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OCD Didn’t Keep This Lacrosse Player Off the Field Long

OCD Didn’t Keep This Lacrosse Player Off the Field Long

by | Dec 1, 2021 | Sports Medicine

Seventeen-year-old Eli has been a leader on the lacrosse field since he started playing at the age of 8. He currently plays lacrosse with the Frisco Lacrosse Association and is an outside linebacker on Frisco ISD’s Lone Star High School football team. This multi-sport athlete from Frisco knows a lot about overcoming adversity, and he’ll be quick to tell you if you ask about one of his greatest victories.

Eli learned that he had osteochondritis dissecans (OCD) in his knee soon after an injury during a tournament in Philadelphia when he was 14-years-old. With hopes that this cartilage condition would improve with time, he continued playing. Several months later, an unfortunate move in a tie-breaking “braveheart” play at a Denver tournament forced him to try a different approach.

Looking for someone with experience treating young athletes with OCD, his family found pediatric orthopedic surgeon Philip L. Wilson, M.D. “Cartilage conditions like this are unique to young athletes, but we have a lot of clinical experience and research interests focused on understanding more about this condition,” Wilson says.
With OCD, early intervention and treatment recommendations, including rest or wearing an unloader brace, may allow the tissue to heal on its own. Unlike braces used for kneecap instability or after an ACL reconstruction, an unloader brace is designed to change the weight distribution in the knee joint.

When Wilson met Eli, it was clear the bone and cartilage on the surface of the joint would need surgery. Wilson describes this condition using an analogy of a pothole. Though it’s unclear why, the bone on the surface of the thigh bone collapses, and the smooth cartilage surface can tear. There are several different surgical techniques that may be used depending on the condition of the surface.

“Dr. Wilson made me feel safe,” says Eli. “He cracked a lot of jokes, which helped me feel less nervous.”

Before returning to the lacrosse field, Eli needed to recover his strength and mobility in his leg. Getting his injured leg to the point where he felt safe on the field seemed like a long process, but his hard work in physical therapy paid off because he now has total confidence in his knee. “My knee feels 110% – better than my other knee, actually,” says Eli. “We are very thankful, and we owe a lot to Scottish Rite,” says his mother, Heather.

Eli believes his experience has given him a valuable perspective that helps him handle challenges and find the positive in any situation. “It always gets better,” he says. “I’ve been through a lot, so I know that I can get through other bad things that come up.”

Eli has advice for other young athletes who are injured and out of the game. He knows how it can not only affect them physically but mentally as well. “I was depressed because I couldn’t play for six months, but I overcame it,” he says. “You can get through anything if you have a good mindset.” Heather encouraged Eli to be active and connected with his friends and coaches throughout his recovery. His coaches recommended that he continue to study the sport to keep his mind ready for the game as he got his body ready. “It’s hard as a parent to watch your kid struggle through it,” says Heather. “You don’t realize how much sports mean to your child until it’s taken away, so staying connected and finding ways to help them stay positive is important.”

Eli has big dreams, and one of them is playing lacrosse in college. He knows that he can overcome adversity and that hard work and perseverance usually lead to something great. “I want to set the bar way too high so that if I meet it in the middle, I’ll be okay, but maybe I can go flying over the top,” he says.

OCD Didn’t Keep This Lacrosse Player Off the Field Long

OCD Didn’t Keep This Lacrosse Player Off the Field Long

by | Dec 1, 2021 | Sports Medicine

Seventeen-year-old Eli has been a leader on the lacrosse field since he started playing at the age of 8. He currently plays lacrosse with the Frisco Lacrosse Association and is an outside linebacker on Frisco ISD’s Lone Star High School football team. This multi-sport athlete from Frisco knows a lot about overcoming adversity, and he’ll be quick to tell you if you ask about one of his greatest victories.

Eli learned that he had osteochondritis dissecans (OCD) in his knee soon after an injury during a tournament in Philadelphia when he was 14-years-old. With hopes that this cartilage condition would improve with time, he continued playing. Several months later, an unfortunate move in a tie-breaking “braveheart” play at a Denver tournament forced him to try a different approach.

