For young athletes, coaches and parents, the beginning of various sports seasons means young athletes of all ages face the challenges of injuries that range from sprains, cuts and bruises on up to more serious problems.
This year there's also a new state law in Missouri aimed at protecting student athletes from concussions.
Jeffrey Nepple, MD joins the show to help pediatricians, coaches and school personnel take the steps necessary to keep kids on the field and healthy when they play sports.
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Injury Prevention In Youth Athletes
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Learn more about Jeffrey Nepple, MD
Jeffrey Nepple, MD
Jeffrey Nepple, MD, is a Washington University pediatric orthopedic surgeon at St. Louis Children’s Hospital and director of the St. Louis Children’s and Washington University Young Athlete Center.Learn more about Jeffrey Nepple, MD
Transcription:
Injury Prevention In Youth Athletes
Melanie Cole (Host): For young athletes, coaches, and parents, the beginning of various sports seasons means young athletes of all ages face the challenges of injuries that range from sprains, cuts, and bruises on up to more serious problems. This year there is also a new state law in Missouri aimed at protecting student athletes from concussion. My guest today is Dr. Jeffrey Nepple. He's a Washington University pediatric and sports medicine orthopedic surgeon at St. Louis Children's Hospital and the director of the St. Louis Children's and Washington University Young Athletes Center. Welcome to the show, Dr. Nepple. So, I'd like to first start with what are some of the most common types of overuse injuries that you expect pediatricians to be seeing during the sports seasons?
Dr. Jeffrey Nepple (Guest): Sure, well thank you, again, for having me. I think we live in an era where sports injuries and pediatric and adolescents athletes are extremely common, so as many as three to four million of these injuries occurring yearly and about half of them are probably due to overuse. So, we see a lot of overuse injuries related to overuse of certain muscle groups and a growing athlete where we have tendonitis or apophysitis where we have irritation of the growth plate leading to injuries. We see this commonly in the lower extremity. Osgood-Schlatter's is a common scenario in the knee. We see it in our baseball and softball athletes; in the elbow, little leaguer’s elbow, little leaguer’s shoulder, all of the irritations of the growing skeleton that are very common in patients that our pediatricians are seeing and what we see every day.
Melanie: What would you like pediatricians to tell their patients and even possibly the school or the parents about preventing these injuries?
Dr. Nepple: Yeah, I think it's important for our athletes, for our parents, coaches and us as medical providers to really be aware of the current environment in pediatric sports. I think we all grew up in an era where we played a variety of sports through our schools and played out in the yard to have fun and nowadays, it's a lot different in that our young athletes have opportunities to be very specialized to play on their school team and multiple club teams at the same time, and so we have very young athletes in some cases playing a single sport year-round so that really sets them up injuries, specifically these overuse injuries that they are utilizing certain muscle groups all year round. That's affecting their development and really leads to a lot of overuse injuries and in some case, more serious sort of acute injuries that can really be reasons that these kids end up dropping out of sports in the long run.
Melanie: Dr. Nepple, this is a tough discussion for a pediatrician to have with the parents as the sports- specific training is what they see and the athlete sees as the advantage in giving their child the advantage in this sport, but how do you want them to have this discussion and explain that there are certain things: cross-training, trying other sports, doing other things in between seasons, how do you want them to have this tough discussion?
Dr. Nepple: Yeah, I think so, nowadays, we actually have some science to support our perspective. So, there's more and more studies coming out that's showing that single sport specialization -- so playing one sport year-round -- is associated with an increased risk of injuries so really before the high school age, we really have to have caution if we're heading down that pathway, and if that is what we're choosing to do, to incorporate cross-training and adequate periods of rest and some time away from that sport to really set our athletes up for the best long-term development, and I think, especially for parents, there's often sort of a false misconception that focusing at such a young age is going to make them better athletes when they're in high school and in college, but, in fact, a lot of our elite athletes are actually developed through multi-sport programs. The US Women's Soccer team recently had some press about this, and most of those athletes played multiple sports and to develop the best athletes down the road, multiple sport participation is probably the best route that playing a single sport might help you develop part of that skill set quicker, but your athletic performance during those developmental years is probably, in the end, it’s better to have a balance between multiple sport participation.
Melanie: Are there are some sports that you would like to see go together? If it is not football season would you like them swimming, or not baseball season you don't want them doing too much with their upper body, maybe switching to a different sport? Are there some that you like that go together better than another?
