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Sports Medicine Research Featured at National Meeting

Sports Medicine Research Featured at National Meeting

by | May 24, 2023 | Research & Innovation

Several of our physicians and trainees attended the American Medical Society for Sports Medicine (AMSSM) annual meeting recently. At this event, individuals are selected to share progress and results on projects that impact the care of athletes of all ages. Our team shared several pediatric-focused studies. Additionally, Jane S. Chung, M.D., served as faculty for a pre-conference event teaching participants how to transform a clinical question into a successful research project. Each of these activities reflects our organization’s commitment to provide the best care, continued learning and teaching through research and academic endeavors. Here are several projects our Center for Excellence in Sports Medicine research team, and trainees, extensions of our team, presented at this meeting.

AMSSM Grant-Funded Project Presented by Lead Investigator
Jane S. Chung, M.D., is conducting a study with the Movement Science Lab team to evaluate movement in pediatric ballet dancers. The larger project includes evaluating demographics, surveys and movement data to determine how ballet dancers respond to training demands of the art. The project presented at this event is titled, “Athletic identity and Injury Patterns in Pediatric Ballet Dancers,” and began to explain how ballet dancers think about their identity as an athlete and found that pediatric ballet dancers, particularly those who trained more and reported a prior history of injury strongly identify with their sport.

 

The purpose of the AMSSM Foundation Research Grant Award program is to foster original scientific investigations by members of AMSSM. Research proposals that investigate issues within the broad discipline of sports medicine will be considered, including clinical practice, injury prevention and rehabilitation, basic science, epidemiology and education. – 

Sport-Related Concussion Projects Presented by Trainees
David Mikhail, B.S., is a medical student at UT Southwestern Medical Center who presented “A Longitudinal Evaluation of Differences Between First and Second Concussion Among Pediatric Patients.” In collaboration with faculty mentor Shane M. Miller, M.D., David reviewed 31 pediatric cases in The North Texas Concussion Registry (ConTex).

A man is giving a presentation at a conference called rising to the challenge | CAMS RISING THE CHALLENGE A Longitudinal Evaluation of Differences in Presentation Between First and Second Concussions in Pediatric Patients UT Southwester SCOTTISH RITE ConTex SAMSS

Comparing variables between sport-related concussions within and between patients, the study aimed to identify the effects of a second concussion on young athletes. Findings included:

  • Pediatric patients presented similarly following first and second concussion and demonstrated similar time to return-to-play.
  • Neurocognitive abilities were not shown to be negatively impacted by a subsequent concussion.

Also representing data from the ConTex registry, Joshua A. Beitchman, M.D., M.B.S., UT Southwestern Medical School second-year resident in pediatric neurology, presented “Endophenotype presentation of athletes with concussion contingent upon sex and time since injury.” Working closely with his mentor and pediatric sports neurologist, Mathew Stokes, M.D., Dr. Beitchman, used a complex system called phenotyping to begin to explain the very difficult task of identifying treatment strategies earlier in the care of concussions. He says, “since concussed athletes experience symptoms differently based on sex and time since injury, predicting outcomes or the prognosis is challenging.” This study is making progress on these challenges in treating athletes with a concussion. A specific direction coming out of this effort is to further evaluate how mood and sleep affect recovery and learn interventions that will address these successfully in this population.

SM EDICINE Annual Meeting SAMESH Co-Authors RISING THE CHALLENGE. A man stands at a podium at an annual meeting

Pediatric Musculoskeletal Ultrasound Expert Shares Results of Novel Study
Sports medicine physician Jacob C. Jones, M.D., RMSK, presented “Increased Ultrasonographic Humeral Retrotorsion in Young Overhead Athletes with Little League Shoulder or Elbow.” This study adds to a small, but growing volume of evidence in the use of musculoskeletal ultrasound in the evaluation and research of pediatric sport-related conditions.

Comparing the shoulders of throwing athletes with and without shoulder or elbow pain with similar athletes in other overhead sports such as gymnastics, the study aimed to describe how the bone is remodeled, or changed, with a high volume of throwing. This study will aid in the understanding of growth-related, training-related and sport-related changes in the shoulder with sports that have a high volume of throwing such as baseball. In particular, studies like this will help to understand why some athletes develop pain with these activities and some do not.

With Her Knees Back in Sync, Abbee’s Ready to Take It From the Top!

With Her Knees Back in Sync, Abbee’s Ready to Take It From the Top!

by | Aug 18, 2022 | General News, Sports Medicine

A woman in a green jumpsuit is dancing on a stage .

