So, when can we get back to sports?

Like most else things related to COVID-19, it depends.

There are definitely different levels of risk, depending on the child’s sport.

• Low risk - Home training
• Moderate risk - Small group training
• Higher risk - Team training in low contact sports
• Highest risk - Team training with high contact

Even with these categories, deciding where your child’s sport fits might not always be clear. Cheer can easily be done as a small group but stunts require higher levels of contact. Baseball players can be spread out but baseballs are shared between players.

So, when should you start to get your child more active?

Now. If and when it can be done safely.

Here’s how to keep your child safe:

1. Encourage your child to practice general and sport specific activities daily at home. Conditioning will be an issue as we get back going so the more activity they have now the better.
2. Use small group training exercises where possible. Does the whole team need to practice three times per week or can shorter episodes with small groups be arranged?
3. Ensure that your coach and facility are maximizing social distancing and disinfecting procedures. Practices should be modified to minimize interaction. Waiting should be done in a social distanced manner.
4. General infection control measures should be stressed: wear masks when appropriate, cover cough and sneezes, find other celebrations than high fives and players/coaches should stay home if ill.
5. Travel should be limited as much as possible. Keeping practices and games local helps to minimize spread between communities.

Is it OK to get your kids back to their sports? Yes, but do so with caution and care.

For more detailed information on this topic, visit the CDC.

Girls are made differently than boys. They have different hormones, looser ligaments and a wider pelvis. They also have a menstrual cycle and this plays a larger role than some may realize. Females need to have regular menstrual cycles to keep their bones healthy and growing at a normal rate.

When girls go through intense training, barely any breaks in the year from sports and possible diet changes, this makes having a regular period difficult. Because of this, females are placed at risk for sport injuries due to weak bones, less energy and fatigue.

Are girl’s muscles and bones weaker than boys?

During an adolescent growth spurt there is an imbalance of bone growth and bone strength, making female bones weaker than boys. Adolescent females do not use the muscles in the back of their thighs when landing from a jump as often seen in males. This increases risk for serious knee injuries. Females use the large quad muscle in the front of their thighs to land from a jump. Females also have less control of their muscles during adolescence.

What are common facts and injuries of the female athlete in different sports?

• Dance: 90 percent of dancers will get injured in their career: stress fractures and foot injuries are common.
• Cheerleading: Cheerleading has become a highly competitive, sometimes dangerous sport. Cheerleading has the greatest number of catastrophic injuries including head injuries (concussions), skull fractures, neck injuries, heat illness, and electrolyte imbalance.
• Gymnastics: Injuries in this sport produce the highest number of injuries requiring surgery. Commonly wrist pain, stress fractures of the spine and ankle sprain.
• Volleyball: These players typically have better form and less injuries. Common injuries include jumper’s knee and ankle sprains.
• Soccer: Huge female athlete participation with ACL strains being the most common injury.

The most common injury is an ACL (anterior cruciate ligament) injury in the knee:

• Females are four to five times more likely to have a non-contact ACL injury than males. This is sad because studies show that 65 percent of athletes (male and female) will no longer player soccer within seven years after an ACL injury.
• Adolescent female soccer players are at the greatest risk for negative long term effects, with more than 22 percent needing revision surgery or surgery on the other knee after an ACL injury.
• At least two-thirds of ACL tears occur when an athlete is cutting, pivoting, accelerating, or landing from a jump; tear occurs within the first 40 milliseconds after initial ground contact. This impacts the female athlete a great deal when you look at the sports many of them are competing in such as gymnastics and soccer.

Female athletes may be faced with more obstacles, but there are ways your female athlete can reduce the risk of injury, including:

• Do not allow knees to go inward during jumping, landing, cutting and pivoting.
• Land softly with knees slightly bent.
• Core/trunk control needs to be part of training.
• Increase awareness when adolescents have a growth spurt as they may be more at risk for injury.
• Monitor menstrual regularity.
• Maintain a balanced diet and stay hydrated.
• Train on dry/safe surfaces.

As a female athlete myself, I’m proud of the strides we’ve made toward equality on the playing field. But we also face new challenges as we compete at a higher level. Make sure to follow the above tips and stay safe.

SPORTS Symposium

Education is the key to keeping our young female athletes in their sport vs. being on the sideline with an injury. To learn more Cook Children’s has an annual SPORTS Symposium to educate those who work with our athletes: Coaches, athletic trainers, physical therapists and school nurses.

Please join us on July 21, 2016, to learn more about the female athlete in the morning and what is sending athletes to the ER in the afternoon.

