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Understanding Hip Impingement in Teens: How it Happens and How to Prevent It

Understanding Hip Impingement in Teens: How it Happens and How to Prevent It

by | Jun 17, 2024 | Sports Medicine

Also commonly referred to as hip impingement, femoroacetabular impingement is a painful condition that occurs in the hips of adolescents and young adults. Two bones fit together to make up this “ball and socket” joint including the head of the femur (ball), which is part of the thigh bone, and the acetabulum (socket), which is part of the pelvis.

Impingement, or pinching, causes pain when the bones in the hip joint pinch the labrum, the soft tissue on the perimeter/edges of the acetabulum.
There are three types of FAI:

  • Cam impingement occurs when the shape of the femoral head or ball is abnormal.
  • Pincer impingement occurs when the shape of the acetabulum or socket is abnormal.
  • Combined impingement occurs when both the ball and the socket are abnormal.

Pediatric orthopedic surgeon Henry B. Ellis, M.D., says, “Repetitive activities make changes in the joints. In the hip, either the soft tissues become damaged, the bone actually changes its shape or both of these occur.” The reason for abnormal bone shape is not known. It may occur during development or may be in response to activity.

Symptoms of hip impingement are more likely to occur in those who perform:

  • Repetitive maximal flexion (bending) of the hip, such as deep squatting or high kicking.
  • Repetitive movements in activities, such as running, dance, gymnastics and hockey.

What are the symptoms of femoroacetabular impingement?

  • Pain in the hip or groin, typically in the front.
  • Tenderness and/or swelling of the hip or groin area.
  • Stiffness or pain after sitting for long periods of time.
  • Aching or pain that worsens with certain activities.

How is it diagnosed?
A thorough history and physical examination are used to diagnose a hip impingement. In most cases, X-rays are used to further assess the shape and fit of the bones. If symptoms do not improve or worsen, additional imaging such as an MRI or MR arthrogram may be recommended to further evaluate the soft tissue, the acetabular labrum. An MR arthrogram uses MRI, fluoroscopy and sometimes an injected medication to show the structures inside the joint.
 
How is it treated?
Treatment depends upon the severity of the condition and typically begins with a nonoperative approach which typically includes resting from activities that cause pain or changing to activities that do not. Other treatment options include physical therapy, joint injections or arthroscopic surgery may be required.
 
In a recently published article “Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient”*, Ellis and others reported findings after reviewing 126 hips (114 patients) under the age of 18 who were being treated for symptomatic FAI. This work helps Ellis and his colleagues around the country provide better counseling to patients considering surgery for FAI.
 
Early recognition and treatment are important because hip impingement has been shown to be a risk factor for early development of osteoarthritis of the hip.
 
How can hip impingement be prevented?
Overuse injuries like hip impingement and FAI occur with a high volume of training, repetition of certain movements and early specialization in a sport.
 
“Hip impingement in a growing child is bad news. We need to help them monitor and modify their volume of repetitive activities to prevent the condition from worsening, or even better, developing.”

  • Henry B. Ellis

These suggestions can help to prevent FAI and other similar overuse conditions:

  • Avoid sports specialization and play multiple sports throughout high school.
  • Emphasize moderation with load and training.
  • Encourage free play and lifetime sports like cycling and hiking.
  • Avoid year-round participation and encourage weekly and seasonal rest from activities requiring repetitive maximal flexion of the hip.
  • Perform proper warm-up and conditioning for all activities.                                                           

Learn more from Ellis about Hip Injuries in Young Athletes.
 
*Yen, Y. M., Kim, Y. J., Ellis, H. B., Sink, E. L., Millis, M. B., Zaltz, I., Sankar, W. N., Clohisy, J. C., Nepple, J. J., & ANCHOR Group (2024). Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient. Journal of pediatric orthopedics, 44(3), 141–146.

Nutrition for Injury Recovery in Young Athletes

Nutrition for Injury Recovery in Young Athletes

by | Mar 19, 2024 | Sports Medicine

Nearly 60 million American children play sports, and many of them experience sports injuries. If your child gets injured, the path to healing starts in the kitchen. Proper nutrition for injury recovery may help your child spend less time on the sidelines. The key is knowing which foods to choose. 

Foods to Avoid After an Injury  

Sports injuries force athletic kids to do one of their least favorite activities: sit around. As they watch their teammates run back and forth, children may forget about habits that keep them on their game. Instead of healthy eating, they may want to fill up on unhealthy snacks and sweets. 

Don’t let your children fall into this trap. Encourage them to eat the same foods they rely on when playing sports to ensure the best nutrition for injury recovery. 

