More Than Checking the Box: Effective Pre-Participation Physical Evaluations Help Young Athletes

More Than Checking the Box: Effective Pre-Participation Physical Evaluations Help Young Athletes

Often buried in a long to-do list, the sports pre-participation evaluation (PPE) is something that deserves our full attention. The intent of the annual, required physical is to address concerns before they are a surprise in an athletic environment. Some screening is designed to pick up more concerning issues than others, but an effective evaluation has the potential to protect a young athlete’s playing time and set them up for optimal performance.

Sports medicine physician Jacob C. Jones, M.D., RMSK, says, “It’s really not meant to be about the permission to participate, it’s meant to reduce the risk of emergencies. When implemented properly, the PPE is effective at identifying the most critical issues.” Jones describes the value of the PPE that helps the athlete on and off the field.

Annual Visit with the Primary Care Provider
Some young athletes may only see their primary care provider for this required activity. This gives the provider an opportunity to address issues beyond safe sports participation, such as developmental and mental health screening, wellness guidance, and education on age-specific topics like menstruation and substance abuse.

Awareness of Family Medical History
A family history of cardiac issues, diabetes, sickle cell trait and other conditions may not be discussed in families if not prompted by a screening tool like the PPE. Improved awareness of family history can help individuals and families make positive changes to reduce the risks of modifiable conditions. Learn how to discuss your family’s medical history before a PPE. 

Reduced Time Out of Sport for Injuries
The musculoskeletal screening portion of the PPE is a quick assessment of the strength and function of the trunk, arms, and legs. Any complaints of pain, especially activity-related pain, should be addressed before the season begins. Many conditions, especially overuse injuries, will have better outcomes if they are recognized and treated early. Proper counseling for injury management and tailored rest will reduce the risk of these problems. Learn more about common overuse injuries.

General Wellness Education
Athletes are at a high risk of missing the mark with nutrition, either due to unrealistic goals for aesthetic sports such as dancing or gymnastics or unintentionally not meeting their nutritional needs for training and competition. The PPE looks for patterns of injuries or other signs that an athlete may be underfueling. Learn more about underfueling.

Learn more about pediatric sports medicine.

Wellness in Youth Sports: Tips for Parents and Coaches of Young Athletes

Wellness in Youth Sports: Tips for Parents and Coaches of Young Athletes

In a medical education series, Jane S. Chung, M.D., and Taylor Morrison, M.S., R.D., CSSD, L.D., informed pediatric health care providers about the role of wellness in recovery and injury prevention. Health care providers are not the only ones to influence young athletes and their choices to prepare for and recover from sports. Tips for Parents and Coaches
  • Teach your athlete to listen to his or her body. Hunger, pain and fatigue are signs that the body is not prepared to tolerate training.
  • Encourage proper fueling for the activity. Consider the duration and intensity of the activity and give specific suggestions to meet appropriate pre-event nutrition needs.
  • Support proper hydration throughout the day, not just around activity.
  • Use positive language when talking about food and sport-specific bodyweight goals.
  • Speak up when performance declines. Talk to the athlete about sleep, eating habits and stress management so you can act quickly when you are concerned.
  • Listen without judgment.
More Tips for Coaches
  • Choose appropriate training load, intensity and duration. The physical and psychosocial demands of training need to be enough for growth and improvement, but not so much that it causes injuries or illness.
  • Integrate recovery into your schedule of training. Cross training and in-season rest days can support better performance and reduce time on the bench.
  • Learn, model and actively teach athletes positive coping skills to manage stress.
Learn more about training load, recovery and young athlete wellness in the summary of Chung and Morrison’s latest lecture.
It’s a Whole New Game: Bridge Program Helps Young Baseball Players

It’s a Whole New Game: Bridge Program Helps Young Baseball Players

When a child or adolescent baseball player completes physical therapy for an elbow or other injury, his needs still look different from those of their peers. Bridge Program Coordinator Ian Wright, P.T., D.P.T., CSCS, USAW, answered the five “W’s” about what a bridge program can do for these athletes.

Who should participate in a bridge program?
Growing muscles, joints, and bones in boys and girls are at an increased risk of injuries from improper training and repetitive activities that occur in baseball and other sports. After recovery from an injury and discharge from physical therapy, all athletes would benefit from a strength and conditioning program to balance sport-specific training sessions. An athlete with a current injury should not start a bridge program without activity clearance from the medical provider.

