Scott Webb (Host): Welcome to the Live Greater Podcast Series, Information for a Healthier You from the University of Maryland Medical System. I'm Scott Webb. And college athletes have teams of professionals helping them to stay healthy, recover, and perform their best, of course. Parents may not have those same resources at home, but they can borrow many of the same principles to support their young athletes. Learn from Dr. Jonathan Packer, team physician for the University of Maryland Terps and orthopedic surgeon at the University of Maryland Orthopedics, on how parents can help keep their young athletes healthy. Dr. Packer, welcome.

Jonathan Packer, MD: Hi, thanks for having me.

Host: Yeah, it's great to have you here. I was mentioning that I have a college athlete in my family. My daughter plays college basketball, so this one's right in my wheelhouse. I've been looking forward to this. And I want to get a sense from you, when you work with college athletes, what healthy habit do you wish they maybe learned earlier that us parents could have taught them earlier in their athletic careers?

Jonathan Packer, MD: First of all, a lot of the college athletes already have a lot of these good habits, and that's what helped get them there. But you notice over the course of the college career, a lot of them will learn the value of taking care of their bodies. It's everything they do in between the games, in between the practices. Getting adequate sleep, critically important. Nutrition, recovery, making sure you are eating healthy. What you put in your body is going to directly correspond to how you perform. And then, mental health is also really important. So, there's all these factors, and that's why we have such a big medical team and staff to help take care of these athletes, because we really want every aspect of their life to be aligned with really optimizing their body and getting them ready. And then, obviously, you know, once they're out, they're just fully prepared to be the best they can be.

Host: Yeah, that's so true in my experience. Daughter came home for a couple of weeks and she gave me a shopping list and I was like, "Who are you? When did you start eating, you know, cottage cheese like it's going out of style, and avocado and some of these, you know, healthier things?" And so, I'm glad to have her home of course, and glad to stock the fridge with things that she needs and likes and that she's used to in terms of like what's been prescribed to her from the team at her school.

And I mentioned there in the opening, athletes have access to coaches, trainers, medical teams. Maybe what habits, you know, from that environment can we realistically help young athletes adopt at home?

Jonathan Packer, MD: Obviously, it's nice to have 20, 30 or more medical professionals helping. But a lot of these different habits that help, you can easily adopt at home. Again, really prioritizing sleep, making sure you're not skipping meals, what you eat, right? Eating candy, you know, is probably not going to help you.

And just adequate recovery. I think that's something that, as athletes develop and as they get into college and then eventually hopefully professionals, if they want to do that, they spend more and more of their efforts into recovery and what they're doing in between to let their bodies recover.

For example, right now is preseason football. They weigh themselves before and after every practice just to see how much fluid they lose, and sometimes it's eight pounds or more. I mean, think about how much fluid that they need to put back into their body so that the next morning they're ready to go again.

So, a lot of those, you might not have access to all of the implements that you would need, but you can really start to adopt those principles. And obviously, you know, seek help if needed.

Host: Yeah. It makes me wonder. We've touched on some of the greatest hits, if you will. So, sleep, hydration, nutrition, and how important they are to athletic performance and injury prevention, of course. Which one do us families, we families, tend to underestimate the most?

Jonathan Packer, MD: I would say recovery, just recovery in general. You know, I see a lot of patients in, you know, my regular clinic, I see a lot of young athletes, and they have some overuse injuries. And then, you ask a little bit more about what they're doing, and it would be the "off-season," and they played five games last weekend. And then, they're in three different leagues. And it's almost like an arms race amongst neighbors to how can you get into the most amount of things. But when the body doesn't have the resources to recover, you're not going to be at your best, and definitely puts you at a higher risk of injury.

So, I would definitely recognize the value in that. And then, in the off-season, I mean, going to the orthopedic realm, strength and conditioning. And there are some—and you can find online, even on YouTube—some very good ACL prevention programs that most colleges have adopted, you know, to do during their off-season.

But there is very good evidence to show that they can substantially reduce the risk of ACL tears, even starting like four to six weeks before the pre-season. Because if you start thinking about this the day before pre-season starts in August, let's say for fall sports, it's already a little late. And I can't tell you how many, times during the pre-season physicals, I've seen cross country runners, and I ask how, "How's your running going?" And they say they haven't been running all summer, and they have their season starting. So, high risk for like a stress fracture or other injuries that way. So, it's kind of thinking year-round, or at least the months before, what can I do to really get my body ready once things ramp up? And we know, I mean, kids are pretty resilient, a lot more so than you and me. But there are limits, and we're really trying to really optimize their health and performance.

