The Work Takes Time, But It Makes You Great

The Work Takes Time, But It Makes You Great

by | Jun 22, 2021 | Sports Medicine

18-year-old Caden has always loved baseball. He has been playing since he was 4 years old, and he’s received numerous awards through the years. When he was just 12, he was awarded Perfect Game’s Super25 MVP pitcher. As a teenager, he was included in Perfect Game’s All-Tournament Selection, Pre-Season All-American and All-Region teams. Caden plays second base mainly, but he has seen time at shortstop and center field. He is also a phenomenal, right-handed pitcher.
 
In 2018, Caden began to have pain in his right elbow, so he visited pediatric orthopedic surgeon Philip L. Wilson, M.D., at the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. “I knew they had an excellent orthopedic program, and I was aware that Dr. Wilson had worked with many high-level athletes,” says Alan, Caden’s dad. “He is very well respected in elbows and shoulders.”
 
Wilson explained that Caden’s elbow pain and inflammation was caused by repeated stretching of the ulnar collateral ligament (UCL), a tight band of tissue on the middle side of the elbow, from throwing. There are two important components to treatment. First, the ligament needs time to heal, so rest from throwing and pitching is crucial. Then, properly timed rehabilitation focused on strength and flexibility of the shoulder and trunk helps the young athlete return to their pre-injury status. After his prescribed rest, he slowly returned to throwing with a strategic 8-week interval throwing program which gradually increases the quantity and distance of throws. The program also encouraged Caden to focus on proper form with every throw to reduce the risk of reinjury. “I was extremely pleased with Dr. Wilson’s entire staff,” says Caden.

Caden utilized additional resources in his recovery to further improve his flexibility and strength and to further reduce his risk of reinjury. Near his home in Rockwall, Caden completed formal physical therapy and a strength and conditioning program with practitioners knowledgeable in the shoulder and pitching programs. These programs helped build Caden’s strength, not only in his arm but in his core and back as well. “It’s not just one muscle – it’s a combination,” says Alan. “It’s getting everything working and firing together so he can handle the stress of pitching.” Physical therapy was humbling at first for Caden. “I saw charts with the average strength levels of collegiate and professional athletes compared to my strength level in high school and saw how long I had to go,” he says.

After six months of physical therapy, Caden was on the field with his teammates at Rockwall-Heath High School performing at the highest level. He was named 1st Team All-District for infield this season, and on June 12, he and his teammates won the UIL 6A High School State Championship. Caden was also named MVP of the game. Caden graduated high school this year and has received a scholarship to play baseball at Northern Oklahoma College in Tonkawa, OK.
 
Alan advises both young athletes and parents to pay attention to any inflammation and soreness that the child is feeling. “Always err on the side of caution and rest when you are dealing with pain,” he says. “If it’s not better after about a week, I recommend scheduling a consultation with Scottish Rite.” Wilson advises any athlete with activity-related pain to have an assessment by an athletic trainer or sports medicine specialist.
 
“Caden is a prime example of an athlete properly responding to pain. He rested, he rehabbed and he’s back at a very high level. If he had continued to throw, he might have ended up tearing the UCL and requiring a longer period out of baseball and possibly surgery. So many are concerned about missing a season, but he’s right – taking recovery seriously pays off in the end.“ – Philip L. Wilson, M.D.
 
Caden hopes his story can help other young athletes understand the recovery process so they won’t get frustrated when it seems like it is taking too long. “The steady work grind takes time, but it’s what makes you great too,” he says. “I think with shoulder care, it’s important to understand that stretching is not just a warm-up but truly a part of your overall pitching program.”

A Soccer Injury Won’t Slow This MVP Down for Long

A Soccer Injury Won’t Slow This MVP Down for Long

by | May 25, 2021 | Sports Medicine

During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.

The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.

While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”

Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.”

In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.

 

Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.

Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. 

 

“Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”
A Soccer Injury Won’t Slow This MVP Down for Long

A Soccer Injury Won’t Slow This MVP Down for Long

by | May 25, 2021 | Sports Medicine

During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.

The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.

While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”

Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.” 

In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.

Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.

Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. “Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”

Young Athletes and Heel Pain

Young Athletes and Heel Pain

by | May 18, 2021 | Sports Medicine

Skeletally immature athletes, those that are still growing, have unique conditions that occur in the growth centers of the bones. Heel pain in adults is caused by different issues because their growth centers are closed. Sports medicine physician Jacob C. Jones, M.D., RMSK, says, “This is one of the most common conditions we see in the developing athlete. Though it is a condition that does not have lasting problems or require aggressive treatment, it can really disrupt an athlete’s training and competition. Following guidance for rest, cross-training, improving ankle mobility and delaying specialization can help to keep the heels game-ready.”

What are growth centers? 
The medical term for a growth center is a physis. The physis is an area of the bone that has soft tissue called cartilage that is later replaced by new bone cells. Some are areas where bone growth makes bones longer. Others, called apophyses, give the bones a unique shape. These growth centers are found in the elbow, pelvis, heel and other areas. The apophyses are attachment sites for tendons.

