The injuries we actually see in August and September

Preseason and the first month of games are when the calls cluster. Bodies are being asked to do things in full pads and Texas heat that they haven't done since last November.

Ankles and feet lead the list. The most common football injuries happen below the knee — rolled ankles, turf toe, heel and arch pain. They're also the ones most often shrugged off, which is exactly why they linger.

Contusions are the most frequent single category — roughly a third of youth football injuries. Most resolve on their own. Some don't, and a deep thigh contusion that isn't managed properly in the first 48 hours can turn into weeks of lost lateral movement.

Ligament sprains run about 15% of injuries. Ankles mostly, but knees are the ones that change a season. An ACL tear is the injury every parent fears, and while it's less common than the internet suggests, the mechanism — planting and cutting, or landing awkwardly — happens on every field in East Texas every Friday.

Concussions account for fewer than 4% of youth football injuries, but they're the one category where "wait and see" is never the right call. Concussion management belongs with your athletic trainer and physician immediately, not with ice and a nap.

The 48-hour rule

Here's the thing most people get wrong. The question isn't how bad does it hurt. Pain is a terrible predictor of how serious an injury is. A mild ankle sprain can hurt more on day one than a partial ligament tear.

The better questions are about function:

• Can they put full weight on it and walk normally?
• Can they move the joint through its normal range?
• Is there swelling that keeps getting worse after the first day?
• Does it feel unstable — like the knee or ankle might give out?
• Is there numbness, tingling, or a "dead" feeling?

If the answer to any of the last three is yes, get it looked at. Instability and worsening swelling after 24 hours are the two signs that most reliably separate "this will be fine" from "this needs attention."

And if they're walking normally within two or three days with steadily decreasing swelling, that's usually a good sign — but it isn't a green light to return to full contact. Most re-injuries happen because an athlete came back before the tissue and the neuromuscular control caught up with how good they felt.

You do not need a referral to see a physical therapist in Texas

This is the part most East Texas families don't know, and it matters most in the first week after an injury.

As of September 1, 2025, Texas law allows a licensed physical therapist to evaluate and treat you for up to 30 consecutive calendar days without a physician's referral. That's House Bill 4099, and it replaced the old rules that limited direct treatment to 10 business days.

In practical terms: if your athlete rolls an ankle on Friday night, you don't have to wait for a Monday appointment with the pediatrician, then a referral, then an opening at a clinic. You can be evaluated by a physical therapist first.

Two things worth knowing. Your insurance plan may still have its own referral requirements separate from state law, so it's worth a call to verify benefits. And if care needs to continue past 30 days, a physician referral is required at that point — which is normal, and something we coordinate.

What a physical therapy evaluation actually looks for

A good evaluation after a football injury isn't just about the sore part.

We're assessing the injured tissue, yes. But we're also looking at what let it happen. Limited ankle mobility that forced the knee to absorb a cut. Hip weakness that changed how the athlete lands. A movement pattern that was going to break down somewhere, and happened to break down here.

That's the difference between treating an ankle sprain and treating the athlete who sprained an ankle. The first gets them back on the field. The second is how you keep them there.

For athletes cleared to return, we build the bridge between "no longer hurts" and "ready for full contact" — progressive loading, cutting and deceleration work, and sport-specific movement under fatigue, because that's when injuries actually happen in the fourth quarter.

Three things that reduce risk before anyone gets hurt

Don't skip the warm-up, and don't let it be a jog and a stretch. Dynamic warm-ups that include hopping, landing, and change-of-direction work have solid evidence behind them for reducing lower-extremity injuries. Ten minutes, done consistently.

Respect the ramp-up. The highest-risk window in any season is a sudden jump in training load — the first week of two-a-days, or the first week back after time off. Bodies adapt to gradual increases. They break with sudden ones.

Address the old injury. An athlete who sprained an ankle last season and never fully rehabbed it is meaningfully more likely to sprain it again. Previous injury is one of the strongest predictors of future injury there is. If something never quite got right last year, August is the time to deal with it, not October.

Common questions from East Texas football families

Do I need a doctor's referral for physical therapy in Texas? No. Since September 1, 2025, a Texas-licensed physical therapist can evaluate and treat you for up to 30 consecutive calendar days without one. Check your specific insurance plan, which may have separate requirements.

How soon after an injury should we come in? Sooner is better. Early evaluation tells you what you're dealing with and often shortens the whole timeline. There's no benefit to waiting a week to see if it resolves on its own.

Will physical therapy make my athlete miss more games? Usually the opposite. The most common reason athletes miss extended time is returning too early and re-injuring, or letting a manageable problem become a chronic one.

Do you work with athletes who aren't injured? Yes. Sports performance work — strength, movement quality, return-to-sport preparation — is part of what we do.

What if my athlete's trainer already looked at it? Athletic trainers are the first and best line of care on the sideline, and we work alongside them. A PT evaluation adds a deeper look at movement mechanics and builds the rehab plan.

We're here in Tyler

Lonestar Physical Therapy & Sports Performance is an outpatient orthopedic and sports practice in Tyler, Texas. Our team is fellowship-trained and board-certified in orthopedics, and we treat athletes from across Smith County and the surrounding East Texas communities.

If your athlete picked something up this preseason — or something from last season never fully resolved — call us at 903.405.4899. We'll tell you straight whether it's something we can help with.

Have a good season, East Texas.