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Scott Webb: As all of us parents know, kids get hurt, playing sports and well, just being kids joining me. Today to discuss typical injuries. It's a sports physicals, and what types of injuries require immediate attention is Dr. Christine Boyd. She's a pediatric sports medicine specialist. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb, Dr. Boyd. Thanks so much for your time today. I have a couple of kids, they played sports. I'm very familiar with going to the doctor's office, going to the pediatrician, getting those sports physicals. And I'm sure a lot of parents are as well, but we're gonna kind of talk through some of this today, why we do it, that benefits a physical sports injuries and so on.

And I've got a whole bunch of questions for you. And I know that the children are heading back to school, including one of my own, and they're gonna be joining the sports teams. So what can we do as parents to prepare them for school?

Dr. Christine Boyd: It's a great time of year. It's an exciting time of year for kids as they're getting back to school. the return to sports typically happens at the same time as return to school as well. And so, I think the most important thing that I typically discuss with my patients is making sure we have a gradual reintroduction to activity. The daily schedule in the summer, is typically very, very different than the schedule, in the school year. And so making sure that we have a gradual transition and the upcoming, exhaustion, fatigue.

Scott Webb: Yeah, definitely. I remember when I used to play football in high school, we would have these, summer practices, two a. Three a day. And we were all just pretty much exhausted before school ever even got started. And I know the contact hours and things have changed a little bit, but one of the key things here in getting them returning to school and returning to sports, and hopefully gradually, as you say, is the sports physical. So what is a sports physical exactly? And let's talk about the ages of children that they're appropriate for?

Dr. Christine Boyd: The definition of a sports physical is a focused physical exam, designed to identify any potential risk factors that a kid may have as they're heading into their sports season. Typically it is done as part of the annual exam for most children. The age of kids definitely does matter. Typically sports physicals start at about the high school age. Sometimes it'll be the middle school as well. As you mentioned with the football players, starting with summer practice,, their season obviously starts a lot earlier, the high school athletes, the younger kids later, but typically sports physicals are the middle school and high school aged kids. And ideally it's done incorporated with their annual exam.

Scott Webb: Yeah. That's been my experience for sure. But let's, also talk about some of the benefits, right? Because I think that for a lot of parents and children, it feels like this sort of obligation you have to do, you just go and they check your height and your weight and your blood pressure and those kinds of things. But there could be some real value, especially for children and families. Maybe who'll have some things that are undiagnosed, right? It's not just a formality if you will. So what are some of the benefits to sports physicals?

Dr. Christine Boyd: There's been a lot of research that's been done about what are the benefits of sports physicals, and the history part is actually surprisingly one of the most valuable, things that we do. Typically with a sports physical, there's a long list of questions. You fill out a lot of people hurry through and click no, no, no, no, no. But it's important to read them and think about what they're asking, because those questions and answer those questions can help us identify who needs potentially further screening.

Whether it be, heart screening or cardiac screening or pulmonary screening or a kid who's had three ankle sprains and maybe we need to double check and make sure that the ankle really is ready for sports again, this season or another kid who's had several concussions and needs to, talk about how do we make sure that we manage this appropriately in the season to come. So that history part of the sports physical is really, really important for parents to take the time, to read it and fill it out.

Scott Webb: I think you're so right. And I've certainly been guilty of that, of the no, no, no, no, no. And over time, over the years, I've come to realize and believe that it's important to really just slow down a little bit, you know, you're there with the clipboard in the office, slow down, really read the questions because the person you're trying to help here of course, is your child. And we all want our kiddos to be happy and healthy and safe and all of that. You mentioned briefly there just, about concussions and I don't wanna go too deeply into that, but in general, especially for parents of children who are just gonna start playing sports, maybe especially contact sports, those kinds of things. What are the most common sports injuries that you see?

Dr. Christine Boyd: So it depends a lot on age, and sports. So in the younger group,, the grade school. Kids. We tend to see more of the bony fractures, bumps, bruises, contusions. They tend to have more, we call macro trauma. As we head into the more middle school age group and in high school, we get a lot more overuse injuries that come in as far as, shoulder pain, back pain, knee pain, combined with some of the acute joint injuries and fractures and things of that nature. So again, a lot of it depends on the age group, but I would say it's either gonna be an acute macro trauma, sprained my ankle, broke my wrist, or an overuse injury related to just a lot of sports.

Scott Webb: Yeah, that sounds. And wondering, can you share anyway, from your experience, there are probably some injuries that are more common, so maybe this injury is more common in soccer and that injury is more common in basketball in general. Can you give parents a sense of the types of injuries related to at least the major types of sports?

