TrueSport Expert Series: Dr. Michele LaBotz on Returning to Play After Injury

Kara Winger:  Welcome again to the TrueSport Expert Series 2022. I’m your host, Kara Winger, javelin thrower. And with me to talk about returning to play from injury is Michele LaBotz, our expert for this episode.

Michele LaBotz:  Well, thank you.

Kara Winger:  Thanks for being here. Yes, this is a near and dear to my heart subject and I’m really excited to hear what you have to say about it. So, the general theme of our conversation today is that previous injury predicts future injury. So, can you tell me what you mean by that?

Michele LaBotz:   Yes. So, it’s not universally true, but it’s a pretty good trend. And so, there’s two things that play into that. So first is, why did the first injury happen in the first place? And secondly, did you completely recover from that first injury? So, the things that play into why people get injured in the first place. Right? So, some of it is are there issues with strength, flexibility? Is it the way someone’s lined up? Right? So, if somebody’s feet roll in, they’re pronated, those knees come in, they’re going to get shin splints and knee pain and stuff like that. Is there something about their playing style? So, for contact sports, for instance, are they particularly aggressive and in there, people like that and they get injured quite a bit. And then there’s people with technique. So, you are in a technically demanding field, right? You’ve got to throw right and well or you’re going to get hurt. And so, if you haven’t addressed those issues that got you that first injury in the first place, it’s just going to come back, right? You’re going to be in a cycle. And so the second thing is, did you completely recover? So, athletes feel better before they are better. Right. And so if you’re just going by pain and how does it feel and you go back based on that, you’re setting yourself up for recurrence. So, did you get the full range of motion back? Right. And I know you’ve had that with some of your injuries. Right. That rehab is so key. So, did you get your range of motion back? Did you get your strength back? For injuries to the legs, did you get your balance back, right? And in the office, I test that. I have them bounce on one leg and close their eyes and bounce on the other leg. And if it’s the same there, does this ring a bell for you?

Kara Winger:  Closed eye balance is the hardest one. The most stringent test for me.

Michele LaBotz:   But you know, the most common injury in sport is an ankle sprain. And the biggest predictor for an ankle sprain is if you did not get your balance back after the last ankle sprain. So, fix the things that got you hurt in the first place and make sure that that first injury is completely recovered. And that’s really about the best you can do, because there’s always that risk, right, when you go out on the playing field.

Kara Winger:   Right. We’re doing our best, we’re pushing ourselves to the limit. So, sometimes accidents happen and injuries do occur. It is really good to know, though, that past injury doesn’t always predict future injury. I definitely to your point about knowledge, are you moving correctly? Are you in the right positions? Did not have that knowledge before my first ACL tear. I knew that women in sport tore their ACLs more often than men, but I didn’t know what the mechanism of injury was. And because it was a javelin thrower and not a soccer player or a basketball player, I never thought it would happen to me. But I learned so much in the course of recovering about how my body works that maybe could help someone, you know, not have that experience.

Michele LaBotz:  And so, who conveyed that knowledge to you? And are you spreading that knowledge to other people now?

Kara Winger:   I’m doing my best. Those are some of my most watched Instagram stories, my rehab videos. Yes. I, like I said, learned so much about my own body in the course of recovery and just will implement those tools for the rest of my life. Because your body isn’t quite the same as it was, especially before surgery. Right? So how can parents help foster this knowledge base, this maybe atmosphere where you can prevent injury and give their kids the tools to be healthy in sport?

Michele LaBotz:   So, there’s a couple of things. So, A., parents have to help their kids kind of dial in to when they’re injured. And so not expecting that the kid will go right back. So, one thing that happens all the time is we have kids sprain their ankle. The parents say, yeah, they sprained on Friday, it’s Monday. They’re feeling better. Can you just write a note to kind of clear to go back without seeing them? And I get it, right, you don’t want to bring the kid in. And it all seems well, but they don’t really know. So, making sure that you are kind of availing yourself of whatever access that you have, whether it’s the athletic trainer at the school or, you know, your primary care physician or a sports medicine physician. Right? What can you kind of do to help assure that they’re able to get back? The other thing is making sure that kids are paying attention to the rules. The rules are there for safety and so especially like in ice hockey, for instance, one of the big features that have really kind of reduced especially risk of concussion and head injury in ice hockey is implementation of the rules. And so there are so many families and especially kind of when they’re kids, that they’re kind of on the cusp of kind of going to the next level. And they’re feeling the pressure to perform, perform, perform, and maybe skirting the rules a little bit. And they’re there for a reason, for the most part. And if you’re not paying attention to those, you are running an increased risk of injury. So, kind of helping your kid learn to be a good athlete and an athlete who is playing within the boundaries of the sport.

