Evo Terra (Host): This is Check-Up Chat with EvergreenHealth. I'm Evo Terra. And I'm joined today by Dr. Ronald Gregush, an orthopedic surgeon specializing in sports medicine. Our topic, making sure your child is ready to play school sports. Thanks for joining me, Dr. Gregush.

Ronald Gregush, MD: Thanks for having me. I appreciate it.

Host: So, what's the most important thing parents should really know as they're preparing their kids for the fall school? I know there's a lot of things, but let's just pick one most important.

Ronald Gregush, MD: I think, from my standpoint, I would say the most important thing for fall sports, especially if you're talking about, say, high school fall sports, where the intensity is a little bit higher than, middle school and elementary school, is to do some conditioning over the summertime so that you don't go into the fall kind of cold, especially sports like cross country that, you know, require a lot of mileage right off the bat. So, I think summer conditioning is really important regardless of the sport, to be honest.

Host: What about the sports physical? I remember having that as a kid. When the child's planning for a sports, how often should they get the sports physical?

Ronald Gregush, MD: Yeah. So, some of that is state-dependent. The sports physical, the pre-participation physical is an important thing. Forty-nine states require a pre-participation physical, plus the District of Columbia. So, just about every state requires it. Now, the school my kids go to require one every year. There has to be a form signed every year.

In general, I think a recommendation would be to have it done every two to three years. But I think a lot of parents are going to be constrained by the school district's requirements or the state's requirements, and a lot of those are that kids have to have one at least once a year.

So, it's an important thing for several different reasons. I think parents probably think of, you know, cardiac issues as being something that gets picked up on a sports physical. Those can be quite difficult to pick up. So, I mean, doing a focused heart and lung exam is important, but there's also other aspects to it. A lot of especially adolescents suffer from things like depression, anxiety, that it's an opportunity for those things to get diagnosed and potentially treated. And for some children, it's a way to get into the medical system, tied into the medical system, for kids who maybe otherwise aren't getting regular physicals for whatever reason. So even though it's not always a hugely specific exam in terms of being able to pick up kids who are at increased risk of things like cardiac issues, it's still an important part of the evaluation.

Host: Right, right. Good advice there. Now, you're an orthopedic surgeon, so you've seen a lot of injuries and other sorts of things. But I want to ask you just what should parents know before they even think about putting their kids in school sports from an orthopedic surgeon's point of view?

Ronald Gregush, MD: From an orthopedic surgeon's point of view, I think it still comes back to kind of that conditioning piece of it. I mean, I would say two things. I think, one, sports should be fun for the kids. And some of that, a lot of that can sometimes come from the parents in terms of what their attitudes are towards sports. So, when it comes down to it, really, it should be about the kids and how much fun they're having.

Then, the other part of it is, yeah, just trying to, you know, get the kids in good, decent condition so that they don't risk an injury when they do start playing those sports.

Host: Yeah. On that first point, if I give you the number to my brother-in-law, can you call him and remind him about—no, I'm kidding.

Ronald Gregush, MD: Yeah. Yeah. No, I know what you mean.

Host: So, back to you. As a surgeon, obviously, people come to see you when they have injuries. So, what are some common injuries you're seeing from kids playing sports? And more importantly, what can parents do to help prevent them?

Ronald Gregush, MD: Yeah. So, I'll highlight two things that I tend to see. The one thing that we see a lot of are ACL tears, ACL injuries. ACL injuries are particularly common in adolescent females. So, the rate of ACL injury in adolescent females is several times the rate of adolescent males. And we know why that is. A lot of it has to do with the way that kids develop or that females develop. Obviously, they don't have testosterone, they don't have as much muscle support, but a lot of it also has to do with the way girls land when they're jumping and the way that they jump and the way that they run. And these are modifiable risk factors.

There are several programs that you can find online that are basically ACL prevention programs. They take a buy-in on the part of the child, that's the difficult part. It takes about 20 to 30 minutes a day of doing these exercises. But if you do them, you can basically decrease the rate of ACL tears in females to the same rate as males. And it's really almost an epidemic.

I think, last year, as I was looking at the high school girls' basketball team at my son's high school, I think half the team was in a knee brace, which is really pretty sad. And I think we see it a lot in basketball, see it a lot in soccer. So, that's really a modifiable risk factor, and it's really important to get the kids doing those exercises. Some schools are actually starting to incorporate that as part of the practices, doing these things for 20 to 30 minutes ahead of time. It would be great if they did that everywhere. But yeah, that's probably the most important thing that I would love to see improve, are all these girls coming in with ACL tears.

The one other thing I was just going to mention, kind of going back to that conditioning part of it, my daughter's a cross country runner. The one thing we always see a ton of in the fall are stress fractures. When kids go out for cross country, they start running 25, 30 miles a week. If they don't do anything over the summertime, they're going to be at high risk for getting a stress fracture. So again, those are kind of two things that are potentially modifiable and, to some degree, not completely preventable, but at least decrease the risk of those things.

