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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).

    Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

    Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

    by | Dec 11, 2023 | Sports Medicine

    Following surgery, the body experiences increased energy demands due to inflammation and tissue healing. Some patients may eat less due to reduced activity, an increased need for sleep and the use of medications. Not eating enough, when nutrition needs are highest, can prolong recovery time and cause muscle loss.

    For young athletes planning to return to sports, the demands can go beyond the early phase of surgery recovery. After knee surgeries to reconstruct ligaments, such as the anterior cruciate ligament (ACL) or after extensive activity restrictions for healing of osteochondritis dissecans (OCD), these nutrition tips should be used throughout physical therapy and return to sports training. These phases can last months and have high energy demands.

    Certified sports dietitian Taylor Morrison, M.S., R.D.N., CSSD, L.D., says, “Athletes have unique needs when there are healthy, but these needs change and continue to be unique as they are recovering from significant surgeries.” Morrison cares for young athletes in Scottish Rite’s sports medicine clinic and teaches principles of healing and muscle recovery that can help an athlete well beyond their care.

    Morrison offers these nutrition guidelines to help preserve and promote muscle health and support recovery in all phases:

    Eat regular meals and snacks to maintain energy levels and promote wound healing immediately after surgery. Eat a meal or a snack every three to four hours and around physical therapy sessions.

    Include quality protein to help with tissue repair and wound healing. Include foods rich in leucine, an amino acid that helps build and repair muscle, such as chicken, milk, yogurt, eggs and cheese, at each meal and some snacks and especially after physical therapy sessions.

    Include quality carbohydrates to provide energy. Carbs keeps protein available for healing and fiber, which can help with normal digestive function. Carbohydrates with fiber include whole grains, fruits and starchy vegetables. Other carbohydrates include milk and yogurt.

    Include healthy fats that are high in omega 3s to fight long-term inflammation. Healthy fats with Omega 3s include salmon and tuna. Other healthy fats include avocado, nuts, seeds, peanut butter, almond butter and vegetable oil.

    Include a bedtime snack that contains casein to support muscle protein synthesis throughout the night. Casein is a slow-to-digest protein found in milk, yogurt and cottage cheese.
    When you head to the store to stock up on recovery-friendly foods to have on hand, take this list with you for ideas.

    • Eggs
    • Greek yogurt
    • Protein bars
    • Peanut Butter, Almond Butter, SunButter®
    • Starkist® Tuna packs + crackers
    • String Cheese
    • Balanced nutritional supplements such as Boost®, Pediasure®, Carnation Breakfast Essentials®, Kate Farms® or Orgain®

    Nutrition after surgery is important for all patients to preserve muscle and provide the increased energy and nutrients the body needs to heal. Some patients will need a specific nutrition plan due to additional medical conditions. If you would like help with an after-surgery nutrition plan, ask your care team about a certified sports dietitian consult.

    To learn more from Morrison, visit the sports nutrition page on our website.

    Shouldering an Injury: What AC Joint Separation Recovery Looks Like

    Shouldering an Injury: What AC Joint Separation Recovery Looks Like

    by | Dec 6, 2023 | Sports Medicine

    Young athletes can experience many shoulder injuries while playing sports, one of which being AC joint separation. Sometimes called shoulder separation, this injury affects the acromioclavicular joint, which rests where a part of the shoulder blade called the acromion connects to the clavicle, or collarbone.

    If your child recently sustained an AC joint separation, you both are likely wondering how long it will take to recover and get back in the game. Athletes can usually return to sports and physical activities after 12 weeks. However, each child’s experience with AC joint separation is different. Your child’s recovery will depend on several factors, including how severe the injury is and the treatment your child receives. 

    Understanding AC Joint Separation 

    To understand the recovery process, it helps to understand what an AC joint separation is and how it impacts your child’s activities. 

    AC joint separation typically occurs when your child experiences a strong blow to the shoulder during a game or falls on his or her arm. The impact can strain or tear the ligaments attached to the underside of the clavicle — the AC and coracoclavicular (CC) ligaments — separating the collarbone and shoulder blade (scapula). Your child may have intense pain, swelling, bruising and limited range of motion in the shoulder and arm. Your child may also develop a bump above his or her shoulder.

    Sports medicine specialists categorize AC joint injuries into several types, including: 

    ·       Type I injuries: These injuries are generally mild. The AC ligament is sprained, and the CC ligament is still intact.

    ·       Type II injuries: These occur with a complete tear to the AC ligament, a sprain in the CC ligament and slight separation between the clavicle and acromion.

