The cost of injury

by Andrew Walker PT | Aug 31, 2015

Physical Therapy can reduce injury risk, and therefore cost of injury,

Physical Therapy is trying to take over social media today. In honor of #GetPT1st we have a new blog post!

With both our bodies and our machines, we understand the importance of preventative maintenance to keep things working as they should and avoid unnecessary problems. Consider, for instance, two very important parts of our lives here in Alabama – our cars and our air conditioners! When they break down, we have two issues:

Not available to use:
- May have to borrow a car, or get lifts from family/friend.
- At the peak of the summer you may have a very hot house, and an unhappy family…
Expense:
- This can vary, and repair is not always possible. The cost can be anything from $$ to $$$$$.

For these reasons many of us choose to get regular service on these things. With the human body we take a similar approach:

Dentist:
- Exam every six-months to help avoid cavities and associated illness.
Doctor:
- Annual exam to screen blood pressure, weight, etc., to help avoid illness and disease.

There is obviously the upfront cost of time, and money to manage a disease. But, many diseases can only be managed, they cannot be cured. So, the cost of disease is often ongoing, which is why many see the benefit in going for these regular examinations to try and avoid disease or catch it early.

The risk of expense, inconvenience, and future issues leads us, both with machines and our body, to consider preventative maintenance. If this is the case should we take the same approach with our athletic pursuits? Let us consider the cost of two types of injuries:

ACL tear

120,000 athletes will suffer an ACL tear each year in the United States¹. These can be both contact and non-contact injuries. Some sports have a higher risk such as soccer, volleyball, and lacrosse. Unfortunately females have a higher likelihood of getting these injuries. You can read more about this in part 1 of our previous blog article on ACL injury prevention. Most athletes in demanding sports will require a reconstruction, which will then require extensive rehabilitation. Many will have the likelihood of early onset of osteoarthritis, many (even professionals) either get back to their sport at a lower level, or do not get back at all, and there is always the risk of re-tear of the reconstructed ligament. With respect to symptomatic osteoarthritis, of all the people who are diagnosed 30,000 to 38,000 are related to ACL tear. Similar is found with total knee replacements with 25,000 to 30,000 each year due to ACL tear². A recent systematic review shows 81% return to any sport, 65% returned to pre-injury level, and 55% of athletes return to competitive levels³. With respect to re-tearing after surgery the same paper found that American football, soccer, and basketball had rates of 8.9%, 7.1%, and 4.0%, respectively. Sadly, it is worth noting that ACL tear not only puts you at risk of re-tear, but also of tear to the other leg! These facts shows that the long-term repercussions from this injury are huge!

Let’s think about the numbers that might make up our bill (I used numbers from my own Blue Cross Alabama Insurance plan):

Visit to an orthopedic MD: Co-pay $25.
- Will need to see him after injury, after MRI, and several times after surgery. A total of at least six visits.
MRI cost: no cost on my plan, but will vary.
Surgery Cost: Outpatient surgery Co-pay $50
Physical Therapy: $300 deductible, then 20% of charges.
- Will be going to therapy for a minimum of 3 months, 2-3 times a week.
- Many athletes will continues beyond this, but once regular daily activities are manageable insurance no longer offers coverage. Return to sport becomes an out-of-pocket expense.

You can try and do the maths but obviously there is a lot of variability. Looking at a few sources, from a Google search, the out-of-pocket cost of ACL surgery can range from $800 to $3000. This however, does not take into account the time lost to work, travel and other expenses. The surgery alone would likely lead to a 3-5 day absence from work. Beyond this, using the minimum scenario above, you would likely have 31 absences over 3 months. With all of these figures in mind it should be no surprise to hear that the cost to society of a reconstructed ACL tears is thought to be $30,000. Interestingly in ACL reconstruction 27% of the total cost, and 67% of the rehabilitation cost was accrued after six years (this accounts for the other issues that can/will occur from this injury). I will let you do your own math if you choose but as you can see an ACL tear is expensive both to you and society (which then affects you in the form of taxes etc!). You may then ask, well what if i tell my kid to hang up their boots and we do not reconstruct? Our second references found that the cost to society of unreconstructed ACL was $50,000 more per person!

Shin Splints

We will spend a little less time on this, partly because it has been less studied. But, shin splints is the number one running related musculoskeletal injury (RRMI). They make up 13-20% of RRMIs. When someone develops this pain they typically will see either their family physician +/- an orthopedic doctor. They may be sent for an MRI to rule out a stress reaction or fracture. If it is shin splints they will likely tell you to reduce or stop running and to go to PT. The initial script for PT will likely be 2-3 x a week for 4 weeks, and at the end of this the therapist might recommend further therapy. If you don’t follow the advice there is the possiblity a stress fracture would develop. In this case you might get placed in a walking boot, told to rest for six-weeks, and then have PT at a schedule similar to the above. Again, I will let you do the math but we are talking about money spent (likely $$$-$$$$), time away from work, and time away from what you enjoy!

To summarize:

Injury has the potential to be costly in the short term with respect to time, money, and convenience.

It has the potential to cause long-term health issues which can also be costly, lead to further procedures, and lead to greater limitations.

It is fair to compare the risk of injury with the risk of high blood pressure. Development of high blood pressure is an issue that has to be treated in the present and can be costly, but it also has an increased risk and cost if it leads to heart attack.

Injuries are an issue that should be given similar consideration, so we should consider what we can do to prevent them or reduce our risk.

What can I do?

At least 26% of non-contact ACL tears are preventable⁴. I do not have any statistics for shin splints, but I am confident a good number are preventable, as along with ACL and other injuries, it is usually related to faulty biomechanics/form. If you or your child plays sports, or even just likes being active and you want them to remain free of injury consider having them see a Physical Therapist. If you do not know all that a Physical Therapist can do and why we are a great choice see this blog post. At PhysioWorks we use professional-grade motion capture to help to break down an athletes biomechanics. When you consider the cost of our bulletproof runner video gait analysis or ACL injury prevention screening, it is worth it compared with the potential cost of injury and ongoing issues.

Still from video showing knee valgus that could place client at risk of injury.

Video running assessment can help identify dangerous patterns of motion

Jump landing analysis can help predict ACL injury risk

Look around society and you will see we have an epidemic going on. I didn’t choose the word epidemic, Dr James Andrew renowned orthopedic and sports surgeon used it in addressing what he is seeing and treating in youth sports injuries. Epidemic is pretty accurate when you consider kids, 15 and under, have seen a 927% increase in ACL surgeries between 1994 and 2006⁵! However, you can help ensure his epidemic does not affect you and your family by taking preventative action before injury occurs!

As always good luck, and please contact us if you have any questions in how we can help you!

References: