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Want to Know What the NBA and Scottish Rite Hospital Have in Common?

Want to Know What the NBA and Scottish Rite Hospital Have in Common?

by | Oct 29, 2019 | Sports Medicine

This weekend, at the third invitation-only Dallas Mavericks Youth Combine, the area’s top middle school basketball players and their parents heard one message over and over again –don’t specialize in one sport too soon.

Our team was excited to be there and happy to support this message. The evidence is piling up against early specialization including early burnout, quitting sports at a young age and less career playing time often directly associated with injuries. Pediatric orthopedic surgeon Henry B. Ellis, M.D., was invited to provide an overview of injuries in basketball. He emphasized the importance of rest, at least three months from each organized sport every year. This interactive conversation with parents included these key messages:

  • Knee overuse injuries (Osgood Schlatter and Sinding Larsen Johansen) are more likely in this age group, particularly with basketball players. Proper knee range of motion and stretching can help.
  • Hip overuse injuries (femoral acetabular impingement) are progressive and should be evaluated to minimize the damage to soft tissues in the hip joint.

In response to questions about bracing and cryotherapy, Ellis reminded parents that there are no fast cures to something that is caused over time. Rest is necessary and the studies are starting to show that diversity in sports and taking breaks throughout the year, can place athletes at an advantage.

Greg Nared, Senior Vice President of Community Relations for the Dallas Mavericks, echoed this in his message to the players and the parents. Convinced that injuries can be avoided with proper rest and skill development, Nared encouraged parents to expose their children to other sports and non-basketball training. He and Ellis decided several years ago that they needed to work together to get this message and others about health and wellness to kids. Playing sports, including basketball, has many advantages and together they want to figure out how to get more involved to help keep kids playing longer.

In the combine event, Scottish Rite for Children staff participated by taking some measurements and offering feedback to the athletes about opportunities for improvement. Some suggestions included:

    • Stretch the ankle and heel cord to improve ankle flexibility. Rigidity at the ankle can cause excess demands on the knee.
    • Stretch the quadriceps (muscles in front of the thigh). Short muscles and repeated jumping and running can cause overuse injuries in the knee.
    • Learn proper squatting form. Poor movement with squatting will translate into poor movement with jumping and landing, leaving a knee vulnerable to significant injury.

    • This NBA-like combine experience was designed with the young athlete in mind. These young athletes are in the prime of their development and growth, putting them at risk of certain injuries. However, it also puts them in a perfect position to learn about protecting their bodies. 

        Learn more about our partnership with the Dallas Mavericks. 

      FOX 4: Coppell High School invests in high-tech mouthguards for football players

      FOX 4: Coppell High School invests in high-tech mouthguards for football players

      by | Oct 18, 2019 | Press Coverage, Sports Medicine

      New technology may be able to help coaches keep North Texas high school football players safer when it comes to head injuries. Our sports medicine expert, Dr. Shane Miller weighed in on the topic with FOX 4 News.

      He says there is still a lot to learn about using sensor technology in high-tech mouthguards to monitor players, but believes it is a step in the right direction.

      “I don’t want parents to have a false sense of security,” he said. “This is not a concussion detection device. You still need to rely on trainers and medical personnel to help identify this. But the technology does have the potential to impact player safety if used correctly.”

      Watch FOX 4’s feature

      Hot Topics in Sports Medicine: Modalities and Trends

      Hot Topics in Sports Medicine: Modalities and Trends

      by | Oct 16, 2019 | Sports Medicine

      Key messages from a presentation by sports medicine physician Jane S. Chung, M.D., at Coffee, Kids and Sports Medicine.

      Watch the lecture
      Print the PDF

      Young athletes present for post-injury care and performance training guidance in many settings from school training rooms to pediatrician offices. All health care providers should be familiar with the basics of popular modalities and trends in order to provide evidence-based advice to children and parents. This article covers four popular areas of sports rehabilitation and performance.

      Chung says, “The key message I want providers to hear is that for many of these trends and modalities, most of these studies have been done specifically in the adult population. Evidence and utility for the pediatric population still needs to be thoughtfully investigated.”

      Platelet-Rich Plasma: Evidence and Current Applications
      Platelet-rich plasma (PRP) is a high concentration of growth factors & cytokines released by platelets to augment the natural healing process. Blood is collected from the patient and processed. The plasma is injected into the treatment area in a clinic or surgical procedure. Some use ultrasound to guide the injection.

      Gaps in literature: Standardized volume to inject, frequency for injections, post injection care not determined
      Indications: Chronic tendon injuries (tennis elbow, jumper’s knee, Achilles tendonitis), ulnar collateral ligament injuries, rotator cuff injuries, acute muscle injuries and knee osteoarthritis

      Show me the evidence: Watch the video to hear a summary of several relevant studies.

      Take Home Points

      • There is no evidence, to date, that PRP in acute muscle injuries is superior than placebo or rehabilitation alone.
      • PRP is associated with a reduction in patient reported pain (up to one year) for certain conditions.
      • Despite widespread usage, little is known on benefits of PRP on the musculoskeletal system.

