Cook Children’s Orthopedics and Sports Medicine Walsh Ranch is expanding to include an outdoor sports complex designed to help young athletes train for peak performance. The John and Tracy Sellers Sports Complex is slated to open Oct. 12 and will include a 30-yard football field, a quarter-mile track, a pitching mound and an agility training area.

Funding for the expansion was generously provided by John and Tracy Sellers, the Walsh Foundation and the James and Dorothy Doss Foundation. The complex expands the offerings of Cook Children’s comprehensive orthopedic, rehabilitation and sports medicine facility in Walsh, which already includes a training gym where these specialties work side-by-side daily to rehab, train and care for the whole athlete.

“This sports complex will be an extension of that and give our athletes more options for training and recovery,” said Stefanie Perry-Charles, site administrator at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch. “We want to be the one-stop-shop for them as they work to get back in the game, build their skills and improve their performance.”

To truly condition the body and test and develop athletic performance, experts say it is best to train in the same environment in which the athlete plays, from the type of field to common game-time temperatures. For example, running in a flat and air conditioned gym does not replicate the same force and stress to the ankles, feet, back or knees that a runner encounters on an outdoor track while wearing spikes.

The John and Tracy Sellers Sports Complex brings a next-level approach to training and recovery, where athletes can hone their skills on surfaces and in conditions similar to what they encounter in their sport.

“Our gym is beautiful and it's an ideal and safe place to initiate rehabilitation following an injury or surgery,” said Richard Ashlock, PT, DPT, SCS, sports clinical coordinator at Cook Children’s Orthopedics and Sports Medicine Walsh Ranch. “However, taking athletes outside where the temperature is different and we have a surface that's a little bit closer to what they're going to use gives them that extra real-life conditioning for peak performance and allows us to really test their readiness to return to a sport after injury.”

Programming and use of the facility will be open to all young athletes and sports teams throughout North Texas looking to level up their game, not just those recovering from an injury.

In addition to rehabilitation services, the John and Tracy Sellers Sports Complex will offer injury prevention programs, sport and position-specific training led by certified athletic trainers and adaptive training for differently-abled kids and teens. Teaching athletes the connection between nutrition, conditioning, preparation, form and recovery to prevent injuries will be a major focus of all programming.

“We want to prevent injuries before they happen,” said Carolyn Snow, MS, LAT, ATC, OTC, sports medicine coordinator at Cook Children’s Orthopedics and Sports Medicine. “The new programs will provide the athlete with the tools needed to safely return to sports after an injury. We want to give kids the tools that they need as young athletes to understand how to move their body correctly which includes teaching them the right exercises and stretches that will benefit them the most. We will also have the ability to help develop diet and nutrition plans. All of this together will help to develop them into the best athlete that they can be.”

It’s programming parents have asked for.

“We recognized the need for therapy services in this area, but we've also had parents asking about injury prevention, strength and conditioning and education programs in an effort to prevent injuries from happening,” said Carolyn Mullins, manager of rehabilitation services at Cook Children’s Orthopedics and Sport Medicine Walsh Ranch. “When parents see one child experience an injury and the rehabilitation that is necessary to return to their activities, they often ask what can be done to help prevent the same from happening to another child athlete.”

The complex will also offer sports camps during school breaks and homeschool physical education programs.

“The homeschool program will be beneficial for the students who need PE credit but may not be ready or have not had the opportunity to go into an organized sport,” said Sarah Connors, MHA, director of practice operations, Cook Children’s Orthopedics and Sports Medicine. “This will give the student the opportunity to be exposed to a variety of sports and activities. Hopefully, finding an activity or sport that interests them and they want to learn more about.”

Pamela Sherman, M.D., is a highly specialized and skilled orthopedic hand surgeon at Cook Children’s who has more than 3,000 hand patient visits per year. In order for her patients to be successful after her surgeries she relies on highly specialized rehab therapists called hand therapists. A hand therapist can be a licensed physical or occupational therapist. To become a hand therapist requires many hours of training beyond the basic education of a physical or occupational therapist. The hand therapists at Cook Children’s work closely with Dr. Sherman in her outpatient clinics to provide collaborative and comprehensive care to the patients and families.

