‘Mixin’ It Up’ Does Wonders for Kids in Sports

Fall and winter sports season is upon us! Boys are playing football. Girls are doing their cheer routines at games.

Cross-country, field hockey, tennis, and volleyball players are in full swing at high schools across the country.

While kids are eager to jump right into these activities, injuries this time of year increase.

Why Do More Sports Injuries Occur in the Fall and Winter?

Sudden increases in activity level
Unpredictable weather and changes in playing surface. Shifting weather patterns are another factor that contributes to sports injuries in the fall and winter.
Muscle fatigue – During the summer months, kids move freely. Suddenly, when school starts, students are cramped into an uncomfortable school desk for eight hours a day. The hips remain flexed at 90-degrees, and the brain focuses on keeping the hip flexors, hamstrings, and spinal erectors engaged to maintain a sitting position. Unfortunately, these are the opposite muscles the body needs to prevent common sports injuries.

What Are the Most Common Fall and Winter Sports Injuries and How Are They Prevented?

Slowly ramping up activity levels over the course of a few months leading into preseason can minimize the risk significantly.

Students should spend at least 10 minutes warming up every practice and devote twice as long to end-of-practice stretches to prevent injuries including:

Tendon injuries
Muscle pulls
Stress Fractures

Middle-school-age children come in with growth plate injuries. A growth plate injury occurs at either end of the leg bone.

A damaged growth plate may lead to arthritis, crooked bones, or limbs that do not grow long enough — although these circumstances are rare. More often than not, kids rebound from a growth plate injury without any further consequences.

To prevent these injuries, be sure you oversee your child’s strength training to ensure he or she is not lifting too much weight too fast. You also want to see that your child is using the proper form.

Playing in extreme cold, certain medications, neurological disorders, metabolic diseases, and genetic factors are believed to all play a role in the development of growth plate injuries as well. It is important to speak with a sports medicine professional to determine whether your child may be at risk for a growth plate injury.

When high school athletes begin to get tired, they get sloppy. Fatigue is the number one factor in ankle sprains. Teach your child to recognize signs of fatigue so he or she can request a break if the coach doesn’t see it.

Some of these early signals may include some or all of the following symptoms:

Inconsistent performance
Decreased focus
Shortness of breath
Muscle twitches
Depression or irritability
Severe thirst
Generalized weakness
Nausea
Muscle cramps
Dizziness
Headaches

According to Dr. Downer, “Mix it up, don’t just play one sport. Instead be diverse and try different types of sporting activities throughout the year. Staying active keeps you well-conditioned and less likely to experience an injury.”

If you believe you are suffering from a sports-related injury and need specialized orthopedic care, the orthopedic surgeons at OSS provide excellent treatment options for your injury. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

OSS Provider Spotlight – Dr. Mark Reed

Dr. Mark Reed is one of the many talented surgeons at Orthopedic Specialists of Seattle.

We had an opportunity to catch him from his busy schedule and find out some interesting and fun information about him.

1) Why did you choose Orthopedics with a specialty in foot and ankle?

I worked as a mechanical engineer and have always had a fascination for how complex mechanisms work. It doesn’t get much more complex than the foot and ankle.

Many bones, joints, tendons and ligaments all work in concert to support the foot and create motion. It’s simultaneously challenging and rewarding to treat foot and ankle conditions.

2) Why did you decided to move and settle in Seattle?

My family and I selected Seattle to put down roots for several reasons. Although my wife (an emergency physician) did our residency on the East Coast, we wanted to relocate to the West Coast so that we could be closer to her home state of Hawaii, which is not a bad place to visit during Seattle winters.

We love the healthy and active nature of the Pacific Northwest and the access to hiking, skiing, and all other sorts of endeavors.

3) Are you involved in the community?

With a one and three-year old, we don’t have a lot of free time, but when we do, we think it’s important to give back to the community. One of the things we do on a regular basis is to cook for and deliver meals to a homeless shelter in Seattle.

We also get involved in clean-up and beautification projects in our local community of west Seattle.

4) Have you been published, made any medical advances or studied new procedures?

Most of the research work I have done has been foot and ankle-related with a focus on biomechanics. I’ve looked at novel ways to perform ankle fusions and done studies comparing the strength and rigidity of various subtalar fusions.

I continue to stay active in the foot and ankle community to stay abreast of the latest technologies. Ankle replacement surgery and joint-sparing procedures for great toe arthritis are two areas that come to mind.

5) Who are you outside of work?

Outside of work I spend every minute I can with my wife and our two boys. I enjoy the outdoors; we try to get out and about a couple of times a month to experience the beauty of the Pacific Northwest. I’m a big supporter of the Seattle professional sports teams.

Read more about Dr. Reed

Preventing Ski Injuries Through Conditioning

A busy ski resort in the United States may see dozens of injuries on the slopes each day.

As an orthopedic surgeon, I also see many patients with ski-related injuries throughout the season. Most injuries are the result of poor conditioning, or equipment failure.

