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Surmounting Setback Through Strength

Surmounting Setback Through Strength

by | Aug 2, 2023 | Sports Medicine

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.

Fear-Avoidance in Athletes

Fear-Avoidance in Athletes

by | Aug 9, 2022 | Psychology

What is Fear-Avoidance?

Athletes who experience an injury often struggle with fear-avoidance once they are physically cleared to return to sports. Out of fear of pain or injury, fear-avoidance is when a person develops and maintains chronic pain due to avoiding certain motions or behaviors. “Fear-avoidance is a model that describes how movement and pain-related fear can impact the development and maintenance of chronic pain and increased sensitivity to pain,” pediatric psychologist Emily Stapleton, Psy.D., says. To avoid perceived pain or injury, athletes may believe they cannot complete some rehabilitation exercises and as a result, the athlete may:

  • hesitate when completing exercises
  • not put in effort
  • hold back in training or competition
  • increase their dependency on family, coaches or medical team

The more the athlete does these things, the greater the anxiety becomes about pain, movement and reinjury. This fear-avoidance cycle is shown below:

What Does Fear-Avoidance Look Like in the Athlete?

“In athletes, fear-avoidance may look like hesitation when completing necessary exercises for recovery or decreased effort in rehabilitation exercises,” Stapleton says. “You may also see athletes skipping certain physical therapy exercises, discontinuing exercises early, or not completing the number of reps or recommended time due to pain or pain-related fear. Outside of rehabilitation, athletes may avoid social activities or sports where they anticipate the need to engage in increased physical activity, or actions they perceive as unsafe or as likely to increase pain, such as walking long distances or standing for extended periods of time.”

Part of the fear-avoidance cycle includes catastrophizing, or assuming that the worst possible outcome or event will happen. “This pattern of thinking increases distress and is linked to both anxiety and depression,” Stapleton says. In athletes, catastrophizing can manifest in many ways:

  • Constant or invasive thoughts about the pain of injury.
  • The athlete might think their injury is the worst possible injury and that they will never get back to their pre-injury performance level.
  • Believe nothing can be done about their pain or injury, and they will never recover.

This negative thinking can lead to fear of pain, movement, further injury and result in avoidance of anything that might cause pain, make the injury worse or result in another injury. As a result of increased anxiety and avoidance, one can become fixated on monitoring physical sensations in their body and very sensitive toward anything that increases discomfort, even physical therapy exercises that are needed for recovery. This often leads to sedentary behavior and will stop or greatly reduce physical activity levels. “Avoidant behavior is expected and healthy in the immediate acute phase post-injury, as following injury rest is often needed for recovery,” Stapleton says. “However, when returning to activities is appropriate or engagement in physical therapy exercises is necessary to recovery and rehabilitation, avoidance of these activities can actually be harmful, leading to increased pain, chronic pain, and/or declines in mood.”

In athletes, deconditioning often triggers more negative thoughts about their abilities, which can lead to depression and disability. Concerning signs and symptoms of depression include:

  • changes in appetite
  • changes in sleep
  • irritability
  • anger
  • sadness
  • frequent crying or emotional outbursts
  • lack of motivation, a decline in academic performance
  • disengagement and/or social withdrawal
  • substance abuse

It is important to learn strategies to cope with the anxiety so that rehabilitation and recovery are not significantly impacted.

How to Provide Support
There are ways that you can help support your child and work through their range of emotions and fears:

  • Help them to identify exercises or activities that increase negative emotions, or triggers. Look for when an athlete becomes distressed, avoids or hesitates prior to certain exercises for clues of triggering activities/exercises.
  • Create a hierarchy of the identified triggers and rate them from least to most fearful.
  • Start with the least feared exercise and have the athlete perform the task in a controlled and safe environment. Challenge the athlete to increase speed, repetitions and/or difficulty until they are performing without worry.
  • Use goal-setting techniques, such as setting SMART goals (specific, measurable, attainable, relevant and timely), to create daily, weekly and monthly goals for building tools to manage anxiety and stress, as well as to do the identified fear exercises.
  • Build coping skills to handle fear and worry triggered by pain and movement. Diaphragmatic breathing, positive self-talk and imagery techniques have all been shown to help reduce levels of distress, increase comfort and build confidence during rehabilitation and return to sport.
  • Provide education about how fear and decreased confidence can increase their pain and get in the way of their ability to return to their sport.

