Building Muscle in Young Athletes: Getting Started

Building Muscle in Young Athletes: Getting Started

by | Jul 21, 2021 | Sports Medicine

Young athletes may express an interest in building muscle or “lean body mass” for a variety of reasons. Body composition includes water, bone, fat, muscle and other tissues such as organs and vessels. The elements that are most affected by diet and exercise are fat and muscle. Pediatric sports medicine physician Jacob C. Jones, M.D., RMSK, says, “there are many benefits to increasing lean body mass, and for athletes, the growth of muscles often translates to improved strength and performance.”

Why might a child or teen want to increase lean body mass?

Motivation can come from inside the individual (intrinsic) or from an outside (extrinsic) demand or expectation. Intrinsic motivation is often called “drive” and can be a healthy approach to making positive changes in one’s life. These may include a desire to compete at a higher level, to be stronger, or to improve other areas of performance. Extrinsic motivation often comes from a parent, coach or peer that causes an athlete to set a bar or goal according to their expectations. These may include positive or negative pressures to meet a goal based on their own performance or in comparison to a standard or a teammate.

How can a parent know when a motivation or behavior is concerning?

When the motivation does not align with positive health goals or is based on an irrational comparison or expectation, there is a concern for the athlete’s safety. When an athlete has set a lean body mass target that is unhealthy, a parent may notice behaviors such as restrictive eating or over-exercising. Learning healthy strategies and setting appropriate goals can help to avoid these approaches. Consulting the pediatrician or primary care doctor can help reset goals and assess the need for additional help.

How can a young athlete increase lean body mass?

The strength of a muscle is defined by the amount of force it can resist. Muscle strength is measured when pushing, lifting or pulling an object or the athlete’s own body. More resistance must be applied progressively to increase the size (hypertrophy), length and strength of the muscle with exercise. With consideration of safety and proper fueling and recovery, resistance training leads to an increase in body mass.

What is a good first step in building lean body mass?

For some, resistance training has a narrow definition and requires lifting weights. Yes, lifting weights with proper technique can improve strength. However, equipment is not necessary to improve strength for most children. Activities that use gravity and body weight are an excellent starting point. These include doing ‘crab walks,’ ‘bear crawls,’ and ‘kangaroo hops.’ These activities properly focus on coordination, developing core strength and learning proper form before adding weight.

How can a parent help guide safe choices with resistance training?

  • Discourage comparison with like (or unlike) individuals. Keep the athlete focused on his or her goals and healthy strategies.
  • Provide access to a trained coach. Look for someone with a background and experience in nutrition and resistance training for children.
  • Promote training changes throughout the year. Strength and conditioning programs should vary based on sport season demand (pre- and post-season),
  • Facilitate rest in- and out-of-season. Year-round training, overuse and overtraining have been shown to increase the risk of injury. Regular rest is important.
  • Learn how nutrition plays a role in building muscle mass. Fueling for training and recovery can make exercise more effective.

What are safe measures of success for resistance training?

Using the scale or the amount of weight on a bar as the only measures of success can lead to poor and unsafe choices. Goals like these must be balanced with others that are more likely to directly translate to success on the field. These might include performance measures like endurance, jump height or other sport-specific skills.

Tips for setting appropriate goals –

  • ​Choose goals that are challenging but still achievable.
  • Consider the demands of the sport and position as well as the current weight and body type of the athlete.
  • Ask for help from the:
    • team coach to suggest goals based on the athlete’s performance, sport and season.
    • strength and conditioning coach to set progressive resistance and repetition goals based on the athlete and his or her capabilities.
    • primary care doctor or pediatrician to establish appropriate body composition goals and to discuss nutritional needs based on family and patient history.

How can a parent support a young athlete to safely increase lean body mass?

  • Encourage open conversations about goals and progress.
  • Ask what is driving the desire for change.
  • Confirm appropriate instruction and supervision is in place.
  • Discuss plans and progress with a sports dietitian, a strength and conditioning coach and a primary care doctor.
  • Monitor for signs of overtraining or worrisome behaviors that increase the risk of injury.
Ten Most Common Orthopedic Conditions Seen in the NICU

Ten Most Common Orthopedic Conditions Seen in the NICU

by | Jul 14, 2021 | Spotlight

Content included below was presented at the 2021 Pediatric Orthopedic Education Symposium by pediatric orthopedic surgeon Amy L. McIntosh, M.D.

