OA Update: Injury Prevention, Athletic Performance and Orthopedic Procedures

OA’s Urgent Sports Injury Clinic Provides Fast Access to Orthopedic Sports Specialists

Saturday morning clinic in Portland re-opens on September 3 providing a cost-effective alternative to emergency room visits for sports-related injuries

PORTLAND, ME (September 1) – The high school sports season begins in earnest this week, and with the return of Friday night high school football, soccer and field hockey comes the inevitable sports-related injuries associated with high impact, fast-paced field sports. To provide injured student athletes with an alternative to potentially costly emergency room treatment of bruises, sprains and fractures, OA Centers for Orthopaedics has re-opened its Urgent Sports Injury Clinic for the fall athletic season beginning on Saturday, September 3 at its Portland office.

Staffed by orthopedic sports specialists, the OA urgent sports injury clinic is open every Saturday morning through October 22, 2011 Athletes may walk in at 9:00 a.m. without an appointment to see a sports medicine doctor for their injury.

With high costs, potentially long waits and a likely referral from the emergency room doctor to an orthopedic sports medicine doctor for treatment and observation, a trip to the emergency room is not necessarily the best course of action. The cost of a typical emergency room visit in Maine ranges from $269 to $1,174, according to Harvard Pilgrim Health. The cost of a typical visit to OA’s Urgent Sports Injury Clinic compares favorably at 60% to 90% of the cost of an emergency room visit depending upon diagnostic services required as a result of the visit.

“With OA’s Urgent Sports Injury Clinic, injured athletes in Southern Maine have an alternative to costly and time intensive emergency room visits,” says John Wipfler, CEO of the OA Centers for Orthopaedics. “Instead of seeing an ER doc, athletes have access to the same physicians that take care of such teams as the Portland Sea Dogs, the Portland Pirates and many other professional, international, collegiate and high school athletes.”

The urgent sports injury clinic is available at OA’s Portland office, located at 33 Sewall Street in Portland. For more information, call 207-828-2100, or visit http://www.orthoassociates.com/urgent_sports_injury_clinic/.

OA Centers for Orthopaedics Bolsters Outpatient Orthopedic Practice with New Satellite Office; Plans Major Changes to its Joint Replacement Practice

Evolving Medical Reimbursement Model Forces Tough Choices as Maine’s Largest Orthopedic Group Affirms its Independence

OA Centers for Orthopaedics announced today it has opened a new medical and physical therapy office in Brunswick at Brunswick Station. The new office has a complete orthopedic clinic and physical therapy center and with initial staff of 15. The new Brunswick office marks OA’s third satellite office to open in the past four years. Patients requiring surgery will be referred to Mid-Coast Hospital or to OA’s main office in Portland, which features a state-of-the-art outpatient surgery center in addition to clinical, diagnostic imaging and physical therapy services.

Simultaneously, OA announced that five of its six joint replacement specialists, all of whom provide hospital-based orthopedic procedures, plan to join Maine Medical Partners by the end of the year.

“Rapid changes in the medical reimbursement model, driven by healthcare reform, have forced difficult choices within our practice,” said John Wipfler, CEO of the 230-person Maine orthopedic center. “Our satellite office strategy, in combination with our Portland surgery center, continues to be a successful independent practice model even in the face of declining reimbursements and increasing expenses for procedures. Over the past few years we have had our strongest financial performance ever.  On the other hand, several of our joint replacement colleagues believe they are better served by moving hospital-side to Maine Medical Partners, a division of Maine Medical Center.”

The regional trend towards hospital employment of physicians continues unabated. More than 70% of all medical doctors in Maine are in an employment relationship with a hospital or federally qualified health center (FQHC), according to the Maine Medical Association. Ten years ago that number was less than 15%.

Earlier this year, OA joined with three other specialty medical practices to form Maine’s largest independent practice association or IPA. Members of the Maine Specialty IPA work together to better manage cost issues and improve the delivery of patient care. The IPA enables physician practices to maintain their independence in a challenging healthcare environment that encourages hospital consolidation of physician services.

