Coaching Kids: Top Tips for Coaches

Coaching Kids: Top Tips for Coaches

Here are simple tips to integrate into coaching messages for kids. Building a solid foundation of good habits will help them well-beyond this youth sports season.

  • Teach athletes to eat a healthy snack with carbs before games and practices.
  • Encourage athletes to drink water before, during and after practice and games.
  • Respond quickly to complaints of pain and encourage an evaluation by a pediatric sports medicine specialist.
  • Learn how to lead your team through a dynamic warm-up and save stretching for after games and practices.
  • Most of all, keep it fun!

As a participant in the University of North Texas Athlete Transition Program, Tyree Eady, B.S., M.S., volunteered at Scottish Rite for Children in the Movement Science Lab on the Frisco campus. He is passionate about changing the future for young athletes through research and using his platform as a professional athlete

Learn more about sport-related injury prevention.

Share Your Story: Bria’s Big Break

Share Your Story: Bria’s Big Break

Bria is a 12-year-old girl who stays busy with a variety of activities. From cheerleading, playing on her trampoline, hanging out with her friends and swimming, she is always on the move. After being diagnosed with Osgood-Schlatter disease, a condition that causes inflammation of the patellar ligament and creates a painful bump just below the knee, Bria and her family came to the Scottish Rite for Children Orthopedic and Sports Medicine Center for treatment. Bria’s mom, Krista, shares their experience in this Share Your Story:

Written by mom – Krista Cardenas

We came to Scottish Rite for Children’s Center for Excellence in Sports Medicine a few years ago for treatment of Osgood-Schlatter disease in Bria’s knee and various cheer-related aches and pains. We really loved Stephanie De Jager, M.S.N., CPNP, and she became our go-to “person” when Bria had injuries.

Last year at an open gym one evening, Bria was tumbling and broke her tibia and had emergency surgery at another Dallas hospital. She fractured it through the growth plate and had compartment syndrome to make things worse. Once she was finally discharged, as the mom, I fell apart when we got home. I didn’t have our “people” to tell me everything was going to be ok, so I called Stephanie. She called me and talked to me at length, reassuring me that we could always switch and follow up later at Scottish Rite. We tried to give the other hospital a chance, but our heart was at Scottish Rite.

At our follow up, their plan of care was hasty, and they didn’t listen to me in discussing her projected growth before scheduling surgery, so we transferred Bria to Scottish Rite for further care. Thank goodness we did, because we got to meet Dr. Ellis, and we absolutely adored him. He really listened and took the time to look at Bria’s realistic growth based on our family heights and her puberty. We watched and waited for almost a year, and each appointment he was conservative and not quick to operate.

Finally, almost a year later, we pulled the trigger and had to do some growth plate modification for limb inequality and to correct a valgus. Our experience was completely different from the first surgery at the other facility. They took the time to explain at length every detail and answer all my million questions, never judging me for my hesitation. Child life specialist Marissa Willis sat with Bria and acknowledged the trauma of her first experience last year. She reassured her that this would be so much different, explaining every step she would experience on surgery day.

Finally on surgery day, we were impressed by every single person we encountered. From Nancy at the desk with her calming and friendly personality, to the volunteer cooking up fresh cookies and tending to my son and Bria’s grandfather, to each nurse we encountered having a kind and reassuring demeanor. Everyone put us so much at ease that we as a family were completely confident in sending her off. We really appreciated Falco’s visit, and he went straight to Bria’s dad to put his head in his lap because Dad was the most anxious. Wow! What an amazing dog! The facility was impeccably clean, updated and everything was so organized.

I can’t say enough about how amazing Scottish Rite is, and we will forever sing your praises. My husband and I both said we want to work at Scottish Rite! Bria’s grandfather couldn’t stop talking about how impressed he was with the facility. He kept saying, “This place is FIRST CLASS!” From the smell of popcorn the moment we walked in, to the kind nurses helping her into the car, this day could not have been any more perfect (for a surgery day that is!).

Learn more about our Center for Excellence in Sports Medicine.DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Surmounting Setback Through Strength

Surmounting Setback Through Strength

Published in Rite Up, 2023 – Issue 2. 
 
