By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • A recently published study provides a 25 year data analysis of emergency department visits for injuries from youth soccer and shows a year to year significant increase in injuries of all types, especially concussion
  • In spite of excellent efforts at rules changes, better equipment, and training methods injuries in youth soccer will still happen
  • A coach as first responder on the field of play is best equipped to provide basic injury recognition that will positively effect an athlete’s health


A comprehensive and well-conducted study on injury rates in youth soccer was published
online yesterday in the journal Pediatrics. I encourage all who are interested in youth soccer’s growth as a sport and even those involved in other youth sports to have a close look at this study.

This study provided data gathered from 1990 through 2014 and showed that over this quarter century period the number of soccer related injuries treated in hospital emergency departments in the U.S. increased by 78% and the yearly rate of injuries increased by 111% among players age 7 to 17.

The article discusses some of the reasons for the increase, amongst which are larger number of kids (especially girls) playing the sport, better awareness and broader definitions of some injuries (such as concussion), and also speculates that more aggressive play could play a role in higher injury rates.

My main takeaway: injuries in youth soccer are going to happen. My main question for youth clubs and leagues: what are you doing about it?

Steps You Can Take To Reduce Injuries: Rules, Equipment, Training

There’s been a lot of very positive steps taken on the injury reduction side. Amongst these are US Soccer Federation’s new rules regarding heading for the U13 and younger age groups. I view this as very positive, although concussion tends to be more common in the older age groups not affected by the rules changes. Still, rules changes are important and commendable. Goals should be properly secured. Training regimens such as the FIFA 11+ should be used.

Injuries Will Still Happen- A Coach Needs To Be Prepared

The study published yesterday provided injury statistics for those injuries that were cared for by physicians in an Emergency Department. That’s an important and large number but it drastically underestimates the more common day-to-day injuries that a coach and parent will deal with that never make it to an ER. Even relatively serious injuries such as an ACL tear that goes straight to the orthopedic surgeon’s office, or a moderate ankle sprain treated with a bag of ice, a brace, and possible physical therapy will not be captured by the data.

What this means is that for a coach as first responder on the field of play you’re going to see quite a few injuries common to the sport and to the age group that may never be seen by a doctor. If an injury happens are you adequately trained to make that basic decision of play/sit out/go to doctor now?

Basic Injury Recognition Training Is Critical

ssd.bannerSo our view is this: as long as sports are played and in spite of everyone’s best preventive efforts injuries will still happen. And if injuries happen the first responder coach should have a basic set of skills that helps that young athlete. No one expects you to be trained like an athletic trainer, nurse, or physician. But a basic knowledge of how to evaluate common injuries using a consistent method will go a very long way to making the sport better for all kids.

The methods we teach at Sideline Sports Doc and currently used in the passcard process for all coaches and staff at US Club Soccer are thoroughly vetted and proven through decades of experience. Our content is produced by me and my partners at Stanford and in association with Midwest Orthopaedics at Rush in Chicago. It’s simple, it’s fast, and it works.

Whether you choose to work with us or someone else, I urge you to take action now. What are you waiting for? If not now, then when?

Fortify your body with cancer-protective produce


Did you know that breast cancer affects more than 200,000 women annually? As weveggies enter October, I wanted to acknowledge Breast Cancer Awareness month with specific nutritional tips designed to help you minimize your risk of cancer. You can’t change your family history, but you can change your nutritional habits—and that could go a long way in protecting your health.

My main recommendation for breast health is to consume cruciferous vegetables and increase your intake of dietary fiber. Cruciferous, or brassica vegetables such as kale, broccoli, Brussels sprouts, and cabbage are rich sources of sulfur-containing compounds known as glucosinolates. Compounds derived from glucosinolates include indole-3-carbinol (I-3-C).

Research shows that with I-3-C activation, markers of risk for breast cancer are reduced. In one case-control study, women who ate more cruciferous vegetables were found to have a 40% reduction in risk of breast cancer.

The evidence for this is largely related to the vegetables’ ability to modify estrogen metabolism. Estrogen can be metabolized by three main compounds:

  • 2-hydroxyestrone
  • 4-hydroxyestrone
  • 16-hydroxyestrone

16-hydroxyestrone is the potent, dangerous compound that has been shown to stimulate proliferation of breast cancer cells. It has about 10 times more estrogenic activity than 2-hydroxyestrone, which is not thought to stimulate breast cancer cell proliferation. The latter presumably has anti-estrogenic properties.

Studies show that women with breast cancer have a lower 2:16-hydroxyestrone ratio than women without breast cancer. Fortunately, this ratio is believed to be modifiable by diet—I3C has been shown to raise the ratio by stimulating the production of 2-hydroxyestrone.

The proposed mechanisms of I-3-C reveal a window into the power of consuming lightly-cooked cruciferous vegetables. As an isolated substance, I3C is still under close scrutiny for safety and experts don’t recommend taking it as a supplement. As always, my primary recommendation is to consume lots of cruciferous vegetables which likely have other beneficial elements and provide positive, synergistic effects on your body.

To your good health,

 Click to receive recipes, healthy insight and seasonal    information in Karen’s periodic newsletter.


Ways to Teach Yourself Yoga

yoga1More than 20 million Americans practice yoga. As a form of physical fitness, yoga helps increase strength and flexibility. However, the mind also benefits from a consistent yoga routine, as yoga’s emphasis on cleansing breaths help center the mind to encourage stress relief and relaxation. Everyone can practice and benefit from yoga, including children and senior citizens. Be mindful of individual limitations. If any health problems plague the body, discuss yoga with a doctor before engaging in practice.

Yoga may be practiced in studio or at home with or without professional instruction.yoga2Different yoga sequences or routines vary in time limitations, but don’t feel the need to monitor the clock.

Individuals interested in trying yoga for the first time and practicing at home can find numerous resources to aid them in the quest for choosing the right yoga wellness routine. For those wanting the aid of a professional instructor, numerous yogis offer guided instruction online. Some require a subscription or a fee, while other videos are free. Those who feel comfortable with guided self-instruction can consult yoga sequences that have been developed by professional instructors. These sequences may vary in difficulty, so sequences should be researched to find one best suited to ability and comfort level.

Practicing yoga at home requires space and a quiet calm atmosphere. Clear away clutter. If practicing on hardwood or tile floors, use a yoga mat. Always practice in bare feet to ensure proper foot grip during postures. The body must be able to move freely. Creating a routine at home should begin with basic yoga postures. Beginners and those new to the foundations of yoga should gently ease the body into postures. Basic poses to try include Upward-Facing Dog, the Half-Moon poses, the Half-Boat Pose and the Bridge Pose.

Once beginner poses have been mastered, move on to discover and try intermediate poses. Ideally, all postures should flow from one to the next. Never push the body during times of injury and don’t push through pain. If a pose feels too difficult, move on to something a bit more basic. Yoga practice should center the mind through breathing. Without the cleansing breath that controls the mind, the body would not be able to ease into the difficult contortions of yoga. The breath overcomes the objections of the mind. Remember to focus on deep cleansing breaths. Always inhale through the nose and exhale the breath through the mouth.

More difficult and advanced yoga postures should ideally be taught by a professional instructor. Moving and positioning the body into the correct form requires skill when yoga3attempting more advanced poses. Some forms of yoga—like Ashtanga—require years of dedicated practice before attempting advanced sequences of postures. Beginners may also choose postures that focus on strengthening certain body areas. A strong core is essential to correctly maintain and contort the body during certain postures, so many yoga sequences help strengthen the core and tighten the abdominal muscles.

Choose an at-home yoga routine that suits physical needs and individual ability. Online professional instructors can provide instruction for beginners or postures can be researched for individualized practice. Regardless, yoga should provide an exhilarating break from stress by strengthening the bo )dy, quieting the mind and centering the soul.

By Ivan Serrano–  Ivan Serrano is a writer from San Jose, California, specializing in technology. He is a graduate of San Francisco State University with a double major in English (Creative Writing, Journalism and Photojournalism).

Staying Active & Functional with OA; Ankle Sprains in the NBA; Advancements in Regenerative Medicine

Episode 16.28 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

new host image2

Segment One: Dr. Tracy Ray, Sports Medicine Specialist with Duke University Health System talks with Dr. Cole and Steve about osteoarthritis and how to keep patients active and functional; use of physical therapy, bracing, anti-inflammatory medication, injections and surgery; relationship of OA to participation in high level sports, aging and genetics.

