Sports Medicine
WHAT IS SPORTS MEDICINE?
Sports medicine is a medical and surgical specialty that considers the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts.
Our world-renowned sports medicine experts are ready to help your injured athlete get back in the game. We have unparalleled experience providing non-operative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip in young and growing athletes.
Board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work side by side with each athlete, their parents and coaches to develop the best game plan for treatment, rehabilitation and safe return to sport.
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Our world-renowned sports medicine experts are ready to help your injured athlete get back in the game. We have unparalleled experience providing non-operative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip in young and growing athletes.
Board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work side by side with each athlete, their parents and coaches to develop the best game plan for treatment, rehabilitation and safe return to sport.
We enjoy hearing about our current and former patients' success stories. Tell us about your MVP.
Sign up to receive our digital newsletter with tips and insights for parents of young athletes.
OUR SPORTS MEDICINE SERVICES
ELBOW
The elbow is a combination hinge-and-pivot joint made up of three bones: the upper arm bone (humerus) and the two bones in the forearm (radius and ulna). The hinge part of the joint lets the arm bend like the hinge of a door; the pivot part lets the lower arm twist and rotate.
Muscles, ligaments and tendons hold the elbow joint together.
Cartilage, or soft tissue, protects the bony surfaces. It’s also found in young bones at areas that are still growing. These growth areas are at risk for injury.
Elbow injuries in young athletes are on the rise, partly due to year-round training and competition. Overuse injuries often occur in throwing sports and gymnastics. Early recognition of signs and symptoms can prevent problems and even career-changing injuries. In youth sports, preventing elbow injuries, particularly those requiring surgery, is a priority.
Learn more about Osteochondritis Dissecans (OCD) in the Elbow.
This is the most common condition in child athletes, typically caused by excessive throwing. The throwing motion puts stress on the middle side of the elbow because the tendons and ligaments of the forearm are pulling on the growing bone.
Pain typically occurs on the inside “bump” of the elbow during or after activity like throwing or pitching. Repeated pulling can tear ligaments and tendons away from the bone. This tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when uprooted. This can disrupt normal bone growth, resulting in deformity and instability with throwing.
Pain typically occurs on the inside “bump” of the elbow during or after activity like throwing or pitching. Repeated pulling can tear ligaments and tendons away from the bone. This tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when uprooted. This can disrupt normal bone growth, resulting in deformity and instability with throwing.
SYMPTOMS
- Elbow pain with throwing or after activity
- Pain and tenderness on the inside of the elbow (on the bump)
- Soreness for days to weeks
- Worsening control with throwing
- Inability to throw desired distance
- Difficulty fully straightening or bending the elbow
- Locking of the elbow
TREATMENT
- Rest. Continuing to throw may lead to major complications and jeopardize a child’s ability to remain active in a throwing sport.
- Common recommendations include 2-4 weeks of complete rest.
- Apply ice packs to bring down any swelling.
- Proper stretching and strengthening.
- May require a cast or splint if the pain does not resolve with rest.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Focused training to improve throwing form is needed.
- Surgery to stabilize the medial epicondyle is rarely necessary, especially in girls over 12 years and boys over 14 years.
An avulsion fracture occurs when the muscles and tendons pull off a piece of bone that is connected by cartilage to the main bone. A strong pull of the forearm muscles, during a pitch, for example, can cause an avulsion fracture of the medial epicondyle on the inside of the elbow.
With this injury, the athlete will typically hear a pop and will have severe pain, swelling and bruising. The child may or may not have had elbow pain before the injury. With operative or nonoperative treatment, most kids may return to the same level of sports following treatment.
With this injury, the athlete will typically hear a pop and will have severe pain, swelling and bruising. The child may or may not have had elbow pain before the injury. With operative or nonoperative treatment, most kids may return to the same level of sports following treatment.
SYMPTOMS
- May hear a pop or giving way
- Immediate pain on inside of the throwing elbow
- Immediate, visible swelling and bruising
- May have pain with wrist movement
- May have numbness or tingling in the ring finger and little finger
- Unable to bend the elbow or pick up heavy objects
TREATMENT
- Ice may be helpful to reduce inflammation in early stages.
- Anti-inflammatory medication may be needed.
- For fractures in good position, a splint is recommended for 2-3 weeks.
- In all cases, aggressive range of motion early in healing stages (within 2-3 weeks) is recommended.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Strengthening and proper throwing progression 8-12 weeks following injury.
- Focused training to improve throwing form is needed.
