Deborah Howell (Host): As parents, we know how important it is to take care of ourselves, but what about taking care of our children and teens as they go back to school and participate in sports? Welcome. I'm Deborah Howell. And today, we'll explore how Family Medicine differs from other primary care specialties with a focus on the importance of back-to-school physicals and guidance on when to see a doctor for sports-related injuries.

Our guest is Dr. Arnold Cuenca, a Family Medicine and Sports physician at MemorialCare Medical Group, Mission Viejo. Welcome, Dr. Cuenca.

Arnold E. Cuenca, DO: Hello. Good to be here.

Host: So glad to have you. So, what makes Family Medicine unique in caring for children and teenagers?

Arnold E. Cuenca, DO: Well, Family Medicine is a specialty that provides comprehensive health care for people of all ages. And because of the type of training that Family Medicine physicians receive, they can consider any family dynamics that may impact the child or teenager's health.

Host: Can you explain to our audience how you manage both the long-term musculoskeletal health and injury prevention for young athletes, especially those participating in winter sports like maybe basketball, soccer, skiing, snowboarding, and ice hockey?

Arnold E. Cuenca, DO: Well, when I see a young athlete, I consider what their goals are, both short and long term. If they present with an acute injury, I discuss with the athlete, as well as the family, when they can and should return back to their sport safely, and how to do that best without causing further injury. For example, if they have a big tournament or event that is coming up in several weeks or months, we work together to determine the best course of action to rehabilitate the injury and as well as prevent any future injuries that would compromise any competitive edge.

Host: As kids are heading back to school after the break, what role does Family Medicine play in supporting them through the challenges of winter sports and busy school schedules?

Arnold E. Cuenca, DO: It's important to address not only their physical health, but to consider any emotional or even social factors. I mean, there's a fine balance to maintain between sports participation and the importance of doing well in school academically. There's also any non-sports-related social activities that you have to consider. And when you add to that, any kind of sports injury or medical illness, it can be a really challenging time for the student athlete. A Family Medicine physician considers all these aspects when they see their patients.

Host: What should parents expect during sports physicals and how can they help prepare their children for sports like basketball, soccer, or even more intense winter activities like snowboarding and skiing?

Arnold E. Cuenca, DO: Often times, there's a form that has to be completed. And it contains this comprehensive health history, which is actually as equally important as the exam itself. And the parents can help make this visit really valuable if they can discuss that health history portion with their child before they come in and they complete that form ahead of time. It helps us physicians really perform a good comprehensive history and exam to help clear them for any kind of sports participation. And regardless of the intensity of the sport, that sports physical will address the same need to screen for any kind of medical condition that may affect sports participation.

Host: What are common injuries that you see in young athletes, particularly in winter sports? And what steps should parents take to ensure proper treatment and recovery?

Arnold E. Cuenca, DO: That depends on the sport. Let's say basketball. That can often include knee and ankle injuries and the occasional finger injury. Skiing and snowboarding, that can involve knee and wrist injuries. Wrestling, there's musculoskeletal injuries that we always think about, but there's also skin infections as well. There's always head injury and concussions, something that we always see in sports. So when an injury occurs, it's really important for parents to have their child seen by a medical professional so that that injury is addressed appropriately and a return-to-activity plan is established.

Host: So, a skin infection is considered a sports injury. That's news to me.

Arnold E. Cuenca, DO: Yeah, absolutely. And especially in wrestling, we think about bacterial infections like MRSA, or even like a kind of viral infection. We call it herpes gladiatorum. And you don't want to spread that amongst the wrestlers. It's really bad for everyone to contract that and will basically take them out of their sport. But you can adapt and you can go and treat that infection and make some kind of accommodation based on certain guidelines, of course, based on sport.

Host: Do you have any advice for parents to help their children follow safety practices during winter sports, particularly regarding head injuries and concussions?

