Consider The Individual When Planning Practice

By John Cone, PhD, CSCS

Founder and President, FitFor90

Key Points:

  • In today’s post from Dr. Cone he discusses the concept of modifying team training in order to minimize injury risk for your players
  • One of the most important points from the coach’s perspective is to know your players, not just tactically and technically, but to know their physical capabilities well
  • The article is focused on soccer but the general principles are applicable to all team sports
  • This article is reposted from Soccer America’s Youth Soccer Insider

It’s that time of year in soccer when youth teams are kicking into a new season. The “preseason” phase of training is one of excitement and anticipation, and well established in sports science as a time of increased risk of injury. The result being that a player’s excitement for a new season can quickly turn to disappointment. Youth Soccer 1 BB.jpg

It’s classically a time when emphasis is on “getting players fit,” and not necessarily on playing soccer and developing soccer athletes. Regardless of your philosophical approach to fitness in soccer, I urge you to consider the individual athlete in your team as you develop your preseason training plans.

In order to avoid injury of an individual player it is imperative that you know a good deal about them, as ultimately you need to know how the player fits in your team not just technically and tactically, but physically as well. The goal being to address the individual within the team, accounting for their physical activity leading into the season is an absolute must if injury is to be avoided.

This in mind, I’ve developed a list of questions that you can ask of your players and their parents that will help refine both your approach to training, and potentially save a player from an injury.

  1. How long was your break from playing soccer? (Note: You may know this if the player is returning, but important to ask to find out about camps, other training, they may have performed, etc.)
  2. Did you play soccer much this summer? About how much each week?
  3. Did you play any other sports, or do any other training/physical activities? What sports/activities? About how much each day?
  4. If other organized sports were played. How often did/do you train? How frequently do you play games or compete?
  5. When was the last time you were challenged physically to work hard? When was the last time you ran as fast as you could? When was the last time you jumped as high as you could?
  6. Do you feel like you grew much over the summer break?
  7. Do you have any aches and pains from growing (nearly applicable at every age)?
  8. Any aches and pains bad enough that you didn’t feel like doing something active?
  9. Any injuries where you couldn’t do anything or had to go see the doctor?

Next is considering your team. Prepare by answering some questions honestly from when they were selected, or as soon as possible in preseason.

  1. What is the variability in age from my oldest to youngest player?
  2. What is the variability in maturation and growth in my team?
  3. Does this variability (age, maturation, growth) favor some players more than others in my team?
  4. Which players struggle to keep pace physically?
  5. Which players are less fit than others?

General concepts in interpreting answers:

  1. How long was your break from playing soccer? (Note: You may know this if the player is returning, but important to ask to find out about camps, other training, they may have performed, etc.)
  2. The longer the break the longer the build-up and the slower the progression of fitness. Progress the players quickly and you will see injuries.
  3. Did you play soccer much this summer? About how much each week?
  4. Lots of soccer in the summer may mean the player is good to go now, but be very weary as the season wear’s on for overuse injury. Make sure these players are developing as athletes as well as soccer players. You need to focus being a physical educator as much as being a soccer coach if you find players on your team don’t participate in multiple sports.
  5. Did you play any other sports, or do any other training/physical activities? What sports/activities? About how much each day?
  6. Activity level will be a good indicator of their fitness level and readiness to train.
  7. If this is always in a structured environment, it may also mean that you need to be aware of potential overuse or growth-related injuries.
  8. When was the last time you were challenged physically to work hard? When was the last time you ran as fast as you could? When was the last time you jumped as high as you could?
  9. This will give you a good indicator of how you will need to build the demands of your training. If the answer indicates they have not performed high-intensity and/or high velocity movements for a while, be patient. Start with bigger games and let the players control the intensity, aka let them play, and give them freedom.
  10. Do you feel like you grew much over the summer break?
  11. Rapid growth increases injury risk[1], and training stress is proposed to increase injury risk.
  12. Do you have any aches and pains from growing (nearly applicable at every age)?
  13. May be worth referring to a sports medicine specialist to get exercises specific to the individual’s complaints for preventative measures even if complaints do not currently keep the player from participating.
  14. Ensure that a player does not get pushed beyond his or her physical breaking point in training, start slowly, build steadily and be prepared, and have the player and parents prepared, to potentially do less than their peers.
  15. Any injuries where you couldn’t do anything or had to go see the doctor? How long ago were you approved to go back to sport?
  16. Important to consider that a substantial layoff will contribute to an increased risk of re-injury, both of the previously injured site and others. Again, be prepared to have the player do less than the group. Build the player up more slowly to limit the potential for re-injury.