Looking for someone with experience treating young athletes with OCD, his family found pediatric orthopedic surgeon Philip L. Wilson, M.D. “Cartilage conditions like this are unique to young athletes, but we have a lot of clinical experience and research interests focused on understanding more about this condition,” Wilson says.
With OCD, early intervention and treatment recommendations, including rest or wearing an unloader brace, may allow the tissue to heal on its own. Unlike braces used for kneecap instability or after an ACL reconstruction, an unloader brace is designed to change the weight distribution in the knee joint.

When Wilson met Eli, it was clear the bone and cartilage on the surface of the joint would need surgery. Wilson describes this condition using an analogy of a pothole. Though it’s unclear why, the bone on the surface of the thigh bone collapses, and the smooth cartilage surface can tear. There are several different surgical techniques that may be used depending on the condition of the surface.

“Dr. Wilson made me feel safe,” says Eli. “He cracked a lot of jokes, which helped me feel less nervous.”

Before returning to the lacrosse field, Eli needed to recover his strength and mobility in his leg. Getting his injured leg to the point where he felt safe on the field seemed like a long process, but his hard work in physical therapy paid off because he now has total confidence in his knee. “My knee feels 110% – better than my other knee, actually,” says Eli. “We are very thankful, and we owe a lot to Scottish Rite,” says his mother, Heather.

Eli believes his experience has given him a valuable perspective that helps him handle challenges and find the positive in any situation. “It always gets better,” he says. “I’ve been through a lot, so I know that I can get through other bad things that come up.”

Eli has advice for other young athletes who are injured and out of the game. He knows how it can not only affect them physically but mentally as well. “I was depressed because I couldn’t play for six months, but I overcame it,” he says. “You can get through anything if you have a good mindset.” Heather encouraged Eli to be active and connected with his friends and coaches throughout his recovery. His coaches recommended that he continue to study the sport to keep his mind ready for the game as he got his body ready. “It’s hard as a parent to watch your kid struggle through it,” says Heather. “You don’t realize how much sports mean to your child until it’s taken away, so staying connected and finding ways to help them stay positive is important.”

Eli has big dreams, and one of them is playing lacrosse in college. He knows that he can overcome adversity and that hard work and perseverance usually lead to something great. “I want to set the bar way too high so that if I meet it in the middle, I’ll be okay, but maybe I can go flying over the top,” he says.

A Bridge Back to the Game

A Bridge Back to the Game

by | Nov 18, 2021 | Sports Medicine

Specially designed for young athletes, Scottish Rite’s training classes help build strength, conditioning and confidence for both patients following rehabilitation after an injury and participants interested in overall athletic performance improvement.
Program coordinator Ian Wright, P.T., D.P.T., CSCS, USAW, TSAC-F, O.C.S., and additional Physical Therapy team members certified in strength training provide focused, intense instruction so sports medicine patients like Lillian, who has recently recovered from an ACL reconstruction surgery, can return to playing soccer.
“Physical therapy sessions may end long before the body is back to sportready,” Wright says. And that’s where this program comes in. Ninety percent of training class attendees are Scottish Rite patients, and the others are athletes looking for performance coaching and movement training that may help reduce injury risk.
Three individuals performing resistance band exercises in a gym, all wearing masks.
“Even though I’m training as hard as I can, the class is still so enjoyable because you do it with so many different kids who have come through so many different injuries. It’s very inspiring,” Lillian says.

Poor movement patterns are associated with growth and increased injury risk, so an ongoing or periodic conditioning program can be important to young athletes. Training participants attend from one to three classes a week and are categorized based on any activity restrictions and individual skill level coupled with the specific demands of the individual’s sporting position.

“If I could give parents advice, I would say there’s something really remarkable when your child is doing therapy in an environment around other children,” Lillian’s mother, Debbie, says. “To do it around other kids is super, super important. Lillian realized she was not the only one.”

Wright and the team care for the unique challenges of busy student athletes and take external stressors participants face on a daily basis into consideration. “Maybe it’s a stressful midterm week or it’s out-of-season or maybe it’s a hectic game schedule coming up, our therapy staff can adapt and change the classes to fit whatever our participants are going through on and off the court,” Wright says.

