Prevention, Treatment Of Injuries In School Sports

CAVANAUGH: While families are stocking up on back to school supplies, there's another seasonal start-up that shouldn't be overlooked: School sports. Along with all the property safety gear, young athletes and their families need to be aware of safety measures out on the field, are at the pool, or in the weight room. My guests, doctor Paul Stricker, sports medicine pediatrician with Scripps clinic. Welcome to the program. STRICKER: Thank you so much for having me. CAVANAUGH: Beth Mallon is cofounder of for injured athletes. Welcome to the program. MALLON: Thank you very much. CAVANAUGH: Doctor Stricker, do you see a big increase in the number of sports-related injuries at the start of every school year? STRICKER: We do, actually. We see it all year-round now since everybody is in sports most of the year. But typically, the fall sports of football and cross-country and other aspects of those kinds of sports give us more of the injuries that we see on a regular basis in the fall. CAVANAUGH: Is that because of the start of school sports? Why do you see that increase? STRICKER: It's amazing here in San Diego where people typically are active all year-round. However, for some reason they still like to kind of take off before school start, they'll be done, and they just want to go surfing or whatever, and all of a sudden school starts, practice starts, hell week starts, and all these kids went from doing nothing to an excessive amount of activity. CAVANAUGH: Are there particular sports that produce the most injuries just starting out? STRICKER: Well, some of the contact sports are always at high risk regardless of what good shape you're in. However we also are surprised in that some of the sports you wouldn't think as an injury sport, such as cross-country, typically can provide also some of the more -- higher number of injuries per sports person because they're overused galore, they're not traumatic but they produce a lot of the overuse we see. CAVANAUGH: And what are those? STRICKER: Shin splints, tendonitis, stress fractures are some of the most common ones. And since cross-country is typically outdoor on trail, they'll do ankle sprains or hurt their knees. But we just tend to see a lot of those at the beginning of the season. CAVANAUGH: What would you say is actually causing these injuries? Are kids doing too much? Are they going out for too many sports? STRICKER: It's a great question. We want kids to be involved in lots of different activities and expose themselves to lots of sports. However, sometimes they'll be overfatigued, which is a big setup for injury. Or they'll be worn out or doing too many sports or not must have rest, then they'll come into these seasons partially injured to begin with, are and it'll make it a problem for them to start out at those really high levels. CAVANAUGH: And also I know because I've read some of the information that you provided to us that there -- you have to take into consideration a child's age as they progress in sports. What are those age-related activities as you go down the line from the beginning school years to perhaps middle school. STRICKER: Well, be some of those earlier years, we love the fact that they've got lots of exposure. And some of those early developmental skills are maintained by certain sports like T-ball. They account for the fact that a 5-year-old has very poor visual skills, so they need a stationary object. Balance control is a really big deal. A lot of people don't understand that age 6 or 7 is when normal adult balance really matures. So then they don't have to think about staying upright. And they don't have to concentrate when they're running. That becomes more natural. The visual development on how to go catch a fly-ball really occurs maybe 8 or 9 years of age. So we don't want them to be pressured too hard. CAVANAUGH: Are there signs that a parent can watch for to see if maybe their child is overdoing it in a sport they've chosen? STRICKER: Kids that don't want to go participate, they come up with excuses, or they get hurt all the time, those are big red flags that that child truly is either getting burned out or just doesn't really enjoy that sport enough to want to be there. You've got other kids who love that sport, and they go so hard, but then they'll be hurting. And the parent will then be able to see, hey, they're not keeping up the way they used to, or they're not as fast as they used to. Those are also big red flags that something is bothering that child, whether they're in pain or they just don't feel like they can get it. Or if they're going through a growth spurt and not feels as coordinated, which is a very real thing. CAVANAUGH: So a child who might really, really like the sport that they're in might not want to tell either a coach or parent or doctor that they are hurting the way they are because they're afraid they're going to be pulled out of the spore. STRICKER: Absolutely. It happens all the time. We try to be their friend and understand that we're helping you with your best performance. And the way to do that is to be as healthy as you can be, which means injury-free. Part of these kids' moto is they don't want to be pulled out, but if they play at 70% of their capacity, they're not helping the team, they're not helping them, and they're a huge setup for injury. The No. 1 cause of a recurring injury is not rehabilitating the first one appropriately. CAVANAUGH: Now, Beth, you know from personal experience how a child's life can be changed in an instant from playing school sports. Remind us what happened to your son, Tommy. MALLON: Well, it was his -- it was 2009, in his final two minutes of his final game of his high school career. He was playing high school lacrosse. And he was a defender running for a ground-ball and collided with another player. And he went down, and what looked like a very benign hit -- we have three boy, we've seen a lot of collisions in our time. And he went down. I actually was a photographer on the field at the time which was shooting down-field at another injury. And then all of a sudden, I started to see players, and turned around, and there was No. 5, and that was Tommy. He was down. He did not get up immediately. So then the athletic trainer went over. The coach went over. And still he did not get up. So I made my way over there. And again it was a very benign hit. So there was a lot of pressure to let him get up off the field. And thankfully we had access to an athletic trainer who recognized the signs and symptoms, that there was a symptom of a nerve involvement. And that made her very cautious, and made her decide to call 911. CAVANAUGH: If I understand correctly, Tommy wanted to get up. MALLON: Yes. He did want to get up. And the first person to Tommy after the injury which is typical is a teammate. And fortunately his teammate, Matt, encouraged him to stay down before