Common Ski Injuries

The most common injuries amongst downhill skiers are knee sprains, shoulder injuries, head/face injuries and wrist/thumb injuries. The knee is the most commonly injured joint, resulting in about one third of all ski injuries. Injury rates and type vary with uncontrollable factors such as weather and snow conditions. Proper equipment and conditioning, however, are factors that we can control.

Equipment

When skiers examine their equipment, it’s important to make sure that:

Skis, poles, and boots are in good condition and properly sized for the individual’s weight, size and skill.
Binding are adjusted and tested prior to each ski season.
Helmets are properly fitted and checked for damage prior to the ski season.
Sunglasses, goggles and sunscreen are part of one’s safety equipment.

Conditioning

Skiers can increase their safety and performance this winter by starting with a pre-conditioning program that includes four components: endurance, strength, flexibility, and balance. Aerobic fitness is the key to preventing the end of the day injuries (the last run).

Cross training, which includes multiple sports and activities in the conditioning regimen, has become popular, especially with a seasonal sport such as skiing. Strength and flexibility focusing on the legs and trunk are vital in injury prevention specific for skiing. Balance training has been shown to be the single most important exercise for preventing ACL tears in women.

A typical conditioning program can include:

1. Aerobic fitness (5 days/week for at least 30 minutes)

Running
Cycling
Swimming
Elliptical or stair climber
Jumping rope
Treadmill

2. Strength (3 days/week, 2 sets of 60 seconds each)

Leg press
Wall squats
Hamstring curls
Toe raises
Lateral leg raises
Sit-ups

3. Flexibility (daily, 2 sets of 60 seconds each)

Hamstring stretches
Achilles stretches
Quad stretches

4. Balance Exercises (daily, 2 sets of 60 seconds)

Standing on one leg, perform mini squats
Single leg hop, holding for five (5) seconds, repeat

In addition to a conditioning program, skiers need to adequately warm up – an activity that is often neglected with skiing. No one would think of running out on the football field or onto the basketball court without warming up first.

But with skiing, one typically sits in the car for an hour or more to get to the slopes, and then stands in line for tickets and for the lift, before finally sitting on the chair for several minutes. By the time one has arrived on the top of the hill, he or she is often stiff and cold.

It’s important for skiers to remember to warm up and stretch before starting down the hill. Often an easy, predictable run is a good idea before heading to the more challenging terrain. The few minutes spent warming up will be well worthwhile in injury prevention.

More about Knee Injuries

Every ski season, I treat many knee injuries. In the 1970′s, ankle injuries were more common, resulting from soft, leather boots. The development of stiffer boots has transferred much of the force to the knee.

Medial Collateral Ligament

The most common knee injury from skiing is the MCL (medial collateral ligament) injury. It often results from catching an edge or having the skis diverge, so that the foot is forced away from the body. This creates a distraction force on the inside of the knee.

Fortunately, the MCL has a good blood supply, and can be treated non-operatively, with a period of bracing for 4-8 weeks, depending on the severity of the injury.

Anterior Cruciate Ligament

ACL (anterior cruciate ligament) injuries are also common skiing injuries. They are thought to occur from the forces created by the long lever arm of the ski that are transmitted to the knee ligaments. Commonly, the ACL is injured with a hyperextension mechanism.

In expert skiers, we see ACL injuries when saving a backwards fall by a strong quadriceps contraction, pulling the tibia (lower leg) forward with enough force to rupture the ACL.

Recent boot and binding technology has reduced the rate of ACL injuries. In young, active individuals, the ACL injuries often require surgical reconstruction. Success rates from surgery are excellent, but require aggressive rehabilitation and six months of recovery time before one can return to skiing or other twisting or pivoting sports.

No one wants to go down the path of surgery and recovery. But too many people wait to think about preparing for skiing until half way through the season, when snow has already accumulated and they are on their way to the top of the mountain. Many times, this is too late.

Although injury is a risk we all take when participating in any sport, a conscientious approach to skiing – including equipment inspection and conditioning – will minimize the occurrence. Not only will these precautions reduce injury rate, but they will also enhance performance, decrease fatigue, and ultimately, increase one’s enjoyment of the sport.

If you believe you are suffering from a knee-related injury and need specialized orthopedic care, the surgeons at Orthopedic Specialists of Seattle provide excellent treatment options available for you.

CrossFit Injuries – Are You Feeling the Pain?

cross fit training CrossFit is a mode of exercise that targets cardiovascular and respiratory endurance, strength, flexibility, mobility, stamina, power, speed, agility, coordination and balance. The workouts change daily and can be performed by individuals at all fitness levels.

Most Common CrossFit Injuries

The most common injuries from CrossFit are from use of poor form with the exercises. Standard push-ups, handstand push-ups, push press, push jerk, kipping pull ups, hang power clean, hang power snatch, ring dips, overhead squatting, and many more are all great exercises at high intensity.

However, they are very stressful, especially on the shoulder – if you don’t have proper scapular positioning and proper stabilizing strength throughout the rotator cuff and scapula. So the next time you are performing these, focus on where your shoulder blade is positioned and try to avoid what we call “winging” by keeping the shoulder blade “pinched back”.

