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Concussions

Concussions & Young Athletes

Daily Dose

Young Athletes and Overuse Injuries

I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.We had a pediatric orthopedic surgeon on the show recently and we discussed overuse injuries in adolescent athletes. I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.

They usually don't have a lot of swelling, and they complain of pain with their activity, but otherwise are fine. When taking a history their biggest complaints occur during the sport or immediately after, and they usually feel better after resting overnight.The pain re-occurs once they resume their work out the next day. The cycle is continuous. The best treatment for overuse injuries is to follow the pneumonic RICE: Rest, Ice, Compression and Elevation. For further relief of pain add an anti-inflammatory medication such as Aleve, Motrin or Advil. If the athlete can play through the pain, it does not awaken them throughout the night and they are fine attending school and other activities, they are probably fine to continue in the sport. If the pain becomes persistent during the day, disrupts their sleep etc, then they will need to have further evaluation. For persistent stress-related injuries rest may be the next step. Many times it is just necessary to let the body have some "time off" and may also involve stretching exercises to strengthen their core muscles, or yoga and Pilates to improve flexibility and strength. This is usually a four to six week period away from their sport. One caveat that was discussed was the importance of watching for depressive symptoms in an athlete who has had to take time off from their activity. Parents need to recognize not only the physical pain their child is experiencing, but also the child's emotional pain related to stopping their sport. Many of these kids have such passion for their sport and also gain a great deal of self worth from their participation. To take that away from them is emotionally devastating, and their young minds are not cognitively developed enough to deal with the loss of their athletic endeavors, even for a short time. Watch closely and be supportive and acknowledge their feelings. It is just as important to seek help for their mental health if that seems necessary. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Over-use Injuries in Kids

1.45 to read

It seems that more and more kids are participating in organized sports at even younger ages. I now have many 3 year olds who are already playing on a soccer team, and kindergartners in football and lacrosse.  They are also “specializing” in a sport at younger ages as well. With the focus on one sport at even earlier ages the risk of overuse injuries seems to be greater.

While many kids play multiple sports, maybe a different one each season, there seem to be more and more who are deciding at an earlier age that they prefer one sport and therefore “specialize”. This seems to be more common in those children who participate in dance, soccer, gymnastics and tennis.

While I have been noticing more and more over-use injuries in younger aged children, a recent sports medicine study supports this. A preliminary report from the sports medicine department at Loyola Univ. School of Medicine found that “kids are twice as likely to get hurt if they play just one sport than those who play multiple sports.”  It seems that those children who participate in multiple different sports are actually “cross-training” and are using different muscle groups and different movements.. The children who are playing just one sport are typically playing or competing for over 10 hours a week (more than those in multiple sports) and this requires repetitive use of the same muscle groups.

Added on to this repetition is the stress that is incurred to a growing body. 8-16 year old bodies are still in the throes of major developmental changes and growth spurts and are more vulnerable to injury.  Their bodies are just not ready to perform at this level every day, year round. They truly have so little down time that their bodies just “tire out” and overuse injuries occur. This is seen with stress fractures in the back, feet, lower legs, as well as with tennis elbow, and knee problems, just to name a few. I have seen stress injuries in almost every area of the body!

The mainstay of treatment for overuse injuries is REST! But there are children as young as 9-10 in my practice who become anxious and guilt ridden when told that they may not participate (in whatever sport that got them to this place) for 4 – 6 weeks so that their body may heal itself. You can’t rush rest and the “body is a temple” that needs time to repair, especially in pre-pubertal children.

It would seem that parents should encourage their children to play/experiment with many different activities during their formative childhood years in hopes that injuries will be fewer and that their bodies will have time to grow before specializing in a sport. By high school the body has matured, there is less risk to growth plates while there is still plenty of time to become a “single sport” jock. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Your Teen

Websites May Encourage Self-Injury

1.45 to read

The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the risk for self-injury.Some at-risk teens are finding new ways to hurt themselves thanks to a popular website with videos that glorify self-injury.

