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Prevention of ACL Injury in Our Young Athletes

Prevention of ACL Injury in Our Young Athletes

by | Jul 17, 2019 | Sports Medicine

Article originally published by pediatric orthopedic surgeon Henry B. Ellis, M.D., and Assistant Chief of Staff Philip L. Wilson, M.D., in second quarter, 2019 issue of the Pediatric Society of Greater Dallas newsletter. Key messages were also presented by Philip L. Wilson, M.D., at Coffee, Kids and Sports Medicine. 

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Sports and ACL Injuries: Epidemics in Pediatrics
The dramatic increase in anterior cruciate ligament (ACL) injuries, particularly in female athletes, and an increase in surgeries in young athletes requires attention by all of us. Our research has demonstrated almost a two-fold increase in ACL reconstruction performed in female athletes since 2009. In a large epidemiology study reported by the American Academy of Pediatrics (AAP) in 2014, female soccer, basketball and gymnastics are among the top sports with highest ACL injuries rates. Male football is also considered a high-risk sport for ACL injuries.

Although there are obvious benefits of youth sport cultures, annual increases in participation rates of children and adolescents in organized and year-round sports now allows for more opportunities for injuries to occur. Youth that play soccer or other sports that require pivoting may be especially vulnerable. Although most of us want to see our kids (and patients) win, a healthy and safe attitude towards organized sports is wise.

How do ACL Tears Occur?
The ACL, which is located in the center of the knee, serves to limit rotation and forward movement of the tibia. When overloaded in a vulnerable position, without the support of coordinated muscles, the ACL (with linear collagen similar to a rope) tears or stretches when stressed beyond capacity. Often, this occurs when stopping suddenly, landing with an off-centered pelvic position, cutting or twisting movements or with a direct hit to the knee. Youth might feel a painful pop within the knee, experience their knee giving way and observe swelling when an ACL tear occurs.

The knee is often unstable with a torn ACL. Participating in sports with an unstable knee may lead to damage of other soft tissues (menisci and articular cartilage) in the knee. Therefore, surgery may be necessary.

ACL Injury Treatment
An ACL injury can often be successfully treated. An athlete who wishes to return to sports that involve jumping, cutting and pivoting, may require surgery to re-build the ligament. Even though almost all kids will return to sports, surgery in a young athlete can be stressful, traumatic and may take up to one year of rehabilitation. Although risk to the growth plate exists during this surgery, orthopedic specialists who are trained in pediatric orthopedics and routinely treat growing children with these injuries can minimize these risks to a negligible incidence.

Pediatric Sports Injury Prevention Programs
ACL Injuries and sports-related knee injuries are preventable. This has been established in numerous studies. The risk of a non-contact ACL injury may be reduced if the muscles of the central and lower body are strong and well-coordinated. Programs centered around coordination and balance, strengthening and falling techniques can improve biomechanics and help prevent injury. While there is a role for “old school” warm-ups, such as running, research has confirmed that training to improve the efficient and timely contraction of muscles to stabilize the knee (neuromuscular control) may reduce ACL injury or re-injury.

What Can Pediatricians Do to Evaluate for ACL Injury Risk? 
While evaluating an athlete’s safety to participate or return to high-risk sports following an ACL injury, the pediatric sports medicine community often employs balance and strength testing. Single leg squat endurance while maintaining proper in-line knee form, drop-landing knee form, and ability to perform single leg balance maneuvers at an appropriate age and symmetry level (Y balance testing -YBT) are common measures for knee safety evaluation.

Pediatricians may consider simple screening techniques to establish high risk patients or in those who play high risk sports. Some techniques include a single leg balance assessment or a standing double or single leg squat in the office, while observing for diminishing in-line knee control (see photo). Another examination of core strength that may also be useful is to have the patient hold a plank for 60 seconds. This might best serve as a conversation starter for families with pubescents and adolescents in pivoting sports, such as soccer or basketball. A “when in doubt – refer for knee injury prevention training” strategy may be safest in this high-risk population.

The following training tips may also reduce the risk of an ACL injury:

  • Encourage kids to play for fun first, and then play to win.
  • Recommend variation in their sports throughout the year. This will help maintain long term athletic development and minimize overuse injuries.
  • Train for activity, but be cautious of fatigue that may develop during year-round single sport play.
  • Perform core body, hip and thigh strengthening exercises.
  • Practice wide-based, flexed-knee squatting, jumping and landing techniques.

