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Youth S ports T rauma and O veruse P revention Dr. Christopher Piller , MD NAON Feb 23, 2013

Youth S ports T rauma and O veruse P revention Dr. Christopher Piller , MD NAON Feb 23, 2013 . Background. Chair, Department of Orthopaedics and Sports Medicine, The Harbin Clinic, Rome, GA. Chief of Surgery, Redmond Regional Hospital Trained at ASMI with Dr. James Andrews 2004

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Youth S ports T rauma and O veruse P revention Dr. Christopher Piller , MD NAON Feb 23, 2013

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  1. Youth Sports Trauma and Overuse PreventionDr. Christopher Piller, MDNAON Feb 23, 2013

  2. Background • Chair, Department of Orthopaedics and Sports Medicine, The Harbin Clinic, Rome, GA. • Chief of Surgery, Redmond Regional Hospital • Trained at ASMI with Dr. James Andrews 2004 • Team Physician: • Rome Braves, Berry College, Rome HS, GNTC • Formerly Auburn University • Board of Directors: • American Sports Medicine Fellowship Society • Harbin Sports Health Foundation

  3. Disclosures • Product Development Consultant and Instructor: Arthrex Corporation, Naples, FL

  4. The Problem • 30 million children participate in organized sports (Source: Safe Kids USA) • Participation in high school athletics is increasing, with more than 7.3 million high school students participating annually (Source: National Federation of State High School Associations)

  5. The Problem • Forty years ago approximately 4 million boys and girls participated in high school athletics nationwide, 7.4% of which were girls. • Today this figure has nearly doubled to 7.6 million participants with 41% being girls.

  6. The Problem • For both genders the rate of participation continues to rise at an average rate of 45,000 athletes a year. • The importance and benefits of participation in youth sports are well documented. • With childhood obesity rates triple what they were a generation ago, sports participation should be actively encouraged. However, being active comes with the risk of injury.

  7. Football — It carries the highest overall risk of injury of any high school sport at 3.5 injuries for every 1,000 times the athlete participates in a practice or game.1,3 • The top three locations of injury were: head/face (24%), knee (17%), and hand/wrist (11%).3

  8. Soccer — For female athletes the top three locations of injury were: ankle (29%), head/face (22%), and knee (15%).3 • In contrast, 26% of male soccer injuries occurred at the head/face, 18% at the ankle, and 17% at the knee.3

  9. Basketball — Basketball had the highest risk of ankle injuries for male athletes out of all sports surveyed (31%).1 • Head/face injuries (24%) were the second most common with the knee a distant third, comprising 10% of injuries.3 • Female athletes followed the same trend: ankle (25%), head/face (24%), and knee (20%).3

  10. Baseball and Softball — Although both genders had the lowest rates of injuries out of all sports, the injury patterns between the two are strikingly different.3 • Male athletes demonstrated a far greater chance for hip/thigh/upper leg (13%) and shoulder injuries (18%), compared to females’ injuries at 3% and 4%, respectively.

  11. Baseball and Softball (cont.) - Females injured their wrist (24%) and ankle (19%) more, with males sustaining only 9% and 8% of injuries.

  12. Volleyball — It has the third lowest rate of injury behind softball/baseball.1 • However, these athletes are still prone to injury, with by far the majority of injuries occurring at the ankle (39%),knee (17%) and head/face (13%).3

  13. Wrestling — It has the second highest rate of injury out of the sports discussed here (2.01 injuries for every 1,000 activities).1,3 • Wrestling athletes most commonly sustain injuries to the head/face (23%), shoulder (16%), and knee (13%).3

  14. References 1. National Federation of High School Associations. 2010-11 High School Athletics Participation Survey. 2011. 2. National Health and Nutrition Examination Survey, Obesity rates among all children in the United States. Centers for Disease Control and Prevention. Last Updated April 2012. 3. Comstock D, Collins CL, McIlvain NM. Data from the High School Sports-Related Injury Surveillance Study, US, 2010-11. Unpublished Raw Data, 2011. http://injuryresearch.net/ resources/1/rio/2010-11OriginalSummaryReport.pdf.

  15. The Problem • More than five million kids (1 in 6) under the age of 18 suffer a sports-related injury each year with approximately half of these due to overuse. • High school athletics account for more than 2 million injuries annually (1 in 4), including • 500,000 doctor visits • 30,000 hospitalizations (Source: Centers for Disease Control)

  16. The Problem • Young athletes are specializing in sports (and positions) at an earlier age, with more than 3.5 million children under the age of 14 treated annually for sports injuries.(Source: Safe Kids USA) • Overuse injuries account for half of all sports injuries in middle school and high school. (Source: Safe Kids USA)

  17. The Problem • Most high school athletes do not have access to trained sports medicine professionals (ATCs) on site (58%) • Most high school coaches are not well trained in the recognition and provision of emergency treatment for catastrophic injuries and/or illness • Deaths and/or lifelong disabilities have increased in recent years.

