“Doc- When Can I Play?”

Posted on 05/15/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

There’s never a good time to be injured. As we come up to the end of many spring sports, players often have their eyes on championships or important tournaments.  When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?”  Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.”  The reality, however, is that full recovery as I outline below can often take much longer than that.  My first bit of advice to athletes I’m treating is to try and “let it go”, and understand that an injury occurred, understand that treatment will almost always get you successfully back to play, and understand that it will take some time to get back.  Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play.

Treating the Injury

The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches. For a broken foot or ankle there may be a cast placed on the leg. For a torn ACL in the knee, surgery is usually needed. This phase of treatment is directed by the doctor, and will take days to weeks depending on the type of injury.

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins.  This will often involve referral to a qualified physical therapist. The physical therapist is highly trained in techniques to restore function of the injured part, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries, we’ve learned over the years that early involvement by a physical therapist speeds up return to play.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks.  Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports.  Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time).  In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together- How Long Until You Can Play Again?

I’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on my practice.

“Moderate” or Grade 2 ankle sprain:

  •             Brace 2 weeks
  •             Rehab and conditioning 2 weeks
  •             Full return to training 4-5 weeks after injury

Foot fracture treated in a cast or boot

  •             Cast or boot 4 weeks
  •             Rehabilitation and conditioning 3-4 weeks
  •             Possible return to training 8-9 weeks after injury

ACL tear treated with surgery

  •             Surgery takes place 3-4 weeks after the initial injury
  •             Rehab begins immediately after surgery, continues through 4 months
  •             Sport specific conditioning months 5-8
  •             Full return to training at 9 months
Posted in Injury of the Month | Leave a comment

Club Players Often Escape Screening For Heart Problems

Posted on 05/10/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

There have been 3 recent well-publicized cardiac arrests in elite level athletes. Norway’s Alexander Dale Oen, the defending world champion in the 100m breaststroke was found dead at a team training camp.  Piermario Morosini, an Italian footballer for Livorno (an athlete who had likely been screened in the preseason for heart problems…) died while on the pitch.  And miraculously, Bolton’s Fabrice Muamba was successfully resuscitated after cardiac arrest during an EPL match.

Sudden cardiac death can-and does-occur in young athletes too.  A recently published policy statement by the American Academy of Pediatrics estimated that 2000 people under the age of 25 die from sudden cardiac arrest in the United States each year.  How many of those young people were screened for heart problems? What screening method is best?  Lost in the debate about screening is one point that concerns me: many club sport athletes have no requirements for preseason physical exams and might escape without any screening at all.

Screening methods are not perfect, but improving

“Screening” means that a large group of individuals are evaluated in some fashion. Those found to be at risk for a condition are restricted from play, appropriately counseled, and treated for the condition.  We screen for concussion risk, heart risk, asthma, orthopedic conditions, etc. The most common method currently in use for young athletes in the United States is the preseason physical exam.  A recent New York Times article presents some interesting background, and I encourage you to take a look at it.  Is there a better way to reliably screen young athletes for potential sudden cardiac death?

An electrocardiogram (EKG or ECG) is a test that evaluates the electrical activity of the heart.  When used in conjunction with the preseason physical exam and questionnaire the EKG can significantly increase the power of the evaluation in detecting potential heart problems.  Unfortunately, as seen by the death of the young Italian footballer, even the best screening methods are not perfect.  There is debate about the cost-effectiveness of these screening procedures.  There is also some debate that screening will lead to “false positives” that would unnecessarily exclude young athletes from sport participation.  It’s also likely that in the near future we will have genetic testing available to screen for some of the most common causes for sudden cardiac death.  The question of the perfect screening test is unanswered.

A big problem: club sport players can escape without any screening

At the very least most kids who are playing high school sports in the United States will be required to go through some form of preseason physical exam and screening.  One of the concerns I have as a team physician are all of those kids playing club sports where they may not have the safety net of the preseason physical exam.  It’s certainly true that most national governing bodies for club sports have a recommendation that the young athletes undergo preseason physical examination but there are very few of these national governing bodies that have a requirement that the athletes do so.If it’s not a requirement to play, most parents choose to skip the preseason physical exam. If you don’t believe me on this point you may want to confidentially poll a number of the parents in your club or league.