Next is considering your team. Prepare by answering some questions honestly from when they were selected, or as soon as possible in preseason.

  1. What is the variability in age from my oldest to youngest player?
  2. It is important to recognize that a bias exists between players born within a single year called the relative age effect, and benefits the players born early due to their physical development.
  3. If you have players who are younger than their teammates, build them more slowly in preseason and be prepared to manage them physically throughout the year.
  4. What is the variability in maturation and growth in my team?
  5. Similar to the above, a later maturing athlete is at an increased chance for injury[2].
  6. Be prepared to manage individual player physical development within the team.
  7. Which players struggle to keep pace physically?
  8. Be prepared to address athletes with different physical characteristics through your managing of their physical load in preseason and beyond.
  9. Which players are less fit than others?
  10. One of the worst mistakes a coach can make is trying to get a player to “catch-up” to his or her teammates’ fitness level. A player less fit than the teammates will develop overuse more quickly than their teammates and be at increased risk for injury. If you try to “catch them up” you are accelerating the problem and even more likely to see the player injured.

The growth in our understanding of performance, player development, and injury prevention drives improving our methodology as coaches. While we work in a team sport, the ability to address an individual within our team is a key to developing individual success and pathways to elite performance, as much as a life in sport. While coaches may tell their team: “There is no I in TEAM,” the coach must subscribe to a different approach.

John Cone has a Ph.D. in kinesiology, an M.S. in Exercise Physiology and extensive licenses and certifications, including his USSF A. Dr. Cone is a USSF national instructor delivering sports science education on coaching licenses from the F license to the A license, and youth-specific Academy Director course. He was formerly the Director of Sports Science with the Portland Timbers in the MLS, and an assistant coach with Sporting Kansas City.Dr. Cone has worked at every level of the game from youth through professional as a coach, and as a sports scientist. Through his company Fit for 90, Dr. Cone delivers sports science consulting, and player monitoring for performance, development, and injury prevention. Fit for 90 clients include the U.S. women’s national team, numerous MLS, NASL, NWSL, collegiate, ECNL and USSDA teams. Fit for 90 is the official player monitoring system of US Club Soccer and the ECNL.

 

 

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Why should you care about sports science?

By John Cone, PhD, CSCS

Founder and President, FitFor90

Key Points:

  • At Sideline Sports Doc, we try whenever possible to use an “evidence based” approach to youth sports health and this week we feature an article by John Cone, who uses scientific evidence to support his athlete training and recovery methods
  • Cone will present a series of articles outlining his philosophy, with key point that most “overuse” injuries in young athletes can be prevented through a combination of rational sports participation and monitoring
  • I had a chance to speak directly with Dr. Cone at US Club Soccer’s Players First launch event on August 9. You’ll find that some of his thinking will challenge your conventional beliefs but I believe we should all pay close attention- his teaching can have a profound positive impact on the health of our young athletes
  • This article is reposted from Soccer America’s Youth Soccer Insider

For most, it is accepted that injury in sport is a part of the game; a result of bad luck and a risk an athlete knowingly takes on by playing.

In youth athletes, it is further accepted that growth-related pain is a natural part of the transition from youth to adolescence and on to adulthood, again a normal occurrence, with not much to be done. The result is we have an “overuse injury rate” in youth athletes that accounts for between 46% and 54% of all sports injuries [1]. soccer training closeup

This statistic that does not include non-contact injuries (many of which are highly preventable, such as anterior cruciate ligament (ACL) tears [2]), or growth-related injury (again highly preventable, with the compounding stress of physical training and growth leading to an increased likelihood of growth-related problems [3]).

Although injuries in youth players occur at an alarming rate they are seldom questioned, but accepted as normal, and “traditional” training practices are continually embraced.

Reality is, and sports science supports it, the majority of non-contact, overuse, and growth-related injuries are preventable. The good news is it is not so much science as it is logic, although it may push you out of your comfort zone.

