Do High Schools Need Athletic Trainers?; Understanding Elbow Injury; Advancements in Regenerative Medicine

Episode 17.02 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 image


Segment One: Katie Varnado from ATI Physical Therapy talks about the responsibilities and qualifications for Athletic Trainers, the difference between pro & non-pro team trainers, the importance of having High School Trainers and how to promote their use.

Katie Varnado is a certified and licensed athletic trainer who is passionate aboutKatie Varnado educating others about concussions, growth plate injuries in athletes, and the need for athletic trainers. In her role as Sports Medicine Director at ATI Physical Therapy, she oversees and provides guidance to the athletic trainers ATI provides to local high schools and colleges and ensures all athletes are receiving comprehensive care to return to sport as quickly and safely as possible.

Katie received her bachelor’s degree in kinesiology with a concentration in athletic training from Illinois State University.  She then went on to earn a prestigious year long sports medicine fellowship at the Steadman Hawkins Clinic in Vail, CO.  Katie has over fourteen years of experience working with both collegiate and high school athletics as well as working with physicians.


Segment Two: Steve and Dr. Cole discuss the various types of elbow injuries, causes and treatments. Dr. Cole describes the many new and interesting advancements in Regenerative Medicine and Stem Cell Therapy – the future of research and applications.

Related Posts: 

Improve your Understanding with 3D Animation on UCL Reconstruction (Tommy John Surgery)

Baseball and Softball: Pain After Pitching

Limiting Innings Pitched after Tommy John Surgery for MLB Players

Shoulder and Elbow Overuse Injuries

Overuse Injuries in Young Athletes


  

Chicago recreational basketball player recovers after Achilles rupture

basketball patient

“I heard a ‘bang’ and then felt as if someone stomped on the back of my left calf, slamming me down to the court. But, when I looked up, both the basketball and the other players were all several feet away staring at me. That’s when I knew I likely had a serious problem.”

This is how Ganesh Sundaram, 31, of Chicago, describes the incident that left him with a ruptured left Achilles tendon earlier this year. “I was playing with a bunch of friends on the weekend and went up for a rebound. Then, I quickly reversed my direction to get back on defense,” he explains. “I later found out that this rapid deceleration followed by acceleration and change of direction is a common cause of injury to the Achilles tendon at the back of the heel.”

He felt numbness, then pain as he limped off the court. He went directly to the nearest emergency department where the physician on duty conducted the Thompson test to determine whether or not his Achilles tendon was intact. After his foot hung loosely when his calf was squeezed, the physician told him it was most likely a full rupture and should see a foot and ankle specialist right away. Sundaram, at the suggestion of his brother-in- law (a Chicago-area physician), made an appointment with Dr. Simon Lee of Midwest Orthopaedics at Rush. Dr. Lee, an expert in treating Achilles injuries, confirmed the diagnosis and presented options for both surgical and non-surgical repair of his tendon.

Given Sundaram’s very active lifestyle which included a regular fitness and full-court basketball regimen, Tough Mudder/Spartan races and keeping up with his toddler son, he chose surgery given the higher likelihood of returning to full pre-injury function, strength and mobility. They also discussed the warning signs that Sundaram experienced several months earlier. After running in high heat while dehydrated and on vacation, Sundaram felt stiffness and pain in his left Achilles tendon when getting up after a long flight home.

Concerned, he took a rest from running, jumping and basketball for a few weeks but maintained the rest of his fitness regimen. He then resumed these activities once he felt minimal discomfort, but didn’t do any pre-activity stretching or warming up and he didn’t see a physician. Midwest Orthopaedics at Rush foot and ankle physicians explain that this scenario is becoming more and more common in their practices. “Over a recent ten-year period, we have seen our number of Achilles patients increase by almost 300 percent,” explains Dr. Lee.

So many more people are participating in extreme sports, like Tough Mudders, marathons and Spartan Races. They aren’t stretching or strengthening their Achilles tendons properly – or at all. We also see lots of weekend warriors who do the same thing.

For both types of athletes, Dr. Lee and his fellow foot and ankle physicians created aMOR300x250 useful resource for athletes to keep their ankles and tendons healthy called ‘Ankles for Life’. It includes injury prevention tips in both a downloadable brochure and video format. It was developed in conjunction with the Illinois Athletic Trainers Association. Sundaram, who is now back to basketball and working out, knows that he should have listened to his body when he had heel pain several months before the rupture.