Young adults and teens may believe that hurting themselves is normal and acceptable after watching videos and other media on Web-sharing sites like YouTube, new research indicates. The findings, published in the journal Pediatrics, warn professionals and parents to be aware of the availability and dangers of such material for at-risk teens and young adults. Deliberate self-injury without the intent of committing suicide is called “non-suicidal self-injury” or NSSI. An estimated 14% to 24% of youth and young adults engage in this destructive behavior, according to the study. NSSI can also include relationship challenges, mental health symptoms, and risk for suicide and death, the study noted. Common forms of self-injury include cutting, burning, picking and embedding objects to cause pain or harm. While other studies have looked at the availability of online information about self-injury, the authors focused on the scope of self-injury in videos uploaded on YouTube and watched by youth. They described their work as the first such study and noted that their findings could be relevant in risk, prevention and managing self-injury. The authors focused on YouTube because, according to the site, since its inception in 2005 “YouTube is the world's most popular online video community, allowing millions of people to discover, watch and share originally-created videos.” Using the site’s search function the researchers looked for the terms “self-harm” and “self-injury,” identifying the site’s top 50 viewed videos containing a live person, and the top 50 viewed videos with words and photos or visual elements. The top 100 items that the study focused on were viewed over 2 million times, according to the analysis, and most – 80% - were available to a general audience. The analysis of the self-injury content found that 53% was delivered in a factual or educational tone, while 51% was delivered in a melancholic tone. Pictures and videos commonly showed explicit demonstrations of the self-harming behavior. Cutting was the most common type of behavior; more than half of the videos did not contain warnings about the graphic nature of the behavior. The average age of uploaders of the self-injury material was 25.39 years, according to the findings, and 95% were female. The authors surmise that the actual average age is probably younger because many YouTube users say they are older in order to access more content. The study concludes that the findings about the volume and nature of self-injury content on YouTube show "an alarming new trend among youth and young adults and a significant issue for researchers and mental health workers." The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the  risk for self-injury. The study warns that health professionals need to be aware of this type and source of content, and to inquire about it when working with youth who practice self-injury because sites like YouTube can reach youth who may not openly discuss their  behavior. Self-harming is not typical behavior for otherwise untroubled teens and young adults, explained Dr. Charles Raison, an Emory University psychiatrist and CNNHealth.com's mental health expert. It’s an action that kids with psychiatric problems may try. “NSSI is a young person’s affliction…one in ten will kill themselves," he said.   "A lot of people will outgrow the behavior.” Raison said that it’s common for troubled young people to share information about hurting themselves. Treatments can include antidepressants, antipsychotic drugs and psychotherapy.

Your Teen

Head Injury Linked To Violent Behavior

2.00 to read

A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior. Every parent knows that childhood often comes with bumps, bruises, cuts and falls. Sometimes those accidents include head injuries. A new study says that children who have suffered a head injury are more likely to get into a fight or take part in other types of violent behavior.

The connection between head injury and violence was particularly strong if the head injury had occurred within the past year, the authors of the study note in the journal Pediatrics. According to the U.S. Centers for Disease Control and Prevention, some 1.7 million Americans experience a traumatic brain injury every year, due to bumps, blows, jolts, or any injury that disrupts the brain's normal functioning. The study author, Dr. Sarah Stoddard with the University of Michigan in Ann Arbor, told Reuters Health that- with this type of research- it is difficult to figure out if brain injury is really the root of the aggression or if some other factor is the reason. Stoddard also notes that activities like drinking, drug use ,and a history of violence didn’t seem to explain the findings. Stoddard and a colleague analyzed several years' worth of data from 850 kids in high school and followed them until five years after they left school. All of the participants had a grade point average of 3 or lower, putting them at risk for dropping out. In the fifth year of the study, 88 of the young adults said they had suffered a head injury. Of those individuals, 43 percent said they had gotten into a fight, hurt someone, or taken part in some type of violence over the following year. That compared to 34 percent of those who didn't report a head injury. The findings suggest that the more recent a head injury is, the more likely a young adult is to be aggressive. According to Stoddard, "The brain does recover over time." Stoddard also adds that researchers should investigate the long-term effects of head injuries in young people, as well as preventive measures such as protective gear for sports and interventions that help kids with head injuries manage their behaviors before they lead to violence. A different study conducted by researchers at the Center for Injury Research and Policy Institute at Nationwide Children's Hospital, of young athletes 15-to-24 years old, reveals that sports are second only to motor vehicle crashes as the leading cause of injury to the brain. And concussions represent 10 percent of all high school athletic injuries. Previous studies have also shown that brain injuries can also cause changes in memory, reasoning, and emotions, including impulsivity and aggression. In studies with prisoners, researchers have found that those with a history of brain injuries are more likely to engage in violence. The study "does suggest there is a link between head injury and violence particularly early on," said Dr. Huw Williams, who has found the same relationship in prisoners, but was not involved in the new work. And if they believe their children experienced a brain injury in the past, they should also get expert advice on what to look for to make sure brain function doesn't deteriorate, he added. "It's important to monitor." Brain injury can range from mild to severe causing a short loss of consciousness and confusion to amnesia and coma. The American Academy of Pediatrics says that head injuries should be observed, and treatment should be sought if any of the following symptoms appear: •       A constant headache, particularly one that gets worse •       Slurred speech or confusion •       Dizziness that does not go away or happens repeatedly •       Extreme irritability or other abnormal behavior •       Vomiting more than 2 or 3 times •       Stumbling or difficulty walking •       Oozing blood or watery fluid from the nose or ears •       Difficulty waking up or excessive sleepiness •       Unequal size of the pupils (the dark center part of the eyes) •       Double vision or blurry vision •       Unusual paleness that lasts for more than an hour •       Convulsions (seizures) •       Difficulty recognizing familiar people •       Weakness of arms or legs •       Persistent ringing in the ears If your child does well through the observation period, there should be no long-lasting problems. Remember, most head injuries are mild. However, be sure to talk with your child's doctor about any concerns or questions you might have. The Center for Disease Control and Prevention’s website, www.cdc.gov/traumaticbraininjury also contains a free online training course on preventing sports-related brain injuries in young athletes.

