Athletes are no stranger to injury — it’s part of the game. In the heat of competition, especially at elite levels, sprains, bumps and bruises are to be expected. But something more dangerous lurks in locker rooms, weight rooms and athletic training rooms: Methicillin-resistant Staphylococcus aureus, better known as MRSA.
Many athletes don’t expect to be sidelined by something off the field, but there are very real consequences for athletes who are infected. Tori Kinamon, a former collegiate gymnast, found that out firsthand.
Here’s how it changed the course of her career:
MRSA’s Changing Landscape
MRSA, a particularly difficult-to-treat form of antibiotic-resistant bacteria, tended to only be a concern in traditional healthcare environments like hospitals. As the culture and norms surrounding athletics started to change in the ’90s, it started to become a serious problem for athletes, as well.
Now, 92 percent of surveyed athletic trainers believe MRSA is a national problem according to the Journal of Athletic Training. Despite increased incidences of MRSA in athletics, many athletes haven’t received proper education on the risks of MRSA from their athletic programs — including Kinamon.
Kinamon has been a gymnast for most of her life, beginning her training at the age of 2.
Throughout her early gymnastic career, she became familiar with MRSA through her biology and science classes — not coaches or athletic training staff.
“Throughout middle school and high school, it definitely wasn't really a concern that was addressed in gymnastics,” Kinamon said.
While it is more readily addressed in football and wrestling, there’s plenty of reasons to be concerned about infection in gymnastics. Cuts and scrapes on the hands and wrists are common because of the bars and gymnastic grips involved. These abrasions are perfect points of entry for bacteria like MRSA.
Eventually, the years of hard work paid off when Brown University recruited Kinamon, but there her infection-prevention education didn’t improve much. There were pre-season athlete health meetings, but MRSA didn’t get much more than a blurb.
“I would say that the education I received on MRSA was not specific to athletics, and the education I received from the athletic setting was not nearly as comprehensive as it needed to be,” Kinamon said.
Aside from education, there were also challenges in implementing hygienic best practices due to time constraints and limited resources, such as the number of shower heads in the locker rooms.
Kinamon said it wasn’t unusual for some athletes to go from practice to the dining hall and then to the library before finally showering in the dorm. It might not seem like a big deal, but both the CDC and Mayo Clinic urge athletes to take showers immediately after exercising to reduce the likelihood of MRSA colonization.
Athletic training rooms are also a cause for concern. For instance, athletes are not supposed to get in a whirlpool if they have open wounds, but it happens regularly. Kinamon believes things like that slip by because athletic training staffs are tasked with so much that it can be difficult to monitor and enforce proper protocols.
Proper education about the risks and prevention of MRSA can help to fill these gaps.
“I think it's also up to the athlete to contribute to keeping the spaces clean,” Kinamon said.
During the winter of 2014, Kinamon learned she had contracted MRSA.
Due to the constant travel involved during the gymnastics season, she can’t say for sure where she picked up her infection. However, where exactly she was colonized by MRSA is not nearly as important to her story as what followed.
Kinamon thought she knew what MRSA looked like. In her athlete health meetings, it was described as presenting like a spider-bite-like lesion. She thought she would immediately recognize the signs of a MRSA infection.
But in her case, the infection didn’t present conventionally.
There was no telltale lesion, just a dull ache in her left hamstring. The pain got exponentially worse over the course of three days during her freshman season. Eventually, Kinamon went to her athletic trainer — sure that something was wrong. He examined her leg and said that it felt like a muscle knot.
By the next morning, she knew it was not simply a knot.
“The next morning, I woke up … my leg was very, very swollen and very hot to the touch. It felt like I was sitting on a heating pad,” Kinamon said. “I had a fever. I was nauseous — all the symptoms of infection.”
Kinamon’s mother came to school shortly after and, sensing something was seriously wrong, took her to the emergency room. Because there was no visible cut or lesion on her leg, it took a few days to correctly diagnose her with a MRSA infection.
Initially, doctors thought it was possibly a soft tissue injury or infection, but Kinamon felt — literally — that it was something deeper. She said a previous incident in which she fractured her back was a “blip on the pain scale” compared to what she was experiencing.