What is a bridge program?
A bridge program is a series of group training classes led by a certified strength and conditioning coach. The coach evaluates the athlete’s movement patterns and provides instruction while supervising specific exercises with proper repetitions, resistance, and rest. Activities range from general strength and conditioning to sport simulation activities that are age- and task appropriate for each athletes. Education to complement the physical activities includes nutrition and hydration information for young athletes.

When is a bridge program appropriate?
A bridge program is most effective when it closely follows rehabilitation closely. Because poor movement patterns are associated with growth and increased injury risk, an ongoing or periodic conditioning program provides value to the young athlete at any point. The instructor must have a solid understanding and commitment to off-season periodization. Periodization is selecting the appropriate type of intensity of training based on the sports season.

For example, for baseball players, three seasons are considered:

  1. Off-Season: August – November
  2. Pre-Season: December – February
  3. In-Season: March – July

Periodization becomes more difficult when athletes participate in a single sport year-round which is also associated with an increased risk of injury.

Where can an athlete participate in a bridge program? 
The program should be implemented in a setting where there is access to equipment for the young athlete to train in a safe environment. For example, an at-home exercise program may have limitations for the athlete because they do not have enough space to perform their activities with the needed equipment. Additionally, proper supervision is important, both the ratio of participants to instructors and the qualifications of the instructors must be considered.

Why should young baseball players participate in a strength and conditioning program?
Physical therapy typically focuses on the specific impairment or limitations caused by the injury or condition. Though sports-focused therapists integrate total body treatment throughout, the sessions may end long before the body is back to normal. Most home exercise programs revolve around continued, supervised resistance training. Young athletes have limited access to well-trained instructors that consider total body conditioning, growth and development, skill acquisition, seasonal periodization, and individualized effective strengthening prescription. When left on their own, athletes are at an increased risk of a new injury or re-injury when they return to sport specific regimens of practice, games, tournaments, coaching clinics, and self-guided training.

Scottish Rite for Children in Frisco is offering training classes to former patients, Contact our Therapy Services team at 469-515-7150 or bridgeprogram@tsrh.org.

Learn more about Osteochondritis Dissecans (OCD) in the Elbow.

Rising Elite Gymnast

Rising Elite Gymnast

When 12-year-old Julia began gymnastics eight years ago, her coaches immediately recognized her strength, focused attention and determination. They knew she could be great. Julia continues to prove them right and has earned her spot on the Hopes team at Plano’s World Olympic Gymnastics Academy (WOGA). Hopes is a pre-elite program for gymnasts under the age of 14 to begin their journey through the Elite Program, where National Team coaches look to find the next generation of Olympians.

While preparing for the Hopes Competition season, Julia was practicing new gymnastic skills progressions, which required her to land on her left leg repeatedly. She began experiencing soreness in her hip, and her coach could tell that something was wrong by the way she was moving. She suggested that Julia get it checked out to prevent further injury. Her mom, Heather, brought Julia to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Texas. She was seen by sports medicine physician Shane M. Miller, M.D., who is very familiar with the demands of gymnastics.

Miller recognized that Julia had an injury to a growth center where the hamstring tendon attaches to the pelvis, called the apophysis. The apophysis is made of soft cells called cartilage that will later be replaced by bone. In growing athletes Iike Julia, the apophysis is vulnerable to injury from repetitive activity. Until Julia finishes growing, this activity-related inflammation called pelvic apophysitis could continue to be a problem.

Fortunately, surgery is not required to treat the condition, so the Scottish Rite team developed a care plan focused on physical therapy to get Julia back in the gym for the USA Gymnastics (USAG) Development Camp. Physical therapist Lorenzo Vite, who frequently works with elite and pre-elite gymnasts, worked closely with Julia to help her achieve her goal. “We began by assessing musculoskeletal dysfunctions. Once dysfunctions were identified, we started low-impact movement skills and then we put her into our brand new Hydroworx® underwater treadmill to allow the muscles to work without too much stress,” says Vite. “From there, we progressed her to strengthening programs, monitoring her all the time to make sure that we didn’t exacerbate the hip pain.”

Julia enjoyed the variety of exercises that she did with Lorenzo. “At first, physical therapy was hard, but after a little bit, it all started getting easier,” she says. Over the course of eight sessions, Vite carefully managed and monitored Julia’s progress until they believed that she was able to perform. After she passed a rigorous functional test with flying colors, they knew that she was ready. Julia performed well in the USAG Development Camp in October and is continuing to compete pain-free!

