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.”

With school back in session, many kids are once again suiting up for fall sports and hitting the field, track or court for competition. Doing so offers a child many benefits. Along with being an outlet for exercise and physical activity, playing sports gives kids an opportunity to develop meaningful friendships, practice resilience and learn the value of hard work and perseverance.

But, like with most activities, there are risks. Sustaining a concussion is one of them.

What is a concussion?

The Centers for Disease Control defines a concussion as “a type of traumatic brain injury 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.” While sports, especially contact ones, carry an obvious risk of head injuries, a concussion can happen any time of year from any type of sport, recreational activity or play.

A 2018 report from the American Academy of Pediatrics evaluating three national injury databases estimated that 1.1 million to 1.9 million recreational and sports-related concussions occur every year in the United States in children 18 years of age or younger. When it comes to sports-related concussions for high schoolers, boys tackle football tops the incidence list with girls’ soccer coming in second, according to the report.

“A lot of concussions go unreported or undetected,” said Nicole Pitts, D.O., a sports medicine physician at Cook Children’s Pediatric Specialties in Prosper. “Usually 2 in 10 high school athletes who play contact sports, including soccer and lacrosse, get a concussion.”

Signs and symptoms

A concussion can sometimes be hard to spot. After all, it’s an internal injury. There are no visible cuts, bruises or breaks. Parents and coaches must rely on how a child feels and behaves to spot the signs and symptoms, which could have a delayed onset and last for days, weeks, months or more.

If your child takes a blow to the head, here are the signs and symptoms that they may have a concussion:

• Persistent headache or increasing head pressure
• Drowsiness or difficulty waking, characterized by grogginess, haziness, sluggishness or foggy feeling
• Dizziness and balance issues
• Blurry or double vision
• Weakness, numbness or reduced coordination
• Persistent vomiting, including nausea
• Slurred speech or slowed responses
• Convulsions or seizures
• Confusion, forgetfulness or difficulty recalling events before or after the injury
• Restlessness, agitation or heightened sensitivity to light and noise
• Behavioral or personality changes
• Loss of consciousness
• Asymmetrical pupil size (one pupil larger than the other)

What to do if you suspect your child has suffered a concussion

If you suspect your child has suffered a concussion, first and foremost, pull them from the game or activity.

“If they're in a game and you suspect they’ve had a concussion or had a blow to the head, or they're having any of those symptoms, even if you’re not sure, but suspect it, they need to be removed from the game immediately,” Dr. Pitts said. “That's the most important thing, and they should not be put back into play in that game or any activity on the same day at all.”

Have them evaluated by a professional, like a physician or athletic trainer, right away, especially if they lose consciousness, are confused and disoriented, are vomiting continuously and have trouble talking.

What's next

The clinical protocol for concussion treatment and rehab includes two strategies for evaluating an athlete’s recovery and readiness to get back in the game. The first 24 to 48 hours after a concussion should be a time of rest for the athlete, followed by a gradual and staged reentry to school and sports using the return-to-learn and the return-to-sports strategies. Athletes should remain in each stage for a minimum of 24 hours and should be able to complete the activities each stage allows with little to no exacerbation of concussion symptoms before moving to the next.

“We'll get them back into school first and once they're back in school and able to do all of their school activities and they're not having any symptoms, then we’ll start them on a return-to sports protocol,” said Carolyn Snow, MS, LAT, ATC, OTC, sports medicine coordinator at Cook Children’s Orthopedics and Sports Medicine. “We don't want to do any sports activities until they’re symptom-free.”

Dr. Pitts utilizes these clinical strategies with her concussion patients in Prosper. Cook Children’s Orthopedics and Sports Medicine concussion clinics at Walsh Ranch, Hurst and Mansfield also follow the return-to-learn and return-to-sports clinical protocols, in addition to utilization of a concussion testing tool called ImPACT to help determine a child’s readiness to return to activity. This computerized test measures memory, attention span, and visual and verbal problem-solving. Dr. Pitts is also certified to administer the ImPACT test.

