Joey Wahler (Host): It's a key part of participating, so we're discussing preventing kids' sports injuries. Our guest is Dr. Scott Berger. He's Chief Medical Officer for University of Maryland Urgent Care. This is the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Berger. Welcome.

Scott Berger, DO: Thank you for having me.

Host: Oh, great to have you. We appreciate the time as always. So first, what would you say, Doctor, are the most common injuries you see these days in youth athletes? And what are some things parents can do in a nutshell to help prevent those?

Scott Berger, DO: Yeah. The things that we see most commonly are sprains and strains, so things around the ankles, you know, you see some knee injuries, overuse sort of injuries where kids are just doing lots of activity. Unfortunately, you know, a fair number of concussions. Those are the sorts of things we see most commonly in the sports injury field.

Host: You mentioned concussions. And soccer for those unaware has a lot of concussions, which perhaps people, if they don't know any better, wouldn't expect because it's not considered a "contact sport," but there are a lot of concussions there, right?

Scott Berger, DO: Yeah, absolutely. Between contested headers-- you know, I used to play soccer as a kid, and I think about the number of times a contested header when you're doing a corner kick or a goalie kick. And you're going up there and banging heads with the other kids. Kids are running around the field at really high rates of speed. And if you don't pivot quickly enough, you can collide with somebody. So, there's lots of opportunities there, and you don't obviously have any protection in that scenario. So yeah, fair number of concussions. Volleyball, gymnastics and tumbling, basketball, all these. It's not just football and lacrosse and ice hockey and sports that encourage contact, it's for the non-contact sports also that you see a fair number of them.

Host: Great point. So, you mentioned there overuse, overtraining, that type thing. So regarding parents, is that one thing they really need to keep an eye on? And how do they monitor that?

Scott Berger, DO: I think there's a really good body of evidence to suggest that doing the same activity repeatedly in the same sport throughout the year, it can be great to become expert at it, but it also leads to challenges because you're using the same muscle groups repeatedly in the same way. And so, balanced training is so important. When kids are young, focusing on technique and making sure that people are doing things the proper way, that reduces some of the sports injuries. Focusing on overall strength and flexibility, not just focusing on one specific element of it.

And then, breaks, that's really important. You know, when kids are doing sports six days a week, things like that, they're just ripe for injuries, either from overuse and just fatigue, right? Where your technique starts to deteriorate over time because you're just tired and you've gotten good at something. So, you can get away with maybe doing something a little bit in the wrong way. And then, when that happens, you're more likely to become injured.

Host: Absolutely. So, how important is it for parents to maybe recognize certain signs short of injury even that overtraining or burnout is occurring? What can they look for?

Scott Berger, DO: Well, you should look for signs that maybe your son or daughter isn't sharing with you that something is hurting, but look for how they're interacting and behaving during the course of the day. Are they limping? Are they favoring an area? Do they seem to be having difficulty? If you are noticing anything, like with day-to-day activities, right? If it's something small and minor, but they're saying it's starting to hurt, think about it in the context of what sport they're playing. You know, a baseball player, maybe say a pitcher who's complaining that it hurts when they're signing their name or they're eating food. You know, start thinking about, "Hey, are they having trouble with their elbow, you know, because they're working too much?" Or the athlete who doesn't want to jump right now when they're just horsing around because their ankle or knee is hurting them, look for these subtle cues that maybe will help parents even when the kids don't want to, right? Because the kids, they just want to keep playing in so many instances and they're so driven to be the best. Our culture has gotten so focused on achievement in athletics, that some of these kids really will push themselves to beyond the point of failure. So, you've got to be their advocate for them and look out for that.

Host: Very well said indeed. Kids just want to play, right? So, most youth sports programs these days, of course, require each athlete to have a preseason physical. Why are they so important? Where can families go to get one?

Scott Berger, DO: Yeah, these things are very important. I mean, when we're doing sports physicals for families and for kids, we're really focusing on a couple of different things. We're focusing on their past athletic performance, injuries that may have occurred, and what has been the recovery from those, you know, making sure that there aren't some limitations that maybe folks are staying quiet about that could impact them in the future. You know, did they have a significant injury that they partially recovered, they did it on their own. But, boy, now their knee's not bending properly, and did they really get the proper care for that? And if they didn't, what do we need to do to make sure that they're safe for that? You know, so that examination.

