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Keeping Up with the Count: When Has She Rehearsed Enough?

Keeping Up with the Count: When Has She Rehearsed Enough?

by | Mar 4, 2021 | Sports Medicine

In youth sports, this message is clear – excessive training puts an athlete at risk for injury. Young dancers may or may not be comfortable comparing their training to that of other “athletes,” but the concern for their safety is similar. Scottish Rite for Children physical therapist, Julia Buckelew, P.T., D.P.T., O.C.S., works with many dancers in our sports medicine practice and hopes to reach others with this message.

Overtraining occurs when there is a high intensity or a high volume of training and performance declines. Overtraining is often associated with overuse injuries and burnout when the dancer no longer enjoys the activity. The year-round nature of dancing creates a culture and environment that, without deliberate efforts to avoid, lead to these conditions. Company auditions, numerous classes, rigorous pre-show rehearsals and summer intensives can run-down a dancer.

What are signs of overtraining?

  • General fatigue felt throughout the day despite amount of sleep.
  • Extended time needed to recover from post-exercise soreness.
  • Reduced performance/technical skill despite normal or increased training hours.
  • Difficulty concentrating.
  • Increased risk of injury.

How can a dancer avoid overtraining?

  • Shift attention to the quality of training over the quantity of training.
  • Apply common time management techniques to plan rest and cross training.
  • Implement training periodization by recognizing performance cycles.
  • Learn about sleep hygiene to improve sleep quality.
  • Learn the value of mental imagery for rehearsal to allow the body to rest.
  • Increase self-awareness about beliefs and behaviors that motivate.

Thoughts on Perfectionistic Dancers
Scottish Rite pediatric psychologist Emily Stapleton, Psy.D., says, “Perfectionistic dancers tend to be ambitious, determined and driven for success in their performance. Unfortunately, these traits that make them successful also increase their likelihood of overtraining.”

These athletes tend to focus on results and have potentially harmful motivations including:

  • Desire to avoid making mistakes.
  • Fear of failure.
  • Fear of negative evaluation by others.
  • Meeting parent or coach’s expectations.

These tendencies can cause significant frustration, low self-esteem and self-doubt when they are not meeting their expectations or the expectations of others (e.g., parent, coach). This leads to the drive to learn new moves, perfect a routine and difficulty taking a break from training. Since they feel training is never complete, they self-select into an inappropriately high-training load. The cumulative effects of endless run-throughs, long hours of rehearsal and impact and stresses from repetitive movements may lead to injuries, exhaustion and reduced quality in performance. 

Stapleton says, “Research has shown that when these athletes direct their perfectionistic behaviors toward progress-oriented goals, rather than focusing solely on results or performance, some of the risks of overtraining are mitigated.” Athletes can do this by implementing cognitive-behavioral strategies including:

  • Appropriate goal setting.
  • Redefining their definition of success in sport.
  • Using positive self-talk.

Emily Stapleton, Psy.D., and Julia Buckelew, P.T., D.P.T., O.C.S., contribute to the article series, Keeping Up with the Count. A collection of tips and information for dancers from a multidisciplinary dance medicine team. They recognize the needs for these highly specialized athletes and aim to help reduce the risk of injuries in this population.

Apophysitis of the Hip or Pelvis

Apophysitis of the Hip or Pelvis

by | Mar 1, 2021 | Sports Medicine

The professionalization of youth sports has led to an epidemic of overtraining. With that comes an increase in injuries caused by overuse. Unlike injuries from overuse in adults, like carpal tunnel syndrome, pediatric overuse injuries occur at areas of the bones called growth centers. These areas are vulnerable to injuries. Pediatric orthopedic surgeon Henry B. Ellis, M.D., says, “Rest and activity modification is crucial for these conditions.”
With an interest in studying and treating conditions in the hip in athletes, Ellis informs families that other treatments are unlikely to work if the aggravating activity continues. He encourages athletes to listen to their bodies and learn to properly stretch and to speak up if there is activity-related pain.

What is apophysitis of the hip or pelvis? 

Tenderness in specific bony areas of the hip and pelvis is called apophysitis. This typically occurs in adolescents ages 10- 19 who have “tight” hip and thigh muscles.

