Strengthen muscles. Conditioning exercises during practice strengthens muscles used in play.
6. Increase flexibility. Stretching exercises after games or practice can increase flexibility. Stretching should also be incorporated into a daily fitness plan.
7. Use the proper technique. This should be reinforced during the playing season.
8. Take breaks. Rest periods during practice and games can reduce injuries and prevent heat illness.
9. Play safe. Strict rules against headfirst sliding (baseball and softball), spearing (football), and checking (in hockey) should be enforced.
10. Do not play through pain.
11. Avoid heat illness by drinking plenty of fluids before, during and after exercise or play; decrease or stop practices or competitions during high heat/humidity periods; wear light clothing.
12. The pressure to win can cause significant emotional stress for a child. Sadly, many coaches and parents consider winning the most important aspect of sports. Young athletes should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition. The main goal should be to have fun and learn lifelong physical activity skills.
Many sports involve a particular technique which can minimize the risk of injury. It is important to learn the correct techniques associated with your chosen sport. By practicing good technique an individual can greatly reduce the risk of sports-related injury to muscles, tendons and bones. This is also important in the gym, where experts will be on hand to help you use all equipment safely and effectively.
Do not over-reach yourself
It is extremely important, when taking part in physical activities, to listen to your body and know your physical limits. When you begin a new sport, begin slowly and steadily to avoid pulling or straining muscles which your body may not be used to using or stretching. If you have not undertaken strenuous exercise for some time, it is especially important to build up your stamina and strength gradually to avoid injury. Over time, you will notice your fitness increase, and you will be able to undertake physical activity for longer periods of time.
Water is vital to keep the body going, and this is especially true when you are active and exercising. If you are exercising in heat or in sunny weather, it is especially important to keep your body hydrated as dehydration can significantly reduce mental and physical fitness.
Just as it is important to warm-up properly, it is also essential that you cool down sufficiently after physical activity. After your workout, spend at least 5-10 minutes undertaking a gentle form of exercise (such as walking) to return your heart rate to a normal rate. The cool-down process allows your body to remove the muscles’ waste products and replace them with oxygen and nutrients. This helps to prevent stiffness of the muscles after exercising, and allows your muscles to recover steadily from physical activity.
Some do’s and do-not-do suggestions
1. Do not leave balls unattended, where people could trip over them.
2. Throughout the warm up exercises and the game, be aware of the location of the players, and make sure that they know that you are near them if you are walking through a court.
3. Do not try to jump over the barriers between the courts because this can cause serious injury if you trip over the barrier or a ball at the other side of the barrier.
4. Do not take water onto the court because spills could result in serious injuries. Make sure that all table tennis tables are in the proper position, and do not lean or sit on tables because the weight could cause the table to fold inwards.
5. Use proper etiquette when you are on the court, and make sure to pay attention to warning signs of injury, such as sharp pain.
If these warning signs are ignored, small injuries can be exacerbated, causing long-term injury, which could ultimately cause thrombosis.
In conclusion, sports is a great activity that everyone should indulge in. It has all the advantages you would like to enjoy (fun, recreation, bodybuilding, endurance, team building, etc.). However, as a sports player, please be aware of its inherent risks of developing injuries and therefore thrombosis. It doesn’t matter who you are, what gender, age, race, or nationality group you belong to, you are still vulnerable to thrombosis. With proper safety and precautions, injuries and thrombosis can easily be avoided. This will make your sports and life much more enjoyable.
Our message to our readers is that prevention of an injury is the best way. If in an unfortunate situation, you do get injured, get prompt medical attention.
Thanks you for your attention and reading our article! Happy Sporting!
Priya Joshi, Tej Shidhaye, and Nimish Kadam, members of the Georgia Thrombosis Forum
#Adopted from “Sports Injury Prevention Tip Sheet”, American Academy of Pediatrics, 2017