Abbee, age 16 of Denton, isn’t like most kids her age. She attends a unique online school just so that she can devote as much time as possible to her true passion – dancing. She is dedicated, spending more than 40 hours a week practicing her dance, earning an invitation to participate in an exclusive pre-professional program at The Joffrey Ballet School.

Abbee dances all day, every day and is determined to pursue a career as a professional dancer. “I knew from a young age that this is what I wanted to do forever,” she says. When Abbee began noticing that her knees were “buckling” while she was dancing, she knew something was wrong. “It would happen while I was dancing, and it would take me out of dance for a few days until the pain went away,” Abbee says. “Eventually, it was happening so often that we decided it was time to see a doctor.”

Abbee visited our Sports Medicine clinic in Frisco to see Jane S. Chung, M.D., pediatric sports medicine physician for Scottish Rite for Children who has a passion for caring for female athletes and dancers. After discussing her history, performing a physical exam and reviewing X-rays and an MRI, Dr. Chung explained that Abbee’s kneecaps sit higher than normal. This position of the kneecap is referred to as patella alta and it can cause patellar instability or patellar subluxation, which is a partial dislocation of her kneecap. Chung reviewed the treatment options, ranging from physical therapy (PT) to surgery. As many patients do, Abbee chose a nonoperative approach first. She began PT to strengthen the muscles in her knees right away, working with physical therapist Jessica Dabis, P.T., D.P.T., O.C.S., to complete exercises to reduce the frequency and hopefully prevent dislocations. After completing PT, Abbee returned to her rigorous dance schedule, and she noticed that her knees felt much stronger.

Abbee visited with pediatric sports medicine surgeon Philip L. Wilson, M.D., and pediatric orthopedic nurse practitioner Chuck Wyatt, M.S., CPNP, RNFA,  who described the procedure and recovery and put her at ease. In November 2021, Wilson reconstructed the torn MPFL, which also corrected her patella alta. This procedure should prevent the instability episodes in this knee. Abbee began PT with Jessica Dabis at Scottish Rite again to rehab her left knee following surgery, working to get back to dancing

Soon after her surgery, Wyatt and Wilson determined that Abbee’s right knee also had a torn MPFL. Abbee knew this meant she would likely need another surgery, but she wasn’t worried. “I was already going to be out for this entire dance season, why not just get them both done and be completely healthy?” Abbee says. She continued PT of her left knee while preparing for surgery for her right knee, just 59 days after her first surgery. After surgery, Abbee was extremely diligent about her rehabilitation, following every instruction.

A woman in a green leotard is standing on one leg on a stage .

She continued PT through July 2022, strengthening the muscles in her knees and following her therapist’s prescribed dance-specific rehabilitation progression. This included a step-by-step return to dance skills and movements, building up from modified to full-out participation. She’s now back to doing what she loves most, dancing, and is so thankful for the team at Scottish Rite for helping her get where she needs to be. 

“Having two back-to-back knee surgeries before the age of 16 is never something I imagined for myself,” Abbee says. “But now I am so extremely proud of myself for making that difficult decision because now I can go back into dance confidently knowing that my knees will be better. I won’t have that fear that my knees will partially dislocate. This entire experience at Scottish Rite has truly changed my life for the better, and I couldn’t have asked for a better team and medical care.”

WE ENJOY HEARING ABOUT OUR CURRENT AND FORMER PATIENTS’ SUCCESS STORIES. TELL US ABOUT YOUR MVP. 

Muscle Strain Q&A

Muscle Strain Q&A

by | Apr 22, 2022 | Sports Medicine

Our world-renowned sports medicine experts are ready to help your injured athlete get back in the game. We have unparalleled experience providing nonoperative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip in young and growing athletes.

Sports Medicine expert Jacob C. Jones, M.D., RMSK, shares information about muscle strains and how to handle these types of injuries in young athletes.

What is a muscle strain?
A muscle strain is a disruption of the muscle fibers in a certain muscle group. Muscle strains can be mild or they can be severe, causing muscle tearing.

What causes a muscle strain?
Muscles are constantly being pushed and pulled, but when a muscle contracts at the same time that it is being pulled, a strain can occur. This type of muscle movement is called an eccentric contraction. 

What are the symptoms of a muscle strain?
In mild strains or low-grade muscle disruptions, the most common symptom will be pain in the area. Severe disruptions or tears can also cause swelling, more noticeable weakness, and even bruising.

Should you seek medical treatment for a muscle strain?
It is definitely wise to seek medical treatment for muscle strains. In mild cases, a young athlete may want to consult with their athletic trainer for advice and recommendations on reducing the pain. Athletic trainers can also help determine whether the athlete needs to see a physician for the injury.