  18. Dr. James Andrews: • “The escalation of injuries in kids, especially as they relate to overuse is alarming.” • “Sports participation teaches kids priceless lessons about life, health and sportsmanship, but they need to be playing various sports, switching up their routines and armed with the correct information and tools to stay on the field and out of my operating room.”

  19. The Lasting Problem A child’s history of injury is….. • A risk factor for future injury during both their youth and adulthood. • A contributor to long term degenerative diseases, such as osteoarthritis.

  20. The Lasting Problem – Part 2 70% of kids participating in sports drop out by the age of 13 because of: • Adults:Coaches and Parents • “Burnout” • Injuries These children lose the benefits of exercise, teamwork and healthy competition!

  21. April is Youth Sports Safety Month and the American Orthopaedic Society for Sports Medicine (AOSSM), the American Academy of Orthopaedic Surgeons (AAOS), and the STOP Sports Injuries campaign are teamed up with the release of a new radio and print public service announcement (PSA) on overuse sports injury prevention in kids.

  22. Founding Collaborators of the STOP Sports Injuries Campaign • American Orthopaedic Society for Sports Medicine • American Academy of Orthopaedic Surgeons • American Academy of Pediatrics • American Medical Society for Sports Medicine • National Athletic Trainers’ Association • National Strength and Conditioning Association • Pediatric Orthopaedic Society of North America • SAFE Kids USA • Sports Physical Therapy Section More than 400 other organizations, institutions, sporting leagues and teams have joined the campaign since it launched in April 2010.

  23. STOP Sports Injuries: Council of Champions Sam Bradford NFL quarterback and Heisman Trophy Winner Dale Brown Former Louisiana State University Basketball Coach Reverend Dr. Richard P. Camp, Jr. Former Nationally Ranked Track & Field Athlete Tom Condon NFL Football Agent, Creative Artists Agency Delos (Toby) Cosgrove, MD President and CEO, Cleveland Clinic James R. Andrews, MD Co-Chair Neal S. ElAttrache, MD Co-Chair Hank Aaron Major League Baseball Hall of Famer Marjorie J. AlbohmPresident, NATA Bonnie Blair Olympic Speed Skater Nicholas Bollettieri Professional Tennis Coach

  24. STOP Sports Injuries: Council of Champions (continued) Bo Jackson Former NFL and MLB Player James C. Justice, II Chairman and Owner, The Greenbrier Resort Stephen D. Keener President & CEO, Little League Baseball, Inc. Ian Lawson Worldwide President, DePuy Mitek, Inc. Dennis Lewin Board of Directors Chairman, Little League Baseball International Howie Long NFL Hall of Famer, Broadcaster Lars Engebretsen, MD, PhDProfessor and Director, Orthopaedic Center, University of Oslo Joe Gibbs CEO, Gibbs Investments, LLC Jerry Goodman President, Health Care Systems (HCS) Smith & Nephew Eric Heiden, MD Former Olympic Speed Skater, Orthopaedic Surgeon Jay R. Hoffman, PhD, CSCS, *D, FNSCA, FASCM President, NSCA

  25. STOP Sports Injuries: Council of Champions (continued) Christie Rampone Olympic Soccer Player Reinhold D. Schmieding President and Founder, Arthrex John Smoltz Major League Baseball Pitcher Bart Starr Former Green Bay Packer John R. Tongue, MD President, AAOS Kevin Wilk, Director of Rehabilitative Research, ASMI Jim Wilson, III Chairman and CEO, Jim Wilson & Associates, LLC Robert L. Masson, MD President, Neurospine Institute and Chairman, NSI Foundation Teri McCambridge, MD Chairperson, Council on Sports Medicine and Fitness Renaldo NehemiahHurdle World Record holder and former San Francisco 49er Jack Nicklaus PGA Golfer Jerry Pate PGA Golfer Rick Peterson Former MLB Pitcher and Coach

  26. Corporate Sponsors • Arthrex – Champion Level Supporter • DePuy Mitek Inc. – Champion Level Supporter • Smith & Nephew – Champion Level Supporter

  27. Campaign focuses on 25 Sports Baseball Basketball Cheerleading Cycling Dance Field Hockey Figure Skating Football Golf Gymnastics Hockey Inline Skating Lacrosse • Martial Arts • Rowing • Rugby • Running • Skiing and Snowboarding • Soccer • Softball • Swimming • Tennis • Volleyball • Water Polo • Wrestling

  28. Educational Content • Sports tips • Sport specific information • Specific educational tip sheets focused on various audiences • Parents • Athletes • Coaches • Healthcare providers • Video podcasts

  29. Website and Technology Comprehensive Website Features: Educational resources Media center Downloadable applications Online survey Blogging Public Service Announcements Social media interaction through Facebook and Twitter

  30. AOSSM, AAOS and the STOP Sports Injuries campaign have several tips to share with all parents, coaches and young athletes to help prevent injuries

  31. Basic Recommendations • Schedule an appointment for your child to receive a pre-participation physical to determine any pre-existing conditions or injuries. • Encourage your child to properly warm up and cool down before and after an activity. • Obtain instruction on proper training and technique.