What causes apophysitis in hip or pelvis?

Muscles of the hip attach on the pelvis and upper leg bones. In growing children, several tendons attach to apophyses (growth plates). On the pelvis, these include the iliac crest apophysis and the ischial tuberosity apophysis and on the hip, the greater trochanter apophysis. These areas are made up of soft cells called cartilage. These weaker cells are at a higher risk of injury.

The most common cause of the pain is repeated pulling of the tendons on the apophysis causes apophysitis (painful inflammation). This commonly occurs during periods of rapid growth or increased activity. Overuse in these areas occur in activities such as dance, gymnastics and those that include running and sprinting.

What are the symptoms of apophysitis?

Apophysitis causes pain or tenderness at the muscle attachment that worsens with activities such as sports or running. Some experience swelling, others feel or hear a pop or snap.

How is it diagnosed?

A thorough history and physical examination are used to diagnose apophysitis. In some cases, X-rays may be ordered to evaluate the growth plate and rule out other issues.

How is it treated?

This is a self-limiting condition where rest is recommended, but kids may participate in activities that do not cause painful symptoms. Treatment includes modifying activities and providing comfort as needed. Learning to properly stretch and strengthen the muscles attached to the apophysis will reduce the tension.

A gradual return to sports is recommended when pain is improved. Symptoms will resolve with completion of growth in this area. In time, stronger bone cells replace the soft cartilage cells, but pain may come and go for months to years. If symptoms persist and cannot be managed with rest, it is important to see a medical provider with experience treating growth plate conditions in young athletes. Physical therapy may be recommended.

Physical therapy for apophysitis

Since the condition requires rest and removal of aggravating factors, more exercise is not an appropriate solution. After a formal evaluation, a physical therapist will provide a custom exercise plan to promote improvements in lengthening of tight muscles and tissues, strengthening of weak muscles and alignment of the body during movement and functional tasks. In many cases, core conditioning, strengthening of the abdominals and other trunk muscles, is a foundational component of treatment.

How can apophysitis of the hip/pelvis be prevented?

  • Apophysitis of the hip/pelvis may be difficult to prevent.
  • Proper warm-up and stretching exercises will reduce the stress on the apophysis.
  • Limit or vary physical activities to avoid overtraining and overuse.
  • Rest when sore or having pain.

Watch Ellis describe this condition in a series for pediatricians and primary care providers on our YouTube playlist for medical professionals.

More Than Checking the Box: Effective Pre-Participation Physical Evaluations Help Young Athletes

More Than Checking the Box: Effective Pre-Participation Physical Evaluations Help Young Athletes

by | Feb 26, 2021 | Sports Medicine

Often buried in a long to-do list, the sports pre-participation evaluation (PPE) is something that deserves our full attention. The intent of the annual, required physical is to address concerns before they are a surprise in an athletic environment. Some screening is designed to pick up more concerning issues than others, but an effective evaluation has the potential to protect a young athlete’s playing time and set them up for optimal performance.

Sports medicine physician Jacob C. Jones, M.D., RMSK, says, “It’s really not meant to be about the permission to participate, it’s meant to reduce the risk of emergencies. When implemented properly, the PPE is effective at identifying the most critical issues.” Jones describes the value of the PPE that helps the athlete on and off the field.

Annual Visit with the Primary Care Provider
Some young athletes may only see their primary care provider for this required activity. This gives the provider an opportunity to address issues beyond safe sports participation, such as developmental and mental health screening, wellness guidance, and education on age-specific topics like menstruation and substance abuse.

Awareness of Family Medical History
A family history of cardiac issues, diabetes, sickle cell trait and other conditions may not be discussed in families if not prompted by a screening tool like the PPE. Improved awareness of family history can help individuals and families make positive changes to reduce the risks of modifiable conditions. Learn how to discuss your family’s medical history before a PPE. 

Reduced Time Out of Sport for Injuries
The musculoskeletal screening portion of the PPE is a quick assessment of the strength and function of the trunk, arms, and legs. Any complaints of pain, especially activity-related pain, should be addressed before the season begins. Many conditions, especially overuse injuries, will have better outcomes if they are recognized and treated early. Proper counseling for injury management and tailored rest will reduce the risk of these problems. Learn more about common overuse injuries.