Dr. Nepple: Yeah, I think, in general that's going to be very driven by the interest of the child. So, participating in any two sports is certainly better than participating in that single sport year-round, so, I don’t think there, we don't have to worry too much about certain combinations in general, but if there is enough variability in the activities they are doing to give them some balance. So, it is certainly better than one sport year-round, and athletes should be sort of free to choose with their parents what they're doing and, in general, I think most any two sports seem to work alright together.
Melanie: And what about other things like stretching and strength training in these young athletes. Do you advise pediatricians to help these kids learn proper technique if they have to do plyometric training or girls with ACL injuries in soccer -- certain things that you'd like pediatricians and coaches to know about working with these athletes to prevent some of these injuries?
Dr. Nepple: Yeah, I think our view on that's really changed a lot in the last several decades as well. So, for strength training, I think there have been sort of chronic misconceptions that strength training at too young an age can lead to injury to the growth plates and problems like that, but really once the child has adequate maturity to sort of understand the rules of lifting weights and has proper supervision and instruction on technique, weight training can actually be very good at a young age as long as they’re ready for it. On the warmup side, I think, that's also changed a lot – a lot of us grew up in the age of stretching and sitting around in a circle and counting to ten, and there's a lot of evidence coming down the road that really static stretching like that isn't as valuable as a dynamic warmup program. So, dynamic warmups where that the kids and athletes are moving really prepares them better for the practice or competition, and it gets them ready and probably decreases their injuries as well.
One of the big areas where we have good science on this topic is ACL prevention. So, ACL injuries, the anterior cruciate ligament, is one of the most common knee injuries that we see in the adolescent athlete, and we even see that in some younger pediatric athletes as well, and a lot of ACL tears happen because of the way we move. So, the neuromuscular control, certain risk factors where as people are cutting and landing the knees are kind of collapsing in called dynamic valgus is a clear risk factor for tearing your ACL and that tends to be more common in females, and we have programs nowadays that can help us to target these movement patterns to teach our younger athletes hopefully to move in ways that could prevent that big injury down the road.
Melanie: So, in summary Dr. Nepple, tell us what you would like pediatricians to know about these overuse and some acute injuries and even concussion so that they can best advise their patients and when do you think it's important for them to refer to a sports medicine orthopedic surgeon?
Dr. Nepple: Yes, I think it's important for pediatricians to understand that there is some science out there for preventing these kind of things. So, sports specialization, I think it's great to be able to educate all of our young athletes on this when the athlete comes in who is sort of headed down that pathway of playing a single sport year-round, and then as we get into things like ACL tears to know that there are ways to prevent some of these things, so there's great programs out there at the Young Athletes Center and St. Louis Children's Hospital or utilizing the FIFA 11 Plus Program which is a way to prevent these injuries that has good science behind it, probably preventing 30% to 50% of injuries including ACL tears, but other things like hamstring strains and ankle sprains that keep these kids off the field.
When you're at a very elite level, the national teams for many sports do all these things to prevent injuries, but we'd love to see these implemented more routinely in our schools and clubs here in the St. Louis area to hopefully prevent these injuries in some of our athletes because for some of them, an injury like an ACL tear can be a really life-changing experience. It might be the difference between them playing sports in college and having a college scholarship or the difference that they sort of lose track and can't keep up with their peers and never really do sports at the same level again, so sports injuries are really a big deal in the lives of these kids, and we have ways to prevent them. So, I think, the education and sort of implementation of some of these outreach programs is really what we're hoping to do here in the next few years.
Melanie: And what could a pediatrician expect from your team at St. Louis Children's Hospital after referring a patient to you?
Dr. Nepple: Sure, the Young Athletes Center at St. Louis Children's and Washington University is really a collection of providers across all specialties who care for the athlete; sort of a comprehensive approach to anything an athlete needs, not only the orthopedic or sports injuries that we see. It's physical therapy. It's nutrition, sports psychology, experienced pain management specialists, all those things that we brought together under this one umbrella so that at Children's and the Wash U Young Athletes Center, we are trying to be the sort of the one-stop shop for the young athlete so that pediatricians can know we have what their young athlete needs, and we'll take excellent care of them and have a good open line of communication.
