I’ll be honest. I haven’t paid much attention to the NBA Finals this year. I’m much more impressed that the Rangers are over .500 at this point and in thick of playoff contention for a Wild Card spot…

Anyways, the NBA Finals are heading into Game 6, with the Toronto Raptors up 3-2 over the Golden State Warriors. When I heard on Monday afternoon that Kevin Durant was planning to play in Game 5, my stomach dropped. If you aren’t aware, Kevin Durant suffered what was called a “mild calf strain” on May 8, during a game against the Houston Rockets in the Western Conference semifinals. What was initially labeled as a “mild” injury, was later in the month described as worse than first thought by head coach Steve Kerr.

Even Durant said he originally thought the injury was worse than a strain. This past Sunday, the day before Game 5 of the finals, Durant practiced with his team for the first time since the injury. It was the perfect making of a sports fairytale – a team down 3-1 in the series desperately seeking a win to avoid losing the championship, the injured hero boldly rushing his return to save the team and hopefully deliver a championship… except the opposite happened.

In the second quarter, Durant pulled up suddenly on a crossover move and then dropped to the floor clearly in pain. Replay appeared to show his calf cramp and shrivel up. He had to be helped off the floor and ultimately left the arena on crutches and in a boot. On Wednesday, Durant confirmed what I feared: an Achilles tendon rupture.

Now that he's had surgery, you can likely rule him out for the entire 2019-2020 season. Recovery from an Achilles tendon rupture and returning to high level sport is roughly 12 months after surgery. So naturally, the questions begin. Who is to blame? Did he rush his recovery? Was he truly ready?

We will likely never know, but I do think this offers a great opportunity to talk about the importance of allowing adequate time for full recovery. In my role as a sports physical therapist at Cook Children’s, I have the pleasure of working with kids and young adults of all ages usually trying to return to some level of sport. My day is typically filled with cases such as the volleyball player with an ankle sprain, the baseball pitcher with elbow pain, the soccer player recovering from an ACL reconstruction, the basketball player with a hamstring strain or the football player who fractured his leg.

I love my job. I love helping these patients get back to doing what they love. But I also recognize that I have a great responsibility to make sure that each patient is genuinely ready to resume their chosen sport.

The physicians I work with depend on my feedback to determine readiness. I’ve been “the bad guy” on more than one occasion and told a patient that I didn’t think he or she was quite ready to play in the tournament that weekend. It’s a tough position to be in, and I recognize that sometimes it’s not received well by both the parents and child, but I always come back to the responsibility and trust instilled in me to make sure that their child is truly ready to play.

We have tests and measures in physical therapy that we use to assess readiness, and we also can simulate game time situations in a controlled environment. I can never 100% guarantee that reinjury will not occur, but I want to be as close as possible. I don’t want that basketball player with the history of a hamstring strain to fully tear his hamstring. I don’t want that volleyball player with an ankle sprain to not have full strength back, change the way she jumps, and then land awkwardly and tear her ACL. On the day of their last appointment with me, I always tell each patient that I genuinely hope they never see me again in the clinic.

My motivation and ultimate goal is that each and every patient has full strength, control, awareness and confidence upon finishing physical therapy. If your child has suffered an injury, we are here to help. Our physical therapy staff collaborate with your physician to create and customize our plan to get your child back in the game. We have their best interests at heart and want to do everything possible to avoid reinjury. The process may feel long, but patience and persistence will certainly pay off.

If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 866-205-7270.

As parents before we just shrug off our children’s injury as nothing too serious, it helps to know exactly what a sprain is.

The American Academy of Orthopedic surgeons define a sprain as a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone to another.

Technically a torn ACL or a torn MCL in the knee is a sprained knee, but we never shrug those injuries off. So why are we so dismissive of ankle sprains? Admittedly a sprained ankle is typically not as severe of an injury as a torn ACL, because an ACL when torn will not heal on its own and requires a surgical reconstruction, but that is a topic for another blog.

Just as with any injury when dealing with an ankle sprain we need to start by determining the severity of these injuries. Ankle sprains are typically divided into three grades based on the severity and presentation of the injury.

Grade 1: Ligaments are stretched, but not torn, ligaments are tender to touch, but no laxity is noted, and the patient is able to walk with little to no pain.

Grade 2: Ligaments are stretched and at least partially ruptured, there is moderate pain and swelling, mild to moderate bruising, some range of motion loss, the patient has pain with walking, and there is mild to moderate laxity noted.

Grade 3: Ligaments are completely torn, there is severe swelling, severe bruising, significant loss of motion, the patient is unable to bear weight or walk on the ankle, and there is significant laxity noted.

The severity of the sprain will definitely influence how we treat these injuries.

So why is it important for my child to rehab an ankle sprain?

The number one predictor of ankle injuries is a previous ankle injury. So what this tells me is that more often than not we aren’t addressing that initial injury effectively. Each ligament sends information to the brain letting us know if our joints are in good alignment or not. This is why we don’t have to look at our feet when we walk to know that our foot is in a good position to take a step. Any time a ligament is torn or stretched we lose some of our awareness of where the joint is in space. If a ligament is completely torn or stretched we aren’t getting those signals until our joint is potentially already in a bad position. After injury we have to do something to make sure that we re-establish that joint awareness, and that is where Physical Therapy comes in.