  32. Basic Recommendations 4. Develop skills that are age appropriate, and increase training gradually. Recent research has shown that specializing in one sport at an early age can actually be detrimental to skill development. 5. Encourage your child or player to rest and take a break, and to speak up if they are in pain or think they are hurt.

  33. Why are Injuries on the Rise? • Immature bones • Insufficient rest after an injury • Poor training or conditioning • Specialization in just one sport • Year-round participation

  34. What Can We Do to Prevent Overuse and Trauma Injuries? Promote injury prevention on multiple levels, including: • Learning about the STOP Sports Injuries campaign and visiting www.STOPSportsInjuries.orgfor resources • Take the Pledge on the website to prevent injuries • Holding ongoing discussions about the importance of rest with athletes • Mandating pre-season physicals • Enforcing warm-up and cool down routines • Encouraging proper strength training routines

  35. What Can We Do to Prevent Overuse and Trauma Injuries? Additional tips: • Drink enough water based on activity and temperature levels • Educate athletes on proper nutrition for performance • Supervise equipment maintenance • Encourage kids to speak with an athletic trainer, coach or physician if they are having any pain.

  36. Additional Prevention Strategies Work with local athletic governing bodies to mandate pitch counts and limit number of matches or tournaments played.

  37. Additional Prevention Strategies • Encourage participation for fun and limit emphasis on winning • Discourage early specialization • Treat symptoms of problems/injuries EARLY

  38. Youth Baseball • In the USA, it is estimated that sixteen million boys play some form of organized baseball. • Five million of them play in an organized youth baseball league outside of school. • Many of these have no mandated rules and regulations for preventing injuries. • In 2010, Little League Baseball implemented maximum pitch counts and mandatory rest days after starting as pitcher

  39. Youth Baseball • Of the sixteen million youth baseball participants, it is estimated that 7 to 20 percent between the ages of nine and thirteen will suffer an injury requiring medical attention, with the total estimated medical costs for these injuries at close to $1.8 billion. • The overwhelming number of injuries stems from the fact that many baseball players play their one sport year-round on multiple teams.

  40. Youth Baseball • Children are at risk for sports-related overuse injuries as a result of improper technique, poorly fitting protective equipment, training errors, muscle weakness, and imbalance. • James Andrews, MD, “Any Given Monday”, 2013

  41. What is Overuse? Overuse is considered excessive and repeated use that results in injury to the bones, muscles or tendons involved in the action.

  42. Overuse • Factors Contributing to Overuse Injuries: 1. Immature bones 2. Insufficient rest after injury 3. Poor training and conditioning

  43. Proper Technique is Key • Provide proper instruction on throwing mechanics • Discourage the teaching of curve balls until high school (puberty) • Ban the radar gun in youth sports • Mandate a 3 month “rest-period” each year for throwing athletes

  44. Youth Baseball Awareness • Be aware of common overuse injuries associated with baseball pitchers. • Educate parents that pain plus tenderness, especially in a joint, are often signs of overuse and should not be ignored. • Educate parents about Little League baseball’s new pitching rules and regulations. • Encourage parents to monitor pitch counts and required rest periods based on their child’s age.

  45. Youth Baseball Awareness • Watch for and respond to signs of fatigue. • If a youth pitcher complains of fatigue or looks fatigued, let him or her rest from pitching and other throwing. • Youth pitchers should learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: (1) basic throwing, (2) fastball pitching, and (3) changeup pitching.

  46. Youth Baseball Awareness • Preseason physicals are important for detecting preexisting health risks. • Adequate hydration is essential. • Prevention is the key!

  47. Youth Baseball Rules and Regulations • Follow limits for pitch counts and days of rest. (Pitch counts should be monitored and regulated.) • Avoid using radar guns. • Youth sports leagues should provide and require first aid training for coaches. (This training should include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses.)

  48. Youth Baseball Rules and Regulations • Youth sports leagues should have clear, enforceable return-to-play guidelines for concussions, neck and back injuries, fractures, and dislocations. • Proper equipment (including face guards on batting helmets) and field surface conditions should be required.

  49. Youth Baseball Rules and Regulations • Pitchers should not throw breaking pitches (curveballs, sliders)in competition until their bones have matured (around thirteen) • Pitchers should be discouraged from participating in tryout showcases. • Medical coverage should be present at all sporting events. • Proper officiating can keep all players using safe-play techniques.

  50. Youth Baseball Tips • Warming up • Check out the coach • Cross-training • Take breaks from participation • Don’t ignore shoulder, arm or elbow pain • James Andrews, MD, “Any Given Monday”, 2013

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