Hand therapy is the art and science of evaluating and treating injuries and conditions of the upper extremity (shoulder, arm, elbow, forearm, wrist, and hand). The Cook Children’s SPORTS program is staffed with hand therapists at three locations across Tarrant County whose expertise is treating children with an injury or condition that affects the arm or hand.  The hand therapists work with the kids  from birth to 21 years to assess their needs and develop a treatment plan that allows them to return to their normal activities. 

Injuries of the hand are quite common, but steps can be taken to prevent some of them from happening.  Here are a few tips to help prevent hand and arm injuries:

1. Wear protective gear, such as elbow pads and wrist guards, during sports activities.
2. Make sure children do not play near treadmills or other exercise equipment.  Be sure to turn off the equipment and/or unplug them from the power source.  
3. Supervise children when using knives or sharp scissors. 
4. When using a game controller, put pillows in your lap to rest your arms on. 
5. Take regular breaks when performing a repetitive task.  This can help prevent overuse injuries.
6. Change positions often if you are going to be holding an object for an extended amount of time.
7. Review your body mechanics and posture when performing a task.

About the author

Cara Smith, PT, CHT, is a certified hand therapist and the Hand Therapy Program coordinator for the SPORTS program at Cook Children's. Cook Children's offers hand rehabilitation services for all ages, diagnoses and stages of care. We help rehabilitate children/adolescents with a wide variety of congenital conditions and traumatic injuries.

For more information, call 817-347-2925. Cook Children's hand rehabilitation services are under the direction of our Sports Performance Orthopedic Rehabilitation Team Specialists (SPORTS). 

Cook Children's offers three SPORTS Rehab locations for hand therapy:

750 Mid Cities Blvd., Suite 130, Hurst, TX 76054

1919 8th Ave., Fort Worth, TX 76110

801 Matlock Rd., Mansfield, TX 76063

With so many things to consider how will I know when my baby is ready? Where should my baby sit for feedings? What should I offer my baby to eat first? How do I do this anyway? Should I try the spoon or just go for the squeezy pouches?

As a feeding therapist these are questions we hear a lot. When your baby is ready for the introduction of pureed foods around 4-6 monhts, it's time for the messy fun to begin! If your baby is showing the following signs, it might be time to give it a go:

• Takes a bottle or breast feeds with ease.
• Watches with interest when caregivers eat.
• Brings objects to his mouth.
• Sits comfortably in a bouncy or infant seat.

Here are a few questions you may have when you are ready to take the plunge:

1. Where should my baby sit for the feedings?

• Stable seating is best for your baby. Babies should not be bobbing, leaning or lounging on their back. In the beginning, babies should be in a semi-upright position, like they would sit in a bouncy seat or infant feeding seat. As babies become more stable sitting up, a booster seat or highchair can be used.
• Position baby at caregiver's eye level.
• Remember, as babies grow their seating will need to be adjusted.

2. What should I offer my baby to eat first?

Start with thin baby food cereals. Rice cereal by spoon is a good choice. Gradually increase the thickness of the cereal as your baby tolerates. Alternatively, Stage 1 or homemade single ingredient purees may be offered.

3. How do I offer these foods?

• Show your baby with your expression and tone of voice that this is going to be fun and enjoyable.
• Show the baby the spoon; a small plastic toddler spoon works well.
• Dip the spoon into the puree wiht a small taste on the end of the spoon.
• Offer the spoon slowly. Place small taste on lower lip.
• Caregiver should model smacking lips.
• Continue to give small tastes of puree modeling "Aaahhh" for baby to open mouth and "Mmmm" for baby to close mouth and use lips to clear the spoon.
• Follow the cues of the baby to continue offering more bites and bigger bites. Hint: If he pushes your hand away or turns his head, he's most likely done. However, if he opens his mouth, he's letting you know he's ready for more.
• Keep mealtimes short and sweet. End feeding in a positive way.
• Let baby get messy, messy, messy! While we're at it, don't scrape food off of baby's face during the meal. Save the cleaning up for after all the bites are done and baby is out of the feeding seat. Washing off at the sink works well.

