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Bill Klaproth (Host): Here to talk with us about kids and common sports injuries is Dr. Lee Kneer, a sports medicine and rehabilitation physician at Emory University School of Medicine. He is also the team physician for the Atlanta Falcons and the Atlanta Braves among other teams. Dr. Kneer, you are a busy man, thank you so much for your time. So let's jump into this. What are some of the most common injuries kids have in sports?

Dr. Lee Kneer, MD (Guest): The most common injuries that kids sustain as compared with to their adult counterparts would be more contusions, more sprains, more traumatic events rather than overuse injury. If you think about an ankle sprain, bruises. Their bodyweight is shifted more superiorly because the head is a little bit larger, more likely to fall because of that, and they're still gaining some of that neuromuscular control over their body and as a result of that, a little more fall type of injury.

Bill: So these types of injuries - as you were mentioning contusions, sprains, bruises - are there ways that these can be prevented?

Dr. Kneer: Well I think identifying risk factors in each sport, protective equipment, it's the reason why we have our children and adults wear pads. Wrist guards to prevent wrist injuries and falls. Training and not over-training to reduce the number of exposures you have to those risky events, something that we've done especially in youth soccer to help prevent the risk of things like concussions by minimizing the amount of exposures we have to those types of events.

Bill: And Dr. Kneer, what about preventative measures such as stretching? Some people say stretching is good, others say not so much. What's your advice, Dr. Kneer?

Dr. Kneer: In general I think that your time is probably not better spent stretching. Most kids are fairly flexible to begin with, and stretching honestly in most sports has never been shown to be protective of injury. I would focus more on things like postural control, something as simple as standing on one foot, moving your body around while you're standing on one foot, closing your eyes while you stand on one foot. I think that's better for your overall injury risk prevention than stretching.

Bill: Postural control, I like that. And Dr. Kneer, speaking of injuries and things like that, can you talk to us about repetitive stress injuries from playing the same sports, using the same motions, et cetera? I imagine that pitcher always throwing, throwing, throwing. Should parents make sure their kids are playing different kinds of sports?

Dr. Kneer: Absolutely. You know, I have two young children myself and I've got my five-year-old even to repeat the mantra that playing basketball will make me better at baseball, playing baseball will make me better at soccer, and so on and so forth. Because these are growing creatures, and their nerves are telling their muscles what to do, and that's a training sort of experience. And so as they gain that, which is done via playing different sports, so you're putting stresses on different parts of the body versus just playing a sport like baseball where as a pitcher you just throw the ball over and over again. You'd be better off picking up an additional sport to improve your overall athletic development.

Bill: And I imagine the more sports you play, you're exposed to it, ultimately as you grow older, you'll find the sport that really fits you better if you try soccer, and baseball, and lacrosse, and other things. By the time you get older, you're like, "I really love lacrosse. This is my sport." It helps you define that too, is that right?

Dr. Kneer: That's absolutely true, and you don't know until you try something. I played nearly every sport growing up, and it wasn't until I was late for tennis tryouts in high school and I stumbled upon the cross country tryouts, and now I've run ultra marathons, and marathons. I'm a life-long runner and never would have known it had I not been exposed to it.

Bill: So that's just really good advice. Try as many sports, and get in there and have fun, and it'll help your body and your mind too because you'll determine what really is the sport for you. So let's stay with injuries now. On minor injuries, things like you were talking about, somebody maybe stretches something or gets a strain, we hear about RICE; rest, ice, compression, elevation. When is that appropriate? Can you give us some guidelines on that?

Dr. Kneer: Any minor injury, and really RICE has become the mantra, and it's become the mantra for a reason. Ice especially, you're not going to stretch and continue to use something, so resting it relatively is important. Compression in some circumstances is important. Elevation, especially for inflammation of a lower extremity like an ankle sprain, is terrific. Those are ideal for situations where we're dealing with more minor injuries. The ability to walk, the ability to still use a limb would be finally treated at least initially with the RICE method.