the -- until the trainer got there. And if someone had pulled him up -- he STFRed a C1 fracture, and his spinal cord would have been severed, and he could have died right there on the field. Of so we are extremely lucky. Everything on that day just went the right way. But it's not always that way for others. CAVANAUGH: Tell us a little bit about his recovery. His time in the hospital. How did that go? MALLON: Well, he -- luckily we had a trauma center in town. He was taken to Scripps and immediately diagnosed with not only the fracture, but a piece of the fracture had nicked an artery. So a clot was forming. Soap he was taken to ICU and stayed there for several days while the clot resolved. Then he was initially put into what they call an Aspen caller and was sent home. And unfortunately over a course of time, a piece of the fracture fragment fell. And then there was a big decision to be made in terms of what do we do now. He either needs to go into a halo device or we need to take him to surgery. And we did choose a conservative route and put him into a halo device for several months. And now he's -- the biggest thing is he's walking, he's alive. He does need to be careful. He was not surgically corrected. So he does need to be careful. He cannot play contact sports again. But he's happy and walking, and he's going to be a senior at University of San Diego, and very involved in the foundation we started. And I think he's saving lives through the message that he's carrying forward about his injury. CAVANAUGH: It's sort of hard to believe that an injury that serious could happen in a split second during a high school game. STRICKER: Yeah, sometimes you think things are just really a no-brainer. Oh, it was a small hit. But incredible things can happen. And having a school trainer there was so valuable. Not every school in the country is that fortunate. And definitely not the lower grades. So your Middle Schools and junior highs virtually never have one. So it's an amazing situation for them that really worked out for the best. CAVANAUGH: Let me ask you, if Middle School play, could an injury like this actually happen? Do the kids hit each other that hard? STRICKER: That's a great question. As we see in lots of things, there's such a wide size range. Muscle range, development range in that age group. You have a 13-year-old who's still four years away from puberty, and another 13-year-old who's been saving for a year. So there's a dramatic difference during that time. So yes, there could be a situation where someone could be strong enough and fast enough to generate that kind of force. CAVANAUGH: Now, Beth, based on your personal experience, you and Tommy founded Advocates for Injured Athletes. What's the mission? MALLON: The mission is to promote sports safety. And we do want athletes playing sports. But what we want to do is provide athletes, coaches, players with knowledge. So the mission really is about education. And our primary goal was to try and fund athletic trainer, try and place athletic trainers out on the fields. We found very quickly that that was a huge goal. So what we did is we realized there was a very underserved niche in the country. And now athletes are not given access to good, solid information. They all play sport, but they don't really have any sports safety education. So we got together with the medical experts from around the country and wrote a curriculum. And the curriculum is based on the stories of three athleteds that survived catastrophic injuries. A girl that survived sudden cardiac arrest, a boy that survived heat stroke, and Tommy who survived neck injury. And we created a program called Athletes Saving Athletes. CAVANAUGH: Now, before I pursue that, why was it such a challenge to get the guards on the field? MALLON: It's about education. It's plain and simple. It's about educating the population that you need -- it is not a coach's job to do the medical treatment. So it's about education. It's simply educating the public that when you drop your child off on a field, you need to ask who's there. Who's there if by chance there's a catastrophic injury? If there's a sudden cardiac arrest, does that person know CPR? Is there an AED? So I believe parents need to start asking who's there. And if there isn't someone there, they need to demand that there be a person there, a certified athletic trainer there. That's the professional person that's trained to handle catastrophic injuries. And people will say, oh, it's about the money. Well, if you have a child in sport, you wouldn't drop a child off at a pool without a lifeguard. CAVANAUGH: Doctor Stricker, how are school programs doing in monitoring for injuries either in practice or on the field? STRICKER: A lot of them are relying on their trainers. And if they don't have a trainer, then they're using either local medical facilities, and sometimes some schools will have visiting trainers that cover four or five different schools, and they rotate around. So that gets to be very challenging to cover that many young people. So it's a real issue. And I think a lot of times it is organizations and groups like this that really make a difference where other even their peers can help recognize things because that's enormous. As she said, if his friend had pulled him up, it could have been devastating. And certain outreach programs Scripps has an outreach program in Encinitas. So there are ways to get the message out there. But it's really a challenge when there's not someone that's physically at the school. And I know budgets are difficult everywhere. But that just seems to be a really big priority. CAVANAUGH: How is the athlete to athlete approach working? Do you have success stories? Is this message getting through to the students that you've been counseling? MALLON: Well, I'm very excited to report that two of our graduates of the athletes saving athletes program have already been credited with saving lives. And that's just what we know of. We know for sure they were in both situations, they came upon a scene where someone had collapsed from sudden cardiac arrest, and they were able to perform CPR until paramedics arrived. We also teach signs and symptoms of concussion, neck injury, heat illness, diabetes, are asthma, and sudden cardiac arrest. So we teach these athletes how to do CPR, what is an AED, what are the signs and symptoms of concussion, how a concussion heals, what is second impact syndrome. So we have had today over 1,500 athletes flew the program. And these athletes then share their knowledge with their teammates. So the success of our program, I think, because the message is coming from athletes that survived, they're telling their stories. Each section in our curriculum is dedicated though to an athlete that did not survive. So we are also honoring the memory of the athletes that did not survive in preventable injuries. CAVANAUGH: I have to leave it there.