An injury is something that causes pain or weakness that is significant enough to change your behavior. It can be difficult in a sport like skating where athletes often having muscle soreness resulting from what could be completely appropriate training loads. Often injuries start as annoyances, hot spots or other minor symptoms that increase over days or even weeks.
You should always report an injury to your parent or guardian, your coach and your physician or another qualified medical professional who can help figure out a plan for treatment and return to full activity.
Many times athletes fear that if the details of an injury are shared with a parent or coach, they will not be permitted to continue to skate or train. While it may be true that certain types of injuries will require time away from the ice, there are also many injuries that can be resolved quickly or by modifying training and gradually increasing back to the normal level of activity. It is better to get evaluated and have a treatment plan than to minimize or ignore an injury until it becomes severe enough that you are missing days, weeks, or even a season off the ice.
Some minor injuries can be treated at home with appropriate rest and supportive care. However, some of these seemingly minor injuries will progress to something more significant or serious if ignored. An injury that is severe in nature, worsening rather than improving, or most definitely in the case of concussion or suspected concussion, requires evaluation by a qualified health care professional as soon as possible.
Expense of treatment is often a reason athletes and their families may avoid getting treatment until a situation or injury gets really bad. Consider the amount of money and time spent on lessons, ice time and off-ice training and think about the quality of these activities if an athlete is injured and unable to train at his/her best.
We budget money for lessons, competitions, dresses, photographs and video, etc. and we need to budget for recovery, therapy and health care as needed.
- AMSSM – Geographically searchable database of sports medicine doctors.
If you don't find a suitable professional on either of the above lists, contact your family doctor and have them evaluate you and refer to the appropriate specialist, if necessary. Also ask your coach if they have worked with a good doctor in the past.
- MoveForwardPT – Geographically searchable database of sports physical therapists.
- Scandpg – Geographically searchable database of registered dietitians by specialty, including sports dietitians (CSSDs) and those experienced with working with disordered eating and eating disorders.
A note about medical professionals: Ideally, you are looking for an MD or DO boarded in sports medicine, a licensed physical therapist and a registered dietitian or an RD/CSSD (an RD with additional training working with athletes). While there are many other fields of medicine and tangential fields of certification, it can be difficult to know the skills and experience of professionals coming from other backgrounds. Be alert to professionals practicing beyond the scope of their training; for example a chiropractor administering nutrition advice (or selling supplements) or a skating parent (with or without a medical background) who has purchased a therapy device and is using it on skaters in the rink. Professionals falling under these categories should be considered "use at your own risk.'
The bottom line is that there is often value to be found in nontraditional or holistic approaches to medicine and therapeutics, but that it is also easy to spend money and resources on questionable or unproven therapies that can be, at best, no help to the athlete and at worst cause further harm or injury. Your best bet is to start with a licensed physician or surgeon with training in sports medicine and work from there.
Sometimes specialist physicians may have a long waiting list of patients waiting for an appointment. Here are some tips to get seen quickly:
- The front desk schedulers hold the key to access! Be especially polite and sympathetic: "I realize the doctor is extremely busy, we really appreciate everything you are doing to get us in quickly."
- Ask about cancellations or options to be 'worked in' to the schedule: "I understand there are no available appointments, but my son/daughter has an upcoming competition and needs to be seen as soon as possible. Could you please call us if there are cancellations in the doctor's schedule?' or 'Could we possibly come sit in the office and see if the doctor can work us in today?"
- Let them know your son/daughter is a competitive ice skater (without sounding entitled) – these docs went into sports medicine because they love sports! Oftentimes creating a personal connection with the doctor's interests will help expedite access.
- If you feel like your request is falling on deaf ears, you can always ask if you can leave a message in the doctor's voicemail (or doctor's direct assistant's voicemail).
- Rude or overbearing behavior is unlikely to get you seen quickly. Treat others how you want to be treated.
Even recreational skaters who skate infrequently can experience traumatic bumps, bruises, sprains, strains and even concussions. Serious, developmental skaters who are skating five or more days per week are at increased risk for these acute injuries. Synchro, pairs and ice dance can have an increased risk of acute injuries because of likelihood of collision with the ice, boards or each other.
Athletes training on a daily basis are subject to overuse injuries, which arise when the athlete has a training load that is either too high in intensity or volume (time on the ice). Athletes are at increased risk when going through a growth spurt and when training changes more than 10 percent (in terms of intensity or minutes on the ice). Poorly fitting, broken down boots or boots that are chronically laced too tight also contribute to increased risk of overuse injuries.
Skaters commonly experience:
- Tendonitis, which is the inflammation or irritation of a tendon that attaches muscle to bone.
- Bumps, blisters or hot spots on the foot and ankle where the boot rubs or impacts.
