Monthly Archives: September 2016

Swiming

Swimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college. Most swimming-related orthopedic injuries are related to overuse and are seen in competitive athletes. However, many injuries can be prevented. Use the following tips and guidelines to help keep your athlete safe.

Safety tips

The following are ways to help prevent swimming-related sport injuries:

  • Never swim alone. Make sure the area is supervised.
  • Don’t run on pool decks and wet areas. Abrasions and contusions (bruises) commonly occur from careless falls.
  • Don’t dive in shallow water. Avoid diving into shallow pools less than 3 feet deep. This will help prevent serious head and neck injuries.
  • Find out if the starting block is at the shallow end. Swimmers using starting blocks in the shallow end need to be instructed on proper technique.
  • Prepare for emergencies. Plan what you would do if a player is injured in or out of the water. Know how deep the pool is. Know where lifeguards and first aid stations are.
  • Wear the right gear.
    • Properly fitted goggles
    • Swim caps
    • Sandals in the pool area
    • Sunscreen as necessary

Use of physical therapy

Physical therapy often is useful to strengthen weak muscles and stabilize joints. It can also improve a swimmer’s endurance and ability to train. Physical therapy is necessary to treat all of the medical and orthopedic conditions listed below and should be prescribed by a doctor.

Medical conditions

The following is a chart of different treatments for common medical conditions affecting swimmers.

Orthopedic conditions

Overuse injuries in swimming are related to repetitive stress to the swimmer’s body. Symptoms of an overuse injury usually include pain or discomfort, muscle weakness, alterations in stroke style, and the inability to keep up intense levels of training. Multiple factors must be considered for proper treatment. Workload, defined as either yardage or pool time, may need to be decreased during a time of injury. An evaluation of stroke technique may identify weaknesses, bad habits, or muscle-tendon imbalances that require correction. Lastly, the genetic predisposition to be excessively loose jointed, flexible, or stiff may require special consideration or treatment.

Ice Hockey

Ice hockey is one of the fastest sports and requires good physical conditioning and skating skills. It is a team sport played from the ages of 5 to 6 years through adulthood.

The severity of injuries is related to speed and physical contact (body checking). In the United States, body checking is allowed in league hockey at the age of 11 to 12 years, although the age can be younger in some leagues.

As player size and the speed of the game increase, injury rates and the severity of injury also rise. However, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics (AAP) about how to prevent ice hockey injuries. Also included is an overview of common ice hockey injuries.

Injury prevention and safety tips

  • Equipment. Safety gear should fit properly and be well maintained.
    • Skates should fit well with socks on. Skates that are too tight can lead to blisters and frostbite.
    • Pads. Elbow, knee, and shoulder pads that fit properly and allow for full movement. Kidney- and thigh-padded shorts that overlap protective socks and shin guards so no skin is showing. Padded hockey gloves to protect the fingers and wrists from stick slashing and sharp skates.
    • Protective guards (neck guards, protective cups, and mouth guards)
    • Helmets with face guards approved by the Hockey Equipment Certification Council (HECC). Cracked helmets or helmets with outdated HECC certificates should not be used.
    • Goalie equipment is even more specialized, with a different helmet and mask, thicker padding, and skates with longer, thicker blades for stability and reinforcement along the inner foot for protection from pucks and sticks.
  • Equipment care. Dirty hockey equipment can lead to skin infections, especially where the hockey gear touches the skin directly. The “infamous” hockey bag smell is due to the growth of bacteria and other germs. Almost all equipment can be washed in a commercial washing machine. Helmets and face masks can be disinfected with antibacterial wipes, and the inside of leather gloves and gear bags can be cleaned with spray cleaners. Mouth guards should be washed after each use.
  • Many rinks have special “dry” cleaning machines that disinfect an entire bag of gear. To decrease the growth of germs, gear should be taken out of the bag after every practice or game, and the bag and gear dried out completely before repacking.
  • Environment. Only walk or skate on a pond or natural body of water that has received safe ice approval from local officials. Also, goal net posts should be easily removed so they are not dangerous obstacles during fast play.
  • Emergency plan. Hockey programs can organize and train a team to respond to injuries during games, as it is rare to stop play while players are treated off the ice. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Special concerns

Dehydration

There is a common misconception that athletes who play in cold weather do not need to drink as much as those playing in warm weather. In fact, hockey players training in cold environments wear more clothing and may be unaware they are losing body moisture. Dehydrated athletes often perform poorly in multiple game situations like tournaments and during the last period of a game.