With repeated throwing, inflammation of the cartilage on the back of the elbow can occur. When this occurs, a growing athlete may have pain during follow-through or when straightening the elbow. In the older adolescent, bone spurs and stress fractures can also occur in this area. Without proper rest and treatment, pieces of cartilage can tear away; removal of these loose pieces may require surgery.
SYMPTOMS
- Pain in the back of the elbow during follow-through and when straightening arm
- Pain in the back of the elbow that becomes gradually worse over time
- Inability to completely straighten the arm
- Popping and locking may be present, but is rare
TREATMENT
- Rest. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Common recommendations include 2-4 weeks of complete rest.
- Ice pack may help reduce inflammation.
- Anti-inflammatory medication may be needed.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Focused training to improve throwing form is often necessary.
- Surgery is only needed in severe cases.
Excessive throwing may also lead to a less common condition called osteochondritis dissecans (OCD). Pulling of the muscles on the inside of the elbow causes pushing, or compression, of the bones on the outside. The pressure on the immature bones can loosen a piece of the bone and cartilage.
SYMPTOMS
- Dull achiness on the outside of the elbow
- Pain that worsens with activity and improves with rest
- Pain that gradually worsens over time
- Inability to completely straighten the arm
- Popping and locking
TREATMENT
- Rest. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Strict throwing restrictions protect the elbow from further injury.
- Immobilization may be necessary in severe cases or if restrictions are ignored.
- If the elbow does not heal or the tissue becomes unstable or loose, surgery may be the best option.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Resume throwing at a minimum of 6-12 months.
- Focused training to improve throwing form is often necessary.
Elbow stability is crucial for throwing athletes. The ulnar collateral ligament (UCL) is the most important stabilizer for the inside of the elbow. With repetitive throwing, the UCL becomes stretched and develops small tears. This is painful and ultimately leads to instability in the elbow. Typically, the pain is on the inside of the elbow – just below the bony bump where medial epicondyle apophysitis can occur.
These injuries rarely occur with a single event or throw. They’re more common in older adolescents, but may occur in younger athletes as well. An MRI with contrast injected in the joint gives the best view of a tear.
The surgical reconstruction of the UCL is named after Tommy John, a baseball player who returned to major league pitching after having this procedure. This surgery doesn’t always lead to improved performance. Though many athletes do return to play after this procedure, preventing the injury is ideal.
These injuries rarely occur with a single event or throw. They’re more common in older adolescents, but may occur in younger athletes as well. An MRI with contrast injected in the joint gives the best view of a tear.
The surgical reconstruction of the UCL is named after Tommy John, a baseball player who returned to major league pitching after having this procedure. This surgery doesn’t always lead to improved performance. Though many athletes do return to play after this procedure, preventing the injury is ideal.
SYMPTOMS
- Pain over the inside of the elbow with throwing
- Gradually increasing pain
- May feel unstable or “give way”
- Rarely popping
TREATMENT
- Rest for at least 6-12 weeks. Continuing to throw with this problem may lead to major complications and permanently jeopardize a child’s ability to play.
- Immobilization for 4-6 weeks followed by a hinged elbow brace.
- Anti-inflammatory medication.
- Therapy to focus on flexibility, strength, trunk and scapular stabilization.
- Surgery is typically needed for complete tears or if the elbow is unstable.
- Focused training to improve throwing form is often necessary.
HIP
The hip is a ball-and-socket joint with lots of soft tissue to help the bones stay together. Dancers, gymnasts, soccer players and ice hockey players move their hips in extreme motions over and over again, causing problems that can become progressively worse over time. Early recognition of signs and symptoms often results in very successful outcomes without surgery.
Conditions we treat:
Conditions we treat:
- Femoral acetabular impingement (FAI)
- Labral tears
- Snapping hip
- Hip and groin strains
- Overuse hip conditions (such as those seen in dancers and gymnasts)
- Pelvic apophysitis
- Pelvic avulsion fractures
ANKLE
Young athletes are more likely to break a bone than to have an ankle sprain. Unlike fractures, subtle injuries to the bone or the soft tissue covering the bones may be difficult to diagnose. Symptoms that don’t get better with rest may need a thorough evaluation by a pediatric specialist. Recognizing and responding to symptoms of ankle instability or pain with repetitive activity can help keep young athletes on the field. The risk of ankle injury can be reduced with good training, proper shoes and field maintenance.
Conditions we treat:
Conditions we treat:
- Ankle instability
- Ankle sprain
- Ankle fractures
- Stress fractures of the foot and ankle
- Cartilage conditions such as osteochondritis dissecans (OCD)
- Sever’s disease
CONCUSSION
A concussion is a brain injury that disrupts normal brain function. The usual cause is a sudden blow to the head or body that shakes the brain, damages cells and creates chemical changes. Concussions are quite common. Most athletes who suffer a sports-related concussion (SRC) do not lose consciousness or experience memory loss.