General Wellness Education
Athletes are at a high risk of missing the mark with nutrition, either due to unrealistic goals for aesthetic sports such as dancing or gymnastics or unintentionally not meeting their nutritional needs for training and competition. The PPE looks for patterns of injuries or other signs that an athlete may be underfueling. Learn more about underfueling.

Learn more about pediatric sports medicine.

Wellness in Youth Sports: Tips for Parents and Coaches of Young Athletes

Wellness in Youth Sports: Tips for Parents and Coaches of Young Athletes

by | Feb 18, 2021 | Sports Medicine

In a medical education series, Jane S. Chung, M.D., and Taylor Morrison, M.S., R.D., CSSD, L.D., informed pediatric health care providers about the role of wellness in recovery and injury prevention. Health care providers are not the only ones to influence young athletes and their choices to prepare for and recover from sports. Tips for Parents and Coaches
  • Teach your athlete to listen to his or her body. Hunger, pain and fatigue are signs that the body is not prepared to tolerate training.
  • Encourage proper fueling for the activity. Consider the duration and intensity of the activity and give specific suggestions to meet appropriate pre-event nutrition needs.
  • Support proper hydration throughout the day, not just around activity.
  • Use positive language when talking about food and sport-specific bodyweight goals.
  • Speak up when performance declines. Talk to the athlete about sleep, eating habits and stress management so you can act quickly when you are concerned.
  • Listen without judgment.
More Tips for Coaches
  • Choose appropriate training load, intensity and duration. The physical and psychosocial demands of training need to be enough for growth and improvement, but not so much that it causes injuries or illness.
  • Integrate recovery into your schedule of training. Cross training and in-season rest days can support better performance and reduce time on the bench.
  • Learn, model and actively teach athletes positive coping skills to manage stress.
Learn more about training load, recovery and young athlete wellness in the summary of Chung and Morrison’s latest lecture.
It’s a Whole New Game: Bridge Program Helps Young Baseball Players

It’s a Whole New Game: Bridge Program Helps Young Baseball Players

by | Feb 5, 2021 | Sports Medicine

When a child or adolescent baseball player completes physical therapy for an elbow or other injury, his needs still look different from those of their peers. Bridge Program Coordinator Ian Wright, P.T., D.P.T., CSCS, USAW, answered the five “W’s” about what a bridge program can do for these athletes.

Who should participate in a bridge program?
Growing muscles, joints, and bones in boys and girls are at an increased risk of injuries from improper training and repetitive activities that occur in baseball and other sports. After recovery from an injury and discharge from physical therapy, all athletes would benefit from a strength and conditioning program to balance sport-specific training sessions. An athlete with a current injury should not start a bridge program without activity clearance from the medical provider.

What is a bridge program?
A bridge program is a series of group training classes led by a certified strength and conditioning coach. The coach evaluates the athlete’s movement patterns and provides instruction while supervising specific exercises with proper repetitions, resistance, and rest. Activities range from general strength and conditioning to sport simulation activities that are age- and task appropriate for each athletes. Education to complement the physical activities includes nutrition and hydration information for young athletes.

When is a bridge program appropriate?
A bridge program is most effective when it closely follows rehabilitation closely. Because poor movement patterns are associated with growth and increased injury risk, an ongoing or periodic conditioning program provides value to the young athlete at any point. The instructor must have a solid understanding and commitment to off-season periodization. Periodization is selecting the appropriate type of intensity of training based on the sports season.

For example, for baseball players, three seasons are considered:

  1. Off-Season: August – November
  2. Pre-Season: December – February
  3. In-Season: March – July

Periodization becomes more difficult when athletes participate in a single sport year-round which is also associated with an increased risk of injury.

Where can an athlete participate in a bridge program? 
The program should be implemented in a setting where there is access to equipment for the young athlete to train in a safe environment. For example, an at-home exercise program may have limitations for the athlete because they do not have enough space to perform their activities with the needed equipment. Additionally, proper supervision is important, both the ratio of participants to instructors and the qualifications of the instructors must be considered.