Hydration should take place before, during, and after games and practices. In general, athletes should drink 5 to 8 ounces of water or an appropriate sports drink every 20 minutes, even if they do not feel thirsty. Players not responding well, unable to drink, or with difficulty breathing may need emergency medical attention.

Exercise-induced asthma

  • Exercise-induced asthma is prevalent in hockey players who are prone to asthma because hockey is played in cold weather under dry conditions. Skaters should have a personal asthma action plan. Asthmatic skaters can prevent episodes by taking their medicines and using an inhaler before practices or games. Inhalers and spacers should always be on hand during activity. Skaters should stop skating and see a doctor if they have difficulty breathing while skating.

Frostbite

Cold weather, wet clothing, and tight-fitting skates can lead to poor circulation andfrostbite. Early signs of frostbite are pale or white skin with numbness and tingling of the exposed body part. It is important to dress in layers and wear wicking, fast-drying wool or polypropylene underwear and socks. Cotton clothing is not warm when wet and can contribute to frostbite and hypothermia by lowering the body temperature. Treat frostbite by increasing circulation and warming cold body parts in a heated room or under the clothes. Change wet clothing often.

Common injuries

Head injuries

Concussions in hockey most often occur from a blow to the head, from falls, or from being checked into the boards. A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion may be more susceptible to another injury than an athlete with no history of concussion.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

Youth hockey programs in the United States and Canada have active head injury prevention programs for athletes and coaches. Safe play and properly fitting helmets can prevent concussions, as does striking the boards at an angle with the head up when a collision can’t be avoided.

Arm and leg injuries

Injuries of the extremities should be treated with rest, ice, compression, and elevation (RICE). Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and swelling, but should be taken with food. Injured athletes should see their doctor if they have pain while playing.

  • Upper extremity injuries of the shoulder, arm, and wrist occur during falls or from being checked into the boards. Shoulder dislocations are very painful until put back into place. Persistent wrist or arm pain after a fall can signify a broken bone (even if there is no visible swelling or deformity) and should be iced and immobilized until it can be treated by a doctor.
  • Groin strains are pulled or torn muscles or tendons of the inner thigh. Hockey players and goalies doing forced push offs or slides on skates may get this injury. Treatments that may help are ice, NSAIDs, thigh wraps, physical therapy, and modification of activity. Groin strains can be prevented by warming up properly and doing muscle stretching as a part of team practices and games.
  • Knee injuries are more common in hockey than ankle injuries because the ankle and Achilles tendon are protected by a stiff boot. Knee injuries happen when the knee is forced or twisted to the side or back. If a ligament or cartilage is torn, a pop may be felt or heard, followed by visible swelling around the knee.
  • Overuse injuries, such as Osgood-Schlatter disease (irritation of the growth plate causing a painful bony bump below the knee), occur in 10- to 15-year-olds who play active sports with running, jumping, or skating. In hockey, a combination of off-ice training, overtraining, and frequent practices and games may lead to Osgood-Schlatter, thus limiting or changing activity may help.

Eye injuries

In the past, blows from hockey sticks and flying pucks caused many eye injuries. Now helmets with face masks have decreased the number of eye injuries, but they still can occur. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Volleyball and Basketball

Acute and overuse injuries are common in jumping sports likebasketball and volleyball. Acute injuries include bruises(contusions); cuts and scrapes (lacerations); ankle, knee, or finger sprains or fractures; shoulder dislocations; eye injuries; and concussions. Overuse injuries include patellar tendonitis (also called jumper’s knee) or Osgood-Schlatter disease, spondylolysis (stress fracture of the spine), rotator cuff tendinopathy, stress fractures, and shin splints.