Learn more and download tips for helping young athletes manage stress.

Psychology Services at Scottish Rite for Children
Our Psychology department has teams of pediatric psychologists at both our Dallas and Frisco campuses. Pediatric psychologists are embedded in the care of each patient, providing support to our sports medicine patients throughout their care and treatment. Learn more about our psychology services.

Emily Stapleton, Psy.D., is a pediatric psychologist at the Frisco campus of Scottish Rite for Children. She specializes in pain management, rehabilitation, coping with acute and chronic illness/injury and sports medicine. She has a particular interest in supporting young athletes following a sport-related injury.

Keeping Up with the Count: When Has She Rehearsed Enough?

Keeping Up with the Count: When Has She Rehearsed Enough?

by | Mar 4, 2021 | Sports Medicine

In youth sports, this message is clear – excessive training puts an athlete at risk for injury. Young dancers may or may not be comfortable comparing their training to that of other “athletes,” but the concern for their safety is similar. Scottish Rite for Children physical therapist, Julia Buckelew, P.T., D.P.T., O.C.S., works with many dancers in our sports medicine practice and hopes to reach others with this message.

Overtraining occurs when there is a high intensity or a high volume of training and performance declines. Overtraining is often associated with overuse injuries and burnout when the dancer no longer enjoys the activity. The year-round nature of dancing creates a culture and environment that, without deliberate efforts to avoid, lead to these conditions. Company auditions, numerous classes, rigorous pre-show rehearsals and summer intensives can run-down a dancer.

What are signs of overtraining?

  • General fatigue felt throughout the day despite amount of sleep.
  • Extended time needed to recover from post-exercise soreness.
  • Reduced performance/technical skill despite normal or increased training hours.
  • Difficulty concentrating.
  • Increased risk of injury.

How can a dancer avoid overtraining?

  • Shift attention to the quality of training over the quantity of training.
  • Apply common time management techniques to plan rest and cross training.
  • Implement training periodization by recognizing performance cycles.
  • Learn about sleep hygiene to improve sleep quality.
  • Learn the value of mental imagery for rehearsal to allow the body to rest.
  • Increase self-awareness about beliefs and behaviors that motivate.

Thoughts on Perfectionistic Dancers
Scottish Rite pediatric psychologist Emily Stapleton, Psy.D., says, “Perfectionistic dancers tend to be ambitious, determined and driven for success in their performance. Unfortunately, these traits that make them successful also increase their likelihood of overtraining.”

These athletes tend to focus on results and have potentially harmful motivations including:

  • Desire to avoid making mistakes.
  • Fear of failure.
  • Fear of negative evaluation by others.
  • Meeting parent or coach’s expectations.

These tendencies can cause significant frustration, low self-esteem and self-doubt when they are not meeting their expectations or the expectations of others (e.g., parent, coach). This leads to the drive to learn new moves, perfect a routine and difficulty taking a break from training. Since they feel training is never complete, they self-select into an inappropriately high-training load. The cumulative effects of endless run-throughs, long hours of rehearsal and impact and stresses from repetitive movements may lead to injuries, exhaustion and reduced quality in performance. 

Stapleton says, “Research has shown that when these athletes direct their perfectionistic behaviors toward progress-oriented goals, rather than focusing solely on results or performance, some of the risks of overtraining are mitigated.” Athletes can do this by implementing cognitive-behavioral strategies including:

  • Appropriate goal setting.
  • Redefining their definition of success in sport.
  • Using positive self-talk.

Emily Stapleton, Psy.D., and Julia Buckelew, P.T., D.P.T., O.C.S., contribute to the article series, Keeping Up with the Count. A collection of tips and information for dancers from a multidisciplinary dance medicine team. They recognize the needs for these highly specialized athletes and aim to help reduce the risk of injuries in this population.

Get to Know our Staff: Psychology Department

Get to Know our Staff: Psychology Department

by | Jan 18, 2021 | Psychology

What role do psychologists play at Scottish Rite for Children?
We play many roles. At Scottish Rite, our providers treat the whole child – this includes children’s physical and emotional health. Specifically, our psychologists are trained in the many pediatric medical conditions treated here. This means we can help patients and families understand and adapt to their diagnoses. It also means that we can help patients and their families understand their treatment options and support families throughout medical decision making. 

