Alcohol And Sports: A Losing Team

When you mix beer drinking with swinging bats and flying balls, the risk of injury skyrockets, according to Roger Willcox, M.D., director of emergency services at Columbia Paradise Valley Hospital in Phoenix. He estimates that half of emergency room sports injuries are alcohol-related. From broken ribs to severed limbs, alcohol and sports do not make a good team.

How common is it to find a sports injury as a consequence of drinking alcohol during the game?

Dr. Willcox: It's amazing how many times people over eighteen, especially males, how much alcohol is involved with sports injuries. The more alcohol that's involved the worse the injuries generally. I've seen over the years a tremendous correlation between alcohol ingestion and the sports injuries and it doesn't seem to be getting any better. It's still a problem. I'm not sure people are aware of the problems. Most people think they are playing this game of softball here, there's not much risk but you know they catch their foot on a base and break their ankle real bad. There was one patient that I saw that was going after a softball in center field and ran right into the Cyclone fence and he ended up with a waffle pattern on his face. So you get sort of all kinds of different problems that you see. I would say the more common are ankle sprains, ankle fractures, and sometimes they can go from a mild sprain, of course the mild sprains are extremely common, just tremendously common. We see bad trimalleolar fractures, very unstable ankle fractures in that situation. We see a lot of wrist fractures, hand injuries, thumb injuries, etc. You can also, without breaking a bone, injure your thumb pretty bad by tearing a ligament and we see that sometimes.

Is it in golf or is it other injuries?

Dr. Willcox: I've seen, in fact rather recently, I saw a big divot out of a guys head from a golf club. He had been drinking a little bit. Also saw a pretty bad, actually a fracture from a golf ball, a skull fracture from the same thing. So as you might guess in Phoenix we see quite a few golf related injuries, even though you don't think of that as a common sport to cause injuries. Golf is ubiquitous here in this area.

What is it about the alcohol that leads to these injuries?

Dr. Willcox: Judgment is probably number one. Secondly equilibrium is off, your sense of balance and your sense of judgment. It's easy not to know that cyclone fence is coming at you at a rapid speed. The most serious problem is just judgment. People do things that they might not ordinarily do. They try things they wouldn't ordinarily do and of course this is what makes drinking and driving dangerous too. Also the coordination is a problem with driving. It's really analogous to motor vehicle accidents in that you have to be reasonably coordinated and alert to drive a vehicle. The same with most sports and people get by with it for a long time and then suddenly they have a major injury. It goes from the very mild to the very severe, including broken necks and serious injury to limb, and even death. Disfiguring injuries, amputations, just about any degree. The problem again is that people are having fun. They don't really think of all the consequences of what could go wrong. Their judgment as far as the risk of a certain activity or whatever is just not there. For the same reason somebody that's been drinking might saw off their finger with a skill saw or wreck their car. The same thing happens on the softball field, or out playing golf, or playing tennis. It's fairly easy. You've had a few beers or Martini's or something, play tennis and you can get serious knee injuries, eye injuries. Handball/racquetball eye injuries are very common. With just about any sport, I'm sure badminton could be dangerous. But sports that you don't think about as being dangerous with a little alcohol on board that whole picture can change.

You said with athletes over eighteen. What percentage of the sports injuries do you see that are also alcohol related?

Dr. Willcox: I would say with twenty one and over certainly that it's, you know, there are some other demographics involved obviously, you see more injuries with males than females. Of course more males are playing sports too, so I'm not sure what the percentage would be but I'd say fifty percent. I'd say probably fifty percent are alcohol related in twenty one and over. The sport makes a difference too. For example, it's more common in softball. But obviously certain things like Rugby, it's asking for trouble right there and plus there is sort of this tradition of drinking beer and playing Rugby, the whole Australian and English thing, and the Genesis and whatever. So it's, unfortunately the same way with softball. There's sort of a tradition of drinking beer and playing softball. It's sort of a tradition and it's a dangerous tradition. Wait until afterwards I say, and then let somebody sober drive home.

A lot of people when they are very physically active, lose fluids in the body and they assume that drinking alcoholic beverages like beer or what have you is going to replenish those and it really doesn't, right?

Dr. Willcox: Absolutely right. That is a misconception a lot of people have that if drinking Gatorade is good to prevent dehydration then drinking beer is good and it's actually just the opposite. You know beer tends to have sort of a diuretic, well most people are aware of that, but it does tend to take lots of fluids out. So that's just a common thing that happens. Not only is one not getting enough of the right fluids, but there's actually probably some diuretic effect also which actually means more fluids are lost. If you throw that with our heat especially-actually obviously people get overheated all over the country and in Phoenix we have a lot of heat. The humidity isn't a problem though, but it's still a lot. You throw in alcohol and heat and there's a real tendency to have a lot of heat related illnesses. Sometimes rather severe. Usually in that group it's a lot of the bicyclist and runners and so on. As far as alcohol you know we've seen it some, it doesn't seem like it's quite as big of thing with running and cycling and stuff. I think people are pretty careful about that.