Watch the full lecture or download this summary.

Newborn care, particularly in the neonatal intensive care unit (NICU) requires the consultation of many pediatric specialists. Scottish Rite for Children pediatric orthopedic surgeon Amy L. McIntosh, M.D., frequently consults in the NICU, and in a lecture for pediatricians and other health care providers, she summarized the ten most common conditions she evaluates in newborns.

Pseudoparalysis
A baby with pseudoparalysis typically presents with one arm laying or hanging limply. In many cases, the hand of the affected limb moves normally and the baby can successfully grasp and release the fingers and thumb.

A mechanical injury, typically during birth, causes the apparent paralysis. These factors may contribute to pseudoparalysis:

  • Vaginal delivery
  • Large baby
    • Delivery converted from vaginal to C-section due to the size of the baby
  • Maternal diabetes
  • Forceps-assisted delivery

The most common causes for pseudoparalysis are:

Fracture to the clavicle or humerus
Though alarming to the parents, these causes of pseudoparalysis typically have excellent outcomes. Treatment is focused on immobilizing the arm and keeping the child comfortable, and follow-up care is minimal. In fact, repeating X-rays in follow-up is unnecessary and not recommended.

The treatment instructions are simple. Put the baby in a long-sleeved onesie and safety pin the sleeve to the torso of the onesie for two weeks. This is the easiest way to immobilize the arm. Tylenol may be given to the baby for any pain.

Injury to the Brachial Plexus
The brachial plexus provides motor control in the arm and fingers. Stretching or tearing of a portion of these nerves can cause true paralysis. The child’s wrist and fingers are held in flexion, and there is no active extension with them. When diagnosed, a pediatric hand specialist will often recommend occupational therapy to teach the parents arm, wrist and finger exercises. Observation for nerve recovery and continued care with a pediatric orthopedic hand/upper extremity specialist is highly recommended.

Developmental Dysplasia of the Hip (DDH)
Developmental dysplasia of the hip (DDH) is an orthopedic condition in which the hip joint is unstable or has a shallow socket. There are several risk factors to consider at the beginning of the consultation including:

  • Firstborn
  • Female
  • Family history of hip dysplasia
  • Breech delivery
  • Significantly low amount of amniotic fluid

During the exam, a Barlow maneuver will replicate the hip dislocation, and an Ortolani maneuver moves the femoral head back into the socket. To visualize the condition of the joint surfaces and shape, ultrasound is used to aid in treatment planning. The treatment for DDH is to position the hips in a “frog leg” posture for 23 hours / day using a Pavlik harness for a period of 6-12 weeks. The earlier treatment begins, the better the outcome. Though treatment is typically successful, annual observation by the pediatric orthopedic specialist is recommended until the patient is 18 years old.

Clubfoot
Clubfoot is a congenital disorder in which the foot is severely turned inward and pointed downward. Clubfoot is often associated with other syndromes, including arthrogryposis and amniotic band syndrome. The majority of clubfeet are easily seen on the prenatal ultrasound that is done at 20-26 weeks gestation. During the prenatal consult, Scottish Rite pediatric orthopedic surgeons explain what clubfoot is and its treatment. The Ponseti method is a series of weekly casts that gently move the foot into the correct position. If the baby is going to be in the NICU for six weeks or more, the entire Ponseti method can be completed in the NICU. Otherwise, treatment can begin after discharge from the NICU.

Amniotic band syndrome (Streeter’s dysplasia)
Amniotic band syndrome is a condition where amniotic bands formed in utero constrict fingers, limbs and other body parts. When clubfoot is related to amniotic band syndrome, it is called Streeter’s dysplasia. Sometimes the constriction from amniotic bands requires the limb to be amputated. To establish a relationship and initiate a prosthetic tolerance program and plan, the pediatric orthopedist collaborates with pediatric prosthetists. At a developmentally appropriate time, a custom prosthesis is created to assist the child in meeting normal developmental milestones on time.