“OA remains resolutely committed to maintaining an independent physician practice,” said Dr. Douglas Brown, an orthopedic surgeon and co-founder of OA Centers for Orthopedics. “While some of our joint replacement colleagues – who deliver the majority of their services at the hospital anyway – have found it to be more advantageous to move to Maine Medical Partners, the majority of our orthopedic specialists continue to believe patient services are delivered more cost effectively and at a better quality in a focused, independent practice environment.”

Dr. George Babikian plans to join Maine Medical Partners on September 1, 2011, while Drs. Donald Endrizzi, Michael Becker, Brian McGrory and Peter Guay plan to join Maine Medical Partners effective January 1, 2012.

“Despite the departure of a few of our surgeons, OA will continue to provide the complete range of specialty orthopedic care - including joint replacement,” affirmed Wipfler. “We are optimistic about our future, and we feel confident that our strategy is designed to meet the challenges of a difficult era in health care. ”

OA Centers for Orthopaedics Conducts Real-time Surgery Center Disaster Simulation and Patient Evacuation

Collaborative Effort with Public Safety Officials the First Known of its Kind in USA and Model for Private Practices with Ambulatory Surgical Centers

 

OA Centers for Orthopaedics completed a successful real-time surgery disaster simulation and patient evacuation this morning working at their outpatient orthopedic surgery center at Sewall Street in Portland, ME. The emergency drill was conducted in collaboration with local public safety officials including the Portland Fire Department, the South Portland Fire Department, the Regional Emergency Management Information System and Northeast Ambulance. Anesthesiologists from Spectrum Medical Group joined OA's surgery center staff to conduct what was the first simulation of its kind in Maine and perhaps the country. According to the Ambulatory Surgery Center Association, OA is the first and only outpatient surgery center in the country to conduct this type of real-time simulation.

 

A total of 15 patients were evacuated during the drill, which lasted approximately 25 minutes. A simulated mechanical disaster occurred and emergency alarms sounded.  Three patients undergoing surgery prepped and evacuated one-by-one and transported by rescue vehicle to Maine Medical Center. Patients in pre-op, induction and post op were also successfully evacuated. The drill lasted approximately 25 minutes from the point the alarms sounded and the last patient was safely transported.

 

According to Tim Nangle of the Portland Fire Department, in the event of a real emergency, ambulances would have arrived within 5 minutes and the entire evacuation process would have taken significantly less time.

  

The purpose of the training drill was to prepare OA's personnel for a real situation in which patient evacuations were required. OA used a formalized process established by FEMA as part of the National Incident Management System. OA’s incident command center featured clear terminology and an established, unified chain of communication in which life safety, perimeter control, and resource availability were assessed and tested. Months of preparation and collaboration with local safety officials contributed to a successful drill.

For more information, please contact Linda Ruterbories, Director Surgical Services and Program Development, OA Centers for Orthopaedics.

NFL Players Cheating on Concussion Baseline Tests?

CBS Sports and ESPN today reported that some NFL players think it's a smart idea to cheat on their baseline concussion tests. Why? Players are concerned that being sidelined by a concussion will hurt their livelihood. The reality is that by cheating on their concussion baseline test, NFL players are potentially planting the seed for long-term concussion consequences. Concussion experts point to conditions such chronic traumatic encephalopathy that is caused by repeated head trauma as cause for concern. Chronic traumatic encephalopathy is linked to depression, dementia and occasional suicide among more than a dozen deceased NFL players, according to the New York Times.

Concussion Management

Avoiding Long Term Consequences of Repeated Head Trauma

The long-term consequences of repeated head trauma are only now being fully realized. Witness the February 17, 2011 suicide of Dave Duerson, a retired Chicago Bears defensive back. Prior to his death, Duerson believed that he was suffering from chronic traumatic encephalopathy, a degenerative disease likely caused by repeated head trauma. Chronic traumatic encephalopathy is linked to depression, dementia and occasional suicide among more than a dozen deceased NFL players, according to the New York Times. Prior to shooting himself in the chest, Duerson sent family members text messages asking that his brain tissue be examined post mortem for the condition.