Why should young baseball players participate in a strength and conditioning program?
Physical therapy typically focuses on the specific impairment or limitations caused by the injury or condition. Though sports-focused therapists integrate total body treatment throughout, the sessions may end long before the body is back to normal. Most home exercise programs revolve around continued, supervised resistance training. Young athletes have limited access to well-trained instructors that consider total body conditioning, growth and development, skill acquisition, seasonal periodization, and individualized effective strengthening prescription. When left on their own, athletes are at an increased risk of a new injury or re-injury when they return to sport specific regimens of practice, games, tournaments, coaching clinics, and self-guided training.

Scottish Rite for Children in Frisco is offering training classes to former patients, Contact our Therapy Services team at 469-515-7150 or bridgeprogram@tsrh.org.

Learn more about Osteochondritis Dissecans (OCD) in the Elbow.

Rising Elite Gymnast

Rising Elite Gymnast

by | Feb 4, 2021 | Sports Medicine

When 12-year-old Julia began gymnastics eight years ago, her coaches immediately recognized her strength, focused attention and determination. They knew she could be great. Julia continues to prove them right and has earned her spot on the Hopes team at Plano’s World Olympic Gymnastics Academy (WOGA). Hopes is a pre-elite program for gymnasts under the age of 14 to begin their journey through the Elite Program, where National Team coaches look to find the next generation of Olympians.

While preparing for the Hopes Competition season, Julia was practicing new gymnastic skills progressions, which required her to land on her left leg repeatedly. She began experiencing soreness in her hip, and her coach could tell that something was wrong by the way she was moving. She suggested that Julia get it checked out to prevent further injury. Her mom, Heather, brought Julia to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Texas. She was seen by sports medicine physician Shane M. Miller, M.D., who is very familiar with the demands of gymnastics.

Miller recognized that Julia had an injury to a growth center where the hamstring tendon attaches to the pelvis, called the apophysis. The apophysis is made of soft cells called cartilage that will later be replaced by bone. In growing athletes Iike Julia, the apophysis is vulnerable to injury from repetitive activity. Until Julia finishes growing, this activity-related inflammation called pelvic apophysitis could continue to be a problem.

Fortunately, surgery is not required to treat the condition, so the Scottish Rite team developed a care plan focused on physical therapy to get Julia back in the gym for the USA Gymnastics (USAG) Development Camp. Physical therapist Lorenzo Vite, who frequently works with elite and pre-elite gymnasts, worked closely with Julia to help her achieve her goal. “We began by assessing musculoskeletal dysfunctions. Once dysfunctions were identified, we started low-impact movement skills and then we put her into our brand new Hydroworx® underwater treadmill to allow the muscles to work without too much stress,” says Vite. “From there, we progressed her to strengthening programs, monitoring her all the time to make sure that we didn’t exacerbate the hip pain.”

Julia enjoyed the variety of exercises that she did with Lorenzo. “At first, physical therapy was hard, but after a little bit, it all started getting easier,” she says. Over the course of eight sessions, Vite carefully managed and monitored Julia’s progress until they believed that she was able to perform. After she passed a rigorous functional test with flying colors, they knew that she was ready. Julia performed well in the USAG Development Camp in October and is continuing to compete pain-free!

Although COVID-19 slowed everything down for a while, it did show young athletes how taking time off can be beneficial. “In the gymnastics culture, people always think that you shouldn’t take any time off, but the pandemic showed us that if you miss some time and if you do it right, you can come right back and avoid injury,” says Heather. “In some cases, girls came back stronger in their core, which made them stronger gymnasts.”

Young athletes often feel like they have to play through the pain, so they don’t let their team or coaches down. Both Julia and Heather encourage other young athletes to speak up when something doesn’t feel right. “Talk to your coaches about it and tell them what’s happening,” says Julia. “Make sure that they know, so they don’t push too hard because you don’t want to hurt yourself.” Injuries may be treated quickly early on, but if athletes continue to practice and compete at a high level, it may become much worse, taking them out of their sport much longer. “Missing practice to go to Physical Therapy, does not mean you are falling behind or not getting stronger,” says Heather. “You are actually getting even stronger by going through physical therapy.”

Today, Julia continues her exercises to help prevent future injuries, and she is using everything that she has learned through this experience to help her fulfill her dream of competing in the Olympics!