Warm-Ups & Stretching

Physical therapist assistant Kim Barb, OPTA, of Cook Children’s Pediatric Specialties Walsh Ranch, says it’s important to stretch and warm up before playing or practicing, as doing so prepares the body for fitness. After a game or practice, incorporate flexibility stretches with static stretches and holding positions, like the typical hamstring stretch, calf stretch and quad stretch. A five- to eight-minute dynamic warm-up prepares the muscles for a better stretch.

Why?

• To increase blood flow
• To improve muscle flexibility
• To prevent injury and tearing of muscles, sprains and strains
• To improve performance

Agility drills prepare the muscles and joints for running, jumping, cutting and footwork.

Examples of agility drills are:

• Soldier kicks
• Knee hugs
• Hamstring scoops
• Skipping
• Hip openers

ACL-Injury Prevention for Soccer Players
Barb recommends strengthening large muscle groups typically used in soccer, such as the hamstrings, quadriceps and the gluteals (including the glute medius, minimus and maximus), with exercises such as squats, lunges and hamstring curls.

Strengthening exercises can help prevent the risk of injury by teaching muscles and joints to be stable and strong. Strengthening hip and core muscles also helps with the reactive forces created when making contact with other players.

Single-leg balance drills increase stability by training your body to stay balanced on one foot while moving, cutting and changing directions.

Examples of single-leg balance drills are:

• Stand on one foot and pass the ball.
• Stand on one foot and head the ball.

Plyometric drills teach athletes how to land with control – a skill that boosts the body’s ability to absorb impact and protect the joints. According to Barb, landing with poor alignment can cause the knees to cave inward, a position known as “knee valgus.” This inward collapse is a common culprit behind serious injuries, making proper landing technique an essential part of any training routine.

Examples of plyometric drills are:

• Box jumps
• Lateral bounds/skater lateral hops
• Depth jumps

Turf Burn Prevention & Treatment

These raw, red friction burns can be very painful, says Cook Children’s physical therapist Jessie Fernandez, PT, DPT, OCS, COMT, of Cook Children’s Rehabilitation (South).

If you have turf burn:

• First, be sure to clean it with soap and water to rinse out any dirt or debris and help to prevent infection.
• Next, treat the burn with an injury ointment, such as Neosporin.
• Cover it with a dressing or bandage. Waterproof bandages can help prevent the bandage from falling off during exercise.

Players can wear tighter-fitting, sliding shorts underneath their regular shorts to reduce the risk of skin damage when sliding on the field. Staying hydrated and keeping skin moisturized can also help reduce the risk of turf burn.

Whether your child plays on a natural grass field or turf, it’s important to continue practicing on the same surface so the athlete can get used to controlling their body on it. Turf fields absorb shock less effectively than natural grass, so running, jumping and playing on them will feel different.

What to Know About Concussions and “Second Impact Syndrome”
The American Academy of Pediatrics (AAP) defines a concussion as “a type of mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”

This sudden movement can cause the brain to move or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. 

A concussion can sometimes be hard to spot. After all, it’s an internal injury.

There are times when a concussion is more easily identified, such as if an athlete loses consciousness. But it’s important to know that anytime there is a blow to the head, a concussion is possible.

“Monitor the athlete immediately after but be aware that sometimes it can take one to three days for symptoms to come on,” Fernandez said.

Immediate symptoms to watch out for and not to delay emergency medical treatment:

• Severe headache
• Blurred vision
• Trouble walking
• Confusion
• Slurred speech
• Unresponsiveness

Symptoms to watch after one to three days:

• Dizziness
• Headache
• Nausea
• Sleep changes, like sleeping too much or not enough
• Changes in mood or emotions
• Difficulty concentrating

Symptoms often resolve on their own, but one extremely important thing for parents to know about is second impact syndrome, which is when a person has a second concussion occur prior to resolution of symptoms from a previous concussion. This is the reason children and teens must sit out of a sport while recovering from a concussion.

“Playing through something like a knee injury is not ideal, but playing when you have concussion symptoms can be extremely dangerous, and can cause permanent brain damage or even death,” Fernandez said. “It’s just not something to mess around with.”

