Pediatric Sports Injuries

Episode 20
Pediatric Sports Injuries

Join board-certified orthopedic surgeon Andrea Kramer, MD, as she offers expert insights on how to prevent and treat a variety of common pediatric sports injuries. Dr. Kramer discusses the growing epidemic of youth sports injuries as well as the rise of overuse in specialization. Whether your young athlete's domain is a field, a court, or a pool, you'll want to tune in to this episode to learn the best ways to keep them in the game.

Hosted by Eric Chehab, MD

Andrea S. Kramer, MD

Featuring  Andrea S. Kramer, MD

Dr. Andrea Kramer is a board-certified orthopedic surgeon specializing in pediatric orthopedics. She provides treatments for all the major congenital disorders, including hip dysplasia, club feet, cerebral palsy, spina bifida and down syndrome. She also provides care for scoliosis and traumatic injuries. Dr. Kramer offers the most up to date surgical and clinical techniques, including the latest in fracture fixation and bracing.

Episode Transcript

Episode 20 - Pediatric Sports Injuries

Dr. Chehab:

Welcome to IBJI OrthoInform, where we talk all things orthopedics to help you move better, live better. I'm your host, Dr. Eric Chehab with OrthoInform. Our goal is to provide you with an in-depth resource about common orthopedic procedures that we perform every day. Today it's my pleasure to welcome Dr. Andrea Kramer, who will be speaking about pediatric sports injuries. As a brief introduction, Dr. Kramer graduated from the University of Michigan in 1989 with a Bachelor's of Science in Neuroscience. She then attended Temple University School of Medicine in Philadelphia where she earned her medical degree in 1993. She then began her orthopedic residency here in Chicago at Northwestern University School of Medicine and then went on to further her training with the fellowship program in pediatric orthopedics at the Primary Children's Hospital at the University of Utah and the Shriners Hospital in Salt Lake City, Utah. Dr. Kramer treats a wide range of pediatric orthopedic conditions, including hip dysplasia, club feet, cerebral palsy, spina bifida, and Down syndrome. She also provides care for scoliosis and traumatic injuries. She is the director of the Pediatric Orthopedic Surgery Department for the Chicagoland Children's Healthcare Alliance at Advocate Children's Hospital here in Park Ridge and Will met. She's a frequent lecturer for the Pediatric Orthopedic Society of North America. She has published numerous research articles and book chapters to help advance the care of the pediatric patient. She herself is a dedicated athlete, would make her well suited to help children with sports related injuries. She has helped thousands of childrens in their families, including my own, with her expert in compassionate care. She's an exceptional physician, innovator, and the best of colleagues always available to help with some of her most challenging cases. So Andrea, welcome to OrthoInform and thanks so much for joining us today.

Dr. Kramer:

Thanks for having me.

Dr. Chehab:

So it appears it's been an absolute explosion in sports related injuries in the pediatric patient. So what do you think's driving this?

Dr. Kramer:

I think it's a combination of pressures from society, coaches, parents really pushing these kids to be far more intense in sports at an earlier age. And it's really causing lots of problems

Dr. Chehab:

And intense in sports in terms of the level of training that they're doing in terms of how much commitment they're making to a single sport.

Dr. Kramer:

I think it's the frequency of training, I think it's the sport specialization. These kids are forced to play at the same sport all year round in order to be able to play at a high level.

Dr. Chehab:

I'm trying to remember the last time I met a kid who's a three sport athlete.

Dr. Kramer:

You don't see them anymore. High schools around us give awards for three sport athletes because it's so rare. 

Dr. Chehab:

We've come a long way, I think in the wrong direction. Yes. We think of kids as their, as athletes, sometimes incorrectly as small adults, but they're not. And so tell us why that's not the case.

Dr. Kramer:

Well, part of it is kids anatomy is different than adults and one of the biggest thing is the growth plate. And I think everyone worries about it and it's where you grow from. And if you injure your growth plate at a young age, you can have issues such as, you know, leg length discrepancy and deformities, you know, from stress if you train the same muscles all year round without any rest.