Education to families and youth athletes regarding these injury prevention strategies and programs is an important wellness initiative for all of us who care for these children. Contacting a community pediatric sports medicine partner is an effective way to gain more information and access to available programs. As participation in youth sports continues to rise exponentially, all of us caring for these children will continue to be challenged to provide valuable and timely “ounces of prevention” for their knees.

Fatherly: What Parents of Young Athletes Need to Know About Concussion Recovery

Fatherly: What Parents of Young Athletes Need to Know About Concussion Recovery

by | Apr 30, 2019 | Press Coverage, Sports Medicine

The top priority for parents of young athletes is ensuring the safety of their child on the field. At Scottish Rite Hospital, we are constantly working toward that same goal.

Member’s of the hospital’s sports medicine team at Scottish Rite for Childen Orthopedic and Sports Medicine Center in Frisco recently released a new study examining concussion recovery in young athletes. According to the study, sufficient, sound sleep during the recovery process may be crucial for those who have suffered a concussion while playing sports.

Read more about the study and the team’s findings.

Sports Preparticipation Physical Evaluations: Why Are They Important?

Sports Preparticipation Physical Evaluations: Why Are They Important?

by | Apr 29, 2019 | Sports Medicine

Overview of presentation from a Coffee, Kids and Sports Medicine lecture. 

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Every year, almost 60 million children and adolescents run onto their respective fields, courts and rinks to participate in organized sports in the United States. To ensure the safety of these young athletes, almost all states require some level of sports Preparticipation Physical Evaluation (PPE), which is meant to screen athletes for injuries, illnesses or factors that may put them or others at risk.

“The primary objective is to screen for conditions that may be life-threatening, disabling or may predispose to injury or illness,” says Shane M. Miller, M.D., a sports medicine physician at Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. “A PPE can also serve as a valuable health care entry point for many young athletes and help the physician determine the general health of the child.”

Miller says an extremely important aspect of a PPE is a thorough medical history for the athlete and his or her family. An accurate medical history can be instrumental in detecting 88% of medical conditions and 67% of musculoskeletal conditions. Without a reliable medical history, the source of an issue may be more difficult to identify. It is estimated that less than 40% of forms completed by an athlete correlate with those completed by their parents. Therefore, the parent or guardian should contribute to the history every time.

Questions to enhance a medical history discussion during the PPE:

  • Have you ever had an injury to a bone, muscle, ligament or tendon that caused you to miss a practice or a game?
  • Have you ever had a head injury or concussion?
  • Has anyone in your family died of heart problems or passed away suddenly before age 50?
  • Have you or anyone in your family had a heart condition diagnosed?
  • Have you ever passed out or nearly passed out DURING or AFTER exercise?
  • Have you ever had discomfort, pain, tightness or pressure in your chest, or does your heart ever race or skip beats (irregular beats) during exercise?

Many organizations and schools require a PPE or health clearance for youth formally participating in sports. Since the intent is to enhance the safety of sports participation, it should become an integral part of the health screening exams for any active patient. Miller reports that a very small number of athletes are denied participation from their sport following a PPE.

“The PPE is a screening tool based on the principles of prevention and education,” Miller says. “It is okay to require further evaluation prior to clearance—that evaluation can establish the foundation for a trusting relationship between physician and athlete that can help keep the athlete healthy and safe throughout their athletic career.” In fact, 3-13% of athletes will require further evaluation.

Common reasons for further evaluation:

  • Chronic ankle sprains or other previous injury
  • Signs or symptoms of overuse injury
  • Recent or multiple concussions
  • Concerns of under fueling for sports participation
  • Recurrent stress injuries or fractures
  • Cardiac – concerning heart murmur, symptoms or family history

The fifth edition of the American Academy of Pediatrics’ text on Preparticipation Physical Evaluation is available now on the AAP website. The fifth edition includes new chapters on transgender athletes, female athletes, mental health and incorporating PPE into routine health supervision care.

Preventing Injuries: What Young Dancers Need To Know

Preventing Injuries: What Young Dancers Need To Know

by | Apr 26, 2019 | Sports Medicine

We asked sports medicine physical therapist Laura Saleem to tell us about hip injuries in dancers and how they can be prevented.

Why do dancers commonly have hip pain?
Dancers put their hips in extreme postures repeatedly and this can cause changes in the soft tissues and/or the bony structures in the hip joint. As a growing child, the body will go through changes EVERYWHERE. Bones and muscles are just trying to keep up. If there is an imbalance of bone, muscles and ligaments, pain can be quite common and cause greater issues if left untreated.