So while there is debate about the perfect screening method for sudden cardiac death, one thing is certain: doing something is far better than doing nothing.  If you’re the parent of a high school athlete make sure that your son or daughter has a properly performed preseason physical exam.  If you’re the parent of a club athlete where the exam is not required I would still strongly recommend that your son or daughter undergo a proper preseason sports physical examination.  I don’t know how many kids we’re missing but the number has to be big. Don’t let the club sport athlete fall through the cracks without at least being screened.  The results could be tragic.

Posted in Sports Science, Tips and Training | Leave a comment

USA Hockey’s Development Model Forges A New Pathway

Posted on 04/24/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

In the past several weeks I’ve commented on the role of single-sport specialization and the need for age-appropriate sport development guidelines.  Here’s one that I think gets it right.  This is USA Hockey’s American Development Model, or “ADM”.  USA Hockey asks the question “What’s wrong with where we’re going” and from the introduction to the ADM here’s what they have to say:

“For starters, many athletes spend too much time traveling, competing and recovering from competition and not enough time preparing for it. Second, there is too heavy a focus on the result rather than the performance. This attitude leads to long-term failure, as coaches forgo the development of skills to focus on specific game tactics. And third, too many athletes are specializing too early on. An early focus on just one or two sports often leads to injuries, burnout and capping athletic potential.”

 Hockey, like many youth sports in the U.S. has followed the pathway towards early age specialization, coaching for results sometimes at the expense of development, and overutilization of full-ice games even at the younger age groups.  While not the “rule” for all hockey associations these points made up the culture of the youth game. Fundamentally, the questions that were asked are: is the current model the best one for long term player development and will it keep kids in the sport for the long term?

The conclusion by USA Hockey was that it is necessary to start a cultural change in youth hockey, and a new model for long-term player development was needed.  They also decided that the best place to start is at the youngest age groups.  After this comprehensive review USA Hockey partnered with the NHL to produce the ADM. The model created emphasizes multiple touches on the puck, cross-ice practices and games, fostering a true love for the game of hockey, and finally age-appropriate competitive excellence.  As far as I can tell USA Hockey’s objective is to create the highest skilled competitive players who want to continue playing into college, the NHL, or adult leagues.

Ok, so that sets the tone for the direction, but how exactly do you enact the types of changes that are necessary to correct the perceived problem?

We spoke to Kevin McLaughlin the senior director of Hockey Development for USA Hockey, and one of the principal forces behind the ADM.  To be sure there are challenges in starting up any system that challenges the status quo, or gets to the very heart of cultural change within a sport.  Mr. McLaughlin told us that the ADM program has been in place about 2 ½ years and is already showing great buy-in from U.S. based coaches.  Interestingly, he pointed out that the relative newness of youth hockey in the U.S. as compared to Canada allows a national governing body greater chances of success in starting new programs.And it can only help to have the NHL in their corner.

The program is relatively new and it will take quite a bit more time to see how it ultimately succeeds as far as keeping kids in the game for the long term.  But I really think they’ve done a lot of things right.  If you’re a hockey league or association and you don’t know about the ADM take a look at the extremely detailed website, get in touch with them, and see if you can implement it in your area.  Better yet, if you are involved in some other sport I’d really encourage you to take a look at this.  Perhaps you can do something similar and contribute to the long-term growth of the kids in your sport.

Posted in In the News | 1 Comment

Mia Hamm: Soccer’s Legend With Advice For Girls, Parents, and Coaches

Posted on 04/18/2012 by Dev Mishra MD

Interview by Mike Woitalla

Note: This article first appeared in Soccer America’s Youth Soccer Insider. Mike Woitalla is the Executive Editor of Soccer America, and is a member of Sideline Sports Doc.

American sports icon Mia Hamm debuted for the U.S. national team at age 15 in 1987. She helped the USA to two World Cup and two Olympic titles. The 158 national team goals she scored before retiring in 2004 remain a world record. We asked Hamm to reflect on her early years and offer advice for coaches, parents and young players.

SOCCER AMERICA: How involved are you still in soccer?

MIA HAMM: It’s a huge part of my life. I’m still involved with U.S. Soccer on a couple of committees to help continue the growth of the game and make sure we’re going in the right direction, in general, as a Federation.

Kristine Lilly, Tisha Venturini-Hoch and myself started a soccer academy called Team First to basically help share with young girls our experiences and what we felt helped make us successful.

