Important Info to know with Fall Sports Approaching

Unfortunately, because pediatric injuries are common and can often hinder the joy these young athletes experience while participating in their favorite sports.

These are just a few examples of young athletes the Sports Medicine providers at Advanced Orthopaedics have the privilege to treat and serve here in the Richmond area.  Drs. Zaslav, Higgs, Herring, Reyes and I, Dr.Reece are all board certified and fellowship trained to provide excellence in orthopedic care. Advanced Orthopadics is proud of the countless community service projects and volunteer care our team of physicians provides.  

Collectively, AO provides care for the Richmond Ballet; Henrico High School, Highland Springs High School, Benedictine College Prep, Glen Allen High School, Colonial Heights High School, and countless middle schools where we make ourselves available to the kids within 24 hours of their call.  Should students or their parents need immediate help our company, Ortho On Call, serves as an urgent care facility for orthopedic services.  With three locations surrounding the city and open after hours and on weekends, these walk-in, free-standing facilities allow us to expand our reach and care for athletes throughout Central Virginia.

What are some of the most common pediatric injuries we see this time of year?  Let’s go over a few to help you as parents recognize these conditions so you can differentiate the ones you can care for at home versus the ones that may require more aggressive work-up and a visit to your orthopedist.

Little League Elbow

Over the past 15 years, I’ve seen the incidence of elbow injuries in young baseball players significantly increase.  It is pretty clear that a marked increase in participation – year round participation – combined with playing on multiple teams simultaneously, the earlier use of curve balls, and throwing high volume pitch sessions all lead to this blossoming “epidemic”, as recently termed by Dr. James Andrews.

Over the past five years, Little League baseball and the American Sports Medicine Institute have led the education of both clinicians and patients alike in recognizing a few simple recommendations to help cut down on the prevalence of Little League elbow:

1. Adherence to pitch count regulations as outlined by the ASMI;
2. No curve balls until physically mature, i.e., no throwing junk until you shave; and 
3. 12 weeks off from overhead throwing during a 12 month period until such physical maturity occurs

Little League Elbow presents as a gradual onset of worsening elbow pain with overhead throwing most often seen in pitchers and catchers.  If use of Advil/Aleve at home along with one week’s rest  and icing does not help your child, then a visit to your PCP or Orthopedist would be warranted.  Should your athlete hear an audible pop with throwing, a more urgent need for that visit is indicated.  

Osgood Schlatter’s

Every parent I know has experienced that feeling on a Sunday morning when his/her kid comes down the steps, asks for pancakes, and when you look up you think, “My goodness, child, you’ve grown three inches overnight?!”  What our parents called “growing pains”, we now lump into a category called juvenile apophysites. Of the many “growing pain” examples, perhaps the most common seen is Osgood Schlatters (tibial tubercle apophysitis). 

Osgood Schlatters is pain that develops over the front of the knee where the knee cap (patella) tendon inserts on the leg bone (tibia).  As youngsters rapidly grow, there is a pulling phenomenon at the patellar tendon insertion. This combined with running and/or sports participation leads to pain and swelling at the open growth area where the tendon attaches.  While this is a painful condition, it is not a dangerous one and is self-limited. The pain will subside (in both the child AND the parents!!) as the child matures and the growth area fuses.  

Treatment includes ice, pain control with Advil/Aleve or Tylenol, bracing to reduce the tension at the patella tendon, and relative rest from the offending activity.  My rule of thumb in the office is that it’s okay to play as long as you’re not limping!  Often we’ll ask the assistant coach to be the one on the lookout for the limp as the Head Coach never sees the limp (especially if your child is a star!) and the parent often sees a limp to protect his/her child!!  

Should this plan not help your athlete improve over two to three weeks, a visit to your PCP or Orthopedist would be reasonable to look into other potential causes of knee pain in children.

Tibial Stress fractures

While Osgood Schlatters is not particularly worrisome, tibial stress fractures are.  Distance runners, soccer players, lacrosse, gymnasts, cheerleaders … all represent athletes at higher risk for shin splints and ultimately tibial stress fractures.  

The common thread in these athletes is high mileage running and the development of worsening shin pain, often in the lower part of the shin bone (tibia).  The pain starts as pain with running, followed by pain after running, pain with walking or daily activity, pain at rest, and ultimately night pain.  I use this progression to help differentiate likely shin splints (pain with and after running) from stress fractures (pain at rest and night pain).  

Stress fractures are not like fractures where the bone breaks and is easily seen on x-ray; rather, these fractures are from repetitive stress without adequate rest and are areas of swelling within the bone.  Think of these fractures like a paper clip repeatedly bent so that you can see where the clip will break but hasn’t completely broken down.  

These fractures are best treated with rest, often with the help of a fracture walking boot and pain control. Also, as the fracture heals, the implementation of a physical therapy program looking at the athletes’ gait and strength, as well as a return to running program overview, will be helpful.

Certainly, if your child athlete complains of shin pain that worsens with ongoing activity, take him/her in to see the pediatrician or orthopedist sooner rather than later to help prevent progression of shin splints into stress fractures.  

PPE

Every year, I enjoy working with our staff at Advanced Orthopaedics to provide the athletes’ required, yearly, preparticipation exams.  We go into the upper and middle schools, and along with volunteers from those schools, see as many students as possible to make the process easy and convenient.  In addition, these on-site visits allow us as clinicians to develop a relationship with the coaches and athletes on their terms and on their home turf. This relationship allows us to get information that we might not get in a stuffy, sterile office setting! And it’s that information that is so critical in identifying any potential threat to the athletes’ health and subsequent participation. Our intention is to identify any life-threatening risk through history or risk found on physical exam that would require further care before clearing the athlete to play. 

We’ve kept the cost of these physicals low to maximize availability and affordability to all kids. In addition, we donate a portion of the proceeds back to the schools’ athletic departments to help with each school’s yearly athletic budgets.

These physicals are participation physicals and are not meant to replace your child’s yearly physical at their PCP’s office. Please keep your relationship with your PCP, as it is critical to the health of your child!

Thank you for taking the time to learn more about athletic injuries and how best to keep your child safe and on the field. Remember Advanced Orthopaedics and Ortho On Call for all of your families’ orthopedic needs!

Dr. Reece is a board certified orthopaedic physician specializing in Sports Medicine. He provides comprehensive medical care for athletes of all ages, sports teams, and individuals looking for a non-surgical approach to their active lifestyles. In addition to being a frequent speaker and writer on various sports medicine topics, he is currently team physician for Glen Allen High School, Highland Springs High School and Benedictine College Prep, where he also serves as an Assistant Basketball Coach for the Cadets. He has previously served as team physician to the University of Georgia, The United States Olypic team, Elon University, volunteer service to the Virginia Special Olympics and extensive time spent with the NBA's Minnesota Timberwolves and Atlanta Hawks.

Appointments with Dr. Reece can be scheduled with Advanced Orthopaedics by calling 804-270-1305