What advice do you give young dancers to prevent hip pain?
Core training is critical for dancers and many other athletes. A strong and well-positioned foundation allows the dancer to move with control and minimize injuries. Also, symmetrical flexibility and body awareness is important as most front split aspects are with the right leg forward. Be sure to work on the left as well! Finally, taking strategic rest breaks each week and throughout the year can reduce the risk of injury from overuse.

What can dancers do to improve body awareness?
Learning how to breathe is the first step to body awareness. Next, foundational activation to trigger core strength, improve posture and reduce improper loading through the spine.

When dancers begin to have hip pain, what is your recommendation?
When any athlete begins to have pain, it is important to recognize which moves are painful and the body’s response to the pain (swelling or continued pain after activity greater than one day). Never ignore the pain. Pain during and after activity should be evaluated, often rest is the first line of defense. Though an athlete never wants to stop their sport or activity, a short break at the first sign of pain can prevent significant complications. If the athlete has rested and returned to activity and the painful response continues, it would be best to see a medical provider and physical therapist for appropriate evaluation and treatment.

Learn more about sports physical therapy and find resources for dancers.

Stress Management For Young Athletes

Stress Management For Young Athletes

by | Apr 24, 2019 | Sports Medicine

Exercise, team play and goal-setting are all benefits of participating in youth sports. However, young athletes face a variety of stressors that other students do not face.

Some of these are:

  • Anxiety about athletic performance can become a distraction in daily life
  • Fatigue from early, late and long training hours can affect school performance
  • External pressure to perform well makes it difficult to focus

Pediatric psychologist Emily B. Gale, Ph.D., ABPP says, “In general, adolescents perform well if they have coping and stress management skills in place before an injury or undesired performance occurs. Parents, coaches and teachers should support the use of healthy coping and stress management skills in low stress situations so when a high stress situation occurs, the teen is prepared.”

Here are some tips to help an athlete stay on top of his or her mental game:

  • Adopt some pre-game centering techniques to clear your mind of distracting or negative thoughts (i.e. deep breathing, performance visualization).
  • Use positive self-talk and realistic evaluation when things don’t go the way you hoped (i.e. highlighting what went well and what could be improved).
  • Reflect on losses or negative performance with a focus on opportunities for improvement
  • Encourage teammates with positive talk

A woman wearing glasses and a blue shirt smiles for the camera

Learn more about pediatric sports medicine and injury prevention. 
Keeping Your Young Athlete Safe

Keeping Your Young Athlete Safe

by | Apr 4, 2019 | Sports Medicine

“Infectious diseases are not uncommon in athletes who participate in team sports, whether it be through school or club sport,” says Jane S. Chung, M.D., Scottish Rite for Children sports medicine physician. “Adolescents in particular are not the best when it comes down to personal hygiene. They like to share, and while ‘bonding’ with teammates is important, they need to be aware that infections can be spread.”

Children and adolescents are most familiar with sharing upper respiratory infections through coughing and sneezing. In youth sports and other settings, infections are also spread through sharing gym towels, water bottles, helmets, mouthpieces, and other equipment. Kids need to know that good personal hygiene goes beyond covering a cough. Parents and coaches should help them prepare for sports by providing individual water bottles or cups and other personal gear such as helmets, mouthpieces, and towels. Coaches and sports organizations must also maintain and clean gym equipment, like mats and weight machines, between workouts. Many teams have access to showers, and athletes should be encouraged to shower before going to the next activity or class.

Tips to teach your young athlete to help minimize the spread of infections:

  • Shower or at least wash your hands after practice and competition, especially before eating.
  • Don’t share water bottles or cups.
  • Be careful not to touch blood or body fluids when an athlete is injured or ill.
  • Tell your parents about symptoms you have or others have reported.
  • Don’t go to practice or a game when you have signs or symptoms of an infection.
  • Tell the coach if you have an open wound, infection, or illness that your doctor says may be contagious.

Shane M. Miller, M.D., Scottish Rite for Children sports medicine physician, works closely with several schools and takes infection control seriously. He says, “We work with our partners to ensure we are meeting the recommended guidelines. All schools and teams should take time to evaluate their current practices and identify areas for improvement to reduce the risk of spreading infections.”

Review the table of 25 organisms identified as a concern for young athletes in this American Academy of Pediatrics Clinical Report: Infectious Diseases Associated With Organized Sports and Outbreak Control.

Learn more about injury prevention and pediatric sports medicine.