    ·       Type III injuries: Both the AC and CC ligaments are torn, and the separation between the clavicle and acromion is more pronounced.

    ·       Type IV, V and VI injuries: These involve tears in the AC and CC ligaments, and the clavicle is pushed further into the shoulder and neck.

    Recovering From AC Joint Separation With R&R

    An AC joint separation can often heal naturally using nonsurgical treatments, such as rest and temporary activity restrictions. Your child’s sports medicine specialist may recommend:

    ·       Cold packs to reduce pain and swelling 

    ·       Immobilizing your child’s arm with a sling for resting the shoulder as it heals 

    ·       Medication for pain relief 

    Kids can often heal without surgery, even with severe AC joint injuries. Your child’s provider may start with conservative remedies before moving to surgery. 

    Surgery for AC Joint Separation 

    Surgery is generally used only with more severe AC joint injuries, and it may help if your athlete continues to experience pain despite nonsurgical treatment. Surgery can also help address bumps (deformities) that form after AC separation. 

    Surgical procedures involve removing a small portion of the collarbone to prevent it from rubbing against the acromion. Minimally invasive or open reconstructive surgery on the AC and CC ligaments may allow your child’s surgeon to reattach them to the collarbone. These procedures may involve plates or other materials to hold the ligaments in place. 

    Children who have nonsurgical treatments typically regain shoulder function within six weeks, while those who have surgery will have a longer recovery. Your child may need rehabilitation before returning to sports. Surgical recovery can take about six months.

    Many children recover well from AC joint separation, and very few have complications.  

    AC Joint Separation or Clavicle Fracture?

    Although older children and teenagers can experience AC joint separation, a more common shoulder injury in children is clavicle fracture.

    Like AC joint separation, a clavicle fracture can occur after a hard fall or an impact from an accident. The two injuries cause similar symptoms, as well, including:

    ·       A bump near the break

    ·       A drooping shoulder

    ·       Pain, swelling or bruising around the collarbone

    ·       Pain that occurs when your child tries to move the shoulder or arm and that causes them to not use the arm as much as they normally might

    Your child’s provider may recommend imaging to determine whether your child broke a bone or experienced an AC joint separation. Fortunately, clavicle fractures, like AC joint separation, can often be treated without surgery.

    Whether your child has AC joint separation or a clavicle fracture, it’s essential to follow the provider’s recovery instructions and ensure your child fully recovers before getting back to the field or playground. 

    At Scottish Rite for Children Orthopedic and Sports Medicine Center, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work collaboratively to develop personalized treatment plans for each young athlete. Call 469-515-7100 to learn about our sports medicine program. 

    Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

    Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

    by | Nov 15, 2023 | Sports Medicine

    Published in Rite Up, 2023 – Issue 3. 

    by Kristi Shewmaker
     
    It was a nail-biting week for Scarlette, of Coppell, during the fall semester of her high school senior year. She was waiting for a phone call from the head coach of the gymnastics team at Rutgers®. She hoped the coach would invite her to join the team. Years before, she had set her sights on going to Rutgers and competing there as a gymnast.
     
    In competitive gymnastics, recruitment for joining a college team begins around an athlete’s sophomore year of high school. During that time, Scarlette visited the campus, attended gymnastics camps and participated in an official visit to get to know the coaches and student gymnasts. All that was left for her to do was wait for “the call” to let her know if her college dreams were coming true.
     
    Born and raised in Oahu, Hawaii, Scarlette started gymnastics when she was 4. “She had tons of energy in preschool,” says Bryan, her father. “She was always hanging from the monkey bars and bouncing around.” Her parents enrolled her in a recreational gymnastics class to burn off energy. “We knew nothing about the sport, apart from what we saw in the Olympics,” Bryan says. But, the coaches picked up on Scarlette’s innate ability, and she excelled quickly. At her first gym, they suggested that she try out for a team. “That was the start of my gymnastics career,” Scarlette says. “I was 6 or 7 years old in my first competition.” And in that early competition, she won. Throughout the years, Scarlette kept winning.

    By the age of 14, she rapidly advanced to level 10, the highest level in the USA Gymnastics Development Program. During her first year as a level 10, she made it to the national competition in Indiana, an incredible feat for her age. To ensure that Scarlette and her younger sister, who is also a gymnast, could get exposure and compete in bigger, more prestigious tournaments on the mainland, the family packed up and moved to Texas, specifically for the program at Texas Dreams Gymnastics in Coppell.
     
