Guest: David C. Geier Jr., M.D. – Orthopedics
Host: Linda Austin, M.D. – Psychiatrics
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. David Geier who is assistant professor of orthopedics and the director of MUSC sports medicines. Dr. Geier, we are talking right now about how do prevent injury in children who are active in sport. Of course almost all parents really want their kids to play sports and injuries can certainly happen, but when you begin to think about how we could minimize the risk, what are some of the principles?
Dr. David Geier: Well, I think there are several underlying guidelines, and I think first and foremost is recognition that kids do get hurt playing sports. They are not simply young and small adults, they are growing boys and girls and they are certainly at risk for injury. Over three million young male and female athletes get sports injuries throughout the course of one given year and so this is a problem, and so you have to remember some basic principles. One, just like adults they are subject to acute injuries, you know bad falls and collisions, and things can certainly break bones and tear ligaments, cause concussions, and thinks like that we commonly assume occur in sports, but they are also some subject to overuse injuries and that’s probably less recognized in the young kids. People don’t think of their kids as being susceptible to, you know, overuse injury, but it is probably just as common and sometimes more worrisome.
Dr. Linda Austin: What are some examples of overuse injuries in children?
Dr. David Geier: Some of the most common in the sports such as baseball for example, in the pitchers when they get injuries that people term little league shoulder and little leaguer’s elbow, really that’s not a specific diagnosis, but that’s kind of a collection of injuries that occur in the shoulder and the elbow related to overuse from pitching year around multiple times a week, you know, pitching too much and to often, throwing to hard, not getting enough rest, and getting injuries to their growing shoulders and elbows overtime due to more stress on these growing bones and ligaments and joints, and not enough rest for these joints to recover.
Dr. Linda Austin: How about for girls, one hears about cheerleading injuries for example?
Dr. David Geier: Actually cheerleading is an interesting question because lot of people don’t consider cheerleading a sport, but there is no question, you know, certainly we see in our office tremendous number of cheerleaders get hurt, both with unfortunately traumatic injuries the ACL tears, the shoulder dislocations, broken bones all of which we?ve probably operated on in the last few months, but they also get the overuse injuries, especially in the tumblers when they do gymnastics to their wrist and elbows repetitively using their hands and upper extremities as weightbearing joints, but they are just as much as athletes, I would argue, as your football and soccer players, they do just as much work and put just as much stress on their muscles and bones and ligaments as any contact sport person.
Dr. Linda Austin: What are some early warning signs of overuse injury?
Dr. David Geier: Well, I think initially you are just going to have aches and pains, and initially the pain will go away, you say in a pitcher they pitch one session then they rest the next day and they are fine, it is when that it start lasting well after they have thrown or run last into their period of rest or it takes longer to go away or the symptoms are lasting longer and longer, they are coming on, the pain or the soreness, the swelling is coming on sooner then it was earlier on, the rest is not making a completely go away. If the young boy or girl tries things like Advil or Aleve or Tylenol, which initially helps or tries ice and that initially helps then that stops helping and then they start to get more and more pain even with non-athletic activities; they are sitting in class and they start to hurt or they are having trouble sleeping that’s certainly where you getting into more of the warning signs where this is going on too long, but again initially it is very subtle and it may not even be pain. It may be, say in a pitcher, that they are not able to throw as hard or they are not able to get their pitches in the right location. There are times when their running may not be as fast. They may a subtle limp and , you know they don’t want to tell their coaches or their friends or their parents because they don’t want to be pulled from the game, and these were all of signs and lot of times kids do a very good job of hiding their symptoms for a lot of reasons; they want to play, they don’t want to let their teammates down, let their parents or coaches down, and I don’t know that there is a right answer as far as how you communicate with them, and again it is a communication which you have to know because at that age you really need to keep an eye on them and back them off before this becomes a chronic lingering problem.
Dr. Linda Austin: I would think that part of the prevention message then would have to do with how you talked with kids about sports participation to begin with that the bottom line is that it is about having fun and it’s about being healthy and developing coordination and that’s the most important thing, not playing even when you are in pain or when you are injured.
Dr. David Geier: Right, absolutely I couldn’t agree more. I think especially in the younger ages, sports are really meant for kids to have fun and to develop social relationships and responsibility and all the beneficial qualities, we think of sports. Your six year old really, they are not playing it to win regional competitions or state competitions and they really shouldn’t be asked to do that and that’s where you get into trouble both from a coaching standpoint and a parent standpoint this ?win at all cost? mentality and having them practice for several hours every day, not giving them enough rest, having them played multiple teams, travel teams, that’s where you really start worrying about injuries and at the end of the day you are really taking away from the child’s fun, and the fun is really where it not only emphasis should lie but if you keep it fun I think you are going to minimize injuries. If kids are having fun out there, they are going to let you know, ?look this hurts and I will take a couple days off? but if they need throw in the secondary pressures of ?you know you are the best pitcher on the team, you need to pitch, and you can’t take a day off, and the team lose without you? that’s when you start getting kids feeling that they are letting people down, and then they start throwing when they are really hurting. They don’t tell anybody that they are hurting, and you start getting into a cycle of these, initially lesser more chronic injuries that turned into a bigger and bigger problems.
Dr. Linda Austin: I would think, also that it’s hard for kids to understand because typically we think that the more you exercise the stronger you will be or the faster you will be, and that the child understand that there is a point beyond which is actually counterproductive product, that must be difficult.
Dr. David Geier: The hard part of about that is absolutely true. It’s hard sometimes to convince the kids and the parents that sometimes too much is not beneficial anymore and the problem is it different in every person. There is not a set number of hours a week to practice or train or a set distance in running, and you, kind of, have to find that balance with everybody, but the key is that they do enough to get the benefits of exercise and strength training in the practice on the field or on the court training, but getting enough rest to recover. I think more than anything is that they have to have enough rest to let their bodies heal, because if they don’t get enough rest then anymore trauma, so you would speak, that they put on their bodies just accumulates, and I think where the line is in everybody is different, but that the younger they are probably the more rest they need, and as you get to where they start going through their growth spurt, so then when stop growing, they can probably tolerate more and more. Their muscles are stronger, their bones are not growing, and they grow stronger, just overall their bodies are more able to withstand stress. You got to know your limits and then again communicate that, and that’s the responsibility not only of the physician, but the parent and the coach and then the child.
Dr. Linda Austin: Dr. Geier, thank you so much for talking with us?
Dr. David Geier: Oh! Thank you.
Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health connection at (843) 792-1414.