Kara Winger:   Yes, pushing it, but within the limits of what is allowed and what is best for everybody. Yeah, I love that piece of setting an example that the medical professional is the authority, is the person who knows if you can safely return to sport, fostering that trust of someone who is only interested in getting the athlete healthy again, I think is really important for a parent to set an example of.

Michele LaBotz:  No, I agree. I agree completely.

Kara Winger:  So, what about coaches like how can a coach foster an atmosphere that might prevent injury and or reduce risk of injury and prevent reoccurring injury?

Michele LaBotz:   Yeah. So, especially we’ve seen this with the pandemic, for instance, where you know that the time that coaches have with the kids are so truncated, right? They get out of the car, they get onto the field, they’re scrimmaging and their home. And so, the things that we would like coaches to do in terms of, okay, make sure let’s have a good warmup and let’s do some additional conditioning, that really kind of went by the wayside. And so one of the challenges in a matter kind of how this pandemic kind of pans out is what tools can coaches provide for kids? And I always tell kids, especially kind of not only with the recovery phase and the rehab, but also kind of the injury prevention stuff. If it’s one more thing you have to do after school and practice and homework and games, it is not going to get done. And so best they can, how can you kind of wrap those preventive measures into the sport experience itself? And I see a lot of dancers, right, into that dance experience itself, and as much as the coach can kind of bring those preventive measures into the sport experience itself, instead of saying, well, just go off and do it on your own, that can be very, very helpful because otherwise those prevention things are not going to get done.

Kara Winger:   What I really like to do, I did this last night, is when I have those extra things that I need to get done, I try to combine them with something else. So, like you’re saying, combine them with sport for sure. But if you can’t have that many people in the gym for that extended period of time to get all that extra work in, what if you walk to practice, if you live within a good distance and it’s warm enough outside so that your body’s moving and you’re getting warm on your way? Last night I had my lift. I didn’t have time to get some planks in. So, I go home and I’m on my living room floor petting my dog because she loves it, like while I do these like four sides of plank. So, I’m spending time with her, but I’m also getting my core ready to throw the javelin, which is an extreme motion. And it needs to be taken care of at 35. So yeah, combining the tasks and if that turns into like more open play, I think that’s really great too for health.

Michele LaBotz:   So, you hit the nail on the head especially for kind of the pre high school group in terms of incorporating active play. So, one of the important things we know about kind of sports development, not only development of athleticism but also reducing injury risk is teach your body to move in a variety of different ways. Right. And what better way to do that than to go climbing over rocks and go on the playground and, you know, play a game of pick up basketball, the kids that are running and adults aren’t making you do stuff. So, kind of bringing that kind of concept of active play in and not making it exercise and kind of grunt work, that’s the magic ticket. If you don’t make it fun, they’re not going to do it.

Kara Winger:  Or I was a multi-sport athlete all the way through high school. Yeah. Huge advocate for health, for multi-sport in youth.

Michele LaBotz:  Oh, yeah. The current literature is all over that in terms of the benefits, not only in terms of injury prevention, which is what we’re talking about, but also is your super good example of kind of achieving athleticism to whatever degree that the more different things that you can do as a younger person, you don’t have to work quite as hard and you can excel oftentimes to a higher level if you’ve got that multi-sport background.

Kara Winger:   I definitely got more injured when I became just a javelin thrower than all of my youth playing all of the sports that I probably could. Yeah, I definitely, definitely agree. Multisport for health.

Michele LaBotz:  Yeah. For sure. Variety is protective. So, if you had a teammate who went through an injury similar to what you did, if you could give them two pieces of advice, what would that be?

Kara Winger:   You’re not going to get better in one day is the first one. The healing process can be really long and it’s really tempting to like do 17 sets of 10 in a day to try and accelerate that process. But you’re not going to do 17 sets tomorrow. So do three, do three tomorrow, do three the next day. Consistency is key. Like that’s my biggest message. And you are getting a lot of benefit out of less movement than you think, especially in the early stages of recovery. So, be okay not being okay.

Michele LaBotz:  You know I think that you bring up two really good points for that. So, A., being mindful about what you’re doing instead of just kind of being rote about it, right? So, if you’re only doing three sets, do it like you mean it. And, the other thing is more is not better and you are exactly right because that is the mindset that so many athletes bring to this, is that, well, hey, if she said that I should do, you know, three sets of the balance exercises, well, I’m going to make it even harder and go on a bosu ball and, no, there is definitely a structure and a progression. And if you skip ahead, you’re probably going to put yourself back. So, I think that’s a fabulous one, as well.

