– Derek M. Hansen –
On a daily basis, I am fascinated as I observe my two young kids interact with each other and their environment, negotiating various situations and challenges that arise. I am always particularly interested in how they deal with the situation of an injury (i.e. scrape, cut, abrasion) and getting hurt during the process of play. Simply falling down can elicit a response that includes lots of crying and wailing, despite the severity of the fall. The magnitude of the response often mirrors their mental state or level of tiredness or hunger at the time of the incident. I have specifically tuned into how much they like the idea of having a band-aid applied to their “boo-boo” and how much comfort and security it brings them. Regardless of how much actual benefit the band-aid brought them, it made the difference between a sobbing mess and them continuing on with their business. The injury itself had not changed, and the amount of actual pain they felt (as opposed to perceived pain) was no different. The band-aid was a miracle cure in their minds.
This phenomenon got me to thinking about the different fixes that we see in sporting life, including knee braces, orthotics, tape jobs, neoprene sleeves, supplements and other medicines. So much effort is put into treating an injury – for better or for worse – in ways that simply give the perception of safety, healing and/or improvement. Whether or not actual improvement is occurring is debatable. The same could be said for many physical training regimes. Perception is more important than reality in the minds of many individuals. There appears to be no difference in the psychology behind many treatments and applications – regardless if you are a young child or a mature adult. Among all humans, band-aids and placebos work.
Some modern examples of fixes for athletes can include the following:
In many sports, you will see athletes training and competing with the use of a knee brace. These braces can take the form of fitted neoprene sleeves with an array of supporting straps or cyborg-like braces with carbon-fiber framing and titanium hinges. In all cases, these devices are advertised as providing protection and support while allowing the athlete to perform and move adequately in their sport. In my experience, an individual must spend a good deal of money to get a customized brace that fits appropriately and provides the specific support that is needed. In practice, I see lots of knee sleeves and straps that provide compression and perhaps even warmth, but not much in the way of support. In the case of rigid braces, I see lots of poorly fitted braces that do not offer appropriate support and also hinder proper biomechanics, resulting in poor performance, lots of discomfort and not much protection. Ideally, an athlete would go without a brace in training and practice – where risk can be more closely managed – to allow for proper movement mechanics and natural strengthening. A properly fitted, structurally sound brace could be re-introduced for competition to provide support and maximize safety. Unfortunately, I often see inadequate, loosely fitted braces provided to athletes in a “band-aid” fashion giving them the illusion of protection and security.
When I was training and competing as an athlete, I was constantly prescribed orthotics for everything from shin-splints to knee pain to hip pain and back pain. It was the miracle cure. “Hey, we figure that all of your different aches and pains all stem from your flat feet.” None of the sports medicine doctors ever asked me about training volume, training surfaces, training progressions or technical execution. The thing that always troubled me was that the doctors would always do their measurements for the orthotics when I was injured. They were not working from a baseline of a healthy individual, but rather measuring me up for orthotics when I was injured and heavily compensating for the aches and pains in my body. It made no sense to me. How could the doctor’s measurements be trusted? I was told that I would likely feel more soreness during the break-in period for the orthotics and shouldn’t train very hard during this period. Of course, because my training volume was lower, inevitably I would feel better. “Hey, it must be these new-fangled orthotic-thingies that are making me feel better!” Rest was the cure – the $400 orthotics were the expensive band-aid.
Groin problems are a common issue for American football defensive backs who are required to change direction quickly, stop and go, turn their hips violently and sprint at a moment’s notice. This is also the case with athletes who play basketball, soccer and ice hockey. While I would commonly implore the coaches to give them more rest between their weekly games and also incorporate some soft-tissue therapy for adductors, abdominals and hip flexors, the team trainers would recommend the athletes go out and buy themselves some “core shorts.” For those of you not familiar with this product, it is the 21st century equivalent of wrapping your pelvis and privates in a corset. The core shorts are advertised as providing the support that your musculature could not provide in the groin and pelvic area, while allowing you to perform dynamically in your sport. When in reality, your range of motion is so compromised by the compression garment that it is impossible to reach any dynamic range of motion that would allow you to stretch your groin and be productive in competition. Instead of bandaging the pain, this band-aid simply does not allow you to reach a level of performance where pain will rear its ugly head. Sitting on the bench for one week and taking part in productive rehabilitation activities could achieve the same results, with a lot less risk and expense.
