Is that sports form due again?
Every year, schools and athletic organizations require that you see a Raleigh, NC, pediatrician to complete a sports physical. So, what are the most common sports-related problems we see at Carolina Kids Pediatrics? For many of the conditions listed below, check out my favorite pediatric orthopedic website, www.orthoseek.com, for more information on how to recognize and recover from sports injuries.
(1) Ankle sprains: Ankle sprains are common, and often cause swelling and pain on the outer portion of the ankle. Many can be treated with a simple splint, maybe crutches for a week or so, ice for a day or two, rest, and ibuprofen. Often a strengthening program is a good idea before a gradual return to sports (for example, tracing the alphabet in the air several times with your toes, using elastic bands with resistance to strengthen ankle muscles, etc.) Growth plate fractures can look like sprains, so if there is pain over bone or your child is limping a lot, please come and see us.
(2) Patellofemoral pain: This is typically considered an overuse injury and referred to as “patellofemoral syndrome.” Pain in the front of the knee is due to pressure overload on the kneecap or patella. In young athletes, this is often due to different degrees of muscle imbalance and high activity levels. It’s important to strengthen, stretch and condition the quadriceps muscle in the thigh if this occurs, in order to stabilize the kneecap. Bicycling and other low-impact activities can help – check out the Orthoseek website above (look under “chondromalacia patellae” under the topics listed) to learn more.
(3) Osgood-Schlatter disease: Osgood-Schlatter disease is an injury at the growth place at the top of the tibia (the bump in your knee under your kneecap). The traction comes from strong and relatively tight muscles (that develop during puberty) and high activity levels. Pain and sometimes swelling can be felt directly over a bump at the bottom of the knee. Treatment includes rest, stretching, ice, ibuprofen, and possibly an over-the-counter knee strap. Although this condition can be painful, it seldom causes serious injury.
(4) Little League elbow & shoulder: This is why growing kids have “pitch count” limits in baseball! These conditions cause pain at the growth plates either on the inside of the elbow or the shoulder. It’s important not to ignore elbow (or shoulder) pain in growing baseball or softball players. If these growth plates are injured significantly, they can require surgery to repair. Early Little League elbow and shoulder injuries often go away with rest, stretching and attention to proper throwing form.
(5) ACL tears: Unfortunately, this injury occurs far too often in young athletes. The anterior cruciate ligament (ACL) is a stabilizing ligament of the knee that is torn during an uncontrolled twisting motion. It almost always requires surgery in young people. While there is a high rate of return to sports after this injury, it is safest to wait at least 7-9 months before considering a return to play.
(6) Hand or wrist (fractures/sprains/tendonitis): Fractures of the wrist usually occur with a fall on the outstretched hand. If swelling at the wrist and pain with movement occur, there is likely a sprain or fracture. An x-ray is typically needed to tell whether the wrist is broken. Many milder wrist fractures can be treated with a cast or splint for several weeks.
(7) Concussion: Concussion usually occurs from a direct blow or rapid turning of the head. Common symptoms and signs include headache, dizziness, nausea, or slowed thinking. The main treatment for a concussion is rest, which means no sports, plenty of sleep and brain rest, including minimal use of electronics and school work. Young athletes may be more susceptible to concussions and may require a longer period of rest for their brains to return to normal function. According to the Gfeller-Waller concussion law, you will need to see a medical provider, such as a Raleigh, NC, children’s doctor at Carolina Kids Pediatrics, or (in more severe cases) a neurologist or sports medicine physician, to complete a return-to-learn and return-to-play plan. Gradual increase in mental and physical activity as symptoms subside is recommended.
(8) Dehydration: Most athletes who become dehydrated are simply not drinking enough. A cup for every 15-20 minutes of activity is a good rule of thumb. Other factors that can lead to dehydration include exercising in the heat, drinking too much caffeine or having a viral illness. Extreme thirst, headache, nausea, abdominal pain and muscle cramping are common signs of dehydration. If an athlete suffers from dehydration, they should stop exercising and drink plenty of fluids. Young athletes may be more prone to dehydration because their thirst drive is not as well developed.