Recognizing the signs and symptoms of concussion early on, and taking immediate action can help protect your young athlete’s mind from further or more serious injury. Getting the proper treatment and rehabilitation can minimize the long-term consequences from concussion and get them safely back in the game when the time is right. 

Before they can pump weights in the school gym or march with the band this summer, teens in Texas need to complete a form that aims to catch any underlying health concerns.

The annual UIL pre-participation physical evaluation form applies to junior high and high school student athletes and marching band members for the 2023-2024 school year. The form has two parts:

1.      Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.

2.      Physical exam – performed by a physician to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some districts, including Fort Worth Independent School District (FWISD), require it annually.

Doctors at Cook Children’s say the physical exams are an important safeguard for student athletes. Sports physicals give doctors the chance to check for a variety of concerns – everything from poor eyesight and asthma to a lingering sprain or even a serious heart condition.  

“The goal of a sports participation physical is to review each child’s health history, to perform a thorough exam, and to identify health issues that could predispose the participant to a high risk of having symptoms or an injury while playing sports,” said Ann Natterer, M.D. at Cook Children’s Pediatrics Cityview in Fort Worth.

Why go to your regular pediatrician for this exam?

Dr. Natterer points out several advantages, including patient privacy and getting up-to-date with routine care, such as vaccinations.

“The pediatrician knows the child the best, has access to past medical history, and is also in a better position to facilitate any follow-up evaluations that may be necessary,” she said.

The pediatrician sees the big picture during a sports physical, said Wuroh Timbo, M.D. at Cook Children’s Pediatrics Lake Forest in McKinney. Your teen’s doctor has the files to track changes over time in weight, heart rate, medications and other parts of health history. Your teen’s doctor also knows about any previous illnesses, such as rheumatic fever, which can cause heart valve damage.

“And I think also just having an already established rapport with the families,” Dr. Timbo said. “It’s way easier to communicate with someone you already know. You’re going to get better information and give better information when there’s already a previously established relationship.”

Dr. Timbo recommends that parents make the appointment for their teen’s sports physical as early as possible. Getting the physical exam done early in the summer beats the rush that typically happens just before football workouts and band practice start. In other words … don’t put it off. It’s better to find out in May rather than in August if a student athlete needs vision correction, an inhaler or physical therapy, for instance.

What to Expect

It takes about 15 minutes, Dr. Timbo said, to go through a sports physical. Blank spaces on the UIL form allow the doctor to make note of any abnormalities with the patient’s eyes, ears, throat, lymph nodes, pulse, lungs, abdomen, back, feet and joints.

A sports exam gives patients the chance to ask questions or report any problems that impact their athletic ability. Knee pain and heel pain are the two most common complaints that Dr. Timbo hears. Sometimes the athletes tell him they’ve noticed shortness of breath or frequent headaches.

“Whether it’s something like exercise-induced asthma that we hadn’t caught before, or it’s an injury that re-aggravates every time they do a certain movement, we want to know, and we want to come up with a treatment plan to address it,” he said.

After the exam, the doctor checks one of three options on the UIL form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns. A referral might be needed for further tests with a specialist.

FWISD Director of Athletics Lisa Langston, Ph.D. said a physician’s clearance offers some assurance that the students can safely practice and compete in sports activities. Thanks to the required physical exams, she said, conditions such as cardiac issues and hernias have been detected through the years.  

“The students understand it’s all about their health and wellbeing. We’re not just doing lip service,” Dr. Langston said.

Dr. Timbo urges his patients to listen to their bodies. Speak up if something feels off. Understand that the annual sports physical is geared to pick up on any medical condition that might hinder their performance. Some underlying conditions could even be life-threatening, such as heart rhythm disorders that might lead to sudden cardiac arrest. 

“All doctors want their patients to be active,” he said. “Athletics is good for the body, good for the heart and teaches great life lessons on the ability to work in teams, resiliency and concentration. But we as physicians want to make sure that they’re safe to participate in these activities.”