Taping the ankle is a rite of passage for most athletes, particularly if you are a football or basketball player. The intent is to protect the ankle from rolling over during cutting movements, stepping on another player’s foot or having someone fall into your planted leg. How much protection the tape job provides is up for debate. A friend of mine once told me that an ankle tape job is rendered ineffective after about 10-15 minutes of play, primarily due to perspiration loosening up the grip of the adhesive, but also because the tape stretches during repetitive forceful movement. In this regard, ankle taping is a short-term fix that only gives the illusion of protection for the rest of the game or training session.
The other side of the coin is that isolating a joint with tape can shift forces to other joints – forces that perhaps these joints were not meant to bear. A heavily taped ankle can easily shift sheer forces into the knee, leading to ligament strains and tears. As one of my wise friends once told me, “It’s a lot easier to rehab an ankle than it is a knee.” To compound the problem, many of the newer artificial field surfaces are much more resilient than regular grass and can grab the cleats of an athlete quite aggressively. In this type of scenario, taped joints can shift profound forces upward and can even result in strains in the groin and low back. One coach even remarked at the extremely high number of sports hernias he is observing in football, when he was lucky to see one or two per year in the past. The compensational stresses, combined with ever-increasing training volumes and inadequate recovery, is leading to an epidemic of injuries never before seen. We like to believe that advances in training, prevention and rehabilitation have enhanced our athletes, yet injuries are as prevalent as ever.
Over the Counter Pain Medications
What better way to mask the pain of an injury than to take a few pills. This is probably the most common band-aid solution used by athletes from the high school level on up to professional ranks. While it allows them to train and compete without the pain and irritation of the injury, it can lead to further problems. I will agree that appropriate application of anti-inflammatory medication can help to reduce the negative impacts of an inflammatory response and facilitate a more effective rehabilitation process. However, abuse of such medications in an effort to simply mask pain can lead to further damage to the injury in question, as well as compensatory problems throughout the body. There should also be concerns regarding the impact of long-term use of non-steroidal anti-inflammatory drugs (NSAID) on internal organs such as the heart and kidneys. One coaching mentor of mine was also convinced that use of anti-inflammatory medication significantly affected an athlete’s reaction time and cognitive function – which I have personally observed in football athletes that have heavily relied on such drugs in-season. As with many of the other band-aid solutions listed above, inappropriate use of pain-killers and anti-inflammatory medication can simply shift the risk to other areas.
The longer I work with athletes, the more I am finding that many of them view supplements as a band-aid solution for their poor nutritional habits. To them, these are not “supplements” but rather “replacements” for proper nutrition. In addition, they seem to believe that some supplements are the answer to their training success, spending lots of money on very expensive placebos. Of course, none of these athletes eat, sleep, regenerate, stretch or train properly. But, the “flavor of the month” supplement pitched in the latest muscle-mag or popular on-line e-zine will solve all of their performance problems. It reminds me of a presentation on TED.com in which Rory Sutherland presents the concept of simply using placebos with the population since they have been shown to work extraordinarily, they are very cheap to develop and they have no known side effects. And, even if they did have side effects, “They are imaginary and you can safely ignore them.”
One could argue that like placebos, band-aids have their place. They create the perception that the situation has improved, even if it really hasn’t. Band-aids capitalize on the power of the human mind to overcome distressing situations or diminish physical pain. When used sparingly and with the intent of discontinuing their use as soon as possible, they serve a useful purpose. Where athletes go overboard is when these band-aid solutions are replacing more appropriate and effective methods of improving their situation. However, when you have a screaming three-year old with a skinned knee in your lap, nothing seems to work better at calming her down than a good-old band-aid.