Dr. Chehab:

So it's this growth plate that's the key distinguisher between the adult athlete whose growth plates at that point have completely fused and aren't gonna be changing versus the pediatric athlete, the young athlete who has a growth plate that will continue to change and training them like an adult can potentially injure those growth plates.

Dr. Kramer:

Correct and part of it is the growth plate is the weakest part of the bone. So where adults tend to sprain their ligaments more kids tend to get growth plate fractures and that's a big difference. 

Dr. Chehab:

A big deal and explain to the listener if you can, in lay terms what the growth plate really is.

Dr. Kramer:

So the growth plate is a part of the bone where your bones get longer from, so it's the end of your bones. So if you injure it, you can end up with one leg shorter than the other, you know, and that's probably the biggest concern.

Dr. Chehab:

Yeah and so what are some of the causes of problems with the growth plate? What do you see most commonly as, sort of the contributing factor to growth plate issues?

Dr. Kramer:

Well, a lot of it is stress and overuse and so I think that's where it starts with all these kids. It is just consistently, you know, stressing their growth plates with all of their sports, the same sport over and over again is where we run into issues. Okay.

Dr. Chehab:

So that this repetitive stress across the growth plate causing problems. And what are the type of problems that you see?

Dr. Kramer:

So with growth plates, probably the most common ones we see a lot, and we can start with some of the sports in baseball, you'll see it in the shoulder and the elbow you'll see it in the knees with almost any type of sport. And one of the more common ones is in the heel where kids come in complaining of pain.

Dr. Chehab:

So let's go through those one by one if you don't mind. Perfect. Let's start with the elbow. What are the things you see around the elbow and why do you see them? If you could describe some of the anatomy and why these things occur.

Dr. Kramer:

So one of the most common sports is baseball as well as softball. It's probably any throwing sport where we start to see stress around the elbow. Since the growth plates aren't closed, if you continue to stress it out, you can actually fracture through a growth plate. And one of the most common things people hear about is little league elbow.

Dr. Chehab:

So what's that?

Dr. Kramer:

And so it is stress on the inside of your elbow. And this is why kids who are not skeletally mature or you know, have finished growing shouldn't be throwing a curve ball. The risk of injury to a growth plate, if you throw a curve ball is you will literally pull the growth plate off of the elbow. Yeah.

Dr. Chehab:

And we've both seen this and it's, we hate seeing and it's a terrible thing because we know it's gonna be a problem for the young kid. And short of pulling it off though, what do the kids present with? What do they have?

Dr. Kramer:

So the kids tend to present with pain on the inside of their elbow and this is why baseball teams have pitch counts mm-hmm. <Affirmative> and they try and keep an eye on these kids and why they sort of try and rotate the kids, you know, into other positions.

Dr. Chehab:

Is it every position that, that kids get the little league elbow or there's some that are specific that you see it more frequently? Pitchers

Dr. Kramer:

And catchers is gonna be much more frequent because they're the ones throwing the ball. Yeah. Over and over and over again.

Dr. Chehab:

Okay. So the little league elbow with pain on the inside of the elbow from repetitive throwing and the prevention is what you mentioned pitch counts. Correct and then so what happens if a kid has a little league elbow? What do we need to do?

Dr. Kramer:

Right. Unfortunately the first thing you have to do is rest.

Dr. Chehab:

And what do you mean by that?

Dr. Kramer:

So most of the time is not pitch or catch and put them in position where it's less throwing, which is usually phase one. If it's really painful then you actually have to have them stop throwing

Dr. Chehab:

For how long?

Dr. Kramer:

It depends, you know, for many of these kids, you know, I'll tell them four to six weeks you know, but I think the bigger thing is to try and prevent it.

Dr. Chehab:

Yeah. And then the prevention being through pitch counts. And what are some other prevention measures for little league elbow.

Dr. Kramer:

And a lot of it is strengthening. Okay. You know, and not throwing to get stronger, but actually strengthening your elbow so you can throw better.

Dr. Chehab:

Okay. So we talked about this briefly before coming on air with strengthening and not throwing. What's the benefit of not throwing?

Dr. Kramer:

It's to rest your elbow? Allow it to grow and get stronger.