“Dr. Lee told me that surgeons have a saying that ‘healthy tendons don’t rupture’. Mine was irritated or maybe even partially torn at the time and I should have attended to it earlier,” he says. Sundaram now incorporates lower body and heel stretching and strengthening into his routine before any sports activity – and encourages all athletes to do so.

For more information on preventing Achilles injuries and to request a gym bag tag with ankle injury prevention tips, visit the Ankles for Life website.

To schedule an appointment with Dr. Simon Lee to discuss your foot or ankle condition, click here or call 877-MD- BONES.

7 Common Youth Basketball Injuries

By Sean Leninger, PT, DPT for Athletico

Basketball is a popular sport among youth athletes, but the duration of the season inyouth-basketball-injuries combination with the athleticism required by players can lead to injury.

Some of the most common injuries experienced by youth basketball players include muscle strains, ankle sprains,  Jumper’s knee and shin splints. Fortunately there are ways to prevent these injuries from happening. Read below to learn more about seven types of injuries that young basketball players are at risk for, as well as some injury prevention tips to help keep young athletes on the court.

  1. Muscle Contusions

One of the most common acute injuries suffered by young basketball players is a muscle contusion, which occurs secondary to impact. In basketball, it is not unusual for a player to accidentally ‘knee’ another player in the thigh causing a bruise to develop. Although painful, this type of injury is typically not serious.

With acute muscle contusions (less than 72 hours after injury), typical treatment includes rest, ice and compression. Once beyond the acute phase of injury, gradual return to activity is recommended and may include light stretching, progressive strengthening, and eventual return to sport once pain has subsided and full function is regained.

  1. Muscle Strains

In addition to muscle contusions, many young basketball players experience muscle strains, or ‘pulled’ muscles. The hamstring, calf and adductors (inner thigh) are common sites for muscle strains to occur given the functional demands of a sport like basketball. Strains can vary in severity from mild (Grade I) to serious (Grade III). Grade I strains occur when the muscle/tendon is overstretched. Small micro-tears in the muscle may or may not occur and the integrity of the muscle remains intact. Grade II strains involve a greater amount of torn muscle fibers and require longer recovery than a Grade I strain. Lastly, Grade III strains occur when the muscle tears or ruptures completely. This type of strain may require surgical intervention for full function to be restored.

Depending on the severity of the muscle strain (Grades I and II), return to sport may take anywhere from 2-6 weeks in most cases. As mentioned previously with muscle contusions, treatment for a muscle strain may include modalities (e.g. ice or heat), stretching, gradual strengthening, eventually progressing to advanced therapeutic exercises, along with sport specific activities such as drills, running, cutting, jumping, etc.

  1. Ankle Sprains

Most people have experienced the classic ‘low’/lateral ankle sprain that is the result of rolling/inverting the ankle. In basketball, ankle sprains can occur when cutting, accidentally stepping on an opponent’s foot or landing awkwardly.  Lateral ankle sprains involve over-stretching of the ATFL (Anterior Talofibular Ligament) and/or CFL (Calcaneofibular Ligament). Much like muscle strains, sprains are graded on a scale from I through III, with Grade I sprains being mild and Grade III sprains being considered severe.

Acute ankle sprains (Grades I-II) are typically treated with RICES (rice, ice, compression, elevation, stabilization). Once beyond the acute phase of healing, gradual pain-free restoration of range of motion, strength, ankle stability, balance and functionality is addressed in order to facilitate safe return to play.  Improper progression or returning to play too quickly may place the athlete at an increased risk of re-injury.

  1. Concussions

Many parents worry about concussions in their young athletes. While most associate concussions with aggressive contact sports like football, hockey, lacrosse and rugby, this type of injury can also occur in basketball players. Such mechanisms of injury may include a player going up for a rebound and getting elbowed in the head, diving for a loose ball and hitting their head against the court, or during the process of defending or executing a layup if contact is involved. Concussions can be a complicated injury and may require rest, follow up with a physician, as well as a proper plan of care under the guidance of a Physical Therapist that specializes in vestibular rehabilitation for safe return to activity.

  1. ACL Injuries

The Anterior Cruciate Ligament or ACL is one of the four main ligaments providing stability to the knee. ACL injuries typically occur in sports that involve quick changes of direction, pivoting, cutting and jumping. Although ACL sprains can be managed conservatively with physical therapy, an ACL tear/rupture requires surgical intervention to reconstruct the torn ligament. It is also important to note that there are multiple predisposing factors (e.g., gender, bony structure, landing mechanics, playing surface) for ACL injuries. Athletes can take steps to reduce the risk of ACL injuries by engaging in a comprehensive strength and conditioning program.