It seems like it's group sports where there's a lot of socialization going on.

Dr. Willcox: Right, you know there is a tendency though, runners often think that beer is good for them. You know for running, that it's a good beverage to take and there's a lot of talk about that back and forth. There a quite a few runners that do drink beer. It's usually not a big problem though that you see with say softball especially.

Is it because it's high in carbohydrates, they think that will give them better performance?

Dr. Willcox: Yes, it's almost legendary, some of the famous runners that believe in drinking beer. I'm not sold on the concept myself. I don't think it's a good idea. I would prefer they drink fruit juice, or Gatorade, or sports drinks. I can't recall where I read it but I know there is starting to be some talk the other way, you know this really is bad for you, why are we doing this, and there is that kind of talk among runners. So I would favor that approach.

Those other fifty percent of sports injuries that come in to you that are not alcohol related, what kind of things do you think could be done to prevent them? Any tips that you can offer individuals that they can do as far as stretching, warming up, things like that?

Dr. Willcox: Prophylactically, have a good understanding of what your limits are and be sensible. I think stretching. Some people, like myself, I'm the opposite of limber, so I really have to stretch and so on. Some people don't need it quite as much but everybody benefits from some stretching before they do physical activity and some of the stretching exercises that we've done for years can even cause problems. So you know my general philosophy is if it hurts don't do that. I think in general, both with when you're playing the sport but even if you are limbering up before, if you are stretching and so on pain is usually nature's way of telling you to slow down. Stretching is excellent if it's done conservatively and done right and usually you need to get all the major muscle groups that you're going to be using in that sport, especially in ball.

Can you talk about things like bandaging, a particular joint that you know tends to be vulnerable to injury?

Dr. Willcox: Well, I think that's more afterwards. Let's say you have an ACL tear or something, then you should be in a special knee brace. As far as other equipment, there are certain orthotics that some people need for their feet and if you need those, if you know you need those things don't go off and do the sport without them. In general, I don't recommend Ace-ing your knee before you play a sport or something because you might hurt your knee, but in certain cases like in certain sports injuries where a lot of people are walking around with an ACL tear that don't have surgery, they don't necessarily need surgery but they need a little extra protection say when they are skiing. That's another sport that there's a lot of drinking and skiing and horrendous injuries there.

Sounds like poor judgment before the alcohol ever hits their lips.

Dr. Willcox: Right, exactly. As far as protection, people that have an ACL tear that it hasn't been operated they generally should wear protection if they are going to be skiing or doing some activity like that. Their orthopedist has probably already told them to. If that's been recommended then you should definitely use it. The problem with all of us and of course I've had sports injuries myself, orthopedic injuries and the orthopedists and the emergency physician for that matter will tell you to do one thing and you've got to do it. It's hard to do sometimes but if someone has recommended something to prevent an injury, for example the ACL tear, you should wear that equipment. As far as just prophylactically using equipment and so on willie nillie, I don't necessarily recommend that. Because for example, there are certain knee braces and so on if they are not really indicated where you tend not to use that knee as much and you actually getting weaker in that knee so you have a detraining effect. So you've got to be careful in that regard.

Once the damage is done, let's talk about some of the myths out there, some of the confusion over how to treat sports injuries. Number one problem, heat versus cold, how do you follow that?

Dr. Willcox: There's a little bit of controversy on that, but I generally like to keep things very simple in that regard. I can't tell you how many times I see an ankle sprain that really wasn't that bad and they've been putting it in hot water or whatever for two days and its all bruised and swollen and it didn't have to be that bad because basically they went with the wrong decision. They went with heat initially. It really makes sense when you think about the logic of it. You go cold initially, you use ice packs initially the first two days. Some people say a day and a half and some people say three days. But I say two days and then heat later. The logic of this is that when you have a fresh injury you've got tissues torn, you've got fluid and blood in some cases, leaking into the extra vascular space and, meaning around the blood vessels, just leaking into the tissue out of the vessels and so on and out of the tissue itself from the injury. You don't want to promote more of that. In other words you want to keep that leakage of fluid because the more of that there is the more of an inflammatory response. Their body is trying to get rid of all this and fight all this off, it just becomes a bigger deal at that point. So you want to minimize that. If you think about it if you use heat that tends to promote more fluid moving into the tissue, more bleeding and so on and so forth.

It could cause more damage, couldn't it?