I still watch tons of soccer. Both the men’s and women’s national teams, MLS, EPL …

SA: What part of the coaching you got as a youngster helped you succeed?

MIA HAMM: Everyone talks about it being fun. And it definitely was. That needs to be the focus. Development over winning was something I felt was there. I think as kids, and especially the players who go on to play at the highest level, they’re naturally competitive. That’s going to be a part of what they do.

At a certain age, that reinforcement is important, but at a young age it’s about development and making sure that the kids really enjoy the environment they’re in so they want to come back and continue to learn and listen.

SA: How different do you think youth soccer is now compared to your early days?

MIA HAMM: The first coaches I had were just dads. And [laughs] probably wearing too small team uniform shirts and a really bad hat or visor on the sideline. And occasionally saying things they got from their days of playing football and trying to apply it to soccer, like “get to the end zone.”

It’s changed a lot. Some good, some bad. Coaching and the players are so much better at a younger age.

I didn’t specialize until I made the national team. I still played basketball and a bunch of different sports, really kind of followed what my friends were playing in the season that was being organized.

I think that helped me not burn out so early and helped my overall athleticism.

SA: In your book “Go For the Goal” you addressed the problem of youth coaches sacrificing “learning skills for winning games.” Youth soccer has continued to get more expensive and paid coaches are the norm, so it would seem that pressure on winning has increased …

MIA HAMM: You’re right, with more money and coaches being paid they feel a lot more pressure to win and parents want a greater return on their investment, whether that’s a college scholarship or an opportunity to play on the youth national team or professionally.

SA: You’ve talked about pickup games – such as soccer at recess in grade school and playing with your brother – being a key to your development …

MIA HAMM: That helped a lot. Playing against boys, against older kids who were more talented than I was — and bigger, stronger, faster. But in the end what was so great was I put myself in those situations, and it was an environment to be able to hang out with my brother.

You don’t hear of as many kids playing pickup soccer as they used to because they’re training five days a week and play 12,000 games on the weekend.

SA: What advice do you have for parents of aspiring players?

MIA HAMM: My parents really allowed soccer — and whatever I chose — to be my passion and not theirs.

I heard one of my coaches say the best advice he can give to the parents is just be their parent.

As a parent myself, I can pay other people to do their job in terms of coaching my kids. I don’t want anyone but me and my husband to be their parents.

I look at that as the important role I can play in their lives. It doesn’t mean I won’t share my knowledge of soccer with them or occasionally go out and coach their teams, but I want to make sure they know I’m their parent first and they can come to me, and I hope they come to me for anything.

SA: What should parents be aware of when girls enter their adolescent years? For sure that’s a time of many changes that can affect the way they approach activities like soccer.

MIA HAMM: I’ve tried to block out that period of my life [laughs]. …

I think, yeah, there’s so much going on and most of it you don’t really understand or you can’t really comprehend.

What I would tell parents is just understand that things can change at a drop of a hat – emotionally, physically, psychologically – for your kids, and to just be there [for them]. And be flexible. And be open, and be that sounding board for them.

They could have a favorite dress and the next day say they hate it and it’s the ugliest dress they’ve ever seen. Or they could say Susi’s my best friend and now they’re not talking to one another.

Expect the unexpected and just make sure you’re there.

SA: How do you think girls benefit by playing sports during those years?

MIA HAMM: With girls going through puberty, I think it gives us a great outlet both socially and physically. Kind of get out some frustration, run it out. Have a group of friends with a common interest whom you can kind of lean on … talk about your parents and how they’re not listening to you [laughs].

I think it’s extremely important.

SA: What advice do you have for young soccer players?

MIA HAMM: Have fun and everyday you step out there let’s see how much better I can get. And doing it together is even better.

(Mia Hamm played for the USA from 1987 to 2004, scoring 158 goals in 275 games. She played at four World Cups and four Olympics, and won two titles at each competition. She also won four NCAA titles with North Carolina and the 2003 WUSA crown with the Washington Freedom. She was inducted into the National Hall of Fame in 2007, three years after her retirement.)

Posted in Tips and Training | Leave a comment

Eye Injuries In Lacrosse: Eye Protection Mandatory For Girls

Posted on 04/12/2012 by Dev Mishra MD

By: Dev K. Mishra, M.D., President, Sideline Sports Doc

Girls’ and women’s lacrosse has shown huge increases in participation across the United States. According to National Collegiate Athletic Association (NCAA) data, the number of women’s lacrosse programs nearly doubled between 1993–1994 and 2003–2004, increasing from 133 teams to 258 teams. Women’s lacrosse is fast paced like men’s lacrosse; but, unlike men’s lacrosse, only incidental player-to-player contact is allowed by rule.

