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INTRODUCTION: Einstein Healthcare Network in Philadelphia presents Doc Talk, with Dr. Donee Patterson, a board certified, family physician and our Director of Medical Community Outreach. In these podcasts Dr. Donee sits down with our medical experts to discuss health topics important to you. In this podcast, Dr. Donee talks about youth sports injuries. Dr. Donee take it away.
Patterson: Hello. We thought it was important to talk about youth sports injuries because it is so common nowadays in the US and other countries. About more than 5 million youths are treated in hospital emergency rooms each year for sports related injuries. You can imagine how many other children are actually hurt, that actually don't show up in our emergency rooms. We wanted to talk today about some ways to prevent; we always want to talk about prevention and some things that we can do for treatment once those injuries occur. Today we have Dr.Rosemary Boehm; did I say your name right Dr. Boehm?
Patterson: Thank you so much for joining us. We want to know, what can parents and coaches do in general to help their children be safer in sports?
Boehm: That's a great question. First of all, my most important thing is when you have your child and you are trying t o get him into a sport, find a sport they like; find a sport they want to play, because if they want to play it and they like it they are going to be safer because they are going to be paying attention. They will be a little more attentive to what they are doing and less injuries. Before they even begin a sport,you want to do a pre-participation physical exam. That is done at the high school level more, it has to be done. Even the younger kids should do that; they should see their pediatrician or family practitioner. You want to make sure their vision is ok; you want to make sure there are no underlying medical conditions that need to be treated before they can participate. You want to make sure they don't have hypertension that would not maybe keep them from participating, but it may be that they need to be in certain sports. Some medical conditions do not allow kids to participate in say a sport-like football that is a contact sport. Once again, the doctor needs to understand; the patient needs to understand they have to be safe. Once you've been cleared to participate, then you want to teach your child to do preseason conditioning; they want to condition; they want to be ready for the sport. You can't just go out there, walk into it. Look at professional athletics, they don't just walk out and play a sport, they train;they have spring training; they stretch; they warm up and they participate in other cross training activities to get them ready. Get them the well fitted equipment they need. If they need equipment, make sure it's correct; make sure it's fitted for them and they have the proper equipment. If they need a helmet, the helmet has to be fitted for that child. They need to be reconditioned every year; if a child plays a whole season, you want to make sure that football helmet is reconditioned; make sure there is nothing damaged in it and children grow. Make sure each game this helmet is still fitting well. You want to make sure that if they need eye wear protection that they have it. If they wear glasses, make sure their vision is good and then get them glasses, then make sure they have sports glasses so they are no tgoing to shatter or contact or some kind of eye protection. You want to team them up by size, rather than age. You know,two children of the same age may not be the same size, so when they are very young, three, four, they are just learning skills so you can have everybody on the field at the same time but as they get older they really need to team up by size so they don't hurt each other. Then, unfortunately, women and boys do need to separate into different sports so they don't hurt each other. Unfortunately, they play different ways. We need to make sure the fields are safe; that the surfaces are safe and that they are ok out where they are playing. We need to do proper training,proper coaching, parent supervision, there needs to be people around to make sure they are not doing things incorrectly. They need to warm up before they go out and play. They need to cool down and they need to stretch, all these things need to b etaught to them, they are not just going to know how to do that. They want to cross train, you don't want to do too much of one sport. If you go out and play one sport over and over again and again, you are going to end up with over-use injuries,stress fractures, all kinds of injuries. So really, they can play their sport but in between they need to do other things, cross training. So if they are playing soccer, maybe ride a bike or do some lifting weights, play other sports, do other cross training. And last, good nutrition and proper hydration. That is extremely important, these kids are growing; we need to make sure they are safe and do it safely and that they are hydrated when they are out on the field.
Patterson: That was pretty awesome; that was extensive. I want every parent and every coach to rewind that, get a piece of paper and a pencil and go back and listen to that a couple of times; write it down and endorse it and tell everybody to listen as well. I think that's pretty awesome. I once read that someone said the younger the child the more safety concerns there are but I kind of have my own issues with that. Do you agree with that statement?
Boehm: That can be taken very broadly. If you have a young child,then there could be more safety concerns for the fact that they don't have as much body control. When you have a young child,they are learning how to run, how to walk so you have to be very careful with them so you don't want to stick them out there with a child that is bigger than them and crush them. They are growing; they have open growth plates, that's how they get bigger;their muscles are growing so we do have to be careful. I think the younger the child we have to be safer and I think that you have to remember when the child is young; they have a lot more years to play so if they get hurt it is not as imperative that they go back as quickly. The older the child the more likely we try to get them back; they are more competitive. Young children don't need to be competitive; they need to learn skills; they need to practice; they need to learn body control;they need to learn all these other things and then they can move on.