Concussions continue to get a lot of attention in the media, and for good reason. At Scottish Rite for Children, we continue to study young athletes to learn more about how their brains recover from concussions. We already know that concussion recovery time in children is longer than in adults.
Concussions continue to get a lot of attention in the media, and for good reason. At Scottish Rite for Children, we continue to study young athletes to learn more about how their brains recover from concussions. We already know that concussion recovery time in children is longer than in adults.
Here are a few additional things our patients have taught us:
- Concussion symptoms are worse and last longer when an athlete continues to play on the same day as their injury
- Girl soccer players are more likely to continue to play on the same day, but boys do too
- Poor sleep is connected to worse concussion symptoms and longer concussion recovery time.
- Anxiety symptoms following a sport-related concussion lead to more time before returning to play.
- In female athletes, delayed presentation to clinic is associated with longer time to clearance to return to play following a sport-related concussion, so it is important to be evaluated soon after the injury.
Learn how to recognize and respond to signs and symptoms of a concussion here or read articles about sport-related concussions on our blog.
As many as 40% of young athletes continue to play in a game or practice after sustaining a concussion. Some report this is because they were not experiencing symptoms at the time and did not recognize they were injured. Others chose to continue to play because they were not fully aware of the risks, including a longer recovery time. Therefore, observing an athlete for signs and symptoms of a concussion is very important. Everyone should speak up and remove the athlete from play when a concussion is suspected.
Note: There are some signs and symptoms following a head injury that are especially concerning. Seek medical attention immediately at the nearest emergency department if any of the following occur:
- Severe or worsening headache
- Increasing confusion
- Extreme sleepiness or trouble waking up
- Vomiting
- Seizures (convulsions - arms and legs jerk uncontrollably)
- Weak or numb arms or legs
- Slurred speech
- Any other sudden change in thinking or behavior
SIGNS
Signs of a concussion are observed by others and include:
- Appearing dazed or stunned
- Confusion
- Forgetting plays
- Being unsure of game, score or opponent
- Exhibiting unsteadiness
- Moving clumsily
- Answering questions slowly
- Losing consciousness (getting knocked out)
- Memory loss
- Being more sleepy or tired than usual
- Seeming sad, nervous or anxious
- Being irritable, easily frustrated or upset
- Having problems with academic performance
- Slow to get up after a fall, collision or blow to the head
- Clutching the head after an injury
- Sleep problems
SYMPTOMS
Concussion symptoms are felt by the athletes and include:
- Headaches
- Concentration or memory problems
- Nausea
- Balance problems or dizziness
- Double or blurred vision
- Feelings of being “in a fog” or slowed down
- Sensitivity to light or noise
- Confusion
- Just “not feeling right” or “feeling down”
Following the rules is the best way to prevent a concussion. Some studies show that wearing appropriate protective gear, and improved core and neck strength may contribute to a lower risk of injury. Though we do not have strong evidence of how to prevent a concussion, we are confident that recognizing a concussion immediately and responding appropriately will reduce the risk of further injury and decrease concussion recovery time.
There is not a specific test to diagnose a concussion. If there is concern for other problems like a skull fracture or bleeding in the brain, an imaging study, such as a CT scan, may be ordered. These are usually not required and do not show if an athlete has had a concussion.
A history and physical examination, along with the patient and family’s report of signs and symptoms, along with tests to assess balance, eye movements, memory, reaction time, etc., are utilized to diagnose a concussion and determine the best treatment for the athlete.
A history and physical examination, along with the patient and family’s report of signs and symptoms, along with tests to assess balance, eye movements, memory, reaction time, etc., are utilized to diagnose a concussion and determine the best treatment for the athlete.
Concussion treatment plans are individualized based on the signs and symptoms experienced by the athlete, as well as results of testing performed during the concussion evaluation. Every injury is different, so there is not a single treatment approach that is best for every patient. Treatment options may include rehabilitation exercises, therapy, medications, etc. Sleep is important for recovery and to reduce symptoms.
To learn more about concussion treatment, view our handout. (English / Spanish).
To learn more about concussion treatment, view our handout. (English / Spanish).
Return to School
The injured brain needs to rest, so it may be appropriate for your athlete to modify school and cognitive activity soon after a concussion. If available, a school nurse or athletic trainer should be involved early to help facilitate return to school and sports as they often have additional training in the management of concussion.
