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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.

What Happens During Concussion Testing?

What Happens During Concussion Testing?

by | Nov 1, 2023 | Sports Medicine

What Happens During Concussion Testing?

As a parent, ensuring the safety and well-being of your young athlete is a top priority. While injuries are inevitable in sports, one concern that often arises is the risk of concussions. A concussion is a mild traumatic brain injury that causes a temporary loss of brain function. These injuries can negatively affect balance, coordination, reflexes and speech, among other skills. 

Concussion testing plays a crucial role in diagnosing and making treatment decisions about a child’s head injury and provides accurate information about your child’s neurological health.

Baseline Concussion Testing With ImPACT

One of the most effective concussion tests your child can have happens before the injury occurs.

A baseline test known as ImPACT measures your child’s memory, reaction times, reasoning skills and abilities in other areas to establish what’s normal for your child. If your child sustains a head injury, specialists can perform the test again. Physicians compare the results to determine if your child has a concussion and, if so, what treatments your child may need.

Your child will take the baseline test online, ideally before the sports season begins. It takes about 20 minutes and asks your child questions appropriate to their age and developmental level. 

The post-injury tests are similar, but if your child is younger than 11, you may need to answer questions about his or her symptoms. A specially trained provider will review the results and provide them to your child’s healthcare team.

Signs Your Child Needs a Concussion Evaluation

Concussions occur following a fall or a blow to the head. The force of the impact shakes the brain, damaging cells and triggering chemical changes. 

It can be difficult to detect a concussion without testing. Some athletes don’t experience symptoms for hours or even days after the event, and kids don’t always think their symptoms are serious enough to sit out the rest of a practice or game.

Contact a sports medicine specialist about an evaluation if your child displays any of the following signs of a concussion immediately or in the days after a head injury: 

·       Acting dazed or stunned 

·       Blurred or double vision 

·       Changes in mood (more anxious, irritable, upset or sad) 

·       Clumsy movements 

·       Confusion 

·       Difficulty concentrating 

·       Dizziness or loss of balance 

·       Fatigue and trouble sleeping 

·       Headaches 

·       Increased sensitivity to light and noise 

·       Slow, slurred speech 

·       Nausea and vomiting 

·       Numbness or weakness in the arms and legs 

Concussion Testing After an Injury 

If your child experienced a head injury, concussion testing helps determine if the event impacted brain function. However, the type of concussion test your child has will depend on the extent of the injury.

Sports medicine physicians use a variety of concussion assessment tools, often starting with a physical exam to review your child’s balance, coordination, hearing, reflexes and vision. 

During a post-injury concussion evaluation, the doctor will ask questions about the injury, including: 

·       What caused it

·       Any signs and symptoms your child has experienced or that you have noticed 

·       Whether or not your child lost consciousness and for how long

Your child’s physician may order imaging tests, such as CT scans and MRIs. These can’t tell you whether your child has had a concussion, but they can reveal bleeding or other injuries resulting from the collision. Bloodwork that checks for proteins associated with mild concussions may also help the physician identify other injuries. 

If your child had a baseline test, he or she will also have a post-injury cognitive test.

Your Child’s Return to School and Play

Depending on the results of the physical exam and post-injury cognitive test, your child’s doctor will begin treatment, which usually focuses on management of concussion symptoms with medication and rest until the concussion fully heals. Kids may need to stay home from school for a few days and gradually return with shorter days, reduced workloads and more break periods.

You’ll want to work with your child’s doctor, school nurse, athletic trainer and coaches to ease your child back on the field or court. Work with the school’s athletic department or local sports organization, as well, because they may have different protocols about when your child can return, even if the doctor clears him or her for participation. 

Accurate concussion evaluation is essential for proper healing and the prevention of further concussions and complications. In addition, following the doctor’s orders about when to return to sports and other activities is critical. If your child participates in sports before a concussion heals and has another injury, he or she may experience severe brain damage. 

Scottish Rite for Children Orthopedic and Sports Medicine Center offers high quality care for concussions and other sports injuries from a dedicated team of sports medicine specialists. Call 469-515-7100 to schedule a baseline testing appointment with one of our athletic trainers and learn more about our concussion program. 

Movement Science – Breaking Down Movements in Young Baseball Players

Movement Science – Breaking Down Movements in Young Baseball Players

by | Oct 27, 2023 | Sports Medicine

As part of SAFE (Sports-specific Assessment and Functional Evaluation), our team is developing sport-specific protocols for the use of motion capture technology in sports medicine that are being used across the country. There are only a handful of sports that have received attention in the motion capture world, and those are typically performance-based models. The models that our team are creating evaluate foundational movements to help us predict injuries and improve return to play protocols. To do this, we will need to record a great deal of data from a large number of athletes.

For the past two summers, our Movement Science Lab team in Frisco has collected data sets on our baseball program participants and some other volunteers. Though we are just getting started on the total number of athletes to test, we are making great progress on tweaking the protocol and looking at preliminary results to understand where to go next. Here are a few things that we are looking at in the study:

Trunk mobility – specifically in the thoracic spine. We’ve identified the best way to capture the mobility of the upper spine. We believe that tightness there may affect the stress on the shoulder during throwing.

 
Motion throughout the body while throwing. Because our movement science lab is spacious, with 14-camera motion capture system, we can monitor joint angles, speed and forces throughout the body during high velocity pitching. We believe some movements are directly related to the development of elbow and shoulder injuries, particularly when there is a high volume of throws without rest.

 
Single leg stability with motion. Most sports require movement of the legs, and most of the time, only one leg is in contact with the ground. We are measuring the differences from side to side and between athletes to identify asymmetry in static and dynamic single leg movements. We believe asymmetry is a factor for increased injury risk in all athletes.

 
Leader of the project and assistant director of the Movement Science Lab in Frisco, Sophia Ulman, Ph.D., says, “Early results from this study are helping us to establish an evidence-based return to play decision-making model.” Many have heard of functional testing or return to play testing for athletes returning to sport after a significant knee surgery, such as an ACL reconstruction. This new upper extremity program is much needed in the pediatric sports medicine community. As we continue to collect information about healthy athletes, we will use the results to continue to modify the upper extremity return to play program. This is an example of where our clinical teams of physicians, physician assistants and physical therapists collaborate with our research team to make changes that impact athletes today.

We are continuing to work on this baseball project and invite healthy young athletes to help us. We schedule testing dates periodically and would be happy to send you the calendar to sign up or work with your team to find a date to do testing together.

To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org.