Running intensely down the long runway, Lawrence launched into a roundoff, followed by five no-handed back handsprings and then a back handspring into a double pike. Landing sharply on the mat with all of the pressure on her ankles, she fell to the ground. “I was in terrible pain, and I just remember paramedics coming over,” says 16-year-old Lawrence, of Richardson. That day in June of 2022, Lawrence broke both of her ankles at the USA Gymnastics® Championships in the trampoline and tumbling event in Des Moines, Iowa. “I was really scared that I wouldn’t be able to tumble anymore,” she says.

A girl doing a handstand in front of a sign that says gymnastics

An elite power tumbler, Lawrence has been a gymnast since she was 5. “I would flip all around the house,” Lawrence says. “I’d flip off the couch, make up routines on my bed and outside with my friends at recess. I’ve always had a passion for it.”
 
After a trip to the emergency room in Des Moines, Lawrence and her family decided to wait until they got back to Dallas to have surgery. “It was the longest car ride ever,” says Hollis, Lawrence’s mother, “but I knew the wonderful reputation of Scottish Rite for Children because I used to work there as a physical therapist, and I had heard that Dr. Ellis was the person we needed to see.”

A few days later, Lawrence found herself in the care of pediatric orthopedic sports medicine surgeon and medical director of clinical research Henry B. Ellis, M.D., and a multidisciplinary team of experts at the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. After having surgery on both ankles, Lawrence underwent a treatment plan that included having splints on both legs and then successively wearing casts, boots and braces before she could walk without aid. For many weeks, she was in a wheelchair until she could use crutches. “The lack of things I could do made me feel pretty hopeless,” Lawrence says. “I stayed in bed all day. I couldn’t do anything on my own, even go to the bathroom or take a shower.”

During her visits at Scottish Rite, Lawrence received a continuum of care in body, mind and spirit, including support from physician assistant Ben Johnson, P.A.-C., A.T.C., pediatric nurse practitioner Heather Barnes, D.N.P., child life specialist Marissa Willis, CCLS, and pediatric psychologist Emily Stapleton, Psy.D. “Dr. Stapleton talked to me every visit about how I was feeling mentally, which I didn’t take into consideration before the injury,” Lawrence says. “I thought I’d just be lying in bed, and then I’d get up and be fine, but it was a lot harder than I expected mentally. She really helped me discover things that I like to do besides tumbling, like reading and doing crafts.”

Hollis says that for her as a parent, Scottish Rite for Children means trust. “I totally and completely trust the doctors, nurses, support staff and therapists,” Hollis says. “Once we were in the hands of Scottish Rite, I knew Lawrence would be okay.”

A woman stands in front of a green wall with her arms crossed

After a few months, Lawrence started walking and began the recovery process. “I was so excited to get strong, work out and do normal things that I took for granted like walking with my friends,” Lawrence says. “It might take a village to get elite athletes back after a bad injury,” Dr. Ellis says, “but the truth is that it takes a special patient with resilience, strength — both mental and physical — and perseverance.”
 
Today, Lawrence is back in the gym taking power tumbling classes and learning a new specialization called acrobatics and tumbling, a sport that combines gymnastics and the athletic aspects of competitive cheerleading. She takes private lessons from Hope Bravo, the 2019 U.S. tumbling bronze medalist who also competed in the Acrobatics and Tumbling program at Baylor® University. Lawrence says that Baylor’s program is the best, and she aspires to join the team when she graduates from high school. “

The care I received at Scottish Rite was amazing,” Lawrence says. “Though the injury set me back and that was really difficult, I’m glad I am where I am now because I didn’t think that would be possible. I love what I’m doing now. I have new goals, and I’m happier than I’ve ever been.”
 
Read the full issue.

The Growing Athlete’s Hip: How to Prevent Problems Today and Tomorrow

The Growing Athlete’s Hip: How to Prevent Problems Today and Tomorrow

Download a PDF of this summary.

In this program, our pediatric orthopedic and sports medicine experts described how the skeletal development of the hip is affected by repetitive and extreme movements inherent to athletic activity. The changes, in some cases, can be permanent. Keep reading to learn what we know about preventing irreversible changes and treating symptoms of these sport-related hip conditions.