The benefits to Lillian are clear to her parents and teammates. “These training classes have actually made Lillian stronger, faster and given her more confidence,” Lillian’s dad, Sergio, says. “It’s created such a good habit, and she’s able to break away with the ball so easily now.”

For information about attending the training classes, contact Therapy Services at [email protected]

The Comeback Kid

The Comeback Kid

by | Nov 18, 2021 | Sports Medicine

Cover story previously published in Rite Up, 2021 – Issue 3.

by Hayley Hair

The Comeback is Bigger Than the Setback

On the wide-open field under the scorching summer sun, soccer player Lillian lines up her kick and launches the soccer ball through the air hurtling toward the goal. Today she’s in practice leading up to her select soccer team’s upcoming season. Last fall’s season looked dramatically different as an anterior cruciate ligament (ACL) rupture and meniscus tear took 12-year-old Lillian and her parents not only by surprise but also, unfortunately, out of the game.

“I was in the far corner and a girl hit me from the side,” Lillian says. “I heard several pops, and then I was on the ground in tears. It was just the most painful thing.” Lillian was able to limp away after the injury, but it hurt, and the pain persisted. Lillian’s mother, Debbie, set up a doctor’s appointment to have Lillian’s knee examined. “I had this vision that an ACL injury was excruciating, and you couldn’t walk,” Debbie says. “She was in pain, but not what I thought it would look like. It hurt, but she was mobile.”

Following X-rays and an MRI, Lillian’s injury was confirmed. “Just hearing the doctor say, ‘torn ACL,’ I couldn’t think of anything. My mind just stopped,” Lillian says. Later that day and feeling overwhelmed about her future sports goals, Lillian searched online to find out what professional athletes experienced injuries like hers. Then she saw her soccer idol’s name pop up on the list. “It’s happened to a lot of professional players, like Alex Morgan, who I’ve looked up to my entire life. That kind of comforted me.”

The Ins and Outs of ACL Injuries in Children

The ACL is a stabilizing ligament in the central part of the knee that stabilizes translation and rotation of the joint and is typically injured in pivoting, twisting and agility sports. Over the last several decades, recognition of ACL injuries has increased, and rupturing the ACL is particularly common in female soccer.

One hears about torn ACLs frequently in adult sports, but what happens when the injury presents in children? Lillian’s X-rays showed that her growth plates were still open, signaling plenty of growing in her future, so her best bet for care would be provided by a pediatric orthopedic specialist. She was referred to Scottish Rite for Children’s Orthopedics and Sports Medicine Center in Frisco and into the care of pediatric orthopedic surgeon Philip L. Wilson, M.D., assistant chief of staff and director of the Center for Excellence in Sports Medicine.

For a growing athlete, the experts at Scottish Rite for Children 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.

“Some ACL injuries may not need to be reconstructed if there are no cartilage injuries or shifting or instability of the knee,” Wilson says. “Unfortunately, this is less common, and despite rehabilitation, many children need surgery due to laxity in their ligaments and their high activity levels.” For Debbie and Sergio, Lillian’s parents, Wilson was the perfect fit for determining their daughter’s care.

“Dr. Wilson sat with me and my daughter and answered every question I had under the sun about the data, his experience and his research. He was an open book about everything,” Debbie says. “The whole team was positive. They made us feel like we had a great plan in place and that it’s all going to be just fine.”

The Right Surgical Technique for Patients Like Lillian

That research Wilson reviewed with the family is the novel ACL surgical technique for growing athletes that he and pediatric orthopedic surgeon Henry B. Ellis, M.D., created and subsequently published in the American Journal of Sports Medicine and presented at the annual meetings of the Pediatric Orthopedic Society of North America and the American Orthopedic Society of Sports Medicine.

“We have found in our research at Scottish Rite studying a particular technique that we developed that this can cut ACL reinjury rates in half,” Wilson says. “Female adolescent soccer players, like Lillian, have a particularly high risk of reinjury, sometimes as high as 25%, which is the highest that we have recorded in youth and young adult sports. Adding the stabilizing ligament helps reduce that reinjury risk. She also had cartilage repair, which is common is 70% in our ACL injury population.”