The following is information from the American Academy of Pediatrics (AAP) about how to prevent basketball and volleyball injuries. Also included is an overview of common basketball and volleyball injuries.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for regular health well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Safety gear should fit properly and be well maintained.
    • Shoes should be in good condition, appropriate for the surface and laces tied.
    • Ankle braces or tape applied by a certified athletic trainer can prevent or reduce the frequency of ankle sprains.
    • Knee pads have been shown to reduce knee abrasions and contusions (bruises).
    • Buddy tape (tape around the injured finger and the one beside it) can prevent reinjury to an injured finger. X-rays should be obtained in all “jammed” fingers.
    • Mouth guards prevent dental injuries.
    • Protective eyewear. Glasses or goggles should be made with polycarbonate or a similar material. The material should conform to the standards of the American Society for Testing and Materials.
  • Environment. A safe playing area is clean and clear. Goalposts should be padded.
  • Emergency plan. Teams should develop and practice an emergency plan so that team members know their roles in emergency situations. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Common injuries

Ankle sprains

Ankle sprains, one of the most common injuries in jumping sports, can prevent athletes from being able to play. They often happen when a player lands from a jump onto another player’s foot, causing the ankle to roll in (invert). They are more likely to happen if a player had a previous sprain, especially a recent one.

Treatment begins with rest, ice, compression, and elevation (RICE). Athletes should see a doctor as soon as possible if they cannot walk on the injured ankle or have severe pain. X-rays are often needed to look for a fracture.

Regular icing (20 minutes) helps with pain and swelling. Weight bearing and exercises to regain range of motion, strength, and balance are key factors to getting back to sports. Tape and ankle braces can prevent or reduce the frequency of ankle sprains. Tape and an ankle brace can also support the ankle, enabling an athlete to return to activity more quickly.

Finger injuries

Finger injuries occur when the finger is struck by the ball or an opponent’s hand or body. The “jammed finger” is often overlooked because of the myth that nothing needs to be done, even if it is broken. If fractures that involve a joint or tendon are not properly treated, permanent damage can occur.

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays are often needed to look for a fracture. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and range of motion exercises are important for treatment.

Knee injuries

Knee injuries commonly occur from cutting, pivoting, landing from a jump, or contact with another athlete. If the athlete feels a pop or shift in the knee, then it’s most likely a ligament injury or knee cap dislocation. Anterior cruciate ligament (ACL) tears are more common in females than males.

Treatment begins with RICE. Athletes should see a doctor as soon as possible if they cannot walk on the injured knee. Athletes should also see a doctor if the knee is swollen, a pop is felt at the time of injury, or the knee feels loose or like it will give way.

Athletes who return to play with a torn ACL risk further joint damage. Athletes with an ACL tear are usually unable to return to their sport until after reconstruction and rehabilitation.

Patellar tendonitis (jumper’s knee) is a common overuse injury seen from repetitive jumping and landing from jumps. It causes pain in the front of the knee with jumping, sometimes associated with a bump, and can be severe. It is treated with ice, stretching, NSAIDs, and relative rest.

Shoulder injuries

Shoulder injuries in volleyball can occur from repetitive hitting (spiking) or serving. Shoulder injuries in basketball can occur from diving or rebounding.

Athletes usually feel the shoulder pop out of joint when their shoulders are dislocated. Most of the time the shoulder goes back into the joint on its own; this is called a subluxation (partial dislocation). If the athlete requires help to get it back in, it is called a dislocation. Risk of dislocation recurrence is high for youth participating in these sports. Shoulder strengthening exercises, braces and, in some cases, surgery may be recommended to prevent recurrence.

Pain from repetitive use is common in volleyball, usually due to weak muscles of the shoulder blade and trunk. Often rehabilitation exercises and rest from excessive hitting or serving are all that is needed.

Eye injuries

Eye injuries commonly occur in sports that involve balls but can also result from a finger or another object in the eye. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Head injuries

Concussions can occur after an injury to the head or neck contacting the ground, equipment, or another athlete. A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion may be more susceptible to another injury than an athlete with no history of concussion.