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Evo Terra: So many aspects of our lives have been put on pause because of the COVID-19 pandemic, including youth sports and other organized activities. After being unable to hold in-person sports and activities for over a year, many youth sports in Oregon are finally returning and welcoming back kids who've been cooped up for the past several months.

With such a long break from playing sports comes an increased risk for injury. The Portland Shriners Hospital's Walk-in Fracture and Sports Injury Clinic is a convenient and reliable resource for when injuries happen on the field.  

Welcome to Healing Heroes PDX, the podcast series from the specialist at Shriners Hospitals for Children in Portland. I'm your host, Evo Terra.

Today, I'm joined by Dr. Dominique Laron, a pediatric orthopedic surgeon that helps staff the Walk-in Fracture and Sports Injury Clinic at the Portland Shriner's Hospital. Welcome to the show, Dr. Laron.

Dominique Laron, M.D: Thank you. Thanks for having me.

Evo Terra: To kick things off, what causes sports injuries in children? And also, have you seen a rise in injuries as sports programs are starting to pick back up?

Dominique Laron, M.D: I think it's important to note that sports injuries in children can come in a lot of different flavors. So you have some acute traumas, especially in our higher contact sports, tackle football, soccer, hockey, and things of that like. And then there's overuse injuries and you can see that more commonly in things like gymnastics and even baseball where the contact is less, but you're doing a lot of the same repetitive motions over and over.

This is really interesting and unprecedented time that we're going through coming back from the COVID-19 pandemic. And there's definitely been a rise of new types of injuries as kids are, you know, kind of getting off the couch, getting out of the home and Zoom school and getting back on the field.

Evo Terra: And after such a long break from these youth sports, I guess, as you mentioned, because of the COVID-19 pandemic, any sorts of precautions that children athletes and their parents should take into consideration before starting back up the sports program?

Dominique Laron, M.D: Well, I think it's important to know that getting kids back out there is definitely what we want to be doing. We want to see them out and active, and that's one of the main reasons I went into pediatric orthopedics and take care of these children. You want them playing, you want them active. It's good for the heart, good for the lungs and definitely good for their mental health as well.

But with also that, the caveat is that most kids haven't been as active. Playgrounds have been shut down. Youth sports have been shut down. And so ramping up from, you know, not doing a lot of activity to getting right back out there and going full blast day one is probably not the best scenario. So what we're seeing is these kinds of acute injuries, and we're even seeing this mirrored in some of our professional athletes in baseball and things of that nature.

So I would just recommend that as you're getting back up to speed, we definitely want your kids to kind of slowly ramp up. If they're soccer players, then, you know, do some scrimmaging, do some drills and, you know, have a good stretch regimen and program rather than just getting back out there.

If you never run and you want to plan to run a marathon tomorrow, that'd be silly. You would slowly ramp up your mileage and get to that point to where you can play full games. I think the excitement of sports, kids are going back and, you know, playing in five, six-game tournaments on a weekend, it's just not a good situation.

Evo Terra: Let's talk about specific sports and some that are more prone to injuries than other. I raised a child who played hockey all the way through high school, so I know that's one. But what other sports are most likely to cause injuries?

Dominique Laron, M.D: I don't think there's any sport that is more or less likely to cause injury. I think the most important thing is what we've seen and the data has really shown that sports specification and early specialization can lead to a lot of overuse and common injuries like that. So it's really common, especially now with parents hoping that their kids be the next LeBron James or something of that nature, where, you know, you're playing one sport year round rather than playing all the different sports and playing football in the fall and soccer in the spring and whatnot. So I think there's no specific sport that I would say is more injury prone. They all have their different risks profiles. But getting out there and playing all the different sports, I think is the most beneficial thing from a cross-training standpoint and not seeing the same repetitive type of injuries and overuse things that we see in the developing skeleton in an adolescent child.

Evo Terra: Yeah, very solid advice there. But if, perhaps when, an injury occurs, when should a child or probably their family seek out medical care or when should they just treat that at home?

