Death, taxes, childbirth and Ultimate injuries

By Dr KL Brobow,(1) (almost-)Dr N Mayaba(2), Dr K Middelkoop(3) & Dr ML Richter(4)

 

Ultimate injuries happen.

All the time.

During pick-up. During the Finals of the most important game of one’s life. During warm-up. While Skying someone else.  While being Skyd oneself. During expensive international tournaments. During drills. Or, even while surfing one arbitrary Sunday morning (right, Oli? 😉

Although it is tempting to think Ultimate players are ticket holders in the injury-lottery and injuries are mainly due to chance, research suggests differently.  Various studies have helped us understand better the frequency, location (game or practice, as well as body part), and severity of injuries to Ultimate players. For example, findings from a cross-sectional study of college Ultimate teams in the USA showed that lower extremity injuries (pelvis to toes) accounted for two-thirds of injuries and that ankle injuries were the most common unique injury (26%.)(5) The study also showed that running and overuse were the most common mechanisms of injury, and that collision-related injuries were more common in matches compared to practice. Gender-based differences in injury body locations and patterns for example were also pinpointed in the study – “men separated or dislocated their shoulders three times more frequently than women, and women tore knee ligaments at a 7:1 ratio compared with men”.  Another study showed that Injury Time-Outs were most commonly associated with contact – again lower limbs were most frequently injured – and the most common activity at the time of injury was laying-out.(6)

Thus, knowing how to deal with a team mate or opponent who gets injured is a vital skill, as you are likely to be confronted with it at some point. Yet, strangely, no Ultimate camp, coaching course or WFDF Guideline teaches one how best to approach a situation where someone is in extreme pain.  It is likely assumed to be a Life Skill that one is automatically born with.  But, from experience, it would seem, few people have.

Collage final

In approaching this touchy topic, we surveyed a range of people in South Africa who have had Ultimate injuries and asked them what was helpful, and what was truly, dreadfully unhelpful when they were injured.   Some answers surprised us, some were sad, and some were downright outrageous. One respondent recounted a scenario where an opposing team completely ignored their own injured player and treated him/her as a nuisance who was keeping the team from achieving its goals. Horrifying, unspirited stuff.

So, drawing on our medical knowledge, our own experiences and those of the people we interviewed, we offer the following as guidance on how to prevent and handle injuries:

Prevention is the Best Cure – what to do to prevent an injury

The best way to avoid dealing with your own injuries or those of others is to prevent them.  Here are some pointers:

  • Use an evidence-based warm-up strategy (7)
  • Do strength- and stamina training
  • Improve your balance and do proprioception (8) training
  • Pace yourself –  especially during tournaments;
  • If you have a recurring injury, let your teammates know about it as well as any specifics about how you are managing it ; and
  • Consider taking an off-season.  The Ultimate calendar is busy, and we often feel pressure to play in all the leagues and tournaments that come along. But rest periods are important for recovery – especially if you are carrying a niggle at the end of a season.

What to do when an injury occurs during a match

So, despite your best prevention efforts and intentions, a person goes down on the field, and doesn’t get up.

A quick recap of the Rules might be useful here: technically only the person injured or her/his team mates can call an Injury stoppage. (9)  In South African Ultimate, when an injury occurs, usually everyone on the field shouts ‘Injury!’ (typically, in a high-pitched, anxious voice) and freezes – especially, when the injury appears particularly painful, or if a loud snap or crack of something was heard.

All SAFDA-sanctioned tournaments should have qualified EMS (‘Emergency Medical & Ambulance Services’ or paramedics) on stand-by at the fields, and they should be called for assistance in assessing and managing the injured player.  While waiting for help from EMS (or if the injury happened during a training session), we recommend that only people who are trained either in first aid or medicine, or who have been designated injury representatives, approach the injured person.

The key goals during this stage are to:

  • Calmly assess the situation;
  • Reassure the injured player(s);
  • Carefully and safely help the player off the field;
  • Substitute the player; and
  • Continue the game.

Try to remember that injuries with their associated unwanted (but well intentioned) attention could be a source of embarrassment for an injured player.

“There is a moment when the injury occurs that has a large group of people flood toward the scene which isn’t helpful”

“In the first 15min when one’s mind is clouded with pain, I can still remember vividly the eyes of the person talking to me, keeping a hand on my shoulder and who stayed with me until I could get proper medical care.”

“[It really helped me when] the guy I’d been marking, knelt down beside me and spoke to me calmly and quietly”

“One person should take the lead in supporting the player. Preferably someone with medical knowledge if available, or someone they know well/feel safe with if not, but even a stranger is fine if he/she has a calm demeanour.”

One player who provided input for this article, spoke about how the unique Ultimate tradition of applauding in encouragement when an injured player leaves the field, made her feel supported and valued.

During an injury with an open wound, Universal Precautions are a must – that is the assumption that all blood could contain pathogens (such as HIV, HBV and others) that can be infectious and direct contact should be avoided (see Rule 19.1.2 in footnote 9 above).

What to do after an injury:

  • RICE (rest, ice, compress and elevate the injury)
  • If pain is severe and does not resolve even with rest, consider seeking medical attention
  • For “not so serious” injuries, consider seeing a doctor (again) about it if the pain or discomfort does not resolve after a few weeks
  • Follow the recommendations from doctors or physiotherapists – don’t try to get back onto the field too soon
  • During the rehabilitation phase, wear injury protection or prevention gear such as knee or ankle braces etc.) and take it easy!

