ABP Sports Medicine common mistakes
ABP Sports Medicine · Understand the traps and how to avoid them.
In a 13-year-old with six weeks of insidious posterior-thigh pain, selects 'hamstring strain' and prescribes stretching, without putting ischial tuberosity apophysitis or avulsion on the differential and without palpating or testing that site.
Adult pattern recognition is applied to an immature skeleton, where the apophysis rather than the muscle-tendon unit is the weak link, and pain from growth-plate traction is often reported away from the site.
What to do instead
Before committing to any soft-tissue diagnosis in a skeletally immature athlete, run a named apophyseal checklist: ischial tuberosity, ASIS/AIIS, iliac crest, tibial tubercle (Osgood-Schlatter), inferior pole of the patella (Sinding-Larsen-Johansson), calcaneus (Sever), and medial epicondyle. Treat hip or knee pain in an adolescent as hip pathology until a hip exam (including limited internal rotation) is done.
On a preparticipation evaluation, documents 'no significant past medical history' and clears the athlete without asking specifically about sudden cardiac death, cardiomyopathy, or death before age 50 in first-degree relatives, and without examining a tall athlete for Marfanoid features.
The PPE is treated as a form to finish rather than a screening test; open-ended questions ('any family history?') yield little, and the highest-yield items are easy to skip or forget.
What to do instead
Use a fixed PPE script with the AHA-style elements asked verbatim (exertional syncope or chest pain, family history of premature sudden death or cardiomyopathy, prior murmur or restriction from sport, Marfanoid habitus, and substance use). For a tall athlete, check arm span versus height, the thumb and wrist signs, and pectus or palate findings. Document each element, and refer abnormal findings for echocardiography instead of clearing provisionally.
Tells athletes to 'drink as much as possible' or to replace fluid so that no weight is lost during a hot-weather event, and applies adult heat guidelines directly to children.
Dehydration risk is over-weighted while the real risk of exercise-associated hyponatremia is ignored; children have a higher surface-area-to-mass ratio, lower sweating rates, and slower acclimatization, so adult regimens do not transfer.
What to do instead
Advise thirst-driven drinking, supplemented by pre- and post-session weighing with roughly 1 L of fluid per kg of body mass lost. Treat weight gain during an event as a red flag for overhydration and hyponatremia, and allow 10 to 14 days for heat acclimatization in youth athletes.
For a collapsed, confused runner with hot skin, orders antipyretics, ice packs to the axillae and groin, and immediate ambulance transport before cooling has been started.
Fever-management reflexes (antipyretics, surface ice) and scene-safety/transport reflexes override the cooling-first principle, even though conduction cooling is the intervention that changes mortality.
What to do instead
Measure rectal temperature in the field when exertional heat stroke is suspected. If it is above 40 degrees Celsius (104 degrees Fahrenheit), begin cold-water immersion before transport and continue cooling en route, stopping at about 38.5 to 39 degrees Celsius. Antipyretics do not work because the hypothalamic set point is normal.
In a witnessed collapse with no pulse (after a sprint, or after a ball strike to the chest), delays defibrillation while securing the airway, obtaining IV access, or waiting for EMS to arrive.
ATLS-style airway-first habits carry over from trauma teaching, and the collapse algorithm is not rehearsed; time to first shock is the strongest determinant of survival.
What to do instead
Drill a fixed sequence: check responsiveness, breathing, and pulse for no more than 10 seconds, start compressions, and apply an AED or defibrillator within 3 minutes, with pads on a chest that is dried if wet or sweaty. Resume compressions immediately after the shock, and transfer care only after the first cycle. Recognize blunt chest impact (commotio cordis) as a shockable arrest.
Allows an athlete whose concussion symptoms resolve within 15 minutes to return to play in the same session, or clears return to sport by a fixed calendar (for example, 'seven days') instead of by completing the stepwise progression.
Old concussion grading scales and 'bell ringer' folklore persist; symptom resolution is mistakenly equated with physiologic recovery, and the adolescent brain recovers more slowly than the adult brain.
What to do instead
Never allow same-day return. After an initial period of relative rest, require return to learn (school accommodations) before return to sport, then a stepwise, symptom-limited progression with at least 24 hours per step, keeping the athlete below the symptom threshold. Document each step and the shared decision among athlete, family, school, and team.
Documents secondary amenorrhea in a 16-year-old distance runner as 'normal for athletes' and prescribes an oral contraceptive, without screening energy availability, prior bone stress injury, or bone density.
Amenorrhea has been normalized in endurance sport culture, and a withdrawal bleed looks like successful treatment even though the underlying energy deficit and bone loss continue.
What to do instead
Treat amenorrhea beyond about three months as a red flag. Screen with a brief low-energy-availability questionnaire, ask about prior stress fractures, review calcium and vitamin D intake, and treat with increased energy intake plus reduced training load. Consider DXA after prolonged amenorrhea with a stress fracture. The oral contraceptive is not the treatment.
Either bars a healthy football player who has sickle cell trait from all conditioning, or, at the other extreme, manages a collapsing athlete who has sickle cell trait as if he had sickle cell disease.
Trait is confused with disease, and exertional sickling is a diagnosis of exclusion in collapse that is commonly attributed to heat stroke or asthma instead.
What to do instead
Sickle cell trait is not a contraindication to sport. Counsel gradual acclimatization over 10 to 14 days, paced conditioning, hydration, and prompt treatment of illness or dehydration, without universal restriction. In collapse, use rectal temperature to separate heat stroke and check the response to a bronchodilator for asthma; treat suspected sickling with rest, cooling, oxygen, and fluids.
At a 15-year-old's sports clearance visit with no guardian present, takes a full confidential history and later tells the coach about the athlete's eating disorder.
Adult confidentiality habits are imported into adolescent practice, and the wish to be helpful to the team overrides the minor's privacy and the duty to protect.
What to do instead
Know the state rules on minor consent for sports participation evaluations, and involve the guardian for clearance. Disclose only the restriction and safety-relevant information to the coach, with the athlete's knowledge. Refer suspected eating disorders or mental health concerns to the appropriate specialist instead of managing them alone.
When a 16-year-old asks about creatine and a 'test booster,' replies only that 'supplements are unregulated' and does not address prohibited substances, therapeutic use exemptions, or documentation of the conversation.
Supplement and doping prevalence is underestimated, clinicians are uncomfortable discussing doping, and counselling is assumed to be optional and not charted.
What to do instead
Explain the third-party testing gap (for example, NSF Certified for Sport), that anabolic agents and many 'test boosters' are prohibited in and out of competition, and that a TUE is needed for legitimate banned medications such as stimulants for ADHD or beta-agonists above permitted doses. Document the counselling in the record.