By Jim Monaghan
Baseball Health Network
Youth sports specialization is on the rise. As a result, the prevalence of pediatric ACL injuries is also increasing. Join Columbia University Sports Medicine on November 13th for Pediatric Sports Injuries: Treating our youth from head to toe to learn about the latest techniques for prevention and treatment of these injuries in our young athletes.
Children are playing sports in record numbers across the United States, and with this increase in participation there has been an alarming rise in the number of sports injuries. Taking optimal care of these injured kids requires extensive knowledge and comfort in techniques that have previously been thought of as only pediatric, or only adult. This webinar reviews and discusses treatment strategies to maximize outcomes and get these developing athletes off the sidelines and back onto the field. Understanding the etiology, diagnosis, surgical, and non-surgical modalities are the key elements of a successful treatment plan. This course will be of interest to Team Physicians, Certified Athletic Trainers, Physical Therapists, Primary Care Sports Medicine Physicians and coaches of all youth levels.
At the conclusion of this activity, participants will be better able to:
- Interpret and differentiate the physiology of pediatric sports injuries to formulate a treatment plan
- Classify and identify different graft options to reconstruct a pediatric ACL injury in order to generate an appropriate recovery plan
- Analyze and recognize the role of Orthobiologics such as PRP in the Developing Athlete
- Understand and implement treatment options for patellar instability in the growing athlete
- Produce a workup and plan for the developing athlete with lower back pain
FACULTY/AGENDA –
Charles A. Popkin, MD
Pediatric ACL Reconstruction: What you need to know in 2018
Elan L. Goldwaser, DO
Concussion in the Developing Mind: Pearls for concussion management in kids under 12
Lauren H. Redler, MD
Patellar Instability in the Developing Athlete
Benjamin D. Roye, MD, MPH
Back Pain in the Developing Athlete: When should you be concerned?
Christopher S. Ahmad, MD
The Tommy John Epidemic in Youth Throwers: How can we stop it?
This course is free to all participants.
In baseball, we have reached epidemic levels of players needing Tommy John Surgery. At the Major League level, one in four pitchers has had Tommy John as a result of tearing their ulnar collateral ligament, or UCL. Unfortunately, these numbers translate to many younger players needing the surgery as well. To help combat the issues facing America’s pastime, I, along with Frank Alexander and Charlie Ahmad put our heads together and wrote Understanding Tommy John Surgery and How To Avoid It: A Guide for Young Baseball Players. 
To reverse these epidemic trends our goal is to start changing the culture at the youth levels before bad habits develop, similar to how we educate children on the dangers of smoking. In our office, we’re seeing younger and younger players walk through the door at an alarming rate. We hope that by educating younger athletes, they won’t wind up in our office when they’re older.
Mike Reinold, PT, DPT, SCS, CSCS is the President and Co-Founder of Champion Physical Therapy and Performance in Waltham, Massachusetts. He is a world-renowned expert in physical therapy and sports performance. He uses his background in sport biomechanics, movement quality, muscle imbalances, and manual therapy to help some of the most elite athletes return to the sport they love. Currently a consultant for the Chicago Cubs, Mike played a key role in 2007 as he led the efforts in keeping the Boston Red Sox healthy on their way to a World Series Championship! He has been featured in ESPN, Sports Illustrated, Men’s Health, and peer-reviewed publications such as The American Journal of Sports Medicine and the Journal of Athletic Training, among many others.
FA: How do you help keep your athletes healthy after they’ve completed their formal physical therapy?
Many overuse injuries happen in adolescent athletes that are still growing. These injuries are fairly common and you may have even heard of a few such as: Little Leaguer’s Shoulder, Little Leaguer’s Elbow, or Jumper’s Knee. Adolescent athletes are not the only population that succumb to overuse injuries. Weekend Warriors, runners, frequent golfers and tennis players also develop overuse injuries. Common overuse injuries in the skeletally mature population include: Tennis Elbow, Golfer’s Elbow, and IT Band Friction Syndrome.
Athletes that have overuse injuries can still participate in sports but may have to stop the sport they got injured playing. If you have Little Leaguer’s Shoulder, it doesn’t mean you have to stop everything for the whole spring or summer, it just means you should take a break from throwing a baseball. Depending on the severity of the condition, some athletes may be allowed to play basketball, soccer, or even swim in a pool. For patients suffering from Golfer’s or Tennis Elbow, a simple adjustment of how you hold a club or a racket may be all it takes to alleviate your symptoms. Any runner with ITB Friction Syndrome may have to take a break from running, but they can still get in the pool or ride a bike. There are plenty of ways to make minor adjustments to exercise routines and still be active while injured!
Exercises to avoid include: dips, chest flyes, lat pull-downs behind the neck, heavy-weight overhead shoulder presses and wide-grip bench presses. Patients should also avoid allowing the shoulders to be stretched to the extreme end range of motions. While these exercises are discouraged, there are variations and other exercises that can be substituted. Variations include: lat pull-downs with the hands in front of the body, using a medium grip for chest press and lat pull-downs, and using dumbbells for bench pressing. Substitutions include: the Thrower’s Ten exercises (internal/external rotation with TheraBands) and lying light dumbbell exercises such as Y’s, T’s, and A’s. 
While some exercises should be avoided, many should be done regularly. The 
of motion and needs to be decreased. If swelling is not diminished before surgery, the outcome will not be favorable for the patient. By doing prehab exercises, icing, and taking anti-inflammatory medications, swelling can be decreased. Many athletes have heard of the GameReady unit. This unit combines both ice and compression through a sleeve that surrounds the knee. Another unit similar to the GameReady is the CryoCuff which operates in a similar manner. These units are highly recommended in both the prehab and rehab phases. They can be discussed with our staff in the office. 
Once improvements are made, the patient is ready for surgery. The prehab process varies for each patient with the ideal time from injury to surgery being 2 weeks. Timelines are not set in stone so while some patients are in the average, some may be quicker and others may be longer. Another factor is severity of injury. Many ACL tears happen in addition to other injuries within the knee such as medial collateral ligament (MCL) tears and meniscus tears. These other injuries need to be taken into account for timing of surgery as well. The more effort put into prehab, the quicker surgery can be scheduled. For many athletes, timing is of the essence and getting ready for the upcoming season will take a lot of work. The hard work doesn’t stop on the day of surgery, athletes will need to keep their work ethic for the months following surgery to ensure staying healthy once they return to the athletic fields.