Treating Position-Specific Injuries in NASCAR: Upper Extremities

Fast fact: As of 2013 there were 3,000 published injury studies on football, 1,000 each on baseball and basketball, 140 on bowling, 43 on arm-wrestling and 7 on tug-of-war. NASCAR injury studies? There were 3.

Epidemiological studies offer a way for the medical profession to track, and prevent, some of the more prevalent and recurring injuries in different sports.  As interest in sports has skyrocketed in recent decades, and with a higher demand to keep athletes healthy, studies continue to be a focus in sports medicine now more than ever. Yet the ratio of studies to individual sports remains notably disproportionate. NASCAR and motorsports injuries in general have gotten far less attention in medical literature than have other sports.

While outstanding modifications have been made in NASCAR injury prevention, in such a fast-paced sport, injuries can still happen. In my role with OrthoCarolina’s Motorsports team I treat 1-2 pit crew members per week and 2-5 drivers per year for hand and wrist injuries alone. Most of these needs are operative and non-operative hand, wrist and elbow injuries. But just like any sport, all athletes in NASCAR aren’t the same. The forces and demands on an upper extremity vary dramatically depending on the position of the body part. We’ve seen an evident trend of certain positions being more prone to different injuries, and how I treat a wrist fracture or tendonitis in a jackman may be very different from how I treat a wrist fracture or tendonitis in a changer or driver.

So how do we decide on a course of treatment? I have each driver or pit crew member bring their gear with them to their appointments. Drivers bring a steering wheel; changers bring an air gun; gasmen bring a nozzle. We custom-make splints and braces specifically for the equipment that they use, and individualize treatment for each member of the team. Traditionally we have focused on treating the injured athlete; however having gained a better understanding of these position-specific injuries we are now able to focus on injury prevention as well.   

Here are some of the most common upper extremity issues I see in motorsports:

• Drivers frequently have carpal tunnel, and sustain hand and wrist fractures in wrecks.
• Tire changers tend to get tennis elbow and ulnarsided wrist pain and thumb calluses.
• Carriers get hamate hook fractures (also common in golf and baseball) at a higher rate from slamming a tire on to a car, when the bone hits the wheel and fractures.

About 5-6 years ago, we found that NASCAR tire changers were getting tennis elbow at an astronomical rate. As part of our motorsports care, we developed a year-round tennis elbow therapy program just for changers that’s now been in existence about 5 years. In the time since we’ve seen the rate of that injury in that position drop dramatically.

Position-specific treatments aren’t a new concept in sports. An NFL lineman with the same injury as a quarterback will be treated differently. But just like published papers on NASCAR injuries are few and far between, customized, position-specific treatments for motorsports are still emerging techniques in the science of sports medicine.  I’m currently working on an epidemiological study with OC Motorsports director Bill Heisel related to position-specific injuries in motorsports, looking at how we can take the aggregated data we collect and use it to strengthen the preventative medicine realm. It’s exciting to be at the apex of this type of medical treatment in motorsports right now.

Dr. Glenn Gaston is the Chief of Hand Surgery and Hand Fellowship Director at OrthoCarolina’s Hand Center. He is a Hand Consultant for Stewart Haas Racing, Joe Gibbs Racing, Hendrick Motorsports, the Carolina Panthers and the Charlotte Hornets and has spoken at NASCAR Summit Meetings. Dr. Gaston has published extensively in journals and textbooks on managing elite athletes.