Common Youth Ice Hockey Injuries and How to Avoid Them

Common Youth Ice Hockey Injuries and How to Avoid Them

by | Oct 17, 2022 | Sports Medicine

Ice hockey is a contact sport that carries a higher risk of injury as the skill and competition level increase. Though ice hockey may not be as prevalent in North Texas as it is in other regions, Scottish Rite’s Sports Medicine team still takes care of injuries from this fast-paced and fast-growing sport.

Rules, such as delaying body checking, change an athlete’s risk of injury. We asked Jacob C. Jones, M.D., RMSK, and Madelyn White, P.T., D.P.T., to answer a few questions about pediatric sports medicine and physical therapy as it relates to ice hockey. Here’s what they had to say.

What do we know about ice hockey injuries?
Injuries occur quite frequently. Even though much of youth hockey prohibits checking and overt contact, that doesn’t entirely eliminate all contact in the sport. Both acute and chronic musculoskeletal injuries happen to hockey players. Concussions are also common in ice hockey players.

Are there different injuries in different age groups or skill levels?
Although many injuries are similar, younger hockey players may have more frequent injuries involving their growth plates since older adolescents may be near completion of growth. As a result, providers should be aware of how any injury may affect a growth plate. This can help provide the best treatment and avoid future complications.

Are there certain considerations when a player returns to the ice after an injury and rehabilitation?
It’s important to allow a gradual return to full participation in on-ice and off-ice training after injury. Be sure to warm up adequately prior to practice and games and avoid playing through pain.

Are ice hockey injuries preventable?
Yes, some of them may be preventable, especially the chronic injuries. Different youth leagues around the world have implemented rules changes regarding checking to help reduce the incidence of acute injuries.

What are tips for a skater to help prevent injuries?
Wearing proper gear, continuing to build flexibility and core strength. Some common injuries include ankle and shoulder injuries. Focusing regularly on exercises that help with the strength and mobility of these areas could help prevent injuries. Many overuse injuries and burnout can be prevented by trying to find at least three months out of the year to do a non-hockey sport or activity.

What should parents know about concussions in ice hockey?
Like other contact sports, these happen even with appropriate protective equipment and rules to avoid contact. Given the unique nature of the sport of hockey compared to other field sports, a treatment plan and return to play program should be tailored to hockey players. Seeing a medical provider familiar with sport-related concussions and hockey can help determine when it is safe to return to the ice, then safe to return to full hockey participation.

Are there exercises to help prevent back pain in ice hockey skaters?
Exercises to maintain hip mobility can help maintain good skating form and avoid back pain during hockey. It’s also important to build up abdominal and glutes strength. Exercises such as planks, banded side steps and crab walks can help prevent low back pain.

Concussion Balance Study

Concussion Balance Study

by | Oct 10, 2022 | Sports Medicine

Learn how we use our Movement Science Lab to evaluate balance testing in sport-related concussion management.

Balance testing is commonly used to assess impairment and recovery after a sport-related concussion in the clinic setting. Measuring imbalances while going through various stances combined with both a firm and foam surface can provide valuable information in the evaluation of a concussion. Scottish Rite’s study, recently published in Brain Injury, was designed to look at how balance performance differed from diagnosis to return-to-play among athletes recovering from a concussion. A standardized test called the Balance Error Scoring System (BESS) is easy to perform in a clinic setting, but it may not provide the level of detail needed for a research study evaluating balance after sustaining a sport-related concussion. By conducting balance testing using the Movement Science Lab’s force plates, or special areas built into the flooring that are sensitive to the weight and force applied, researchers could correlate the BESS results with a highly objective center-of-pressure (COP) measure.

Principal investigator and director of movement science Sophia Ulman, Ph.D., explains the differences between these tests. “The BESS is a subjective test that requires clinical training and practice,” she says. “Alternatively, the force plate used to assess COP provides very specific, multidimensional measures that allow for discrimination of small differences in balance performance.”

