Fatigue, Fractures, and Cupping, Oh My!

Well the Olympics are over, but some athletes face lingering injuries and a long road to recovery. We sat down with Samantha Burton, an Athletic Trainer in the Orthopedic Surgery Department at Baylor College of Medicine to answer some of our burning question about injuries and injury recovery.

  1. Which Olympic athletes are most prone to injury? Least prone to injury? Should parents worry about starting their future Olympians in certain sports?

Here is a great chart that illustrates the rate of injuries in Olympic sports:


With any youth sports, moderation and being a well-rounded athlete is critical.  For example, it is common to specialize in gymnastics starting as early as age 8 or 9 which is a huge indicator for injury.  Several sports medicine professionals have complimented the training of Simone Biles- she is obviously very strong and does a lot of cross training.  She also practices her actual routines much less than what you would traditionally see in elite gymnastics.  This has limited her injury occurrence quite a bit.  

What’s the safest thing that parents should do?  Make sure your child is a multi-sport athlete or at least takes a significant break (1-3 months) from their preferred sport.  Let them be a kid- climbing trees, playing tag, and rollerblading are all great ways to cross train!

  1. Most Olympic athletes compete in multiple events stretched out over weeks. How does muscle fatigue affect performance and injury risk? How can athletes avoid these pitfalls?

Muscle fatigue is an obvious concern for those participating in multiple events, but these are also some of the most well-prepared athletes in their ability to recover.  Recovery is multi-factorial: physical rest, diet, muscle work, sleep, and understanding how to recover from their sport.  Recovering from a contact sport can take an entirely different approach than recovering from a marathon.  Athletes at this level are equipped with athletic trainers, physicians, biomechanists, sports psychologists, dieticians, and other professionals to ensure that the proper path is taken.  Also, athletes at this level are very in tune with their bodies and have often developed a recovery process as well as a better understanding of their physical limitations.

One of the biggest issues we see as non-elite athletes recover is the tendency to participate in an event (a race or game) and spend the next two days lying on the couch, eating whatever they feel like.  Ideally, athletes should keep their bodies moving in some way- an easy bicycle ride, light stretching, and a healthy diet filled with protein, .  This will help recovery far more than your muscle being inactive for multiple days.

  1. Older athletes are crushing it this year! What sort of injury risks is, say Michael Phelps facing in these Games that he may not have had to worry about in Athens during the 2004 Games?

Phelps almost looked like he wasn’t human during these games.  I think the biggest thing that we, as viewers, saw was that he was recovering more slowly towards the end of the Games.  That fatigue, as discussed earlier, can definitely increase the injury risk, but it was well managed by the medical staff in Phelps’ case.  In sports like swimming and running (Bernard Lagat was outstanding at 41!) there isn’t as high a level of age-associated risk for acute injury as there is in gymnastics or another contact sport.  We saw that 40-year-old Oksana Chusovitina from Uzbekistan did an outstanding job; however she appeared to lack the shear leg strength of the young gymnasts, especially after landing on high-impact apparatuses like the vault.  Chusovitina talked about how she had to modify her training to limit the impact on her knees, which could have led to a catastrophic injury in competition as she applied a force to her body that she wasn’t used to.

  1. What about teen athletes that are still growing and developing? Do they face different risks than a fully grown adult?

One thing we are noticing in orthopedics is that pediatric patients are experiencing adult injuries at a higher rate than we have ever seen before.  This is concerning because having an ACL reconstructed on a 9 year old child will increase their risk of arthritis and anterior knee pain in the future.  Starting the cycle of acute and overuse injuries in this younger population can make it tough to manage recreational sports as an adult.  Besides the risk of adult injuries, we know that concussions can have much more serious implications in pediatric and teen patients.  The return to sport timeline must be carefully considered for these athletes, as well as the return-to-learn and classroom management. Multiple concussions in a young athlete in a short period of time should be looked at by parents and healthcare professionals as a red flag for continued participation in high-risk sports.  Another injury that can change based on the age of the patient is fractures.  If the athlete is still growing and sustains a growth plate fracture, they are more likely to need surgery to recover.

  1. Some Olympians are competing just months removed from major surgery. How do they recover so fast? How has new technology and recovery techniques helped the recovery process?

The comeback following surgery has been quite amazing.  Surgical techniques are always being perfected and these athletes are usually available to work with a physical therapist to rehab for many more hours per day than a normal athlete.  The individualized treatment plan for these athletes is a huge factor in how they can recover with access to new techniques that are still being researched such as platelet rich plasma injections and the use of stem cells.

