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:


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Stress Fracture Can Stop Your Summer Running

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • A stress fracture is a type of overuse injury
  • Stress fractures often start with mild activity related pain that never disappears
  • Stress fractures will usually heal with proper treatment, allowing return to sports but the healing process can take a long time


Last week we wrote about an overuse/growth related injury called Osgood-Schlatter syndrome and this week I’d like to focus on another overuse injury: stress fractures.

Here’s a common scenario:

A high school distance runner started developing a slight ache in her inner leg towards the sore calfmiddle of spring track season. She thought very little of it and continued to train and compete. She iced down religiously after training, used a compression sleeve, and used a foam roller. The pain gradually intensified to the point where she needed to pop 3 or 4 ibuprofen pills before every race just to be able to finish. High school season ended, she took two weeks off from running and then went straight into summer training, now using hill runs in preparation for a marathon she wanted to run this July. But the pain worsened immediately on her first training run and bothered her with any amount of walking or even just weight bearing.

When this young woman came to see me the concern was for a stress fracture in her tibia, and we confirmed this with imaging. My suspicion is that she started with a shin splint syndrome but continued to power through the pain. The muscles and soft tissues were unable to support the running stress, the stress transferred to the bone instead, and a stress fracture in the bone was the result.

What is a stress fracture?

A stress fracture is a crack in a bone that results from overuse. It occurs when muscles become fatigued and are unable to absorb added shock. In the scenario above the suspected shin splints ultimately caused bone overload. Eventually, the bone gave out as well and developed a crack.

Stress fractures often are the result of increasing the amount or intensity of an activity too rapidly. They also can be caused by the impact of an unfamiliar surface (a tennis player who has switched surfaces from a soft clay court to a hard court); improper equipment (a runner using worn or less flexible shoes); and increased physical stress (a basketball player who has had a substantial increase in playing time).

Most stress fractures occur in the weightbearing bones of the lower leg and the foot. More than 50 percent of all stress fractures occur in the lower leg. The tibia, fibula, and metatarsal bones are common stress fracture sites.

In my experience runners are most susceptible to stress fracture. Other sports placing the young athlete at risk for stress fracture are tennis, gymnastics, and basketball. In all of these sports, the repetitive stress of the foot striking the ground can cause trauma. Without sufficient rest between workouts or competitions, an athlete is at risk for developing a stress fracture.

Symptoms of a Stress Fracture

Pain with activity is the most common complaint with a stress fracture. This pain typically subsides with rest. If your pain progresses to the point where simple walking is painful, you should see a sports physician. You should also see a sports physician if your pain returns immediately after a period of a few weeks rest. As you can see from the scenario at the top of this post there’s sometimes a progression from shin splints to stress fracture, so if you’re just not sure what you are dealing with then get professional evaluation from a sports physician early on.

How are stress fractures treated?

The most important treatment is rest. Athletes need to rest from the activity that caused the stress fracture, and engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal. If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Re-injury also could lead to chronic problems where the stress fracture might never heal properly. In addition to rest, shoe inserts or braces may be used to help these injuries heal.


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Growing Pains or Osgood-Schlatter

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:


  • Overuse injuries related to growth spurts are common in certain sports, especially sports involving jumping, sprinting, and rapid changes of direction
  • Osgood-Schlatter syndrome is a very common growth related pain in the front of the knee
  • Osgood-Schlatter can be successfully treated by rest from the activities causing the pain, and allowing gradual return to sports


School’s out now for many kids, and I’m starting to see a lot of kids come through the office to get “tuned up” for summer activities. Typically we are now dealing with a number of nagging overuse injuries, and one extremely common type is pain in the front of the knee. Osgood Schlatter

Pain in adolescent athletes is often called “growing pain” but there are specific age ranges and sports that predispose a young athlete to pain.

“Osgood-Schlatter” syndrome (sometimes called Osgood-Schlatter disease) is one such specific problem. The young athlete can develop a painful lump below the kneecap particularly in children and adolescents experiencing growth spurts during puberty.

Osgood-Schlatter syndrome occurs most often in children who participate in sports that involve running, jumping and rapid changes of direction — such as soccer, basketball, figure skating and ballet.

While Osgood-Schlatter syndrome is more common in boys, the gender gap is narrowing as more girls become involved with sports. Age ranges differ by sex because girls experience puberty earlier than boys. Osgood-Schlatter syndrome typically occurs in boys ages 13 to 14 and girls ages 11 to 12. The condition usually resolves on its own, once the child’s bones stop growing.

Some kids will have only mild pain while performing certain activities, especially running and jumping. For others, the pain is nearly constant and debilitating.

Osgood-Schlatter syndrome usually occurs in just one knee, but sometimes it develops in both knees. The discomfort can last from weeks to months and may recur until the young athlete is finished growing.

How do you treat Osgood-Schlatter’s?

Activity modification is the main treatment for Osgood-Schlatter’s. For those kids that end up in my office we will typically spend a long time carefully analyzing sports, activities, and time spent on each. Treatment generally means cutting back substantially on jumping and sprinting sports until the pain is gone, and then gradually restarting those sports. Other conservative treatment measures include ice, stretching, controlled strengthening, physical therapy, simple over-the- counter pain medicines, and a patellar strap. In more severe cases, a short period of casting or bracing may be recommended.

The good news is that Osgood-Schlatter doesn’t last forever. The hard part is cutting back on activities that cause the symptoms. The symptoms of Osgood-Schlatter’s almost always improve with rest and also usually subside when the athlete finishes growth. In rare cases, a fragment of bone may not unite to the underlying tibia and symptoms may persist into adulthood.

Although extremely rare, an athlete who continues to play vigorous sports with persistent pain from Osgood- Schlatter’s may develop a complete fracture through the growth plate at the top of the tibia. Usually, however, the only long-term consequence of Osgood-Schlatter’s is a residual bump on the front of the knee that does not interfere significantly with sports.


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Yoga Catching On With Young Athletes

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • Participation in yoga is increasing amongst all age groups in the United States
  • When done correctly, yoga has many benefits for young athletes in improving core strength, flexibility, and psychological benefits
  • Some poses may need to be avoided or modified if the athlete has some pre-existing medical conditions, such as avoiding lunges if you have Osgood-Schlatter syndrome


This week we’ll continue the discussion of sports and activities outside of team sports. Last week we looked at some aspects of dance, and this week focus on yoga. kids yoga

Various estimates of yoga participation in the United States appear to show increases in all age groups. It’s generally believed that the percentage of U.S. adults who said they practice yoga increased from 5.1 percent in 2002 to 9.5 percent in 2012, according to one survey conducted by the National Institutes of Health and the Centers for Disease Control and Prevention. Yoga participation amongst kids is also on the rise: the percentage of children ages 4 to 17 who do yoga increased from 2.3 percent in 2007 to 3.1 percent in 2012.

I’m generally a yoga fan, although there’s quite a bit of commercialism surrounding mainstream yoga. Yoga encourages balance, strength, proper

posture, improved breathing, control, and awareness of one’s body, and has potential mental benefits as well. We are seeing some more injuries than we did several years ago, but with a few simple guidelines, many of these injuries can be prevented or limited. Additionally, when working with an experienced instructor, yoga may be helpful for injury recovery from numerous orthopaedic conditions such as common strains and sprains.

There are several types or disciplines of yoga. Not every form is friendly for beginners and some can be quite strenuous. Depending on your athleticism, fitness, flexibility, and conditioning as well as pre-existing medical conditions, you should choose a style that fits you well. You should also communicate your goals and needs with the instructor before embarking on a new program.

Injuries can be avoided by knowing your limitations. If you have pre-existing medical problems or extremity injuries, consult your physician or orthopaedic surgeon prior to starting or renewing a yoga program. Discuss any pre-existing conditions with the yoga instructor before starting a class. They may want you to avoid certain poses or positions.

Typically, injuries occur when participants attempt a challenging pose or posture without having the initial capability, flexibility, or strength to perform that maneuver or when the pose is performed improperly. In yoga,

it is better to do a portion of the maneuver perfectly than to push from poor alignment into a full pose.