It has been well established that there is an increased risk of prolonged symptoms as well as potential for compounding injuries if an athlete returns to play too soon after a sport-related concussion. Although balance is not the only measure used to determine readiness for sport, the proper assessment of balance is an important factor in this decision making. After reviewing data for these two tests in 40 patient-subjects, our team noted that the commonly used BESS test may not provide the information needed to assist with balance assessment as symptoms improved.

What does this mean for providers managing sport-related concussions?

Despite the volume of studies on the topic, the Sports Medicine team is continuing to learn about managing sport-related concussions in young and growing athletes. Pediatric sports medicine physician Shane M. Miller, M.D., says, “Until there is a better test to use in the clinical setting, we will continue to use tests like the BESS to do our best to assess balance improvement and identify the right time to return athletes to their sport. I suspect this will be a conversation for many years.”

The study, “Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures,” was published in July 2022 in Brain Injury, the journal of the International Brain Injury Association.

Does my child need surgery to fix a clavicle fracture?

Does my child need surgery to fix a clavicle fracture?

by | Sep 28, 2022 | Sports Medicine

Pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., along with colleagues from the multicenter study group Factors Associated with Clavicle Treatment Study (FACTS) have published another set of findings in the American Journal of Sports Medicine. This group, like many others in pediatric orthopedics and sports medicine, merges the experiences and data from across institutions to provide the best evidence for care in the pediatric population. This group focuses their efforts on collarbone (clavicle) fractures and injuries in children and adolescents.

Here are some highlights from the publication. You can also visit the journal’s website to read the full article.

  • Midshaft clavicle fractures most often occur in adolescents, yet, most medical evidence is in adults until now.
  • More than 400 patients (10 to 18 years) with 100% displaced clavicle fractures were included in the study.
  • After two years, there was no difference in outcomes between those that had surgery and those that did not.
  • Those who underwent surgery had more nerve damage (loss of sensation on their chest wall) and more second surgery to remove plates and screws.
  • The study conclusion states, “Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function or prevention of complications after completely displaced clavicle shaft fractures in adolescents at two years after injury.”

So, the answer to the question, “Does my child need surgery to fix a clavicle fracture?” is not yes. But, that also does not mean it is no. The study describes the general experience of a large group patients who have and have not had surgery for this condition. The individualized assessment of the patient is still important and necessary, but the study does show that there is not an obvious answer that applies to all patients. “This work is new and very important for the growing body of evidence in caring for this population,” Ellis says. “We can confidently tell families that one path is not yet obviously better than another.” In our individualized patient care, it is important for us to provide evidence-based recommendations, and in our research, we aim to define the recommendations.

This study, Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group, was published in the American Journal of Sports Medicine in September 2022.

Current Concepts: Management of Acute Shoulder Instability in Young Athletes

by | Sep 26, 2022 | Sports Medicine

Watch the full lecture.

Our latest presentation from Coffee, Kids and Sports Medicine covers the management of acute shoulder instability in young athletes. Sports medicine physician assistant Ben Johnson, P.A.-C., dives into the differences in instability patterns between the skeletally immature and skeletally mature shoulder, on-field/acute management of shoulder dislocation and evidence-based recommendations for treatment of first-time shoulder dislocation.
 
Johnson begins the presentation by discussing the epidemiology of shoulder dislocations in high school and collegiate athletes in the United States and explains why it matters. He then shares important insight in how children and adolescents differ from adults physically, especially in relation to the capsular elasticity, a smaller anterior-inferior recess and more. Johnson shows the changes that occur in the shoulder as an adolescent enters puberty, and he discusses how this affects shoulder injuries.
 
Next up, Johnson teaches on-field and acute management of shoulder dislocations in pediatric patients and what medical providers need to know. Acute management includes taking a brief history, initial assessment and considering sport-specific factors. He breaks down when and how on-field reductions should be performed, sharing the benefits of early reductions and red flags to consider.
 
