Thursday, August 30, 2018

A Parent’s Guide to Pain and Injury in Young Athletes

As a doctor and mother of 3 active kids involved in a wide range of sports, I am vigilant about keeping my kids injury free.  From the bleachers, I am always amazed at the flexibility, toughness and skills of these young athletes.  I have winced at some training drills and wondered often how injuries aren’t actually more frequent!  I think about the treatment they will or will not receive and remind myself that children ARE resilient.  They have the ability to recover from injuries in a quarter the time as adults.  They can complain of severe pain that magically disappears within a day, and even within a game.  Still, what do you do when the child comes home in pain?

The goal of this article is to allow you, the parent, to identify pain that needs medical attention and guide your actions to manage pain that does not. As with every child related issue, communication is key.  If there was an actual injury your child cannot recall the details from (a common phenomenon), ask the coach or another parent who saw the injury happen.  If there was no injury, try to pinpoint the first time your child noticed the pain.

Key questions that suggest a more serious issue to ask your child are: 
Does the pain bother you when you aren’t moving?
Has the pain been getting worse?
It the pain waking you up at night?
A yes to any of these questions merits medical attention.  Also, if the painful area is swollen and your child is not moving normally, see a medical professional.  This can start with a pediatrician, a physical therapist or a sports medicine physician.  (MD or DO)  

Symptoms that suggest the pain can be managed by you:
Pain comes and goes
Pain responds to 1 low dose of over the counter pain medication
Pain is not present while not playing sports
Protective behavior (limping or holding arm to side) does not occur when your child is distracted.

Injury related pain that lingers is most often due to muscle or tendon sprains, strains or contusions (bruises.)   If you are concerned about a fracture, there is usually bruising in the area and pain with motion.  A ligament stretch or tear will be accompanied by swelling and limited function of the joint.  The child may recall a popping sound or sensation.  These issues should be seen immediately by a sports medicine professional, as improper healing could lead to long term consequences.

Non-injury pain is most likely due to overuse, but can also begin suddenly. This pain occurs when muscle, ligament, tendon or bone becomes inflamed due to excessive repetitive drills, weight training, increased intensity, double workouts, or not resting at least 1 day a week. If the over-activity is associated with both muscle and physical fatigue, balance and form can be off and lead to more severe injuries.   Rest is imperative.  Don’t be shy communicating with the coach that your child needs rest.  Get a doctor’s note if you must.

Growth makes children more susceptible to pain as the nerves, muscles, tendons and ligaments, while developing, can lead to pain sensitivity and trouble with coordination and balance. Growing pains, described as aching and throbbing in the legs, are more symptomatic in the afternoon or evening. They occur most frequently between ages 3-4 and again at ages 8-12.   Growth plate injuries are also a possibility and cause pain in a joint with motion or load bearing.  Girls are typically growing until age 15; boys to 17. 

Initial home treatment should begin with the RICEM protocol:
Rest:  I use the term “relative rest” to describe staying active as long as it does not cause pain
Ice:  5-10 minutes 3 times a day. You can never go wrong with ice over heat.  Ice is the best treatment for inflammation and pain; heat can increase inflammation.   Be careful not to place ice directly on skin as it may cause a skin burn. 
Compression:  if a joint is swollen, wrapping it snuggly can help with discomfort and limit further swelling (NOTE:  for swelling medical attention is recommended) 
Elevation:  Keeping a sore ankle or knee elevated helps with circulation and lessens swelling
Meds:  a low dose of over the counter advil or aleve can help and even heal as it decreases inflammation along with improving pain.  Tylenol does not decrease inflammation but helps with pain.  Follow directions on the bottle and consider starting with half the recommended dose.  For children under 12, use pediatric pain medications. 

Pain you can manage should resolve within a few days.  If you are uncomfortable with your child’s pain even if symptoms fall under the “pain you can manage” category, see a physician.  Urgent care centers are excellent at clearing injuries if you are unable to get to your doctor or a specialist.   If pain is low level, but keeps returning over weeks or months, consider physical therapy.  If it still continues after 4-8 physical therapy treatments, return to your doctor and ask for testing.  The sooner pain is treated and resolved, the healthier, happier and more successful your child will be. 

Tuesday, July 31, 2018

When Too Much Exercise is Bad for Your Health

There’s nothing better for your health than exercise.   Exercise both treats and lowers risk of diseases including high blood pressure, diabetes, obesity, heart disease, cancer, and dementia.  Exercise strengthens your bones and muscles and improves posture and lung capacity to keep your body systems functioning at their best.   Exercise also strengthens your immunity to fight infections.  

The mental benefits of exercise cannot be beat:  studies have found exercise to be as effective as medication for depression.  Exercise improves sleep and mood, helps to manage stress, and keeps the mind clear.  It is a sure-fire way to improve longevity.  

With all these amazing benefits, is more exercise better?  Not necessarily.  Too much exercise can actually cause you harm.  While the threshold for over-exercise is different for everyone, if you are performing Intense exercise more than 2 hours a day, 7 days a week your health can be at risk. 

Here are signs you may be over-exercising:  

FATIGUE is the first sign of Overuse Syndrome, a medical condition of over-exercising without enough rest.  Fatigue and poor performance are the first symptoms, often followed by illness and injury.  A female type of overuse syndrome is The Female Athlete Triad, which includes disordered eating, lack of menstrual period, and osteoporosis.  This can lead to bone fractures, hormone disturbances, depression and fertility issues.

ILLNESS results from weakened immunity due to low energy supply and body stress from over exercise.  Natural killer cells, the cells of that fight diseases, cannot function well in a low energy environment.   While moderate exercise actually strengthens immunity, extreme amounts of exercise can lead to weakened immunity and more susceptibility to sickness.  