Of course the rules don’t cover everything that actually happens in the course of a game. Because of stick and ball contact injuries to the head, face, and eyes, U.S. Lacrosse recommended protective eyewear for women in 2004 and made it mandatory for girls and women at all levels of play in 2005. Although most head, face, and eye injuries are minor, there is great potential for severe injury with a hard ball thrown at eye level at speeds approaching 60 miles-per-hour.

Eye goggles are proven to decrease the number of eye injuries and prevent catastrophic eye trauma. Some recent scientific studies point to significant reduction in eye injuries since the start of required eye protection in 2005.  This study by Lincoln and colleagues examined injury rates in girls’ scholastic lacrosse.  The rate of eye injuries was reduced from 0.10 injuries per 1000 athlete exposures (AEs) in 2000 through 2003 before the use of protective eyewear to 0.016 injuries per 1000 AEs in 2004 through 2009.

Some people have suggested that more protective equipment could actually increase the number of injures by making it less risky to make contact with another player. However, studies in other sports such as the implementation of helmets in ice hockey have not demonstrated more aggressive or reckless play with the introduction of protective equipment. And certainly there has been no increase in eye injuries with protective eyewear.  It just makes sense, right?

If an eye injury occurs follow some simple sideline principles and get help immediately if there is eye pain

  • For eye injuries, try to visualize the eyeball to see if there are any obvious injuries or redness.  Do not attempt to forcibly open the eyelids.
  • If the athlete can open her eyes, see if she can track your finger movement (up-down-side to side) without pain.  Also ask her if her vision is normal (have her read something) and whether she is seeing double vision.  Lightly apply ice over the affected area.
  • Do not attempt to remove a contact lens in the presence of eye trauma.

Seek medical care immediately if:

  • there is any persistent eye pain (with or without eye motion)
  • increased redness of the white (conjunctiva) of the eye associated with pain
  • bulging of the eye and swelling of the tissues surrounding the eye
  • the vision remains blurry, there is a loss of vision, or double vision
  • floaters (black spots or lines) or flashes of light appear
  • the eye tearing does not stop
Posted in Who We Are | Leave a comment

Little League Shoulder: Unfortunately, It Means Springtime Is Here

Posted on 04/05/2012 by Dev Mishra MD

By: Dev K. Mishra, M.D., President, Sideline Sports Doc

This week I’ve already seen three young baseball players with “Little League Shoulder”, which unfortunately puts us on record pace.  In years past I’ve usually seen only 3-5 of these in a quarter and definitely not in one week.

Little League Shoulder is essentially a stress injury through the upper growth plate in the arm bone (called the “humerus”).  It happens through overthrowing.  In a growing child the growth plate is made of cartilage.  Lengthening of the bone happens through this area.  As the child reaches maturity the cartilage area turns into bone.

Throwing a baseball can put tremendous amounts of stress upon the throwing arm of both adults and younger baseball players. In adults the ligaments and tendons absorb the stress, and as a result they tend to get ligament injuries from overthrowing. However, in growing children the stress is absorbed by the weakest part of the bone, which is the growth plate. Damage to a growth plate can lead to long-term problems such as shortening of the bone or abnormal angulation of the bone.

The earliest sign of possible Little League Shoulder is pain with throwing, and as the damage progresses the pain can continue after throwing. If the damage becomes worse there may be weakness, limited motion, and a complete inability to play any sports involving the arm.

If you’re consistently feeling shoulder pain with pitching or throwing get rest early and get some help

This is a classic example of an injury that needs rest early, and that rest can save a huge amount of downtime later.  As a player, a parent, or coach beware of persistent pain. Rest the player from throwing for several days.  Often that will let the shoulder return to normal with a minimum amount of time off.  For any pain that lasts more than a few days, or keeps coming back with each throwing session it’s very important to see a physician skilled in diagnosing and treating shoulder injuries.

The physician will listen to the description of the problem, do an exam, and probably get X-rays. On the X-ray the growth plate damage may show up as widening of the growth plate. If the X-rays are normal then it may be necessary to do other studies, such as a bone-scan or an MRI (Magnetic Resonance Imaging). These tests may show subtle damage not visible on regular X-rays.