Johnson provides an evidence-based review of external and internal immobilization compliance and outcomes, along with the pros and cons of each method. He then answers questions about operative versus nonoperative treatment, breaking down the consequences of each.
 
To wrap up the presentation, Johnson provides a summary on pediatric glenohumeral dislocation and the steps that should be taken when assessing treatment strategies, as well as sharing a treatment algorithm. The presentation is crucial for sports medicine physicians and other medical professionals who treat young athletes, especially those at a high risk for shoulder injuries.

After an ACL Injury: Physical Therapist Explains Quadriceps Strengthening Progression

After an ACL Injury: Physical Therapist Explains Quadriceps Strengthening Progression

by | Sep 20, 2022 | Sports Medicine

The anterior cruciate ligament (ACL) is a supportive structure inside the knee joint. After it is injured, there are many important areas to focus on during recovery including range of motion, flexibility, strength, balance and core strength. Each of these areas, as well as mechanics with running, jumping, sprinting and cutting, must return to normal before returning to sports.
One area that requires extra attention during recovery is the quadriceps (quad), a group of muscles on the front of the thigh extending to the knee. Due to an injury and after surgery, the body’s response is to “turn off” the nerves to the quadriceps muscle.
What is persistent quadriceps weakness?
Some athletes have quadriceps weakness, and this takes longer to get stronger than other muscles. Unfortunately, this weakness can last years, and bodies will find ways to compensate for quadriceps weakness. However, you may be able to do activities like running and jumping while still having poor quad strength. This is because your hips and ankles are able to compensate, which “hides” quadriceps weakness. This continued weakness can change the way the knee is loaded when running and jumping, which might stress the joint over time.
What is the best way to strengthen the quad muscle?
“There are ways to strengthen the weak quad muscle in isolation,” Physical therapist Jacob Landers, P.T., D.P.T.,O.C.S., CSCS says. “Using a knee extension machine is the most efficient exercise for strength training.” Ideally, strength training should occur three times per week.

Finding the correct weight to use can be difficult, but here are some helpful tips:

  • Set the weight to a challenging amount and attempt as many reps as possible.
  • Try to do a full set with both legs and then repeat the exercise with one leg.
  • If you can do more than 10 reps, add more weight and try again.
  • Repeat this process until the maximum number of reps you can complete is less than 10. This will be your starting weight.

 What comes next?

“Once you have built a base of quad strengthening throughout the first couple of months, work on training different aspects of strength, such as explosiveness and deceleration,” Landers says. Work on performing this quadriceps exercise at faster speeds or performing the lowering phase of the exercise more slowly. Ask for guidance from a strength and conditioning coach or physical therapist for other variations.
This training should be part of a comprehensive program for athletic readiness. Want to know how you can work with our team at Scottish Rite for Children? Read about our bridge program and sign up today!

Hydration Tips for Young Athletes

Hydration Tips for Young Athletes

by | Sep 19, 2022 | Sports Medicine

Our certified sports dietitian Taylor Morrison, M.S., R.D.N., CSSD, L.D., frequently teaches athletes that staying hydrated is an important part of staying healthy. She says, “Our bodies need water to replenish and refuel, especially after exercising or playing sports, and young athletes have different hydration needs than adults.” Each child or teen may have unique needs based on a variety of factors. Taylor shares key tips on how to help keep your young athlete hydrated and healthy.

  • Choose a fun water bottle. Try customizing with team stickers so it’s easy to identify on the sidelines.
  • Add high water content foods like oranges, cucumbers or yogurt to meals to make hydrating more fun.
  • Drink fluids throughout the day. Carry your water bottle or stop by the water fountain between classes.
  • Do not drink a large volume of fluid right before an event or physical activity.
    • This may not fully hydrate or rehydrate the athlete.
    • This may cause stomach discomfort or a trip to the restroom during the event.
  • Drink plenty of fluids during and after the event.
  • Learn what works for different activities.

