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New Program "Bridges" the Rehabilitation Gap for Young Athletes

Melanie Cole (Host): So many of our young athletes are unprepared to really fully participate in sports without risk of injury. My guest today is Paul Jenkins. He’s a physical therapist and the Rehabilitation Supervisor at St. Louis Children’s Hospital. Paul, I’m glad to have you with us as I’m an exercise physiologist and I see what this is and these kids that are not completely prepared. What are you seeing as the most common injuries our young athletes are facing today?

Paul Jenkins PT, MSPT, OCS (Guest): So, I think the most common injuries are still things like just ankle sprains and things of that nature. But the more serious injuries are happening more often and that requires so much extensive rehab and keeps kids off the field for such a long period of time. ACL injuries which used to be rare in children are really becoming almost commonplace.

Host: So, before we talk about the Bridge Program, do you feel as a sports medicine professional, a physical therapist, that we are seeing a lot of sport specific overuse injuries and you mentioned ACL and we see that in girls’ soccer players, but that we are seeing too much sport specific at a young age, so by the time they are in their teens or even wanting to play collegiate sports; they’ve got some overuse injuries that are very tough to deal with.

Paul: Oh yeah, I think it’s a real challenge is that with sport’s specialization at such an early age, that the kids are not necessarily developing all the different muscles as well as the neuromuscular patterns to really use their muscles to do different things. And then when suddenly a move takes place during whatever sport they are playing, they can really be at more risk of injury and then the overuse like you already mentioned becomes the strain on the tendons over and over again from performing in the same repetitive functions, really can add up where there are a lot of kids we find are playing in pain but they don’t want to risk saying anything because they are afraid to lose their position on the team.

Host: That’s true. It certainly is. So, tell us a little bit about the Bridge Program. What is it?

Paul: So, the Bridge Program is a group exercise class for adolescents, and it’s led by physical therapists and athletic trainers focusing on lower extremity strengthening and incorporating that neuromuscular training that has been shown to reduce a lot of these injuries.

Host: Why did you see the need for a program like this?

Paul: So, we actually saw two different needs that we tried to combine into one program. First, we saw that need for many of the healthy individuals that we’ve been talking about, these healthy athletes don’t have an opportunity to perform the specific strength training that’s been shown to reduce injuries because they are focusing on their team or their practices and their skills. And then second, we had many of our postoperative and post-injury patients who were so limited by their number of insurances and needed much more strength training to supplement what was going on in physical therapy and there was just no place for them to go.

Both of these groups we feel like have few opportunities in this age range because most of the gyms and places where they could go to work out really don’t allow 12-year-olds, 14-year-olds, even 15 and 16-year-olds to come in and work out there. So, unless they are really getting into the school gym or there’s programs like that; there is no place for them to go. And what’s out there isn’t necessarily led by skilled professionals who can really appropriately understand the ability of the children.

Host: So, you mentioned 12 and 14-year-olds. What’s the minimum and maximum age of participants?

Paul: So, currently, we are offering the program for 12 to 18-year-olds. It’s important that we had a cohesive enough group that the kids can actually work out together and we don’t want to end up where there’s just a real mismatch in abilities and we targeted this population because we saw the biggest needs. As we progress, we are looking at possibly beginning to offer either breaking it down to more age groups or expanding that in the future, but right now, it’s 12-18.

Host: And I love that age group because they can really motivate each other and do the buddy system and really help each other to thrive and to achieve whatever they are trying to achieve. So, tell us, is this a referral based program or can anyone participate?

Paul: So, there’s no referrals required. And that’s one of the things that is a distinction between our program and formal physical therapy. The exercises are not customized for one patient, so they are not meant to replace physical therapy but target those common needs. We do ask that patients who have had an injury or surgery are cleared by their physician to perform strenuous exercise but there’s not necessarily a referral requirement.

Host: And where are these sessions held?

Paul: So, we hold these at the Young Athletes Center at the Children’s Specialty Care Center which is at 13001 North Outer Forty Rd in Town and Country.

Host: And now, let’s talk about what actually happens at the program and at these classes. What types of exercises are you using, what’s involved and who is facilitating these sessions?