Many respondents spoke about the time after the injury as being particularly difficult.  Not necessarily in terms of physical pain only, but feeling excluded from the team, its dynamics and of course, not being able to play Ultimate. Being ignored or neglected, or being asked about the injury in an instrumental, pressuring way only were sources of great unhappiness and hurt for some players. A few respondents felt judged when the pace of their recovery was slower than some team mates expected.

We recommend that team mates check-in with injured colleagues regularly, and remain encouraging and non-pressurising in their support.  This is of even greater importance if you were the cause of the injury.  Naturally, no-one injures a team mate or opponent on purpose in Ultimate (or so we fervently trust), and accidents happen all the time. Supporting the injured person by remaining in contact with her/him and checking on their progress until full recovery is not only empathetic, but also constitutes the respect and consideration that are associated with Ultimate Frisbee as a non-contact sport.

 “Having teammates and other players check in on you now & then is great and helps one feel included even though you might be off the field for awhile. However, being asked repeatedly when you’ll play again can just add to existing despondency, so rather focusing on one’s current condition (e.g. medicine side-effects, sleep, pain, mobility”

“I think respect for people’s pace of recovery is important, and encouraging them not to rush back into playing”

“I felt that a face-to-face, heartfelt apology would have been good. I think [the opponent] felt really bad, and also wanted to give me some space – which I completely understand. […] For example, I felt he could have popped into the hospital on the night I had to spend there after surgery. […] I’d recommend that if you’re partly the cause of a serious injury, take the person out for brunch, or send them some flowers, or visit them. Just something to say sorry that they can grasp when you are not half-drugged by pain meds.”

“ Keep me off the field until I am healed enough to play. Keep me motivated in my rehab. Still involve me in practice and other such activities.”

“Just people making an effort to talk to you and ask how your recovery is going helps”

Conclusion

“Death, taxes and childbirth & Ultimate injuries!    There’s never any convenient time for any of them.” – Margaret Mitchell Gone With the Wind (1936) plus authors’ addition

Unless you give up Ultimate today and take up Chess, chances are that you will be confronted with an Ultimate injury – either your own, or someone you share a field with.  Being able to prepare yourself for this inevitability and knowing some basic Life Skills and how to act in a moment of crisis will help make you a better team mate, and opponent.

 

Footnotes

  1. MBChB, MSc, DPHIL
  2. MBChB
  3. MBChB, MPH, PhD
  4. BA (Hons) MA LLM PhD  (Please don’t ask me for medical advice. About sex worker access to health care services during the 2010 World Cup, yes, but No to anything to do with medicine)
  5. David I. Swedler, Jamie M. Nuwer, Anna Nazarov, Samantha C. Huo, and Lev Malevanchik “Incidence and Descriptive Epidemiology of Injuries to College Ultimate Players” Journal of Athletic Training 2015 Apr; 50(4): 419–425.
  6. Yen, Leslianne E Gregory, Andrew MD; Kuhn, John E; Markle, Ross M “The Ultimate Frisbee Injury Study: The 2007 Ultimate Players Association College Championships” Clinical Journal of Sport Medicine: July 2010, Vol. 20, Issue 4, pp 300-305
  7. Some warm-up regimens which focus on lower limb strength and flexibility have been shown to be associated with a decreased risk of injury in football.  For example, the “FIFA 11+ [warm-up programme] has demonstrated how a simple exercise program completed as part of warm-up can decrease the incidence of injuries in amateur football players. In general, considerable reductions in the number of injured players, ranging between 30% and 70%, have been observed among the teams that implemented the FIFA 11+. In addition, players with high compliance to the FIFA 11+ program had an estimated risk reduction of all injuries by 35%” – Noël C. Barengo, José Francisco Meneses-Echávez, Robinson Ramírez-Vélez, Daniel Dylan Cohen, Gustavo Tovar and Jorge Enrique Correa Bautista “The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review” Int J Environ Res Public Health. 2014 Nov; 11(11): 11986–12000.
  8. Sometimes called a Sixth Sense and refers to “the concept of knowing where your body is in space and the ability to safely manoeuvre around your environment” (From “What is Proprioception and Why is it Important?”)
  9. WFDF Rules of Ultimate, 2017: 19. Stoppages 19.1. Injury Stoppage 19.1.1. An injury stoppage, “Injury”, may be called by the injured player, or by any player on the injured player’s team. 19.1.2. If any player has an open or bleeding wound, an injury stoppage must be called and that player must take an immediate injury substitution and must not rejoin the game until the wound is treated and sealed. 19.1.3. If the injury was not caused by an opponent, the player must choose either to be substituted, or to charge their own team with a Time-Out.  19.1.4. If the injury was caused by an opponent, the player may choose to stay or to be substituted. 19.1.5. If the injured player had caught the disc, and the player has dropped the disc due to the injury, that player retains possession of the disc.  19.1.6. The injury stoppage is considered to have been called at the time of the injury, unless the injured player chooses to continue play before the stoppage is called.  19.1.7. If the disc was in the air when the injury stoppage was called, play continues until either the pass is caught, or the disc hits the ground. If the injury is not the result of a foul, the completion or turnover stands, and play restarts there after the stoppage.

     

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