SPORTS MEDICINE

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Most schools require your child to have an annual sports physical examination before playing competitive sports. This is a law in many states and a requirement for school accident insurance. Sports physicals can be performed in a group or individually.

Group physicals (locker room exams) are impersonal, insensitive to privacy, and usually fulfill only legal requirements rather than yield meaningful information. Group exams by sports medicine specialists are best reserved for college athletic programs, not for school-aged children.

An individual examination by your child's pediatrician is most meaningful, since this doctor knows your child. This physical is necessary:

Sports physicals should be scheduled at least three weeks prior to sports participation for two reasons: In case a medical illness or contraindication to participation is detected, sufficient time remains for treatment. It also allows time for sufficient conditioning exercises to prepare growing muscles and joints for competitive sports.

Sports, either competitive or individual, are a necessary part of your child's physical and social development. An increasing awareness of safety in sports and a new medical specialty called "sports medicine" has emerged during the past ten years. In this section, you will learn the major topics of sports medicine, which are relevant to the pre-adolescent and adolescent, with emphasis on minimizing the risk of sports-related injuries and parenting the young athlete.

Concern about the effects of twisting forces on growing bones (e.g. Little League Elbow) and other potentially serious injuries are justified. Since pediatricians are frequently asked for their opinion on this matter, I will offer mine. A child needs to play, and nearly all play involves some risk of injury. I feel the risk of injury in a well-coached, well-supervised, well-equipped, weight-matched football game is less than the risk of an injury to a child who is "hanging around" an unsupervised playground, riding his bicycle around the neighborhood or on busy streets, or participating in unsupervised sandlot sports. Most children who can escape parental pressures to play a certain sport will choose a sport, which matches their temperament. If your child is comfortable in the sport, which he has selected, then he will profit both physically and emotionally from the sport. If, on the other hand, he plays football not because he wants to but because Dad wants him to, his self-esteem will suffer. Pressuring a shy, gentle child onto a football field of "gorillas" in order to "make a man out of him" is questionable parenting. His talents may better be channeled into other activities befitting his temperament.

Peer acceptance is a primary social need of most preadolescents and adolescents. The concept of the team fulfills this basic need. Team sports, such as soccer and football, may contribute more to the social development of these children than individual sports (e.g. tennis). Endurance sports, such as swimming and track, are usually safer than contact sports. What your child may lose by not participating in a contact team sport, such as football, he gains by acquiring a skill. Team sports may contribute to a child's social development during his adolescent years, whereas individual skill sports may contribute to your child's self-esteem and be more beneficial to him for a longer period of time. In summary, a sport should give your child both enjoyment and learning. The sport should match the child's temperament. Parental guidance is more profitable than parental interference.

In most organized league or school sports, your child will be properly fitted with safety equipment. However, many injuries occur during unsupervised activities when safety equipment is often overlooked. In activities such as roller-skating and skateboarding, the knees, elbows and head are frequently injured, and therefore helmets as well as knee and elbow pads should be used. For ordinary bicycle riding, special pads are available which fit over the handlebars and crossbars, the two sites, which children frequently fall against.

Sports shoes. Short-cleated, soccer-type shoes are certainly safer than baseball spikes. If your child does a lot of running (e.g. jogging), a shoe with an adequate heel that fits properly is essential. If he usually runs on a hard surface (e.g. a basketball surface) and complains of heel pain, a soft rubber pad may be inserted inside his shoe beneath his heel. This cushions the effect of pounding his soft, growing bones against a hard surface. Generally, a growing child should avoid prolonged running on any hard surface. They should jog on soft grass or on a field rather than on pavement. If your child has a history of ankle injuries, high-top shoes, plus preventive ankle taping, may spare him further ankle strain. Rubber teeth guards should be worn for all contact sports such as hockey and football; these are often overlooked in unsupervised sports.

Being careful. The trampoline is a potentially hazardous piece of gymnastic equipment because of the risk of serious neck injury, which can result in paralysis. Both the American Academy of Pediatrics and the NCAA (National Collegiate Athletics Association) have recommended that the trampoline be banned from school gymnastics. Parents would be wise to also follow this recommendation and ban the trampoline from the backyard. Skateboards are also potentially hazardous. Skateboard accidents are very common in the United States. If all the inventions designed to propel our children through their childhood faster, (walkers, skateboards, and mopeds) were banned, our children's worlds would be a lot safer, and their alternative activities would probably be more meaningful. If a skateboard is a "must have," be sure your child wears a helmet, elbow and kneepads and perhaps wrist guards. Ditto these precautions for roller blading .