Former NFL players like Duerson did not benefit from the recent heightened awareness around the seriousness of concussive brain injuries. Players often complained of “having their bell rung,” but if they were not rendered unconscious, they may not have received appropriate treatment for the injury.

“One of the greatest fallacies is that a concussion only occurs after loss of consciousness,” said Dr. William Heinz, a concussion management and sports medicine specialist at OA Centers for Orthopaeidcs. “In reality loss of consciousness occurs in less than 10% of all concussions.” As a result, a significant number of concussions still go undiagnosed, resulting in the potential for longer-term problems to develop in our younger athletes.

Physical and Cognitive Rest Required to Avoid Long Term Concussion Problems

Recovering from a concussion requires both physical and cognitive rest. And while keeping a high school player off the field is one thing, asking them to rest their brains is another. Cognitive recover protocols include refraining from activities that are taxing on the brain, such as computer work, texting and driving.

“With physiological and cognitive testing, we are able to determine when an athlete can go back to school as well as return to the field,” said Dr. Heinz, a concussion expert. “If a young athlete tries to push through symptoms, that athlete risks prolonging the injury with the potential for longer term problems and second impact syndrome, a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before effects from an earlier one have subsided.”

Concussion Management in Maine

7,207 Maine High School Athletes Received Baseline Neurocognitive Concussion Tests in 2010

When Boston Red Sox pitcher Josh Becket sustained a concussion in spring training this past winter, fans knew about it. The same could be said for Minnesota Vikings quarterback, Brett Farve, as the media reported extensively on his season-ending brain injury this past December. But what can be said of the hundreds, if not thousands, of Maine high school athletes sustaining concussions each year?

Thanks to the Maine Concussion Management Initiative (MCMI), the awareness and identification of mild traumatic brain injury among high school athletes has risen dramatically over the past two years. In fact, the 55 Maine high schools participating in MCMI’s program performed 7,207 baseline neurocognitive concussion tests on student athletes during 2010. Among those athletes, 737 athletes or 10.2% of participants were re-tested during the season after incurring a suspected concussion.

Founded in 2009, MCMI’s primary goal is to educate coaches, parents, trainers and students about concussions and to increase awareness about the seriousness of these injuries. The nonprofit organization also seeks to standardize concussion management throughout the state. Establishing neurocognitive testing in all 155 high schools in Maine is an important component of that goal.

Neurocognitive testing is an objective measure for determining both the nature and extent of an athlete’s concussion. The ImPACT neurocognitive test used by MCMI's concussion experts establishes baseline  brain function by measuring verbal and visual memory, visual motor speed, reaction time and impulse control at a time when the athlete is free of concussion. Then, if a  concussion is sustained during the season, the athlete is tested on ImPact to determine the extent of impairment and when it is safe to return to activities.

The ImPACT Clinical Report above shows the baseline concussion symptom score for an athlete on August 18, 2010. In January 2011, this same athlete experienced a head injury. She was tested on January 10, and a concussion was confirmed. A subsequent test on January 17 shows that the athlete was still experiencing concussion symptoms. After another 10 days of rest and recovery, the athlete was tested and cleared to play on January 27, 2011.

 “Prior to neurocognitive testing, concussion management was inconsistent and poorly defined,” said Dr. William Heinz, co-founder of MCMI and a sports medicine physician at OA Centers for Orthopaedics. “Neurocognitive testing of the kind supported by MCMI, coupled with gradual return to play guidelines as recommended by the Zurich Conference on Concussion Management, assure that our young athletes are fully recovered from concussions prior to resuming full academic and athletic activity.”

With a concussion diagnosis, athletes are placed on a rest and recovery protocol designed to speed their recovery based upon their individual symptoms. The cornerstone of concussion management is physical and cognitive rest until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play. This always means that an athlete refrains from immediate return to an athletic contest, and it often entails missing school and refraining from computer, television and texting activity. The athlete is re-tested every 7-10 days until such time as their concussion symptom score and neurocognitive function returns to normal.