Two common areas for potential problems are with pre-existing conditions such as Osgood-Schlatter syndrome in the knee or Sever’s syndrome in the heel. If a young athlete has these conditions you’ll likely need to modify or avoid some poses, such as avoiding lunges.

With proper techniques and guidance yoga can be extremely rewarding both physically and mentally. Following this straightforward advice, injuries are unusual and the disciplines can be quite beneficial for core and postural strength, balance, and flexibility.


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

Keep Moving When You Dance

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • Dance classes are very popular amongst adolescent girls, but a recent study shows that only about one third of a typical dance class involves moderate to vigorous physical activity
  • Several organized sports practices as well as dance activity might be improved to encourage larger amounts of movement based activity


You would think that dance equals movement, right?

Many prominent national health and medical associations recommend that children and ballet classadolescents participate in at least 60 minutes of moderate to vigorous physical activity on most days of the week. There are multiple physical and psychological benefits of that type of activity, however, several studies have shown that in general only 42% of children and 8% of adolescents are meeting these guidelines. It’s no secret that starting at the youngest ages we’ve become a much more sedentary society.

The emphasis has shifted away from the schools to provide physical activity, and these days a considerable amount of physical activity among adolescents occurs after school in structured or organized programs such as sports teams or dance lessons. Dance is particularly popular among girls, which means it has the potential to make up the gap in physical activity typically seen in adolescent girls. Dance has many health benefits such as muscle and bone strengthening, increased flexibility, improvements in balance and spatial awareness, and enhanced cognitive functioning.

A recent published study attempts to put some objective data behind the amount of physical activity typically found in dance class. New research shows that over all, the level of physical activity in children’s’ and teenagers’ dance classes is surprisingly low. On average, students spend only about one-third of their class time in moderate to vigorous physical activity.

The study used accelerometers to measure activity. Accelerometers can underestimate actual activity since they measure arm or upper body movement, but still the amount of activity the kids spent actually moving is quite low. In fairness to the dance instructors, their dance classes are usually designed around teaching dance skills and are not the type of dance class found in an aerobics studio. Dance instructors in dance studios are there to promote an art form, which is a great idea.

But the takeaway lesson is that many types of sport or dance activity don’t actually involve a lot of activity. In my experience this is certainly not limited to dance. If you observe many types of organized sports practices you’ll find a lot of kids standing around as instructions are yelled at them, or as drills are done in a sequential one v one design.

As a coach or instructor you’ve got a great opportunity to structure your sessions around more movement, which will usually lead to a better, fitter young athlete. And as parents spend some time observing the sessions and if necessary encourage more vigorous activities.



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Exercise For Your Vision Might Save Your Brain

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • Published research from the University of Cincinnati shows that visual field training has the potential to significantly reduce concussion rates in college football
  • This very early research needs to be repeated for applicability in youth and high school football as well as other sports, but may have promise


I do hope that someday we’ll have a tighter handle on reducing concussion risk so we won’t have to write about it quite so much, but until then I’ll continue to highlight some developments in science that could benefit young athletes. This week I’d like to focus on an interesting preliminary study from the University of Cincinnati showing that training for improved peripheral vision has the potential to decrease the incidence of concussions in football. W_EagleVisiontraining

Peripheral vision training has become commonplace as a performance enhancement tool for some sports. Training athletes for better peripheral vision reportedly improves a batter’s ability to hit a baseball, a tennis player to return a serve, a quarterback to see receivers, and other sport specific tasks. Fighter pilots and NASA astronauts use peripheral vision training to improve their critical job performance.

Is it possible that improving peripheral vision might somehow allow an athlete to avoid the serious hits that lead to a concussion? Would improved peripheral vision decrease the blind side hits that lead to an unexpected jarring of the head and neck? Researchers working with the University of Cincinnati football team conducted a study to find out.

From 2006 to 2009, the University of Cincinnati football team averaged about nine concussions a year. From 2010 to this most recent season, the team’s average concussion rate has dropped below two a year. Researchers attribute the large decrease in concussions to peripheral vision training for the players using a Dynavision light board on its football players.

