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

Last night, NBC 5 Investigates released an enlightening report looking at the rates of concussions in North Texas districts. This report showed a much higher rate with more than 2,500 concussions reported in just 41 districts.

There are still a lot of misconceptions about concussions, what they are and what they might mean to your student athlete.

Here are 5 concussion MYTHS:

1. It was just a “mild” concussion.

Concussions are brain injuries, period.

One might classify a concussion as mild if symptoms were brief and not severe. However, you cannot predict whose symptoms will be severe based on the way the child was injured or even the symptoms right after the injury.

Even seemingly minor trauma can cause headaches and other symptoms for weeks.

2. If the child/athlete didn’t lose consciousness, it wasn’t a concussion.

Symptoms of concussion vary from child to child but passing out or blacking out are not required to make the diagnosis. Basically if a child has a fall or other injury that results in any neurologic symptoms, they can be diagnosed with a concussion.

Some examples of concussion symptoms are headache, nausea/vomiting, vision changes or problems with concentration and memory. Some of these symptoms may take time to develop, so it’s possible to diagnose a concussion a few days after the injury.

3. Concussions are only a problem for football players.

Almost all sports can cause concussions, including the cheerleaders on the sideline of the football games. Some other sports that are known to have higher incidents are soccer, baseball and softball. Other common causes are kids riding bikes and falling off playground equipment.

4. All concussions need either an MRI or CT of their head.

Most concussions can be diagnosed based on telling your doctor the story of the injury and the related symptoms along with a physical exam. Imaging is not necessary because a CT or MRI will most likely be normal even in the midst of a severe concussion.

Also remember that a CT of the head does not come without risk. While we should perform them when necessary, we should make sure we are not using them in situations where they will not provide useful information.

5. Don’t let your child sleep after a concussion.

Treatment of concussions is evolving. If you suspect your child has sustained a concussion, you should immediately seek medical attention and advice from a doctor about how you should treat your child’s symptoms.

There have been some changes in the treatment of concussions. First, we no longer require that you keep someone with a concussion awake for a set period of time. In fact, after their evaluation, the doctor may recommend that you allow them to sleep in order to help their brain heal. Your doctor might also prescribe some time away from TVs and other screens, school or homework or other activities that might cause their brain to work harder.

Concussions are much more common than we previously thought. I believe that the UIL will make changes to better track the risk of concussions for our high school athletes, which will hopefully lead to better ways of evaluating and treating concussions. In the mean time, don’t buy these common concussion myths.

After a child sustains a concussion, he or she should be removed from the game or practice in order to allow the brain to rest. While the importance of rest following a concussion has been scientifically validated, the definition of "rest" has not been well-established. As such, an individualized approach to concussion management is preferred. While limiting physical activity is often the first area considered when a child is instructed to rest, limiting stress in other areas of life can be equally important. In addition to physical rest, cognitive and emotional rest is also important following a concussion.

Although an extreme approach to cognitive rest is sometimes recommended, studies suggest that a more moderate approach results in better long-term outcomes. In fact, scientific evidence documenting the benefits of cognitive rest is limited. Nevertheless, limiting cognitive exertion can decrease the frequency or intensity of other symptoms, such as headache.

School is the most cognitively demanding activity for most student athletes, and their baseline level of academic functioning should be considered when creating a treatment plan. Students with more severe symptoms may benefit from staying home from school for 1 to 2 days.

However, because symptoms typically resolve within a few days, formal homebound education services are generally unnecessary because the amount of instruction provided is minimal (e.g., typically only about 4 hours per week). Furthermore, homebound school services are typically reserved for students expected to miss school for an entire month.

Immediately returning to school may be a better option for some students with mild symptoms as well as students who are likely to become severely distressed if they miss a day of school. In addition, when children are told to maintain complete cognitive rest (e.g., sit quietly in a dark room with no electronics), they may become overly focused on their symptoms and consequences of rest (e.g., having to make up multiple school assignments later).

It is also important to understand the role of electronics and technology in the lives of children, especially adolescents. While using a computer or texting on a telephone may trigger headaches, completely prohibiting a teenager from engaging in these activities can result in social isolation and contribute to emotional distress. Depending upon the assignment, prohibiting all use of electronics can result in a student being unable to complete homework requiring use of a computer.

When compared to other areas, less attention is typically given to importance of emotional rest. Particularly for teenagers, social and emotional situations can be a big concern. Limiting a child's exposure to volatile emotional situations (e.g., pressure from friends and coaches to return to play, arguments between parents) is important. In addition, peers and teachers often have a variety of reactions to a child's concussion.

For example, while most people will likely respond with understanding and support. Others, however, may discount the significance of the child’s symptoms and doubt whether the symptoms are "real" because the child does not look "sick."

When the validity of symptoms is questioned, a child will sometimes unconsciously exhibit persisting or worsening difficulties. An athlete may also feel pressure from peers, teachers, or parents to return to play before they are ready, which can lead to emotional distress as well as the appearance of persisting or worsening of cognitive symptoms.