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

More and more young athletes are experiencing pain while participating in sports. Some have traumatic injuries like sprained ankles and torn ligaments, while others experience overuse injuries like low back pain and tennis elbow. All of these athletes can suffer from significant pain on and off the field. No athlete is exempt.

All sports require a baseline of flexibility, strength, stability and endurance, as well as a time of rest between activities to safely perform the required activities. With the rise in athlete specialization in a single sport, played year-round, we have seen an increase in injuries and pain in these young athletes. These young athletes are also starting at a much younger age. Many more stress injuries have resulted, such as ligament tears, shoulder strains, stress fractures and back strains. In addition, there has been a rise in chronic pain (pain lasting longer than 3 months) among younger athletes. I never heard of a teenager with chronic pain when I was growing up! How do we deal with this growing population? “No pain, no gain?” “Just grin and bear it, the pain will go away?” “Slap some ice on it and get back out there?” There needs to be a better way. Fortunately, there is!

The best plan is obviously prevention. However, for the purpose of this article, we will assume the athlete is already experiencing pain. In this case, there are several things to be done. Pain should not be ignored! Our body is trying to tell us there is something wrong. Acute pain should be addressed with the gold standard: Rest, Ice, Compression and Elevation (RICE). We are typically willing to ice, compress and elevate, but many times rest is not followed properly. “He’s our best pitcher!” “If she’s not playing, we will lose our chance to make it past district!” “I really want to play, so I won’t tell coach about the pain.” If we do not allow the tissue to heal properly, the tissue can become weaker and will be at a higher risk for being injured again, maybe even worse than the first time. Now that pain is being addressed properly, what do we do? Now is the time to work on the basics again:

Flexibility: Muscular flexibility is vital. Tight muscles are much more prone to injury than flexible muscles. Tight muscles can be damaged during high velocity movements. Also, tight muscles can alter how our joints move, making other structures more prone to injury, such as ligaments, joints and bones.

Strength: Muscular strength is also very important. Strong muscles allow our bodies to perform the tasks that we put them through. Strong muscles also allow greater protection from injury.

Balance/control: And don’t forget about core strength! This is maybe the most missed strengthening component in most sports and possibly the most important muscle group for any sport! A weak core places an increased stress on other body parts and increases our risk for injury. How can we expect a soccer player to avoid ankle or knee injuries if he/she can’t even balance on one foot?

Return-to-sport: If the athlete’s strength is improving and the pain is under control, we can work on sport specific activities. This is where a physical therapist or athletic trainer with a strong knowledge of sports performance is vital. Coaches properly trained in technique can do this as well as long as they are able to spend dedicated one-on-one time with the athlete.

If pain from a recent injury is not properly dealt with, or the injury leaves the athlete with pain that lasts more than 3 months, chronic pain may develop. Now our focus as a physical therapist is more on return of function versus the pain itself. Seeing a physician that specializes in pain, such as Dr. Artee Gandhi and Dr. Aimee McAnally at Cook Children’s, can be beneficial as well. The physician could prescribe or recommend one or more of the following treatments in conjunction with the physical therapy:

1. Medications to reduce pain or inflammation while working on regaining function.

2. Biofeedback therapy with a psychotherapist, such as Wayne Martin, LCSW, psychophysiologist at Cook Children’s, to help the athlete learn how to relax muscles, reduce stress and visualize performance for relief of pain and return to normal activities.

3. Pediatric massage therapy to address tension and/or increased sensation.

4. Acupuncture therapy to help control pain.

Related links:

• Football injury prevention
• Baseball injury prevention
• Softball injury prevention
• Basketball injury prevention
• Soccer injury prevention
• Hockey injury prevention
• Gymnastic injury prevention
• Tee-ball injury prevention
• Swimming injury prevention
• Tennis injury prevention
• SPORTS resources
• Does your child play one sport?
• 9 ways to prevent injuries in young athletes
• Cheerleader injuries
• Dance injury prevention
• Top 10 questions parents have about sports injuries
• 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