- A school may consider the following accommodations to help a student athlete:
- Reducing homework and class work
- Postponing tests until the student has recovered
- Providing alternative activities for the athlete for taking notes during class, watching videos, being in a loud environment (lunchroom or gymnasium), or participating in physical activity (PE, athletics, recess)
- Allowing a student to take frequent breaks in the nurse’s office or alternating a class with a rest
- Permit the athlete to go to the nurse’s office for worsening of symptoms during classes
Return to Play
Clearance by a health professional is strongly recommended, and, in some cases, required by law, the school or organizational concussion protocol. Returning to play before complete recovery from a concussion puts the athlete at risk for a more serious injury, permanent brain damage and even death, from another injury known as Second Impact Syndrome.
When the athlete has returned to everyday and school-related activities and has no symptoms, make an appointment for an evaluation and sports clearance. For patients with severe or persistent symptoms, a referral to a sports medicine specialist may be helpful.
Concussion protocols are typically designed as a one week return to play progression. This is often misinterpreted as the answer to “how long will a concussion last?” The protocol insists that the five- to seven-day progression begins and only continues when the athlete is symptom free. In college athletes and adults, a week or two is typical. We find that young athletes take longer to recover, even if they are following recommendations. For some, symptoms may last for months. Our goal with treatment and management of concussions is to get an athlete back to school and daily function as efficiently as possible. Then, we begin return to play protocols.
Return to Play Guidelines:
Once the athlete is completely symptom-free, and has been cleared by a health care professional, they may begin a progressive return-to-play protocol. A symptom-free period of 24 hours is required before moving on to the next stage. If symptoms occur during or after activity, the athlete should stop and consult with their health care provider.
Remember, the athlete MUST BE:
- Symptom-free with daily activities and schoolwork (including tests) to begin the protocol.
- Symptom-free during/after exercise to progress to next stage.
Return to Play Progression:
- Begin light aerobic exercise with no resistance – e.g. riding a stationary bike or light jogging for 10-15 minutes.
- Sport-specific activity – e.g. running drill for 20-30 minutes with increased exertion.
- Non-contact training drills with resistance training – e.g. ball handling or passing drills
- Full contact practice (must have physician clearance) – e.g. scrimmage and game-like training drills.
- Competitive game play.
This is a collection of concussion tests used to assess the cognitive function of the athlete’s brain. Our team uses ImPACT™, an online, neurocognitive baseline testing system. This program is used in many local concussion protocolsduring pre-season baseline testing. Each computerized test measures the ability to perform certain tasks, such as memory and reaction time.
Athletes 5 years of age and older without a recent history of a head injury can take a baseline test, used for future reference (ages 5-12 will be given ImPACTTM Pediatric). For athletes with a recent head injury, we recommend making an appointment with one of our sports medicine physicians before scheduling a baseline test. In the event of a concussion, an athlete can repeat the test and the Credentialed ImPACT™ Consultant (CIC) can then analyze the results. The comparison of the post-injury scores to the baseline test helps the provider develop an individualized plan for the athlete.
Our sports medicine specialists, Shane M. Miller, M.D., and Jane S. Chung, M.D., are Credentialed ImPACT™ Consultants. These physicians and our athletic trainers have undergone specialized ImPACT™ training to administer and interpret this test for use in concussion care management.
Athletes 5 years of age and older without a recent history of a head injury can take a baseline test, used for future reference (ages 5-12 will be given ImPACTTM Pediatric). For athletes with a recent head injury, we recommend making an appointment with one of our sports medicine physicians before scheduling a baseline test. In the event of a concussion, an athlete can repeat the test and the Credentialed ImPACT™ Consultant (CIC) can then analyze the results. The comparison of the post-injury scores to the baseline test helps the provider develop an individualized plan for the athlete.
Our sports medicine specialists, Shane M. Miller, M.D., and Jane S. Chung, M.D., are Credentialed ImPACT™ Consultants. These physicians and our athletic trainers have undergone specialized ImPACT™ training to administer and interpret this test for use in concussion care management.
PAYMENT
Because this service is not covered by most insurance plans, a $24 payment is required at the time of the visit. We accept all major credit cards. We are not able to accept cash or check at this time.
VISIT
Baseline testing appointments are scheduled for one hour. Some athletes may finish the test faster than others, but typically the computerized testing takes about 30-40 minutes. Before starting the test, our staff will ask a few questions about the athlete’s history; however, there will be no physical examination or discussion with a physician.
A parent may remain in the room with the athlete during the test. If additional family members, particularly young siblings, are present, we request they remain in the waiting area with a parent to allow the athlete to concentrate and for optimal test performance.
A parent may remain in the room with the athlete during the test. If additional family members, particularly young siblings, are present, we request they remain in the waiting area with a parent to allow the athlete to concentrate and for optimal test performance.