A confirmed Little League Shoulder can take many months to return to throwing

The initial treatment for a confirmed growth plate injury is complete rest from sports.  If the shoulder is very painful an arm sling might be needed.  Here’s a typical progression that I see from the young athletes in my office:

  • First 3 weeks: complete rest
  • Weeks 4-6: partial activity possible, such as running, bike
  • Weeks 7-10: usually physical therapy to get strength and motion back
  • Weeks 11-14: sport specific training, such as interval throwing program

Every one responds a bit differently but the timelines are usually pretty close to the one above.  Wouldn’t you rather take a few days or a week off early rather than lose 4 months?  Pay attention to total innings, pitch counts, and absolutely pay attention to early arm pain.

Posted in Injury of the Month | Leave a comment

Circling Back To The Curveball

Posted on 03/27/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

For quite some time now sports medicine professionals have believed that young pitchers should not throw curve balls due to the increased stress on the pitching elbow and the subsequent risk of a major elbow injury.

Well-designed scientific studies are presented at national meetings or published each year that shed a bit more light on the topic of pitching injuries.  Sometimes these confirm what we think intuitively but sometimes these studies are inconclusive, or go counter to what we believe.

Good Science Is Hard To Do

The difficulty is that good science can be very difficult.  For example, we believe that consuming too much processed sugar leads to obesity but proving this scientifically is challenging.  Due to the nature of study design, statistical needs, cost, etc. it can take huge numbers of people to study, and a very long time to complete to get conclusive results.  This is the way it is with elbow injuries for young pitchers too.  Each year we get more information, like pieces in a puzzle, but we still don’t have the puzzle finished.

What We Know

As we look at the scientific evidence there are some risk factors for injury that we can agree upon.

  • Too much throwing, or overpitching, is definitely a factor in elbow injury risk, regardless of the type of pitch thrown.  This recently published study by Mihalik et al as well as numerous studies performed at the American Sports Medicine Institute(“ASMI” run by Dr. James Andrews) point to the conclusion that overthrowing is a risk for pitching injury, regardless of the pitch type.  So what’s the definition of “overthrowing”?  Here again is where the available evidence points us in the direction adopted by Little League Baseball.  A few good studies show conclusively that young pitchers who pitch more than 100 innings in any year were 3.5 times more likely to have a serious arm injury than those who pitch fewer innings.  Overpitching is especially common in players participating in multiple teams at the same time.Keep total innings below 100 in each calendar year.
  • Good pitching mechanics learned early will benefit the young player.  Dr. Andrews recommends basic throwing, then fastball, then change-up.  There is no recommendation for curveballs.
  • Core strength, lower extremity strength, and flexibility are very important in minimizing throwing risk.  Core and lower extremity weakness can lead to arm fatigue, poor mechanics, and arm injury.

What Our Experience And Instinct Tells Us

Orthopedic sports medicine specialists see a skewed population- in our offices and operating rooms we’re only seeing the players doing badly.  It’s possible that there are plenty of players doing well and we don’t see them in the office.  But many years of experience and instinct tell us that pitch counts, limiting annual innings, and restricting types of pitches is the right thing to do.  My belief is that this is an instance where we are far better off going with what we know to be true from experience and let the scientific studies catch up someday.  For ASMI’s recommendations click here.

If You Have A Sore Pitching Arm

Many problems can be “fixed” easily with early medical or rehabilitation input.  There’s a common misconception among players that going to the doctor automatically means they will be shut down.  This is not true.  It all starts with an accurate diagnosis, but a sports medicine specialist may recommend stopping pitching temporarily but could allow field positional play if the injury is noted early.  Physical therapy may be required, or correcting strength deficits in the core muscles.  In serious cases, yes, the athlete may be shut down completely or even need surgery.  But far more often than not an early diagnosis and treatment will save an arm and the season.

 

Posted in Tips and Training | Leave a comment

High School Sports Still Matter- For Now

Posted on 03/20/2012 by Sideline Sports Doc

By Dev K. Mishra, M.D., President, Sideline Sports Doc

Today’s post is a follow up to last week’s, and I am straying from our usual injury and fitness topics.Please bear in mind that what follows is one man’s opinion and doesn’t represent anyone’s official policy.  The decision by the US Soccer Federation to go to essentially a year-round schedule and prohibit their male Academy players from participating in high school soccer is an interesting one, and I think it’s reasonable to take a look at a few other popular boys’ sports to see how they do things.

