"Insomnia and Sleep Hygiene" with Heather Prayor-Patterson, PhD
In this conversation Dr. Prayor-Patterson talks about sleep issues that unfortunately have become so prevalent in today's society. She discuss the root causes, different kinds of sleep issues, including insomnia, and the ways we can help these conditions and retrain our bodies enabling them to finally get some rest. Tune in to learn more!
Featuring:
Heather Prayor-Patterson, PhD
Dr. Heather Prayor-Patterson is a clinical psychologist with an emphasis in health psychology. Over the last 8 years of practice, her focus has been on using cognitive-behavioral interventions to treat psychological concerns related of chronic medical conditions including insomnia, obesity, diabetes and chronic pain, as well as, using evidence-based treatments for depression and anxiety disorders. She completed her graduate training at the University of Alabama at Birmingham, and additional health-focused trainings at the Salem Veteran Affairs Medical Center and the Cleveland Clinic. She has been an Assistant Professor of the Psychiatry and Behavioral Sciences department at Emory University since 2017 engaging in clinical practice and supervision of medical residents. Transcription:
Bill Klaproth (Bill): Repetitive strain injury in youth athletes impacts muscles, nerves, ligaments, and tendons. These types of injuries are commonly caused by overuse, so how should a youth athlete train to prevent these types of injuries? Here to talk about youth athlete development and overuse injuries is Dr. Neeru Jayanthi, an Emory Sports Medicine Physician, Director of Emory Sports Medicine Research and Education, and Director of the Emory Tennis Medicine Program. Dr. Jayanthi, thank you so much for your time. Let’s talk about culture a little bit first. What is the current culture of youth sports in America?
Dr. Neeru Jayanthi (Guest): Yeah, Bill, I think things have changed over probably the last 20 years or so — even 30 years — where now, young athletes are training for expertise trying to become elite athletes, not so much for fun. It’s becoming a bit adult driven, and while it’s great to develop a lot of young athletes at the elite level, we’re actually hurting some of our participation numbers, and as a result — which we’ll talk about — is perhaps, getting more overuse injuries based upon our research.
Bill: The issue of youth sports specialization, how is that compounding this whole issue?
Dr. Jayanthi: Yeah, it used to be where you go and try a bunch of different sports and explore and find the one that you liked maybe in high school and perhaps, through high school you still played a number of sports. But now, a lot of emphasis has been placed on younger and younger athletes only to the one sport. What that age and when that should be is not completely clear. We did a study looking at about 1,200 young athletes and found that kids are training and specializing only in one sport at about the age of 12 in many sports — and sometimes even younger — and leading to more overuse and also serious overuse injuries. Is it really the right path to do for most sports? It probably isn’t. There are certainly exceptions, but the thought that this is going to be the way to develop the best young athlete in most situations is probably not the right path for most young athletes. I say most because there certainly are exceptions with certain sports and certain situations.
Bill: Do you think it’s a good idea then to have youth athletes play a variety of sports?
Dr. Jayanthi: Well, I think that answer is sport-specific. If you look at a football player, the best athletes in football are great at track, and wrestling, and basketball, and they do a lot of sports, and the best athletes rise to the top and they may get college scholarships. For certain technical sports like gymnastics and maybe tennis, which I do a lot of obviously, sometimes you may need to try to get those technical skills younger. But what is that age? Should you be doing that at 6, at 8, at 10? We think that you want to get to at least middle adolescence for most sports, so at least get to 10 to 12, maybe even a little later, if possible. Understanding that while some people may still choose only to specialize in a sport and they may be getting their benefit, you want to watch for early signs of injury where the risks are much higher and there are signs of burnout and overtraining. Yes, it can still be successful to play only one sport, but I think you have to look at each kid individually and not think that every kid is going to get a college scholarship and train our entire youth athlete population the same way and then get a whole bunch of injuries and kids quitting as a result.
Bill: That’s really, really good information. Let’s talk about your research. What has your research done to change youth sports? Because this is very valuable information for parents and for children too.
Dr. Jayanthi: You know, we stumbled upon these things probably almost ten years ago where we were the first report that there was a potential risk of overuse injury with single sport activities, like specializing in one sport. It wasn’t just that playing only one sport was the issue. It was actually — and not just getting overuse injuries — but it was actually the serious overuse injuries. Kids are being out for one to three months and having a lot of recurrent injuries. I believe it allowed national governing bodies and other organizations, and academies, and sports medicine to look at this based on that early data that we’ve been able to reproduce — and others, as well — showing hey, we need to make a culture change so that not everyone is trying to train to be an elite athlete and then having these problems, but looking at a different model that makes sports a lifetime experience for kids. This is probably a 10 to 20 year project to do that. We followed through with a number of other studies as well, and maybe we can try to prevent injuries as well.