Daily Dose

Paying Attention to the Road

I am always talking to my own children about paying attention to the road and having no other distractions in the car.As I was driving to work today, I routinely go through a school zone. Today was the day that they had motorcycle police using radar and ticketing those drivers who were not following the school zone speed limit. There were a lot of people pulled over getting tickets and a line waiting for the police officer.

This is the same school zone that my children walked through on their way to school, and therefore I am always aware of the speed limit as it is closest to my home. I am always amazed at the number of cars that go speeding by oblivious to the flashing yellow lights. But, I am also sure that I am not as aware of other areas of the city and those school zones. We all get preoccupied while driving and it seems to be related to other things going on in the car. Whether it is children fighting in the back seat, or the noise from a movie on the car DVD player, or the cell phone or blackberry, there are too many opportunities to have our attention diverted. I am always talking to my own children about paying attention to the road and having no other distractions in the car. I even went as far to have the radio disconnected when our oldest started driving (that didn't go over well!) Well, I think "us" parents need to heed the same advice. Stay off the phone in school zones, no texting while driving, and let's not have kids watching TV on their way to school. Instead, how about talking to the children in the back seat. Whether it is weather, sports, spelling words or quizzing math facts, talking to our kids is far better than any thing else we can find to do on the way to school. And if you find yourself in a school zone, and don't have kids in the car, just pay attention to the rules and enjoy the quiet. That's your daily dose, we'll chat tomorrow! Send your question to Dr. Sue!

Daily Dose

Common Thumb Injury

1.00 to read

Have you ever slammed your finger in the door or has your child hit their thumb with the head of a hammer?  If this has happened to anyone in your family you may recognize the bruised and bloodied nail bed, which is called a subungual hematoma.  Essentially this is a collection of blood, like a bruise, beneath the nail. 

This kind of trauma, albeit not life threatening, can cause a lot of pain and discomfort. Because the blood has no where to go due to the overlying protective coating of the nail, the injured finger or thumb just pounds and throbs as the blood pools under the nail.  

If the hematoma is fairly small and the injury minor, the nail just looks dark and the pain goes away fairly quickly and the nail may not even fall off. But with a bigger crush injury and more damage, the hematoma involves the entire nail bed and it is pretty painful and won’t stop pounding.  

The treatment is really fairly simple and I can remember keeping a large paper clip at home for just this reason. With my own children and friends and neighbors, I often was the “hero” Mom for a second or two as I would clean the injured finger and then heat the tip of the paper clip and just “magically” poke a hole through the fingernail to let the oozing blood out!!! Voila, no more pressure or pounding and really no pain with the procedure. Kids loved to watch his trick! 

Modern medicine has advanced and we have now moved to an electric cautery in the office. It does the exact same thing, puts a hole in the nail and relieves the pressure of the blood beneath the nail. It is just a little “slicker” than that handy dandy paper clip. 

So.....here you go, my last patient was happy to oblige with this picture of the procedure and I promise you there were no tears. Maybe a few tears of joy when the nail quit throbbing! 

 

 

 

Daily Dose

Spring Sports Injuries

1.30 to read

With the advent of spring the sport season heralds in baseball, softball, track and field.  This also means that kids need to be prepared to play.   

Professional ball players spend 4-6 weeks in spring training, preparing for the season, but for many kids the spring ball season starts without any real spring training.  Some kids have been less active during the winter, others may have been playing indoor sports, but with spring kids of all ages head outside to “play ball”.  Their bodies may not be quite ready for “full steam ahead” play.  

I am already starting to see both boys and girls coming in complaining of early muscle strains and sprains.  Kids need to get into shape with throwing, hitting, pitching and fielding increasing over time. But no one seems to understand “gradual” these days.  

Kids want to play ball and they may want to impress their coaches as well.  They are being watched to determine who plays which position, batting line up etc. which may make some athletes try to throw too much or too hard as they first start back. 

Parents (and coaches) need to encourage daily pre-activity warm up and stretching followed by light throwing to prepare the body to increase the activity and intensity over several weeks rather than days.  

Kids need to learn proper throwing mechanics which will not only improve efficiency but will control stress on the body.  The shoulder joint is held together almost entirely by muscles. Developing strength and endurance in the key muscle groups that keep the shoulder stable will help to prevent fatigue. 

The same goes for pitching.  Strict adherence to pitch counts, and well as following the recommended rest period between pitching will help to prevent overuse injuries as well. I have already seen a high school baseball player with elbow pain who admitted to me that he was pitching curve balls and fast balls, far over the number that he is supposed to. He does not realize the stress that he is placing on his body, and it is still very early in the season.  He was not thrilled that I told him he need a week off to rest before he started back and then much less aggressively. He has a few more years of high school ball before he even thinks about college baseball and needs to stay healthy. 

Remember to use ice as an anti-inflammatory as well as ibuprofen. And if shoulder or elbows already hurting, try a slower spring re-entry into throwing and pitching. 

There is an American Academy of Pediatrics policy statement on Baseball and Softball with some practical information for parents and coaches and officials.  Check it out at: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2011-3593

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

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