Evo Terra (Host): Getting kids involved in sports can be a great way to put them on a path to good health. But, in a world with increased competition, how do we keep them healthy as they play? Let's find out with Jessica Martschinske, an athletic trainer with Shriners Children's Portland. Welcome to Healing Heroes PDX, the podcast series from the specialist at Shriners Children's Portland. I'm Evo Terra. Today, we're discussing keeping kids in sports with Jessica Martschinske, an athletic trainer with Shriners Children's Portland. Jessica, welcome to the show.

Jessica Martschinske, MA, ATC/L: Hey, thank you for having me!

Host: So let's start by you telling me a little bit about your athletic training background and your role there at Shriners Children's Portland.

Jessica Martschinske, MA, ATC/L: Absolutely. So I started off with my undergraduate degree at University of Idaho. That was in athletic training where I sat for a certification exam through the BOC. And then I went on to get my master's at University of Connecticut. So right now I'm rooting for the Huskies in March Madness, both men and women's.

I then did a residency program in athletic training to really help me perform and understand the physician practice. And that's where I am here now. At Shriners, my focus is obviously in pediatrics. And that's where I'm identifying sports medicine and orthopedic needs out in the community of Portland and Oregon and Southwest Washington.

And I'll be seeing patients in conjunct with providers here and trying to provide elevated care in orthopedics, sports medicine, and communicate between departments, whether it's physical therapy, or out in the community, or getting an MRI scan, and getting that kid accurate and timely care, because we know our athletes, they want to get back out into the field, but we want them to do that safely. And so, that's what my background is and that's kind of what I'm doing here at Shriners Children's. And right now it's actually National Athletic Training Month. And so our tagline is from head to your toe. And so we are healthcare professionals that work in the high school, colleges, professional sports. And like, I just spoke about hospitals or physician practices as well.

Host: Right. You know, it's been a number of years since I have had a child in sports. My kid has finally grown these days. I know that were always a concern back then but things may have changed. What are some common types of sport injuries we see in young athletes today and what can we do as parents or possibly even coaches to recognize these before they become serious problems?

Jessica Martschinske, MA, ATC/L: Right. So, the low hanging fruit, the obvious ones, are usually joined with tears or the kid self immobilizing. So, those are what we call acute injuries, meaning they happen suddenly and there was an event or an injury that you witnessed or they can describe. So, this could be falling off the jungle gym, monkey bars, skateboard, falling on an outstretched hand.

Easier said it is called FOOSH for short, or you have an athlete that collides with another player and rolls, rolls their ankle. So that kind of leads me to break down acute injuries. That can be where you injure a ligament in an ankle or in your knee, tendons where our muscle attaches to bones, and you could break a bone.

Often seen in pediatrics, we'll see clavicle fractures, distal radius fractures, which is your forearm bone. The distal tibia in the ankle or fibula, which is your lower leg. And then there's joint injuries, these bigger injuries to your hip, your shoulder, the knee itself. Many of us are unfortunately familiar with ACL tears or patella dislocations.

There's very important pieces of the young kids growing bones and the ends of their bones where the cartilage is. There's conditions called osteochondral lesions, where it's injury to the bone that supports the cartilage. And what we know is the cartilage is the surface of the joint. And that's very important to keep healthy because what we don't want is something to lead to arthritis in the future of our athletes or our kids.

And so it's these very important pieces of a kid's bone and body that whether it's a chronic condition or an acute condition, so I just described acute, right? These sudden injuries. But I'm also seeing chronic injuries in our kids. And those are harder to, for parents and coaches to recognize. A kid could be complaining of some pain.

Are they sore? Did they just get bruised? But if that kid is complaining of pain after practice and then it turns into during and after practice. And before, during, and after practice. That's where you worry about these chronic overuse conditions that develop over time. Tendinitises or apophysitises, which is where a muscle attaches on a bone of a young kid.

And itis means inflammation. So you're having these overuse conditions for these kids that it's hard to identify, but a kid complaining of pain for a longer period of time, a couple, a week or two or longer, and it's starting to affect their play or them to just voice concern, those are some red flags.

Host: Yeah. Yeah, I can see that they would be. And look again, I had a kid who was in sports, so I understand that injuries are unfortunately pretty common in the world, but I've got to imagine there are some sort of effective injury prevention strategies, I guess, that we could implement to keep kids safe. And I know it's going to change from sport to sport, but overall, how do we limit the chance of these injuries happening to our kids?

Jessica Martschinske, MA, ATC/L: Absolutely. It's important to really take a big net approach. It's multifaceted. So there's a lot of pieces that you can implement to keep your kid healthy, safe, active, and making them lifelong athletes. You'll hear me say that a few times because I think it's super, uber important.

Something like adequate sleep. Our young kids, you don't realize youth, if you talk to your pediatrician a five to 12 year old should have nine to 12 hours of sleep. A 13 to 18 year old should have eight to 10 hours of sleep. What athlete that participates in you know, sports year round or these heavy, heavy week loads really gets 10 hours of sleep, you know,

Host: No it's 6 AM ice time, right? No, that's not happening.