Host: Yeah, so true. Sports is a year-round thing, a year-round business. As you say, many athletes go from one sport to the other, or they play the same sport year-round. My daughter did comment when she came home and continued to play, you know, shoot baskets and work out and all this, that she misses the recovery program that they have at school because she was feeling a lot more sore than she ordinarily was at school, because she doesn't have that recovery after a workout, after shooting, you know, hundreds of shots.

So, I'm right there with you. And we should talk about injuries. You touched on that a little bit. You know, we encourage young athletes to speak up when they're hurt, of course, but we also know that they know that if they speak up and we think they're hurt, then maybe they, like, might not play or they might not start or whatever's important to them.

So, there's a kind of a balance there. And I think it's maybe, Doctor, helping them understand the difference between, like, normal soreness and pain and maybe, you know, something that shouldn't really be ignored. Like, some things will go away and some things might not. So, how do we sort through all that?

Jonathan Packer, MD: Yeah, no, it's a great question. It's something I encounter a lot. And we get it. They want to play, right? So, there's an understandable feeling that, "Hey, if I tell a coach, a parent, or a doctor that something hurts, they're going to tell me I can't play." They might not speak up. So, I think it'd be important to maybe not wait until they're hurt, but just ahead of time, just say, "Hey, look, we want to make sure you're healthy." Reiterate that if you're healthy, you're going to be at your best, and that oftentimes something that could be easily addressed with maybe a day or two of rest or a week. If you keep playing, it can become something worse. And now, ultimately, you'll end up missing more time, and you won't be as good when you play.

I've also unfortunately seen many times, more often in high school where they try to play through, let's say, a right leg injury. And then, they'll tear an ACL on the other side or get a problem on the other side, because they're compensating and they're hobbling around. So, sometimes you're not just making that problem worse, but you're at risk for a different injury somewhere else that might cost you a year, like in that ACL.

So, unfortunately, I've tried to convince some high school kids, and their parents who are on the college track to get something addressed, and they don't want to because it's, you know, recruiting season. And you can find a doctor to tell you what you want to hear. You can find enough of them. But it's just, again, really important to address things as they come up. And so, in college, you have a lot more eyes on you. The athletic trainers, they look out for this. They won't let you get back in there. There's a doctor there every day.

So, they have more eyes on you, whereas you can slip under the radar a little bit before that in middle and high school. So, I would just tell them to open up the communication and that we're just trying to help. And for specifics, it's obviously a little bit harder if you're not in the medical field. I would say as a general rule of thumb, if it's kind of a bump or bruise, and if it's within 24, 48 hours, if it's a lot better, that's usually, you know, a good sign that it's nothing serious. If it's something that's getting worse and not better, particularly, like, if we use a knee joint, for example, if there's a lot of swelling in the joints, if it really blows up for any child, that's something that should get evaluated.

If the pain is sharp, if you feel like something's unstable, you know, those are kind of some of the buzzwords, it may not be anything serious, but that puts a definitely a higher risk of something that needs to be warranted. You know, going to the emergency room is rarely going to be helpful, just because they're not really trained in this. But in urgent care, many of the orthopedic clinics will have urgent cares or just getting in to with either your primary doctor or primary sports physician or orthopedic surgeon. And, you know, at least, you know, we can help rule out some of the serious injuries.

Host: Yeah, it does seem in high school there's more of that rub some dirt on it mentality. Whereas you say at the college level, there's just so many eyes and so many experts looking out for them, helping them, and I wanted to kind of focus in on that a little bit. Maybe what could young athletes learn from college athletes in terms of recovery after practices, after games, after tournaments? You know, like, they could maybe use them as the model a little bit of like, boy, they're always ready to go next game. How do they do that?

Jonathan Packer, MD: I would say the first thing is, again, I'll just use the football example because we're coming up to football season. Right after practice, the vast majority of them do not just shower and go home. Practice is over, but now it's the post-practice. So, they are in the ice tubs. They are icing. They are getting treatments by an athletic trainer.

I mentioned the fluid loss. They immediately are hydrating. They have protein they're drinking. So, the recovery starts the second they get off the field. So if you wait until the next morning or later that night, you've already lost a lot of valuable time. Stretching, you know, they're going to stretch, cool down, et cetera. So, these are all the things that they're thinking about immediately. What can I do to get myself ready for the next practice or whenever it is?