The theory behind the improvement is that improved peripheral vision allowed the players to avoid the most vulnerable positions that would typically result in an unexpected impact. By seeing and sensing the impact before it happens the player is in a better position to protect himself from the hit and thus have a chance to avoid a concussion. You can read the study here.

My initial take on this study is that it is promising, especially for collegiate football, it makes sense, and certainly can’t hurt. We will of course need additional research to prove that the vision training caused the decrease in concussions, but this small study is very interesting. It’s also hard to say how applicable the training would be in reducing concussions in sports with different concussion mechanisms, such as soccer where many concussions occur in head to head impact while trying to head the ball. It would also need some data in younger age groups, and cost is likely to be an issue for high schools.

So more research is needed, but visual training is catching on in sports at the youth level, in college and beyond. The hope is that by seeing the field of play in a different light, more athletes will avoid a concussion that takes them out of play.


Posted in Concussions, Football | Leave a comment

Elbow “Tommy John” Surgery: Are You Better Than Before Surgery?

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • A common myth is that Tommy John surgery will actually make the elbow better than a “normal” elbow- this is not true
  • But results from surgery on a torn elbow ligament show that about 88% of high school aged athletes can successfully return to pitching
  • Plan on recovery after surgery taking about one year


Last week I wrote about some of the overuse factors that can lead to elbow ulnar collateral ligament injuries in baseball and softball players. This week we’ll dig into some of the myths and facts surrounding the surgery itself. elbow UCL stress test

As more and more professional athletes successfully return to high levels of play after “Tommy John” surgery (properly known as ulnar collateral ligament reconstruction), many young athletes, parents, and coaches have come to recognize that elbow ligament injuries in throwing athletes are not necessarily career ending. As public awareness about Tommy John surgery and its success stories have grown, so too have some myths and misunderstandings about the surgery.

Tommy John surgery will actually make me a better pitcher than before my surgery.

A common myth about Tommy John surgery is that having surgery when the ligament is not completely torn will actually add velocity to a player’s pitches. The fact is that most pitchers with elbow ligament injuries will go through a period of several months where they are losing velocity, control, or endurance long before the surgery. Then, responsible orthopedic surgeons will typically ask the young pitcher to go through several more months of nonsurgical rehab before deciding on surgery. By the time the surgery comes around it may have been 9 or more months since the last time the pitcher pitched pain free and effectively. With surgery we are attempting to get the elbow back to that old level, and with proper body conditioning and mechanics it may be possible to improve on that baseline. The surgery’s goal is to get as close to a normal elbow as possible. It would be wrong to think that the surgery makes the elbow itself better than before the surgery or that operating on a normal elbow can somehow make it even better.

Pitch counts and innings counts are separate in different leagues and don’t cross over or add up.

Wrong! All pitches and innings count as far as the elbow is concerned. The ulnar collateral ligament is typically injured as a result of cumulative damage over time and it really doesn’t care what league you’re pitching in. Staying just under the limit in two leagues in the same week will add up and exceed the overall limit. If an athlete is participating in multiple leagues and playing on multiple teams it is the collective responsibility of the player, parents, and coaches to ensure that the TOTAL pitch or inning count doesn’t exceed the recommended limit.

Having Tommy John surgery means my career is over.

Wrong again. Results from Tommy John surgery are generally very good. For professional athletes having elbow reconstruction surgery the success rate is about 90%, and recent studies have shown success rates of about 88% for high school age pitchers. If you follow the plan and go through proper rehab chances are high that you’ll successfully pitch again.

If I have surgery, I’m out for the year.

Finally, this is mostly true. Recovery from ulnar collateral ligament reconstruction usually takes about 12-16 months before you’re fully back on the mound but occasionally you can be back by about 9 months. If you’re having surgery it’s best to plan on a year for recovery.



