REPOST: For young athletes, injuries need special care

Sports medicine is a need for athletes of all ages to help their bodies heal from injuries quickly and get back to top form. Laura Landro of the Wall Street Journal writes about the growing need for physical medicine departments of pediatric hospitals to accommodate teen and preteen athletes.

Children's hospitals are expanding programs to care for a fast-growing category of young patients: injured athletes.

Kaylyn Lambertt, a high-school soccer player and now a freshman at Florida State University, had surgery on her left hip her junior year and her right hip her senior year. Image source: wsj.com

The rehabilitation needs of children and teens are different than those of adults. More sports medicine programs are working exclusively with young athletes, using surgical techniques and physical therapy protocols that don't interfere with growing bones and cartilage.

One aim of this is to prevent affecting the growth plate—the area of growing tissue near the end of long bones in children and teens. For example, while adults may lift heavier weights to build muscle during physical therapy, pediatric patients may do higher repetitions with lower resistance to avoid hurting growing bones, muscles and tendons. The programs also offer encouragement and support for kids upset to be sitting out of a beloved sport.

More than 3.5 million children a year receive treatment for sports injury, according to Stop Sports Injuries, a campaign whose backers include the American Orthopaedic Society for Sports Medicine. And high-school athletes account for an estimated 2 million sports injuries each year. While concussions account for about 15% of youth sports injuries, experts say many sports carry risks for musculoskeletal injuries, in large part due to increased emphasis on year-round competition, single-sport concentration and intense training regimens.

A study published last year by Boston Children's Hospital warned that children of all ages are sustaining significant sports injuries that require surgical intervention. "In the past we'd put a cast on a broken leg, take it off six to 13 weeks later and send kids home," says Lyle Micheli, director of the hospital's division of sports medicine. "Now we realize we have to very systematically rehabilitate these kids for strength and basic function, and determine when it is safe for them to return to play."

Image source: wsj.com

While injuries from recreational activities such as biking have fallen over the last decade, team sports including football and soccer saw injuries rise by 22.8% and 10.8% respectively, according to a study last year by Cincinnati Children's Hospital Medical Center.

Doctors are seeing more overuse injuries. There has been a fivefold increase since 2000 in the number of shoulder and elbow injuries among youth baseball and softball players, according to Stop Sports Injuries.

Children's Hospital & Research Center Oakland, in California, last fall opened a Sports Medicine Center for Young Athletes at its Walnut Creek campus. "It's hard for kids to do rehabilitation next to an 85-year-old stroke victim or a 75-year-old cancer patient," says Nirav Pandya, the center's director, and an orthopedic surgeon. The center and many other pediatric clinics offer classes and programs to help kids improve sports performance while avoiding injury.

Physical therapy after injury and surgery, such as repair to the anterior cruciate ligament in the knee, is covered by insurance for varying periods. After that, clinics may design a regimen children can perform at home or at a local fitness facility.

Jeremy Frank, a pediatric orthopedic surgeon at Memorial Healthcare System's Joe DiMaggio Children's Hospital in Hollywood, Fla., says that there is often little pain a week after minimally invasive ACL surgery, so young people "think they are good to go and don't realize they have six months of rehabilitation in front of them." Often, he says, there is a "bargaining moment" where his young patients try to get him to approve more activity than they are ready for. Patients are generally referred to Memorial's two U-18—for Under 18—physical rehabilitation clinics in Coral Springs, Fla., where therapists work with families and coaches to stress the importance of healing.

Dr. Frank, U-18's assistant director, says while the vast majority of athletes get back to sports and do well, there are times when a young patient sustains multiple injuries such as a third ACL tear. "You have arthritic changes in your knee, and you have to stop playing soccer," he says.

Dylan Rupert, 17, a running back and captain of the Cypress Bay High School football team in Weston, Fla., tore his ACL during play last fall. His parents opted for a repair technique, which surgeons are more often using in pediatric patients. The procedure avoids drilling through the growth plate and may decrease risks of future pain and re-injury. The surgery used part of Dylan's own hamstring rather than a cadaver tissue more commonly used in adults. He started rehab at Coral Springs three days after his Oct. 22 surgery.