Really timing meals. Let's say you burned 800 calories in a practice, you got to get that back or you're going to be sluggish the next day. So, just tracking that. Now, obviously, in the college level, they have a nutritionist, they have a lot of resources, but you can do a lot of this on your own, you know? There's a lot of great resources online nowadays. And it's just trying to incorporate those habits. I think if you start to think about recovery in those terms, as you go on and as you learn—and everyone's body's different obviously. What athlete one will need for recovery would be very different than athlete two, and kind of learning your body so that as they go to college and maybe beyond, they really have ingrained into them what they need to do. I think that that's really important.

Host: Yeah, I've learned the value, Doctor, from my daughter. You know, I used to see in athletes, college and pro, the circles on their backs and stuff, you know, from the cupping. And then, I always wondered, what is that, and why do they do that to themselves? And I've learned from my daughter it's a part of the recovery, something that they do after workouts, after practice. So, I understand a little better why she has all these circles all over her body. So, I kind of get that now. And recovery's so important.

And we've touched on a little bit the importance of rest and cross-training and overuse, and just how many young athletes just play and play and play year-round. Like, what can we learn from college programs about the importance of things like rest, and then implement at home?

Jonathan Packer, MD: Just because you don't have all those resources doesn't mean you can't do a lot on your own. So, you might not have a masseuse to massage you after a game, but you can get a foam roller and a lacrosse ball and start to work on some of those same principles.

One thing I do want to mention, something you see more for youth sports and not as much as, you know, college, that they really should be—in my opinion, especially elementary and middle school—you should be playing multiple sports or at least getting some diversity. And I think it's really important to develop the kids to be an athlete.

A lot of our very successful Terp athletes that went on to successful professional careers in many different sports were multi-sport stars in high school. If you think about it, if you're a football lineman, but you were wrestling in high school, that's going to help you, those skills. If you were a wide receiver in high school, that might help you as a basketball player down the road. And also, more importantly, as the seasons change, you're giving different stresses to your body.

So, we see a lot of these single sport athletes when they're young that, let's say they're playing baseball all year round. And as I mentioned earlier, they're playing many games in a weekend, and there's just really no stopping. And they develop these overuse injuries that quite frankly, when I was a child, we just never saw because it just wasn't commonly done. And I always remind them, professional athletes, they have an off-season. LeBron James, he doesn't get much of an off-season because he's always playing in the playoffs, but I can assure you that he, like, has a plan to recover his body for the months that he has in between the seasons, just to get ready to go again, because it's such a grind. And if you don't give yourself any rest at all, you don't really get the benefits of recovery. But switching from one sport to a different sport can kind of give you some kind of relative rest. So, I think, and I understand there are some sports where, you know, to get to a certain level, you might need to specialize earlier than others.

In many of the popular American sports, they've even done studies that early specialization does not necessarily correlate to making it to a D1 or professional level. So, multiple sports I think is a very good thing, especially the younger you are. And also, just getting some rest, even just a week or two away from sports or, you know, letting them go on vacation and not, you know, doing that sport, I think can really go a long way. And ultimately, they may end up playing more that way, because these overuse injuries, sometimes you really have to shut them down for a while. And it might be during the season when you don't want it to be.

Host: It's been good stuff today. As we get close to wrapping up here, Doctor, what's like one thing if every athlete would just listen to Dr. Packer, like, what's that one thing you wish they would do to stay healthier, perform at their best as often as possible? What would that one thing be?

Jonathan Packer, MD: I would just say, I guess in general, prepare your body and try to understand what you're about to put your body through. And like let's say, yeah, we're August, whatever sport you're going to do, you're about to start a high preseasn soccer, you know, a rigorous month or whatnot. You know in May that that's coming, say, if you want to play. So, plan it out. You want to be running, you want to make sure you're conditioned. I mentioned those ACL prevention programs. We see a lot of ACL injuriesand at all levels, but especially high school. And some of those ACL prevention programs have showed 60% to 80% reduction in ACL tears. So, that is something that you can do. You can work on strength training and, again, there's a lot of resources out there. And the off-season's a good time to develop some of these habits, these recovery habits. We'll see what happens if you're doing certain warmups. We didn't talk about warmups as much, but also very important.

And that way, you can just start to think about, "Hey, it's not just what's my game plan for that game, the actual playing part, but making sure I have the right equipment, I have the right sleep, I have the right nutrition, I'm hydrated." These are all things that as athletes develop into college and maybe beyond, they focus more and more in their efforts on those type of things, to not only perform at your best, but it's going to help prevent injury.

Host: Yeah, especially now with many athletes considering playing a fifth year, right? You know, if they're able to stay. My daughter mentioned, you know, she's like, "Will I still be able to play at that age?" I'm like, "If you take care of yourself, probably," right? And so, she's already thinking like, "Okay, I might want to play five years. I better, you know, avoid the candy now when I'm eighteen so that I can still play, you know, when I'm twenty-two."