The other piece is looking at their history in terms of family history and their own individual history for things that could be red flags for some of the very tragic things you hear about. You know, thank goodness they're relatively infrequent. But every now and again, you catch somebody who through asking about the family history, there is something concerning from a parent, a grandparent, a cousin that could there be a congenital sort of thing that nobody knows about that is identified during one of these evaluations.

And again, we talked a little bit about concussion earlier. The aggregate effect of head injuries is pretty obvious to most folks now. And so, you never want to take a child out of athletics altogether, but you want to make sure that everybody's aware of the risk. And if a child has had two or three concussions, we need to make sure everybody's on the same page with this and that they're connected with the right specialists. You know, University of Maryland has an incredible group of sports physicians, throughout the whole system that can track and monitor these kids and make sure that they are safe.

Host: You mentioned earlier there can be issues with specializing in one sport year round overtraining, burnout, et cetera. How about your advice, Doctor, for balancing multiple sports year round?

Scott Berger, DO: Personally, my take is that a well-balanced athlete is going to likely, in the long run, be the best athlete. Because you're using different muscle groups, you're developing different aspects of your balance centers. And that will only benefit you when you do specialize in one sport as you get older. Making those transitions between the sports Is probably the best way to achieve.

I do worry about when somebody specializes in one sport all year round. And I think when kids are doing multiple sports during any given season, it can be challenging both from the time commitment, it takes away from other aspects of their life. You know, let's make sure they're academically achieving. Let's make sure that that they have downtime, right? We are so plugged in as a society now. And these kids, they're more or as much as any of us, we all need downtime. So, my feeling is that there shouldn't be athletics every day of the week, that you need downtime, you need just kind of casual social interaction. You need to focus on your studies and do the other things that are important. Spend time with family and friends.

Host: All important, for sure. So, speaking of which, some kids do take time off, of course, between sports seasons, especially if they play just one sport. What's your advice then, Doctor, for the off season to safely return to action once it's time?

Scott Berger, DO: It's very good to prepare in advance, right? It's something that you don't want to, and I know I could think back to my own high school sports days where we would show up for soccer practice at the beginning of the year, the day before. And that was terrible. And I think of some significant injuries I had because of it, because I wasn't prepared. And kids do a much better job now with this. It's focusing on overall fitness, overall strength and flexibility and proper technique preparing for the season. Whether it's soccer, it's tennis, it's whatever sport it is, you want to make sure that you're focusing on doing things the right way and building up your endurance over a period of time so that when you hit the season, you're hitting the ground running, right? Because everybody wants to start on their team and perform to the highest level. And you need time for your body to get adapted and back into the mix with it. Youth is great because it's a great equalizer in terms of you can perform at a higher level quicker, but you still need time.

Host: And picking up on that, how about age-appropriate strength or conditioning programs you recommend to help prevent injuries, especially?

Scott Berger, DO: Yeah. It's all about focusing on the whole body. Young kids shouldn't be focusing on building muscle mass particularly. They should be focusing on just overall making sure they have good core muscle strength, making sure they have great flexibility, and that they're focusing not just on their arms or their back. You know, that they're doing it all, their legs, that they're doing a little bit of everything, so that when they get into those athletics, they're really able to perform and no part of their body fails them when they get into those sports. So, it's doing all that. It's taking your time to get into those sorts of programs and really not focusing on being the next Arnold Schwartzenegger as part of it if you're doing sports.

Host: I love that you went with Arnold to drive that point home. That's great.

Scott Berger, DO: I'm a little dated, but that's all right.

Host: It works. Everybody knows who he is. Even younger people know him more from the movies than as a great bodybuilder years ago. A few other things, Doctor. How about that very important parent-coach relationship here. How can parents best advocate for their child's safety with coaches or athletic programs overall, especially if their child is injured or in pain and maybe others aren't recognizing that enough?