Apophysitis and Apophyseal Fractures in the Hip and Pelvis

Apophysis is a normal bony outgrowth that arises from secondary ossification centers. The bone fragment will ultimately fuse with the primary bone. The apophysis contributes more to the shape of a bone than the longitudinal growth. Until the ossification center fuses, also referred to as the point at which the “growth plate closes,” the tendon or ligament attached to the apophysis can pull and cause pain in the soft cartilage in the apophysis.

Hip and pelvic apophyses that are vulnerable to acute or overuse injuries are located at the ischial tuberosity, the iliac crest, the anterior superior iliac spine (ASIS) and anterior inferior iliac spine (AIIS). An apophyseal avulsion fracture. An anterior-posterior view of the pelvis is helpful when evaluating complaints in the pelvis so contralateral comparison can be made.
Risk factors for injury includes:

  • Tight muscles and muscle groups
  • Early in the sports season
    • Change in activity from sedentary to active
    • Sudden increase in intensity or duration of training or competition
  • Ignoring activity-related pain
  • Minimal recovery from workouts
    • Year-round training
    • Lack of cross-training
    • Overtraining

Treatment for these conditions is most often nonoperative and is centered around protecting the area involved. Rest, protected weight-bearing, gentle passive ROM and gradual return to play are necessary elements of the plan. Healing and symptom resolution may take 12 weeks or more and radiographic healing is not required prior to returning to sports.

Internal and External Snapping Hip

Athletes may report “popping” in the hip.

If you can see it, it’s likely coxa sultans externus, external snapping hip. This is a condition of the iliotibial band popping over the greater trochanter on the lateral side of the femur. Runners may complain of this when running or walking, and they may describe that it “pops in and out.”

If you can hear it, it’s likely coxa sultans internus, internal snapping hip. This occurs when the iliopsoas muscle, deep in the groin, causes painful popping. This condition is often seen in dancers and tumblers. Treatment includes hip flexor stretching and activity modification.

Femoroacetabular Impingement (FAI)

An overuse injury seen in adolescent and young adult athletes in the hip can be caused by changes in the shape of the femoral head-neck junction (Cam-type) or the acetabulum (Pincer-type). These changes can cause pinching and tearing of the labrum, the soft tissue surrounding the acetabulum that acts to deepen the socket. Early injury from impingement can cause premature hip arthritis. Therefore, this condition is continuing to get more attention with the goal to prevent deformity and consequences.

How does a Cam-type deformity develop?
The femoral head collides prematurely with the acetabulum. The impact causes a change in the shape of the head from being spherical to being more “cam” shaped, or oblong. These may develop secondary to another medical condition in the developing hip, such as:

  1. Slipped capital femoral epiphysis (SCFE) is seen in approximately one in 10,000 may occur and result in avascular necrosis of the femoral head.
  2. Perthes disease – rare condition affecting blood flow in the hip and causes deformity.
  3. Trauma or fracture

In athletes, there is not a primary condition like those listed above. Therefore, idiopathic Cam deformities have been identified in teenage athletes who participate in soccer and other sports. Younger players studied do not show this condition, so the window of opportunity and the exacerbating activity are being studied more closely. Shearing forces may be occurring at the physis to protect the bone, but ultimately may be causing changes in the growth plate and therefore the shape of the femoral head.

Can this be prevented?

Early conversations are looking at the parallel occurrence in the shoulder and elbow in baseball players. Evaluation of the dosage of activity, such as pitch counts in baseball, have been implemented to preserve the anatomy and improve performance in elite athletes. For now, working on proper mechanics and activity modification in adolescence may be our best tools to prevent this deformity.

Considerations and Components of a Hip Injury Prevention Program

Factors that must be considered to prevent hip injuries in adolescent athletes include:

  • Open growth plates
  • Peak height velocity (PHV)
  • High volume of training particularly with loading in rotational and axial movements
  • Sport-specific end range of motion demands
  • Explosive and eccentric demands

Modifiable factors may include:

  • Muscle imbalances
  • Muscle weakness
  • Inflexibility
  • Poor technique
  • Sport-acquired deficiencies
  • Joint instability
  • Overtraining