 

OA Centers for Orthopaedics to Open Orthopedic and Physical Therapy Center in Brunswick, Maine

The Times Record reported on Thursday that OA Centers for Orthopaedics has signed a letter of intent with JHR Development of Maine to occupy 10,000 square feet of office space at Maine Street Station in Brunswick, Maine.  The new office will serve as a satellite location for both OA’s clinical orthopedic practice as well as its physical therapy center. OA presently has satellite offices in Saco and Windham in addition to its main office, which features an orthopedic surgery center, in Portland, Maine.

John Wipfler, CEO of OA Centers for Orthoaedics, is quoted by The Times Record, ‘“OA sees over 70,000 patients a year in our Portland, Maine, center and supporting satellite centers in Saco and Windham. That means OA performs more orthopedic procedures than any other practice in Maine, including some of the most advanced procedures in the nation… With long-term relationships with entities like Bowdoin (College) and many patients coming from the Brunswick area and the north, we thought it was appropriate to be able to offer services in the Brunswick area.”’

The Maine Street Station location is currently being constructed with occupancy planned for late summer or early fall. OA’s space is on the second floor, above space to be occupied by Mid Coast Hospital’s walk-in clinic and adult primary care offices.

Wipfler continued, ‘“Our long-term plan, once we’re up and running, is to have easily 15 to 16 employees, primarily new positions… Those jobs would include physical therapy positions, receptionists, secretaries and medical assistants, with one full-time primary care sports medicine doctor on staff and office space for as many as three physicians.’’ OA’s orthopedic specialists will rotate through the office, seeing patients, just as they do now in Portland, Windham and Saco, Maine.

Milliseconds matter when it comes hand injury prevention

OA Donates $5,000 to Local High School for SawStop® Table Saw

Dr. John Chance, a hand doctor at OA Centers for Orthopaedics, has seen the damage caused by table saw accidents more often than we would like. That’s why when Cape Elizabeth High School technology director, Jim Ray, approached him for possible funding to support the purchase of a SawStop® table saw, he was happy to help.

The SawStop table saws are among the most advanced saws in the world, setting a new standard for safety and hand injury prevention. The SawStop table saw is equipped with a safety system that detects accidental skin contact with a spinning saw blade. The saw literally stops the blade within milliseconds of skin contact, avoiding a devastating hand injury from the saw. The saw includes an electronic detection system that induces an electrical signal onto the blade and then monitors that signal for a change in frequency. In effect, the saw detects the electrical capacitance of the human body. When a hand comes in contact with the blade, the signal drops and the saw stops before inflicting serious injury.

The drawing below from the SawStop website illustrates the changes in electrical signal when part of the hand comes into contact with the teeth of the spinning saw.

As reported by the Cape Courier in the February 23 issue, both the school department and the Cape Elizabeth Education Foundation had turned down Ray’s previous requests for funding. OA stepped up and provided the financial support necessary to purchase the SawStop table saw. “We had a great year last year,” said John Wipfler, CEO of OA Centers for Orthopaedics. “And, we were pleased to be able to give back to the community and help prevent hand injuries at Cape Elizabeth High School.”

Baseball-related injuries are avoided with proper technique and practice

By William Heinz, MD

For many of us, playing baseball or softball is the first true sign of spring. Children and adults across the country anxiously anticipate the first chance to play catch, hit a few balls, or play pickle at the old ball field. While it may seem gentle when compared to some contact and collision sports, baseball can be a demanding sport on the body. Swinging bats, running the bases, and hurling balls at high speeds inevitably lead to some scrapes, bumps, and bruises along the way. Many of the accidental injuries that occur while playing baseball are just that, accidents — an errant pitch hitting a batter, turning an ankle on a base, or a grounder taking a bad hop.