Lillian had a quadriceps tendon autograft for her ACL repair. She also had a lateral tenodesis with her iliotibial band, which means Wilson used a strip of tissue from the side of the knee to add a secondary stabilizing ligament that helps control rotation and protect the knee.

“There’s nothing you can tell a parent to put them at ease when their child is going through the actual procedure,” Sergio says. “There’s nothing routine when someone puts your child under anesthesia, but when you are in a facility like Scottish Rite, in a place where the doctors are proven performers, that gives you peace of mind.”

Scottish Rite provides world-class care for patients including access to psychologists, nutritionists, physical therapists, athletic training staff, specialized nurses, advanced practice providers and many others who play a significant role in ensuring complete physical and mental readiness to return to play. “We are fortunate to have the resources to take care of the whole patient,” Wilson says. “We also have a keen interest in the research surrounding these injuries and contribute to that research in terms of factors predictive of injury, surgery techniques, patient outcomes and potential complications of treatment.”

Novel ACL Reconstruction Diagram

Returning to Sports After Surgery and Physical Therapy

Finding the proper treatment and completing the surgery are a huge jump start to recovering from an ACL injury, but getting back on the field and ready to safely return to competitive game play takes time. For Lillian, it was nine months.

“When you see your child be very physically active, and then one day, it all comes crashing down, that for me as a parent was deeply concerning,” Debbie says. “I knew the journey to get anywhere near that level of activity again was going to be many, many months.”

By helping Lillian understand that recovery could take up to a year, Wilson worked alongside the family to get her healthy both physically and mentally to return to soccer. “Every time I went to visit him, he said I was doing great and healing ahead of schedule, and that made me want to work even harder,” Lillian says. “I pushed my hardest through every single drill and activity I did, and here I am, and I feel better than ever.”

Wilson says the biology of internal healing in the knee takes at least nine months. That time allows for the new ligament graft to heal to the bone and grow a blood supply. That also includes building back the muscle and strength to regain control of the leg to protect the surgically constructed knee. “Return prior to that time leads to increased reinjury rates,” Wilson says. “Scottish Rite has a stepwise progression of strengthening, agility and neuromuscular control activities to help prepare patients to return to sports.”

Following Scottish Rite’s well-established, highly successful physical therapy program, Wilson recommended Lillian participate in Scottish Rite’s training classes to foster further recovery and prepare for the functional testing and physician’s clearance required for her to safely return to soccer. Following months of rehabilitation, many patients need additional strengthening and emotional support to trust their injured leg, beyond what can typically be received during traditional physical therapy. “I just felt so much comfort even though I didn’t know anyone there,” Lillian says. “Being around the people who have had an injury and who are around my age, it just felt so heartwarming. We would help each other no matter what, and it was just an amazing feeling.”

Back on the Field

Lillian followed her sports medicine team’s instructions very closely. With a great deal of hard work, and added support and encouragement from her parents and her teammates, she successfully passed her functional test.

The new soccer season has arrived, and Lillian’s parents love seeing her back out there. “Whenever you have to see them take their first tumble to the ground, you kind of hold your breath, but she popped right up,” Debbie says. “She just needs to be playing and doing what she loves. For the longer term, the more she’s out there, the more she’s going to learn to trust that knee.”

Lillian has learned a great deal during her ACL injury recovery and from her care at Scottish Rite for Children. “Throughout my entire recovery, I always had one quote in the back of my head — ‘the comeback is always stronger than the setback,’” Lillian says. “I carried that with me throughout my entire recovery. It’s been quite an experience, but I think it’s going to all be worth it.”

Read the full issue.

Keeping Up with the Count: Hip Health in Dancers

Keeping Up with the Count: Hip Health in Dancers

by | Oct 20, 2021 | Sports Medicine

Dancers and other performing artists place demands on their hips that are unlike those of other athletes. Movements push the range of motion of their hips to extreme ends from an early age. They must have the flexibility for turnouts, leaps, or grand battements, and also absorb dramatic forces from leaps and jumps. All of this while maintaining impressive limb control and stability of their support and gesture limbs over sustained periods.