Five Domains of Injury Prevention Strategies of the Hip

  1. Training Load Management
    Higher incidence of athletic hip pain found with athletes who specialize in a single sport before high school and participate in regular training at earlier ages and four times per week before the age of 12. Recommendations include sampling a variety of sports rather than specializing, monitoring workload, neuromuscular training programs and taking rest breaks from sport (two to three nonconsecutive months/year).
  2. Hip Mobility During Rapid Growth
    Through stretching, dynamic warm-up and eccentric training, hip tissues can stay flexible. Progression of eccentric training can improve the length-tension curve to improve performance and resist injuries.
  3. Motor Control and Stability
    Hypermobility and poor motor control need to be addressed with strategies that improve core stability and teach foundational movement patterns for sport-related movements, such as jumping and landing.
  4. Strength to Improve Imbalances & Specificity
    Once mobility and control are addressed, strengthening can occur. Eccentric adductor & abductor strength can be improved by combining activities, such as the Copenhagen plank and a Nordic Hamstring exercise. Looking for sport-specific strengthening tasks.
  5. Sport-Specific Movement Mechanics
    The culmination of these strategies is executing the sport-specific movement patterns with all of the fundamental movement competence and technical accuracy to ensure safety. Whether the sport demands jumping and landing on a court, changing direction at high speeds on the ice or holding extreme postures on a balance beam, the steps follow a standard pattern.

Implementing Hip Injury Prevention Programs

With confidence that many of these elements are modifiable due to neural plasticity of youth athletes before and during growth, making an effort to prevent injuries is appropriate. Research will continue to define the right and wrong approaches; however, we have some tips that are generally accepted. To avoid detraining, it is recommended to perform activities two to three times per week, approximately 20 min duration, up to 60 min for at least six weeks. It is important to implement it prior to the beginning of a season. Qualified instructors and supervision for continued implementation of the proper techniques are crucial elements of a safe and successful program.

Learn more about hip health in dancers.

This is a summary of a presentation in a monthly series for medical professionals called Coffee, Kids and Sports Medicine. Through events like these, Scottish Rite for Children experts share their experience and knowledge with others to ensure young and growing athletes are getting the best care in every environment.

Orthopedic Sports Medicine Fellowship – Vacancy

Orthopedic Sports Medicine Fellowship – Vacancy

The Scottish Rite for Children and UT Southwestern Medical Center (UTSW) Sports Medicine Fellowship is a new 12-month ACGME accredited fellowship program with an emphasis on pediatric sports medicine. Led by Philip L. Wilson, M.D., and Henry B. Ellis, M.D., this fellowship is an extraordinary clinical training program that allows physicians to master the skills needed to manage the full gamut of sport-related injuries in adults and pediatric patients including conditions such as osteochondritis dissecans (OCD), discoid meniscus, shoulder instability, femoroacetabular impingement (FAI) and a variety of anterior cruciate ligament (ACL) reconstruction options from a physeal-sparing to a traditional ACL with or without a lateral extra-articular tenodesis (LET). The fellowship will include exposure to fracture management that is common in athletes as well as osteotomies when indicated in athletes. 

The Sports Medicine program at Scottish Rite and UTSW participates in high level research as well as exposure to several multicenter study groups. The fellowship will also include experiences with quality improvement as this institution hosts a multicenter quality improvement initiative called SCORE – Sports Cohort Outcomes REgistry.

The one-year fellowship program is available to a postgraduate surgeon who has completed an orthopedic residency, but it may also be ideal for a surgeon who has just completed a fellowship who would like more exposure to pediatric sports medicine conditions and treatment. This fellowship is perfect for a PGY4 who is interested in sports medicine and may have been overlooked or gone unmatched. A PGY5 who is interested in a second fellowship is also an ideal candidate. 

Training Start: Clinical position to begin in August 2024 

Accredited Positions: 1 

How to Apply: Please send your contact information, CV and other supporting documents to orthosports.fellowship@tsrh.org. We would like to fill the position as soon as possible.

For more information about the Orthopedic Sports Medicine Fellowship, please visit the Fellowships & Graduate Programs page on our website.

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Healio Orthopedics Today: MPFL Reconstruction

Healio Orthopedics Today: MPFL Reconstruction

Patellar instability most commonly affects skeletally immature pediatric patients with open growth plates and medial patellofemoral ligament reconstruction should be the primary treatment for first-time patellar instability in skeletally immature patients, despite historical use of the adductor sling technique.

Medical Director of Clinical Research Henry B. Ellis, M.D., recently discussed MPFL reconstruction for first-time patellar instability with Orthopedics Today. 

Watch the full segment