How can physical therapy help my child recover from an ankle sprain?

Initial focus in physical therapy will reduce swelling and inflammation with RICE (rest, ice, compression, and elevation), and regaining ROM. While this first phase is very important, the portion of rehab that really helps to prevent recurring injuries is the strengthening and proprioceptive (or balance) training. The balance exercises are the exercises designed to retrain joint position awareness by training the muscles to recognize and stabilize where our joint is in space. The balance and strengthening exercises are what will truly help a patient return to higher level activities like jumping and cutting in sports.

When do I get help for my child who has an ankle sprain?

• Any time an injury causes notable laxity or instability on exam.
• Any time a patients is unable to walk without pain.
• Any time balance is negatively affected.
• That means grade 2 sprains and above should automatically get help and any grade 1 sprain with balance deficits should also do rehab. If there is ever any doubt, error on the side of caution and contact your physician.

At Cook Children’s, our SPORTS physical therapists are trained in proper rehabilitation of all grades of ankle sprains and work to restore full function and safely guide return to athletic activities. If your child has a history of frequent ankle sprains or you are concerned about risk of future injury, talk to your doctor about a referral to physical therapy.

SPORTS resources

• Ankle sprains
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Young athlete's injury prevention guide
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• Preventing children's sports injuries
• Pain that won't go away

One of the tops reasons is that younger kids are doing more than their growing bodies can withstand. Children are no longer just playing outside for fun. They are playing at a higher skill set than in the past, often times with parent coaches who aren’t formally trained to stretch their players in the correct manner. Make sure your young athlete stretches for his or her game.

Other causes of injury include weakness to the gluteus medius, loose joints, tight muscles, decreased balance and motor control and coordination.

I’ve spent the first two paragraphs talking about the injuries, but I actually feel the ACL has gotten a bad reputation because it’s a very important ligament that allows an athlete to run, jump and cut. Many non-contact ACL injuries can be avoided if athletes understand the issues that lead to ACL tears.

If you have a child who is an athlete, it’s important to know the proper way to stay safe during athletics and preventing ACL injuries. Below are 6 steps to preventing an ACL injury.

1.Strengthen your gluteus medius - The gluteus medius (located in the buttocks) weakness are common culprits in ACL injuries. This is one of the muscles that stabilizes your hips and in terms of ACL injuries prevents the knee from pointing too far inward when landing during jogging, hopping or cutting. A good way to know if this muscle is working the correct way is to watch the knees while performing squats or single leg squats. If the knees point inward past the inside of the ankle, the athlete may have weakness in his or her gluteus medius. To strengthen the gluteus medius, the athlete should perform exercises that cause his or her hip to come away from the body such as side steps, clamshells, or side lying leg raises.

2.Strengthen your hamstrings- Another important thing that should be looked at is the strength of the hamstrings (large muscles at the back of your thigh) in relation to the quadriceps (large muscles at the front of your thigh). When the quadriceps are significantly stronger than the hamstrings it can pull your tibia (shin bone) too far forward causing stress on the ACL. This is common with female athletes.

3.Stretch your quadriceps- When the quadriceps (large muscle on the front of the thigh) is too tight, it is similar to them being stronger than the hamstrings. It creates a forward pull on the tibia (shin bone). To stretch this muscle, grab the shin to bend the knee and hold it for 30 seconds repeat this 3 to 5 times. Make sure your young athlete stretches when he or she has been active. Stretching when not warmed up, is not as effective.

4.Work on your balance- Balance is another important part of any injury prevention program. People often think that their balance is poor but do not realize that it can be improved. Children who can’t stand on one leg for 1 minute without placing their toe to the ground, need to work on their balance. Have your child practice standing on one leg for a minute. Once this becomes easy, have your child try doing this with his or her eyes closed. For safety, always make sure your child has something steady to grab onto if he or she starts to lose balance.

5.Strengthen your core- Like the gluteus medius, the core assists with control of legs when athletes are active. It is important to have good control if you are an athlete. There are many ways to strengthen the core but some examples are planks, side planks and/or exercises on a stability ball.

6.Wear good shoes- Proper shoes are especially important if your child has flat feet. Shoes that are too flexible or without arch support may cause an increased risk of injury. If your child has flat feet ask the shoe salesman for shoes that help with control to help prevent injuries.

Following surgical repair, ACL injuries require 6 to 9 months of rehabilitation. However, athletes can prevent non-contact ACL injuries by strengthening their muscles properly, having a good stretching routine, working on balance, and wearing supportive shoes. Although it is important to properly maintain all leg muscles these are six of the most important ways to prevent an ACL injury.

SPORTS resources

• Anterior knee pain
• Top 10 questions parents have about sports injuries
• Injury Prevention Guide
• Strength training in children/adolescents
• Core beliefs
• Young athlete's injury prevention guide
• Strength training in children/adolescents (5-15 years)
• Rise of overuse injuries in school-age athletes
• The basics of sports injury prevention for kids
• When growing pains are not growing pains
• Preventing children's sports injuries
• Pain that won't go away