Dr. Willcox: More damage, right. So I recommend ice initially because that basically has the opposite effect, it kind of restricts to some extent and it calms things down. There's less fluid leakage, there's less bleeding. So ice initially and then heat later. Now later you want all this stuff that's leaked out into the tissue, you want it all absorbed and you want it all to go away and you want your ankle or whatever it is to heal. So heat then actually kind of promotes the whole metabolic process that's going on or the breaking down of protein fluids, the protein substance that's where it shouldn't be, breaking that down, taking that away. All the little white cells so on and so forth working. You've probably seen films and whatever in high school or whatever where you see all the little white cells at work and so on. You want your body to be doing its best to take care of these problems so heat at that point kind of just makes that happen a little fast and it of course feels soothing, it kind of tends to relax muscles that are kind of tight and it's also pleasant at that point in time. But it's not pleasant initially because it promotes more bleeding, more swelling and so on. So you've just got to use cold and heat in the right spot but both really help an amazing amount. Like I said, I've seen people here in the emergency department that didn't even need to be here if they would have known that. I don't know how many times I've heard, "Oh, gosh, I couldn't remember if it was heat or cold so I went with heat." I think that's why I always try to explain what's happening there and then it's more logical than just a guess. Well is it hot or cold, it makes sense that way.

Should we bandage or not bandage?

Dr. Willcox: Well, I would say in general yes if you're talking sprains. Again we'll use a sprained ankle as an example again. Compression is also a useful thing again initially. Sort of in the same time period that you're talking about ice. For the same reason to some extent, it might give some support but the main thing it does is by compression by not being as dispensable, the ankle fluid doesn't tend to just easily move into the extra vascular space and it just keeps the ankle in this case, from swelling as much and thus there are less problems later on. I think an Ace wrap initially is very useful. You see people wearing Ace wraps for weeks and I don't really recommend that. There are problems sometimes, people sometimes put them on too tight and then you get a lot of swelling above or distal to it. Sometimes I've seen people actually put a wrap around the ankle and then the foot swelled because it didn't extend on down into the foot. So you've got to do that right too but it does help. The other thing initially that really helps a lot and again for the same reason really is elevation. If you can stay off, we'll use the ankle again as an example. If you stay off your foot, if you're not putting pressure on it, obviously you're not re-injuring it. So that's another reason. Just elevating it, and again we usually say above your heart in those especially initially and the more severe cases, then that again tends to keep the fluid build up in the ankle in this case, from being as much. So those kind of elevation, compression, ice and the other thing is a question of anti inflammatories and Tylenol and pain relievers.

Is a prescription drug like a narcotic better than taking some regular aspirin?

Dr. Willcox: Yes that's true because the pain relievers for the most part don't have anti-inflammatory with them. Most of the narcotic type pain medicines usually have Tylenol in them, or acetaminophen. Acetaminophen is the generic name. There's a balancing act here and here's the balancing act. Acetaminophen is good in that it doesn't promote bleeding o.k., but it has no anti inflammatory effect. Ibuprofen, aspirin, naproxen, the anti inflammatories unfortunately have a tendency to promote bleeding a little bit. But they have an anti inflammatory effect and so actually, especially later on are very, very helpful in encouraging healing. So they actually not only have an analgesic or anti-pain effect, they actually have a beneficial effect because of the anti-inflammatory nature of those drugs.

So they really do promote the healing?

Dr. Willcox: Right, but then there is the other side of it, they do promote bleeding just a little bit. The platelets are important for your blood clotting and to be not as sticky when you take an anti-inflammatory, so they don't stick as well, they don't function quite as well, you can affect the clotting process just a little bit. So usually if I'm concerned about much bleeding, especially if something is getting black and blue right away, usually I'll hold off on aspirin or non steroidals initially just because I don't want to promote bleeding. As soon as I feel like that's not a problem usually in a day or so, then anti-inflammatories actually are better.

If that's not a problem and they are in pain and the prescribed amount on the bottle just isn't doing it for them, is there ever a time when they can take more than what the prescribed amount is?

Dr. Willcox: Well, yes and no. Here's the thing. Because it's over the counter most people think that the two hundred milligram ibuprofen, the little tablet that's over the counter, that that's the dose, one table every six hours or whatever. The fact is when we prescribe ibuprofen by prescription we prescribe six hundred milligrams or eight hundred milligrams. So I don't recommend going over a prescribed amount, what the amount should be but it tends to be under dosed over the counter and again it's because of the safety concerns and the fact that they are not seeing a doctor they are just buying the drug and taking it. But in general it's not a bad idea to check with the doctor or whatever to see if they are taking the appropriate dose in general. For an adult, three two hundred milligram ibuprofen rather than one would be the sensible dose.

A lot of it has to do with body weight and size?

Dr. Willcox: Absolutely. I usually try to go more by what their ideal weight would be. So if I see a person weighs three hundred pounds, but they are only three feet tall or something then I wouldn't prescribe by the weight probably. I'm of course exaggerating. But you're right, absolutely weight. But in general, an adult would be like six hundred milligrams. There are tiny people around. There are people that don't weigh very much, are not very big and they shouldn't tend to go on the high side. Certainly pediatrics is a whole different situation. As the pediatricians say, kids aren't just little adults, so you do have to be careful with medications with children. But some of the same principles apply.

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