Although COVID-19 slowed everything down for a while, it did show young athletes how taking time off can be beneficial. “In the gymnastics culture, people always think that you shouldn’t take any time off, but the pandemic showed us that if you miss some time and if you do it right, you can come right back and avoid injury,” says Heather. “In some cases, girls came back stronger in their core, which made them stronger gymnasts.”

Young athletes often feel like they have to play through the pain, so they don’t let their team or coaches down. Both Julia and Heather encourage other young athletes to speak up when something doesn’t feel right. “Talk to your coaches about it and tell them what’s happening,” says Julia. “Make sure that they know, so they don’t push too hard because you don’t want to hurt yourself.” Injuries may be treated quickly early on, but if athletes continue to practice and compete at a high level, it may become much worse, taking them out of their sport much longer. “Missing practice to go to Physical Therapy, does not mean you are falling behind or not getting stronger,” says Heather. “You are actually getting even stronger by going through physical therapy.”

Today, Julia continues her exercises to help prevent future injuries, and she is using everything that she has learned through this experience to help her fulfill her dream of competing in the Olympics!

Rising Elite Gymnast

Rising Elite Gymnast

When 12-year-old Julia began gymnastics eight years ago, her coaches immediately recognized her strength, focused attention and determination. They knew she could be great. Julia continues to prove them right and has earned her spot on the Hopes team at Plano’s World Olympic Gymnastics Academy (WOGA). Hopes is a pre-elite program for gymnasts under the age of 14 to begin their journey through the Elite Program, where National Team coaches look to find the next generation of Olympians.

While preparing for the Hopes Competition season, Julia was practicing new gymnastic skills progressions, which required her to land on her left leg repeatedly. She began experiencing soreness in her hip, and her coach could tell that something was wrong by the way she was moving. She suggested that Julia get it checked out to prevent further injury. Her mom, Heather, brought Julia to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Texas. She was seen by sports medicine physician Shane M. Miller, M.D., who is very familiar with the demands of gymnastics.

Miller recognized that Julia had an injury to a growth center where the hamstring tendon attaches to the pelvis, called the apophysis. The apophysis is made of soft cells called cartilage that will later be replaced by bone. In growing athletes Iike Julia, the apophysis is vulnerable to injury from repetitive activity. Until Julia finishes growing, this activity-related inflammation called pelvic apophysitis could continue to be a problem.

Fortunately, surgery is not required to treat the condition, so the Scottish Rite team developed a care plan focused on physical therapy to get Julia back in the gym for the USA Gymnastics (USAG) Development Camp. Physical therapist Lorenzo Vite, who frequently works with elite and pre-elite gymnasts, worked closely with Julia to help her achieve her goal. “We began by assessing musculoskeletal dysfunctions. Once dysfunctions were identified, we started low-impact movement skills and then we put her into our brand new Hydroworx® underwater treadmill to allow the muscles to work without too much stress,” says Vite. “From there, we progressed her to strengthening programs, monitoring her all the time to make sure that we didn’t exacerbate the hip pain.”

Julia enjoyed the variety of exercises that she did with Lorenzo. “At first, physical therapy was hard, but after a little bit, it all started getting easier,” she says. Over the course of eight sessions, Vite carefully managed and monitored Julia’s progress until they believed that she was able to perform. After she passed a rigorous functional test with flying colors, they knew that she was ready. Julia performed well in the USAG Development Camp in October and is continuing to compete pain-free!

Although COVID-19 slowed everything down for a while, it did show young athletes how taking time off can be beneficial. “In the gymnastics culture, people always think that you shouldn’t take any time off, but the pandemic showed us that if you miss some time and if you do it right, you can come right back and avoid injury,” says Heather. “In some cases, girls came back stronger in their core, which made them stronger gymnasts.”

Young athletes often feel like they have to play through the pain, so they don’t let their team or coaches down. Both Julia and Heather encourage other young athletes to speak up when something doesn’t feel right. “Talk to your coaches about it and tell them what’s happening,” says Julia. “Make sure that they know, so they don’t push too hard because you don’t want to hurt yourself.” Injuries may be treated quickly early on, but if athletes continue to practice and compete at a high level, it may become much worse, taking them out of their sport much longer. “Missing practice to go to Physical Therapy, does not mean you are falling behind or not getting stronger,” says Heather. “You are actually getting even stronger by going through physical therapy.”