After a sports injury, your child should avoid the following: 

  • Inflammatory foods. White bread and pastries are refined carbohydrates, which have much of their nutritional value stripped away. They are also associated with inflammation, which slows the healing process. Similarly, saturated fats found in butter, full-fat dairy, fried foods, and red and processed meats can raise inflammation but don’t offer additional nutrition value.  

  • Sports drinks. Full of electrolytes, sports drinks help your child rehydrate when they sweat excessively during activity. While your child is resting and recovering from injury, however, sports drinks are just another sugary drink. Like refined carbs and fried foods, sugar is associated with inflammation. 

Proper Nutrition for Injury Recovery 

To help your injured athlete maintain muscle mass, feed them healthy, nutrient-dense foods, including: 

  • Complex carbohydrates. Along with providing energy for your body to heal, complex carbs are full of vitamins and minerals. Good sources of complex carbs include lentils, brown rice, quinoa, and whole wheat breads and pastas. Rotate these different options into evening dinners to add variation to your family meals.  

  • Fruits and vegetables. The vitamins and minerals found in fresh produce have many benefits. They heal wounds, aid in tissue growth and repair, and more. Fill your child’s plate with a variety of fruits and vegetables. Find various ways to prepare and present produce to keep things interesting. Dust vegetables with exotic spices like turmeric or crumble berries over Greek yogurt for a creamy afternoon treat.  

  • Healthy fats. Eating healthy fats gives your child an energy boost. Additionally, healthy fats can have anti-inflammatory properties. Add healthy fats to your child’s diet by offering flax or chia seeds, avocado, or fish. Make these options intriguing by mixing avocado into a spicy guacamole or blending chia seeds into a fruit smoothie. When cooking other foods, use olive or sunflower oil for even more healthy fat.  

  • Lean sources of protein. Protein intake protects against muscle loss. Foods rich in protein include lean meats, fish, low-fat dairy products, and nuts and seeds. Think turkey sandwiches, peanut butter toast and grilled chicken over colorful vegetables. The amount of protein your child needs varies, so talk with their provider to determine the right amounts during injury recovery.  

  • Water. Complete nutrition for injury recovery requires hydration to help joints heal. Encourage your child to drink lots of water. To add bright flavor to your child’s beverage, consider spritzing it with slices of lemon or other types of citrus fruit.  

Let your child help you as you prepare their meals and snacks. You may even consider using your child’s time off from athletics to plant a garden filled with fruits and vegetables they can enjoy throughout the year. Building healthy dishes together helps your athlete stay connected to their wellness as they recover. It is also a great opportunity to set and achieve goals as a family.    

A Word on Concussion Nutrition 

When young athletes experience a sport-related concussion, they also seem to benefit from proper nutrition for injury recovery. Research has shown that certain nutrients may benefit children after a concussion. They include:  

  • Protein 

  • Magnesium 

  • Omega-3 fatty acids 

  • Vitamin D 

Additional research is needed on the effects of nutrition on concussion recovery. These nutrients can be found in many healthy foods but talk with your child’s provider before giving your child any supplements after a concussion.  

Is your young athlete sidelined with a sports-related injury? Our expert team at Scottish Rite for Children is ready to get them back in the game. Call 469-515-7100 to learn about our sports rehabilitation services. 

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

by | Jan 9, 2024 | Sports Medicine

Anterior cruciate ligament injuries (ACL) continue to be a problem in youth sports such as basketball and soccer. Many athletes and families are very aware of the lengthy physical aspect of returning to sport after an ACL injury and surgery. Some are surprised by the mental challenges and demands that come along with an injury. Patients, like Johanna, are supported by our multi-disciplinary team from the moment they walk into our sports medicine clinic.

Watch Johanna tell her story.

Physical therapist Rushi Patel says, “a lot of times people talk about the physical aspect of an ACL initial injury but you could argue the mental aspect is just as hard.”

Upon arrival, our team begins assessing a new patient from the “inside out.” We ask questions about how the athlete was injured, what level of competition they want to return to and what challenges they are facing physically and mentally in addition to the injury. These help us decide who needs to be involved in the athlete’s care from day one. Here are three tools we implement in our care of young athletes:

  • Certified child life specialists assist children and teens in understanding diagnoses and medical procedures, this helps to keep anticipation and fear under control.
  • Psychologists are available to consult when our clinic team or responses to screening questionnaires suggest an athlete may need more individualized guidance on pain management, coping with the injury and fears related to returning to sports.
  • Many of our patients receive stress management and pain management skill instructions to help them navigate day to day moments and the progression of rehabilitation. Download PDF.