      Blood Flow Restriction Technique: What is it, Applications in Therapeutic Setting
      Blood Flow Restriction (BFR) technique or training is a form of strength training which is an important component of rehabilitation and performance training. This modality uses partial vascular occlusion while performing exercises at low loads to improve muscle strength, size and endurance.

      This technique uses low-load resistance (20-30% 1RM) for training while in the restricted state. This is less than half of traditional heavy-load (60-70% 1RM) strength training. Therefore, this may be appropriate for certain populations where heavy-load training is not appropriate.

      How it works: Induce BFR using a pneumatic cuff inflated proximally on a limb. Perform low-load exercise while blood flow is restricted.

      Populations where heavy-load strength training is contraindicated and BFR has been studied: Post-ACL reconstruction (ACLR), knee osteoarthritis (OA), adults with sarcopenia and inclusion body myositis.

      Show me the evidence:

      • Past decade, research showing BFR in combo w/ LL (light load) training → significant muscle strength and size in healthy individuals
      • Concerns about adverse effects have not been published in studies, only case reports.
      • Promising but not conclusive results for post ACL reconstruction early strengthening and pain for some patellofemoral pain populations.
      • Positive results as an adjunct to traditional physical therapy post-knee arthroscopy.

      Take Home Points

      • Clinical applications for BFR training in patients with musculoskeletal conditions are vast.
      • Further studies are needed to study the efficacy and safety of BFR in both operative and non-operative orthopedic conditions.
      • More effective than low-load training alone but less effective than heavy-load training.
      • Limited data is available in the pediatric population.
      • Might be appropriate adjunct therapy for knee OA, patellofemoral pain, post op knee arthroscopy, post-ACLR and muscle injuries (hamstrings).

      Whole Body Cryotherapy: What is it, A Cool Trend That Lacks Evidence?
      Whole body cryotherapy (WBC) is a brief, full body exposure to dry air at cryogenic temps of -110⁰ to -140⁰ C for two to four minutes, in a nitrogen-cooled cryochamber, where liquid nitrogen fluxes through pipes inside the chamber’s wall.

      Gaps in literature: 

      • Lack of standardized protocols for temperature, timing and frequency.
      • Unknown effects on muscle recovery after mechanical overload in athletic populations.
      • Wide variation in study designs.
      • Inability to blind (and unable to eliminate placebo effect).

      Take Home Points

      • Possible benefits include enhanced recovery after injuries, post-exercise and counteract inflammatory symptoms from overuse, post-traumatic recovery, pain and performance.
      • NOT FDA regulated, NOT cleared/approved by FDA as a safe and effective device to treat medical conditions.
      • Skilled and trained personnel must control procedures to prevent adverse effects (necrosis, skin burning).
      • Current contraindications: cryoglobulinaemia, cold intolerance, Raynaud’s disease, hypothyroidism, acute respiratory system disorders, cardiovascular disease, purulent-gangrenous cutaneous lesions, sympathetic nervous system neuropathies, cachexia, hypothermia, claustrophobia, mental disorders hindering cooperation during test, pregnant women, children  under 18 (need parental consent).

      High Intensity Interval Training: Pros and Cons, is it for Everyone?
      High intensity interval training (HIIT) is repeated bouts of high intensity effort followed by varied recovery times. The intense work period can range from five seconds to eight minutes at 80 – 95% of estimated maximal heart rate. Recovery periods can last as long as work periods performed typically at 40-50% of estimated maximal heart rate. Total workout time ranges from 20 – 60 minutes.

      Known benefits are consistent with other cardiovascular exercise, these include aerobic and anaerobic fitness, reduced blood pressure, improved cardiovascular health, improved cholesterol profiles, loss of abdominal fat and body weight while maintaining muscle mass, insulin sensitivity and possibly improved brain health.

      Contraindication: exertional rhabdomyolysis

      Gaps in literature: General lack of studies on the topic, optimal exercise duration and rest intervals remain unclear.

      Take Home Points

      • Positive results in studies that include children and adolescents.
      • Living sedentary lifestyle or periods of inactivity, obesity, hypertension, diabetes: obtaining medical clearance from physician may be appropriate prior to starting HITT program.
      • Can easily be modified for people of all fitness levels and special conditions (i.e. overweight, diabetes).
      • Can be performed on all exercise modes: cycle, walk, swim, aqua training or elliptical.
      • Time efficiency: similar benefits as to continuous endurance workouts, but in a less time.
      • Burns more calories especially post workout due to increased excess post-exercise oxygen consumption (EPOC) after HIIT workouts.

      Young athletes are highly motivated to return to sport quickly after an injury and will look for any advantage in the process. The highly competitive nature of youth sports is also driving healthy young athletes to seek ways to improve performance. Our responsibility as health care providers is maintain a general knowledge base about treatment options in the market. Understanding the risks and perceived or potential benefits of these and other modalities will help you guide parents and young athletes in making informed choices.

      Little Leaguer’s Shoulder Syndrome

      Little Leaguer’s Shoulder Syndrome

      by | Oct 7, 2019 | Sports Medicine

      We continue to see preventable injuries in young throwing athletes. We are hopeful that continued efforts to educate parents, athletes and coaches will encourage them to comply with recommendations for pitch counts and days of rest to protect throwing arms. Children and adolescents should not experience activity-related pain and should not be encouraged to play through pain.