Key Considerations for Hip Health for Dancers

  1. Mobility in the hip and surrounding muscles.
  2. Balance and stability in the pelvis and core.
  3. Managing training volume.

Hip Mobility
Turnout and extreme ranges of motion during dancing and other performing arts often require more than “normal” hip mobility. For some, the end of the thigh bone in the hip is naturally in a position of retroversion, which allows for the extreme external rotation needed for turnouts. Others have soft tissue laxity, also called joint hypermobility, that predisposes them to successfully achieve the extremes in rotation, extension, flexion, and abduction (out to the side, such as a la seconde) required for their art form. Dancers with natural hypermobility may be more likely to continue, whereas others may “self-select” out of the sport.

Dancers that are not born with these factors may acquire laxity in the joint with many years of training and aggressive stretching of the muscles and soft tissue that make up the hip capsule.

Proper supervision and a comprehensive program are necessary to ensure the stretching does not cause hypermobility in the lower spine. Additionally, extreme motions may cause damage to the labrum, a soft tissue rim that stabilizes the hip in the socket. Therefore, prompt response to signs of pain with mobility should be addressed to avoid damage to the soft tissue, and ultimately the bones in the hip.

Pro Tip: When the core stabilizer muscles don’t support the lower spine, the hip muscles, including the flexors or hamstrings, are forced to provide support. This protective tightness is an undesirable compensation and can be corrected by doing core stabilization exercises.

Pelvic and Core Stability
Mobility of the hip and leg is dependent on having a stable platform. Core stability means abdominal strengthening to many, but there are deeper muscles that must be considered, including:

  • Gluteal muscles – deep hip rotators that help to maintain active turnout and appropriate knee alignment in the posture leg with grand plies and more.
    • Gluteus maximus (hip rotation and extension)
    • Gluteus medius (hip rotation and abduction)
  • Transverse abdominis – deep abdominal muscles

Imbalances and weakness of these muscles cause stress on other joint tissues, including the capsule, labrum, and ligaments. Stretching or stressing beyond their limits can cause pain and injuries in those non-muscular tissues, which then shifts more demand to the muscles around the hip to provide extra support at end ranges of motion. The body then uses other muscles like the hip flexors to stabilize the hip and support a high volume of hip flexion with a turned-out leg, as seen in dance.

A consequence of this demand or overuse of a muscle is muscle tendinitis, the inflammation of the tendon part of a muscle. This condition worsens when there are sudden spikes in the frequency or duration of training, particularly when there is inadequate support from the core to control the pelvis during repeated hip flexion movements.

Stability Exercises:

Abdominal Hollowing Technique
To prevent this chain of compensation, a dancer can learn how to activate the transverse abdominis, the deep abdominal muscles. These muscles help to create a stable base prior to limb movement. Activation of these muscles is described as a “hollowing” technique as the belly button is pulled inward toward the spine. This contrasts with a “bracing” technique that activates the superficial abdominals.

Pro Tip:
A dancer should be able to do an active straight leg raise without any arching of the lower back during the movement. For added abdominal/core muscle activation, use a band for a pull-down during the straight leg raises. This prepares a dancer for flexion associated with high kicks and grand battements without anterior pelvic tilt.

Gluteal Medius Strengthening

Example exercises:

  1. Single leg glute bridge
  2. Kneeling, side plank, hip abduction raises
  3. Clamshell side planks
  4. Side plank development

Pro Tip: It is important to learn to use the gluteus medius instead of the spinal muscles, called the quadratus lumborum, with abduction motions out to the side (a la seconde) or in the posture leg.

Manage Training Volume
Poor form and muscle fatigue can cause undesirable compensations with other soft tissues and muscles, and may lead to direct tissue injury in the joints or muscles. As overuse injuries worsen with time, performance suffers when the muscles are fatigued.

