Protecting our young Protecting our young AthletesAthletes

Michael Hatzakis Jr. MDMichael Hatzakis Jr. MD

Rehab Options of Issaquah, WARehab Options of Issaquah, WA(425) 394-1200(425) 394-1200Nancy Mitrano PTNancy Mitrano PTImpact Physical Therapy, Seattle, WAImpact Physical Therapy, Seattle, WA(425) 778-2325(425) 778-2325

IntroductionIntroduction No matter how much time is spent on No matter how much time is spent on

injury prevention, sooner or later, injury prevention, sooner or later, injuries happeninjuries happen

Acute or chronicAcute or chronic

– Acute injuries, traumaAcute injuries, trauma– Chronic, repetitive, overuse Chronic, repetitive, overuse

activitiesactivities

IntroductionIntroduction Goal of talk:Goal of talk:

– Help preparing pre-athletic programs to reduce Help preparing pre-athletic programs to reduce preventable injuries and reduce disabilitypreventable injuries and reduce disability

– When an injury occurs, better able to quickly When an injury occurs, better able to quickly identify problem and formulate an expedient identify problem and formulate an expedient solution along with an individual prevention solution along with an individual prevention planplan

– Help devise support infrastructure in teams to Help devise support infrastructure in teams to handle prevention and injurieshandle prevention and injuries

OutlineOutline Statistics and trendsStatistics and trends Types of injuriesTypes of injuries Common conditions and warning Common conditions and warning

signssigns General Paradigms of General Paradigms of

treatment/preventiontreatment/prevention

StatisticsStatistics Cultural trendsCultural trends

– Significant increase in participation by Significant increase in participation by young children, particularly femalesyoung children, particularly females

The most common injuries include The most common injuries include sprains, muscle strains, bone & growth sprains, muscle strains, bone & growth plate injuries, heat illnesses and plate injuries, heat illnesses and repetitive motion injuriesrepetitive motion injuries

StatisticsStatistics 30 mil youth participate in organized 30 mil youth participate in organized

sportssports 3.5 million injuries each year3.5 million injuries each year Almost one-third of all injuries incurred Almost one-third of all injuries incurred

in childhood are sports-related injuriesin childhood are sports-related injuries Most common are sprains and strains.Most common are sprains and strains. Sports and recreational activities Sports and recreational activities

comprise more than 21 percent of all comprise more than 21 percent of all traumatic brain injuriestraumatic brain injuries

Types of InjuriesTypes of Injuries Sprain and StrainSprain and Strain Overuse injuriesOveruse injuries FracturesFractures Head injuriesHead injuries Thoracic and abdominal Thoracic and abdominal

injuries injuries Heat and environmental conditionsHeat and environmental conditions Aggravations of health conditionsAggravations of health conditions

Survey of injury sitesSurvey of injury sites Hip Pain:Hip Pain:

– Bursitis or gluteal strains, Bursitis or gluteal strains, Either trauma or overuseEither trauma or overuse Rest, inflammation subsideRest, inflammation subside Inadequate abductor strengthInadequate abductor strength Strengthen hip abductorsStrengthen hip abductors Weak and tight hip adductors and abductors Weak and tight hip adductors and abductors

associated with poor performance and higher associated with poor performance and higher injury rates, especial in soccer players injury rates, especial in soccer players (Hrysomallis 2009 J. Strength & Cond)(Hrysomallis 2009 J. Strength & Cond)

Don’t forget to stretch flexors Don’t forget to stretch flexors

Survey of injury sitesSurvey of injury sites Knee PainKnee Pain

– Patellofemoral Syndrome (Runner’s Patellofemoral Syndrome (Runner’s Knee) (Chondromalacia)Knee) (Chondromalacia)

– Pain behind the kneecap, walking, Pain behind the kneecap, walking, running, or sitting, worse when running, or sitting, worse when walking downhill, may have snapping, walking downhill, may have snapping, popping, or grinding in the kneepopping, or grinding in the knee

– Overuse injury, plus, too tight quadsOveruse injury, plus, too tight quads– Rest, stretch & strengthen, cross-trainRest, stretch & strengthen, cross-train

Survey of injury sitesSurvey of injury sites Knee PainKnee Pain

– Patellar Tendonitis (Jumper’s Knee can Patellar Tendonitis (Jumper’s Knee can give rise to Osgood-Schlatter’s)give rise to Osgood-Schlatter’s)

Repetitive micotrauma results from the Repetitive micotrauma results from the frequent use of the extensor mechanism frequent use of the extensor mechanism (jumping) (jumping)