Patterson: I just was thinking about the 15 and 16 year old football players that are attacking each other and the rugby players that are just so aggressive and thinking about those safety concerns I just seethe four and five year olds kind of running around still picking dandelions in the field and comparing that with some of the teenagers that are so competitive, but I think the take home message is just to make sure at any age that you are protecting your child and that your child knows what to look for and just kind of emphasize that they need to make sure they let us know. Ic an imagine in your experience that you have seen parents that are pushing kids to continue to play hurt. What do you say to those parents?
Boehm: First of all, try to explain to the parents that this is their child; they need to protect them in every way. I understand,I am very competitive, I have been an athletic all my life; I know what it is like to want to be out on that field and that child should have a competitive nature to him, that's what sports is about. The old adage, no pain no gain is really not true, we hear a lot about these injuries; we hear a lot about football players with concussions and hopefully we will be able to talk about that where they think they have a small injury and they go back and they get re-injured so there can be damage. We really need to be safe and we really need to just take things a little bit more seriously.
Patterson: Let's switch gears a little bit. What do you think about things like mouth pieces and head gear and eye wear? Are those always important?
Boehm: It's sport dependent obviously. There are some sports that make you wear gear and you cannot participate without it and if that's true, then you should make sure you are wearing it during practice. There is a reason why someone is saying you need that equipment, so yes you should wear it. Now, if you wear equipment and it is not the right size or it's not on correctly,it's not going to do you any good so you have to make sure it'swell fitting. Helmets for football are very important but once again the first thing you need to teach a child, when they put a helmet on, is the helmet is not to hit with. The helmet is to protect your head in case of some injury. What I try to teach young children is when you put a helmet on, if you can't see it, you can't hit it. They can have serious head injuries,serious neck injuries, so while your helmet is important, it is not the end all be all. Other equipment, eyewear protection, if it's needed, you have to wear it. If they wear glasses, you have to make sure they have these sports glasses, it's easier for the child to wear; it's much safer. Mouth guards, once again, if the sport recommends it, they should wear it and they should be well fitted. You can have the dentist make one or you can get the ones you buy, but you can't just stick them in, you have to heat them and make sure they are well fitted for you. Mouth guards are good for facial injuries; you don't lose your teeth, things like that. There is a lot of controversy or whether they help with concussions, we always thought years ago they helped with concussions, not necessarily. But once again if someone is recommending some protective gear, it's for a reason. They use to find football players; they would take their tail pad out because they felt uncomfortable. Then they get hurt and they realize it was there for a reason. Somebody has done research to figure out that this is what you need so if you need it wear it whenever you are playing that sport.
Patterson: We all know that hydration is very important in athletics, but how much they should drink and what kind of drinks the child should drink, Gatorade is a big name but what kind of drinks do you recommend? Are some of those drinks unsafe?
Boehm: Even a 1% loss or body weight a child can reduce their performance. A child can become sluggish if they are dehydrated; they can feel just not right. They don't even know what's wrong; they have a headache; they just don't feel right, even with a little bit of dehydration. Normally, for the older kids it's a lot easier, we tell our football players to weight themselves before practice, after practice and we will see how much they lose weight. For most sports, water is usually sufficient. If they are going to go out there and they are playing for an hour, they are going to be practicing for a little bit of time, water is usually sufficient, especially for the younger children. They should have their own water bottles and you have to remind a child to drink. If you give them a time out from practice they are going to go out and play with their friends and talk to them, so you have to tell them, this is a break for a drink and you have to drink and they will drink, because once the child becomes thirsty, the boat has already sunk, they are already dehydrated so they have to drink in advance. For most of the children they are going out for soccer practice only for half an hour, now if the temperature is really high, 90 degrees,it's really humid out, then you might want to add some other drinks. Just for fluids though, you can do 16 oz of water about two hours prior to participation and then while they are playing they should do 5-10 oz every couple hours while they are playing. So the coach has to make them get a break. Years ago, once again, we didn't let kids take breaks because that was tough, but it is not tough anymore, the kids need to drink. So if you are drinking the water, that's fine. As far as sports drinks, if you are an endurance athlete, you definitely need a sports drink. You need carbohydrates, you need more than just water, or if you do a stop and go sport such as soccer, sprinting, things were you are going to be out on the field for a longtime. If you are going to a rowing meet or are going to a track and field event, you are going to be out there in the hot sun all day; Gatorade is not a bad idea. These sports drinks are OK, you want to drink them in moderation; you have to remember there is a lot of sugar in them so while you are getting your carbohydrates, while you are getting your hydration, your potassiums, your sodium, your electrolytes, you are also getting calories. You have to think about that if your child is diabetic or if your child is a little overweight, you might not want to be giving him the calories, although if they are working out and they are working hard, they are sweating, they may need their electrolytes, so sports drinks are not bad. You have to remember, kids don't really like water so if you can flavor the water or give them a little bit of watered down Gatorade and sometimes they will drink a little more. You read some of it and they say oh you water down your Gatorade, it doesn't make a difference, it may make a difference to make the kid sip a little more so it may be worth it.