Pay attention to sudden increases in training duration or intensity, such as fall preparation for The Nutcracker, when added to typical training classes because it can leave a dancer vulnerable to injury. Dancers should take a day off one to two times each week for recovery. Proper rest can help prevent injuries, so you stay healthy throughout the season.

Hockey Player Has No Regrets After Making a Hard Call

Hockey Player Has No Regrets After Making a Hard Call

by | Sep 21, 2021 | Sports Medicine

In June of 2020, 15-year-old hockey player Daniel was training after an outstanding season as captain of his team. It appeared that they had a great shot at going all the way in the upcoming season when everything suddenly went wrong. As he was going for the puck, Daniel’s knee collided with the knee of a player on the opposing team, and then he crashed into the boards. Daniel and his father, Andrew, knew that something was wrong, but they didn’t realize just how bad it was.

Daniel’s coaches had always recognized his speed since he started playing at ten years old. “They say that Danny’s speed is one of his best assets,” says Andrew. “They say that you can teach skills, but you can’t teach speed, which is a great benefit for him.” Daniel remained positive and motivated as he discovered the extent of the injury and his treatment options.

At the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, an X-ray and MRI showed that Daniel had an osteochondral fracture of the patella (kneecap) and a loose body in the joint, likely a piece of bone or cartilage. When Daniel was hit on the outside of his knee, his kneecap likely slipped out to the side and scraped the thigh bone, causing the bone and cartilage injury. This injury is often called a patellar subluxation or, more generally, patellar instability. Scottish Rite for Children offers care of complex cartilage conditions, including osteochondral fractures like Daniel’s.

Pediatric orthopedic surgeon Henry B. Ellis, M.D., offered Daniel two approaches for treatment. One option was to focus on the osteochondral injury on the patella. This option would likely get him back on the ice faster, which was an important consideration for Daniel. When the patella slipped, a vital ligament stretched and tore. Without fixing it, the knee would be vulnerable, and another similar injury would have put Daniel at risk for knee issues as he got older. The second option Ellis suggested was to combine the first option with the reconstruction of the medial patellofemoral ligament (MPFL), even though it would take him out of the game for at least six months. To add to the complexity, Ellis recognized that Daniel had a discoid meniscus, meaning the cartilage in his knee was misshapen. Though relatively uncommon and often without symptoms, this pediatric condition is very familiar to Ellis, so he recommended reshaping it during the surgery as well. Together, these procedures would leave Daniel with much better stability and a much better outlook for the future. Even though Daniel wanted to get back on the ice as soon as possible with his team, he and Andrew decided to go with the comprehensive plan. “Dr. Ellis explained everything to us very clearly, so it made the decision much easier, even though it wasn’t what Danny wanted at first,” says Andrew.

An MPFL reconstruction requires time for tissue healing and an intensive rehabilitation program to return to activity and progress to sports safely. “It was pretty hard at first, but my therapist told me that I was doing pretty well and that I was progressing pretty fast, so that kept me encouraged,” says Daniel.

When Daniel first returned to the ice about four months after surgery, he was feeling less confident than he did before his injury. His teammates and his coach encouraged and supported him, which helped ease his concerns about using his full speed again. When Daniel scored his first goal after his full release back to hockey, everyone cheered wildly. Daniel says that he is doing great now and that he has total confidence in his knee. Daniel and his team, the Texas Warriors, worked hard all year, and in March of 2021, their hard work paid off when they won the state championship, and he has the ring to prove it. Daniel and his team also played in the 2021 USA Hockey National Tournament as state champions of Texas.

Many patients, including Daniel, acknowledge Ellis’ ability to explain the options and include them and their families in the decision-making process. Daniel is also thankful that he did not settle for the quickest option. “Not always taking the fastest option can be a good life lesson,” says Daniel. “Don’t get discouraged and keep working hard to get back where you were.” Some athletes tell us they end up better than they were, and it looks like Daniel is on that path, too!

“Daniel had to make a tough decision and was mature enough to think about the long term more than the short term,” says Ellis. “Turns out he made the correct decision as both short-term and long-term goals were met. Congrats, Daniel, on a well-deserved ring and championship!”

We enjoy hearing about our current and former patients’ success stories. Tell us about your MVP.