Bill: You were just mentioning more serious injuries in youth athletes, so what are some specific guidelines that may be helpful for preventing youth sports injuries?
Dr. Jayanthi: That’s true, yeah. I always say that cancer and cardiology researchers are way smarter than me. I try to just do some basic research to get some simple guidelines and simple training rules that can help parents and coaches. Some of those, for example, are we found that if you train more hours per week than your age as a young athlete, you are more likely to get overuse injuries. For example, if you are 12-years-old, you’d want to do less than 12 hours a week of training.
Another simple rule aside from trying to delay specialization if possible is certainly kids under 10 or 12 years old, try to get them to have a variety of sports. There’s actually this concept of free play, and free play is playing sports for fun. Imagine that concept. We seem to have lost that one in today’s culture where kids are just playing without adult supervision and coaching. We’ve found that actually kids who play twice as much or train twice as much in organized sports as they do for fun are also more likely to get overuse injuries. We think that when you play for fun and you play on you own you’re much more likely to self-regulate. The kids can say, “I’m tired,” and stop. In fact, they can actually get more physical activity during the week, but on their own terms. I think if we can get more kids getting environments where they’re actually self-directing their sports path, I think will be more successful.
Bill: That’s really interesting information. Great, and easy to remember guidelines. Basically, only train up to your age in hours and encourage free play. Very easy to remember, and I would think easy to execute as well as a parent is watching over their son or daughter who are practicing and training in a specific sports. When it comes to a youth athlete having an injury, what should a parent or a coach know about when to bring a child in for an evaluation?
Dr. Jayanthi: Yeah, that’s a really great, and important question. When we think — you can’t bring everyone in the first day of an injury. This is barring concussions, and fractures, and ACL injuries. We’re talking about these kind of silent overuse injuries. When is normal pain okay? There are certain high-risk areas I think we need to pay attention to, which is — among them in young athletes is the low back is one big one where almost half of young athletes who have low back symptoms for a couple of weeks end up having some sort of bone-stress injury. Also, the elbow in particular of an athlete, and the shoulder have been really high-risk areas for young athletes.
One of the more recent ones we’re seeing is actually hip and joint problems and hip impingement, which is happening in a variety of sports. Trying to identify those kids early so they don’t have to go on and have injections and surgeries is another critical area that we’re seeing. The whole concept of injury prevention is — we’re left with that until this culture changes — is trying to identify things early, getting evaluated early so you’re not out for long periods of time. We were very interested in doing this and we did a study where we compared kids who would get a bunch of counseling recommendations on some of these things that I told you about — of our training guidelines— and kids who did not get them. We just followed them for a year, and we found a significant reduction in their injury rates in those kids who were able to follow recommendations. This is getting published in the British Journal of Sports Medicine in a few months.
It gives us hope that we can help guide parents. You mentioned it being easy. The parents have the best intentions, but it’s not easy in the environment because you might say, “I want my kid to play a little bit less,” but then all of a sudden, they’re not making their team, and they’re not making their high school team, and they’re not making their club team, and they kind of get siphoned out of the system. We have some work on both ends, the injury prevention, the early recognition signs, but also trying to make sure we help improve the culture so parents, and the coaches, and everyone is on board to say, “It’s okay. You don’t have to do this in every situation. You don’t have to train maybe this much for this particular child who has a higher risk of injury or other problems.” I think if you work on all ends then you have a better chance of helping out a lot of young athletes.
Bill: Well, that’s a good point as well, finding that balance in training. Thanks for bringing that up because that makes a lot of sense. You were talking about low back, elbow, shoulder, some areas to really be cautious about if there is an injury in those areas. And to wrap up, Dr. Jayanthi, are there other ways to prevent overuse injuries in youth athletes?
Dr. Jayanthi: I mean, we think actually off-court conditioning, which helps to unload some of the areas that are at risk in some ways. There are some pretty clear evidence on things that we call neuromuscular training programs, which are simple warmup techniques that you can do in young girls’ soccer and even in tennis we do dynamic warmups. The proper way to warmup, not typical stretching, but really movement patterns that recreate your sport. These are a lot of simple ways that you make part of your habit, and that goes along with parents, athlete, and coaching education to do that. We’re here at the end of it if things are ending up affecting their performance, having pain or injury that keeps them out from being where they want to. We’re always here, as Sports Medicine Doctors, to take care of those kids, but I’d love to rather see them on the tennis court or on the soccer field, in my opinion. It’s much more fun to see that than to see them hurt in the office.