What’s Up With High School Baseball, Basketball, and Football?

Baseball is one of the few sports that allows drafting of top prospects in high school, still allows them to play in high school, and in many instances also allows them to play in college.  The typical elite baseball player is being identified very early- sometimes as early as age 12.  The best of these players will be involved in elite travel teams, have personal coaching, play in “area code” tournaments, compile a video highlight/statistical portfolio early on.  The typical D1 or pro prospect has been identified through this system and is further scouted at prominent high school programs.  These players are strongly encouraged to play high school baseball, and are often contacted by D1 coaches in their freshman or sophomore years.  The high school experience is built into the culture of the sport, even though a good deal of scouting takes place in the club or travel team system.

Basketball is a bit tricky.  The very best of the best can unfortunately be involved in the shady world of “street agents” as early as middle school, with a token freshman year of college merely serving as a stepping stone to the NBA.  But that’s just a tiny handful of players.  For the vast majority of elite basketball players a combination of high level travel team (often run by AAU) and exposure in high school ball is required.  Thus some players will skip college straight for the NBA but no one skips high school ball.

And football is still all about Friday Night Lights, especially in the south.  Even as it’s become essential for elite football players to seek additional exposure in showcase events, all-star games, and 7-on7, the high school football team is the central part of a teenage football player’s competitive experience.

So what’s different about soccer?

Soccer is the most popular participant sport in the world, and at the world-class level we in the United States are playing catch up.  Naturally, US Soccer looks to established soccer nations for models of best practices, especially at the youth level.  Apparently the rest of the world doesn’t think much of scholastic soccer.

And that’s fine, if the culture of youth sports and education in your country support this.  But in the United States, high school sports represent a very unique tradition.  The professional football, baseball, and basketball players in this country don’t seem to have been harmed by playing high school ball.  All the professional athletes I’ve cared for over the years have spoken very favorably of their high school sports experiences.

Somehow I think US Soccer got this wrong.  I’m sure it wasn’t their intent, but the directors of the Academy program come off sounding incredibly arrogant. “Tough Choices” for the athlete. But what if they are right?  Several Academy coaches say that they polled their players, who overwhelmingly stated they were fine to never play high school soccer.  The answer will probably be found somewhere between the extremes of the heated rhetoric.The answer will also be found wherever we follow the money.

I’m not pining for the bygone era of the 1950’s, and change is inevitable. Until someone figures this out you can find me on the sidelines of a high school football game this fall.  I hope to see you there.

Posted in In the News | 1 Comment

High School Sports Are The Last Home For The Multi-Sport Athlete

Posted on 03/13/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

Specialization is common and accepted in most professions.  At some point in time Einstein probably decided to focus on theoretical physics, Tom Brady focused on football rather than baseball, and YoYo Ma chose the cello over the double-bass.  The world is better for their decision.

When is the right time in a person’s life to specialize?  Much has been written about specialization in youth sports and there are persuasive arguments made for and against the practice.  We’ve seen a recent article in the New York Times about the U.S. Soccer Federation’s move towards year-round single sport commitment for their elite boys in their Academy program which will prohibit these players from participating in high school sports.  Some argue that this model will create the best chance to make world-class soccer players, and others argue that taking away a chance to play high school soccer deprives these players of a critical part of their social development.

Whatever the “answer” to the question of specialization happens to be, the tone of the governing bodies of certain sports is clearly that if you are any kind of decent athlete you better do it our way.More on this topic next week.

But what if a young athlete doesn’t want to specialize?  Is the notion of a multi-sport athlete “wrong”, antiquated or even dead?  My feeling, without any data to support this, is that there are plenty of multi-sport athletes still out there and that high school sports are the best environment for these young athletes to compete.

Let’s stay for a moment on the subject of high-level boys soccer.  I know of two examples in our community of talented young athletes who decided to pursue what makes them happiest for now, and that’s to stay with several sports.  One young man, recently a Regional ODP selection for soccer also happens to be a very promising distance runner.  Another boy, formerly a Regional ODP selection for soccer also plays high school football and is a 6-handicap golfer.  Single sport specialization would rob them of experiences they enjoy. These are only two out of thousands of examples across the country. Can we really find fault in the pursuit of happiness?  And are they somehow second-rate soccer players for choosing not to specialize?