There is an old axiom in sports medicine: "Get in shape to play, don't play to get in shape." This advice is especially relevant to children. At least three weeks of gradual conditioning are advisable before you move into high gear in competitive sports. Too much too soon results in a variety of muscle aches and strains. During the pre-adolescent and adolescent growth spurt, children's bones grow faster than their muscles. This is why pre- stretching exercises are even more important for children than for adults. Sustained stretching exercises of the major muscle groups for at least fifteen seconds several times a day, and ten minutes before a game, is very important for the young athlete. Conditioning, stretching exercises and pre-game warm-ups decrease your child's risk of muscle injuries and also enhance his athletic performance.

A crash diet and rapid weight loss to make the team is a common problem in weight-matched sports. Weight can be gained and lost in only two areas of the body�lean body mass (muscles) and body fat. Weight in a growing child should not be lost from his lean body mass, only from his excess fat. Since most children have at least five to ten percent of their body weight as excess fat, a weight loss of at least five to ten percent of their present body weight would be safe for most children. An obese child could lose more, and a lean child should not lose any. Weight loss in a growing child with a well-balanced diet should occur primarily by increased energy expenditure from exercise, not by a restrictive diet.

"How much can my child lose without hurting himself?" is a valid question. If your child must lose weight to make the team, here are some simple suggestions for a safe program of weight loss.

This is popular because it results in a rapid increase in muscle strength over a short period of time. However, each year I see many teenage boys in the office who complain of chest and muscle strains resulting from improper weightlifting. Weightlifting should be supervised, with programs designed by an athletic director. To be certain your child is not gaining fat from overeating, his physician can check any change in body fat by measuring skin-fold thickness at several points with calipers.

There are three common types of sports injuries: strains, sprains and fractures; contusions; and over-use injuries.

FRACTURES AND SPRAINS
How do children's bones and joints differ from those of adults? Why are sprains and fractures of greater significance in children? Near the end of each bone, children have soft areas called growth plates . These growth plates are weaker than the ligaments that attach to the ends of the bone. When a sudden force is applied (e.g. twisted ankle), the growth plate may separate. This produces a type of "fracture" unique to growing bones. The same type of injury in an adult would result in a torn ligament because there is no growth plate and the ligament is the weakest part of the adult joint. If a growth plate injury is not properly treated, growth of the bone may be partially disturbed and shortening of the affected limb may result.

A muscle cramp is a sudden, severe, incapacitating pain in a large muscle, usually the thigh or the calf, which is associated with a marked spasm or "tightening." Heat and massage usually give prompt relief to muscle cramps. There is usually no lingering pain and the athlete can resume his activity.

CONTUSIONS Contusion means "striking" and the injury is frequently called a "charley horse." This is a common tackling injury in football and occurs most frequently in the front thigh muscles. Contusions result in pain and swelling at the site of the trauma; this pain is exaggerated with flexion of the muscle. These signs may occur immediately, or as late as twenty-four hours after the injury. Contusions over bony prominences (shoulders and hips) are called "pointers."

OVER-USE INJURIES Young athletes commonly complain, "The only time it hurts is when I run." The ends of children's bones, called epiphyses, are prone to inflammation if the joint is overused, especially if the motion involves twisting or pounding (e.g. "Little League Elbow" from throwing curve balls, "jogger heel" pain from pounding on hard surfaces).

SHIN SPLINTS Shin splints are a very painful condition caused by inflammation and swelling in the muscles frequently used in running. This problem results from poorly conditioned muscles, running on hard surfaces, and an improper running technique. Parents should remember that if their child begins to complain of pain in a bone or muscle used frequently in his sport, he should stop the activity immediately and seek medical attention. Listen to your child's "joint signals." If he complains of pain or you notice a sudden decrease in his performance, seek medical attention. Don't think it will get better as the season goes on. Joint irritation caused by over-use usually worsens with time and may result in permanent limitation if not attended to properly.