Dominique Laron, M.D: Well, I always kind of joke that if you're a parent, you're a world expert in something and that's your child. And so if you know your child and you know your child well, which I assume most parents do, you really are the world expert. And so if something seems off, I think you should have it looked at. If your child is not wanting to play, not wanting to run, doesn't have a limp of any sort, I think that's when evaluation would be had.

There are some kids that are "tougher" and want to tough things out and just really knowing as a parent what seems abnormal, I think that's that's good enough for me to seek further evaluation. But in general is a good rule. If any child has a limp, if any child has continued pain after, you know, a long game of some sort, or doesn't want to go back to play, those are the bigger red flags for me.

Evo Terra: Yeah. And this may seem like an obvious question because we want the best thing for our children, but why is it important that when we decide the child needs to see an orthopedist, why is it important we go to one that specializes in pediatrics rather than going to a general orthopedist?

Dominique Laron, M.D: Well, that's actually not a silly question at all. A lot of times people say, "Well, you know, my neighbor's an orthopedic surgeon who does total hips and total knees," And that's just something that they're well-versed. I think in the world of orthopedics, we've become somewhat of a sub-specialty field here and someone who has trained in both pediatrics and sports medicine in pediatrics especially has a different understanding, different training, different skillset when it comes to the developing child.

Essentially, their bones are different, their joints are different, their muscles are different and the injuries that can happen are different. Bony injuries can be affecting the growth plates and overall growth. And there's different respects that you have to have from both injuries that can happen and also the ways that we can treat them. So treating a skeletally mature 18-year-old is very different than a 9-year-old with an ACL tear per se. But you just have to really have that training and know what the differences and what the different options are.

Evo Terra: Let's talk about the recovery process. You know, when I was a kid, the recovery was "Rub some dirt on it and you'll be fine," but clearly that's not sage advice. What about this? When athletes are injured themselves, how long will it take them before they can actually return to their sport?

Dominique Laron, M.D: That's a hard question beause the myriad of different injuries that an athletes can sustain. But in general, I would say that we always want to get kids back as soon as possible when it's as safe as possible. So with a broken bone or something like the timeframes are pretty set, you know, things heal well and heal pretty reliably and kids especially, you know, skeletally immature kids who are still growing, they heal bones, get them in the same ZIP code and they'll heal.

But overuse injuries, ligamentous injuries, muscular injuries can be a little bit more difficult to manage. So it depends on what the injury is itself. But in general, you know, for every bony type injury whether that be a fracture or a bad sprain, you're looking usually in the 6 to 10-week period, of course, there's a big range of things like that that can really determine how long they're out for.

Evo Terra: You brought up overuse injuries then a couple of acute injuries or fracture or sprain or something. But let's talk about the difference in how we would treat those two, something that's long time, slowly overused, and then the other, just, you know, I broke something, what are we going to do?

Dominique Laron, M.D: Well, I think you want to think about acute injuries as trauma, whether that be a big fall, big collision, concussion, that sort of thing. There's an acute moment that instantly happens and your child is hurt. That's something that we can't ever control, even with all the safety precautions and new technologies from safety equipment, they just happen. So those are just injuries that are unavoidable that can just happen.

Overuse injuries are a little bit different. Those are subjecting a developing skeleton, a developing musculoskeletal system to the same repetitive motions. We see this a lot in gymnastics, sometimes figure skating. If you want to take a specific example, pitchers. So overhead throwing athletes like pitchers do the constant motion. And even with pitch counts and limitations, the Little League and high school level, you know, they are allowed to throw certain amount of innings per week. A lot of these kids are playing for two, three, even four different teams and so those numbers are really hard.