Arnold E. Cuenca, DO: I would encourage any parent to understand the sport their child is participating in. And we always talk about rules of the game. What I'm specifically referring to is safety rules of the sport. There's different questions that parents should really ask themselves, like are they wearing the right gear for the sport? Does it need to be replaced? Do they have the right clothing, especially layered clothing during the winter months? And even asking questions like what are their physical limits? Are they really aware of their skill level? And finally, they have to warm up properly and are they adequately hydrated during their event?

With regards to head injuries though and concussions, which I had mentioned earlier, parents really need to ensure that their child understands the importance of wearing a helmet in sports like skiing and snowboarding and, of course, learning how to fall in a safer way to minimize injury.

Host: And even biking. Got to wear that helmet.

Arnold E. Cuenca, DO: Oh yeah, biking too, absolutely.

Host: And I suppose there's other winter sports we haven't even discussed where you have to have a helmet these days. We grew up, you know, just being so free without them, but...

Arnold E. Cuenca, DO: I remember those days too, just riding your bike in the middle of the night. And of course, you're coming home late until the lights come on. Absolutely, I remember those days.

Host: Yeah. It was fun, but dangerous. So, as we know, sports can be both physically and mentally so demanding. What signs should parents look for to ensure their child is not overly stressed or burnt out?

Arnold E. Cuenca, DO: In sports medicine, there's definitions we refer to for athletes who may be training too hard. And some of them in order to maximize their training, they'll try to do what we call overreach, which is when they really try to push their training beyond their limits. And when it's done and planned correctly, there's actually a benefit to doing so. But if the increased training load leads to a decline in performance, they start to over train. And then, the body takes more time to recover and they start to experience different kinds of symptoms like fatigue and mood swings. They have trouble sleeping and they may even get sick more often. And they keep training, it's monotonous over time. There's emotional components or mental factors that start to play in. That can all lead to burnout. And what may happen is that that athlete will just have to take a complete break away from the sport to kind of focus on themselves, their mental and physical health.

So, I think when parents are having their child in some kind of program like this, they have to look for certain signs. If they find any, they should talk to their coach about adjusting their training regimen, as well as have their child see a physician if any adjustments made are not working.

Host: We've been talking about athletes mostly, but how can parents promote physical activity in ways that engage their children who may not naturally gravitate toward team sports?

Arnold E. Cuenca, DO: It's important that the physical activity itself is fun and enjoyable, and it doesn't always have to be intense or competitive. I mean, the family can get involved, right? So, like an activity like hiking or biking, that's a good start, right? Getting them introduced to being active, and even playing games with your kids at a young age, like hide and seek and tag. Those are good stepping stones as well. And distractions, there's screen time. We got to limit that. That way, way they go out and play more, right? But, you know, really in the end, I think that being a good role model for your kids can be the most influential of all. I mean. If your children see you, go for walks, you run, you work out at the kickboxing gym, and you're having a great time, and they see that, they just might want to join you, too.

Host: All right. You know, I've come to the end of my questions. Is there anything else you'd like to add, Dr. Cuenca?

Arnold E. Cuenca, DO: I think, just being with your kids, spending that time, being as active as possible. And of course, looking out for any kind of safety concerns. I think really the best part of being active is if you can demonstrate that kind of interest yourself and, as a family, do that together, and promote it at a very, very early age.

Host: That's right. Get them started hiking at age three.

Arnold E. Cuenca, DO: There you go. Absolutely.

Host: Well, thank you so much, Dr. Cuenca, for your time and your expertise today. We really enjoyed having you on the podcast, and we learned a lot.

Arnold E. Cuenca, DO: Thank you for the opportunity. Glad to be here.

Host: I'm Deborah Howell. For more info or to listen to a podcast of this show, please visit www. memorialcare.org/mcmg, and click Find a Provider or call 877-696-3622 to make an appointment at MemorialCare Medical Group, Mission Viejo. That's all for this time. Thanks for listening, and have yourself a terrific day.