What growth center is in the heel?
The calcaneal apophysis is in the calcaneus (heel bone). The apophysis is the attachment site for the very strong tendon from the calf muscle, called the Achilles tendon.

What causes heel pain in the calcaneal apophysis?
Children become more committed to sports around 8-12 years old. With running, or repetitive jumping, the Achilles tendon pulls on the cartilage in the heel. This, accompanied by the impact on the ground with running and jumping, can lead to irritation in this area. Because this has a gradual onset, this is referred to as an overuse injury and is often referred to as Sever’s disease.

What is Sever’s Disease?
Sever’s disease, or calcaneal apophysitis, is a type of overuse injury and the most common cause of heel pain in active children ages 8-12. It is caused by repetitive movements, like running and jumping and may occur in only one or both sides. The pain is usually not related to a specific injury and comes on gradually.

What is the treatment for Sever’s disease?
Changing shoes or adding heel cups may be recommended to help with comfort during recovery. Simple ankle stretching exercises may also be helpful. Other treatments are available and should be considered on an individual basis, but rest is the most common prescription for this condition. Returning to a sport and other physical activity may gradually prevent recurrence. Pain may last months to years and may come back or worsen with increased sport or activity.

How long does Sever’s disease last?
Sever’s disease will resolve with completion of growth in this area. Because the growth plate is soft until it is closed, this problem can happen again in this age group. Pain in this area typically resolves by the mid-teenage years.

What factors may increase risk of initial or recurrent Sever’s Disease?

  • Playing sports on a hard surface or barefoot.
  • Footwear with poor cushioning, such as soccer cleats.
  • Year-round sports participation.
  • Sudden increase in training intensity.
  • Increase in duration or frequency of activity, such as tournaments and camps.
  • Tight Achilles tendon or calf muscle.

Learn more about Sever’s disease in this popular short lecture featuring sports medicine physician Jane S. Chung, M.D.

Keep Pushing

Keep Pushing

by | May 12, 2021 | Sports Medicine

17-year-old Jazzy has been playing basketball since she was 3 years old. Her mom, Krystal, first began to see signs of Jazzy’s gift for the sport when she was in fourth grade. “She was tenacious,” says Krystal. “She was really good.” As Jazzy got older and continued to play basketball, she became involved with Trey Athletes, a nonprofit organization that helps high school athletes become leaders, role models and influential voices for their communities. “I love it so much!” says Jazzy. “It’s super fun and definitely very educational. I learn a lot about myself and things like my college experience, so I am grateful for that.”

As a sophomore at Frisco’s Liberty High School, Jazzy played on the UIL 5A State Championship team and was recognized as M.V.P. at the 5A State Championship. Soon after this, COVID-19 brought all organized sports to a halt, so Jazzy couldn’t play for several months. Once things began to open again, Jazzy was ready to get back on the court for Amateur Athletic Union (A.A.U.) practice, but she stepped wrong and felt her leg give out on her.

Krystal found out about the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco from Jazzy’s assistant coach. When she brought Jazzy to meet with pediatric orthopedic surgeon Henry B. Ellis, M.D., he determined that she had torn her Achilles tendon and that surgery was needed to repair it. “Dr. Ellis was great,” says Jazzy. “This was my first surgery, so there was definitely a lot of doubt and questioning. He made the experience so much better, and I was very comfortable, and I trusted him through the process.”

After a successful surgery, Jazzy’s natural tenacity and the strong sense of self and resilience developed as Trey Athletes helped her get through a long physical therapy process. “It was definitely a mental struggle more than anything just because I would be fighting with myself more so than my body,” says Jazzy. “But it was a great process. I learned a lot, and I feel like I got better, even with the rest of my body.” Krystal was very impressed with physical therapist Jessica Penshorn, P.T., D.P.T., A.T.C., L.A.T., and physical therapy tech Timothy Nuckols. Although it was hard work, Penshorn and Nuckols made the experience enjoyable for Jazzy, and she looked forward to going every day. “J.P. and Tim are one of the best teams that I’ve seen,” says Krystal. “We are trying to figure out ways to go back to see them. I’m like, ‘Jazzy, does anything else hurt?'”

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After another winning season at Liberty, she and the Redhawks fought for the state championship again in 2021. For her performance in that game, Jazzy was named to the 5A All-Tournament Team. Today, Jazzy says that she feels great and that she is 100% recovered. As she continues to build her strength in certain parts of the game, Jazzy realizes that she wasn’t as strong as she thought she was before surgery. “Now, the stretches and exercises that I did in physical therapy have become a part of my whole process of playing basketball,” she says. “These ways of strengthening my legs are things that I’ll keep with me forever.” Jazzy hopes to play basketball in college and says her recruiting process is very open right now.

Jazzy tells other young athletes with injuries not to get discouraged. “You can have a bad moment, that’s understandable, but don’t let it turn into a day, a week or even a month,” she says. “Just have that moment, recollect and keep pushing.”

Want to learn more about the exercises J.P. recommends to young basketball players? Check out this article and warm-up program designed to help prevent injuries like Jazzy’s. 

