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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.
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.

The Work Takes Time, But It Makes You Great

The Work Takes Time, But It Makes You Great

by | Jun 22, 2021 | Sports Medicine

18-year-old Caden has always loved baseball. He has been playing since he was 4 years old, and he’s received numerous awards through the years. When he was just 12, he was awarded Perfect Game’s Super25 MVP pitcher. As a teenager, he was included in Perfect Game’s All-Tournament Selection, Pre-Season All-American and All-Region teams. Caden plays second base mainly, but he has seen time at shortstop and center field. He is also a phenomenal, right-handed pitcher.
 
In 2018, Caden began to have pain in his right elbow, so he visited pediatric orthopedic surgeon Philip L. Wilson, M.D., at the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. “I knew they had an excellent orthopedic program, and I was aware that Dr. Wilson had worked with many high-level athletes,” says Alan, Caden’s dad. “He is very well respected in elbows and shoulders.”
 
Wilson explained that Caden’s elbow pain and inflammation was caused by repeated stretching of the ulnar collateral ligament (UCL), a tight band of tissue on the middle side of the elbow, from throwing. There are two important components to treatment. First, the ligament needs time to heal, so rest from throwing and pitching is crucial. Then, properly timed rehabilitation focused on strength and flexibility of the shoulder and trunk helps the young athlete return to their pre-injury status. After his prescribed rest, he slowly returned to throwing with a strategic 8-week interval throwing program which gradually increases the quantity and distance of throws. The program also encouraged Caden to focus on proper form with every throw to reduce the risk of reinjury. “I was extremely pleased with Dr. Wilson’s entire staff,” says Caden.

Caden utilized additional resources in his recovery to further improve his flexibility and strength and to further reduce his risk of reinjury. Near his home in Rockwall, Caden completed formal physical therapy and a strength and conditioning program with practitioners knowledgeable in the shoulder and pitching programs. These programs helped build Caden’s strength, not only in his arm but in his core and back as well. “It’s not just one muscle – it’s a combination,” says Alan. “It’s getting everything working and firing together so he can handle the stress of pitching.” Physical therapy was humbling at first for Caden. “I saw charts with the average strength levels of collegiate and professional athletes compared to my strength level in high school and saw how long I had to go,” he says.

After six months of physical therapy, Caden was on the field with his teammates at Rockwall-Heath High School performing at the highest level. He was named 1st Team All-District for infield this season, and on June 12, he and his teammates won the UIL 6A High School State Championship. Caden was also named MVP of the game. Caden graduated high school this year and has received a scholarship to play baseball at Northern Oklahoma College in Tonkawa, OK.
 
Alan advises both young athletes and parents to pay attention to any inflammation and soreness that the child is feeling. “Always err on the side of caution and rest when you are dealing with pain,” he says. “If it’s not better after about a week, I recommend scheduling a consultation with Scottish Rite.” Wilson advises any athlete with activity-related pain to have an assessment by an athletic trainer or sports medicine specialist.
 
“Caden is a prime example of an athlete properly responding to pain. He rested, he rehabbed and he’s back at a very high level. If he had continued to throw, he might have ended up tearing the UCL and requiring a longer period out of baseball and possibly surgery. So many are concerned about missing a season, but he’s right – taking recovery seriously pays off in the end.“ – Philip L. Wilson, M.D.
 
Caden hopes his story can help other young athletes understand the recovery process so they won’t get frustrated when it seems like it is taking too long. “The steady work grind takes time, but it’s what makes you great too,” he says. “I think with shoulder care, it’s important to understand that stretching is not just a warm-up but truly a part of your overall pitching program.”

A Soccer Injury Won’t Slow This MVP Down for Long

A Soccer Injury Won’t Slow This MVP Down for Long

by | May 25, 2021 | Sports Medicine

During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.

The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.

While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”

Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.”

In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.

 

Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.

Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. 

 

“Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”
A Soccer Injury Won’t Slow This MVP Down for Long

A Soccer Injury Won’t Slow This MVP Down for Long

by | May 25, 2021 | Sports Medicine

During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.

The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.

While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”

Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.” 

In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.

Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.

Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. “Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”

Young Athletes and Heel Pain

Young Athletes and Heel Pain

by | May 18, 2021 | Sports Medicine

Skeletally immature athletes, those that are still growing, have unique conditions that occur in the growth centers of the bones. Heel pain in adults is caused by different issues because their growth centers are closed. Sports medicine physician Jacob C. Jones, M.D., RMSK, says, “This is one of the most common conditions we see in the developing athlete. Though it is a condition that does not have lasting problems or require aggressive treatment, it can really disrupt an athlete’s training and competition. Following guidance for rest, cross-training, improving ankle mobility and delaying specialization can help to keep the heels game-ready.”

What are growth centers? 
The medical term for a growth center is a physis. The physis is an area of the bone that has soft tissue called cartilage that is later replaced by new bone cells. Some are areas where bone growth makes bones longer. Others, called apophyses, give the bones a unique shape. These growth centers are found in the elbow, pelvis, heel and other areas. The apophyses are attachment sites for tendons.

What growth center is in the heel?
The calcaneal apophysis is in the calcaneus (heel bone). The apophysis is the attachment site for the very strong tendon from the calf muscle, called the Achilles tendon.

What causes heel pain in the calcaneal apophysis?
Children become more committed to sports around 8-12 years old. With running, or repetitive jumping, the Achilles tendon pulls on the cartilage in the heel. This, accompanied by the impact on the ground with running and jumping, can lead to irritation in this area. Because this has a gradual onset, this is referred to as an overuse injury and is often referred to as Sever’s disease.

What is Sever’s Disease?
Sever’s disease, or calcaneal apophysitis, is a type of overuse injury and the most common cause of heel pain in active children ages 8-12. It is caused by repetitive movements, like running and jumping and may occur in only one or both sides. The pain is usually not related to a specific injury and comes on gradually.

What is the treatment for Sever’s disease?
Changing shoes or adding heel cups may be recommended to help with comfort during recovery. Simple ankle stretching exercises may also be helpful. Other treatments are available and should be considered on an individual basis, but rest is the most common prescription for this condition. Returning to a sport and other physical activity may gradually prevent recurrence. Pain may last months to years and may come back or worsen with increased sport or activity.

How long does Sever’s disease last?
Sever’s disease will resolve with completion of growth in this area. Because the growth plate is soft until it is closed, this problem can happen again in this age group. Pain in this area typically resolves by the mid-teenage years.

What factors may increase risk of initial or recurrent Sever’s Disease?

  • Playing sports on a hard surface or barefoot.
  • Footwear with poor cushioning, such as soccer cleats.
  • Year-round sports participation.
  • Sudden increase in training intensity.
  • Increase in duration or frequency of activity, such as tournaments and camps.
  • Tight Achilles tendon or calf muscle.

Learn more about Sever’s disease in this popular short lecture featuring sports medicine physician Jane S. Chung, M.D.