Andrew Cosgarea on Sports Injury Prevention

Andrew CosgareaWith the weather getting warmer and spring sports in full swing, it’s important to stay informed about injury prevention and treatment, especially for school-age athletes. Andrew Cosgarea is the head team physician for the Johns Hopkins University Department of Athletics and a professor of orthopaedic surgery at the Johns Hopkins University School of Medicine. As such, he has seen and treated his fair share of sports injuries.

As today’s expert on sports injury and prevention, Cosgarea invites you to submit your questions about sports injury and prevention in today’s Ask the Expert.

For more information on sports medicine, contact the Johns Hopkins Department of Orthopaedic Surgery at 443-997-2663 or

For more information on rehabilitation, contact the Department of Physical Medicine and Rehabilitation at Johns Hopkins at 410-583-2665 or


In your opinion, what are some of the top causes of sports-related injuries?

Sports injuries generally occur for two different reasons: trauma and overuse. Traumatic sports injuries are usually obvious, dramatic scenes; for example, when we see a player fall down clutching a knee. One of the most recognized injuries is an anterior cruciate ligament, or ACL, tear. Overuse injuries, which are actually more common, are usually caused by pushing the body past its current physical limits or level of conditioning. Poor technique and training errors, like running excessive distances or performing inadequate warmups, often contribute.

What are the most common injuries seen related to the increase in spring activities?

With warmer spring weather, many people head outdoors to ramp up their exercise programs. Runners are prone to shin splints, patellofemoral (knee cap) pain, iliotibial band syndrome (pain on the outside of the knee) and tendinitis. The ankle is vulnerable to Achilles tendinitis. Upper-extremity injuries, such as tennis elbow (pain on the outside) and golfer’s elbow (pain on the inside), also occur frequently during the spring months. Traumatic injuries like ACL tears, ankle sprains and shoulder dislocations often happen in spring sports like lacrosse and baseball.

What preparation tips can you offer to people who plan to begin new activities?

I am a strong advocate for setting goals and working hard to achieve them, but it is crucial that our goals are realistic, achievable and sustainable. Most importantly, we need to allow for adequate time to gradually increase training levels so that our bodies have time to adjust to the stresses on our bones, joints and muscles. When running, increase mileage gradually and give yourself plenty of time to recover between workouts. Alternate running days with other cross-training activities like swimming and biking.

Preparation and planning are very important in staying healthy when choosing a new sport. Research the activity and learn the proper techniques. Classes are a safe and enjoyable way to get started. Most importantly, listen to your body and adjust your activities accordingly. While a mild and short-lived muscle ache is generally considered “good pain,” pain in your joints is not normal and is a sign that you should cut back. And if you have not exercised regularly in the past and are just starting a new program, make sure you discuss it with your primary care provider first.

Are there any nutritional guidelines pre- and post-exercise that you recommend?

Dietary recommendations vary greatly based on the specific needs of each individual. I generally recommend no more than a light snack prior to exercise, followed by a protein source like chocolate milk afterward. Adequate hydration is extremely important, especially as the spring days begin to warm up. As exercise programs become more intense, it makes sense to find a more formal nutritional program.

There are many resources available locally through your primary care provider, a nutritionist or online. One useful approach is the three-level concept developed by the U.S. Olympic team nutrition specialists. Recommended meals are matched to the level of workout intensity—easy, moderate or hard. On “easy” days, athletes eat a nutritious and balanced diet focused on maintaining a healthy weight and making smart food choices. On “hard” days, meals provide the fuel the body needs to perform at a peak level for a sustained period of time, primarily through higher levels of carbohydrates. The guidelines can be found on Team USA’s website.

What can be done to prevent and treat shin splints?

Shin splints are a common type of overuse injury in athletes involved in running sports. Pain is usually over the front and inside of the shin in a relatively broad area, closer to the ankle than the knee. The mainstay of shin splint prevention is gradual increase in training intensity, proper footwear, maintaining good Achilles tendon and ankle flexibility, and cross-training to allow for less continuous high-impact activity. Shin splints are primarily treated with ice, rest and gradual return to sports. Stretching exercises of the calf with the knee straightened and with the knee bent may play a role in prevention and treatment. Formal physical therapy and orthotics may be necessary in cases that are not responsive to initial treatment.

Should injury occur, when is it proper to see a doctor?

The appropriate time to see a clinician is ultimately up to each individual, but here are some good reasons for seeking medical care:

  • Inability to bear weight on the injured limb
  • Sharp pain, swelling or a sense of instability in any joint
  • Pain or swelling that does not improve with rest
  • Numbness, tingling or muscle weakness
  • Persistent pain or dysfunction that prevents you from participating in desired activities

If you have these symptoms, contact your primary care provider or schedule an appointment to see a clinician in the Division of Sports Medicine by calling 443-997-2663. Additional contact information can be obtained on the Department of Orthopaedic Surgery’s website.

What are the keys to the successful rehabilitation of a sports injury?

Patience, persistence and a disciplined rehabilitation plan are the keys to successful recovery. If your initial efforts don’t result in substantial improvement, seek advice from your primary care provider or physical therapist. Most rehabilitation programs will incorporate targeted muscle strengthening and flexibility exercises with gradual return to sports activity after initial pain, swelling and stiffness are addressed.

The Department of Physical Medicine and Rehabilitation at Johns Hopkins has physical therapy offices at several locations throughout the Baltimore area and can be reached at 410-583-2665. Additional information can be obtained on the department’s website.


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