Playing it Safe

The 411 on ACL tears and concussions

By Susan Tulino, Novant Health UVA Health System

The start of a new school year means a new season for sports. High school and college athletes typically start football, cheerleading, field hockey, cross country, golf and volleyball seasons in the fall. With teams finalizing rosters and hitting the practice fields, now is a good time to be reminded of common injuries and risks associated with playing a sport and learn about treatment.

Frederick W. Parker, III, MD, M.Ed is a provider at Novant Health UVA Health System Bull Run Family Medicine – Manassas who frequently treats sports-related injuries in young athletes. Dr. Parker says he and his team see the full gamut of sports injuries at their practice and are well-prepared for varying levels of severity.

“The severity depends on the sport, how the injury occurred and sometimes the age of the athlete,” said Dr. Parker. “The majority of injuries we see are ligamentous or soft tissue, such as overuse injuries, sprains, strains and contusions, that usually heal quickly and without lasting impact. But there are two looming concerns among young athletes and their parents: ACL tears and concussions.”

ACL Tears

The anterior cruciate ligament (ACL) is one of the major ligaments in the knee. ACL tears are some of the most publicized sports injuries. When a professional athlete goes down with a career-ending ACL injury, news outlets cover the heartbreaking moment in detail. Closer to home, many of us have had friends or family undergo the dreaded ACL repair surgery — or even experienced one ourselves.

“ACL tears are a big fear because there is little we can do to prevent them,” said Dr. Parker. “One awkward landing is all it takes, and the risk of a tear can be exacerbated by preexisting issues, such as weak supporting muscles, congenital issues or even hormonal imbalances.”

One reason they are such a concern is the recovery period. ACL tears typically require surgery and have a six-month rehabilitation period that athletes must take very seriously.


Perhaps not as widely publicized as ACL injuries, head injuries are another big concern, especially for athletes participating in contact sports. Schools’ athletic training departments participate in concussion training and athletes are given concussion tests at the beginning of the season.

“Concussion testing records an athlete’s neurocognitive responses, so we have a baseline for evaluating an incident’s severity,” said Dr. Parker. “When a patient shows signs of a concussion, we use this baseline neurocognitive test, with evaluation of their symptoms and a physical exam, to determine recommendations for further management.”

Signs of a concussion can include:
A history of head injury followed by a headache
Difficulty with balance
Sleep problems
Increased anxiety

In serious cases, individuals might also lose consciousness, experience seizures or exhibit unusual behavior. These cases should be evaluated immediately by an athletic trainer or emergency medicine provider and may require a computed tomography (CT) scan.

Neurologists generally don’t have the appointment availability to assess athletes on a weekly basis for return to play approval. For this reason, the last decade has seen marked improvements in concussion diagnosis and management among primary care providers. According to Dr. Parker, primary care sports medicine doctors who are trained in concussion management are much better at treating concussions efficiently and effectively and getting athletes back to play safely.

“In the past, doctors typically diagnosed concussions acutely and recommended taking a week off, but only saw the patient again if there were persistent symptoms,” said Dr. Parker. “Now we understand that wasn’t an effective way of managing a concussion. Even seemingly minor head injuries can lead to ongoing symptoms.”

To return to their sport, an athlete must be symptom free and back to their baseline measurements. The athlete will gradually increase activity in accordance with a three- to five-day “return to play” protocol. If symptoms are observed during this window, the athlete starts the process again. Doctors caution against sending athletes back into play before they are fully recovered and symptom-free.

Don’t Live in Fear

Despite the risk of injury, Dr. Parker emphasizes the benefits of kids and teenagers participating in sports, including teamwork skills, lessons in sportsmanship and healthier lifestyles. In fact, many doctors encourage kids to be multi-sport athletes, which helps avoid overuse injuries.

“There is always a risk of injury, but you can’t live in fear,” said Dr. Parker. “You can do the same amount of damage slipping on ice or tripping on stairs. I would never discourage athletic activity because of the overall health benefits of exercise.”

For more information about orthopedics and sports medicine services at Novant Health UVA Health System Prince William Medical Center, please visit–sports-medicine.aspx.

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