Scott Berger, DO: This is all about advocacy, and most parents are great advocates for their kids. Their number one priority is the safety of their child. But for those instances where there's an overzealous coach or perhaps a coach who's just not recognizing it, you know, you've got multiple kids on the field and you're not recognizing that this one child might be struggling and the kid might not be telling them, it's really important that the parents have a relationship with those coaches and realize you are the final arbiter of what is safe for your child. It doesn't matter if that coach really wants to win. If your child is not feeling well, is injured, it is your right and responsibility to say, "Not today. That college scholarship isn't going to go away if you miss one game, one tournament." If your kid is really to that level, that's not going to be the deciding factor for them. And you need to make sure that they're safe and healthy, because they've got the rest of their lives to lead. And you don't want them having a catastrophic knee injury that impacts them for the rest of their adult lives or another concussion, and they wind up with issues from that. So, it's really about advocacy.

Host: Definitely need to keep things in perspective. We touched earlier on concussions. What should parents know about preventing them? And what to do if they suspect one is evident?

Scott Berger, DO: So if you suspect one has happened, the most important thing is to get medical attention right away. Whether that's a child's pediatrician, if you have a relationship with a sports medicine physician who specializes in concussion, University of Maryland Urgent Care does initial screening and evaluations for children and adults who may have sustained a concussion and then get them connected with the right specialists throughout the organization so they can track their progression and improvement through it.

One thing that's really important for families to understand is the signs and symptoms of a concussion don't always show up right away. So, a challenge that we're sometimes faced with is the parent who comes in with their child and they had a significant blow to the head an hour or two earlier on a sports field. Everyone wants that child to be cleared to return to sports a few days later. And understanding that some of those symptoms that develop from a concussion take time. So, that child needs to be removed from athletics to give some time to see how their brain is recovering from that injury and make sure that they're safe. Again, it's all about preventing then that next injury and making sure that we get them in the right space so that they have a great outcome long term and that they can perform academically in the future. And if they continue to perform in sports, that they're safe to get back into the sports.

Host: Naturally having you and yours available at UMMS is great, but are there any common injuries here that can be treated at home?

Scott Berger, DO: I would say mostly minor sprains and strains, cuts and bruises, things of that nature. If they seem to be recovering quickly, if there's no obvious deformity, I think that would be fairly obvious to folks. If things seem to be improving quickly within a day or so, that there's no pain. They're not limping, you know, they're moving their wrist okay. Things of that nature with some ibuprofen, some rest and some ice. Those are fine to stay home and just kind of evaluate and see how things are going.

A lot of high schools now have access to athletic trainers who are highly skilled professionals who are able to assess these athletes and make determinations as to whether or not they need to go to an urgent care or to a sports medicine physician, get x-rays or other advanced imaging and bracing. It's all about guidance and what you need to do.

Another beautiful aspect of healthcare in 2025 is the availability of telemedicine. It's possible to get some anticipatory guidance and some limited physical examination through a telemedicine appointment. We offer that during our hours of operation so that if a family just wants somebody to put eyes on somebody and say, "Hey, is this something that we need to come in for?" we can take care of that for folks. If they're out further from one of the clinics, they can get some additional advice just using a video link.

Host: Telemedicine indeed. Definitely becoming more popular than ever. And finally, Doctor, in summary here, if you had to list job one, maybe in terms of just a mindset the parents should keep in mind, if they have a school-aged kid playing sports and they want them to prevent injury, what would it be? Oftentimes, there's so much going on, right? There's getting the kid to and from wherever they need to. There are other kids, perhaps siblings. You've got your job, you've got meals to cook or prepare or whatever. And sometimes, things can get lost in the shuffle, right?

Scott Berger, DO: I think well rested, proper nutrition, and making sure that the focus is on having fun. That if you do those things, your child will excel to whatever level they can and want to excel to. And that's really what's most important. What does the child want? And just being happy for them to whatever level of achievement they're looking to achieve and not pushing too hard.

Host: Yeah. Oh, by the way, remember to have fun, right?

Scott Berger, DO: Yes.

Host: That's the best advice of all. Well, folks, we trust you are now more familiar with preventing kids' sports injuries. Dr. Berger, such great advice. Keep up all your great work, and thanks so much again.

Scott Berger, DO: Thank you.

Host: Please check out the show notes to learn more about University of Maryland Urgent Care Services and locations. You can find more shows just like this one at umms.org/podcast on YouTube or your favorite podcast platform. If you found this podcast helpful, please do share it on your social media. And thanks again for being part of Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again.