In a series of up-coming articles, I will look to tackle some of the most common problems, misconceptions, and challenges that face the youth and adolescent athlete, parent, and coach.

The goal is simple, enable the players to continue to enjoy the game, stay healthy, performing at a high level, and to achieve their personal goals through increasing awareness of sports science and its practical application to training youth athletes.

John Cone has a Ph.D. in kinesiology, an M.S. in Exercise Physiology and extensive licenses and certifications, including his USSF A. Dr. Cone is a USSF national instructor delivering sports science education on coaching licenses from the F license to the A license, and youth-specific Academy Director course. He was formerly the Director of Sports Science with the Portland Timbers in the MLS, and an assistant coach with Sporting Kansas City.Dr. Cone has worked at every level of the game from youth through professional as a coach, and as a sports scientist. Through his company Fit for 90, Dr. Cone delivers sports science consulting, and player monitoring for performance, development, and injury prevention. Fit for 90 clients include the U.S. women’s national team, numerous MLS, NASL, NWSL, collegiate, ECNL and USSDA teams. Fit for 90 is the official player monitoring system of US Club Soccer and the ECNL.

DiFiori, J.P., et al., Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med, 2014. 24(1): p. 3-20.?2. Shimokochi, Y. and S.J. Shultz, Mechanisms of Noncontact Anterior Cruciate Ligament Injury. Journal of Athletic Training, 2008. 43(4): p. 396-408.?3. van der Sluis, A., et al., Importance of Peak Height Velocity Timing in Terms of Injuries in Talented Soccer Players. Int J Sports Med, 2015. 36(4): p. 327-332.

 

 

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Turf Toe Injuries Can Be Successfully Treated

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • “Turf toe” refers to a sprain injury to the bottom of the big toe joint
  • These injuries are common in football, especially in linemen
  • Successful treatment usually does not involve surgery and can result in return to play in 1 to 6 weeks depending on the severity of the injury

Many schools are starting more intense training for the upcoming high school football turf toeseason so I’d like to take a look at some football injury topics over the next few weeks. I’ll start this week with a common injury that often gets ignored, until it gets worse and really becomes a problem: turf toe. (photo at right from AAOS)

Perhaps you’ve heard the phrase “turf toe” with some NFL players who are out on injured reserve. The simplest definition of turf toe is that it is a sprain of the main joint of the big toe. It happens when the toe is forcibly bent up into hyperextension, such as when pushing off into a sprint and having the toe get stuck flat on the ground.

Physicians started seeing more of these injuries with the older versions of artificial turf. Those artificial fields were often a thin layer of artificial grass placed over cement. There was very little cushioning in the turf and impact with the turf was often sent through the player’s body, resulting in a number of injuries. Fortunately modern versions of artificial turf fields are much better than the old types, but still we see these injuries.

Turf toe injuries can vary in severity — from stretching of the soft tissue on the bottom of the big toe to partial tearing, and even total dislocation of the big toe joint.

Physicians usually grade turf toe injuries to help guide our treatment and to predict return to play timelines.

  • Grade 1. The soft tissue on the bottom of the toe has been stretched causing pinpoint tenderness and slight swelling.
  • Grade 2. A partial tearing of the soft tissue causes more widespread tenderness, moderate swelling, and bruising. Movement of the toe is limited and painful.
  • Grade 3. The soft tissue support is completely torn causing severe tenderness, severe swelling, and bruising.

Treatment and Estimated Return To Play Times

Most cases of turf toe are treated without surgery. Nonsurgical treatment is determined by the grade of the injury.

  • Grade 1. Initial treatment is with rest, ice, compression, and elevation. Taping the big toe to the adjacent toe will provide some support during healing. Non-steroidal anti-inflammatory medications may relieve pain and swelling. Pain is usually tolerable and an athlete can continue sports participation using a stiff-soled shoe. Orthotics are sometimes used. Typical return to play is at about 1 week after injury.
  • Grade 2. To keep the big toe joint immobilized for proper healing, a walking boot may be prescribed for up to a week if needed. Afterwards, these injuries are managed with a taping regimen and the Grade 1 treatments discussed above. Stretching and strengthening exercises can reduce joint stiffness. In most cases, an athlete with a Grade 2 injury needs 2 to 4 weeks of treatment before returning to play.
  • Grade 3. These more severe injuries are most often treated with immobilization for several weeks. The athlete may wear a walking boot or be put in a cast that keeps the big toe in a partially pointed down position. These injuries often need 4 to 6 weeks of treatment before return to play but some may take substantially longer.