Melanie: Thank you so much for being with us today. A physician can refer a patient by calling Children's Direct Physician Access Line at 1-800-678-HELP. That's 1-800-678-4357. You're listening to Radio Rounds with St. Louis Children's Hospital. For more information on resources available at St. Louis Children's Hospital, you can go to stlouishildrens.org. That’s stlouischildrens.org. This is Melanie Cole. Thanks so much for listening.
Injury Prevention In Youth Athletes
Melanie Cole (Host): For young athletes, coaches, and parents, the beginning of various sports seasons means young athletes of all ages face the challenges of injuries that range from sprains, cuts, and bruises on up to more serious problems. This year there is also a new state law in Missouri aimed at protecting student athletes from concussion. My guest today is Dr. Jeffrey Nepple. He's a Washington University pediatric and sports medicine orthopedic surgeon at St. Louis Children's Hospital and the director of the St. Louis Children's and Washington University Young Athletes Center. Welcome to the show, Dr. Nepple. So, I'd like to first start with what are some of the most common types of overuse injuries that you expect pediatricians to be seeing during the sports seasons?
Dr. Jeffrey Nepple (Guest): Sure, well thank you, again, for having me. I think we live in an era where sports injuries and pediatric and adolescents athletes are extremely common, so as many as three to four million of these injuries occurring yearly and about half of them are probably due to overuse. So, we see a lot of overuse injuries related to overuse of certain muscle groups and a growing athlete where we have tendonitis or apophysitis where we have irritation of the growth plate leading to injuries. We see this commonly in the lower extremity. Osgood-Schlatter's is a common scenario in the knee. We see it in our baseball and softball athletes; in the elbow, little leaguer’s elbow, little leaguer’s shoulder, all of the irritations of the growing skeleton that are very common in patients that our pediatricians are seeing and what we see every day.
Melanie: What would you like pediatricians to tell their patients and even possibly the school or the parents about preventing these injuries?
Dr. Nepple: Yeah, I think it's important for our athletes, for our parents, coaches and us as medical providers to really be aware of the current environment in pediatric sports. I think we all grew up in an era where we played a variety of sports through our schools and played out in the yard to have fun and nowadays, it's a lot different in that our young athletes have opportunities to be very specialized to play on their school team and multiple club teams at the same time, and so we have very young athletes in some cases playing a single sport year-round so that really sets them up injuries, specifically these overuse injuries that they are utilizing certain muscle groups all year round. That's affecting their development and really leads to a lot of overuse injuries and in some case, more serious sort of acute injuries that can really be reasons that these kids end up dropping out of sports in the long run.
Melanie: Dr. Nepple, this is a tough discussion for a pediatrician to have with the parents as the sports- specific training is what they see and the athlete sees as the advantage in giving their child the advantage in this sport, but how do you want them to have this discussion and explain that there are certain things: cross-training, trying other sports, doing other things in between seasons, how do you want them to have this tough discussion?
Dr. Nepple: Yeah, I think so, nowadays, we actually have some science to support our perspective. So, there's more and more studies coming out that's showing that single sport specialization -- so playing one sport year-round -- is associated with an increased risk of injuries so really before the high school age, we really have to have caution if we're heading down that pathway, and if that is what we're choosing to do, to incorporate cross-training and adequate periods of rest and some time away from that sport to really set our athletes up for the best long-term development, and I think, especially for parents, there's often sort of a false misconception that focusing at such a young age is going to make them better athletes when they're in high school and in college, but, in fact, a lot of our elite athletes are actually developed through multi-sport programs. The US Women's Soccer team recently had some press about this, and most of those athletes played multiple sports and to develop the best athletes down the road, multiple sport participation is probably the best route that playing a single sport might help you develop part of that skill set quicker, but your athletic performance during those developmental years is probably, in the end, it’s better to have a balance between multiple sport participation.
Melanie: Are there are some sports that you would like to see go together? If it is not football season would you like them swimming, or not baseball season you don't want them doing too much with their upper body, maybe switching to a different sport? Are there some that you like that go together better than another?
Dr. Nepple: Yeah, I think, in general that's going to be very driven by the interest of the child. So, participating in any two sports is certainly better than participating in that single sport year-round, so, I don’t think there, we don't have to worry too much about certain combinations in general, but if there is enough variability in the activities they are doing to give them some balance. So, it is certainly better than one sport year-round, and athletes should be sort of free to choose with their parents what they're doing and, in general, I think most any two sports seem to work alright together.