Every team member, from nurse to physical therapist is focused on caring for kids and teens all day, every day. We use age- and developmentally appropriate strategies when we talk to kids, formulate treatment plans and create our educational materials.

Johanna says, “Scottish Rite has been like no other care I’ve gotten at a medical facility I truly feel loved and cared for and not just seen as a number or a patient with an issue to get resolved but they truly care about who I am what my goals are and ultimately what I want to accomplish in life.”

Check out how you can help us learn to prevent ACL injuries.

What to Expect If Your Child Has a Stress Fracture

What to Expect If Your Child Has a Stress Fracture

by | Jan 8, 2024 | Sports Medicine

If you have a young athlete in the family, you probably know that bumps and bruises are part of the game. A more severe injury, like a stress fracture, however, can be worrisome for any parent. Being informed about the nature of stress fractures and how to help your child heal can ease your mind.

What Causes Stress Fractures in Kids?

A stress fracture, sometimes called a hairline fracture, is a tiny crack in a bone caused by physical stress. This type of injury often occurs when a specific muscle or joint is overused or strained, known as an overuse injury.

Stress fractures commonly occur when a child performs the same movements over and over again, for example, running, jumping or throwing a ball.

Telltale Signs of a Stress Fracture 

Stress fractures develop over time, and one of the first signs you may notice is your child frequently complaining of pain after playing or practicing their sport. 

Your child may experience other symptoms, including:

●      Pain during exercise that doesn’t always go away with rest

●      Redness

●      Swelling

●      Tenderness

Swelling or bruising may develop around the bone in the early stages of the injury when it’s considered a “bone stress reaction.” As the injury worsens, it develops into a stress fracture, causing a crack or tiny break in the bone.

Stress Fractures Commonly Seen in Kids

Stress fractures are most common in the weight-bearing bones in the legs and feet, including the tibia bone (shinbone). However, young athletes can experience stress fractures in many other parts of the body. 

Gymnasts, for example, can develop stress fractures in the wrist, while softball and baseball pitchers may experience stress fractures in the arms or shoulders. Stress fractures affecting the lower extremities are common in nearly all sports since most activities place stress on the legs and feet. Rarely, stress fractures can develop in the spine or ribs.

How Are Stress Fractures in Kids Diagnosed and Treated?

If your child has symptoms of a stress fracture, check in with a medical provider. A sports medicine specialist can help determine the cause of your child’s discomfort and provide a treatment plan.

To diagnose an injury, the provider will first gather your child’s medical history and then conduct a physical examination, focusing on the area of discomfort. If the provider suspects a stress fracture, he or she may order imaging tests, such as an X-ray, CT scan or MRI, to confirm a diagnosis.

The primary treatment for a stress fracture is rest. Because the injury is most often the result of overuse of a bone and the surrounding muscles, taking the stress and strain off that part of the body is essential. Your child should take a break from activity, and if the injury is in the lower body, your child may also need to wear a boot or use crutches to take weight off the injured bone.

In rare cases, bones that don’t heal after a long period may require surgery to heal correctly.

Prevention 101

To reduce the risk of a stress fracture, have your child avoid repetitive movements as much as possible. Also, encourage cross-training. Having your young athlete do activities that require different muscles and movements not only limits stress on a single joint, but it can also strengthen other muscles and improve their performance in their primary sport.

You can also help your child prevent stress fractures by having them prioritize rest between games and practices, using proper sport-specific equipment and eating a balanced diet rich in vitamin D and calcium. Finally, teach your child never to play through pain.

Think your child may have a stress fracture? Call 469-515-7100 to schedule an appointment with one of Scottish Rite for Children’s sports medicine specialists.

Sports Medicine Year in Review

Sports Medicine Year in Review

by | Jan 8, 2024 | Sports Medicine

Scottish Rite for Children Orthopedic and Sports Medicine Center has had an exciting year! We celebrated our fifth birthday in the beautiful facility where we serve children with a variety of pediatric orthopedic needs requiring all levels of care from observation to complex reconstructive surgery. Our mission is often described having three elements, clinical care, teaching and research. Together, they provide a rich experience for patients and trainees and help to define pediatric orthopedics across the world.

Here are a few updates from the Sports Medicine team.

CLINICAL CARE
In the sports medicine clinic, we see more than 16,000 visits each year, and that number continues to grow. Recognized again for excellence in patient experience, our team focuses on educating the patients and families and providing outstanding care so that patients have the outcome they desire. Our work to integrate screening for psychological and nutritional needs help our patients succeed in their rehabilitation and return to sport efforts.