I find that physical therapy can be very helpful in Grade 2 and 3 injuries. A good physical therapist will be able to improve the motion and strength in the toe and can also assist the athlete in returning to proper running and sprinting form.

 

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The Real Reason Why There Are So Many Youth Pitching Injuries

By Mike Reinold, DPT, ATC

Founder of Champion Physical Therapy and Performance, Boston, MA

Key Points: (comments below from Dev Mishra, M.D.)

  • This article is written by Mike Reinold, a colleague and friend who happens to be one of our country’s foremost experts on pitching mechanics and pitching injuries
  • This article appeared in Reinold’s blog
  • Last week we wrote about overuse being the main factor in risk for pitching injury, but here Mike goes one step further and says that lack of education and awareness from coaches (and likely parents) is the cause of the overuse
  • Improved awareness of guidelines for safe pitching should lead to a reduction in pitching injuries

This article that you are about to read is really disappointing.  Pitching injuries in young athletes continue to rise despite research and effort designed to reduce these injuries, this is a problem. baseball pitcher

To quickly summarize what we have learned about youth pitching injuries, we know that approximately one third of youth baseball pitchers will experience shoulder or elbow pain during a season.  We also know that youth pitching injuries increased sixfold in the early 2000’s with Dr. James Andrews at his center in Alabama.  This number is probably even higher now.

After years of speculation regarding exactly why these injuries occur.  There is only one factor that continuously correlates to these pitching injuries.  I’ve discussed the Little League curveball debate in the past.  It isn’t throwing a curveball, it isn’t pitching at an early age, and it isn’t long tossing.  The reason is simple:

Youth pitching injuries are due to overuse

But I think we are being polite be saying “overuse.”  I would imagine we can even say “abuse” or maybe even “neglect.”  Let me explain why.

After years of research showing that high pitch counts, pitching too frequently, throwing for multiple teams, pitching in showcases, and pitching while fatigued are significant factors in the rise of your pitching injuries, Little League Baseball and USA Baseball did the right thing.  They consulted with many experts in the field of throwing injuries, including James Andrews, Glenn Fleisig, and the experts at the American Sports Medicine Institute, to develop pitch count rules to protect our youth from this overuse.

Kudos to them for stepping up and doing the right thing.  But here is the problem….

A recent study published in Sports Health surveyed 95 youth baseball coaches about their knowledge of the safety guidelines established by the USA Baseball Medical and Safety Advisory Committee.  The results are disappointing to say the least.

  • Overall, coaches answered 43% of questions correctly
  • 27% of coaches admitted to not following the safety guidelines, however only 53% of coaches felt that other coaches in the league followed the safety guidelines
  • 19% of coaches reported that they pitching a player while having a sore or fatigued shoulder or elbow

I’m sorry to say this, but…

Not understanding the safety guidelines is irresponsible and intentionally not following them is abuse.

The cause of youth pitching injuries are definitely multifactorial, however, overuse has been shown to be the most influential.  Sadly, overuse also seems to be the easiest to address. So what can you do?  It probably starts with education.  Share this article to help spread that word that overuse needs to end and safety guidelines need to be followed.

You can go back and read my article on Little League pitch count rules.  USA Baseball also has some guidelines.  To summarize them, in addition to monitoring pitch counts, players should not pitch with pain, should limit their throws from other positions (especially catching), limit their participation in our leagues, limit their participation in showcases, and not progress to more demanding pitches until their bodies start to mature.

All coaches need to be aware of these recommendations.  Injury prevention begins with the understanding of how injuries occur and what the specific safety recommendations entail.

The next step is getting on a proper injury prevention program.  I’ve discussed some of these topics in my article on preventing Little League pitching injuries and have shared with you my Little League injury prevention exercises that I prepared for MGH several years ago.  I probably need to update these but it serves as a good basis to begin. It really is a shame that all these youth pitching injuries are occurring, let’s do our best to spread this education and help reduce these Little League injuries as much as we can!