“I mean, it was excruciating,” she said. “I knew it wasn't just a superficial infection.”
Once it was determined that the infection had made it to Kinamon’s hamstring, doctors had to take severe measures.
“I was hospitalized with the infection for a month, had eight surgeries over a two week period and I almost lost my leg because of the infection,” Kinamon said.
The surgeries were just the first step in a long recovery process.
The MRSA infection and subsequent surgeries took a toll physically, but also mentally.
“There was a point where I went to sleep for one surgery, and I didn't know if I was going to wake up with both my legs,” Kinamon said. “That was obviously the most unnerving and terrifying thing that I've ever experienced because you definitely don't budget for that as an athlete.”
Kinamon had to sit out the second half of her freshman season while she recovered. To her, it felt like her identity had been stripped away.
“I hit some very low emotional points because not only did I not have my sport, I didn't have my health at all,” she said. “I was bedridden for three months and had to learn how to walk again.”
When Kinamon returned for her sophomore season, she was motivated to come back from the MRSA infection. She didn’t want it to be the end of her collegiate career. Unfortunately, pushing herself so hard after the infection and rehabilitation might have contributed to other injuries.
Early in the season, she tore her Achilles on the same leg that had been infected. She came back to compete during her junior season, but toward the end of the season, she tore her ACL meniscus.
“I don't really think that my leg was ever the same, so I was compromising in different ways,” Kinamon said. “So it definitely continued to affect me for the rest of my career.”
By her senior season, Kinamon made peace with medically retiring and served as assistant captain on her team. Time away from competition opened another door, though. It created an opportunity for her to become an advocate for infection prevention among athletes.
During her senior year, Kinamon started to dig into research and advocate for improved awareness about athletically acquired infections such as MRSA. After graduating, Kinamon continued this research with a fellowship she received to study MRSA in athletics, while also coaching gymnastics.
She knew she couldn’t change what happened to her, but others could benefit from her experience. Her goal was to highlight athletes’ susceptibility to infection and the potential severity of infections.
This led Kinamon to develop an educational program for athletes that she shared with several schools—some of which even changed hygienic policies based on what they learned. Some colleges she reached out to were hesitant to talk about MRSA. It wasn’t something they wanted to be associated with. However, some digging revealed nearly every one had some sort of story involving MRSA or infection.
The program includes various direct actions athletes can take to ensure their health and safety. Athletes should shower immediately after practice and wash their hands after any athletic participation—especially weight lifting. They should also be aware that body shaving also puts them at risk because any nick in the skin creates an entry point for bacteria.
Kinamon also recommends that athletes monitor their skin on a daily basis and make sure any wounds are cleaned appropriately by an athletic trainer and then covered. While they might seem like a badge of honor, cuts and scrapes can put a whole team at risk for infection.
Athletes advocating for themselves is also crucial.
“I know as a freshman, I wanted to prove myself to the team, prove that I could work through pain,” Kinamon said. “When my hamstring was bugging me at first, I didn't say anything because I thought to myself, I didn't really get hurt. I should be able to work through the pain.”
Athletes should talk with athletic trainers about the procedures in place, too. Kinamon encourages openly discussing topics like how the athletic training room is disinfected, what kind of adhesive pads are being used and whether the whirlpool is being cleaned regularly.
“You know, I think that everybody wants to assure you that they’re keeping spaces clean, and it helps hold people accountable,” Kinamon said.
By being aware of risk factors and advocating for things like accessible hand sanitizer, disinfectant spray bottles and antimicrobial products like MicroBlock, athletes can fight against threats to their health.
Finally, skin health and hygiene is not just confined to a single athlete. It can affect everybody else on the team. Kinamon urges athletes to follow best practices to not only take responsibility for themselves, but also their teammates’ health.
Hopefully, her story inspires others to be proactive about MRSA and infection prevention. While most athletes expect musculoskeletal injuries here and there, the most devastating injury Kinamon experienced was an infection she never saw coming. She’s determined to make sure others do, though.
While MRSA knocked her off balance as a gymnast, she’s stuck the landing as a dedicated MRSA educator and advocate for athletic infection prevention.
For more information on how you can keep athletes safe from MRSA, visit our blog.