  1. Overuse Injuries

Overuse injuries such as Patellofemoral Pain Syndrome (PFPS), Jumper’s knee/patellar tendinitis, shin splints and stress fractures tend to develop over the course of a season. Many athletes are hesitant to bring up injuries to their coaches because they don’t want to miss playing time. That being said, overuse injuries tend to get worse as the season progresses. This is because overuse injuries can be linked to repetitive jumping, hip/ankle weakness, muscle imbalances (e.g. quad dominance), and running/playing/practicing while not allowing for a proper rest and recovery period. Because of this, coaches and parents should encourage young athletes to speak up when they are feeling unusual pain and discomfort.

  1. Apophyseal Injuries

Apophyseal injuries are specific to the pediatric population. These types of injuries occur at sites where tendons attach to bony prominences and include inflammation and soreness to avulsion fractures. Common sites of apophyseal injuries in youth basketball players include the calcaneus/heel (Sever’s disease) and the tibial tuberosity/shin (Osgood-Schlatter’s disease). Apophyseal injuries are typically associated with skeletal immaturity, flexibility deficits, repeated trauma (e.g. repetitive jumping and running) and muscle imbalances. Conservative treatment is usually effective in managing such conditions, making physical therapy an excellent treatment option.

The Importance of Injury Prevention

Injury prevention is important because it lessens potential healthcare costs and keepsathletico300x250 athletes playing their respective sports at a high level. As such, many chronic and even some acute injuries may be mitigated or prevented through a proper “pre-hab” exercise program along with incorporating a sport-specific warm up routine. For example, youth basketball players may benefit from balance training, dynamic and static stretching, hip/ankle stability exercises, as well as strengthening of the core and lower extremities.

Should an injury linger, further follow up with a physician and formal physical therapy treatment may be the best route for optimal outcomes.

Athletico also provides complimentary injury screens at a location near you. Click here to get started.

ANKLE SPRAIN: WHEN CAN I PLAY AGAIN

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

Key Points:

  • Recovery and return to play after ankle sprains will vary depending on the severity of the injury, and the injured athlete’s unique healing response
  • Sport specific reconditioning after an ankle sprain often takes much longer than you think
  • For the common Grade 1 sprain, I typically see return to play with a brace at 1-2 weeks after injury
  • For the common Grade 2 sprain, I typically see return to play with a brace at 4-5 weeks after injury

There’s never a good time to be injured. As we come up to the end of many winter sports, SwollenAnkle_2players often have their eyes on championships or important tournaments. When an injury happens one of the most important questions the young athlete wants to know is “when can I play again?” Usually their point of reference is the newsfeed on some professional athlete’s injury, and the answer from the news media is almost always “2-3 weeks.” The reality, however, is that full recovery as I outline below can often take much longer than that. Let me outline the general phases for injury recovery, and finish with some rough timelines for return to play after ankle sprains.

Treating the Injury

The treatment phase involves the healing of the injured part. For an ankle sprain, this may involve a brace, sometimes crutches, and typically “RICE”: rest, ice, compression, and elevation. Ankle sprains are classified by physicians in “grades”, ranging from Grade 1 (mild) to Grade 3 (severe, with complete ligament tear).

Rehabilitating the Injury

Once the treatment for the injury has started, the next phase of recovery begins. This will often involve referral to a qualified physical therapist or working with your athletic trainer. The physical therapist and athletic trainer are highly trained in techniques to restore function of the injured ankle, develop a plan for sport-specific training, or suggest equipment modification such as bracing. For many injuries we’ve learned over the years that early involvement by an athletic trainer or physical therapist speeds up return to play.

Conditioning the Injured Athlete for Return to Play

Here’s the part that can take some time, often much longer than you initially realize. Let’s say you’ve had a significant ankle sprain. You were treated in a brace for 2-4 weeks, and then you started getting some movement skills back for another 2-4 weeks. Now we’re up to 4-8 weeks from the time of your injury, and you know what you haven’t been doing- practicing or playing sports. Getting yourself fit will take a few more weeks (or even months, if you’ve been out a long time). In this phase we will usually rely on the trainer to start sport specific conditioning drills designed to safely return you to play.

Putting it All Together- How Long Until You Can Play Again?

ssd.bannerI’ve broken the process into “phases” above, but the reality is that there’s a lot of overlap between the phases. For example, treatment and rehabilitation will be going on at the same time and will overlap, and rehabilitation and conditioning will also overlap. Additionally, each person responds differently to injury and healing. So each situation can vary quite a bit with the specifics of your injury, but here are some very rough guides based on real world experience from my orthopedic practice.