To Brace or Not to Brace? And Other Bracing FAQ’s in Pediatric Sports Medicine

To Brace or Not to Brace? And Other Bracing FAQ’s in Pediatric Sports Medicine

by | Apr 21, 2021 | Sports Medicine

The opinions about bracing joints to address or prevent injuries in youth sports are constantly evolving. The objective comparison of one brace to the next is challenging because of the many variables associated with the conversation. Age, type of brace, joint flexibility, sport, level of competition and many other factors come into play. Additionally, there are hundreds of braces on the market that promise to protect a joint or offer relief from an injury.

What is an orthotic?
An orthotic is the medical term for braces and splints that provide support or protection to muscles, joints or bones. Our sports medicine team provides splints and braces after an injury when appropriate. Athletic trainer Josh Stevens, A.T.C., L.A.T., says, “Most sport-related injuries do not need a cast, but braces offer immobilization and provide protection of the joint while it is healing.” Since braces are removable, they have a lower risk of complications than a cast and can be an appropriate treatment for a fracture.

Braces and orthotics range from off-the-shelf, or ready to wear, to custom designed and fabricated for a single patient. We asked Scottish Rite orthotist, Kelsey Thompson, C.P.O., to respond to common questions from patients. 

Off-the-Shelf
Some braces are easily found online and in sporting goods stores and pharmacies. These offer a range of benefits. These may include compression to reduce swelling in a new injury or stability to prevent movement in a specific direction. These do not require the orthotist to participate in selection, fit or adjustments.

Should I wear an ankle brace to play basketball?
There’s not one answer for everyone. There isn’t evidence to show that an ankle brace is going to prevent an injury. For athletes that have ankle injuries or ankle instability frequently, a comfortable, well-fitting brace or properly applied ankle tape may be helpful.

What is a patellar tendon strap?
In older teens, a condition called patellar tendonitis may cause pain in the front of the knee. The strap is placed across the middle of the patellar tendon, the short, tight band between the patella (kneecap) and the lower leg bone. The pressure on the middle of the tendon changes the intensity and direction of the tension (stretching) that causes the pain with movement.

Semi-Custom Braces and Orthotics
In some cases, an orthotist may be involved in measurement, selection or modifications to these braces. 

Are all shoe inserts the same?
Shoe inserts are often recommended to help reduce foot pain from flat feet or high arches. The purpose of a shoe insert, also called a foot orthosis, is to provide stability to a flexible foot or support to a rigid (inflexible) foot. Since every foot is unique, an athlete may try several inserts before finding one that works.

Proper foot positioning will help an athlete by providing a solid foundation for movement. The foot is considered the beginning of the kinetic chain, a series of mobile and stable joints and muscles working together to produce movement and control. An orthotist evaluates the mobility and function of the foot and ankle to design a custom foot orthotic when off-the-shelf options do not provide the support needed.

Why do some football players wear a knee brace?
You might notice that football linemen often wear a brace on each knee. These hinged braces have been shown to protect the knee joint from stresses to a ligament on the inside of the knee, the medial collateral ligament. This ligament may not withstand the forces of tackles in these strong, and typically, larger players. These braces are made in many sizes and require a good fit and proper application to be effective.

Custom Braces
An orthotist participates in the measurement and recommendation for these devices. Some are even fabricated from raw materials for the patient in our orthotics and prosthetics lab.

After an anterior cruciate ligament (ACL) reconstruction, will I have to wear a brace to play sports?
Every case is unique. Some athletes do need a custom or semi-custom functional knee brace to return to contact or sports that require a lot of change in direction. Our physical therapy team provides functional and sport-specific rehabilitation to enhance intrinsic protection (muscle and nerve control and power inside the body) to reduce dependence or eliminate the need for an external brace. Depending on the patient’s maturity and extent of injury determines how long the brace needs to be worn. The goal of the brace is to prevent re-injury to the ligament that was surgically repaired.

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Are there injuries that require long-term permanent custom braces?
Yes, in cases like Scottish Rite MVP Kalen, a significant joint injury can cause nerve damage. When a nerve is no longer able to “talk to” a muscle, the muscle will no longer do its job. For Kalen, a traumatic knee injury left him unable to lift his foot putting him at risk of tripping when walking, running and playing football. The orthotist fabricated an ankle foot orthosis (AFO) that fit inside his normal shoes and could also be worn with his custom knee brace. The AFO was flexible enough to allow running but prevented the footdrop that might cause tripping.

What advice do you have for young athletes?
If I had to pick one piece of advice, I would remind them that flexibility and stretching are so important. Here at our Frisco campus, we see a lot of patients with flat feet or low back pain and most of them would benefit from regular stretching to increase their flexibility. Look for sports and activities that promote flexibility. Choose a supportive shoe with an off-the-shelf insole is also a great option to add to prevent unwanted aches, pains and injuries. Kids grow very quickly and without proper stretching, they can get tight. Encourage them to actively stretch or even try sitting on the floor with their legs straight when playing a video game.

Learn more more about pediatric sports medicine.