4. Why should I start with the spoon and NOT the pouch?

Here are all of the wonderful things your baby is learning when you offer pureed foods from a spoon:

• Practice getting the tongue and jaw to move in more coordinated and controlled movements getting them ready for harder solids.
• A chance to work on lips clearing the spoon rather than just sealing as they do for breast and bottle.
• A chance for baby to begin working on moving tongue from side to side and biting on a firm object.
• A chance to build a feeding routine that fosters skills and confidence.
• A chance to work on building trust and incidental feeding experiences as they see someone they love and trust offer and explore foods with them.
• A chance to begin working on the co-feeding stage, redefining the parent role and the child role in feeding as babies move toward independence with finger feeding and spoon holding and licking while still needing help from their caregiver.

5. While we are on the subject, how about pureed from pouches?

Pouches are so convenient. They offer parents an easy way to expose their little ones to a variety of flavors, they're easy to transport and easy to offer on the go. For those times when you simply can't pass on the pouch, remember these tips:

• Consider squeezing onto a spoon.
• Remember to get face to face with your baby when using a pouch.
• Offer pouch foods that are more single ingredient or just a few ingredients so that the pouch is an added food, not the whole meal. 
• Offer the pouch when seated in a stable highchair with a tray, offering some of the puree on the tray for the baby to touch and practice licking from the fingers.

About the author

Melissa Smith is a speech pathologist at Cook Children's. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

The more frightening thing is the amount of patients that we don’t read about who are undergoing the same surgery. More and more, young baseball players ages 15-19 years old are sustaining this same injury and having to undergo this surgical procedure.

Ulnar collateral ligament reconstruction used to be an injury that we saw in ball players later in their careers. John Smoltz played for the Atlanta Braves and was recently inducted into the Baseball Hall of Fame. His career benefitted from Tommy John surgery. Currently, he's the only player inducted into the Hall of Fame who received Tommy John surgery. But he warns against the number of young people receiving the surgery today, calling it an "epidemic."

"I want to encourage the families and parents that are out there that this is not normal to have a surgery at 14 and 15 years old," Smoltz said. "That you have time, that baseball is not a year-round sport. That you have an opportunity to be athletic and play other sports. Don’t let the institutions that are out there running before you guaranteeing scholarship dollars and signing bonuses that this is the way….

I want to encourage you, if nothing else, know that your children’s passion and desire to play baseball is something that they can do without a competitive pitch. Every throw a kid makes today is a competitive pitch. They don’t go outside, they don’t have fun, they don’t throw enough — but they’re competing and maxing out too hard, too early, and that’s why we’re having these problems. Please, take care of those great future arms.”

So are his concerns warranted? In short, yes.

A recent study showed that 15-19 year-olds accounted for 56.7 percent of the ulnar collateral ligament reconstructions performed in the U.S. between 2007-2011.

This is a scary statistic considering this means that over half the UCL reconstructions done in the U.S. are performed on patients who haven’t finished their freshman year of college. So why has this become so much more prevalent in younger athletes?

I think the simple answer is the volume of pitches being thrown. If we look at the trends with today’s young baseball players, more often than not they are playing year round, playing on multiple teams, and at times playing on multiple teams at the same time. At some point kids have to put down the baseball and give their arm a break.

Little leaguers who pitch have a major disadvantage compared to their major league counterparts: they are still growing. This means that each time they take the mound they are pitching with a new body. As kids grow taller, it means they have longer limbs that they have to control, and this takes more strength and more coordination, strength and coordination that often doesn’t keep pace with how fast the athlete is growing.

So how do we reverse the trend of these young baseball players dealing with this terrible injury? Here are four recommendations.