The treatment between the two. For acute injuries, there's usually an acute process to where we either have to mobilize them for say a broken bone or have them rest for a tendinous or ligamentous injury and often or sometimes surgery for those sorts of things. Overuse injuries can be a lot more treated with either rest, activity modification and physical therapy. A lot of those overuse injuries can be dynamic imbalances in the body. It's things like, you know, speed skaters, which isn't that common in the United States, but always turning that one way on an oval track can cause different loading of the body and knees. And so we've seen that the kinematics in those kids is different. So having physical therapy work with them to really have muscular balances work and just make sure their mechanics work. And in that same vein of talking about pitchers, limiting pitch counts, and making sure that their pitch mechanics are sound and safe as possible.

Evo Terra: Sure. Sure. Earlier, you mentioned that there's not really a specific sport that causes injuries. I mean, injuries happen. I assume that there are some common injuries that you see in your profession. Any tips on how we can prevent those?

Dominique Laron, M.D: Yeah. I see things a lot of ankle issues, ankle sprains in our kids who play soccer. And then there's a lot of issues around the knees when it comes to basketball players and things of that nature. What we'll see is ACL tears, sprains. And then in some of our overhead throwing athletes, you'll have elbow issues and shoulder issues.

I think the biggest tip for prevention of those is really getting the kids out there and getting strong and really having someone monitor their mechanics. And if they're having any type of soreness or issues and when they're playing that sport that they're either doing year round or playing a lot of, I think even the simplest things. Have them play different sports. Have them mix it up and really kind of cross-train throughout all that. I think that can be really easy way to avoid big overuse injuries. And then from other prevention standpoint, I think, you know, the NFL is doing a lot as far as preventing concussions and both female and male soccer, there's a lot of prehabilitation and strengthening and stretching regimens that are widely available on the internet to avoid any of these kind of soft tissue ACL type injuries.

So just educating yourself as a parent, educating yourself as a young athlete and knowing that we can never take that risk down to zero, but we can get it closer by making sure our bodies are conditioned, which is the funny thing about coming out of this pandemic. We're seeing just a stark rise in kind of these "I haven't really done much in the past year and a half, and now I'm getting back out there and everything hurts" situation. Here at Shriner's, we're doing a little bit of research just from a public health kind of standpoint to see if those numbers are really increasing and how they're increasing and which sports. So stay tuned for more.

Evo Terra: Great info. Let's talk briefly about what a family might expect when they make a trip into your Walk-in Fracture and Sports Injury Clinic.

Dominique Laron, M.D: Well, I think it's great that the Shriner's Hospital for Children has a walk-in clinic, so you don't need an appointment. It's open every day, 7:30 to 4:00 PM. And so, you know, even if your kid has an injury at a playground, 7:00 in the morning, come on in and we can take care of them. The beautiful thing about our system here, it's all pretty much wraparound care right in-house. So we have our radiology room right across the hall with state-of-the-art radiology technology, some of the only EOS system in the state. If they need any bracing or walker boots or things like that, we have service prosthetics and orthotics department upstairs. And we have, I would say, the second to none rehabilitation and therapy and PT here as well, who are well-versed with great technology, whether that be treadmills, bikes and things, like that so that the kids can get back and get strong.

So the beautiful thing about coming to Shriner's Walk-in Fracture clinic, one, you don't need an appointment and, two, we're here to take care of you and whatever is needed. If that be heaven forbid surgery, we have a huge group of people who are able to take care of those things. And if that's something like bracing or for physical therapy, we also have that. And it's all in one building makes it an easy stop for the family.

Evo Terra: A nice and one-stop shop. Thanks. Dr. Laron. Let's look forward to getting the kids back out there and playing some sports.

Dominique Laron, M.D: I would love to see it and stay safe out there.

Evo Terra: For more information on sports injury care and prevention for kids, please call (503) 221-3422 or visit our website at portlandshrinershospital.org. That concludes this episode of Healing Heroes PDX, the podcast series from the specialist at Shriners Hospitals for Children. Head on over to our website at portlandshrinershospital.org for more podcast episodes. I have been your host, Evo Terra.