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Pitchers: Watch Your Pitch Counts And Innings

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Excessive throws for a young arm can lead to significant injuries to the shoulder and elbow
  • The American Sports Medicine Institute recommendations call for a maximum 100 innings thrown per year, age appropriate pitch counts, and at least 3 months complete rest from throwing each year
  • The throws can really add up if you are on multiple teams, taking private lessons, throwing at home outside practice, and taking throws from infield positions

It’s that time of year for pitchers: all-star teams and travel teams are in high gear. That means it’s also the time of year when it can become easy to overwork a young pitcher with LittleLeaguePitchingInjuriestoo many innings or too many pitches. It’s worth having a look at the American Sports Medicine Institute recommendations for youth pitchers. This important set of guidelines was developed through the pioneering work of Dr. James Andrews and his colleagues.

ASMI believes that the proliferation of year round baseball is strongly contributing to the large increase in injuries to the shoulder and elbow seen in young baseball players. For the elbow in particular the accumulated wear and tear likely occurs over many years, often long before the actual problem surfaces.

We often find that the players who are racking up the innings are generally the more advanced players on the team. This means that they will often play an additional defensive position when not pitching. This can add up to a lot of throws for a young shoulder.

It can be easy to lose track of a player, where they might for instance take 50 infield ground balls in practice on the same day they throw a bullpen session. All of these throws will add up in the total wear and tear on that arm. Even though it’s not all throwing from a mound they are throws nevertheless.

Some common additional factors to consider:

  • Some players will participate on multiple teams. It’s likely that none of these coaches are communicating pitch counts to the other coaches, leading to the possibility of a very large number of pitches thrown
  • The player may be throwing at home outside practice
  • There may be private pitching sessions taking place

Most, but not all leagues have rules to prevent players from playing or practicing with another team during that league’s season. These rules are designed to protect the players from over use and are good rules to have.

Unfortunately, it isn’t unusual to have an athlete paying for private lessons and throwing bullpens during the season. As far as I know there are no rules to prevent this from happening.

When a young pitcher comes to my office with shoulder or elbow problems, we’ll work to fix the problem and also use that opportunity to have an honest discussion with the player and parents about the underlying factors that lead to the injury. My hope is that this talk will have a positive effect in reducing that player’s chance for another injury.

It’s unfortunate that the talk I have with the player is often the first time they’ve heard any type of discussion about pitch counts or annual innings. It’s also unfortunate that the talk I have with them is only happening because they’ve already been injured. If you’re the parent of a young pitcher it might fall on you to keep track of your child’s pitching activities. I certainly wouldn’t expect you to be present at every session to log pitch counts but having a general awareness of the throwing activities your child is participating in might allow you to intervene before it’s too late.

Posted in Baseball, Elbow, Shoulder, Softball | Leave a comment

Sideline Sports Doc: Why We Do What We Do

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

It’s mid-July and in the heat of the month we’re taking it a bit easy with this week’s post. ESPN Sports Med WeeklyHere’s a link to a recent interview I did with my colleague Dr. Brian Cole and Steve Kashul his co-host of ESPN Radio’s Sports Medicine Weekly. Have a listen to the podcast here.

In the interview I discuss with Brian and Steve the key aspects of the problem as it now stands:

  • Most youth sports coaches receive little or no formal training in the main injury areas common to their sport
  • There’s a significant risk and negative impact on the young player’s health due to the lack of proper training
  • Any training method should cover basic injury evaluation, application of RICE, and the main injury topics specific to each sport (this means knee, ankle, shoulder, etc.- not just concussion!)
  • Our method is sport specific, presented as eBook, mp3 audio, and online course to address multiple learning styles
  • No one else does this! We hope your sport organization will be one of the ones working with us to help make your sport safer and better for your young athletes

 

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The “Wild West” Of Concussion Treatment

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • If you have been diagnosed with a concussion and you are having continued symptoms after the concussion event you should be under care from a qualified neurologist or concussion specialist physician
  • Seek guidance from your specialist before starting any concussion recovery treatment
  • Many different types of concussion treatments are available; some are marketed with little scientific support. Be cautious and consult your doctor first.

For this week’s post I’d like to point you to a recent New York Times article highlighting concussion hyperbaricthe explosion of various treatments reported to treat concussion. It’s an excellent read if you have interest in concussion treatments. One company CEO quoted in the article refers to the expanding number of varied treaments as the “Wild West”, with so many methods now available. It seems that the public’s awareness combined with several research studies have contributed to a ripe market for companies developing methods to treat concussion. Some of these will likely turn out to be very useful but the article also sounds a note of caution when considering some of the treatments.