Jessica Martschinske, MA, ATC/L: Right. And so sleep is one of those things, adequate hydration and nutrition. And that might look a little different kid to kid and understanding what their needs are. So involving the parent, the pediatrician or the coach to understand what that kid might need. And like you said, it's going to differ; soccer player, to a lineman, to a baseball or throwing athlete. There's resistance and strengthening programs that are proven to mitigate some injury risk because they are prepping their body for the stress that they're about to incur in their sport. Making sure you have good and proper warmup, cool down, stretching, and then an athletic trainer if the school has it, or usually in our older population of kiddos, but they're skilled in prevention strategies that they'll implement with certain programs, or go through emergency preparedness protocols on an annual basis to make sure coaches and everyone's aware of what to do in an emergency. And it's in professionals like them that will help mitigate those injury risks as well.

Host: You know, back when i was a kid, we just played sports, whatever they happened to be. Whether that was a the game of stickball across the street or maybe your high school varsity team but we live in a world now where things are much more specialized I've got two nephews that play baseball every day. And they only play baseball, right? My son only played hockey. Are there risks associated with this specialization that we're seeing in children?

Jessica Martschinske, MA, ATC/L: There are. We are seeing that more and more in the literature and the research that comes out. And we have such a large amount of kids across the U.S. that are participating in sports. We have 30 million of kids from 6 to 18 that participate in team sports and 60 million in organized athletics.

So the volume of kids in sports is higher and higher than it's ever been. And I think it's important to understand what sports specialization is. And a lot of organizations use the definition of participation in intensive training and competition in an organized sport for more than eight months per year or year round and participation in one sport at the exclusion of another sport.

We're even limiting free play. So free play meaning going out to the playground, riding bikes, doing things that we did as kids that kids are don't have the time to. And them avoiding, just being a kid to participate in this one sport, it increases your risk. And so what are those risks that go with specialization?

The two biggest ones is your burnout risk. You don't become a athlete for life or a active participant in athletics to any degree, whether it's cycling, hiking, or increased injury risk. And those are two big things that can be life changing for an individual. Somebody who gives up on their sport because they got burnout.

Now, you know, they are not active and then there's these comorbidities that you have as an adult, diabetes, cardiac concerns, and those are things we all know in healthcare, we want to avoid. And so if specialization in sport is something that can potentially lead to that oh, we've got to be mindful with how much we specialize as a young kiddo.

Host: Yeah, I think so too, and I know that that goes hand in hand with the elevation of competitiveness in sports, it's not just play anymore. Now it's play on three travel teams, and now it's get in the minors, and all of these other activities. So, what advice do you give to parents who are considering highly competitive sports leagues for their kids at a very young age?

Jessica Martschinske, MA, ATC/L: I mean, listen to your kid when they describe their sport, what makes them participate? I hope it's not you as a parent. I hope it's not their coach. I hope they're not living vicariously through your needs or your goals. So, understanding your kid and their goals and desires is super important.

We have kids that are perfectionists. Those are at higher risk of burnout. You've got to save them from themselves a little bit. That's our role as adults and parents to identify those risks. The National Athletic Training Association advocates for six recommendations, delaying specializing in a single sport for as long as possible.

And I'll see that in a lot of different sports organizations recommendations. A lot of them are recommending waiting until 14 and older to speecialize. You have a sport telling you, don't just play my sport, play other sports. It's important. Those that participate in multiple teams in the same season, it should be one team at a time.

You know, you participate in two, three different teams, you're getting pulled so many ways and you have no time to sleep, to hydrate, to do other things, be a kid properly, that you know your risks go up for injuries, burnout.

Participating less than eight months per year. The recommendation of no more hours per week than the age you are in years, meaning if you're 12 years old, you should not be participating more than 12 hours per week in your organized sport. And multiple healthcare organizations make that recommendation. So I think that's a good tool. How old is your kid? No more hours per week than they are age in years.

They should great have two days per week of rest. And they should have some recovery and rest from their organized sport. Playing that sport year round, they, whether it's planning your family vacation around the time AC, sorry, coach. I can't start because we're going to the coast. We're going on a trip and forcing your kid, to, well, come with you on a vacation, but also give yourself a break.

 And so that's super important. And I think if you research your league or your sport and your org and what drives them and what their recommendations are, I think you'll have a good indication if that's the type of club you want to join.

Host: I imagine there's some symbiosis. Why do I have to imagine this? I've seen this. There needs to be a symbiosis between the coaches and the parents working together just to make sure the kid excels in the sport, but I'm thinking about that from safety and encouragement and all of that. So are there tips for parents and coaches to work together towards this goals?