NOT Amniotic band syndrome or compartment syndrome –> Limb Ischemia with dry gangrene and auto-amputation
In extremely rare occasions when intrauterine fetoscopic laser surgery is done to treat twin-to-twin transfusion syndrome (TTTS), a loss of blood supply to the developing extremities may cause ischemia and necrosis of a limb or limbs. In these cases, a pediatric orthopedic surgeon monitors and supports efforts to prevent infection while awaiting an autoamputation to occur. Establishing an early connection with a pediatric prosthetist ensures timely training and care to protect normal developmental progression.

Polydactyly / Syndactyly
Polydactyly is a hereditary condition that causes supernumerary (excess) fingers and/or toes, typically on the medial or lateral side. Syndactyly is a condition that causes two or more digits to be fused together. With preaxial polydactyly, the thumb or great toe (first digit, or medial-sided) is duplicated, which can be associated with tibial dysplasia or a tibial hemimelia. It is important to get X-rays of the tibia, fibula and foot to fully assess for tibial dysplasia. With postaxial polydactyly, the fifth, most lateral digit is duplicated. Postaxial polydactyly is never associated with tibial hemimelia, and it is much easier to treat surgically. Surgery is typically offered at 6 months of age or greater. Referral to a pediatric orthopedic surgeon for a thorough evaluation and discussion of treatment considerations is highly recommended.

Congenital knee dislocation
Congenital knee dislocation (CKD) is often associated with other syndromes, so a genetic consult is indicated. These babies are usually born Frank breech, and some may have required a Cesarean delivery. The knee or knees present in a hyperextended position. Ultrasound should be used to rule out hip dislocations, since the knee and hip are often both affected. CKD is treated with serial casting. A series of long leg plaster casts will slowly reduce the knee joint into a more normal position. Once the knee can be flexed to 90 degrees, a Pavlik harness is used to maintain knee flexion. Treatment can be completed during the NICU stay or as outpatient procedures after discharge.

Calcaneovalgus foot
Unlike a clubfoot, with a calcaneovalgus foot, the calcaneus is dramatically everted and flexed, sometimes the top of the foot is almost touching the tibia. This condition is usually caused by intrauterine positioning. With appropriate stretching, the foot position gradually improves in the first 4 to 6 weeks of life.

There is an association between calcaneovalgus feet and posteromedial bowing of the tibia. When an X-ray of the tibia reveals or confirms a posteromedial bow, the child is very likely to have a leg length discrepancy of 2-5 centimeters. These children should be referred to a pediatric orthopedic specialist with experience in limb reconstruction to monitor, and if needed, address the leg length discrepancy caused by the tibia bowing prior to skeletal maturity.

Spinal dysraphism
Spinal dysraphism is a reference to congenital abnormalities in the vertebrae, spinal cord and/or nerve roots. These signs are commonly associated with underlying spinal abnormality:

  • Hairy patch on the midline of the back
  • Central, sacral dimple
  • Abnormal fat distribution in the lumbosacral area

These cutaneous manifestations are all significant hints that the underlying spinal cord or vertebrae did not form normally. An MRI of the spine is required to determine the exact nature of the spinal dysraphism. Possible definitive diagnoses include tethered cord, abnormal development of the spinal cord, lipomeningocele or spina bifida. Referral to a pediatric orthopedic specialist with experience in neurological and spine conditions is highly recommended. The child will need ongoing evaluation and intervention to maximize function with spine and limb deformities with growth.

Addressing positioning, postural and orthopedic concerns may not be a top priority in the early days, but consulting a pediatric orthopedic specialist should be considered as soon as the need is identified. A collaborative approach to prioritizing care with treatment plans and accurate information is beneficial for treatment outcomes and reassuring to the family.

Nutrition Tips for Young Athletes in Stop-and-Go Sports

Nutrition Tips for Young Athletes in Stop-and-Go Sports

by | Jul 9, 2021 | Sports Medicine

A stop-and-go sport, also known as a high-intensity interval exercise, includes baseball, softball, football, volleyball, basketball, ice hockey, soccer and tennis. These sports require coordination, agility and concentration. Quick reactions in these sports demand bursts of energy, speed and power.