RESULTS
Results are provided upon request. At the end of the visit, or anytime in the future, the family may call 469-515-7100 to request a unique code (Passport ID) for another Credentialed ImPACT™ Consultant to access the results.
FEMALE ATHLETE TRIAD
Female Athlete Triad is a medical condition that can affect girls and young women. It involves the following three components: energy availability, menstrual function and bone health. Clinical signs and symptoms may not all occur at the same time, so further evaluation is needed with the presence of any of these problems. Jane S. Chung, M.D., advises that education and early intervention are keys for young women with Female Athlete Triad.
Young girls who are very lean, who train a lot or who do not have a well-balanced diet may start their menstrual cycle later than others. Some may start in a normal time frame; however, changes to diet and exercise habits may cause the cycle to be less frequent or stop during times of heavy training.
Each athlete has a unique nutritional need to keep their body prepared for training, competition and normal growth. Sometimes, in an effort to achieve a specific weight or appearance, an athlete may restrict calories or make other choices to limit gaining weight. Poor eating habits can lead to changes in several normal body processes. This can actually worsen performance, when an athlete is really trying to improve performance.
Changes in hormone production that cause changes in the menstrual cycle lead to poor bone strength. A diet without proper amounts of calcium also causes bones to become weak. Therefore, athletes with eating issues are at high risk of injuries to bones. These often show up as stress fractures, small breaks in the bone that are difficult to detect but cause pain and require long rest from activity.
OSTEOCHONDRITIS DISSECANS
The surfaces of the bones in the joints are covered with smooth tissue called articular cartilage. Osteochondritis dissecans (OCD) is a problem in this cartilage and the bone just beneath it. It occurs most commonly in the knee, elbow and ankle. Repetitive motions or overuse injuries in these joints put pressure on the cartilage and bones that cause injury over long periods of time.
We see OCD most often in patients that are 12-16 years old. Though it can happen to anyone, we see this problem in athletes that perform repetitive motions like running, jumping, pitching or certain motions in gymnastics.
We’re unsure what causes this in some patients. It could be a change in the blood supply to the bone and cartilage. Sometimes an injury causes the changes. This is called an osteochondral fracture or injury.
We see OCD most often in patients that are 12-16 years old. Though it can happen to anyone, we see this problem in athletes that perform repetitive motions like running, jumping, pitching or certain motions in gymnastics.
We’re unsure what causes this in some patients. It could be a change in the blood supply to the bone and cartilage. Sometimes an injury causes the changes. This is called an osteochondral fracture or injury.
SYMPTOMS
There may be pain in the joint that gets worse with activity. Or there may be symptoms like popping, clicking or swelling in the joint.
TREATMENT
In early stages, your provider may recommend rest and a brace to help the tissues recover on their own. In later stages, more aggressive treatments are required. Pediatric orthopedic surgeons, like Philip L. Wilson, M.D., and Henry B. Ellis, M.D., treat OCD with minimally invasive arthroscopy. The treatment is only necessary after a thorough investigation of the tissues with X-rays, an MRI or diagnostic surgery. Watch a detailed look at the procedure.
RETURN TO SPORTS
In many cases, activities like swimming, diving, biking, golf and yoga are good alternatives for young athletes. Our goal is to keep children active, but to protect joints that are at risk of long-term problems from overuse injuries.
KNEE
Knee injuries and their prevention in youth sports are hot topics. Young athletes have unique risk factors and require unique treatments. All growing bones have sensitive spots called growth centers that are filled with cartilage until the bone takes its final shape. Some growth centers are at risk of injury from running and jumping. Others that help our legs grow symmetrically and straight are at risk of being damaged from fractures or during surgeries for major ligament injuries. In these cases, a pediatric orthopedic surgeon has the expertise to make a plan for treatment and monitoring for the best outcomes.
Learn more about knee injuries.
Learn more about knee injuries.
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SHOULDER
As a shallow ball-and-socket joint, the shoulder allows for a wide range of motion for overhead sports like baseball and volleyball. This range of motion also increases the risk of instability and injury to the joint. Repetitive motions or a single, forceful event may lead to tissue damage, resulting in changes to the shape of the bones and soft tissues. Many shoulder problems in young athletes are preventable. And early recognition often allows nonsurgical treatment with faster recovery.
Learn more about shoulder injuries.
Learn more about shoulder injuries.
Sports Nutrition
Our team is committed to caring for young athletes - even before they may need us. Learn more about the importance of sports health and nutrition and fueling the body to stay healthy and in the game.
Learn more on the Sports Nutrition page >>