A pathway to regaining natural motion and a healthier lifestyle

THE DJO GLOBAL SOLUTION? PRESCRIBE MOTION. Patients experiencing pain may be less inclined to be physically active. Without motion, the risk of health decline increases as may the overall cost of healthcare. Over time,

DJO 600degeneration may accelerate to the degree where surgery is the only option. MotionCARE provides education and guidance along the patient’s pathway to care, to help patients restore motion and improve their lives by addressing four common areas; pain, alignment, strength and stability. Motion is Medicine encourages patients to select treatment options which optimize activity level, thereby decreasing their risk for diabetes, heart disease and other conditions associated with low levels of physical activity.

Segment Two: Steve and Dr. Cole discuss ankle sprains in the NBA; causes, treatment and prevention.

A little about the ankle joint.. The ankle joint is made up of three bones, shaped to stabilize the lower leg and the foot. Ligaments connect these bones together and help reinforce and prevent unnecessary movement.

What happens when the ankle is injured/sprained? A sudden movement, twist or pivot; commonly on the lateral/outer ankle, can overstretch the supporting ligaments. This can cause ligament tears, bleeding and inflammation around the ankle joint.

Symptoms include: swelling (within minutes or over several hours), pain to the ankleswollenankle joint, especially when weight-bearing or walking and bruising. Ankle sprains are most commonly seen in sports which involve jumping, side-to-side movement (basketball and netball) and running. If someone has previously sprained their ankle, they are usually prone to reoccurring injuries, especially if not treated properly.

Immediate treatment

STOP activity; REST ankle joint; ICE effected area for 24 hours, every hour for 15-20minutes. This helps ease pain and decrease the inflammation around the joint; COMPRESS with a bandage from the foot to the lower calf

Segment Three: Peter Stevens, Vice President of Strategy, Development & Growth at AlloSource talks with Dr. Cole about the advancements in regenerative medicine; new uses for donor tissue to improve healing and recovery; cartilage repair; use of stem cells to help healing and improve bone union.

Advancing Sports Medicine Research

AlloSource has recently partnered with NASA to utilize new techniques to avoidAllo_ESPN_logo-banner_300x250_04-16 contamination and promote health retention of live tissue to shorten the approval phase in transplantation.

In his role with AlloSource, Peter oversees the ongoing development of the overall company strategy, ensuring input from all sources, both internal and external. He is directly responsible for the implementation strategy through the coordinated activities of Research & Development and Licenses & Acquisitions.


cuatroCuatro’s busy, outdoor lifestyle came to an abrupt halt after an unfortunate skiing accident. While enjoying a ski day in Steamboat Springs, Colorado, he broke his leg on the second run of the day. Doctors placed a rod in his leg to help correct his broken tibia, but it was only the beginning of his health challenges.

This break of my tibia resulted in a non-union, which basically meant it refused to heal on its own. When your mobility is limited, it changes your life dramatically,” said Cuatro.

Six months after his initial surgery, Cuatro endured another procedure to replace the rod in his leg. This surgery also required a bone graft from Cuatro’s hip, which he described as a very painful procedure. When that did not solve the problem, he became desperate. Cuatro found Dr. Ross Wilkins, who was confident he could help. Instead of a larger operation, Dr. Wilkins used an AlloSource bone graft provided by a deceased donor and Cuatro’s own stem cells. Following this procedure, Cuatro healed quickly.

When asked about receiving donated human tissue, Cuatro’s appreciation is clear.

I feel blessed and have a huge appreciation for those who recognize how great the giftAllo_ESPN_logo-banner_300x250_04-16 of tissue donation is for others who need it. I am a registered donor and hope that it may improve the lives of others who, like in my case, desperately need it.” After his recovery process, Cuatro was excited to “have both feet on the ground for the first time in over a year – a blessing for sure!”

Cuatro has resumed his active lifestyle, returning to skiing and rock climbing. He owns a mobile bicycle repair shop, now helping others take advantage of the Colorado outdoors he too is able to enjoy. His experience provided not only gratitude for his mobility and the donor who helped him heal, but also a new outlook on life.