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More Kids Suffering ACL Injuries

2:00

Kids involved in sports like soccer, basketball and football are increasing their odds of damaging their knees, according to a new study.

A common knee injury — an anterior cruciate ligament (ACL) tear — has steadily increased among 6- to 18-year-olds in the United States, rising more than 2 percent a year over the last two decades, researchers report.

These injuries peak in high school, said lead researcher Dr. Nicholas Beck, an orthopedic surgery resident at the University of Minnesota. Girls have a higher rate of ACL injuries, Beck added.

Sports like soccer and basketball often require the child to pivot or cut back and forth, putting stress on their ACL and risking a tear.  Contact sports like football can further increase the risk. But ACL tears can occur in tennis and volleyball, too.

The study didn’t look at why the injuries are on the rise, but co-author, Dr. Marc Tompkins, an assistant professor of orthopedic surgery at the University of Minnesota, has a theory.

“One potential cause is the year-round sports specialization that is occurring in kids at an earlier age,” Tompkins said.

Instead of playing a variety of sports and using different muscle groups, many kids are focusing on just one sport creating muscle fatigue and an increase for injury, Tompkins explained.

“Another potential cause is that children as athletes play with more intensity and force than 20 years ago, which may put the body at increased risk of injury,” he added.

The numbers of girls experiencing ACL tears are rising because their sports participation numbers are up.

Beck hopes this study will increase awareness of ACL tears in young athletes and promote interest in prevention programs or developing athletic participation guidelines.

The anterior cruciate ligament sits in the center of the front of the knee. It’s one of the ligaments that holds the knee bones together. When it tears, the ligament splits into two, causing knee instability, according to the American Academy of Orthopaedic Surgeons.

“ACL injuries are serious in the short term because they generally require six months’ to a year’s worth of hard recovery work before going back to sports. And even then it often takes longer to get back to pre-injury function,” Tompkins said.

“ACL injuries are serious in the long term, too, because we know that even if they recover well with or without surgery, the risk of developing arthritis in the injured knee is higher than before the injury,” he added.

Some sports medicine specialist say there are ways to reduce injuries among young athletes, by having coaches teach good running techniques that promote improved function and agility.

Children participating in sports can also benefit from flexibility and stretching programs.

The researchers found that girls of all ages experienced a significant increase in the incidence of ACL tears over 20 years. In boys, however, only those aged 15 to 16 showed such an increase.

The report was published online journal Pediatrics.

Story source: Steven Reinberg, http://www.cbsnews.com/news/acl-tears-on-the-rise-among-kids-especially-girls/

Daily Dose

Sledding Accidents

Over 20,000 children were seen in the emergency room for sledding accidents. how to keep your kids safe while still having fun.With another major snowstorm hitting most of the East Coast and blanketing the south in ice, it seems like there will be several more “snow days” with children (and their parents) home from school.

I have such fond memories of growing up in Washington, D.C. and the idyllic “snow days” spent outside with our Radio Flyer sleds.  My brother and I would head out the door for the big hill right outside of our house which would become a mecca for the sledders. The street was fairly steep and for that reason was often closed (guess they didn’t make 4 wheel drive vehicles then?), and the hill was perfect for a fast ride that was probably ¼ mile long. The ride down was glorious, the trek back up seemed VERY long.  Those were the days!  We could spend hours out there, only coming in long enough to change out of wet gloves, grab a hot chocolate, and back out we went. I must say, most of the time there was very little adult supervision, and thankfully there were no “major” injuries that I recall. With those memories in mind I decided to do a little research on sledding safety and accidents. An article in the September 2010 issue of Pediatrics reviewed sled related injuries.   Did you realize that there were over 230,000 sledding injuries reported over a 10 year retrospective period, in other words more than 20,000/year and those were only those that were seen in emergency rooms. There were probably many more that went unreported as the child was seen in an urgent care, or private practice rather than ER. Children 10 – 14 years of age were in involved in 42.5% of sledding related injuries and boys represented about 60% of all cases.  WOW! Sleds can reach speeds of up to 20-25 mph and head trauma is one of the biggest concerns.  It is reported that the head was the most commonly injured body part (I feel lucky that I survived those sled races) and that injuries to the head were twice as likely to following a collision. Children 4 years of age and younger were 4 times more likely to sustain a head injury. Other injuries reported from sled related accidents included fractures, contusions and abrasions.  In this study about 4% of cases required hospitalization and of this number nearly half were due to fractures while about ¼ were due to traumatic brain injuries. The injuries were more common when toboggans, snow tubes or discs were used than with traditional sleds that have a steering mechanism. Another interesting finding was that many of the injuries occurred due to the fact that the sled was being pulled by a motorized vehicle which resulted in more collisions. As you well know, the advent of helmets has really helped to prevent injuries from biking, and helmets are now recommended for sledding, skiing and snowboarding.    A report from the consumer product safety commission showed a 58% reduction in head injuries among children less than 15 years of age after helmets were used for skiing and snowboarding. As more and more people wear helmets for these activities one would hope to see a decrease in injuries reported from sledding. To ensure safety while sledding make sure that there is parental/adult supervision at all times. Sledding on streets should be discouraged and never sled where a hill meets a pond which may not yet be frozen. Sledding slopes should be free of tress and other obstacles that might cause collisions.  Children should sit up and face forward and never sled head first. Sleds should never be pulled by a motorized vehicle, which includes a snow mobile.  Sleds with the potential to rotate like discs (I guess that is the flying saucer of old) and snow tubes may carry significant risks, and should be discouraged. With 49 of 50 states currently reporting have snow “somewhere” on the ground make the winter sledding safety a priority and go buy a helmet and have fun. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comments to me. I would love to hear from you.

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Sports Injuries

Daily Dose

Athletes & Injuries

1.30 to read

I see a lot of athletic teens, and while many of them participate in several sports more and more tweens and teens are “specializing” in one sport. In other words, they may only play soccer or basketball, or be a gymnast or a dancer.  In some cases they practice or compete almost 365 days a year. (I think they often are only off on the 6 holidays/year that our office is closed!).  They too work really hard.

I have recently had more than a handful of elite athletes, especially girls who are gymnasts, cheerleaders and dancers, who have come to me complaining of back pain.  In most cases lower back pain is musculoskeletal in nature and will resolve with some anti-inflammatories (like ibuprofen), alternating ice and heat to the back and a few days of rest. But in some cases the back pain worsens, especially with activity and further work up is required.

In several cases the ongoing back pain is due to a spondylolysis, which is a fracture of the pars interarticularis of the vertebrae. It is akin to a stress fracture in other areas.  It is most commonly found in the pediatric population and is thought to be due to mechanical stress of the trunk with repetitive flexion, hyperextension and trunk rotation.  All of those maneuvers are the “usual” for a cheerleader doing back flips or a gymnast doing exercises with hyperextension.  Athletes who are into weight lifting (seems they all do this now) and even children who carry heavy backpacks may be at risk for a “spondy”.

The spondylolysis may show up on a plain X-ray of the back or may require a CT scan to see the fracture.  

In our community there is some difference of opinion on how best to treat the condition.  Unfortunately, it seems that the best treatment is rest which may be for weeks-months.  This is NOT what they competitive gymnast or star football player wants to hear.  

Once the pain has resolved a structured physical therapy program seems to be of benefit as well.  If conservative management for over a year does not help some orthopedists would recommend surgery. Again, there are several different views as to the benefits of surgery in this age group.

But if your child has persistent lower back pain that worsens with activity and hyperextension you should think about this condition and talk to your doctor. It is becoming more prevalent as our kids compete at higher and higher levels.  

Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?

 

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