Alternating periods of intense power and speed, with short or long periods of rest, involve all of the major energy systems in the body. Therefore, meals and snacks throughout the day for these athletes should include appropriate mix of all foods and nutrients.

“It’s easy for busy young athletes to not make food a priority, showing up for practices and games under fueled and thinking they can power through”, says certified sports dietitian Taylor Morrison, M.S., R.D., CSSD, L.D. “However, the reality is that food and nutrition are very important components to optimal performance and injury prevention. The good news is that this food and nutrition doesn’t have to be complicated. An athlete can incorporate simple meals, snacks and fluids throughout the day using some general guidelines thereby reducing concerns and optimizing health and performance”.

CONCERNS FOR THE YOUNG ATHLETE IN STOP-AND-GO SPORTS
Burning Out Early 
Because of the intensity of some stop-and-go sports (like basketball, soccer, tennis and hockey) and because of the length of some games (like baseball or football) and tournaments (like basketball, soccer, tennis and volleyball), young athletes can use up their energy stores before the event is over. This especially becomes a problem if the athlete has not eaten a proper meal or snack earlier in the day or prior to the event and does not bring appropriate snacks for during the event.

End of the Season Injury
If this pattern of burnout continues, the constant fatigue during events can put the athlete at increased risk of injury due to decreased motor skills and performance. Poor nutrition or under-fueling can also lead to a lack of important nutrients like protein, fat, iron, calcium and vitamin D, which can also increase an athlete’s risk of injuries like stress fractures.

Dehydration
Dehydration is another contributor to fatigue, but also a cause of headaches and muscle cramps in the young athlete. Either of these can lead to decreased performance and injury. Of special concern are those young athletes playing in the heat or with extra gear like football, softball and hockey. Dehydration in these young athletes can lead to heat illness if it is not properly recognized and addressed.

NUTRITION SOLUTIONS FOR THE YOUNG ATHLETE IN STOP-AND-GO SPORTS
Proper Fueling Before and During Events
Eat a balanced meal at least three to four hours prior to the event and a small snack just before. Make sure to offer easy-to-digest carbohydrates to keep energy levels up until the very end of games and tournaments. More popular suggestions are fruit slices, dried fruit, crackers, pretzels, fig bars or sports drinks.

Balanced Meals Throughout the Day
Remember that the exact amount of food and nutrients needed vary depending on gender, height, weight, stage of development, sweat rate, sport played and position played. However, overall a young athlete’s plate should consist of:

  • Variety of Carbohydrates – Mix it up with sources like milk and yogurt, whole grains, fruits and starchy vegetables. Carbohydrates provide short and long-term energy to fuel for a practice, game or tournament.
  • Lean protein – Protein is important to repair any torn muscles and build tissue.
  • Healthy fats – Fat is important for the growing brain and has potential anti-inflammatory benefits.
    • Healthy fats, such as mono- and polyunsaturated fats, are important for brain development and function, aid in the absorption of vitamins A, D, E, and K and may have anti-inflammatory benefits. Learn more about healthy fats for the young athlete.

Getting carbohydrates, protein and fat from a variety of sources ensures that the athlete is also getting proper amounts of other nutrients like calcium, vitamin D and iron, among many others. Eating enough calories from carbohydrates, protein, fats and these nutrients helps promote optimal recovery and prevents injuries.

Hydrate
Drink fluid consistently throughout the day. Most of the time, an athlete should choose water and milk. Make sure to bring plenty of water to events adding a sports drink (for electrolytes and carbohydrates), if needed and encourage sips during timeouts, breaks and halftime. For heavy sweaters, salt can be added to drinks or salty snacks can be incorporated into breaks and halftimes.

Visit our sports hydration page to learn more about nutrition and fueling the young athlete.