These unfortunate events should be treated properly and immediately to minimize the players’ discomfort. (Think RICE: rest, ice, compression, and elevation.) There are, however, some injuries that can be avoided to keep you and your children in the game. These involve various muscle pulls, shoulder problems, and elbow sprains. The most common baseball injury involves the rotator cuff — a collection of four muscles surrounding the shoulder that functions to maintain correct biomechanics. Tendonitis (inflammation) of the rotator cuff occurs when the tendon is overused, often as a result of repetitive overhand throwing and underdeveloped muscular strength. Pitchers and catchers are most susceptible to rotator cuff injuries because of the amount of throwing involved in those positions, but outfielders and other players also can be affected.

Plan and Prepare

To prevent these injuries, all players are encouraged to develop a regimen of warm ups and stretching before throwing as well as proper throwing mechanics. Unfortunately, because children are often less aware of their physical limitations and sometimes put increased pressure on themselves, it is critical that parents and coaches pay close attention to their children’s play and be aware when their performance may have changed for the worse. For example, a pitcher who throws in control for the first few innings and then starts to throw wild pitches may actually be showing signs of fatigue or early injury to the rotator cuff. To avoid potential injury, this child should be removed from the game as performance begins to deteriorate.

During the game, players also are encouraged to look after themselves by observing the following habits:

• Stay warm: Keep a jacket on between innings.

• Stay loose: Jog out to your position on the field at the change of innings.

• Stay in the game: Keep moving between pitches.

If a shoulder, elbow, or hamstring begins to hurt, it is important to talk to your family doctor or sports medicine specialist to properly diagnose the problem. They will help develop a plan for resting and then strengthening the trouble spot. For easy reference, I have provided a few Web resources that describe some simple, effective strength exercises specifically targeting the rotator cuff and elbow. While lifting heavy weights will strengthen the large muscles in your body, the only way to strengthen the underlying tendons is through these very specific exercises that target the smaller muscles of the rotator cuff. Often, the only resistance needed is a piece of elastic tubing.

Timing

The USA Baseball Medical & Safety Advisory Committee recommends that the first pitch introduced to Little Leaguers should be the fast ball at 8 years old, followed by the change-up at 10, the curve at 14, the knuckle ball at 15, and the slider and fork ball at 16. Following these guidelines will allow the arm muscles to develop properly to meet the physical demands of each pitch and avoid “Little League Elbow,” a chronic inflammation of the growth plate in the elbow joint. It is also important to note that throwing fast or far is not purely a result of arm strength. Velocity comes from developing good mechanics and strengthening of the trunk, legs, and hips. The stronger you can make these parts of your body, the less stress you will put on your arm. Lastly, although it may seem like many of the players we see take the field at Hadlock or Fenway simply jump off the bus and hit the field ready to go, nothing could be further from the truth. Professional baseball players often reach the park four to five hours before game time and have done two hours of warm ups and stretching before even taking batting practice. Take a page out of their book and give yourself enough time to warm up.

William Heinz, MD, specializes in the diagnosis and treatment of sports-related musculoskeletal injuries. He received his undergraduate degree from Purdue University and graduated from Indiana University School of Medicine. He completed his residency in internal medicine and performed a fellowship in primary care sports medicine where he sub-specialized in shoulder injuries. He is the team physician for the Portland Sea Dogs and a team physician for U.S. Soccer. He is also the company physician for the Portland Ballet and the orthopedic consultant for Bridgton Academy, Gould Academy, and Deering High School.  

Preventing Overuse Injuries in Young Athletes

(Continued from Avoiding Overuse Injuries…)

Overuse injuries are a result of repetitive strain on tissues such as bone, tendons, ligaments, or specific muscles. Injury occurs when these tissues undergo sustained stress without enough time for recovery. This can lead to pain, inflammation, and a cycle of tissue damage. If unchecked, these acute injuries lead to chronic injuries. Injuries may occur because of intrinsic factors in the athlete such as anatomical misalignments, flexibility issues, or strength imbalances. However, extrinsic factors, such as training volume and progression, are often the trigger.