Let’s be clear that the companies and treatments mentioned are being used to treat someone with continuing sypmtoms from a concussion or multiple concussions. Post-concussive symptoms can be incredibly difficult for the individual to deal with since these symptoms can affect just about every aspect of your life. The treatments mentioned here are not used to diagnose a concussion.

Some interesting areas to consider from this article are that many highly touted possible treatments for concussion might eventually prove to be minimally beneficial. It often takes quite a bit of time and rigorous scientific testing to prove the worthiness of a medical treatment and sometimes initially promising results are shown to be less effective when studied carefully.

If you or your child are having continued symptoms after a concussion it’s very important for you to be under the care of a neurologist or other physician with specific expertise in treatment for post-concussive symptoms. Proper treatment will often require the input of many different types of practitioners, with the overall care directed by your specialist.

Be very cautious before starting any treatment with a shorter track record. Make sure to consult your concussion specialist for recommendations specifically tailored to your situation.

 

Posted in Concussions, Sports Science, Treatment | 1 Comment

The Importance of the High School Preparticipation Physical Exam

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


 

Key Points:

  • The Preparticipation Physical Exam (PPE) is a very important part of preseason high school sports readiness
  • The real purpose of the NFL Combine is to do preparticipation physical exams on the athletes entering the NFL draft
  • A high school PPE is designed to ensure the safety of the athlete, and to identify areas where rehab may be necessary prior to the season

 

We are now roughly 6 weeks before most high school football programs will start summer two-a-days or other intensive preseason training. This means that you should have already completed your clearance physical exam from your doctor, commonly called a “preparticipation physical exam” or “PPE”. Many high school students attempt to skip this important step but doing so could place your season- or your long-term health- at risk. PPE

Just about every NFL fan is somewhat familiar with the “NFL Combine” held each spring prior to the NFL draft. This event is now a mind-numbing televised display of 40-yard dash times, shuttle runs, bench press reps, etc. But how many of you know the real purpose of the NFL Combine?

Well, the real purpose of the NFL Combine is to provide medical exams for the players entering the NFL draft- it is their preparticipation physical exam. The NFL Combine is properly called the National Invitational Camp and the first camp was held in 1982. The need for the camp arose out of a need from team executives and medical staff to determine the physical health of the players entering the draft. Prior to 1982 there was no standardized way to assess player health coming out of college. The Combine was a way to do very detailed health assessments including possible heart and lung ailments, concussion history, and of course orthopedic history. Team medical staff will assign clearance classifications or grades to athletes that often attempt to predict future risk or effects on performance. Many millions of dollars ride on these assessments.

For the high school athlete the purpose of the PPE is a bit less detailed than the assessments at the NFL Combine but no less important. The main objective is to detect possible life threatening or disabling conditions, detect conditions that might predispose the athlete to illness or injury, and to fulfill possible legal requirements from the individual State governing organizations. From a practical standpoint it also gives the physician a chance to work with the athlete in those last few weeks prior to the start of their season to do necessary rehab or training.

Each state high school association has its own rules for conducting the PPE. Your school will typically send out notifications to athletes at least 2 months in advance of the fall school year. Some states may require that a licensed physician perform a comprehensive exam each year, other states require a comprehensive exam at the start of freshman year and then focused updates in the following years. There are some controversies regarding the use of special tests such as baseline concussion tests (for example the King-Devick test or ImPACT test), or baseline EKGs, but there’s one thing we can all agree on: don’t skip your PPE. It’s there to make your season as successful as possible.

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Why Ankle Sprains Need Rehab

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:


 

  • Significant swelling, any bruising, or inability to bear weight might indicate a more severe ankle injury. Get an evaluation from an orthopedic surgeon or sports medicine physician for the proper diagnosis
  • Many ankle sprains are undertreated, meaning that they are not properly rehabilitated
  • Good rehab with a physical therapist for more significant ankle injuries can get you back to sports faster and decrease chances for another injury

 

Last week we wrote about baseball and softball sliding injuries. There are a number of different kinds of injuries that can occur from sliding but by far the most common injury is an ankle sprain. SwollenAnkle_2

An ankle sprain typically happens when the ankle rolls inward following landing from a jump, as in basketball or volleyball, or forceful contact with the bag in baseball or softball. This stretches the ligaments on the outside of the ankle. This is such a common type of athletic injury that it is often undertreated and the athlete can have a chronic problem. It’s important to adequately assess the injury and form a treatment plan that will ensure a prompt and safe return to sports and also ensure that an athlete will have no long-term problems.