If surgery is recommended, we help patients and families to become as knowledgeable and prepared for surgery as possible, including prepping patients for any post-operative expectations. We also assist patients in supporting their adherence to any treatment recommendations, such as brace wear, medication or physical therapy. 

Why is psychology involved in patients’ pre-surgical preparation?
There are many psychosocial and behavioral factors that may impact a patient’s readiness for surgery, as well as their recovery post-operatively. Psychology’s involvement in pre-surgical evaluations helps to proactively address any concerns that may impact a patient’s recovery and rehabilitation, which in turn helps to mitigate post-operative challenges. 

Additionally, we provide patients and their families significant, developmentally appropriate education, to ensure that they fully understand the surgical procedure, as well as what is expected from them throughout the recovery process. Having this information ahead of time helps to provide patients with a roadmap of what to expect and allows them to feel in control. These evaluations are also used to answer any questions the patient and family may have. 

How is psychology involved in pain management?
Our team is uniquely trained to support children and adolescents with pain concerns, whether from acute injury, surgical pain or chronic pain complaints. Scottish Rite psychologists play an important role in assessing psychological, social and environmental factors that may impact a patient’s experience of pain and by providing targeted intervention. Our team has expertise in evidence-based psychological pain management interventions, like cognitive-behavioral approaches, including relaxation skills training, distraction techniques, cognitive restructuring and parent training.

How are you different from a counselor or therapist a patient may see in the community?
That’s a great question. Our team is different in that we are focused specifically on supporting patients and their families as part of their medical care at Scottish Rite. We know that having a medical condition may elicit feelings of stress, anxiety, worry or sadness. We also know that stress, anxiety, worry or sadness can exacerbate certain medical conditions and make treatment more difficult to manage. We support patients and families in understanding those relationships and how to cope with them. 

That said, we greatly value mental health providers in the community and will frequently partner with them. For example, if a patient is working with a counselor in their community, we may ask to speak to that counselor to help coordinate care. Or, if appropriate, we may recommend that a patient work with a local counselor or psychiatrist to receive additional, longer-term support. 

In addition to seeing patients, what other roles do you play at Scottish Rite?
In addition to clinical care, our team is also very involved in research. We have partnered with many of the surgeons and physicians throughout the institution on active lines of research and regularly present at national conferences. We also have a Pediatric Psychology Fellowship training program, where we provide training, education and supervision for post-doctoral fellows in pediatric psychology. Additionally, we are involved in numerous committees within Scottish Rite, and we are engaged in nation-wide psychology organizations such as the American Psychological Association. 

MEET THE TEAM

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Area(s) of expertise – I have the pleasure of getting to work with numerous departments, including the Neurology and Rehabilitation Medicine team, the Hand team, as well as multiple orthopedic providers. Specifically, I work with patients with scoliosis and spine conditions, hip conditions, complex foot and ankle conditions, lower extremity conditions and patients requiring limb lengthening and/or reconstruction.

Special interests – I am particularly interested in the provision of interdisciplinary care, the role of the family in supporting pediatric patients and transitional care. 

I like working in pediatrics because: The patients I get to serve. Children are curious, insightful, honest, funny, adaptable and resilient. It is incredibly rewarding to support a patient in their medical journey and assist in making it as positive an experience as possible.

Area(s) of expertise – I work with a variety of departments and teams, including Rheumatology, General Orthopedics, Prosthetics and scoliosis teams. I love the variety of the clinics I support and being able to meet families with an array of medical conditions. 

Special interests – I particularly enjoy working with children and teens who are experiencing chronic pain. Psychology plays a critical role in chronic pain management and I enjoy seeing children and teens return to the activities they enjoy. Recently, I have developed expertise in the emotional and psychological needs of patients with a prosthesis.

I chose to work at Scottish Rite because: The mission is consistent with my training of treating the whole child and family. I was eager to join a team who cares about giving kids more than a positive medical outcome, but also a positive emotional outcome for the patient and their family.  

Area(s) of expertise – I have gained extensive training in integrated health settings, specifically in providing interventions for pain, adherence and treatment related mood difficulties. At Scottish Rite, I support the Sports Medicine department and provide care to young athletes throughout the course of the treatment and return to sport.  