This is why Fernandez says that if there are any symptoms or concerns, the athlete should wait to return to play until they resolve. Usually, return-to-play protocols are overseen by a physician, athletic trainer, or physical therapist to work on the step-by-step process.

While neck strengthening and stability exercises can help prepare players for planned contact, like heading the ball, Barb notes that many concussions are harder to prevent because they stem from unexpected collisions that a player can't brace for.

“If you go up for a ball and someone hits you on the side of the head, you’re not prepared for that or it’s likely that you’re not stabilizing your neck muscles and that’s when the problem arises.”

So who is considered a “running” athlete? Cross-country and track first come to mind, but don’t forget sports such as soccer, football, or lacrosse. A typical soccer game played at the varsity level can consist of 7-9 miles, if an athlete plays the entire game. And in the peak of the season, a cross country athlete might run 20-30 miles per week or more.

Each sport comes with its own recommendations of training intensity for kids. The number one rule to remember when it comes to fitness in kids is to emphasize fun and safety. When running stops being fun or aches and pains become commonplace, that’s when we need to worry we’re pushing our kids too far. Keep these tips in mind to help prevent injuries.

• Invest in a good pair of running shoes, socks, and appropriate clothing. Most local running stores have employees trained in gait (walking) and running analysis. They make educated recommendations on proper footwear for each individual. Running shoes should be changed every 300-500 miles or if breakdown is occurring. Moisture wicking (not cotton!) socks and clothing are also important to prevent blisters and help with body heat regulation.
• Maintain a well-balanced diet, and drink plenty of water every day – not just race/game day. Proper nutrition is important in all kids but especially in athletes.
• Avoid running in extreme heat or cold. High humidity should also be avoided. If you are running in warm weather, remember to wear bright, reflective clothing made of wicking material, and be sure to hydrate often. If running in cooler weather, dress in thin, wicking layers, and don’t forget gloves and a hat. Hydration is still crucial in colder temperatures, too.
• Stretch both before and after running. It’s important to stretch the major muscle groups in your legs – quads (thighs), hamstrings (back of your thighs), calves, and hips. Dynamic stretching  prior to running is an excellent warm-up, while static stretching can be used as part of a cool down. Foam rolling is also beneficial for these muscle groups.
• Follow intense running/workout days with an easy or rest day. Youth should have 1-2 rest days per week.
• Running should not be your only form of exercise. Cross training is very important. Biking, swimming, and elliptical are excellent alternatives.
• Build your mileage gradually - no more than a 10 percent increase per week. The most common injures that affect runners are typically the result of overuse. Too sharp of an increase in mileage can predispose runners to injuries like shin splints, tendinitis, or even stress fractures.
• Taking a walking break is not a sign of failure. Walk/jog intervals can help with increasing overall endurance.
• If possible, avoid running on uneven or slanted surfaces (like the sides of roads).
• Be alert and aware of your surroundings. Run with a partner or let someone know which route you’ll take. If you listen to music while running, keep one ear free. Avoid running at night.
• Work with coaches/trainers on proper running technique. Many local running stores also offer free classes on running form.
• Don’t ignore pain! “No Pain, No Gain” does not apply. Unfortunately, aches and pains from running can happen. Don’t ignore it or think it will go away.

If your child is having pain from running or you are concerned about risk of injury, a visit to a physical therapist can be extremely beneficial. At Cook Children’s, our SPORTS physical therapists have experience with the common injuries that affect runners. We also have staff members who are active runners and understand the demands of the sport.

About the author

Melissa Bro, PT, DPT, is a physical therapist for the Cook Children's SPORTS Rehab program. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind. As a part of Cook Children's integrated pediatric health care system, our patients have access to a multitude of pediatric specialty areas with board certified doctors, as well as laboratory services, nutritional consultations and sports medicine counseling.

Patients benefit from this integrated system because it allows our staff to use all of the system's resources during treatment. It also improves communication between the various departments whose physicians are focused on caring for children and adolescents.

If you have a young runner, sign them up for the Cook Children's 5K at 9:30 a.m. on Saturday, Feb. 27, 2015, as part of the traditional Cowtown running weekend.