The Pandemic's Impact on Athletes' Training and Injuries

by Kwadwo Owusu-Akyaw, M.D.

The Pandemic's Impact on Athletes' Training and Injuries

Sports are very near and dear to my heart, as I’m sure they are to the vast majority of our culture. Sports are a psychological release for many athletes. They may be a community for you. They may be a fellowship.

Sports may be an opportunity for you to travel and reach goals you would not be in the position to achieve otherwise. Of the many things this global pandemic has negatively impacted, sports are one that hits home for a lot of us. In this discussion, I want to take a step back and talk specifically about how this pandemic affects athletes of all levels regarding their training and injuries.

Safety precautions athletes must take

The CDC and Virginia Department of Health guidelines related to sports are very clear and have been outlined extremely well. I encourage anyone who is an athlete or the parent of an athlete to go to both the CDC’s and Virginia Department of Health’s sports guidelines and read them for yourself.

The highlights of these safety measures that you really need to take home are as follows.

Highest risk

When thinking about sports participation, we look at the highest risk vs. the lowest risk activities. Of course, the highest risk is playing a sport under the norms of a world without COVID-19. So, what does that look like?

That includes traveling to play other teams in other counties or cities after being in practice with your teammates, cramming into a bus, and sharing another school’s locker room and equipment. This scenario has the highest risk of transmission for any virus, COVID-19 included.

Lowest risk

Naturally, at this point in time we are not following that highest risk status quo. As you keep lowering the amount of social contact you have when playing sports, the risk of exposure and transmission significantly decreases. The lowest risk is practicing and training at home where you can be isolated. But just because you’re alone at home doesn’t mean you can’t sharpen your skills. Find some space where you can perform drills and do bodyweight workouts (push-ups, sit-ups, planks, wall sits, etcetera).

Medium risk

In-between the highest and lowest risk scenarios, there is a kind of sweet spot. When looking at the CDC guidelines for participation in sports, a team sport that maintains social distancing in a large enough area outside is considered to be on the lower end of risk for transmission. More specifically, masks must still be worn during the activity. Six feet of distance between athletes must be possible.

But it’s important to remember that in situations where there’s strenuous activity such as running, jumping, dunking, etcetera, the risk for transmission does go up a bit. So, the CDC guidelines increase the distance needed between two athletes from 6 feet to 10 feet in situations of strenuous activity.

The 10 feet of social distance must also be kept in mind in a situation where there might be cheering, chanting, or the raising of voices. Shouting, cheering, or even just talking loudly increases the number of droplets going from our mouths into the air. Those droplets can contain COVID-19 and can stay in the air for up to 3 hours, ready for someone else to breathe them in. Droplet transmission is the largest transmitter of COVID-19, so wearing masks and staying far away from others is crucial to help prevent the spread.

What should an athlete do if they contract COVID-19?

There is a lot of concern about athletes who may have contracted COVID-19. It’s imperative to remember that some people, including younger athletes, are at a higher risk of having a bad outcome. Younger athletes may have diabetes, asthma, lung and heart conditions, and so on and so forth.

The guidelines for an athlete who has contracted COVID-19 start with being evaluated by their primary care doctor for the possibility of needing a referral to a cardiologist (heart specialist) or pulmonologist (lung specialist). We know there are potentially long-term effects of COVID-19 to the heart and lungs. Before returning to any strenuous activity, it is critical for a COVID-19 patient to have their heart and lungs checked.

What should athletes do when trying to get back to the new normal?

Over the course of the pandemic, we’ve lost our normal rhythm of life. For athletes, there’s training sessions, an off-season, and the season that continuously occur in a cycle. You’re used to using your body more consistently in a more regular manner.

But with this disruption, athletes aren’t consistently playing like they used to. So, they become deconditioned, and as a sports specialist, I can confirm that injuries such as ACL tears often occur to people who are not properly conditioned. If your core, gluteus, or quadricep strength isn’t where it used to be, then you are at more risk for landing in an awkward position, resulting in an ACL injury.

During the pandemic, the risk of deconditioned-related injuries has increased due to team practices and training sessions being paused. Once you stop regularly performing a sporting activity, it takes days, not months, to lose your gains. Some studies say that you lose 10% of your muscle gains and endurance per week every week that you’re not consistently training.

From that standpoint, it is very important that we find ways to do sports specific drills and activities in a safe, socially distanced manner. For a lot of athletes, that’s going to mean working on those drills at home. If you’re a basketball or soccer player, try focusing on dribbling and cone work drills. If you’re a football player, try honing in on those footwork and hand dexterity drills. If you’re a dancer, try doing barre work in a socially distanced manner.

Every athlete can be working on core strength. You should be doing sit-ups, crunches, planks, and wall sits.

Staying safely active is crucial for our bodily maintenance. While we find ourselves in a situation where we can’t play competitive sports in the same way as we used to, we really need to be working on our individual strength and conditioning so we don’t see an increase in injuries once we do finally transition into that new normal.

Frequently asked questions

What’s the rate of injury in single sports players versus multi sports players?

That’s an interesting question even pre the COVID-19 pandemic.

With youth sports in particular, we have an increasing concern about over specialization (kids playing the same sport throughout the year). We see more and more overuse injuries because they are using the same muscle groups as opposed to cross training.

Over specialization continues to be a concern during the COVID-19 pandemic as athletes start training on their own for one sport without the supervision of a coach or trainer watching their form. Again, I would tell athletes to focus on general skills that apply to all sports (core strength, dexterity, footwork).

Is it safe to wear a mask while playing a sport?

Yes. I have not seen any literature or data showing that wearing a mask while playing any sport will cause harm.

On an individual basis, if someone is really struggling wearing a mask while playing, they may need to sit out from that level of competitive play until it’s safe to return to athletic competition without masks. The benefits of wearing masks cannot be understated. It’s something we must continue doing.

As a sports medicine doctor, you also treat those who might not describe themselves as athletes. Has COVID-19 and the focus on home projects increased the injuries in this population?

I have seen an increase in what I call DIY-type injuries, people who were trying to put stuff together in their shed and hurt their biceps tendon. That has definitely increased.

I would encourage everyone to be careful and be safe no matter what activity you’re doing, whether that be training for a sport or working in your garden.

What types of injuries are athletes suffering when training by themselves?

That really varies and is heavily dependent on what sport(s) they may be training for.

Training by yourself without having somebody to coach you or make sure your form is correct can make it easier for overuse injuries to occur. If you’re a pitcher throwing on your own and your mechanics are off, over the course of time you may see an increase in elbow or shoulder injuries.

I’ve seen an increase in ACL injuries on account of the deconditioning that we discussed earlier. Athletes may not be as fit as they were pre-COVID-19, and so their bodies aren’t as capable of taking the impact that sports require, leading to them land on their knees in awkward positions. A lot of that has to do with how much control you have of the muscles above your knee (quadriceps, core, gluteus). Everyday living doesn’t really condition those muscle groups.