Life is Fragile, Handle with Care

James Butterfield, the second year ISB physiotherapist, has been asked the most common injuries that he sees here at ISB amongst the high school student student athletes. His response to what the most common injury is, and how to avoid it, is interesting for more than just the student athletes.

The most common injury has has seen with high school student athletes is ‘overuse’. When he says ‘overuse’, he explains that “this is mostly due to sharp spikes in training load, for example, students may do no physical activity at all during the summer holidays and season one, and then go directly into Rugby or Basketball training.” His advice to none, one, and two season athletes is to try and stay fit year round, so that going straight into season training isn’t too much for the body.

To help students recover from this type of injury, they are placed on a 4 step recovery program. This is outlined below:

The first phase is called “acute management.” James says that this phase is supposed to “promote a rapid and successful transition from the inflammatory phase to early proliferation healing.” Some interventions include  “desensitize irritated tissue, reduce swelling / effusion.” The most emphasized step of this phase is RICE, rest, ice, compression, and elevation. The main reason for this phase is to get rid of the inflammation, and begin the healing process.


The second phase of the program is called “low-level loading.” This phase is meant to “re-establishing neural pathways and normal motor patterns within the limits of pain and injury irritation.” By saying this he means that the athlete will begin to start mild constant training without causing pain from the injury. The reason for this training to begin is to “return to normal gait and balance mechanisms. Proprioception / balance training.” By doing so, the athlete is able to begin muscle build up to prevent further damage to the injury.

The third phase for this injury is called “Progressive Functional Training.” The reason for this phase to be in the program is to “expose the foot and ankle to an increasing program of multi-plane stress.” He says that it is to “Ensure the athlete is fully ready to return to maximal intensity, multi-directional training” Overall the main reason for this phase is to push the athlete with intense training so that they will be ready to return to maximum intense training for their sport.

The final phase of this program is “High-level Loading / Return to Competition.” In this phase the “athlete must demonstrate that they can cope with pre-injury training volume and intensity, without irritation to the injury.” This is to watch and make sure that the athlete is okay at maximum intensity and that the athlete is mentally ready for full training, and competition.

The worst injury that James has seen in his career was not here at ISB, but during his time at Buriram United, professional football club based in Buriram, Thailand. Watch the whole video link below as the injury happens during the celebration of the goal. This player ruptured his posterior cruciate ligament, which sits behind the ‘ACL’ or anterior cruciate ligament in the knee. As you can see in the picture, the player’s leg bent backwards causing the cruciate ligament to rupture. He says that, “we had an incredible team of sports medicine staff at the time, and we had the player back playing at international level within 6 months.”

When asked what types of good habits athletes should do to try and help prevent injuries from happening, James responded “without exception; the fitter, stronger and more mobile you are, the less likely you are to get injured. It is really as simple as that. In addition, you cannot neglect your sleep and nutrition. If you have terrible eating and sleeping habits, you will have less energy and be more fatigued during practice. This not only means that you are more likely to get injured, but it also means that you are denying yourself the opportunity to train at the highest of your ability.” He says that overall staying fit and strong while getting enough sleep is key for preventing injuries.

Lucas W

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