      Many are familiar with Little Leaguer’s elbow syndrome. However, there seems to be a continued lack of awareness regarding a similar injury in the shoulder. Little Leaguer’s shoulder syndrome, also called proximal humeral epiphysiolysis, is the most common diagnosis associated with young throwing athletes with complaints of shoulder pain. Though its name correctly associates it with the higher occurrence in young baseball players, it can be also be a problem for athletes in other sports including softball, volleyball, tennis, gymnastics and swimming. These sports require similar repetitive overhead motions used by a baseball pitcher.

      This shoulder condition is only seen in athletes with open growth plates. These are the growing areas of the bone that are relatively soft because the cartilage has not yet matured into hard ossified or calcified bone. These areas disappear when the bone has completed growth. The growth plate is softer than the bone on either side of it and therefore is at a greater risk of injury. The repetitive motions in sports can cause cumulative small injuries to these areas. Without proper rest and recovery, this can lead to pain and widening of the growth plate.

      Little Leaguer’s shoulder syndrome is a condition of the growth plate of the upper end of the upper arm bone, the humerus. Because the rotator cuff muscles in the shoulder attach to the bone above the growth plate and other muscles attach below the growth plate, there is a rotational or twisting stress across the growth plate with each throw.

      Little Leaguer’s shoulder may be seen in athletes as young as 8 or 9 years of age. It is rarely seen beyond age 15 or 16. When the growth plate is ossified, repetitive activity may then lead to other types of injury. A diagnosis is typically made with a physical exam and standard shoulder X-rays. In some cases, an X-ray of the opposite shoulder is used to compare the growth plates to confirm the diagnosis. An MRI of the shoulder is not necessary and, in most cases, should be avoided to minimize costs.

      With early recognition, Little Leauger’s shoulder syndrome is successfully managed with rest from throwing for a period six to 12 weeks. Exercises that include shoulder stretches and strengthening can be added when symptoms improve. A proper program focuses on flexibility and stability around the shoulder and throughout the body. An interval throwing program is a strategic approach to returning to throwing starting with short tosses and progressing to longer and faster pitches. After completion of this program and when symptoms have completely resolved, the athlete can return to overhead throwing sports.

      Overuse injuries are considered preventable. Here are tips to keep a throwing arm injury free:

      • Focus on proper form with each throw.
      • Stop throwing when tired.
      • Follow pitch count guidelines.
      • Respond early to complaints of pain during or after throwing.
      • Schedule rest throughout the week and throughout the year.

      Additional education:
      Key concepts for injury prevention in baseball players

      Learn more about pediatric sports medicine.

      This information has been edited from an original article by Chuck Wyatt, R.N., CPNP, RNFA, submitted for publication on another website.

      What Is Baseline Testing for Sports Concussions?

      What Is Baseline Testing for Sports Concussions?

      by | Sep 19, 2019 | Sports Medicine

      Watch the video to learn more about baseline testing.

      Many studies suggest that access to baseline information when monitoring post-injury symptoms and deciding when a student athlete is ready to return to school or sports is helpful. Though this concept is useful with all diagnoses, it is most frequently utilized to manage return to learn and return to play after sports concussions.Baseline testing is a common term used to describe objective information that is gathered before the season begins. This may include tests of skills we can see like balance, speed or coordination. However, many use the term “baseline testing” to reference neurocognitive testing, specifically. These tests are typically done on a computer or one-on-one with a psychologist and they evaluate how the brain performs skills we can’t see such as remembering, solving problems, reacting quickly and paying attention. All of these are particularly important to student athletes, both in school and on the field. After a concussion, performance on these tasks is worse than at baseline.

      With this information, a physician can compare the athlete’s pre-injury performance with results from the same tests after a head injury. Therefore, decisions for care can be customized rather than comparing the athlete to others in his or her age group. Though baseline computerized neurocognitive testing is helpful, it is not the only tool used to determine when a student is ready to return to class or the field.

      Some schools have programs that require athletes to participate in preseason testing, but some do not. For young athletes in settings that do not provide baseline testing, the hospital’s Center for Excellence in Sports Medicine offers this service in our clinic for athletes ages 10 and up. Please call 469-515-7100 for more information, or request an appointment online.

      Learn more about sports concussions and pediatric sports medicine.

      Texas Orthopaedic Association: A Look at the Evolution of Football Injuries

      Texas Orthopaedic Association: A Look at the Evolution of Football Injuries

      by | Sep 17, 2019 | Press Coverage, Sports Medicine

      Have football injuries evolved through the years? 

      Shane M. Miller, M.D., a sports medicine physician at Scottish Rite for Children Orthopedic and Sports Medicine Center, recently spoke with Texas Orthopaedic Association about the evolution of football injuries and their treatment. 

      “Increased awareness, media attention, and legislation have prompted even the most avid sports enthusiasts to evaluate the safety of participation in youth tackle football,” Miller says. 

      Read the full interview.