High Intensity Exercise

The intensity level of CrossFit pushes an individual to their limits every day and over time, overuse of the shoulder and other joints in the body can lead to an injury if not attended to prior to performing another CrossFit session. Studies suggest that constantly exercising at high intensity may even provoke overtraining — a drop in energy and performance that happens when the body isn’t able to fully recover from workouts.

Intermittent high-intensity exercise is a great way to get fit, but only when the body can recover. By not overdoing it, you avoid the risk of injury. If you are considering a CrossFit regimen, call OSS and schedule an appointment with one of our physicians about how to proceed in getting the most out of your CrossFit workout without injury.

According to Dr. Reed, “CrossFit is an exercise regimen that can lead to huge performance gains and improved athletic and cardiovascular function when performed correctly and safely. It’s important that each individual concentrates on good form and optimal nutrition and hydration, and keeps on the lookout for signs and symptoms of overtraining.”

If you believe you are suffering from a workout-related injury and need specialized orthopedic care, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

Ulnar Wrist Pain in Tennis – Tips to Help Prevent Injury

The 2014 US Open Tennis tournament was filled with ups and downs this year. Mirin Cilic beat out some top seeded players to win the men’s championship and the favorite on the women’s side, Serena Williams won the title. Years of training, wins and losses have been part of any tennis player’s repertoire, so have injuries.

Ulnar Wrist

Wrist injuries are common for tennis players and elite professionals. The anatomic location of the wrist and its major role in the kinetic chain needed in stroke production, it is unfortunately a common site of pain and disability. Often, the pain presents on the pinkie-side, or ulnar side, of the wrist.

Many players experience this ulnar pain in the non-dominant hand during two-handed backhand strokes. In this stroke, the top hand is placed in extreme ulnar deviation and extension, while dynamically moving from supination to pronation. This same motion-type occurs in many tennis strokes, and as such can lead to acute and chronic ulnar wrist injuries.

Tennis players can present with an acute event of sudden onset – either after a violent fall with the wrist in extension and pronation/supination, or after hitting the tennis ball and having an immediate feeling of ulnar wrist pain. According to Dr. Weil, “Ulnar sided wrist pain in tennis players can often be due to tendinitis and can be treated in a conservative fashion. Sometimes degeneration of the cartilage of the wrist can occur.

If you are experiencing pain for more than a few days while playing tennis an evaluation by an orthopedic surgeon is recommended.” When the presentation of pain is chronic and insidious, the ulnar wrist pain arises over the course of days or weeks, and the athlete usually cannot recall a single inciting injury.

Wrist injuries in tennis players often result from over-use, improper technique, and even using the wrong equipment. Also, excessive wrist motion during the stroke will predispose a player to injury. Some things to consider to help prevent ulnar wrist pain:

Equipment: Using the wrong grip size, wrong strings, and improper string tension can all lead to wrist pain. The grip size can determine the amount of force needed to hold the racket through the stroke, leading to increased firmness of grip and potential injury. Too firm a grip can restrict free movement of the arm. The grip should be only as firm as necessary to ensure proper stroke technique.
Grip: Extreme grips like a Western will compromise the position of the wrist, forearm, and elbow which places additional stress on the adjacent muscles and tendons. For the two-handed backhand player, use of the continental grip on the bottom hand and the Eastern forehand grip on the top hand is preferable. Players using extreme grips (Western) place their wrist and forearm in positions that place additional stress on the muscles, tendons, and ligaments and can predispose them to injury. Additionally, another breakdown in technique is when the player uses the wrist and hand as primary force generators during ball strike. The wrist and hand must be viewed as links in the kinetic chain whereby large forces generated from the ground, lower extremity, and trunk are transferred.
Position of wrist at ball strike: In the two handed back-hand, the tendency for some players is to place the top hand in extreme extension and ulnar deviation prior to ball strike. The thought is to power the ball into creating topspin at contact. By using the Eastern Forehand grip in the top hand (left hand in right handed players) and by incorporating the players’ core and lower body/legs into the stroke properly, the lower body/core can load the energy and transfer load and energy up the kinetic chain into the arm and wrist to abate some of the torsional stress on the wrist.
Physical: Due to the physical demands of tennis and all of the repetition that is involved, tennis play causes the dominant playing side to over-develop which leads to overall body muscle imbalance. Exercises that strengthen the wrist, forearm and elbow include wrist curls, radial and ulnar deviation resistance maneuvers, and ball dribble off the floor then wall to improve both strength and endurance.

Helpful tips to prevent wrist injury:

1) Choose your equipment carefully, take into account level of play and age.

2) Be sure to use proper grip and technical skills, and be open to reviewing these periodically, even using video, making note of changes in swing mechanics pre and post ball strike.

3) Have a daily routine to include strength and flexibility exercises that increase stamina and maintain range of motion; this should include the hands, wrists, forearms, elbows, and shoulders.

4) Have elastic bands in your bag to allow you to perform strength exercises anytime and have them easily accessible; also, you should be able to perform this routine away from the supervision of coaches, trainers, and parents.

5) Perform strengthening exercises after practice or match play or on “off” days where not hitting is done to avoid muscle fatigue during play.

If you believe you are suffering from a tennis-related injury and need specialized orthopedic care, Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.