- Shin splints, which is soreness and swelling along the shin bone. Sometimes these symptoms are confused with stress fracture and typically an MRI or bone scan can be utilized to rule out other problems of the shin.
- Patello-femoral syndrome ('jumper's knee), which is pain in the front of the knee and around the patella (kneecap).
- Osgood-Schlatter Disease and other growth plate issues can cause incapacitating pain in growing athletes when there is too much/too frequent force going through the growth plates.
- It is important to understand that a bone bruise, a stress reaction and a stress fracture are all essentially the same injury, in order of increasing severity. In skaters, stress fractures are most commonly seen in the tibia, ankle, foot and low back. Bony stress injuries arise when the remodeling process of the bone, which happens continuously in a healthy athlete, is unable to keep up with the stress and impact forces from training. Stress fractures will heal if and only if the athlete rests appropriately. The problem with stress injuries is that the athlete will become asymptomatic (stop having pain or other symptoms) fairly quickly upon resting, but if they resume the same impact/training, the injury will likely quickly recur. Untreated or ignored stress injuries can lead to serious issues requiring prolonged time off the ice and even surgery. Stress fractures occurring in an area making contact with the skating boot should always initiate a close inspection of the boot to be sure that the injury is not arising from the boot interacting inappropriately with the skater's body.
- Injuries to the hip labrum, sports hernias and groin strains, which are all potentially serious and typically manifest as deep groin pain, can be difficult to diagnose precisely and can be serious. An experienced sports doctor is essential to diagnose and treat this type of injury.
Concussion is a potentially serious injury when the brain's normal function is disrupted by biomechanical forces to the head.
- This can be caused by a blow or a fall in which the athlete hits his/her head on the ground, the boards or another athlete's body, but it can also be caused when an athlete suffers whiplash or other jarring forces.
- Loss of consciousness doesn't necessarily indicate a concussion, nor does lack of loss of consciousness mean a concussion hasn't occurred.
- You can't "see" a concussion on a radiological evaluation, although sometimes ER doctors will order a head CT to look for bleeding in or around the skull.
Concussions or suspected concussions should always be evaluated as soon as possible. Waiting to evaluate a concussion can result in increased severity and a longer time needed for the athlete to return to full activity.
Be aware that concussion symptoms often take hours or days to fully manifest. Concerned parents can take an athlete to the ER, have them evaluated and discharged, and consider them "cleared" when, in reality, concussion symptoms and issues will continue to develop and can cause serious issues if the athlete immediately returns to skating. If the athlete is evaluated in the ER, the athlete should also have subsequent follow up with a neurologist or sports doc experienced in working with concussed athletes. At the very minimum, an athlete with a concussion or suspected concussion should follow an incremental return to play plan that will take a minimum of seven to 10 days to return to full training and activity.
Bottom line: A concussion evaluation from the ER is the first step in a return to play progression for the figure skater.
Example: Concussion return to play plan for singles discipline athletes:
Phase 1: Cognitive rest (including limited screen time, homework, etc.)
Phase 2: Permission to stretch and work on balance, watch practice or skating on video
Phase 3: Permission to do aerobic activity that elevates the heart rate submaximally for 30 minutes or less
Phase 4: Permission to get on the ice for one session of forward and backward stroking with limited turns and twisting and no spins or jumps. Total time should be one session.
Phase 5: Permission to execute choreography (with or without music) with turns but with no spins or jumps. Total ice time can be increased slightly.
Phase 6: Permission to execute choreography and do program run-throughs marking jumps and spins.
Phase 7: Permission to do basic spins and single jumps.
Phase 8: Permission to do advanced spins and double jumps.
Phases 9-10: Permission to do all spins and triple jumps.
Important note: An adult athlete with a mild concussion or suspected concussion may spend a minimum of one day at each phase. Younger athletes, particularly those under 18, will likely require longer time intervals at each stage as their brains are still developing. There are neurologists and other sports docs who specialize in treating concussion and progressing athletes back to full activity appropriately. Search online for a concussion center in your area.
Dealing with a potential eating disorder can be tricky. Being very thin or possessing a thin body type does not automatically signal an eating disorder. Likewise, an athlete who seems to be normal or even overweight could have seriously disordered eating or an eating disorder.
Things to consider:
- While it is appropriate to express concern about peers or other athletes, comments about an athlete's weight, even if perceived as positive, can reinforce negative habits that can lead to or reinforce disordered eating or an eating disorder.
- Weight is often the most tangible parameter accessible to athletes, coaches and parents, but weight in and of itself says nothing about the athlete's ability to perform.