How Much Fluid Does My Athlete Need?

Fluid needs vary based on age, gender, weight, and even genetics. For young athletes, other factors are just as important, such as stage of development, activity type, and the duration and intensity of activities. For some athletes, the amount of sweat or the composition of sweat may also affect how much and what type of fluid is needed. The below table shows a child’s or teen’s daily baseline fluid needs based on age and gender. Make sure to increase fluid intake above this when active or playing sports.

Hydration Strategy for Sports

Having a plan for staying hydrated is essential for young athletes playing sports or doing other physical activities. A hydration strategy is especially important for athletes who train in extreme temperatures or climates and participate in physical activities that last more than an hour. A good strategy for young athletes is to drink fluids before, during and after physical activity.

Before:
Drink fluids with and in-between meals and snacks throughout the day. Two to fours hours before physical activity, athletes should consume 2.3 to 4.5 milliliters per pound of body weight. This is the minimum amount of water your young athlete should be consuming in milliliters. A 12-ounce water bottle is about 350 milliliters, which is appropriate for pre-activity hydration for a 100-pound athlete.

During:
Athletes 9 to 12 years of age should drink three to eight ounces of fluids every 15 to 20 minutes. Athletes 13 to 18 years of age should drink 34 to 50 ounces of fluids every hour.

After:
Young athletes should drink fluids right after the event or physical activity, as well as with meals and snacks following the event.

When to Drink More Fluids

Special Conditions

Certain conditions can increase an athlete’s fluid needs. These conditions may increase sweat rates, alter the body’s ability to cool itself and increase the body’s core temperature:

  • Hot weather
  • Humidity
  • Altitude
  • Type of sport played
  • Length of activity
  • Clothing
  • Recent illness
  • Certain medications or supplements

More than Water

Water is the first choice for hydration but sometimes a sports drink or salty snack is necessary to replace sodium and other electrolytes lost through sweat and to provide energy from carbohydrates. After puberty, an athlete may sweat more, so replacing electrolytes becomes more important. Some salty snack ideas are sports drinks with six to eight percent carbohydrate, pretzels or salty crackers, cheese, pickles, or broth-based soup or vegetable juice.

A sports drink or salty snack may be needed for the following:

  • High intensity activities lasting longer than an hour
  • Tournaments and back-to-back events
  • Hot conditions, indoors or outdoors
  • Having salt on the skin or clothes after activity

Signs and Symptoms of Dehydration

If your young athlete is experiencing any of the following signs and symptoms, he or she may be dehydrated, and a hydration strategy may be needed.

  • Fatigue early in the game or practice
  • Decreased/poor performance
  • Headache
  • Muscle cramps
  • Overheating
  • Difficulty focusing
  • Urine that is dark in color, like apple juice
  • Low amount of urine

If you suspect that your young athlete is dehydrated, use our strategies above to rehydrate them. If your child is especially lethargic, a call to your medical provider may be in order.

Signs and Symptoms of Heat Illness

Heat illness is a preventable condition, and dehydration is an early sign of heat illness. Respond quickly if you notice any of the following signs of heat illness:

  • Weakness
  • Vomiting
  • Excessive thirst
  • Headache
  • Fatigue
  • Sweating
  • Nausea
  • Light-headedness
  • Confusion or disorientation

If your child is exhibiting one or more of the signs of heat illness, immediately call your medical provider for assistance to determine if treatment is needed. It is important that your young athlete knows these signs and symptoms so that they can recognize heat illness if they experience it.

Additional Support

With practice, a young athlete should learn what hydration strategy works best for training and competition. If you need help, reach out to a medical provider, the school’s athletic trainer or a certified sports dietitian for personalized recommendations.

Learn more about five strategies for keeping your young athlete fueled.

Learn more about hydration and nutrition for young athletes.