Melanie: And what about other things like stretching and strength training in these young athletes. Do you advise pediatricians to help these kids learn proper technique if they have to do plyometric training or girls with ACL injuries in soccer -- certain things that you'd like pediatricians and coaches to know about working with these athletes to prevent some of these injuries?
Dr. Nepple: Yeah, I think our view on that's really changed a lot in the last several decades as well. So, for strength training, I think there have been sort of chronic misconceptions that strength training at too young an age can lead to injury to the growth plates and problems like that, but really once the child has adequate maturity to sort of understand the rules of lifting weights and has proper supervision and instruction on technique, weight training can actually be very good at a young age as long as they’re ready for it. On the warmup side, I think, that's also changed a lot – a lot of us grew up in the age of stretching and sitting around in a circle and counting to ten, and there's a lot of evidence coming down the road that really static stretching like that isn't as valuable as a dynamic warmup program. So, dynamic warmups where that the kids and athletes are moving really prepares them better for the practice or competition, and it gets them ready and probably decreases their injuries as well.
One of the big areas where we have good science on this topic is ACL prevention. So, ACL injuries, the anterior cruciate ligament, is one of the most common knee injuries that we see in the adolescent athlete, and we even see that in some younger pediatric athletes as well, and a lot of ACL tears happen because of the way we move. So, the neuromuscular control, certain risk factors where as people are cutting and landing the knees are kind of collapsing in called dynamic valgus is a clear risk factor for tearing your ACL and that tends to be more common in females, and we have programs nowadays that can help us to target these movement patterns to teach our younger athletes hopefully to move in ways that could prevent that big injury down the road.
Melanie: So, in summary Dr. Nepple, tell us what you would like pediatricians to know about these overuse and some acute injuries and even concussion so that they can best advise their patients and when do you think it's important for them to refer to a sports medicine orthopedic surgeon?
Dr. Nepple: Yes, I think it's important for pediatricians to understand that there is some science out there for preventing these kind of things. So, sports specialization, I think it's great to be able to educate all of our young athletes on this when the athlete comes in who is sort of headed down that pathway of playing a single sport year-round, and then as we get into things like ACL tears to know that there are ways to prevent some of these things, so there's great programs out there at the Young Athletes Center and St. Louis Children's Hospital or utilizing the FIFA 11 Plus Program which is a way to prevent these injuries that has good science behind it, probably preventing 30% to 50% of injuries including ACL tears, but other things like hamstring strains and ankle sprains that keep these kids off the field.
When you're at a very elite level, the national teams for many sports do all these things to prevent injuries, but we'd love to see these implemented more routinely in our schools and clubs here in the St. Louis area to hopefully prevent these injuries in some of our athletes because for some of them, an injury like an ACL tear can be a really life-changing experience. It might be the difference between them playing sports in college and having a college scholarship or the difference that they sort of lose track and can't keep up with their peers and never really do sports at the same level again, so sports injuries are really a big deal in the lives of these kids, and we have ways to prevent them. So, I think, the education and sort of implementation of some of these outreach programs is really what we're hoping to do here in the next few years.
Melanie: And what could a pediatrician expect from your team at St. Louis Children's Hospital after referring a patient to you?
Dr. Nepple: Sure, the Young Athletes Center at St. Louis Children's and Washington University is really a collection of providers across all specialties who care for the athlete; sort of a comprehensive approach to anything an athlete needs, not only the orthopedic or sports injuries that we see. It's physical therapy. It's nutrition, sports psychology, experienced pain management specialists, all those things that we brought together under this one umbrella so that at Children's and the Wash U Young Athletes Center, we are trying to be the sort of the one-stop shop for the young athlete so that pediatricians can know we have what their young athlete needs, and we'll take excellent care of them and have a good open line of communication.
Melanie: Thank you so much for being with us today. A physician can refer a patient by calling Children's Direct Physician Access Line at 1-800-678-HELP. That's 1-800-678-4357. You're listening to Radio Rounds with St. Louis Children's Hospital. For more information on resources available at St. Louis Children's Hospital, you can go to stlouishildrens.org. That’s stlouischildrens.org. This is Melanie Cole. Thanks so much for listening.