Relative rest, in combination with muscle rehab, is the best treatments for a strain. It is important to allow the muscle to heal while also building strength and flexibility to avoid further injury. Even in high grade muscle tears, surgery may not be commonly recommended. 

Are certain muscles more at risk for strains?
Yes, muscle groups that are at the highest risk for strains are those that cross multiple joints. For example, some hamstring and quadricep muscles cross both the hip and knee joints and calf muscles cross the ankle and knee joints. Any muscle can be strained, but those groups are more likely to be injured.

How can you avoid muscle strains?
Muscles are less likely to have a strain if they are flexible and strong. Stretching daily can help provide your muscles with more flexibility and strength. Additionally, it is important to also warm up your muscles before working out or playing a sport. Muscles are less likely to strain or tear when they are warm, so it is important to not skip warm-ups before practice.

What does recovery from a muscle strain look like?
Once pain allows, it is important to do some rehabilitation to the muscle before returning to regular activity. In mild strains or low-grade disruptions, recovery time may take weeks. In more severe cases that lead to muscle tears, recovery time may take months. We look for good range of motion, minimal to no pain, and good strength prior to return to sport.

What happens if an athlete returns to sports or activity before the strain is healed?
The biggest risk of returning to athletics or sports too soon is re-aggravating the muscle and extending the recovery time. Additionally, having a strain may cause you to favor one leg or arm and could lead to further injury.

How can ultrasound be used to diagnose and treat muscle strains?
Specially trained experts can use musculoskeletal ultrasound to evaluate injured joints, ligaments, tendons, muscles and bones. Ultrasound can visualize soft tissues like muscle well with a high level of detail. When looking at a muscle using ultrasound, a low-grade strain may show some edema, swelling caused by fluid in tissue, while a more severe strain that has already torn will clearly be visible. Using ultrasound can also allow physicians to determine where additional treatment or care is needed in treating muscle strains. Ultrasound can also be used for treatment of chronic muscle tears not improving with other conservative measures.

Sports medicine is a medical and surgical specialty that considers the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our Center for Excellence in Sports Medicine and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work side-by-side with each athlete, their parents and coaches to develop the best game plan for treatment, rehabilitation and safe return to sport.

Keeping Up with the Count: Hip Health in Dancers

Keeping Up with the Count: Hip Health in Dancers

by | Oct 20, 2021 | Sports Medicine

Dancers and other performing artists place demands on their hips that are unlike those of other athletes. Movements push the range of motion of their hips to extreme ends from an early age. They must have the flexibility for turnouts, leaps, or grand battements, and also absorb dramatic forces from leaps and jumps. All of this while maintaining impressive limb control and stability of their support and gesture limbs over sustained periods.

Key Considerations for Hip Health for Dancers

  1. Mobility in the hip and surrounding muscles.
  2. Balance and stability in the pelvis and core.
  3. Managing training volume.

Hip Mobility
Turnout and extreme ranges of motion during dancing and other performing arts often require more than “normal” hip mobility. For some, the end of the thigh bone in the hip is naturally in a position of retroversion, which allows for the extreme external rotation needed for turnouts. Others have soft tissue laxity, also called joint hypermobility, that predisposes them to successfully achieve the extremes in rotation, extension, flexion, and abduction (out to the side, such as a la seconde) required for their art form. Dancers with natural hypermobility may be more likely to continue, whereas others may “self-select” out of the sport.

Dancers that are not born with these factors may acquire laxity in the joint with many years of training and aggressive stretching of the muscles and soft tissue that make up the hip capsule.

Proper supervision and a comprehensive program are necessary to ensure the stretching does not cause hypermobility in the lower spine. Additionally, extreme motions may cause damage to the labrum, a soft tissue rim that stabilizes the hip in the socket. Therefore, prompt response to signs of pain with mobility should be addressed to avoid damage to the soft tissue, and ultimately the bones in the hip.

Pro Tip: When the core stabilizer muscles don’t support the lower spine, the hip muscles, including the flexors or hamstrings, are forced to provide support. This protective tightness is an undesirable compensation and can be corrected by doing core stabilization exercises.