These are very personal issues and I don’t claim to be an expert on the best way to develop a child.  But I do like the idea of sports choice and I don’t like the idea of forcing anyone down a pathway that’s not of their choosing.

If a talented young musician, dancer, artist, mathematician, or athlete shows the drive and discipline to pursue specialization that’s great.  Let’s provide the appropriate channels for them to pursue what they’d like to do.  And if they don’t want to specialize I hope we can still give them opportunities to explore and advance their skills without making them feel marginalized.

Who is the high school athlete?  She’s the small-town athlete who plays volleyball in the fall, basketball in the winter, and runs track in the spring.  He’s the suburban athlete with access to every possible resource who doesn’t want to do just one thing. She’s a good but not “great” talent who couldn’t make the cut for the travel team in softball. And he’s the elite level multi-sport athlete.  In my mind it’s not so much about right or wrong, it’s about providing opportunity.  In the reality of today’s club youth sports environment I hope high school sports continue to give young athletes the choices they deserve.

Posted in Tips and Training | Leave a comment

Confidence: One Guy Who Has It, One Guy Who Had It, and One Guy Who Lost It But Might Have It Back Now

Posted on 03/06/2012 by Dev Mishra MD

By Dev K. Mishra, M.D., President, Sideline Sports Doc

Confidence is essential to successful performance in sports, or even just enjoyment from sports activities. Without confidence, athletes can find themselves paralyzed by fear, which can lead to poor performance or embarrassment. Some people think you are either confident or you’re not, you have it or you don’t, as if it’s an in-born trait. But you can actually become a more confident athlete.

Let’s take a quick look at three prominent professional athletes, and how confidence changed their games.

First, there’s Mr. Lin-Sanity, Jeremy Lin of the New York Knicks.  For those of us living in the San Francisco area, we’ve known about Mr. Lin since his high school days.  His saga is well known:  high school star, not recruited by major college basketball power schools, attended Harvard (pretty good fallback position!), didn’t latch on with the Golden State Warriors, eventually landed successfully with the Knicks.  Is he a substantially different player physically than he was with the Warriors?  Probably not.  Certainly there are a lot of factors such as the team’s system of play, personnel needs, etc. that played a role here, but Mr. Lin himself firmly grounds his success in his personal faith (his is an active faith in God).  Whether faith equals confidence is a subject of debate, but the point is that it was a non-physical trait that contributed to success.

Next, there’s Kurt Warner, former NFL quarterback.  His is one of the true NFL rags-to-riches stories.  Played at a small college, not drafted, ended up bagging groceries, then NFL Europe, and finally the NFL itself and a Super Bowl ring.  There were no steroids involved, no magical physical transformation.  Warner was described by his teammates as a supremely confident but not arrogant person.

And finally, Tiger Woods.  We watched him play a phenomenal round of 62 yesterday which has many people wondering if Tiger is now “back”.  Time will answer that question, but what caught my attention was a post-match interview in which he described his thinking going into the second shot on 18.  He said that he remembered a similar situation in another tournament, one where he pulled off a stunning approach leading to an eagle putt.  That successful memory and the visualization gave him the confidence to attempt the shot yesterday.

In the world of youth sports there are many instances of two athletes with similar physical traits taking different pathways in the same sport:  one propelled to success, and the other struggling along.  Oftentimes the difference between the two comes down to confidence.

There are a few simple steps we as coaches or parents can take to encourage confidence in our young athletes.  None of this is new thinking but it’s easy to forget especially with all the pressure imposed on kids.

  • For the coach, positive language really does work.  You’ve heard this hundreds of times but how often do you put it to use?
  • For the coach, tolerate mistakes.  That’s a tough one.  In just about any profession those at the very top will tell you they’ve made plenty of mistakes along the way, and sometimes massive errors.  The key is figuring out for yourself how to successfully get out of trouble.  Encourage your players to think for themselves in practice, which will likely make them more confident in game situations.
  • For players and coaches, practice the right technical things.  Doing things correctly in practice builds a skill foundation needed in any sport.
  • For parents, we also need to tolerate mistakes.  Just as for the coach, this can be really tough.  We all want our kids to succeed but sometimes they need to fail a bit first.
Posted in Tips and Training | Leave a comment