Bill: Absolutely. Well, Dr. Jayanthi, thank you so much for your time today. I’ve really enjoyed speaking with you. For more information, please visit www.emoryhealthcare.
Bill Klaproth (Bill): Repetitive strain injury in youth athletes impacts muscles, nerves, ligaments, and tendons. These types of injuries are commonly caused by overuse, so how should a youth athlete train to prevent these types of injuries? Here to talk about youth athlete development and overuse injuries is Dr. Neeru Jayanthi, an Emory Sports Medicine Physician, Director of Emory Sports Medicine Research and Education, and Director of the Emory Tennis Medicine Program. Dr. Jayanthi, thank you so much for your time. Let’s talk about culture a little bit first. What is the current culture of youth sports in America?
Dr. Neeru Jayanthi (Guest): Yeah, Bill, I think things have changed over probably the last 20 years or so — even 30 years — where now, young athletes are training for expertise trying to become elite athletes, not so much for fun. It’s becoming a bit adult driven, and while it’s great to develop a lot of young athletes at the elite level, we’re actually hurting some of our participation numbers, and as a result — which we’ll talk about — is perhaps, getting more overuse injuries based upon our research.
Bill: The issue of youth sports specialization, how is that compounding this whole issue?
Dr. Jayanthi: Yeah, it used to be where you go and try a bunch of different sports and explore and find the one that you liked maybe in high school and perhaps, through high school you still played a number of sports. But now, a lot of emphasis has been placed on younger and younger athletes only to the one sport. What that age and when that should be is not completely clear. We did a study looking at about 1,200 young athletes and found that kids are training and specializing only in one sport at about the age of 12 in many sports — and sometimes even younger — and leading to more overuse and also serious overuse injuries. Is it really the right path to do for most sports? It probably isn’t. There are certainly exceptions, but the thought that this is going to be the way to develop the best young athlete in most situations is probably not the right path for most young athletes. I say most because there certainly are exceptions with certain sports and certain situations.
Bill: Do you think it’s a good idea then to have youth athletes play a variety of sports?
Dr. Jayanthi: Well, I think that answer is sport-specific. If you look at a football player, the best athletes in football are great at track, and wrestling, and basketball, and they do a lot of sports, and the best athletes rise to the top and they may get college scholarships. For certain technical sports like gymnastics and maybe tennis, which I do a lot of obviously, sometimes you may need to try to get those technical skills younger. But what is that age? Should you be doing that at 6, at 8, at 10? We think that you want to get to at least middle adolescence for most sports, so at least get to 10 to 12, maybe even a little later, if possible. Understanding that while some people may still choose only to specialize in a sport and they may be getting their benefit, you want to watch for early signs of injury where the risks are much higher and there are signs of burnout and overtraining. Yes, it can still be successful to play only one sport, but I think you have to look at each kid individually and not think that every kid is going to get a college scholarship and train our entire youth athlete population the same way and then get a whole bunch of injuries and kids quitting as a result.
Bill: That’s really, really good information. Let’s talk about your research. What has your research done to change youth sports? Because this is very valuable information for parents and for children too.
Dr. Jayanthi: You know, we stumbled upon these things probably almost ten years ago where we were the first report that there was a potential risk of overuse injury with single sport activities, like specializing in one sport. It wasn’t just that playing only one sport was the issue. It was actually — and not just getting overuse injuries — but it was actually the serious overuse injuries. Kids are being out for one to three months and having a lot of recurrent injuries. I believe it allowed national governing bodies and other organizations, and academies, and sports medicine to look at this based on that early data that we’ve been able to reproduce — and others, as well — showing hey, we need to make a culture change so that not everyone is trying to train to be an elite athlete and then having these problems, but looking at a different model that makes sports a lifetime experience for kids. This is probably a 10 to 20 year project to do that. We followed through with a number of other studies as well, and maybe we can try to prevent injuries as well.
Bill: You were just mentioning more serious injuries in youth athletes, so what are some specific guidelines that may be helpful for preventing youth sports injuries?