Bill: And what about heat? When does heat come into play?

Dr. Kneer: I would never use heat in the acute setting. So think of heat as a pro-inflammatory. When it gets warm, our blood vessels will expand to allow more blood flow to the area. When you first injure something, you kind of want to restrict blood flow to that area. You want to decrease the amount of inflammation rushing in, and so I would typically advise the use of heat more in later stages of recovery, and usually more for muscular things. Our muscles really like a steady supply of blood after that acute initial phase, and so I often tell my patients kind of the warm up and cool down. Use heat in the morning to get things moving, and ice in the evening to sort of deal with the day's inflammation.

Bill: Good advice. Also speaking of prevention then, what about physicals? Are physicals an important part of staying healthy?

Dr. Kneer: I think physicals are an important part of identifying potentially - I don't want to use the word 'catastrophic' - but identifying potential medical concerns that would warrant further workup that may never be apparent in a very healthy kid otherwise. I'm thinking about things like cardiac issues mainly, but occasionally a hernia is diagnosed in that kind of exam, and you wouldn't want to find out that you had a hernia by aggravating it and getting sort of a bad outcome from it. The same is definitely true with any sort of cardiac abnormality. As a kid, I had a murmur that developed when I was about twelve that I had never had before, and typically my course is the same as most. I went and had an echocardiogram, which is a painless ultrasound, I was cleared to return to sports with a clean bill of health, but it's better to identify these things than to not know that they're there.

Bill: And Dr. Kneer, you're a sports physician for an NFL team, let's talk about kids in youth football. We hear a lot about heads up tackling and other safety initiatives. What advice do you have for parents with kids that are in football or thinking about football?

Dr. Kneer: Absolutely, I think that the data has become a little bit more clear over the years, and it's more the accumulative sort of exposures. So as far as me personally and professionally, I would rather a kid avoid the number of times they have head-to-head contact until their bodies are a little bit more mature to deal with that, and that may mean restricting football to ages around the middle school ages rather than Pee-Wee football. And I would never tell anyone that they couldn't play football, or that they absolutely shouldn't allow their child to play football, but for my family, I think that that sort of restriction is an appropriate thing. And honestly, if they love football, they're going to love it just as much in middle and high school as they would have whenever they were six or seven.

Bill: Right, well the data is starting to show maybe delaying that start right until they get older is the wise thing to do. And we've been talking a lot about sports injuries, but can you tell us about the benefits of sports too? I know there's a lot there, things like weight control, physical development, building character, and self-esteem. Can you talk about the other important factors of playing sports?

Dr. Kneer: I think it allows you to develop a second identity, and when you're young, going to school, being a brother or sister, being a son or a daughter, and then there's also being an athlete, right? It allows us to develop the ability to deal with wins and losses, to develop confidence in developing a part of our bodies, and allowing our mind, it also teaches discipline. So the ability to work towards a longer-term goal is something that definitely comes from things like playing a musical instrument, or academically, and I think sports is an accompaniment to those things as well.

Bill: Absolutely, Dr. Kneer. And if you could wrap this up for us, any final thoughts on kids in sports?

Dr. Kneer: Yeah, I really would recommend as parents that we get out with our kids and participate in that sport with them, right? As parents, I think we more often get pushed to the side as spectators of these, but the more that you're involved with your kids, I find that with my kids they start talking about things that I never would have heard about at school only in the setting of being comfortable while we're playing sports. So the sport has really sort of opened the door to communication with our kids, and that's something that they might not be so forthcoming with otherwise.

Bill: Well Dr. Kneer, thank you so much for your time today and the great information. To learn more, you can visit www.EmoryHealthcare.org/sports. That's www.EmoryHealthcare.org/sports. You're listening to Advancing Your Health with Emory Healthcare, I'm Bill Klaproth, thanks for listening.