Pelvic and Core Stability
Mobility of the hip and leg is dependent on having a stable platform. Core stability means abdominal strengthening to many, but there are deeper muscles that must be considered, including:

  • Gluteal muscles – deep hip rotators that help to maintain active turnout and appropriate knee alignment in the posture leg with grand plies and more.
    • Gluteus maximus (hip rotation and extension)
    • Gluteus medius (hip rotation and abduction)
  • Transverse abdominis – deep abdominal muscles

Imbalances and weakness of these muscles cause stress on other joint tissues, including the capsule, labrum, and ligaments. Stretching or stressing beyond their limits can cause pain and injuries in those non-muscular tissues, which then shifts more demand to the muscles around the hip to provide extra support at end ranges of motion. The body then uses other muscles like the hip flexors to stabilize the hip and support a high volume of hip flexion with a turned-out leg, as seen in dance.

A consequence of this demand or overuse of a muscle is muscle tendinitis, the inflammation of the tendon part of a muscle. This condition worsens when there are sudden spikes in the frequency or duration of training, particularly when there is inadequate support from the core to control the pelvis during repeated hip flexion movements.

Stability Exercises:

Abdominal Hollowing Technique
To prevent this chain of compensation, a dancer can learn how to activate the transverse abdominis, the deep abdominal muscles. These muscles help to create a stable base prior to limb movement. Activation of these muscles is described as a “hollowing” technique as the belly button is pulled inward toward the spine. This contrasts with a “bracing” technique that activates the superficial abdominals.

Pro Tip:
A dancer should be able to do an active straight leg raise without any arching of the lower back during the movement. For added abdominal/core muscle activation, use a band for a pull-down during the straight leg raises. This prepares a dancer for flexion associated with high kicks and grand battements without anterior pelvic tilt.

Gluteal Medius Strengthening

Example exercises:

  1. Single leg glute bridge
  2. Kneeling, side plank, hip abduction raises
  3. Clamshell side planks
  4. Side plank development

Pro Tip: It is important to learn to use the gluteus medius instead of the spinal muscles, called the quadratus lumborum, with abduction motions out to the side (a la seconde) or in the posture leg.

Manage Training Volume
Poor form and muscle fatigue can cause undesirable compensations with other soft tissues and muscles, and may lead to direct tissue injury in the joints or muscles. As overuse injuries worsen with time, performance suffers when the muscles are fatigued.

Pay attention to sudden increases in training duration or intensity, such as fall preparation for The Nutcracker, when added to typical training classes because it can leave a dancer vulnerable to injury. Dancers should take a day off one to two times each week for recovery. Proper rest can help prevent injuries, so you stay healthy throughout the season.

Nutrition Tips for Dancers

Nutrition Tips for Dancers

by | Aug 19, 2020 | Sports Medicine

Mix it Up

With long practices or multiple sessions a day of different intensities, the young dancer should be sure to include a variety of fuel sources, including protein, carbohydrate and healthy fats in meals and snacks.

  • Protein, carbohydrate and fat are all considered macronutrients. They are the nutrients that provide our bodies with energy.
  • Different intensities of training use different macronutrients for fuel.

Spread it Out

While dance is considered one of the sports that values leanness, it’s important to remember that the young dancer is still going through growth and development that requires extra energy and nutrition. Plus, they are expending extra energy for their sport. Make sure your dancer is getting three balanced meals a day and at least a couple of snacks.

Start Out Right

If your young dancer has trouble eating before a practice or competition, try snacks containing simpler carbohydrates about 30 to 45 minutes before the event. These snacks are easily digested and provide energy for the upcoming event. Snacks ideas include:

  • Fruit
  • Pretzels
  • Crackers
  • Plain mini bagels
  • Small juice or sports drink

Add a Snack

Your dancer might need a pre-event snack if he or she:

  • gets dizzy or light-headed during practice.
  • gets shaky during practice.
  •  is having trouble concentrating.
  • complains of fatigue during practice.

Pack a Lunch

When packing lunch for a long day of practice, mix up items from these categories:

  • Carbohydrates: bread, pasta, quinoa, rice, fresh fruit, potatoes, winter squash, peas, beans, yogurt, milk
  • Protein: turkey, chicken breast, lean ground beef, chicken or turkey, eggs, tofu, beans, yogurt, milk
  • Veggies: greens, carrots, cucumbers, peppers, mushrooms, squash, brussels sprouts, etc.
  • Healthy fats: nuts, seeds, nut or seed butter, olive oil, vegetable oils, avocado, salmon and tuna

End it Right

After a long and intense practice, the best snack is one that provides:

  1. carbohydrate to refill depleted energy stores in the muscle.
  2. protein to repair any damaged tissues.
  3. fluid to rehydrate the body.

For the best recovery, aim to get this snack within 30 to 45 minutes after practice.

Change it Up

A dancer’s nutrition plan and needs will not be the same every day. Remember that needs change based on length and intensity of training sessions. Needs on the day of a performance may not be the same as needs on a day of summer intensives.