The injury was devastating for Dylan. It came just as he was getting the attention of college coaches, says his mother, Monica Puga-Finch, an information technology program director at the clinic's parent Memorial. In his first physical therapy session, senior therapist Whitney Chambers helped calm his fears, but "told him that she was going to push him, and he couldn't say 'I can't.' " As the sessions continued twice a week he would often come out sweating and sore but excited, "with a sense of accomplishment," Ms. Puga-Finch says. Ms. Chambers helped with the emotional aspects of being sidelined, encouraging him to go to practices and games with his team. His rehabilitation is expected to take six to eight months. He plans to return to sports in college.

Ms. Chambers says physical therapy after the growth-plate sparing procedure is more conservative than for the traditional ACL reconstruction. It starts with protective weight bearing exercises using crutches and a knee brace, gentle range of motion work, and ice and electrical stimulation for swelling and pain control. Then she works on strengthening muscles and restoring joint flexibility. To make it more fun, she uses games or obstacle courses.

The clinic uses screening questionnaires to identify kids at risk of depression, who may be referred to a child psychologist.

Kaylyn Lambertt who has played soccer from the age of 6, was a junior in high school when she felt a searing pain in her left hip during a game in December 2010. She continued to play for months as it got worse. Her labrum, part of her hip joint, was torn in two places, with a socket out of place. A lump on her bone was wearing down the cartilage every time she walked or ran. She had surgery to repair the damage in 2011, followed by months of rehabilitation with Ms. Chambers.

She returned to soccer her senior year, but began feeling pain, this time in her right hip. Dr. Frank told her that she had torn the labrum. She underwent a second surgery in December 2012. She returned to Ms. Chambers and realized during their talks that "soccer isn't everything." Now a freshman at Florida State University she plays a pickup game of soccer now and then, but is focused on what Ms. Chambers inspired her to chose as a career: physical therapy.

Dr. Mary Kneiser has behind her two decades worth of experience as a physical medicine and rehabilitation specialist. Visit this Facebook page for more updates.

REPOST: What Kids Should Know About Spinal Injuries in Sports

Laura Landro discusses efforts to raise awareness of a little-understood but dangerous risk to young athletes: injuries to the cervical spine which can lead to paralysis or even death. More from this Wall Street Journal article.

There is a new push to alert high school athletes about neck injuries.
(Image source: wsj.com)

It could be a hard tackle in football, a cross-check in ice hockey or a fall off the top of a cheerleading pyramid.

A new push is under way to raise awareness of a little-understood but dangerous risk to young athletes: injuries to the cervical spine, the highly vulnerable area between the first and seventh vertebrae that protects the spinal cord connecting the brain to the body. Players and teammates may not instantly recognize the severity of the damage, and the wrong move can damage or sever the spinal cord, resulting in paralysis or even death.

In addition to programs to educate coaches, parents and students, a number of groups are pressing for more certified athletic trainers who are qualified to quickly recognize and respond to spinal and other injuries.

Though less common than concussions, cervical-spine injuries most often occur when players in contact sports lower their head or tuck their chin into their chest and collide with another player, the ground or objects such as goal posts. While players often recover from injuries such as fractures of one or more vertebrae, commonly referred to as a broken neck, cervical spine injuries can also be quickly fatal.

De'Antre Turman, a 16-year-old Atlanta-area high school football player, died in August after being injured during a scrimmage, suffering a fracture to his third vertebra on the field, Fulton County Medical Examiner investigator Mark Guilbeau said in a telephone interview.

San Diego-based Athletes Saving Athletes co-founder Tommy Mallon, kneeling, conducts a demonstration with volunteer Danny Kolts during a 2012 seminar.
(Image source: wsj.com)

The Centers for Disease Control and Prevention estimate as many as 20,000 spinal-cord injuries occur annually in the U.S., with sports accounting for about 12%, and new cases most often occurring in 15-to-35-year-olds.

Robert Cantu, chief of neurosurgery at Emerson Hospital in Concord, Mass., and medical director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill, says new rules put in place in 1976 to discourage headfirst contact in football—known as "spearing"—aren't consistently followed.