(9) Shin splints: Pain in the front of the shins with running can indicate an overuse injury, excess pressure in the tissues in the front of the leg, or sometimes a stress fracture of the tibia (shin). Rest, ice, compression sleeves, and elevation are often enough to treat shin splints, but if pain persists, if pain is severe, or if it is localized to one area, ruling out a stress fracture is a good idea.
(10) Heart problems: Although rare in children and teenagers, some of the most serious sports-related health problems are heart-related. If your child every faints during exercise, or experiences significant chest pain, dizziness, or palpitations (sensations of an abnormally rapid heartbeat) with exercise, it’s important to come in to Carolina Kids Pediatrics to evaluate this further with an exam, and sometimes with an EKG or further cardiology evaluation. These can be warning signs of an underlying cardiac problem.
Remember that the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina are here seven days a week to help address any sports-related injuries or problems your child experiences.
Like all pediatricians in Raleigh, North Carolina, and beyond, we at Carolina Kids Pediatrics spend a good bit of our summer completing sports physical forms – and a fair bit of the rest of the year managing some of the injuries that result from sports.
In last week’s blog, we talked a little bit about how to prepare your child for an upcoming sports season. This week, I’d like to address a few common sports injuries, and how to recognize them.
As a pediatrician in Raleigh, NC, these are some of the most common sports injuries I see, and what to do about them:
PATELLOFEMORAL STRESS SYNDROME: A common issue in teenagers – the complaint is usually a vague pain around the knee cap that worsens with going down stairs or squatting. This is caused by uneven movement of the knee cap across the knee joint, leading to inflammation and pain behind the knee cap. It’s often fixable with low-impact exercises that strengthen and stretch the thigh muscle and help it hold the knee cap in the right place as it moves.
ANKLE SPRAIN: This is usually due to stretching or tearing of the ligaments on the outside of the ankle when the foot turns in during a stumble or fall. An ankle brace or wrap, elevation, ice for the first day or two, and crutches for 2-3 weeks may be needed depending on the severity of the injury. What’s even more important is rehabilitation after the sprain. When the brace comes off, it’s important to strengthen the ankle before going back into full sports mode. Simple exercises like tracing the alphabet in the air with your toes are a start, with a gradual increase in training and activity until the ankle is strong enough for running and jumping. Kids get into trouble when they go straight from wearing an ankle brace to participating fully in their sport without proper rehabilitation.
OSGOOD-SCHLATTER DISEASE: Doesn’t that sound awful? It’s not as bad as it sounds, but it does hurt. The bony bump right below the knee cap (called the tibial tuberosity) has a growth plate in growing tweens and young teenagers. With a lot of running and jumping, this one spot right under the knee cap can become painful and swollen. A flexible knee brace can help, as can ibuprofen and ice. However, the ultimate cure happens when this bone stops growing in the mid to late teen years.
SEVER DISEASE: Same problem, different spot. There is a growth plate in the back of the heel which can become painful and inflamed with running and walking in tweens and young teenagers. The treatment is heel cord stretching, sometimes a soft gel heel lift in the shoe, and pain medications like ibuprofen.
SHIN SPLINTS: Pain in the shins with running can be due to swelling in some tight spaces, or compartments, in the front of the lower legs. If this is the case, ice and ibuprofen are the immediate treatment, and the pain should go away quickly with rest. It can be useful to decrease the intensity of training, and build up more gradually toward a goal. However, if pain continues at rest, particularly if it always remains in one spot, this can be a sign of a stress fracture (small break in the bone from over-exertion) - this may need orthopedic treatment and a prolonged period of rest and rehabilitation.
LITTLE LEAGUE ELBOW: If your young pitcher frequently hurts on the inside of his/her elbow, beware. There are growth plates here too, and pain on the inside of the elbow in a growing pitcher can be a sign of bone injury in this location. If it goes untreated, it can require surgery to heal, but injuries caught early can often be treated with rest and physical therapy. Be sure your child’s coach follows strict pitch limits – no more than 350 throws per week – to avoid this problem. A similar problem is also possible higher up – “Little League Shoulder”, which involves the growth plate in the upper arm.
A nice website for reading more is https://www.niams.nih.gov/