Click here to register and attend the event. Click here to register for the Web cast.

Early Bird Special Ends June 30, 2016

This is often said when someone is hit in the head during a sporting event. But this type of injury should never be taken lightly. A concussion can occur when a person has a trauma such as a blow to the head or the head being shaken. In fact, concussions can happen whether the person is actually “knocked out” (loses consciousness) or not.

Concussions are a common issue among school aged children and teenagers, especially if they are active in sports. In the United States alone, more than 300,000 concussions occur per year as a result of sports. An athlete who plays a contact sport, such as football, wrestling, basketball or soccer, is estimated to have a 19 percent chance of suffering a concussion in a single season. Other activities such as gymnastics, cheer, skateboarding, bicycling, or even jumping on the trampoline also come with an increased risk of concussion.

Can my child still get a concussion if he or she is wearing a helmet?

Yes. Although helmets do protect your child from a fracture of the skull or an injury that causes bleeding to the brain, they do not necessarily prevent concussions. It is possible to sustain a concussion while wearing a helmet because the helmet protects the bones of the head, but cannot stop the brain from making contact with the inside of the skull.

But what exactly is a concussion?

A concussion is a type of brain injury that interferes with the way the brain functions. It can cause symptoms such as:

• Headaches
• Nausea and vomiting
• Vision changes
• Irritability
• Difficulty concentrating
• Memory problems
• Balance issues
• Sleep disturbances

The majority of concussions (80-90 percent) resolve within 7-10 days, but may take longer for children and adolescents. Sometimes, the symptoms of a concussion will linger or worsen. If symptoms become persistent, your child may require further treatment to help symptoms resolve so they are able to return to attending school and participating in normal activities. Even a child with a “mild” concussion should be evaluated by a physician. A doctor will be able to decide if any tests are needed to check for more serious injuries. He or she will also check your child’s symptoms to find out the severity of the concussion, and determine whether referrals to other healthcare providers, such as a physical therapist, are required.

As a parent, what do I need to know to help my child get back on the playing field after a concussion?

Patience is key when it comes to safely returning to sport following a concussion. Every young athlete is eager to get back to sports or activities as soon as possible. It is up to the parents to make sure that this process is not rushed and happens in a safe way. More and more research studies are proving that the effects of concussions can compound and have long-term effects if another concussion occurs before adequate time for recovery is allowed. If an athlete or child returns too soon, he or she may be susceptible to negative effects of post-concussion syndrome such as depression, memory loss, fatigue, chronic headaches or pain. Parents should be diligent with following up with healthcare providers to get appropriate treatment prior to returning to sports.

How can a physical therapist help an athlete return to sport after a concussion?

Physical therapists will assess the need for treatment of any musculoskeletal injuries that occurred at the time of concussion. If your child has pain in the muscles or joints of the neck or spine as a result of injury, a physical therapist can help decrease this pain with hands on techniques or exercises. An injury to the brain can affect the brain’s ability to tolerate physical activity, movement, and balance. Sometimes these symptoms interfere not only with an athlete returning to his or her sport, but also with every day activities such as attending school, reading a book, or playing video games. A physical therapist will also assess the athlete’s tolerance for activity, function of the vestibular system (a part of the inner ear), and balance.

A physical therapist has the ability to monitor a patient’s symptoms while safely progressing from light aerobic activity, to sport-specific drills and eventually to non-contact drills. This allows the athlete to return to full practice and eventually to his or her sport. The vestibular system is a part of the inner ear that sends signals to the brain regarding a person’s movements and position in space. Additionally, the vestibular system is closely associated with an athlete’s ability to maintain balance. Balance can be affected when a child suffers a concussion, and can require rehabilitation from a physical therapist. Physical therapists can use specific exercises designed to strengthen the vestibular system and improve balance to prepare your child to safely return to sport or activity.

So what’s the bottom line when it comes to concussions?

1.Head injuries, or “getting your bell rung”, should not be taken lightly.

2.Helmets protect the skull, but do not always prevent concussions.

3.It is important that a physician evaluate your child after an injury to the head.

4.Parents and athletes must be patient in order to safely return to activities in order to allow concussions to fully heal.

5. Physical therapists can treat patients who have had a concussion to help with musculoskeletal or vestibular system issues, tolerance for physical activity, and balance training to help safely return to sport.