Paul: So, I would love to go into that. So, each session what we have done is we’ve designed this so that each session begins with the FIFA 11+ Warm Up Program, which was developed actually for soccer, but it’s been shown through research to have very much of a cross effect on a lot of your court sports and things of that nature. So, a lot of the sports that are lower extremity dominant, basketball, La Crosse, all those sorts of sports are really feeling the same sorts of value that we saw initially in the soccer players.

So, we do that as a warm up and then each of the exercise sessions has a different focus. We do three different groupings. One we just focus on strength training specifically, the next is more the plyometrics and the agility portions of the training and then the third session would be a combination of both. So, we kind of rotate through one of those main topics focus each time. And each session is facilitated either by a certified athletic trainer or a physical therapist or both. Most sessions we will usually have one of each at so that way we have rehab professionals that have the similar but not necessarily the exact same point of view that are able to work with the kids to really make sure that they are doing things to the best of their abilities.

And all the staff that we have are really experienced at specifically working with this age range of athletes.

Host: That’s really cool. Paul, I think that that’s excellent because as you said, these kids are looking for a place that’s not just their physical therapy appointments and those are limited by insurance and everything else. So, does this program meet the requirements of the FHSA and is there a cost? How can somebody get involved and register?

Paul: So, we designed the program to meet the requirements of the Flexible Healthcare Spending Accounts. So, for most programs this should really work into that if the families have that option available. But we do recommend that you check with your specific FHSA, just to make sure because some have unique requirements and we did not have the ability to necessarily customize it to all. But we really wanted it to be accessible and we wanted it so that cost would not be a burden.

The cost is $25 per class and you can register in one of two ways. You can either go to www.stlouischildrens.org/bridgeclass or by calling at the 314-454-KIDS line. Online is really simple and you can sign up for as many sessions as you want, but the one downside of that is that closes a day before each class so that if you wanted to sign up for either the same day or just the day before that you will need to do by phone.

Host: So, when would you like kids, because this show is for providers, when would you like them to bring up this discussion with their young athletes, if they are visiting their pediatrician or they’ve been in physical therapy and it’s kind of ongoing, but they really need a little expansion and they need to get involved in something like this. How would you and when would you recommend that providers start referring to this class and saying you know what, here’s some really great information about this Bridge Class?

Paul: So, I think that’s a great thing to think about. I think really when the kids are coming in for their annual physical visits, if the pediatricians are going to give them a good breakdown on what they are doing as far as physical activity; if they find that these kids are involved in athletics and sports, especially when they start seeing those single sports focused kids or even just any of the all-around athletes; that they kind of look at that as being there is a risk of sports injuries. That rate has gone up quite a bit through the years, so I think that it’s important that they look at that and now that we have such strong evidence that shows the injury risk can be reduced by programs like this; that they want to offer that so they know that understanding that the evidence of dynamic strengthening and neuromuscular movement patterns can reduce injuries so that their patients all have the least likelihood of getting hurt and the most opportunities to really excel in what they are trying to do to the best of their abilities.

Host: What a great program, Paul, so wrap it up for us. It’s not meant to replace physical therapy, right, so it may be a supplement, an adjuvant type of therapy but a lot more fun, I imagine for these kids. What would you like us all to know and other providers to know about the Bridge Program?

Paul: I think you really actually brought up one of the I think the key topics there. Is that it’s the working out together that creates a unique element here to this. It’s one of the things that I think is really great because so many times when the kids are doing exercises together, it’s in that team environment where the focus is on the sport. And this way, we really take that out of it and can let them focus on the underlying skills that they need to be able to perform the skills in the sport. We’re working on that and they can really see a positive gain quickly. The kids we see in an enjoyable and encouraging each other and they motivate each other really which makes it a much more enjoyable experience.

And they really are able to then, because they are working on the underlying skills needed for performance; they see a lot of their success a lot more quickly.

Host: Wow. That’s great information and thank you so much for coming on Paul and telling us all about the Bridge Program. And again, to register please visit www.stlouischildrens.org/bridgeclass.  

And that wraps up this episode of Radio Rounds with St. Louis Children’s Hospital. To consult with a specialist or to learn more about services and resources available at St. Louis Children’s Hospital, please call Children’s Direct Physician Access Line at 1-800-678-HELP or head on over to our website at www.stlouischildrens.org for more information and to get connected with one of our providers. If you as a provider, found this podcast informative, please share with your patients, their parents and on your social media and be sure to check out all the other fascinating podcasts in our library. This is Melanie Cole.