Special interests – I enjoy working with and supporting young athletes throughout the course of their medical treatments, especially related to coping with anxiety and pain related to treatment and addressing barriers to adherence and return to sport. 

Scottish Rite is special because: The organization stands true to its mission in “treating the whole child and never just the condition.” The provision of wholistic, interdisciplinary care is what is so special. Every staff member cares so deeply about each patient and works tirelessly to ensure the best possible outcomes, both medically and psychosocially.

Area(s) of expertise – Pediatric psychology and childhood trauma are my main areas of focus. 

Special interests: Childhood trauma, providing coping assistance to those with acute and chronic illness/injury, pain management, behavior management, providing integrated behavioral health care and providing trauma informed care

I chose my specialty because: Throughout the course of my training and clinical practice, I have developed a passion for working with children and adolescents, along with the team around them, in helping them strive to become the best version of themselves as they process and cope through difficult traumas in their life. Working with childhood trauma and physical health related issues has become a primary focus for me over the course of my early years as a psychologist. I believe that providing education and intervention to children, families and fellow medical providers on how emotional and physical functioning can be connected is one of the most important interventions to begin the healing process for the whole child.

Area(s) of expertise – I have undergone extensive training in early childhood assessment and intervention, developmental delay/disability, multicultural psychology, trauma, behavioral management and integrated health psychology. At Scottish Rite, I work specifically with teams treating a variety of spine conditions, including scoliosis.

Special interests – I love working with preschool populations and children on the autism spectrum, as well as teaching parents new techniques to improve their child’s behavior. I also enjoy training and educating others on culturally humble and sensitive practices we can employ to be more respectful in our approach with diverse patients.  

How do you help your patients feel comfortable: I enjoy working with younger populations because I get to bring out my inner clown and be comical. Therefore, I use a lot of humor and comedy in my interactions with children and adolescents. It often helps them see my humanity first, as opposed to my professional hat.

Helping Young Athletes Manage Stress

Helping Young Athletes Manage Stress

by | Nov 18, 2020 | Sports Medicine

For all kids, managing stress is important. However, young athletes have an added layer of pressures and our team is here to provide tips on properly managing those stressors. Pediatric psychologist Emily Stapleton, Psy.D., works closely with our young athlete population at our Frisco campus. As a former athlete herself, she has a passion for supporting athletes’ mental health for optimal performance, injury prevention and rehabilitation outcomes.

Below are a few tips to help parents, athletic trainers and coaches of young athletes manage stress.

CONNECT and help problem solve.
When overwhelmed, teens may struggle to break down a situation into manageable pieces. Talk to them and help them take one step at a time.

TIME your conversations wisely and keep it positive.
Let emotions from games or practices settle before talking about performance or outcomes. Waiting a couple of hours to discuss these topics allows athletes to reflect on their performance with less stress.

REFRAME success.
Expectations from parents and coaches can unknowingly increase pressure to perform and negatively affect self- confidence. Encourage athletes to focus on putting forth their best efforts and measuring personal progress rather than only focusing on end results or winning.

TEACH coping skills for life.
Coping skills can help an athlete learn to self-manage when stress starts to take over. Expose your athlete to yoga, taking walks, diaphragmatic breathing (i.e., deep breathing), progressive muscle relaxation (i.e., tensing/releasing muscles) and other techniques to relax.

MAKE ROOM for breaks.
Teach athletes the importance of down-time for rest and recovery. Helping athletes develop time-management skills and minimize over-scheduling will improve stress management.

ENCOURAGE life outside of sport.
Making time for other interests and hobbies apart from the primary sport, including fun activities and time with friends, helps create balance and build resiliency. Allowing athletes to have a breadth of interests and hobbies to draw from when experiencing distress.

PROMOTE healthy sleeping and eating habits.
Stress is easier to manage and less likely to build up with healthy habits in place. A balanced, sport-appropriate diet and quality sleep (at least eight hours for teens) support young athletes in academic, sport and social settings.

ASK for HELP when you need it.
Talking through stressors with a licensed psychologist or mental health counselor can be a healthy outlet for chronic stress and help athletes learn positive coping strategies to use in the future when experiencing negative stress.

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Learn more about pediatric sports medicine.