    During her sophomore year, Scarlette tripped as she was running into a tumbling pass and rolled her ankle, landing on her arm. “In Hawaii, we have several hospitals but only one main hospital for children,” Bryan says. “In Texas, we didn’t know where to go, but her coaches and other gymnasts’ parents said, ‘You have to go to Scottish Rite for Children.’” At Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Scarlette learned that she had not only sprained her ankle but also would need care for a more complex injury to her ulnar collateral ligament (UCL) in her left elbow. Assistant Chief of Staff and Director of the Center for Excellence in Sports Medicine Philip L. Wilson, M.D., evaluated Scarlette and consulted with her and her family regarding her individualized treatment options.
     

    The UCL is a band of tissue that runs along the inside of the elbow and works to stabilize the elbow joint during overhead movements. Baseball players, gymnasts and, occasionally, quarterbacks sustain this injury. “It has to do with the way you use your elbow, either for weightbearing or throwing,” Dr. Wilson says. Baseball players sustain the injury from repetitive throwing, bringing the elbow back at a certain angle repeatedly, causing stress on the ligament. “For gymnasts, it’s a weightbearing issue,” Dr. Wilson says. “We all have a little bit of an angle in our elbow called valgus. Gymnasts develop more of that angle as they grow due to repetitive weightbearing from a young age.” The force of a gymnast landing on her hands over and over causes repetitive stress on the ligament.

    For most people, the treatment plan for a UCL injury is nonoperative with a recommendation of rest and physical therapy (PT). For athletes like baseball players or gymnasts, the plan could include surgery, depending on their injuries and their goals. “When we consulted with Dr. Wilson, part of Scarlette’s treatment plan depended on whether she wanted to stay at the competitive level or just do gymnastics for fun,” Bryan says. The direction she chose would determine the aggressiveness of the treatment.
     
    “It is always challenging for the family to make a decision about what to do,” Dr. Wilson says. Ligament reconstruction surgery requires a long commitment to rehabilitation, and often takes a year for the athlete to get back to the competitive level. “An important part of our job is to partner with the family, provide quality counseling time and ensure that they have all of the information they need to make the best decision,” he says.
     
    In their initial consultation, Bryan said that it was the first time he heard Scarlette say that she wanted to do gymnastics just to enjoy it. “A few months before my UCL injury, I had been struggling a lot in the gym,” Scarlette says, “and when I got hurt, I was like, ‘Is this a sign? Is this telling me to just be done?’” Bryan explained that Scarlette had hit a plateau in her skillset, which is common for competitive gymnasts, and in her mind, the injury was a setback.
     
    Scarlette decided to take the nonoperative route, and Dr. Wilson recommended PT twice a week at Scottish Rite. After seven months, Scarlette was back in the gym when she injured her elbow again. “I was doing a release on the uneven bars, but I missed the bar and landed on my hands and knees,” she says. “The pain shot up my whole arm.”

    After the reinjury, Scarlette decided to pursue surgery. “I was getting my skills back, and I think I just needed to take a step back and rest my body,” she says. “I was able to think.” The light at the end of the tunnel, Bryan said, was that she would get a new ligament in her elbow, and she would be much stronger.
     
    Scarlette underwent surgery the summer before her junior year. Wearing a brace, she started range of motion exercises and began PT within the first week. Over many months, her therapy goals included regaining mobility of her joint and then progressing toward strengthening, endurance and power production. At six months, she went back to the gym while continuing PT, and at eight months, she resumed training but not at full skill level. Finally, the summer before her senior year, she was given the all clear to train without restriction and to fully return to gymnastics that fall.

     

    “I learned a lot about myself during my recovery,” Scarlette says. “I had to build my way back up. The basics I received to get my skills back really helped my confidence and my performance. I trusted my care team, their process and everything they did.”

     

    “I have massive respect for the program at Scottish Rite,” Bryan says. “Dr. Wilson gave Scarlette the option to do what she wanted to do. He didn’t go right to surgery. The professionalism of him to offer PT first, that he even took that into consideration, is a big deal. For any parent considering a facility for their child’s orthopedic needs, it’s a no-brainer. There’s no reason to go anywhere else.”
     
    In the 2023 gymnastics season, Scarlette finally got to compete in all four events — vault, uneven bars, balance beam and floor exercise. “After all that she had been through, it was enlightening to see her compete,” Bryan says. “Her demeanor changed. She was driven and confident, not too deep in thought. She just went out there and did her thing, and let it be in the judges’ hands.”
     
    After more than a year and a half of injuries, surgery and recovery, Scarlette said that waiting to hear from Rutgers felt like forever. But, the phone finally rang. She was officially offered a position on the team. And, her answer was, of course, yes!