Young athletes are particularly vulnerable because of skeletal immaturity and incomplete or imbalanced muscle development. Susceptible areas of injury include growth plates (physis), tendon attachments at these growth plates (apophysis), and tight ligaments and tendons that result from growth spurts.

Sports medicine specialists categorize these injuries in three ways:

• Repetitive micro trauma is caused by normal stress to the bone without adequate recovery (i.e. stress fractures)

• Growth plate injuries or fractures, which can cause permanent damage and interfere with proper growth if untreated

• Muscle, ligament, and tendon injury; these are often related to different mechanical properties in growing children.

Parents are the first and most important factor in overuse injury prevention. Many children will not willingly pull themselves out of a sport. They do not want to miss the experience, may be concerned about losing a spot on the team, or may worry about letting down parents, coaches, and/ or teammates.

A classic example of a parent’s importance in prevention is the Little League pitch count. This rule is in place to avoid excessive stress to the shoulder and elbow by limiting the number of pitches a youth can throw in a game and per week. However, many kids play on multiple teams and spend hours in their backyards “practicing” their throwing. Coaches may have no idea how many pitches that athlete may actually have thrown in a given week. Without parent supervision and diligence, the pitch count is meaningless.

While prevention is optimal, early recognition of overuse injuries is paramount to a quick recovery and avoiding long-term consequences. If a complaint of pain and disability is not forthcoming from a young athlete, several signs may be present. These may include: excessive use of over-the-counter pain medications, changes in performance or techniques (i.e. funny gait), and psychosocial signs such as social withdrawal, anxiety, or depression. The bottom line is that our children participate in sports for fun, to boost self-esteem, to maintain physical fitness and to foster selfdiscipline. Accidental injury may be a part of sports, overuse injuries should not be.

Overuse Prevention Tips

• All children involved in organized athletics should undergo a pre-participation exam with a qualified sports medicine specialist. If done properly, this exam can detect conditions that may limit participation or predispose an athlete to an injury.

• Prevent overuse with conditioning and training to address muscle imbalances.

• Avoid sudden activity increase and always allow for a progressive increase in activity level.

• Cross-train throughout the year to prevent any one area of the body from becoming overworked and stressed.

• Do not push children to participate in sports at a level inconsistent with their interests and abilities.

• Avoid sport specialization in a single sport before adolescence.

• Never encourage a child to “play through” the pain.

• Follow the 10 percent rule: training (intensity, frequency, duration) should increase no more than 10 percent per week.

Preventing Childhood Obesity

By Adam Tielinen BS, CSCS and Lucien R. Ouellette, MD, FAAP

What is one of the largest growing epidemics our country is facing each and every day, month and year?

If you look around at different schools, playgrounds, malls or any place a child may be, the answer is clear—childhood obesity. According to the Centers for Disease Control (CDC), over the past 20 years, the number of children who are overweight has doubled for those aged 2-5 and tripled for those 12-19 years old. Children who are obese have an 80 percent chance they will remain obese as adults. Most people are aware of the issue, but what is being done about it? What are we doing to fight this ongoing problem with our youth? At the current pace, our children will be the first generation of Americans in nearly a century to die younger than their parents.

Researchers have found many factors associated with childhood obesity:

•Transportation (riding rather than walking)

•Sedentary activity (video games, computers, television)

•Large portion sizes, high-calorie drinks and food

•Genetics. In addition, there are endless consequences involving all facets of life:

•Decreased performance in school

•Increased behavior issues at school and home

•Adult-type illnesses at younger and younger ages

• Increased rate of depression and poor self-esteem.

No part of life can escape the consequences of childhood obesity. So why are our children “growing?” What are parents, teachers and society doing to combat childhood obesity? What examples are they setting in their personal lives? How do we “thin down” our children?

There is no easy answer to any of these questions. The simple explanation of balancing your energy intake (food) with your energy output (activity) is easy to understand, but much harder to apply to each choice we make throughout the day.