Dr. Jayanthi: That’s true, yeah. I always say that cancer and cardiology researchers are way smarter than me. I try to just do some basic research to get some simple guidelines and simple training rules that can help parents and coaches. Some of those, for example, are we found that if you train more hours per week than your age as a young athlete, you are more likely to get overuse injuries. For example, if you are 12-years-old, you’d want to do less than 12 hours a week of training.
Another simple rule aside from trying to delay specialization if possible is certainly kids under 10 or 12 years old, try to get them to have a variety of sports. There’s actually this concept of free play, and free play is playing sports for fun. Imagine that concept. We seem to have lost that one in today’s culture where kids are just playing without adult supervision and coaching. We’ve found that actually kids who play twice as much or train twice as much in organized sports as they do for fun are also more likely to get overuse injuries. We think that when you play for fun and you play on you own you’re much more likely to self-regulate. The kids can say, “I’m tired,” and stop. In fact, they can actually get more physical activity during the week, but on their own terms. I think if we can get more kids getting environments where they’re actually self-directing their sports path, I think will be more successful.
Bill: That’s really interesting information. Great, and easy to remember guidelines. Basically, only train up to your age in hours and encourage free play. Very easy to remember, and I would think easy to execute as well as a parent is watching over their son or daughter who are practicing and training in a specific sports. When it comes to a youth athlete having an injury, what should a parent or a coach know about when to bring a child in for an evaluation?
Dr. Jayanthi: Yeah, that’s a really great, and important question. When we think — you can’t bring everyone in the first day of an injury. This is barring concussions, and fractures, and ACL injuries. We’re talking about these kind of silent overuse injuries. When is normal pain okay? There are certain high-risk areas I think we need to pay attention to, which is — among them in young athletes is the low back is one big one where almost half of young athletes who have low back symptoms for a couple of weeks end up having some sort of bone-stress injury. Also, the elbow in particular of an athlete, and the shoulder have been really high-risk areas for young athletes.
One of the more recent ones we’re seeing is actually hip and joint problems and hip impingement, which is happening in a variety of sports. Trying to identify those kids early so they don’t have to go on and have injections and surgeries is another critical area that we’re seeing. The whole concept of injury prevention is — we’re left with that until this culture changes — is trying to identify things early, getting evaluated early so you’re not out for long periods of time. We were very interested in doing this and we did a study where we compared kids who would get a bunch of counseling recommendations on some of these things that I told you about — of our training guidelines— and kids who did not get them. We just followed them for a year, and we found a significant reduction in their injury rates in those kids who were able to follow recommendations. This is getting published in the British Journal of Sports Medicine in a few months.
It gives us hope that we can help guide parents. You mentioned it being easy. The parents have the best intentions, but it’s not easy in the environment because you might say, “I want my kid to play a little bit less,” but then all of a sudden, they’re not making their team, and they’re not making their high school team, and they’re not making their club team, and they kind of get siphoned out of the system. We have some work on both ends, the injury prevention, the early recognition signs, but also trying to make sure we help improve the culture so parents, and the coaches, and everyone is on board to say, “It’s okay. You don’t have to do this in every situation. You don’t have to train maybe this much for this particular child who has a higher risk of injury or other problems.” I think if you work on all ends then you have a better chance of helping out a lot of young athletes.
Bill: Well, that’s a good point as well, finding that balance in training. Thanks for bringing that up because that makes a lot of sense. You were talking about low back, elbow, shoulder, some areas to really be cautious about if there is an injury in those areas. And to wrap up, Dr. Jayanthi, are there other ways to prevent overuse injuries in youth athletes?
Dr. Jayanthi: I mean, we think actually off-court conditioning, which helps to unload some of the areas that are at risk in some ways. There are some pretty clear evidence on things that we call neuromuscular training programs, which are simple warmup techniques that you can do in young girls’ soccer and even in tennis we do dynamic warmups. The proper way to warmup, not typical stretching, but really movement patterns that recreate your sport. These are a lot of simple ways that you make part of your habit, and that goes along with parents, athlete, and coaching education to do that. We’re here at the end of it if things are ending up affecting their performance, having pain or injury that keeps them out from being where they want to. We’re always here, as Sports Medicine Doctors, to take care of those kids, but I’d love to rather see them on the tennis court or on the soccer field, in my opinion. It’s much more fun to see that than to see them hurt in the office.
Bill: Absolutely. Well, Dr. Jayanthi, thank you so much for your time today. I’ve really enjoyed speaking with you. For more information, please visit www.emoryhealthcare.