Jessica Martschinske, MA, ATC/L: 100%. I think I kind of highlighted it as being approachable and mindful of the goals of your kid and encouraging them. And then the American Development Model is a model that outlines guidelines and principles to make sure your athlete is training at an age appropriate way. Encouraging these principles to develop skills that transfer between sports, keep your kids safe and create a generation that loves sports and activities to be a lifelong athlete.

So if your organization follows this American Development Model, I think that's one key piece to be mindful of. A lot of organizations, encourage safe sport training, heads up training through the CDC to be able to recognize concussions. So having a level of training for the coaches, and I think parents need to have some training that's required if they're going to put their kid in a sport.

I would love to see education of early sport specialization, what that means, what risks there are, to be mandated for parents. I think that's coming down the pipeline over the years and hopefully that's something the CDC starts to implement like what they did with concussions. And encourage your kid to sample.

We don't want them to have burnout and burnout's less when they sample as opposed to specializing. We know this. We know that sampling, cross training, gives your kid different physical, cognitive, different environments and they transfer from sport to sport. It's just so important and it's going to make them a better athlete. It really is.

Host: Yeah. Well, let's switch gears or perhaps to stay in theme, switch positions. Oh, there we go. And talk about the sports medicine program that you have there at Shriners Children's Portland. How is it different than what people might find at other sports medicine centers?

Jessica Martschinske, MA, ATC/L: Here at Shriners Children's Portland, we have multiple sports medicine providers and our chief of sport, Dr. Baomi, is a fellowship trained in both pediatrics, which you love to see, knowing that your provider understands kids, the growing body, and what their needs are, and, but he's also dual fellowship trained in sports medicine, and so he has an understanding of the athlete and the athlete's mindset, what their needs are for their specific sport and also what their needs are as a kid.

And I think that's super important and that's something that we offer and that we have a lot of depth to it. It's not just our team of surgeons, but it's our physical therapists who understand our kiddos and the needs. We have a bracing department that understands our kids and needs.

Our Cast Tech understands how to speak to kids, right? It's, he oftentimes uses the phrase, gonna bring out a tickle machine for a very scary cast saw. That can, we don't want to traumatize kids. And

if they're going to a organization that's not familiar with dealing with kids, it's impactful for the kid where it might give a bad taste in their mouth and you don't want that when it comes to somebody who's trying to help them. And so we have a walk-in fracture clinic that you don't need any appointment. You don't need a referral. It's 7:30 in the morning till 4 in the evening.

And you can walk in with your injury that, it could be acute, like what we described earlier, or it could be a few weeks old. It's not for chronic conditions, but if you're wanting somebody who understands the pediatric, kid, adolescent body, and orthopedics, and the concerns with this type of population, we have a group of individuals that are ready at the helm for you to walk in, for us to order an x-ray, evaluate that x-ray, potentially order an MRI, get timely and accurate care.

 And then having timely care to our sports med surgeon if that's the case, or this is something that might need physical therapy, and being able to articulate that to a family and parents.

And so, whether it's treating them with crutches and a period of non-weight bearing or like I said, needing the MRI because that's the next step. It's a one stop shop, which is lovely to have. You're not driving across the city going to an urgent care or the ER when that's not where you're meant to be with an acute kid injury.

Host: Right, you don't want to be triaged to the lowest listing if you're at an ER, right? You'd like to get in, seen quickly and not have to do explain that, no, this is not a work related injury. This is just. Do you have anything else you wanted to add? This has all been great information thus far, Jessica.

Jessica Martschinske, MA, ATC/L: I think being mindful of your child's goals, just to hit that nail on the head and encouraging it and encouraging some degree of activity or club participation. There are sports that are not, if they're fearful of an organized sport or getting, being involved in something a little more too aggressive, open their eyes to the world of golf, tennis, something that's going to get their blood pumping and keeping them stronger and creating that again, I'll hit the nail on the head with a lifelong athlete and just whatever that means to them, is through trial and error and not foreseeing what you think they might need. And then also allowing them, breaks and being the parent in the case of, I know they want to play this year round, or I know my friends as an adult, right, their kids play and I just, I have this family of friends all our kids do this.

I mean, putting your kid first, and sometimes you don't know what that means. And I'd be I would encourage just the research of how do I keep my kids healthy, safe, active. And there's some few resources whether it's your athletic trainer at high school or the National Council of Youth Sports,

or orthokids.com. These things, there's a lot of organizations who have, they're stakeholders in youth athletics and they want to keep them healthy. And so, for parents to understand there's resources out there, they just have to dig a little bit.

Host: Keep our kids healthy. Kids first, sounds like an exceptional advice to me. Jessica, thank you for all the information today.

Jessica Martschinske, MA, ATC/L: Yes, you're welcome. Happy to share.

Host: Once again, that was Jessica Martschinske , an athletic trainer with Shriners Children's Portland. For more info, please check out our website at ShrinersPortland.org. And if you found this podcast episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm Evo Terra and this has been Healing Heroes PDX, the podcast series from the specialists at Shriners Children's Portland. Thanks for listening.