For a lasting answer, children need to learn lifelong skills regarding what the healthy choices are in the two major areas of nutrition and activity. Our society has molded itself into a quick service, fast food and a constant entertainment culture. It is very easy to access oversized portions of calorie-dense, nutritionally poor food or drink multiple times a day, without ever leaving your car.

The average daily calorie need for an adult woman is 1,200-1,500, and for an adult man 2,000-2,500. Kids need less, but with the average McDonald’s Cheeseburger Happy Meal having 550 calories, it doesn’t take long to surpass this daily amount.

Did you know that healthy meals can be convenient as well? Planning and preparing meals ahead of time packing healthy snacks in the car and in lunchboxes, and most importantly, setting a good example by eating healthy meals and snacks can go a long way in educating our children about healthy choices. Show the child that healthy food does taste good and can be refreshing. Keep children involved in meal selection and preparation so they understand the choices they have in food selection. Have them help you prepare a healthy meal or pick out fruits and vegetables at the supermarket.

Schools have started implementing the 5-2-1-0 model, which is easily adaptable to the home environment as well. This model promotes five servings of fruits and vegetables each day, no more than two hours of screen time per day (TV, computer, video games), one hour of physical activity each day, and no sugar sweetened beverages. This is an easily adaptable model that incorporates both the nutrition and activity side of the puzzle.

One of the biggest ways to prevent childhood obesity is to get the child moving, and it doesn’t have to be complicated or expensive. Society again has created an environment where free play has disappeared and organized sports are everywhere. In the case of healthy living and weight control, free play is best! Children need to be outside moving and learning about their bodies through tag, chase, made-up sports, riding bikes, jumping rope, climbing, crawling, etc. Most importantly, do it with them!

Show them how much fun exercising can be, so they develop lifelong skills they can use later in life. Exercise doesn’t have to be painful, but the initial transition to an active lifestyle will be met with some resistance. Start easy with family walks after dinner, short trips to the park to play catch, use stairs instead of the elevator, park farther away from stores to get the extra walk, and drink water to stay hydrated instead of sports drinks that are made for endurance athletes. Any challenge is easier as a family!

At OA Centers for Orthopaedics, our sports medicine specialists are aware of childhood obesity and are taking steps to fight this serious problem. With the addition of the OA Performance Center, home of the Parisi Speed School, we strive to empower America’s youth through sport and exercise. Programs are aimed towards teaching kids how to eat healthy and use proper exercise techniques at an appropriate frequency through mentoring and personal commitment. In addition, kids are taught how to set goals and learn habits they can carry with them into adulthood. With this positive personal environment, they can create healthy lifestyles and strength in character. Now that seems like the right kind of growth for any child!

 Lucien R. Ouellette, MD is a Board Certified Pediatrician and holds a Certificate of Added Qualification in sports medicine. Dr. Ouellette works within the OA Sports Medicine Center. Adam Tielinen BS, CSCS is a Performance Coach at the OA Performance Center. He is a member and a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association (NSCA).  

Avoiding Overuse Injuries in Young Athletes

A little prevention can keep kids playing for life   

By D. Scott Marr, MD, FACSM  

An increasing number of children are focusing on one sport and training year round for it. While they and their parents may feel that this concentration is necessary to be competitive, it leaves little time for important rest and recovery. I often remark to young athletes that professional athletes all schedule a “down-time,” so why not young athletes?

A recent Youth Sports Injuries public service campaign used the tagline: “What will they have longer, their trophies or their injuries?” While somewhat sensational, the message should be given careful consideration. With 35 million children (6 to 21 years old) in the United States participating in sports, the risk for overuse injuries is high.

According to the U.S. Consumer Product Safety Commission, more than 3.5 million sports-related injuries in children younger than 15 were treated in 2003. Thirty to fifty percent of these injuries were caused by overuse, with the frequency of injury equal among boys and girls.

Sports medicine specialists are now seeing many repetitive strain injuries in young athletes such as tennis elbow and Achilles’ tendonitis that we used to see only in adults. The following is a look at overuse injuries commonly seen in children and their symptoms.

