I could give you a list of all the things you should look for but instead I’d like to give you a simple acronym that you can use in any sport, any age group, boys, girls, men, and women.
This is a quick framework on how to figure out whether you should consider an urgent visit to the orthopedic surgeon, urgent-care facility, or emergency room for a potentially serious injury. We use an acronym called “SAFE,” and call our decision tree The SAFE Method.
SAFE stands for Story, Appearance, Feel, and Effort. When you’re trying to decide whether to go see a doctor urgently what you’ll want to do is use this acronym as a coach on the field, a parent at home, or athlete yourself and be on the lookout for Red Flags. If Red Flags are present, it is likely best to get urgent professional help. Let me take you through The SAFE Method for the knee and see how it can assist with the decision.
“S” stands for story, meaning that you want to get the story of how the injury happened. For knee injuries, some of the serious things that need urgent attention are broken bones, dislocations, and possibly ligament injuries. In the story listen for descriptions of “I heard/felt a pop,” “I heard/felt something crack,” “my knee gave out” or “it REALLY hurts.” If any of these phrases apply to this injury, those are Red Flags and we’d recommend urgent evaluation. If there are no Red Flags, then move on to “A.”
“A” is for appearance. You’ll want to see what the injured knee looks like. Is the kneecap obviously out of place? Is the knee bent at an unnatural angle? Is it already swollen or bruised just a minute or two after the injury? These are all Red Flags, and if you see these it would be best to have a doctor evaluate urgently. If no Red Flags for appearance you’d move on to “F.”
“F” is for feel, meaning that you want to gently press around the injured area. There’s no need to press forcefully. What you’re looking for here is if you press lightly but it produces a lot of discomfort or pain, that’s a Red Flag. Still no Red Flags? Then move on to the final assessment, “E.”
“E” stands for effort, in which you’ll want to have the injured player move the knee on her/his own. This usually takes place while lying down or sitting down. If the player is unable to move the knee, or experiences significant difficulty moving the knee these are Red Flags. If the movement is fairly comfortable you’d ask them to stand and walk. How does that go? If the player is unable to bear weight on the injured knee that’s also a Red Flag, time for a professional to have a look.
So that’s the basic process. It’s like a funnel that gets narrower and is designed to sift out the serious possible injuries. No method is 100% certain to pick up every possible serious injury, so if you have a concern it’s always reasonable to have a doctor at the local urgent care facility check it out.
Otherwise, use The SAFE Method and our little acronym. More than 75,000 non-medically trained coaches have used our method, and pretty much every team doctor in America will use something very similar on the sidelines.
• The SAFE Method is a very handy acronym to assist any coach, athlete, or parent decide whether an injury is serious enough to require urgent evaluation by a trained physician.
• “SAFE” stands for Story, Appearance, Feel,
• In each of the assessment points you look for Red Flags. If Red Flags are present it means that it would be good to have urgent physician evaluation.
FURTHER READING: Do you need an MRI to diagnose an ACL tear?
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury recognition and management at SidelineSportsDoc.com Blog.)