    “I’m excited for a whole new chapter,” Scarlette says. “I get to experience college life as a student athlete and compete on a much bigger stage. I can’t wait to experience that whole new world!”

    Read the full issue.

    What Is Turf Toe? 7 FAQs About This Common Sports Injury

    What Is Turf Toe? 7 FAQs About This Common Sports Injury

    by | Nov 6, 2023 | Sports Medicine

    A serious condition with a funny-sounding name, turf toe can sideline aspiring and professional athletes alike. It’s a condition that targets one of an athlete’s most important tools — their feet. Learn how you can identify turf toe in your child and the steps you can take to keep it from ruining their season.

    What Is Turf Toe?

    In very basic terms, a turf toe injury is a sprain that impacts the big toe’s main joint — the metatarsophalangeal joint. It occurs when the joint gets bent beyond its normal range of motion, leading to stretches or tears in the ligaments, tendons and tissues that hold the joint in place.

    What Causes Turf Toe?

    Turf toe got its name because it was first seen in football players who play on artificial turf. The firm and less forgiving surface can contribute to strains on the big toe during play.

    Nowadays, doctors see this injury in athletes who play any sport that involves running, jumping and other activities that place a lot of strain on the foot and big toe. Those sports include basketball, dance, gymnastics, soccer and wrestling.

    In those sports, as with football, footwear can play a role in causing turf toe. Wearing shoes with flexible soles that do not adequately support the big toe joint can increase the risk, whereas stiff-soled shoes offer better protection.

    What Are Common Symptoms of Turf Toe?

    Common symptoms include:

    • A feeling of instability or weakness in the big toe
    • Bruising
    • Difficulty walking or bearing weight on the affected foot
    • Limited range of motion in the big toe
    • Pain, tenderness, and swelling at the base of the big toe

    If your child experiences discomfort or pain in the big toe joint after activity or playing sports, schedule an appointment with a sports medicine specialist. It can take time to recover from turf toe, so treating the condition at the first signs of pain can reduce your child’s time on the sidelines.

    Diagnosing turf toe begins with a physical exam. Your child’s doctor will measure the toe’s range of motion and look for signs of tenderness and instability. Your child may have an X-ray to rule out any fractures, but sometimes the doctor will order an MRI scan. This type of imaging provides detailed views of the foot’s soft tissues, helping to confirm the extent of the injury.

    How Long Does Turf Toe Take to Heal?

    The recovery time for turf toe can vary depending on the severity of the injury and how well it is managed. In general, mild cases of turf toe may heal in a few weeks, while more severe cases can take several months for full recovery. To help your child heal as quickly as possible, follow their treatment plan and doctor’s recommendations.

    Treating turf toe typically involves a combination of the following:

    • Rest, ice, compression and elevation, a.k.a. “RICE.” The RICE method starts with letting the joint rest and allowing it to heal. Your child should avoid activities that put strain on the big toe joint. Applying ice, compressing the affected area with a bandage, and elevating the foot can help reduce pain and swelling.
    • Anti-inflammatory medications. Over-the-counter anti-inflammatory medications can help manage pain and reduce inflammation, but ask your child’s doctor which medications to use. Aspirin and adult-strength medications may not be safe for your child.
    • Custom orthotics. Depending on your child’s injury and sport, their doctor may recommend custom orthotic inserts to support and protect the big toe.
    • Physical therapy. Physical therapy can restore strength and range of motion in the big toe. A physical therapist can provide exercises and techniques to promote healing and prevent future injuries.

    Is It Safe to Walk on Turf Toe?

    In mild cases of turf toe, it may be possible to walk with some discomfort, although rest is still recommended. Your child should listen to their body and avoid activities that worsen their pain or discomfort.

    What Happens to Untreated Turf Toe?

    If left untreated, turf toe can lead to complications and chronic issues, including:

    • Increased pain and discomfort
    • Limited range of motion in the big toe
    • Reduced athletic performance
    • Risk of future injuries or damage to the joint

    Can You Prevent Turf Toe From Coming Back?

    You can reduce your child’s risk of getting turf toe again by helping them take some simple preventive measures:

    • Wear proper footwear with stiff soles that adequately support the big toe joint.
    • Use orthotic inserts if your child’s doctor recommends them.
    • Practice exercises that strengthen the muscles around the big toe joint to provide additional support.
    • Learn proper running and movement techniques to limit strain on the big toe.

    Scottish Rite for Children has the experience necessary to help your child overcome (or prevent) turf toe. Call 469-515-7100 to schedule an appointment with one of our experts.