I.C.E. Can't Do It Alone.

How to get your injured athlete back up and into the game

WHENEVER AN athlete is injured, prompt first aid is essential, but I.C.E. (Ice, Compression, and Elevation) is usually the first play in the healing process and the strategy involved in getting the athlete back into the lineup.

All of the processes require the services of a fulltime athletic trainer. But what if the budget prohibits it?

Enter the coach. Who else knows the individual athlete as well, understands his or her competitive spirit, supports the injured athlete's desire to get back on the field, and who is right there on the field with the athlete everyday?

That is why every coach should be trained in protecting the athletes and getting them back on the field through proper treatment and rehabilitation.

The challenge is accentuated when neither professional help nor access to a rehabilitation center is available. Fortunately, there are still a number of things a coach can do to help put his injured athlete back on the road to recovery.

First, a coach can take a sports-medicine, first-aid, and CPR class. EMP America (www.medicfirstaid.com) offers a course that provides a good foundation for the handling of sports-medicine emergencies. For additional in-depth instruction, the coach can check out a local college for introductory athletic training. If time is limited during the week, the coach can check for weekend courses.

Information on specific injuries is also available on videotape. The injury video series produced by Cramer Products (www.cramersprtsmed.com) provides an excellent source of information on the diagnosis, immediate treatment, and basic rehabilitation of injuries to the ankle, knee, shoulder, or back.

The following tips will help you deal with injured athletes through the difficult rehabilitation period.

If a physician or athletic trainer is available, have him evaluate the injury. If neither is available, the I.C.E. treatment can help decrease swelling and pain:

* Ice the injured area and surrounding tissues immediately for 20 minutes, then remove the ice for an hour. Repeat this cycle for 24-72 hours while awake, or until the swelling subsides. Make sure to protect the skin by placing a cloth or towel between the ice and skin.

* Compress the injured area with an elastic wrap.

* Elevate the injured area above the level of the heart.

The athlete should also be referred to a physician for diagnosis and possible treatment.

Warning: Some physicians will inadvertently complicate the recovery simply by telling the athlete not to do anything for six weeks. This instruction is often taken much too literally.

Sure, an athlete who sprains an ankle and does nothing for six weeks will get better. But what about the rest of the body? If the athlete does nothing to stay in condition for six weeks, he or she will be worse off than right after the injury.

I tell my athletes that I expect them to be more physically fit when they come back than they were when they left. The conditioning program when they get hurt is as demanding as the in-season conditioning. A sprained ankle only affects the ankle - the rest of the body is fine. It must be kept in condition so that when the ankle is ready to return to competition, the rest of the body is ready as well.

Protection of the injured area is another important aspect of the healing process. Fortunately for the athlete who does not have a professional trainer or even sports-medicine products, the number of off-the-shelf products for treating sports injuries has increased dramatically in recent years. It is now possible to go to a local sporting goods or specialty store and purchase the sports-medicine item specifically designed to treat a particular injury.

Better yet, the products are labeled very simply so even someone not familiar with sports-medicine terminology can easily find the right brace, pad, or wrap.

Ankle braces range from a simple lace-up or lace-up with straps, to a rigid brace with hard plastic stays on both sides. Any of these braces will provide comfort and support, but the rigid ones are usually the best.

Don't expect support from an elastic wrap. Elastic wraps are best used to decrease swelling.

Rehabilitation or reeducation of the muscles surrounding the injured area should begin within 24 hours of the injury. Strengthening can be done through isometric exercises -- a muscle contraction with no motion. Since it is motion that generally causes pain, the muscle is exercised without it.

For example, with an ankle injury: Have the athlete push the ankle against an immovable object from the top, bottom, and both sides.

These rehabilitative exercises should be performed after practice, not before. If the exercises are done before practice, surrounding muscles may fatigue before the end of the event and aggravate the injury.

To add variety to the routine during the muscle reeducation period, you can put the athlete on a stationary bike to replicate the work done in a normal practice session.

An upper body ergonomic (UBE) "bike" is another alternative for working both the cardiovascular system and the upper body. If you don't have access to a UBE, be inventive. You can place a regular bike upside-down on a table, pull up a chair, and have the athlete work the pedals with his arms. After doing this for a couple of days, the athlete will be anxious to get rid of the bike and get back on the court.

Athletes can also practice foul shots and work on balance by standing on one foot.

If a joint is involved, the athlete should start the recovery of its range of motion as soon as the swelling subsides, if not before.

For an ankle injury, this can be done by stretching the Achilles tendon.

For a knee injury, put the athlete on a stationary bike (also good for an ankle injury). For a shoulder injury, have them bend over and do arm circles.

Once the athlete is able to do the isometric exercises with no pain and the swelling has subsided, it is time to step up the conditioning to isotonic exercises. Isotonic exercises consist of muscle contractions against resistance with motion, such as pulling against elastic bands or tubing.

As with isometric exercises, the joint must be worked slowly in all directions. These isotonic exercises can continue the reconditioning process after returning to play.

Although the science of medicine has improved, access to good health care has become a greater challenge than ever before. HMOs have changed everything. That's why I tell the parents I deal with that the new acronym is I.C.E.I. That last "I" stands for insurance -- the right insurance.

If you have the right insurance and you tear the cartilage in your knee, you can see an orthopedist, get the tests required for a definite diagnosis, and have the necessary surgery within a couple of weeks.

Compare that to the alternative presented by many HMOs: The family physician, reluctant to provoke a source of his income, tells you to give it some time, the pain will go away. Not true, if it's torn cartilage.

The bottom line is that parents must understand and prepare for a time when their kids may get injured. Preparing for injuries means obtaining adequate insurance for sports participation.

Many of the schools I deal with offer low-end policies that cover only one-third of the reasonable and customary costs for the medical care their athletes receive.

School administrators have to be educated in this area. For only a little more money, they can offer coverage for up to 80% of the reasonable and customary charges -- the amount most medical establishments will accept as full payment.

For example, an MRI can cost as much as $1,200. The parents' payment on a low-end policy would be almost $800, and that's just their cost for the diagnostic test! Repairing the damage costs even more.

On the other hand, with proper insurance, the worst-case scenario for the parents amounts to $240 for the test.

The low-end insurance compromise creates the worst situation possible, short of no insurance: The athlete risks inadequate health care, the parents are lulled into a false sense of security, the coach has an athlete sitting on the sidelines longer than necessary, and the school may be liable for misleading the parents regarding the insurance coverage.

In some ways, low-end coverage may even be worse than having no insurance at all, because if the parents don't realize the deficiencies of their coverage, they are in for a rude shock -- on top of worrying about their child.

So, what is the most important thing you can do to help your athletes return to play following an injury? The answer is simple: Address the subject of insurance before an injury occurs.

No one wins when an athlete is disabled, even temporarily. That's why we established the I.C.E.I. acronym.

If you search hard enough, you may find an insurance agent who will give your athletes a price break. If you are interested in a total plan for risk management that includes insurance coverage for all of your student athletes, contact me at [e-mail]. I have a creative solution for you.

If you want more information on the care of athletic injuries, contact EMP America for the Sports Medicine 1st Aid Class; Cramer Products for the Injury Video Series; or Career Publishing, Inc. at 1-800-854-4014 for my new book, Sports Medicine Essentials: Core Concepts in Athletic Training and Fitness Instruction.

Best of luck!