Many ankle sprains in young athletes will be mild injuries with little to no swelling and only mild discomfort. These will often improve with RICE (rest, ice, compression, elevation) and allow the player to return to sports after a few days. But some injuries can result in a very swollen ankle, bruising, and difficulty weight bearing. In those instances it’s best to see a sports medicine physician or orthopedic surgeon for a proper diagnosis. This could be a growth plate injury, a bone fracture, or a more severe ankle sprain.

After being evaluated for any bone or excessive ligament damage, the treatment plan will be started. The first stage is to continue the ice, compression, and elevation to minimize the swelling. Sometimes taping or an ankle splint may be used to relieve the pain and reduce further swelling.

As the athlete can gradually bear weight to tolerance, it is also important to start range- of-motion and strengthening exercises. This is where I tend to recommend working with a skilled physical therapist. The therapist can usually start strengthening and coordination exercises that will get the athlete back in shape quickly. I also find that restoring balance is very important in restoring sport specific skills and in reducing the chance for a repeat injury. You’ll be doing a lot of “homework” too, such as work with elastic bands for strength and alphabet writing with the toes for motion. You might find some of these exercises a bit boring but they work!

When an athlete comes to the office with multiple past sprains we often find that they did not go through the proper rehabilitation in their previous sprains. Good rehab is the missing link in these cases. Cutting corners can lead to ongoing issues that make you susceptible to repeated injuries. The right rehab will get you back to playing faster and should decrease chances of reinjury later on.

 

 

 

 

Posted in Ankle, Baseball, Basketball, Soccer, Softball | Leave a comment

Tips For Preventing Baseball Sliding Injuries

By Daryl Osbahr, M.D.

Level One Orthopedics at Orlando Health

Note: the following post is from the STOP Sports Injuries Blog and appeared on July 24, 2014

While baseball is commonly known as a non-contact sport, the risk of collision is certainly not minimal. Some are due to contact with the ball, bat, or another player, but it is easy to forget that a base can cause injuries. Help young baseball players avoid sliding injuries with these tips from Dr. Daryl Osbahr. 

As the Assistant Team Physician for the Washington Nationals, a member of the USA baseballtournamentBaseball Medical & Safety Committee, and a member of the STOP Sports Injuries Outreach & Education Committee, I work with players, parents, coaches and athletic trainers to reinforce the importance of proper baseball sliding technique. Here are some helpful tips that you can apply in your own life or teach to your children to help avoid a serious injury:

  • Always take time to stretch and warm up properly. This will help you avoid lower body ligament injuries while maintaining flexibility and strength.
  • It is important that proper sliding technique is taught and practiced before using an actual base.
  • Always practice with a sliding bag first. Once the player has learned the correct technique, gradually move to a breakaway base and then, if your league requires it, to a standard, anchored base.
  • Players under the age of 10 should not be taught to slide.
  • When coming into home plate, the baserunner should attempt to slide safely in order to avoid a collision with the catcher.
  • The obstruction rule should always be taught and observed. It is dangerous to get in the way of the runner or block the base without possession of the ball because it could cause serious injury to both the baserunner and the fielder.
  • If league rules allow it, use separate bases for the runner and the fielder to help prevent foot and ankle injuries.
  • Always wear the appropriate footwear. Your cleats should have enough traction to help avoid slippage, but not so much that they can get caught in the turf or injure another player.
  • Know what equipment your league (or your child’s league) is using, and be sure to have a thorough understanding of league rules.

In every situation, prevention is always the best treatment. Together, we can make sliding safer—but it takes an athlete’s entire influence circle to make a difference. The athlete, parents, coach, team personnel and doctors all need to be dedicated to preventing injuries together.

For information about Dr. Osbahr’s practice please visit:

https://www.orlandohealthdocs.com/leveloneortho/

 

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