TEACHING
Pediatric sports medicine is a relatively new subspecialty in pediatric orthopedics. In fact, only a handful of organizations have an ACGME-accredited* fellowship program focused on this area. We are very excited to share that we are currently in the process of selecting our first fellow to join our team in 2024. This year-long training program offers a sports medicine surgeon the opportunity to train alongside our experts in the clinic, on the sidelines and in the operating room. In the past year, we had 13 orthopedic residents rotate through our clinic to learn about care and research in pediatric sports medicine.

RESEARCH
This year, our team published more than 20 articles in prestigious medical journals. Many authored by our medical staff and trainees and others were collaboration with peers in the Pediatric Research in Sports Medicine (PRiSM) Society. Here are findings that are being presented at national and international conferences and have the potential to change sports medicine in the areas of diagnostics, clinical care, return-to-sport decision making and injury prevention.

The Sports Medicine team is presenting results from more than 25 projects at a national meeting for the PRiSM Society in January. This work is made possible by our patients, national grants, generous donors and many student trainees learning about pediatric orthopedics and sports medicine.
Learn how healthy athletes can volunteer for a study or you can donate.
 
* The Accreditation Council for Graduate Medical Education (ACGME) is the accrediting body for graduate medical education. They hold programs to standards that prepare physicians in nearly 200 specialties.

What’s in an ACL Injury Prevention Program?

What’s in an ACL Injury Prevention Program?

by | Jan 2, 2024 | Sports Medicine

In a study conducted by members of Scottish Rite’s sports medicine research team, we have found that one in five parents are not aware of injury prevention programs that can reduce the risk of anterior cruciate ligament (ACL) injuries. This is alarming because studies show that these injuries can take an athlete out of sports for at least nine to 12 months and increase the risk of a second injury and knee problems as an adult. Many say they would participate in these programs if they knew how. Here are three elements of day-to-day training that align with sport-related injury prevention and can be implemented individually or as a team.

    1. Wake Up Your Brain and Muscle Connection

    This step is called muscle activation and is focused on waking up small but very important muscles that maintain core stability during activity. From planks to squats, controlled movements that engage specific abdominal, spinal, shoulder and hip muscles are a key to a safe start for practice or competition. This step is rooted in principles of neuromuscular coordination, and with repetition, it is believed to improve stability and reduce injury risk during activities.

    1. Warm Up Your Muscles

    Now that your brain and muscles are talking, you need to get the blood flowing into those muscles and move them through their full range of motion. Athletes are familiar with dynamic warm-up exercises like soldier walks and knee hugs, and learning ways to maximize these exercises can help improve the effectiveness and reduce the time needed for the warm-up. Make sure you’re warm before you take off at full speed or make large movements with force like jumping, throwing a long distance or kicking a ball.

    Physical therapist Jessica Penshorn has put together a great easy to follow program for basketball players that combines mobility, activation and dynamic warm-up. Watch the short video, or read a summary of the program and download a handout here.

    1. Wind-down

    After the training or competition session is over, abruptly stopping can leave muscles confused and angry. Post-activity recovery strategies like foam rolling, contrast baths and gentle stretching can reduce the onset of muscle soreness and setting the body up for a quick turnaround to activity the next day.
    Email bridgeprogram@tsrh.org to sign up for our Athlete Development program for group training sessions that use all of these strategies to build solid foundations and strength, power and speed for high performance.

    1. Warm Up Your Muscles

    Now that your brain and muscles are talking, you need to get the blood flowing into those muscles and move them through their full range of motion. Athletes are familiar with dynamic warm-up exercises like soldier walks and knee hugs, and learning ways to maximize these exercises can help improve the effectiveness and reduce the time needed for the warm-up. Make sure you’re warm before you take off at full speed or make large movements with force like jumping, throwing a long distance or kicking a ball.

    If you want to learn more about injury prevention programs for your young athlete, check out these resources:

    *Sparagana, P., Selee, B., Ellis, H., Ellington, M., Beck, J., Carsen, S., Crepeau, A., Cruz, A., Heyworth, B., Mayer, S., Niu, E., Patel, N., Pennock, A., VandenBerg, C., Vanderhave, K., Williams, B., & Stinson, Z. (2023). Parental Awareness and Attitudes Towards ACL Injury Prevention Programs in Youth Athletes: Original Research. Journal of the Pediatric Orthopaedic Society of North America, 5(4).