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

Risky Behavior For Baseball And Softball

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • Baseball and softball pitchers need to be aware of the burden placed on young shoulders and elbows by playing on multiple concurrent teams, or by overpitching
  • Players would be wise to follow published recommendations for good pitching behavior by Dr. James Andrews and the American Sports Medicine Institute


It’s springtime, which means it’s time for sports medicine physicians and physical therapists to see an uptick in the number of shoulder and elbow injuries in young baseball and softball pitchers. Somehow it seems to me that we haven’t made much of a dent in reducing the numbers of these injuries. My orthopedic practice is just one small data point but the conversations with kids and parents continue yet the injuries keep coming.Grant Lewis

Here’s an illustrative example. I recently saw a promising high school softball player for elbow pain. The concern was for a possible ulnar collateral ligament injury. She informed me that she has a scholarship commitment to pitch at a prominent D1 university, so she is “in”. In spite of that she pushed pedal to the metal before seeing me, pitching concurrently for her high school, club team, and traveling tournament team. Fortunately her story has a happy ending. She had a mild ligament strain that responded well to rehab, and she then cut substantially back on her pitching to focus on total body conditioning. She even enjoys her last few months as a senior in high school.

Our continuing national conversation on youth sports injuries may be most apparent in baseball and softball leagues and organizations across the country – often talk involves increasing pitch counts, overburdened arms and pitchers who are burnt out before even completing their high school playing career.

Until recently we’ve had a limited amount of solid data to back up our general feelings about the burdens of overpitching these young arms. To better grasp how behavior and activities has influenced injury patterns, a group of researchers from the American Orthopaedic Society for Sports Medicine (AOSSM) led a national survey of young players. Some highlights of their research are included below.

Of 754 participating pitchers:

-43.4% pitched on consecutive days

-30.7% pitched on multiple teams with overlapping seasons

-19% pitched multiple games a day during the 12 months prior to the study

These numbers alone are concerning, especially considering they suggest sizeable amounts of young arms are going against recommendations from Dr. James Andrews and the prestigious American Sports Medicine Institute (ASMI).

The study goes on to say that those pitchers reporting these activities had a greater chance of experiencing arm pain related to pitching, leading to an increased risk of injuries. Those with arm pain had 7.5 times greater odds of suffering a pitching-related injury.  The full study was published in the American Journal of Sports Medicine and is available here.

If you’re a parent or coach of a young pitcher please watch out for your young arms. It’s early in the spring for most players; let’s hope they have a successful summer without a trip to the doctor.

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

Sunscreen Is The Smart And Simple Choice To Reduce Skin Cancer Risk

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • Many types of cancers are strongly associated with repeated exposures to cancer triggers, and the association between sun exposure and some types of skin cancer is strong
  • Sunscreen is a simple and effective way to reduce sun exposure risk
  • Only about 20% of young athletes routinely use sunscreen for daytime outdoor sports
  • Coaches are in an excellent position to positively influence the young athlete’s attitude and use of sunscreen

Veteran soccer referee Randy Vogt wrote an excellent piece in Soccer America’s Youth Soccer Weekly about the importance of sun protection for referees. The article encourages referees to take care of themselves with appropriate protection (hat, sunscreen), which sometimes requires the ref to challenge traditional dogma. I couldn’t agree more. In this week’s post I wanted to examine the issue of skin cancer risk with an eye towards the young player. sunscreen_kid

Sun exposure increases risk of skin cancer in many outdoor sports and young athletes rarely use sunscreen

Ultraviolet (UV) radiation that comes with sun exposure is estimated to be one of the most important risk factors for nonmelanoma and melanoma skin cancers. Athletes practicing outdoor sports receive considerable UV doses because of training and competition schedules with high sun exposure, and in alpine sports, by altitude-related increase of UV radiation and reflection from snow- and ice-covered surfaces.

Young athletes commonly have an indifferent attitude towards sun protection. In several published studies it’s been shown that only about 20% of outdoor sport athletes routinely use proper sunscreen for daytime practices and games. For most of the athletes the reasons cited for lack of sunscreen use were mostly psychological. They simply don’t think about it, they don’t know the association between sun exposure and skin cancer, or they may even be practicing resistance because some parents force sunscreen on to the young kids.

There are some physical reasons for not using sunscreen too, such as complaints that sunscreen combined with facial sweat will sting the eyes, and some sunscreens are “greasy” resulting in decreased grip. These are valid points but the newer generation of sport sunscreens are designed to really minimize these problems.