The number of reported cervical-spine injuries that lead to permanent or temporary neurological damage, such as partial or complete paralysis, remains small but appears to be on the rise. The center's Annual Survey of Catastrophic Football Injuries in high school and college last year found that in four of the previous 10 years, the number of such injuries that led to some paralysis was in the double digits—14 in 2008, for example—after dropping into the single digits throughout the 1990s. Many severe spinal-cord injuries in sports also go unreported, Dr. Cantu says.

Coaches who were surveyed told the researchers that they teach players to tackle with the head up, but many players still lower their heads before making contact and many ball carriers are injured with their heads down.

"There is a sense of invulnerability in young athletes who think it's not going to happen to them," says Ron Courson, director of sports medicine at the University of Georgia. In addition to training players on proper blocking and tackling techniques, his team practices injury response scenarios on the field with trainers, physicians and emergency responders before football season begins.

At Penn-Trafford High School in Harrison City, Pa., there are three athletic trainers on staff for the 1,600 athletes in grades 9 to 12, says Larry Cooper, head athletic trainer. Parents can attend classes for coaches about injury risks and a sports emergency action plan is available on the school's website.

While college athletic programs nearly always have athletic trainers on staff, the National Athletic Trainers' Association says only two-thirds of U.S. secondary schools with athletic programs have access to full- or part-time athletic trainers, who are typically licensed by the state and work under the direction of physicians. That's up from 40% to 45% in 2005, but leaves a third of schools without one, the nonprofit association says. The group is conducting a state-by-state ranking of public schools and a similar study on private schools to determine why schools don't have trainers. (Expense is one factor.) The group also is analyzing the medical care available at games when an athletic trainer isn't present.

Athletes Saving Athletes graduate Tucker Boucher, left, with fellow San Diego-area student-athletes. ASA focuses on sports safety education and injury prevention.
(Image source: wsj.com)

"Parents who would never leave their kids off at a public swimming pool without a lifeguard think nothing about dropping them off at football or soccer without an athletic trainer. But they need to ask who is taking care of their kids when they are participating in these sports," says Jim Thornton, president of the athletic trainer association and director of sports medicine and athletic training at Clarion University in Clarion, Pa.

The association issued recommendations for management of cervical-spine injuries in athletes in 2009 which include special care in removing a helmet, face mask and shoulder pads and immobilization techniques on the field. Erik Swartz, an athletic trainer and associate professor at the University of New Hampshire who co-wrote the recommendations, says one of the highest risks in a spine injury is moving an athlete.

Tommy Mallon, now 22, collided with another player during a lacrosse game in 2009 at Santa Fe Christian high school in Solana Beach, Calif. A teammate ran to his side but fortunately didn't attempt to help him up until athletic trainer Riki Kirchhoff got to the scene. She kept Mr. Mallon on the ground until emergency medical responders arrived.

At the hospital, he was diagnosed with a fracture in his spine at the C1 vertebra and a damaged artery restricting blood flow to the brain. After months of grueling rehabilitation, including traction in a massive "halo" device to immobilize his head and neck and physical therapy, he was able to start classes at the University of San Diego in the spring of 2010. Though he won't be able to play contact sports again, he sustained no permanent neurological damage.

Mr. Mallon and his mother, Beth Mallon, a photographer who was at the game when his injury occurred, formed a nonprofit group, Advocates for Injured Athletes, to help other families navigate the challenges of injuries and lobby for certified athletic trainers at every high school.

Last year the Mallons also launched Athletes Saving Athletes, a program which offers classes taught by athletic trainers to help student-athletes understand signs and symptoms of different types of sports injuries and conditions. About 1,500 athletes in the San Diego area have participated and Ms. Mallon aims to expand the program. "We can educate athletes to recognize basic symptoms, and if they suspect a neck injury, don't move them. Don't touch them. Just stay with them until help arrives," she says.

Tucker Boucher, 16-year-old junior at Cathedral Catholic High School in San Diego, says after going through the program, he talked to his lacrosse team about risks and how to recognize symptoms of injury. His mother, Annie Boucher, who also attended a session, says the training "empowers these kids with knowledge of certain situations that can save somebody's life."

Dr. Mary Kneiser works with athletes as they regain their strength and form after suffering an injury. Learn more how physiatrists help injured athletes get back on their feet on this Facebook page.