Just finish up here, Doc. We're all well-meaning parents. At least I think most parents are well-meaning, right? And we want to help our kiddos. We want to keep them on the fields and on the courts. And I'm sure we all unintentionally put pressure, or we increase the possibility of risk, you know, or injury on our kiddos because we're just pushing them so hard and rub some dirt on it and get back out there. And so, to form this into a question, what can we do as parents? What can we be on the lookout for in our own language and behavior so that we're helping our kids in their best interests?

Jonathan Packer, MD: Every parent-child relationship's a little different and every child is different. So, you know, each one might respond to something different. As we all know, children sometimes need to pushes to really be at their best. But you obviously don't want to push them too much.

It's a tough environment right now, because you hear about the phrase keeping up with the Joneses, like maybe financially, but it's kind of become like that with athletics nowadays, that all the other kids in your class are doing a million different camps in a million different leagues, playing 100 games a week. And it's extremely understandable to think, "Well, I got to be doing that too," or "So and so did X, Y, Z and now they got a scholarship to college. So, this is what I need to do."

I would say there's there's a lot of pressure on kids. And I've definitely unfortunately seen it where I think their parents are more interested in them playing than the actual kids. So understand, well, first of all, but sometimes at least doing more, again, to what we talked about earlier, getting that fatigue and not recovering, sometimes more is not better and can kind of cause their bodies to break down, and can also cause a little just mental fatigue and that might cause the kids not to like it as much.

I think that's also some of the value in doing different sports, just to change it up, right? Like, a lot of us adults are like that too. You do the same workout over and over and over again, you know, sometimes it gets hard to be motivated to keep doing it. But again, every kid is different. Some might need a little bit more push from their parents, some might be more self-motivated. So, I know that's tough, and it's definitely out of my realm of expertise, but that's just something that I've noticed. So, I think just, you know, the direct communication and especially the younger they are, you know, let them be kids. And a lot of them will develop at different times. Some may really peak in the end of high school, some might be a little earlier, and that's okay.

Host: It is okay. And, you know, as imperfect as I may have been as a parent along the way with my kids, I always tried no matter what pep talk dad gave them that day or pep text dad sent them that day, I always tried to end with, "Just have fun," right? "Be a kid, have fun. Someday you might be a professional and it might be so important that you play this game and play so well. But for today, when you're 13 or 14, you know, play hard, have fun, and that'll be good enough for everybody." And that was always my message. You know, right or wrong, that's what I said to my kids. It's like, "Be a kid," because you only get one shot at this," right? We were talking about what it was like when we were kids. You only get one shot to be a kid, and make the most of it, right?

Jonathan Packer, MD: Yeah. And at the end of the day, most kids, most people playing high school sports will not play college sports. Most people in college will not play professional, and most professionals won't have a very long, successful all-star career. So, I think just try to enjoy the whole process, right? And that's actually what a lot of the college coaches will talk about. You're not just focused on winning games, it's the whole process. Addressing practice like you would a game; the recovery parts, just taking care of your body, doing all the little things all of the time to just help you be better and prepare you.

One last thing I would say for those high schoolers that are very interested in continuing to play in college, what you will see sometimes, a lot of times they have enough athletic natural ability, or they're physically bigger, or a combination of them, where they maybe don't need to do all the things we talked about to be an all-star in high school, to really succeed, to get recruited by a lot of colleges.

So, they maybe haven't really taken care of their body nearly as much as they need to, and then they get to college and everybody is like that, or they're no longer the biggest person, or they're competing against people that are putting 20 hours a week in the weight room in the off-season. And they quickly learn that, hey, this isn't enough anymore. Again, adopting that thought. It's not just, "Hey, well, I'm better than all the kids in my high school team." It's "how can I be better? How can I be the best version of myself? What can I do to improve so that if I do want to play at the next level? I am fully prepared?" So, kind of always, you know, trying to have that kind of mindset for self-improvement.

Host: Yeah, and you've given us some great expert advice today on how we, they can prepare and perform and recover. All good stuff. I really appreciate your time and your expertise today. Thanks so much.

Jonathan Packer, MD: You're welcome. Thanks for having me.

Host: And that's Dr. Jonathan Packer, team physician for the University of Maryland Terps and orthopedic surgeon at the University of Maryland Orthopedics. And thank you for listening to 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. Please share this on your social media. And for more great health information, visit health.umms.org.