Kara Winger:  My second ACL, I was within a year of the Tokyo Olympics and so I was like, we got to have surgery right now, like I am on a deadline and instead we use BFR technology, took three whole weeks of like intentional, very intense rehab. And my recovery was phenomenal. And I had just those three weeks, I was like, oh my goodness, we’re running, I can’t even believe I haven’t gone under the knife yet. Like this is not okay. And it was so much better than it would have been if I hadn’t done that. It’s my second piece of advice for people going through really difficult injuries is to have something outside of athletics that they’re working toward or enjoying in their life, because it doesn’t have to be like a big giant life change or whatever. But for me it was really helpful to have other stuff like feel like a whole human. So whatever it may be, the first time I had only been a professional athlete for three years, but that is all I had done. So, I had graduated college and then I was just a javelin thrower and I felt just a bit lost, right? But like I applied for a grad school program. I got accepted on scholarship to an MBA program, and I remember crying so hard because all of a sudden I had something else to look forward to in the face of my first surgery. And my second surgery on my knee, I got a full time job. Wild. So, like, you don’t have to go that crazy, right? I think I would have started to play the piano again or really thought about how I could spend time with family more. And just like having something else that makes you a more well-rounded person than being obsessed with your recovery every single day, day in and day out. Do something else with your time.

Michele LaBotz:  So, one thing that we’re seeing a lot with concussions, for instance, where a certain point home after a few concussions and especially if people aren’t recovering well, they probably need to think about kind of stepping back from a contact sport. And so what other sport can you do and engage that doesn’t put you at the same risk? And I’ve had a few athletes who, you know, they thought they loved soccer and football, but oh, jeez, they turned out to be really good tennis players or really good kind of scholarship swimmers and they never would have gone that route, especially with like how these kids are getting specialized so early now. They don’t have that same sport sampling, that same multi sport experience that you had that if you never got into the pool, how are you going to know you’re a fabulous water polo player if you’re always on the soccer field? So, kind of you don’t really know necessarily where your passion talents lie until you have an opportunity to try them out. And if you play an injury right, an injury can provide you with some of that opportunity.

Kara Winger:  Yes. Both knowledge in the sport that you maybe got injured in or an avenue to something else. And if you’re running in the pool, maybe that’s where you get your love of water and start water polo. Yeah. Incredible. So, maybe this is an athlete, a young athlete’s first injury and the parents, their guardians don’t necessarily know how to get that diagnosed. What would you tell a family member to look for in a physician? How do you go about finding the right help in an injury?

Michele LaBotz:   So, there’s a couple different kind of venues to go for that. I would say, if it’s a high school athlete and that school is fortunate enough to have an athletic trainer who are so important, so important for kind of healthy athletic participation and preventing injury.

Kara Winger:  And so much more common than they were when I was growing up.

Michele LaBotz:   And so I would say for them, that athletic trainer really probably should be the first point of contact. And they can give you a sense, is this something that really rises to the level where you should seek the care of a physician, or is this something that that they can kind of rehabilitate in the training room fairly readily? If families are going to be going to see a physician, you’d like to have a physician who kind of engenders your confidence, that when you walk in and you say okay sprained his knee. Watch how they examine the knee. Are they comfortable with that? Are they watching how the athlete moves? Are they talking about the demands in the sport? And when you’re kind of coming up with a recovery plan, do they take that into account as they are kind of crafting what that treatment plan looks like? And it’s so important to recognize in a good physician who knows kind of sports injury knows that sports is not all or nothing. Right? So, okay, so maybe you have a stress fracture and you can’t go for a run. So, what are you going to do to maintain your cardio in the meantime? Right. You’re going to get on the bike. You’re going to get in the pool, you’re going to start it with rehab and that type of thing. And so if it’s a physician who just says, okay, you’re out for six weeks, I’ll see you in a month, there’s probably other better options typically. And to me that would be maybe a bit of a red flag that that there’s a physician who probably isn’t as knowledgeable about what that recovery process, how that recovery process could be optimized.

Kara Winger:  Yeah. And I, I love that. I think the theme here has been culture that injuries do happen. They might happen again. But if you’re in the right situation and you’re supporting people, getting the right medical professionals to be honest with you and help you along the path to recovery, you’re going to get back. And it might be different, but it’s going to be great if you have the right people around you. Thank you so much for being here. This has been returning to play after injury and not all injuries have to recur. But if they do, it’s going to be okay. So, look for more from our TrueSport Expert Series 2022.