For more information:

• What every parent needs to know about concussions
• Concussion management and update
• Football injury prevention
• ​Soccer injury prevention
• Hockey injury prevention
• Gymnastic injury prevention
• ​SPORTS resources
• 9 ways to prevent injuries in young athletes
• Cheerleader injuries
• Top 10 questions parents have about sports injuries

About the author

Jessie L. Diebold, PT, DPT, OCS, is a SPORTS physical therapist at Cook Children’s. Cook Children’s SPORTS Rehab is a leader in the community in sports injury. Additional information and helpful tips can be found on the Cook Children’s SPORTS Rehab website. Cook Children’s SPORTS Rehab is a leader in the community in sports injury prevention.

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

Even highly competitive and high intensity training can be healthy, but can it become unhealthy?

One of the dangers of intense training can be a lack of food intake to keep up with the demands of the sport. Have you seen the pictures of food in front of Olympic swimmers? They often eat up to 10,000 calories per day. Yet, our young teenage athletes, in an attempt to manage their weight or achieve a particular body image sometimes cut calories to levels even below their less active peers.

This is when their health could be in danger.

Certain sports may put athletes at higher risk to engaging in unhealthy behaviors. Think about those where body image plays a large role such as dance or gymnastics. Those competing in sports that classify participants based on weight class can also be at risk. Even participants in sports that don’t fall into these categories can have pressure put on them to “lose a few pounds” in order to improve.

These problems can arise in boys and girls, but girls can have particular health consequences that need to be considered.

What is the female athlete triad?

• Energy deficiency (not eating enough food)
• Loss of periods
• Low bone mass (osteoporosis)

Energy deficiency -This can be the result of simply not consuming enough food or it can be a conscious method to decrease calorie intake for weight loss. In more severe cases it can be the results of an abnormal body image or an eating disorder.

Loss of periods -The calorie deficiency can lead to decreased production of hormones that help periods to be regular. This can lead to missed periods or for periods to stop altogether. Missed periods are often the symptom that brings attention to the overall problem. Because of this, I recommend you check in with your athletes intermittently about their periods. Despite the weird and embarrassed look on faces (it translates, “Mom, can you believe he’s asking this?”), I ask at every check-up.

Low bone mass - Decreased hormones and intake of calcium can lead to thinning of the bones. When severe, this can cause stress fractures, which are fractures that occur with very little or no trauma. In addition, girls are supposed to building up bone density in this time frame and the long term implications of not doing so could have severe consequences.

What can you do?

Pay attention to your athletes and their eating habits.

If you see any of the following, set up a visit with your pediatrician to address your concerns:

1. Weight loss or disorder eating habits.
2. Irregular periods or no periods.
3. Injuries from mild activity or that tend to linger.

Together you and your pediatrician can gather a team around your athlete to ensure their health for now and into the future.

Some potential members of the team could include a:

1. Pediatrician
2. Dietician
3. Counselor
4. Coach or trainer

That’s great. I appreciate all the efforts to protect the well-being of those players.

But today, I want to focus on our youth and how to make sure injuries can be prevented at the 14 and under level. In 2012, the City of Fort Worth estimated 10,000 volunteer coaches managing youth sports teams throughout the Fort Worth and Tarrant County, under the age of 14. The report said “most of these coaches are parents or other family members who have not been specifically trained on how to coach youth sports or youth sports safety.”

Sports activities help children and adolescents stay fit, learn about teamwork and develop self-confidence. However, with the number of youths participating in sport activities increasing, the rate of injuries is also steadily rising for this group. Each year, approximately 775,000 children under the age of 15 are treated in emergency rooms for sports injuries across the nation.

How can injuries be prevented?

According to the American Academy of Pediatrics, it is recommended that children wait until 6 years of age before participating in team sports. Young children could sustain injuries because they do not understand the concept of team play. In addition to age, sports injuries can result from not following recommended procedures for the young athlete before, during and after their sporting activities.

Here are nine recommendations for lowering the risk of injury to the young athlete.

1. Get a sport physical from a physician for your child.
2. Coaches/instructors/athletic trainers should have annual education on specific sporting activity and guidelines.
3. Make sure your child has well-fitted safety/protective equipment and shoes.
4. Have an Emergency Action Plan in place and practiced as a drill.
5. Follow a pre- and post-practice/game dynamic warm-up program.
6. Take the time teach the correct technique of skills.
7. Take rest breaks and drink water frequently during activities.
8. Know the signs of overtraining.
9. Maintain good mental health.

If you are coaching youth sports or you are the parent of a youth participating in sports, please read all of the “young athlete’s injury prevention guides” from our experts at Cook Children’s Sports Performance Orthopedic Rehab Team Specialists.

Additional training for coaches both recreational and professional:  City of Fort Worth Training Video complete with a pre/post-test.