Host: Yeah. You brought up cross country. We talked, you know, basketball knee injuries. And, again, my son, when he was in high school, played hockey, and that's its own level. He was a goalie too, which makes it even more complicated. But what are these specific sports or maybe positions that you see higher injury rates from?

Ronald Gregush, MD: I'd say the highest injury rates, I would say, got to be girls soccer, girls basketball. Again, coming back to knee injuries. We see them for boys too. But like I mentioned, girls are just at increased risk of those things. Those are kind of the two sports that have the highest incidence of kind of cutting, pivoting injuries. We see a lot of football injuries in the fall, of course. It's a contact sport. It's a highly contact sport. You see all kinds of different injuries through football. That's primarily boys, although there are girls flag football programs starting around the area now, and so we're starting to see knee injuries with those kids too.

But yeah, I mean, honestly, probably the most common one is in the fall, just fractures and knee injuries, shoulder injuries too with football players a lot. It's hard to prevent a lot of those. It's kind of a tough sport when you see the 110-pound freshman out there going up against 250-pound seniors. It doesn't always turn out well.

Host: Yeah, I remember those days all too well, because my son was a bit of a late bloomer. So, it can happen to him. You know, one of the things I also remember from him growing up is he wouldn't always tell me when he was hurt, and wouldn't tell his coach he was hurt, because he wanted to play. He's got another goalie got to go up and against to see which one. So, what do we do as parents looking out for our kids while they're playing sports?

Ronald Gregush, MD: Yeah, I think it's hard. I know exactly what you're talking about. Kids want to play no matter what. Sometimes they don't want to tell us if they're hurt. A lot of it goes back to kind of what you see out on the field. You know, reasons why you really probably should bring them in for, or at least give them a few days off, if not bring them in for evaluation, would be if you see them limping around, If they can't really run, there's probably something wrong. At least kind of give them a few days off, see if things improve.

You know, potentially reasons to actually bring them in for an evaluation would be if they can't bear weight on, you know, the injured leg. If they have a knee injury, ankle injury, and they can't put any weight on it, that would be a little bit more concerning, or if there's actually significant swelling, especially of the knee. I mean, we see a lot of ankle sprains. That's, you know, something that's going to swell, and they don't all necessarily need to be seen by an orthopedic surgeon. But if you start to get fluid in the knee, swelling in the knee, that would definitely be a reason to get it evaluated. So, sort of more objective indications of an injury rather, you know, than just saying they have pain sort of thing.

Host: Okay. My kid has been injured. When is it right to go seek out a doctor? Not necessarily an orthopedic surgeon, but just to go see a doctor. Does a sprained ankle require it? Tell me.

Ronald Gregush, MD: Most sprained ankles don't require it. So for a lot of things, giving it a few days to see what happens is very reasonable. Majority of ankle sprains are going to get better regardless of what you do. But if you get a situation where you really can't bear, you can't put weight on the ankle at all, on the foot at all after an injury, that'll be a reason to get it evaluated.

So, there are actually these things called the Ottawa ankle rules that they used to look at in the emergency department to determine whether a patient should even get an X-ray when they come in with ankle pain. And one of those things is are they able to put weight on it? And if they are, then it's probably not broken or damaged to the point where it's really all that severe.

Trainers are also a great resource, especially if you're talking about high school athletes. The trainer at your high school, most of them, you know, they want to help the kids out, and a lot of them do have established relationships with orthopedic surgeons or physicians in the area. There's a local high school I've been helping out with for many years. And so, the trainer there, if she has a kid she's worried about, she'll just, you know, email me or text me so we can get them in and have them looked at. So, the trainers are also a great resource.

Host: You're an orthopedic surgeon. But before you break out the knife, what are some non-surgical options that we have available to us for kids who have had a sports injury?

Ronald Gregush, MD: Yes, a lot of these things do get better with a period of rest and physical therapy. You know, physical therapy, a lot of times we can start that early on to keep the strength up, while a child is recovering from an injury. And the majority of things that we do see in clinic, they don't require surgery. It might be a period of rest for four to six weeks. That can be really hard, especially if a child starts to feel better after a couple weeks and wants to go back to play. But a lot of things that we do can be, you know, rest and then physical therapy and get you back, you know, after that kind of six-week timeframe, depending on the injury.

Host: Any parting thoughts?

Ronald Gregush, MD: The only thing I would say, probably I'd just go back to how important some of this conditioning stuff is over the summer. I keep coming back to it. We see so many injuries in the fall, whether it's football players, cross country, you know, girls' soccer. The summer's a time to decompress and have fun. But anything you do, even cross-training can be really helpful, to help prevent some of these injuries down the road.

Host: So, you hear that kids have fun, but also do your wind sprints even though they're terrible things to do. I understand. Dr. Gregush, thank you very much for sharing all this information with me today.

Ronald Gregush, MD: Thank you for having me today.

Evo Terra (Host): And that wraps up this episode of Check-Up Chat with EvergreenHealth. Please visit our website at evergreenhealth.com for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. And for more health tips and updates, follow us on your social channels. I'm Evo Terra. And this has been Check-Up Chat with EvergreenHealth. Thanks for watching.