  1. What’s the deal with cupping? Is there any evidence that it works? Would your clinic ever recommend it or other pseudo-science recovery methods (i.e. acupuncture, chiropractic massage)?
Image 4

Michael Phelps shows off his cupping bruises before celebrating a relay win. (Daily Mail)


Cupping is a hot topic; however there hasn’t been much research to back it up.  I would not typically recommend it to a patient because, unlike most manual therapy techniques, there is no professional certification and training required.  Being unsure about the formal training of the clinician in such an invasive procedure would lead me to recommend other modalities.  The jury is still out on alternative recovery methods, and each clinician and physician has their own comfort level on what they would recommend.  I don’t know that I can make a blanket statement about recommending certain types of treatment, for me it is more important that I know the practitioner’s background and training.  I’ve seen some of these modalities, like acupuncture, work magnificently when performed by some clinicians but fail with others.  Big picture?  Find a doctor that you trust for advice and always question someone’s background and training before you agree to alternative treatments.

  1. Walk us through some of the high-profile/gross/cool injuries that have occurred at these Games so far. What exactly happened? What’s the recovery time? Will they compete again?

Samir Ait Said– Samir had a tibia and fibula fracture coming off the vault, which was reminiscent of Kevin Ware and the Louisville Cardinals.  The frustrating thing for Samir is that he missed the 2012 Olympics with a fracture in his right leg coming off the vault as well.  So why do some landings cause a grotesque fracture, but most people land normally and walk away?  We may never know exactly.  If this were my athlete, I would ask questions like- do they have a normal bone density?  Do they have proper strength for their event?  Are they overtraining and progressively weakening the bone? What is their nutrition like?  What were the biomechanics that led to each of their injuries?  There are so many questions we don’t have the answer to that I’m sure his coaches and medical team are actively striving to find.  Recovery time is variable depending on what exactly they found in surgery.  One clean break will often be quicker than multiple fracture sites.  Also, without knowing how the surrounding muscles were affected, it’s hard to say exactly.  Unfortunately, it is hard to predict the likelihood of Samir coming back at this time.  The success of the surgery and his commitment to rehabilitation will play a significant role in his ability to return to a high impact sport like gymnastics.

Image 2

Samir Ait Said, French gymnast suffers gruesome leg fracture off the vault. (The Sun)


Andranik Karapetyan– Andranik suffered an elbow dislocation while weight lifting, which can be a very painful injury.  Not much was released following the injury, so it is hard to say what exactly could have happened to him. There are 3 types of dislocations:

A simple dislocation does not have any major bone injury.

A complex dislocation can have severe bone and ligament injuries.

In the most severe dislocations, the blood vessels and nerves that travel across the elbow may be injured. If this happens, there is a risk of losing the arm.

Some people are born with greater laxity or looseness in their ligaments. These people are at greater risk for dislocating their elbows. Some people are born with an ulna bone that has a shallow groove for the elbow hinge joint. They have a slightly higher risk for dislocation.

Depending on what additional imaging and exam found, the type of dislocation can drastically impact the recovery and return to sport.

Image 3

Armenian weightlifter, Andranik Karapetyan dislocates his elbow during a lift. (Joe.co.uk)

Annemiek Van Vleuten– For those who missed the Van Vleuten cycling crash, it was one of the most horrific I have seen in any sport.  We know she had 3 fractured vertebrae and a concussion, so it looks like she will be okay long-term.  Any back injury, however, can be chronic if not managed appropriately.

  1. One that probably won’t make it into the final cut, but how is Ellie Downie not dead?
Image 1

Ellie Downie of the Great Britain Gymnastics team lands awkwardly on her neck. (NBC)

Ellie Downie suffered a cringe-worthy fall on her head and neck.  I know I wasn’t alone in wondering how she walked away from that injury (that mechanism of injury and the angle she fell is one of the most dangerous), but HOW DID SHE COME BACK? If there is anything I learned from working college football, it’s that not every injury is how it appears to the viewers.  Some of the craziest hits and falls can leave the athlete with minimal to no symptoms, while some of the most minor touches can cause a season-ending injury.  Sometimes I have to temper my desire to “couch diagnose” these athletes- they are in VERY capable hands! 

Samantha Burton, MS, ATC, LAT
Samantha received her B.S. in Athletic Training and M.S. in Exercise Science from
Brigham Young University where she worked for the BYU Football team and the BYU
Track and Cross Country team.  She is currently working at Baylor College of 
Medicine to develop the Sports Medicine Outreach program and bring medical care 
and education to athletes of all ages and skill levels. She is trained in manual 
therapy, Graston technique, Functional Movement Screen, Titelist Performance 
Institute Certified,concussion testing, and is a Red Cross first aid + CPR 
instructor.  She is married to a medical school bound scientist, has 1.5 kids 
(both boys), and spends 100% of her free time traveling and dreaming of being 
independently wealthy.
Anthony Barrasso (President)
AnthonyBarrasso_AvatarAnthony is a 4rd year graduate student studying retinal development. 
His career interests include cancer research, education, and politics.
Outside of lab, he likes playing with his dog and eating delicious
food. Follow him on twitter @barrasso67


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