Patterson: Got it. One of the hot topics is concussions. What would you say to parents about, I think it is obvious if the child is unconscious what to do, but for those mild concussions and we have manufacturers trying to sell us concussion-reducing equipment, should be leery about those things?
Boehm: I think so. Once again, years ago we would have different helmets and one of the schools I used to work at if a kid had a concussion the next day they would come out with a helmet that was thicker around it, they would put this foam on it. The kids were always embarrassed to tell anybody they had a concussion because they would have the thick helmet the next day. I think a good fitting helmet, once again as we talked about, is important, but it doesn't stop concussions; they are not for hitting people with their helmet. It is not just football;any sport you can get a concussion; any time you run into each other or soccer ball hits your head, football, basketball you hit your head on the ground so a lot of the different areas you can get a concussions are many. You can get a concussion playing on a playground and hitting your head with a swing. Really, most important to know is that if a child gets hit, they have a head injury, take it seriously, bring them out of the game; let them be evaluated by a medical professional before they go back because the risks of that injury being bad far outweigh the benefit of going back into that game. Even if they have a bell ringer,literally they run their bell and they saw the birds flying around for a minute, they really need to come out and be evaluated. The American Academy of Neurology had their meeting this week and they came up with newer guidelines. The last guidelines they put out were 1997 and originally what we did was when you had a concussion, we would look at the child on the field and we would say, OK, did you lose consciousness, what symptoms do you have? We would look at those kinds of things about whether they could go back into the game and when they could go back to play. Now,they have done a full circle and they have come back to no, now we don't base it on what symptoms you had initially, but on how long it takes for your symptoms to clear. Now to return to play,what they recommend is you have to have complete clearing of all symptoms, not a headache, not blurry visions, ringing in the ears,any symptom; everything has to be totally cleared. You have to have complete return of all memory and concentration. A kid might just say I was watching cartoons and I forgot what I was watching or I forgot what I was reading or I couldn't concentrate I school; little subtle signs, important in a concussion. Once everything totally clears, then we put them through what is called provocative testing. We have them jump up and down, run,anything that raises their blood pressure and heart rate to make sure the symptoms don't come back; then they can safely return to play. The body of research shows that concussions are followed by a period of increased vulnerability to repeat injuries,so if you have a head injury and you don't let your symptoms clear and you have another head injury, that could have very bad effects,not just when the child is five or ten, but when they are 30 or 60 or 80, so we really have to be very careful. If they have symptoms, they need to rest, any kind of symptoms, headache, blurry vision, ringing in their ears, nausea, vomiting, memory or concentration problems, they need to rest, not just their body but their mind too. They need to rest their mind and let everything calm down and they need to see a professional. They need to be tested, they need to be serial examined before they return to play.
Patterson: So part of the take home message there parents is that like everything, some injuries really need healing time. Most injuries need healing time and we have to rest our children's brains as well. I wanted to talk now about asthma. A lot of people thing that you just have to wheeze, if you are not wheezing, you don't have asthma. But there is a condition called cough variant asthma, where children will go out and when they exercise they actually start coughing or they get short of breath ore than other children. I just wanted to make sure I brought attention to that issue. Do you have anything to say about exercising induced asthma?
Boehm: I do, even smaller c children, they won't tell you that they are coughing or you don't even hear them coughing or they don't tell you they are short of breath, they will just tell you they are tired; they can't keep up with the other kids. I don't play soccer as good as the other kids do and sometimes that can be just that they are not good at soccer but one of the things you have to think about is that they have asthma, exercise induced asthma. You don't always have to have asthma to have exercised induced asthma. You really have to make sure the child gets looked at by a professional and tested and it's easy to do. If the child is complaining of cough or shortness of breath or they are just more winded or tired than the other children, they can test them; they can do peak flow meters; they can get them running and exercising and check them again and see if those numbers drop and they are not just getting enough good oxygenation and then they can try to treat them. It is a simple treatment and it is simple and it really does make a difference in the athlete's life if you can treat exercise induced asthma.
Patterson: I want parents to hear this loud and clear; it doesn't mean their child cannot play, if just means we can help them to be better; to breath better. Pay attention to your child; are they short of breath just after a short time of playing; are they coughing; are they sitting down trying to rest after a short time of play? It is very important to pay attention to that. I also want parents to know the old question, ice versus heat; can you explain that to parents?
Boehm: Great, yes. Anytime that there is an acute injury, you can never go wrong with ice.
Patterson: Acute meaning it just happened?