1.Decrease the volume of throws

2.Don’t pitch with fatigue

3.Don’t throw breaking pitches (until skeletally mature enough and skilled enough to do it correctly)

4.Delay specialization (play multiple sports)

Decrease the volume of throws

Decreasing pitch volume I feel is the most important of these three recommendations. It’s not just following pitch counts it’s avoiding playing multiple positions with a high volume of throws. I have had many patients come in and say “we follow all the recommended pitch counts,” but as I dig deeper I find out that, yes, they are following pitch counts, but the child is playing catcher when he isn’t pitching. The bottom line is that it isn’t just pitch count alone, it is the total volume of throws we need to think about.

Don’t pitch with fatigue

Making sure our players aren’t pitching fatigued is also a big part of keeping our young throwers safe. If a player is fatigued and continues to pitch, even if they haven’t reached their pitch count, they are putting themselves at risk. The National Athletic Trainers’ Association (NATA) Position Statement on Prevention of Pediatric Overuse Injuries cited a study showing that a greater percentage of pitchers with shoulder or elbow injuries started at another position and pitched with arm fatigue. So if a player has been out in the hot sun playing short stop in the first game of a double header it probably isn’t a wise decision for him to pitch in the second game

Don’t throw breaking pitches (until physically mature enough and skilled enough to do it correctly)

I think most parents of young baseball players have at least heard the recommendations to avoid curveballs and sliders until the player is older, but for some reason we still have young pitchers throwing these breaking pitches. Another study cited in the NATA Position Statement on Prevention of Pediatric Overuse Injuries showed the risk of elbow pain increased 86 percent in youth pitchers throwing sliders, and the risk of shoulder pain increased 56 percent for pitchers throwing curveballs. We as parents need to remember our kids are going to watch their favorite big league pitcher and want to throw all the same pitches it is up to us as parents to step in and say you aren’t ready for that.

Delaying Specialization

There is an interesting study finding that more of the successful, Hall of Fame–type pitchers come from up north, where Hall of Fame hitters come from all over — a lot of them from the South. The gist of the study was that because there are several months of the year in these northern states that it is too cold to be outside playing baseball these pitchers couldn’t participate in baseball year round. During the winter months they had to put the baseball down and do something else. Once again referring back to the NATA’s position statement they state, “Young athletes who participate in a variety of sports tend to have fewer injuries and play longer, thereby maintaining a higher level of physical activity than those who specialize before puberty.” Delaying specialization is also a big part of decreasing volume, because if kids are playing another sport they will get that nice break that they need from throwing.

This blog by no means touches on all the factors that lead to these injuries, and the four recommendations are by no means the complete list of ways to prevent these injuries, but following these recommendations is a good place to start to keep, our young ball players’ arms nice and healthy.

Resources

• Baseball Injury Prevention
• Top 10 questions parents have about sports injuries
• Young athlete's injury prevention guide
• Strength training in children/adolescents

Why is it important for my child to be treated for a finger injury?

Just because your child’s finger may not look like it is broken, it is still important to have it looked at by a professional. The bones of the hand are quite small, and fragile. But, the bones aren’t the only thing in the hand that can be injured. There are also several ligaments and tendons in the hand that are at risk for injury. A ligament connects bones to other bones and their job is to support the bones and joints, and in some cases, prevent certain movements. If a ligament is injured and not allowed to heal, it can cause the bones to be unstable which can lead to further injury.

When should I get help for my child that has injured their hand or finger?

• If your child’s finger looks like it is out of place.
• If there is any bruising, swelling, or pain that lasts more than a couple of days.
• If your child is unable to bend or straighten the finger.
• If your child is favoring that hand or finger and doesn’t want to use it in everyday activities.

If your child injures their finger and it looks to be out of place, you should seek immediate attention from a medical professional. Do not try to put the finger back into place on your own. You could cause further damage.

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

Photo credit: Kelly Gavin, Texas Rangers.