Injury to a high school athlete can be a significant disappointment for the teen, his family, and his coaches. The goal is to safely return the patient to activity as soon as possible, but often it means missing an important game or event.

Often, the athlete wants either to stay in the game or to return to the next game or practice, while the orthopaedist thinks it is not safe or reasonable to do so. It is the responsibility of the treating physician to help protect the athlete. Usually, it is best to err on the side of caution in allowing the student to return to the game or practice. This is especially important in head and neck injuries.

Sports related injuries account for about 20% of visits to the emergency room for injury. Basketball and cycling account for most of theinjuries. Football and baseball are next in frequency. Gymnastics, cheerleading, and playground injuries are next. (see table below)

Sport-Related Injuries (From the National Center for Health Statistics)

Activity	Percent of Sport-Related Visits
Basketball	17.1
Pedal Cycling	16.1
Football	10.3
Baseball/softball	9.4
Skate board/roller blade	5.7
Gymnastics/cheerleading	5.6
Playground	5.2
Snow sport	4.2
Water sport	3.8
Soccer	3.6
Exercise/track	3.6
Others	15.3

Many finger fractures and dislocations in basketball may be treated with "buddy-taping" and rapid return to play. Ankle sprains may not allow return to sports for three to six weeks or more.

The usual progression of lower extremity injuries is that when the athlete can walk without limping, he or she can run. When they can run without limping they can return to sport practice.

Upper extremity return can be more difficult to determine, but usually the athlete must have normal range of motion and strength should be near normal as well.

Athletic concussion is currently an area of growing focus of attention. There are many equipment and rules changes that have tried to help decrease the incidence of injury. The burden on the team physician, family doctor, or orthopaedist is deciding when to have the injured child return to sports (usually football or hockey).

• Amnesia
• Memory loss
• Difficulty concentrating
• Headache
• Sensitivity to light
• Dizziness or vertigo

Delayed symptoms can include:

• Sleep disturbance
• Fatigue
• Depression
• Feeling slowed down or in a "fog"

Physicians should "over treat" head injuries and keep athletes out of the game if they are "not right," appear to have memory loss, headache, nausea, or any of the symptoms above.

Athletes who sustain one concussion have a two to three times greater risk of sustaining another concussion. Athletes who may have sustained a concussion should not be allowed to return to play until they are symptom free. If there is any temporary loss of memory, the athlete should be held out of the next week's game. If they have sustained multiple concussions, they should not play for a year.

A consensus statement on Sideline Preparedness for the Team Physician developed by American Academy of Orthopaedic Surgeons, the American Academy of Family Physicians, the American College of Sports Medicine, and others advises physicians to be "conservative" in allowing an injured high school athlete to return to play.

Consensus Statement on Sideline Preparedness for the Team Physician (AAOS)Consensus Statement on Sideline Preparedness for the Team Physician (AAOS) (http://www.aaos.org/about/papers/advistmt/1022.asp)

Team Physician and Return to Play (American College for Sports Medicine)Team Physician and Return to Play (American College for Sports Medicine) (http://www.acsm.org/AM/Template.cfm?Section=Clinicians1&Template=/CM/ContentDisplay.cfm&ContentID=1623)