Repeated “exposures” are key factors in several types of cancers

Our understanding of risk factors for various cancers is advancing rapidly over the past several years. One fundamental concept is that repeated exposures to some toxic substances can lead to cell damage and this in turn can lead to formation of cancers. I don’t want to get overly technical here but for those of you interested I’d encourage you to take a look at this video by Dr. Craig Thompson, CEO of the Memorial Sloan-Kettering Cancer Center in New York. Dr. Thompson explains the process in clear terms but here are some cancers with known links to exposures:

  • Cigarette smoking dramatically increases lung cancer risk
  • Women with exposure to the human papilloma virus are at risk for cervical cancer
  • Obesity and consumption of toxic foods (especially processed sugar) is associated with cancers of the digestive system
  • Sun and ultraviolet radiation increases skin cancer risk

Dr. Thompson states clearly in the Wall Street Journal article that the links between some exposures and cancer is compelling and methods to reduce the risk are fairly simple and withn reach for all of us. He writes:

“Don’t smoke, use sunscreen, avoid unnecessary radiation exposure, get vaccinated. Sometime this decade, it is expected that obesity, driven in large part by excess sugar intake, will surpass tobacco exposure as the No. 1 cause of preventable cancer in the U.S. Already, in terms of population health, we are putting this new scientific knowledge to use.”

Coaches need to set the example for the young athlete

Some of the studies on sunscreen use in young athletes note that the athlete may be practicing a form of resistance towards their parents if the sunscreen is slathered on before practices and required by their parents. It’s hard to know whether that might or might not be true, but one thing is common in most sports: if the coach requires it, it will generally be done. In my opinion the coach is in a great position to positively influence good behavior in young athletes. Use sunscreen yourself and put a large container in your sideline kit for your young athletes. If the sun’s out ask them to use it. It takes virtually no time, there’s nothing to lose and much to gain.





Posted in Prevention, Sports Science | Leave a comment

Skyrocketing Rates Of ACL Surgery In Young Athletes

By Dev Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University


Key Points:

  • A recent study revealed a 924% increase in ACL surgery performed in the under-15 age group between 1990 and 2007
  • This study along with other data point to the need to do ACL tear prevention training in the youngest age groups



A recently published study in the open source Orthopaedic Journal of Sports Medicine revealed some amazing – and somewhat disturbing – trends in ACL surgery. The authors examined data on ACL surgeries performed in the United States from 1990 to 2007. From the youth sports perspective one of the key findings was an astounding 924% increase in surgeries performed on individuals younger than 15 years old. allograft ACL

This study focused on people who had surgery to reconstruct the ACL, thus it does not give us data on how many people actually sustained ACL tears in any given year but it gives us insight into the trends favoring surgery in the young athlete. The data used is already old, with 8 years elapsed between the end of the data set and now so I suspect the numbers of young athletes opting for ACL surgery has only increased.

There are two possibilities for the huge rise in ACL surgeries amongst young athletes. First, there could be many more ACL tears in young athletes. And second, the number of young athletes with ACL tears electing to have early surgery rather than delaying it into their later teenage or early adult years is also increasing.

Both reasons are plausible and there is evidence to support both mechanisms. We know that overall numbers of adolescents participating in organized sports rose during the study period, and several studies point to an increased number of those athletes sustaining ACL tears. This is particularly true amongst girls. So it is likely that the number of adolescents with ACL tears increased considerably from 1990 to 2007.

Additionally, there is evidence that U.S. based surgeons favor ACL surgery over nonsurgical options for almost all age groups compared to their European colleagues. This type of treatment bias likely contributes to the rise in ACL surgery for young athletes too.

Regardless of the reasons behind the trends I believe it is clear that more adolescents sustain ACL tears nowadays compared to 20 or more years ago. I wrote recently about the need to start ACL protection training as early as possible, and these surgical trends support the same theme: ACL tears are happening more often in young athletes so we need to do whatever we can with training and rules enforcement to give these athletes the best chance to compete with healthy knees for as long as possible.

Posted in Knee, Treatment | Leave a comment