PAIN: Pain is a sign you have put too much stress on your bones, ligaments, muscles or tendons.  Increasing your exercise frequency, repetitions, or resistance too quickly, not using proper equipment, or having poor form can lead to pain and injury.   Wincing, stabbing or sharp pain is a sign you should stop the exercise immediately.   Pain present at times other than exercising for more than a few days should be evaluated by a doctor, as should pain that keeps you up at night.  

BROWN of RED URINE: Rhabdomyolysis/ “Rhabdo” is life-threatening situation requiring emergency hospitalization when the combination of extreme exertion and dehydration causes muscle breakdown so severe the kidneys cannot keep up.  Symptoms are extreme muscle pain and soreness, nausea, intensenfatigue, confusion and brown or red urine.  Beware muscle soreness lasting more than 3 days as this can predispose you to Rhabdo. 

LIGHTHEADEDNESS: Cardiac arrhythmias and enlarged heart can develop in extreme athletes.  This can lead to heart disease or heart attacks.  Sudden cardiac death syndrome is a condition in young athletes with symptoms of lightheadedness and fatigue.  Your doctor should be aware of any feelings of dizziness, shortness of breath or fatigue and you will be referred for EKG and echocardiogram to evaluate your heart’s function.  

If you heed the following advice you will keep your exercise routine as healthy as possible: 

Keep your exercise at moderate intensity at least 2 days a week.  
If you have a heavy exertional day, rest or take it easy the next.  
Always take one day a week off from intense exercise to let your body recover.  
If you are fighting a cold or flu, limit exercise to mild to moderate to boost immunity.
If you have pain that persists, change your exercise type to pain free.
If your muscles are severely sore for more than three days, rest until resolved.
If pain lasts longer than 1 week despite avoiding painful activities see your doctor. 

While these conditions sound scary, they are avoidable and manageable if you listen to your body’s signals.  Keep moving!  Don’t let these risks discourage you from obtaining all the stress-reducing, mood-bolstering, health-improving, longevity increasing benefits of exercise.  

Monday, June 11, 2018

How to Manage an Overuse Injury: Tennis Elbow

Sports Overuse Injury:  Tennis Elbow

Back in December, I played tennis outside in Long Island.  The temperature was 49 degrees.  I returned one of my daughter’s ferocious serves and wow my elbow hurt.  We played the next day again and it hurt worse.  My 12 year old daughter and I had a weekend rivalry;  it was always a close game.  Everything was fine until it got cold.  Why did my elbow hurt?
Because she is a FIERCE player and in order to compete with her I have to grip hard to serve hard, return hard, volley hard and lunge for shots that put me in positions that compromise the arm/elbow/wrist/grip mechanism… leading to TENNIS ELBOW!!Besides all the gripping and smashing, the repetition of 2 matches within 24 hours was a major pain contributor.    The cold contributed too as I had to grip harder because my fingers felt numb! This onset of elbow pain had all the indicators of trouble:  2 sessions close together, changing playing style in the cold and playing through the pain.   
How did I make it through the game?
I tried to focus on hitting the ball in front of me.  I let the balls that were out of position go (easier to do that when you are playing against your child!)  And I realized when I was picking up or receiving balls I was much better off using my opposite hand and not scooping with my racket or hitting it in the air to stop the ball.  I conserved the use of my right forearm muscles to light activities, applied ice a few times a day and it bothered me very little. 
The pain started to return when I became obsessive about knitting January through February.  Thick, heavy yarn.  Knitting for an hour a night.  I finally had to put away the needles and my elbow pain resolved, only to return in March when I had to run through the airport twice in a week carrying overnight bags.  My tennis elbow came back.  Worse than ever.  In fact it was so bad one night it kept me up and I even wondered if something was seriously wrong.  Night pain is a sign you have bad pain. 
But some strong anti-inflammatories, some office treatments and rest improved it.
Now it is tennis season again.  A  month ago I still had pain with each shot.  Physical therapy and taping was the answer. In fact I was  miraculously better.  Home exercises and icing help too. 
Since this is my business, I knew what to do.  For those of you who do not, here are the steps to resolving your pain from tennis elbow, golfers elbow, knee pain, ankle sprain, shoulder pain, wrist tendinitis and any other overuse injury. 
1)ICE: If you feel even a hint of soreness, ice the area after play, working out, lifting, or anytime it is sore.  Also ice it at the end of the day…Just for 5-10 minutes
2) LIMIT PAINFUL ACTIVITY to what you really love.  If you don’t want to give up tennis, don’t take up any other activity that may bother it such as fishing or golfing. 
3) CONSIDER MEDICATION: If the pain bothers you at rest, take an anti-inflammatory (ibuprofen or naproxen) as directed on the bottle. 
4) CONSIDER A BRACE: A brace that limits motion will decrease irritation and let the joint heal.

If your pain persists despite a week of these instructions, see a health professional.  In New York, you can also start directly with physical therapy which may be the ultimate cure.  If 1 or 2 visits do not help schedule a doctor appointment.  An accurate diagnosis will guide more effective treatment.  Your doctor can also prescribe stronger medications and may recommend change in treatment or even an injection.  There are non-cortisone injections that are very effective.    

Final tips include returning gradually back to the irritating sport.  I am currently playing only 30 minutes of tennis twice a week and gradually building up.  Consider scheduling a lesson as good technique can reduce the offending motion.  Equipment is also important  In the case of tennis elbow, changing to a lighter racket with less vibration and the proper grip size is essential.  When it comes to lower body injuries, a new pair of well cushioned, stable shoes can be the final cure. 
While you are healing, cut the activity down to pain free motion, and make up for it with a new activity.    It’s the time of year when outside sports prevail.  I am loving biking, jogging, and kayaking!  And keep that ice pack in the freezer just in case….