A concussion often results in increased fatigue, particularly in the first few hours after the injury. Indeed, some scientific evidence shows that physical rest during the first 24 to 48 hours may result in an overall faster recovery. In addition, because other studies have demonstrated that a concussion sustained within a week of a prior concussion can result a longer duration of symptoms, avoiding high-risk activities (e.g., returning to play) in the days following a concussion may be best.

However, studies have also shown that extreme physical rest for more than 3 days can worsen symptoms and lead to deconditioning. Most children and adolescents who sustain a concussion will stop experiencing severe symptoms within hours to days and will completely recover within a few days to a couple of weeks.

Regardless of when a student returns to school, it is important that the school nurse and all teachers be informed that the student has sustained a concussion. Following a concussion, students may exhibit inattention, distractibility, slow thinking, and confusion as well headaches, vision difficulties, and fatigue.

Some temporary accommodations can include preferential seating in the classroom (e.g., at the front of the room and away from distractions), testing in a separate room, extra time to complete tests and assignments, shortened assignments, copies of teacher notes prior to lectures, note-taking services, rest breaks during the school day, and permission to eat lunch in a quiet environment.

Considering the typically rapid recovery following a concussion, a formal accommodations plan at school is usually unnecessary because, by the time a plan has been finalized, the student is no longer symptomatic.

If, however, a child is slower to recover, a more thorough medical evaluation may be necessary to further investigate and treat physical dysfunction (e.g., headaches, dizziness). In addition, a neuropsychological evaluation can be helpful in evaluating the specific areas of cognitive difficulty and severity of the deficits as well as provide guidance regarding the need for a more formal academic plan.

About the author

Carla Hearl Morton, Ph.D., is a pediatric neuropsychologist at Cook Children's. She is a licensed psychologist with expertise in how learning and behavior are connected to the development of a child's brain structures and systems. At Cook Children's, neuropsychologists work closely with a team of neurologists andneurosurgeons to provide the best treatments and interventions that meet the individual needs of each child.

The answer is complicated.

Yes, it's very important for toddlers ages 1-3 to interact with other kids their age and challenge their balance, strength and coordination. Sports are a great way to promote these skills and literature shows that athletes who play sports at a younger age are more likely to be active adults than their peers who don't participate in sports.

However, organized sports  may not be the best solution for children 3 and under, and aren't the only way to teach our children these skills. The list below describes activities for toddlers and some benefits of these activities for their development.

Swimming: Helps strengthen the arms and legs, as well as improve coordination since the child has to use both arms and both legs at the same time. Learning swimming at an early age helps promote good water safety habits later in life. You can practice swimming in a "parent and me" swimming class. 

Dance: Improves balance, coordination, strength and flexibility. You can practice in a class setting or by having a "dance party" or playing a game of "freeze dance" at home.

Biking: Between ages 2 and 3, kids should be able to begin riding a tricycle. For young kids, there are tricycles that offer a parent guide bar to help kids move and steer. You can practice biking in your neighborhood or on trails.

Soccer: Most teams start between ages 3-5; however, kicking a ball in the backyard with your toddler is a great way to help them learn to run, develop core strength and balance on one foot for a short period of time.

Basketball: Helps kids develop hand-eye coordination when dribbling and shooting and improve running and jumping skills, as well. You can play with an adjustable hoop in the driveway, or sing up for a community team (which will generally begin between ages 3-5).

T-Ball: Teaches running, balll skills and coordination skills. Using larger balls for young children will help them be successful with catching and throwing.

Yoga: Helps improve flexibility, which is very important since toddlers are growing quickly and develop tight musles quickly. Yoga can also improve strength (especially in the core muscles) and balance. Several toddler yoga videos can be found online, and classes are available throught out the DFW area.

Gymnastics: Another way to gain strength, balance and flexibility, gymnastics is a sport that children can begin learning as early as 18 months old. Many gyms have special toddler and preschool classes, as well as "parent and me" classes.

Yard games: The old staples of "tag" and "hide and seek" are great for teaching turn taking and problem solving, as well as practicing and running and climbing. Taking your child to a local playground also offers a wide variety of ways to practice climbing stairs, running, swinging, balance, etc. 

With all of these, safety is a primary concern. Toddlers are at high risk of injury when practicing new things. Contact your pediatrician if you feel like your child is having difficulty learning new skills and they may refer you for evaluation by a physical therapist to evaluate your child and help them learn these new skills.

About the author

Jodi Burgett PT, DPT, CPST, is the clinical coordinator of Neurodevelopmental Physical Therapy at Cook Children's. Physical therapy at Cook Children's focuses on large motor and functional skils to enhance development, restore function and prevent disability from pediatric conditions, illness or injury. Cook Children's has Rehabilition Services in locations in Fort Worth, Hurst and most recently in Mansfield.