Therapeutic Camps Improve the Self-Esteem and Confidence of Kids with Hand Differences

Therapeutic Camps Improve the Self-Esteem and Confidence of Kids with Hand Differences

by | Jul 9, 2021 | Research & Innovation

Scottish Rite for Children is world-renowned for its patient-centered care for children with orthopedic conditions. Our Center for Excellence in Hand is committed to caring for children with hand and upper limb conditions. The center is focused on providing innovative treatment to help patients live active and independent lives. Occupational Therapist and Certified Hand Therapist Amy Lake, has recently published The impact of therapeutic camp on children with congenital hand differences in the Cogent Psychology.

The goal of this study was to evaluate the efficacy of hand camp by investigating camp participation and outcomes on self-esteem, physical function, activity participation, and peer relationships. Forty patients with a congenital hand difference seen in hand clinic between the ages of 10 and 13 were eligible to attend hand camp. Following hand camp, Peer relationships, upper extremity function, and self-esteem improved immediately. Upper extremity function and self-esteem scores continued to improve significantly throughout the 6-month follow-up period. The authors of the study believe that research related to therapeutic camping experiences is integral when identifying best-practice interventions to increase the quality-of-life outcomes for children with congenital hand differences.

To date, no research has been conducted on the effects of camp participation in the pediatric congenital hand difference (anomaly) population. Another goal of this study was to evaluate the efficacy of a therapeutic hand camp for children with a congenital hand difference. Attendees of the 2015 Tween Camp (ages 10–13 years) completed self-report assessments of self-esteem, function, participation in activities, and relationships with peers. Attendees also completed an assessment to determine if they believed camp objectives were met. This specific camp was chosen for the initial study due to the camp attendees’ ability to complete assessments independently.

Some of the key takeaways from this study are:

  • Participants reported that their upper extremity function had significantly improved from pre-camp to immediate follow-up
  • Participants expressed a significant improvement in their self-esteem from pre-camp to immediate follow-up
  • Following camp, participants indicated improved skills in peer interaction, daily physical activities, willingness to try new things and confidence in explaining their hand difference.

This suggests that following camp, a child is: more apt to participate in extracurricular activities; have higher self-esteem with regard to their hand difference; be more independent in activities of daily living; and manage negative reactions from others regarding the appearance of their hand. This supports the hypothesis of the study, that camp can indeed make a positive impact on children with congenital hand differences.

Because of the success of our hand camps, Scottish Rite for Children has helped start-up hand camps around the globe based on our Hand Camp Model including camps in Florida, Missouri, California, Italy, and England. Coming soon to Australia.

Learn more about hand research.

Share Your Story: Wide Open Future

Share Your Story: Wide Open Future

by | Jun 30, 2021 | Clubfoot & Foot Disorders

Meet Larry, a patient who is treated by our experts in the Center for Excellence in Foot. Learn more about his journey below.

Blog written by Larry.

My name is Larry, and I was born with bilateral clubfeet. After years of treatment at other hospitals, my family found Scottish Rite for Children when I was 5, and ever since then, it has changed my life. At the age of 15, I had my reconstruction/leg lengthening of my left foot, which was more severe than my right. The way my left foot was formed, I was always walking in a tiptoe position, without any ankle movement. And then on my right side, I wore a brace and needed a shoelift to help balance things out. Dr. Riccio and his team did a miracle on me, the impossible reconstruction of my foot and ankle along with lengthening my left leg with a fixator.

Throughout my time at Scottish Rite, I participated in research studies so I could help the doctors learn more about clubfoot and allow other people to benefit from their findings. I believe that more has to be done, and I want to do my part in helping out.

RUNGE 75 75 OSTRIS. A football player with the number 75 on his jersey

Although I faced many challenges with my condition, it has never stopped me from participating in everything I love.

I grew up playing Little League baseball, worked at my local CrossFit gym, participated in track and field and also played varsity high school football. Today, I am enjoying my senior year in high school, and I am in my final season on the varsity baseball team playing first base. After graduation, I hope to attend college to earn my associate degree in business and then attend the Universal Technical Institute in Houston, Texas for diesel/automotive mechanical school. 

My future is wide open, and I continue to go beyond my own expectations. I want to thank Scottish Rite, Dr. Riccio and his team along with all the staff for providing the best care to me. Because of Scottish Rite, I am able to walk and run with both of my feet!

 of Larry’s clubfoot journey.

 

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