  • “Mild” or Grade 1 ankle sprain: Brace or Ace wrap for 3-5 days, Return to play with ankle brace 1-2 weeks
  • “Moderate” or Grade 2 ankle sprain: Brace 2 weeks, Rehab and conditioning 2 weeks, Full return to training 4-5 weeks after injury
  • “Severe” or Grade 3 ankle sprain: Boot or brace 3 weeks, Rehab and conditioning 4-6 weeks, Full return to training 7-9 weeks after injury
  • “High Ankle” or syndesmosis sprain (highly variable return times): Boot or cast 3 weeks, possibly crutches as well, Rehab and conditioning 6-12 weeks, Full return to training 9-15 weeks after injury

ACL SURGERY IN GROWING ADOLESCENT KIDS

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

Key Points:

  • We are seeing more ACL injuries in young growing athletes than we used to several decades ago, and more young athletes choose to have early ACL surgery
  • ACL surgery in a growing athlete requires special considerations to minimize chances of injury to the growth plates
  • With proper techniques, risk to the growth plates is low and success rates for surgery are very good although results are not as good as they are for adults after ACL surgery

An ACL tear in growing athletically active kids is a challenging issue to manage from a allograft ACLsurgeon’s standpoint. It appears that the number of young people sustaining ACL tears is on the rise, and in particular we are seeing more ACL injuries in kids who are not done with their growth.

As compared to kids who are still growing, teenagers who are done growing can be treated as adults when it comes to surgical decision making. Regardless of age, the main issue with a torn ACL is that the knee is typically unstable, making some sports and daily activities difficult. A knee with a torn ACL often gives way or buckles with activities.

Some surgeons will recommend that a young patient modify activity and possibly wear a brace until growth is finished, and then go through the ACL surgery. This is theoretically possible but it’s often very difficult to successfully manage a young person’s activity level, leading to quite a bit of unhappiness. This study showed that only 6% to 52% of young athletes were able to remain physically active to their desired level when managed without surgery, whereas 80% to 100% of young athletes managed surgically were able to successfully return to their desired level of activity. The surgical option tends to be much more appealing to most kids and parents.

The surgery for a torn ACL- called “ACL reconstruction”- involves building a new ligament by drilling tunnels in the tibia and femur, and then placing a new tissue called a “graft” in those tunnels. As the graft heals and matures it functions as the new ACL. In a young growing athlete the key consideration is that the areas of the bone where growth takes place, the “growth plates”, can theoretically be damaged by the surgery. This means that there’s a chance that either the leg length or the angulation of the leg could be altered by the surgery.

Considerable research has gone into the ways to minimize risk to the growth plates during surgery. Some techniques involve modifications to the tunnel positions to avoid crossing the growth plates. Other research has studied the effects of various types of ACL grafts on growth using conventional surgery techniques.

Not surprisingly, in this relatively new area of ACL research there is some controversy. The growth plate sparing techniques may have somewhat reduced stability compared to a conventional technique. And some graft choices may have a higher risk of damage to the growth plate. For example, a patellar tendon graft with bone plugs is commonly used in adults but there appears to be a higher risk of growth disturbance if the bone plug crosses the growth plate. Hamstring tendon grafts and conventional tunnel drilling technique seem to have the best combination of stability, excellent return to sport, and low risk of injury to the growth plates.

Some recently published studies have shown excellent functional results from the surgery with low rates of bone growth issues. This study of surgery on young people with open growth plates using conventional surgical technique and hamstring grafts showed about 15% of kids with some x-ray evidence of growth issues at 4 years, but none of the issues was limiting to the young athlete. Interestingly, this study showed that during the 4 year follow up period 16% of the kids retore the ACL, and 16% tore the ACL in the other knee. Success rates are quite a bit higher in adults.

ssd.bannerThis is a controversial area with a number of important considerations when deciding treatment pathways. My advice if you’re a parent of a young growing athlete with an ACL tear is to seek the opinion of highly experienced sports medicine surgeons, or possibly a pediatric sports medicine specialist to assist you in your decision.

Preventing ACL Injuries

Dr. Adam Yanke, MOR sports medicine physician, recently sat down to discuss a study that showed athletes with fatigue are at higher risk for anterior cruciate ligament (ACL) injuries. One of the ACL injury prevention programs that Yanke recommends for young athletes is Knees For Life (Kneesforlife.org), which offers a downloadable brochure and an opportunity to obtain complimentary gym bag tags featuring warm up exercises and other prevention strategies.

MOR300x250