Dr. Christine Boyd: Yeah. So definitely there's a seasonality to our clinic. So as we head into soccer season and football season, this fall, we're gonna see a lot more ankle injuries, a lot more bumps and bruises, a lot of hamstring, muscle strains, ankle injuries, knee injuries, those all typically go with soccer. As we head later into fall, for cross country and running, we'll see more of the shin splints, and shin pain in the spring for baseball. It's a lot of shoulders and elbows. So yes, there's definitely different sports, different potty parts.

Scott Webb: Yeah, definitely different body parts. And a lot of us like to think of us, ourselves as sort of parent doctors, citizen doctors and we try to diagnose , our kids' injuries or their bumps and bruises and ailments. And maybe you can clarify this is always the one that kind of messes with my head a little bit when it comes to ice versus heat. Maybe you can clarify the types of injuries maybe that we should maybe try to treat first at home and how we should treat them? Is it ice then heat, heat,then ice. I always get a little confused.

Dr. Christine Boyd: Yeah, good rule of thumb is always ice. So if the injury is brand new, for the first 72 hours, ice is gonna be the correct answer, and we rarely ever wanna use heat on an acute injury. We use heat for more of the ongoing or chronic injuries. The advice that parents oftentimes will ask is how do I know when I need to go to the doctor or if it's on the weekend, do I need to go to the emergency room? Or can it wait till Monday? Any bone or joint that's obviously deformed needs to be seen right away. Any pain that's not controlled with home remedies also needs to be seen.

Everything else usually can wait a day or two, and watch for joint swelling and see how it evolves. If after a day or two, it's still swollen, it's still not moving correctly. The child can't walk on ankle or foot. Then it needs to be seen. So if it's visibly deformed and doesn't look straight and doesn't look right, it needs to be seen right away. Otherwise it can wait a couple days. And if it's not better than it needs to be seen.

Scott Webb: Yeah, that sounds about right. Good to have a sense of when we should go immediately. And when we could maybe make an appointment and go a couple of days later, and there's a culture doctor, in sports and even in youth sports of sort of, rubbed some dirt on it. You know, metaphorically and get back out there and,, trying to prove who's the toughest and that kind of thing. What would you say to that?

Dr. Christine Boyd: Obviously playing through pain is not always a good idea. The pain that kids have sometimes is a little bit different than the adults. But there is an element of sports that there is gonna be some discomfort and things are gonna hurt. And it's sometimes challenging to know when is it okay to let your kid play through the pain. More often than not, it's motivated by the kid and sometimes the coaches and the peer pressure. But the kids usually wanna be out there playing. So when I talk to kids in my office about, is it okay to go back and play? Or when do I have to stop?

If there's swelling in a joint, if a joint doesn't move fully, like you can't fully expend or extend your knee, if you're running with a limp or the pain is getting progressively worse, then that's pain that you should not play through. If it's just a little bit of a soreness and it's not getting any worse. And when you play, you don't feel it, but you're a little sore afterwards, that's something that we can watch over the course of a couple days or weeks. And then if it starts getting worse, then we gotta shut you down.

The other thing that's also important with that is knowing what you're dealing with and knowing the diagnosis. So if you've seen a doctor and you know what's causing the pain, it's much easier to decide if it's safe to let your kid play through the pain, versus you're not quite sure why their elbow hurts, but you're gonna let 'em throw anyway. So it's better to know because then we can give you guidance on whether or not it's safe to keep playing or.

Scott Webb: Are there any healthy habits or tips that you have so we can maybe not worry so much that they're gonna get hurt and try to prevent those injuries?

Dr. Christine Boyd: Yeah, I guess one of the motto that I use in my office sometimes is that too much, too fast, too soon. So most injuries are preceded by one of those things. So either too much. So if your overall volume of training and play and practices playing for three different baseball teams or two different soccer teams, and then having private training three days a week. That's probably too much. That's a setup for injury. Too fast is so if you're been on summer break and the soccer team's first day of practices today, and you haven't touched a soccer ball in three months, just remember that you probably shouldn't go at a hundred percent today. That's a big one for injury.

And then too soon is the last one. And that's coming back too soon after an injury. So spraining your ankle and not being a fully recovered, but going back. Reinjuring it again, just making sure if you have an injury that you're really ready to get back before you head back. So you don't have a recurrent injury and those are kind of my guidelines to go by, to try to keep kids on the field.

Scott Webb: Yeah, we're just trying to keep them on the fields and keep them on the courts. But as you say, sometimes it can be too much, too soon, too fast. So really great advice from an expert today. Thank you so much. And you stay well.

Dr. Christine Boyd: All right. Thanks you too.

Scott Webb: And for more information, go to Stanfordchildrensdot org, and we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is aHealth Talks from Stanford Medicine Children's Health. I'm Scott Webb, stay well, and we'll talk again next time.