Today, Julia continues her exercises to help prevent future injuries, and she is using everything that she has learned through this experience to help her fulfill her dream of competing in the Olympics!

Common Injuries in Volleyball: Recognize Them and Reduce the Risks

Common Injuries in Volleyball: Recognize Them and Reduce the Risks

Sports medicine physician Jane S. Chung, M.D., has a special interest in caring for young female athletes. She worked to let coaches and parents of young volleyball players know about injury risk and prevention in the sport.

Download the Volleyball Safety Sheet to share with parents of teammates and coaches.

Like many sports, volleyball comes with some inherent risks. This popular, fast-paced, explosive-natured sport requires players to react quickly, swiftly generate power from the legs and arms and perform movements repeatedly. Year-round, intense competition adds to the challenges for preventing overuse injuries and burnout. However, strategic rest periods and following appropriate safety recommendations can help decrease injury risk and help keep these athletes on the court.

COMMON PROBLEMS FOR VOLLEYBALL PLAYERS

Knee Pain and Injuries
Pain in the front of the knee is a common complaint from growing, active females. A proper strength and conditioning program can help prevent this discomfort and improve the alignment of both hips and knees for more power in squatting and jumping. Activity-related pain should not be ignored. Landing awkwardly from a jump can cause sprains and tears to ligaments and other soft tissue in the knee. A swollen knee after an injury warrants removal from play and an evaluation.

Finger Injuries
Blocking high-speed hits and setting the ball can put the fingers at risk of being jammed, fractured or dislocated. While jammed fingers typically heal with rest and ice, they can sometimes cause injury to ligaments and cartilage, which may require closer evaluation. If you are unsure or if pain and swelling do not subside with rest, it is best to have a medical evaluation.

Ankle Injuries
Ankle injuries are common in many sports, including volleyball, and typically occur while changing direction or landing on another player’s foot after a jump. Mild ankle sprains are often treated with RICE (Rest, Ice, Compression and Elevation). Repeated sprains, more severe sprains or an inability to bear weight may require an X-ray, evaluation and rehabilitation.

Shoulder Pain
The repetitive overhead motion of serving and hitting the ball can lead to pain in and around an athlete’s shoulder. Without ample recovery time, the tissue cannot adapt to the stress, and the muscle, tendon, bone or cartilage can be damaged. If pain persists after resting the injury for a couple of days, it is best to have a medical evaluation. For further information on shoulder pain, please visit Sports Medicine

Concussions
Liberos seem to be at the greatest risk of concussions in volleyball, but a hit or fall can happen to any player. An athlete with any symptoms or change in behavior, thinking, or physical functioning after a blow to the head or body should be suspected of having a concussion. This athlete should be removed from play immediately, even if there was not a loss of consciousness. The athlete should not return to play the same day as the injury and should have a medical evaluation.

Groin Injuries
Defensive moves require rapid changes in direction and speed, which can cause the adductor muscle group (inner thigh) to become overstretched. Pain from a muscle strain to this group may occur suddenly or over time. A medical evaluation is appropriate if the condition persists or occurs repeatedly.

Low Back Pain
Back pain that persists or does not get better with rest should not be ignored. Promptly addressing it can keep it from worsening. Overuse injuries such as a stress fracture (spondylolysis) in the lower back can develop from repeated hyperextension common in volleyball. Studies have found that volleyball players with a history of ankle sprains may be at a higher risk of low back pain. Strength and conditioning programs that include core training will help to prevent back pain.

TIPS TO HELP PREVENT INJURIES IN VOLLEYBALL

Play Smart and Be Aware of the Environment 

All coaches want their players to hustle, but it is equally important to make smart plays.

Communicate
Volleyball is truly a team sport where one athlete cannot shine without the others.

Pre-Participation Evaluation (PPE) 
A PPE is an essential first step in injury prevention.

Dynamic Warm-Up
A dynamic warm-up involves continuous movement in preparation for competition or practice.

Stay Hydrated
Whether, indoors and outdoors, an athlete’s performance can be impacted by even mild dehydration.

Rest
Take a day or two off from volleyball each week to let the shoulder rest even if there are no symptoms.

Wear Appropriate Gear
Athletes should wear properly sized shoes that are tied correctly and are appropriate for the playing surface.

Learn more about pediatric sports medicine.