- It is U.S. Figure Skating's position that specific dietary advice, including daily caloric intake recommendations, should be given only by a qualified professional (registered dietitian). A CSSD is an RD who has completed additional training working with athletes. When searching on scandpg.org, you can search specifically for a CSSD or for an RD specializing in eating disorders.
- While it may be useful for coaches to discuss best practices in performance nutrition and fueling, coaches should be aware that it is at times a slippery slope and that specific recommendations of weight loss and/or caloric intake should come from a qualified professional, not a coach.
- Athletes, coaches and parents should consider all aspects of performance, not just use weight as a metric for performance. Athletes may have a belief that they need to be a specific scale number in order to perform best. While we can acknowledge that thinness may be advantageous in a rotational sport, there is a distinct difference when discussing weight, thinness and body composition.
- Weight loss is rarely appropriate for an athlete still going through growth and development and should be handled with extreme care and by an appropriate professional (RD).
- It is never appropriate to weigh an athlete publicly. Athletes should NEVER be given a specific metric by a coach (examples: "I want you to lose 5 pounds; I want your thighs to be XX inches."). If a coach, parent or athlete has concerns about specific metrics, they should be referred to an RD and/or physician for consultation.
- It is not appropriate for officials to comment on an athlete's weight, even with the best of intentions. Concerns about an athlete should be brought to their committee chair or to U.S. Figure Skating's director of sports science and medicine.
In the case of minors, all communication must go through the parent. In the case where the parent denies a problem, it can be appropriate for the coach and/or rink management to request medical documentation from the parent in order to assure the athlete can participate safely.
For further information about disordered eating and eating disorders, see U.S. Figure Skating's position paper here.
You need to know that U.S. Anti-Doping (USADA) has the ability to test any U.S. Figure Skating athlete for any reason and at any time. However, USADA is extremely unlikely to randomly test non-International Selection Pool (ISP) athletes. Even ISP athletes who are not on the World Junior, World or Olympic teams are unlikely to be randomly tested (although it does happen with more frequency than non-ISP athletes). ISP athletes competing at international competitions as members of Team USA are very likely to be tested, either as a result of competition placement or as a random pick.
Regardless of whether you can expected to be tested or not, all U.S. Figure Skating athletes are fully responsible for following the rules as stated by WADA and USADA and should pay attention to which substances are prohibited in and out of competition.
Before taking any medication, prescription or over-the-counter, you should always check it online at www.GlobalDRO.com – record or print the serial number generated with your inquiry result. Ideally, consult GlobalDRO in the presence of the medical professional who is prescribing you the drug.
Some substances prohibited in and/or out of competition may be allowed in certain circumstances with what is called a herapeutic Use Exemption (TUE). A TUE is obtained by going through USADA (typically by completing forms on their website) and justifying/documenting why use of a specific drug is medically necessary.
Common drugs requiring a TUE:
- ADHD medication
- Steroids and steroid-based drugs
- Growth hormone
Commonly used over-the-counter drugs that are prohibited in competition:
- Pseudoephedrine (often included in many combo cold drugs) and other stimulants
- Levmetamfetamine (nasal inhaler) and racepinephrine (nebulizer) are prohibited in-competition but are also found in some cold and flu products
- Some narcotics (a scant few narcotics are available OTC in Canada)
Your health and safety comes first. In case of emergency intervention, follow the advice of your care team and contact USADA and U.S. Figure Skating immediately to figure out how to report use of potentially prohibited substances.
Because supplements are largely unregulated in the United States, it is a constant risk that banned substances could be present in supplements (both inadvertently and intentionally). It is U.S. Figure Skating's position that ALL supplements should be considered "use at your own risk."
Major brands of vitamins and micronutrients are generally considered safe. Engineered foods sold as food (example: sports drink) are generally considered safe. Engineered foods containing stimulants sold as supplements (example: energy drinks) are generally considered NOT safe.
Two categories of supplements should almost always be avoided for potential of containing banned substances:
- Supplements that claim to boost energy (stimulants), particularly supplements that claim to help you gain or lose weight (mass builders, appetite suppressors, metabolism modifiers). These are not to be confused with food products like 100 percent organic whey protein.
- Supplements advertising sexual enhancement.
A very limited amount of supplements are tested and certified free of banned substances by the National Science Foundation. A list of these products (by serial/lot number) are listed on the NSF for Sport app available for download for iOS and Android.
Marks of certification, purity or efficacy present on supplement product containers are often counterfeit (i.e. "Certified free of banned substances!"). Neither USADA nor WADA certify any supplements whatsoever, so any assurance/seal of approval from WADA or USADA should immediately arouse suspicion.
Bottom line: What are you looking for in your diet and can you obtain this from food? An RD or CSSD is a great place to start if you have questions about supplements and optimizing your performance nutrition.
More information about supplements can be found on USADA's supplement website here.