Boehm: It just happened, right, or within a couple days, three days,always ice it. Ice is an anti inflammatory, what is the first thing, if you have an injury, RICE, rest, ice, compression and elevation.
Patterson: Write that down.
Boehm: You will never go wrong if you do RICE with anyone. Heat is reserved for more longer term injuries, if they need to stretch, if it's a cold day and your child is going to be pitching and you want to warm them up, you can use heat. I tell most of my patients only when we tell you can you use heat, because heat can get you in more trouble. Ice will never get you in trouble.
Patterson: OK, awesome. I always get concerned a little bit about eating disorders in my teens and my athletes. They intend to go often hand in hand with sports where the child has to be weighed, but not necessarily. What do you have to say about children and eating disorders in athletes?
Boehm: Very important topic. Once again, there could be a difference between life and death if eating disorders are not found and children are not educated about these eating disorders. It is actually in children who do need to make weight classes, but it is also in children who have body imagine, such as cheerleaders,gymnasts, anyone who has to look good in their suits. We look in thee magazines and what is on the front of all these magazines? Skinny women in bathing suits. A lot of kids think they need to look like that or they are not worth it and that's not true. We need to tell children that it is OK to look how your body looks and so we don't have to be the thinnest one out there. What happens with children, they start modifying their eating habits or they just don't eat proper nutrition; they don't eat well balanced diet because they want to lose wight; they want to be the thinnest one and that can reallycause some serious problems with eating disorders. There can be some serious consequences of that.
Patterson: Absolutely. Also, females have to pay attention; there is such a thing called the female athlete triad where they all have stress fractures and they will have menstrual disorders and they have an eating disorder. So it is very important for parents to know if their daughters are menstruating; to pay attention to pain that they consistently complain about; chronic pain and to also pay attention to what your child is eating or not eating. What do you say to the parents of the children that don't seem to be eating or eating in secret?
Boehm: Yea it can go both ways. There can be children who don't eat and there could be children who eat and purge and binge. Really, get a nutritionist involved. Have a one on one talk with your child; find out what is going on; what they are thinking. They just may be thinking that they are doing the right thing and becoming a better athlete and you can say to them no, there are other ways; let me have you talk to a nutritionist,sports nutrition is a big field and we can help you with this. Get them on the right track and get them talking to people; get them talking to a family doctor or a sports medicine doctor. Once they have the injuries and they start having the problems, unfortunately, now we have more problems; we can catch it early on. Years ago the adage was oh you are not getting your period just because you are an athlete. Yes it is because you are an athlete, but it's because you don't have enough body fat,you don't have enough estrogen around so we really need to look at that; we need to know that. If girls are having stress fractures or eating disorders we need to do things about that and we need to either put them on medication or a little bit more body fat can get you having your period again and that will safely help you move along and it will make your bones stronger when you get older.
Patterson: We want to emphasize when you hear the word "body fat" that is not necessarily a bad thing. We need fat to help our brains be healthy. There are healthy fats and unhealthy fats, but just to hear that word fat you don't have to be afraid by that.
Patterson: Our podcast is winding down; I do want to make sure that I emphasize…how do you explain to the parents about the importance of warming up and cooling down? I may see some athletes warming up, but don't always see them cooling down. Can you touch on that before we end here?
Boehm: Yes, it is actually very important. Your child should warmup; they should cool down' they should stretch. When a child gets out to practice, they shouldn't run right out and play; they should warm up. They should do a little bit of jogging or a little bit of biking, then they should do some stretching, then they do their sport. Now we have to cool back down, we can bike or jog to bring ourselves back down. That just allows the blood flow to change from where it needs to be on to different spots. So we want to cool own the muscles; we don't want them to kind of keep going; we want to move the blood away. So cooling down is just as important as warming up. Jut as doing a lot of exercises for the body, you don't want to do just one thing; you don't want to do just your sport. Warming up and cooling down is getting ready for your sport but once again, it invites other muscles to be involved. If you are just playing a sport, your nerves and your muscles will work together in that you need to be able to recruit other muscles to work so you want to cross rain. You want to be doing other activities. You want to get your body doing other things. That protects your bones; that protects your muscles; it protects you from having injuries and especially overuse injuries, from overusing the same muscles to do the same activity, time and time again.
Patterson: I love it; I love the message. If you know someone that needs to hear this message you make sure you forward it to them. If you have comment or other questions about this message, you can ask us those questions on Facebook; you can go to Einstein's Facebook page at Einstein Health. You can also follow us on Twitter, we encourage you to do that and you can follow Dr. Donee on Twitter @DrDonee. We appreciate you listening;we would love to hear your questions and comments and feedback. If you have other topics you would like to hear in the future, why don't you send us a message on Facebook. Thank you again for listening and we appreciate you. Take care.