Rest, ice then stretch and strengthenRest, ice then stretch and strengthen Infrapatellar strap, develop strong thigh Infrapatellar strap, develop strong thigh

musclesmuscles

Survey of injury sitesSurvey of injury sites Knee Pain:Knee Pain:

– ACL Injuries:ACL Injuries: ACL prevents front-back motionACL prevents front-back motion Injuries occur, cutting, Injuries occur, cutting,

landing, stopping, side impactlanding, stopping, side impact Girls 8x > boysGirls 8x > boys Highest in basketball, Highest in basketball,

volleyball and soccervolleyball and soccer

Survey of injury sitesSurvey of injury sites Knee PainKnee Pain

– ACL Injuries:ACL Injuries: Causes: weak quads: girls land with less knee Causes: weak quads: girls land with less knee

flexion, more valgus (inward) stressflexion, more valgus (inward) stress Decrease H:Q muscle imbalanceDecrease H:Q muscle imbalance Dynamic Warm-up, Plyometrics/Jump Dynamic Warm-up, Plyometrics/Jump

Training, Speed and Agility Training, Training, Speed and Agility Training, High Intensity Strength Training, High Intensity Strength Training, Flexibility TrainingFlexibility Training

Need to learn to absorb Need to learn to absorb landing with entire limb, “soft-land”landing with entire limb, “soft-land”

Cross-trainCross-train

Survey of injury sitesSurvey of injury sites

Ankle PainAnkle Pain– Ankle Sprain: Grade I, II or IIIAnkle Sprain: Grade I, II or III– 90% are lateral, inversion 90% are lateral, inversion

strain/sprainsstrain/sprains

Survey of injury sitesSurvey of injury sites

Ankle PainAnkle Pain– Must seek medical attention ifMust seek medical attention if

Inability to bear weight for >1 day, or symptoms Inability to bear weight for >1 day, or symptoms do not improve x several days, or, numbness in do not improve x several days, or, numbness in toes persist, or, pain above the ankle or in the toes persist, or, pain above the ankle or in the footfoot

Causes: tight calfs, weakness in stabilizersCauses: tight calfs, weakness in stabilizers– Elastic wrap acutely to control Elastic wrap acutely to control

inflammationinflammation– Prevention: calf stretching, Prevention: calf stretching,

strengthening, ankle drills, strengthening, ankle drills,

General ParadigmsGeneral Paradigms Engage in appropriate conditioning program for Engage in appropriate conditioning program for

6 weeks prior to beginning daily practice routine6 weeks prior to beginning daily practice routine

Appropriate warm-up/cool-down. Practices two Appropriate warm-up/cool-down. Practices two hours or less to avoid overuse injuries and hours or less to avoid overuse injuries and medical complications. Do not over-trainmedical complications. Do not over-train

Make time for stretching and specific stretching Make time for stretching and specific stretching exercises. Be sure young athletes know it is exercises. Be sure young athletes know it is important to you that they stretch and important to you that they stretch and strengthen; they will take cues from youstrengthen; they will take cues from you

General ParadigmsGeneral Paradigms Overuse:Overuse: Cross training using other muscle groups to Cross training using other muscle groups to

manage or prevent overusemanage or prevent overuse Do not chose same muscle group cross-Do not chose same muscle group cross-

trainingtraining– Ie., chose swimming for running athletesIe., chose swimming for running athletes

2-3 months per year break, with alternate 2-3 months per year break, with alternate conditioning conditioning – ““The American Academy of Pediatrics has The American Academy of Pediatrics has

issued two policy statements on overuse issued two policy statements on overuse injuries in three years, the latest in 2007.” injuries in three years, the latest in 2007.”

General ParadigmsGeneral Paradigms Make sure injured athletes have Make sure injured athletes have

access to medical assessments:access to medical assessments:– ““Team doctor” assessmentTeam doctor” assessment– Encourage player to seek out primary doc Encourage player to seek out primary doc

or community sports medicine, orthopedist or community sports medicine, orthopedist or physiatrist or, require evaluation note or physiatrist or, require evaluation note from player than an evaluation or from player than an evaluation or treatment plan has occurred. Close treatment plan has occurred. Close relationship with physical therapyrelationship with physical therapy

Thank YouThank You Michael Hatzakis Jr MDMichael Hatzakis Jr MD

– Rehab Options of IssaquahRehab Options of Issaquah info@Rehabissaquah.cominfo@Rehabissaquah.com www.Rehabissaquah.comwww.Rehabissaquah.com

(425) 394-1200 (425) 394-1200

Nancy Mitrano PTNancy Mitrano PT– Impact Physical TherapyImpact Physical Therapy

(425) 778-2325(425) 778-2325