Common Overuse Injuries

Injury                                       Possible symptoms

Tibial stress fracture                  Focal shin pain, worse with activity

Swimmer’s shoulder                   Shoulder pain worse with overhead motion, may feel loose

Little League elbow                   Pain on medial elbow, usually with throwing motion

Runner’s knee                            Pain around kneecap

Shin splints                                Diffuse shin pain, less focal than stress fracture

Sever’s disease                           Heel pain, worse with activity

Osgood-Schlatter disease            Pain, swelling below kneecap at patellar tendon insertion

Apophyseal avulsion fracture      Abrupt onset of pain at tendon insertion on bone

Gymnast’s wrist                          Diffuse wrist pain from repetitive wrist extension loading

(Continued… Preventing Overuse Injuries)

D. Scott Marr, MD, FACSM, graduated from Dartmouth College and the University of Massachusetts School of Medicine. He holds a Certificate of Added Qualification in Sports Medicine. Dr. Marr has a special interest in elite endurance athletics including performance physiology and injury prevention.   

 

 

Training for a Triathlon Swim

By Bernadette Shaw, PA-C

Whether you are an experienced triathlete or a first-time racer, the swimming portion of a triathlon is often the least favorite and the most intimidating. There are several easy steps you can take to make the swim more enjoyable and improve your overall triathlon experience.

Prepare in the pool during the preseason

Sports-specific cardiovascular training is important, especially when it comes to swimming. Some of the most in-shape land athletes feel hopelessly out of shape when they start training in the pool. It is also important to work on stroke technique in order to become more efficient in the water and conserve energy for the rest of the race. Taking a formal swim clinic or incorporating stroke drills into your regular swim routine is a good way to accomplish this. First, concentrate on getting maximum distance per stroke. This means keeping a long bodyline, focusing on hip and shoulder rotation, developing a steady rhythm and minimizing resistance. Try counting the number of strokes it takes you to get to the end of the pool. This is a good task to do regularly during a workout, particularly as you tire and your stroke shortens.

Catch-up

To improve stroke lengthening and body position you can incorporate the catch-up freestyle drill into your workout. Start with your hands in a streamlined position out in front of you. Pull with one arm at a time following the regular freestyle stroke pattern. One arm is always extended forward towards your destination while the other arm performs the stroke. When the arm performing the stroke moves forward and “catches-up” with the stationary arm they change places.

Strength training

Upper body strength is essential to swimming success and injury prevention, just ask our sports medicine specialists. This can be accomplished by several strength training sessions a week, focusing on shoulder stabilization and muscle balance. An easy exercise to perform is the wall push-up.

Wall push-up Keep shoulder blades down and back, and start with your hands at shoulder level. Slowly lower your shoulders towards the wall and return to start position. Avoid shrugging your shoulders. Progress to table-end push-ups and finally to floor push-ups.

Train in your race environment

When the weather allows, it is important to gain some familiarity with your triathlon-swimming venue. If your race is in the ocean or a lake, wearing a wetsuit may be recommended or required. Spend time swimming in your wetsuit so you are comfortable and have a proper fit. It is also essential to test out the cap and goggles you plan to use on race day. Practice sighting buoys or objects when you train in the ocean or lake. In order to make sure you stay on track, try lifting your eyes just high enough off the water every five to six strokes and spot your target.

Race Day

On race day, get to the event a little early to check out the water conditions. Spend some time on the beach and take note of tides and currents. Review the course entry and exit, paying special attention to details such as rocks, wave action and beach slope. Get in the water, test out your gear and warm up. Keep in mind that it can be difficult to catch your breath during the first several minutes of the race due to the cold water and chaotic environment of other swimmers and crashing waves. Take comfort in knowing that your swimming heat will spread out. Focus on getting into your own rhythm. Most importantly, have fun!

 

Bernadette Shaw, PA-C, is a physician assistant and clinical research coordinator who works in the OA Sports Medicine Center. She enjoys competing in local triathlons and open water swim races.