Dr. Chehab:

Okay. And if you throw your around

Dr. Kramer:

And throw your around, you're just putting far too much stress on the elbow. I mean, and with baseball your shoulder is stronger, your elbow is stronger, your wrist is stronger and more importantly your core and your lower body. And that's where you're gonna get strength in your pitching. And this is a hard thing to convince young kids of and this is where we have to educate the coaches and the parents that it's about overall strength. Makes you a better baseball player.

Dr. Chehab:

Yeah. Yeah. And then moving up from the elbow to the shoulder, what happens in the shoulder? Is it a similar process? 

Dr. Kramer:

 Similar process. We tend to get more overuse injuries than the softball players and kind of any overhead athlete, you know, the swimmers, volleyball players, you know, any basketball players, it's just over and over again stress on the shoulder.

Dr. Chehab:

And where do the patients have pain in their shoulder when they have a growth related injury around the shoulder

Dr. Kramer:

Tends to be in the upper part of the arm right around the shoulder.

Dr. Chehab:

Okay. And what other symptoms might they have?

Dr. Kramer:

It's usually pain. Pain with throwing, sometimes pain with rest, you know, when you sleep you tend to lean on your shoulder and sometimes that'll lead to pain.

Dr. Chehab:

Okay. And the treatment

Dr. Kramer:

Once again is rest 

Dr. Chehab:

It's a four letter word,

Dr. Kramer:

You know that none of the parents or athletes like to hear and it's once again getting stronger. Yeah.

Dr. Chehab:

And for how long with the rest?

Dr. Kramer:

Usually four to six weeks.

Dr. Chehab:

Same idea. Okay. So these growth plate injuries around the elbow and the shoulder generally require rest. We can see fractures around the elbow from overthrowing or trying to throw through the pain. Do you see fractures around the shoulder as well?

Dr. Kramer:

We do, It's not as common.

Dr. Chehab:

Okay, but you have seen them. Yes and how is that treated typically?

Dr. Kramer:

So typically those are not surgical. They tend to be more rest, you know, unless it's a traumatic fall. But usually the stress injuries are treated more with rest. 

Dr. Chehab:

And we didn't mention this earlier, but you did mention if someone pulls off the bone in the elbow, what's the reason to do surgery around the elbow?

Dr. Kramer:

So in the elbow, if you pull your growth plate off, that's where your muscles attach. So those become surgical problems. Yeah, so then you need to fix that either with pins or screws, depending on the age of the patient.

Dr. Chehab:

And that sounds like you're baking in a lot of rest after that type of procedure.

Dr. Kramer:

Correct.

Dr. Chehab:

And how long does it take for a kid who's had that type of avulsion pull off fracture to return to throwing again? Usually,

Dr. Kramer:

So after surgery it's probably about six weeks of letting it heal. And then another probably good month of rehab, gaining strength, reworking the mechanics of throwing. So it takes some time. Yeah.

Dr. Chehab:

Okay. So that's obviously an injury we wanna prevent. And so rest is the treatment. What are some of the prevention strategies? You mentioned strengthening in the off season and then fundamentally not, fundamentally.

Dr. Kramer:

Not throwing all year round and you know, one of the things I tell all my patients is pick two months out of the year and don't throw it. Doesn't mean don't work out, don't strengthen, but don't throw. They need to change working the same muscles year round. Yeah.

Dr. Chehab:

I remember reading an article in the New York Times by Tyler Keppner who was writing about baseball's young ACEs being in the operating room. He was like, if you wanna see baseball's, young ACEs go to the operating room. And init Joe Gerardi was interviewed and quoted as saying with this 12 year old son, he shuts him down in October and lets him play other sports during the winter to te keep him away from baseball. And what I found so interesting about that is this guy, Joe Gerardi arguably knows more about baseball than anybody in the entire planet and he takes his kid outta baseball. And I wish that's something that we could educate our parents and coaches that it is a benefit to your kids' baseball playing to remove them from baseball.

Dr. Kramer:

Absolutely. And it's all throwing sports. Yeah. Take two, like pick a different sport, work different muscles, you'll become a better athlete and in the end that makes you a better baseball player or a softball player or whatever sport you're doing.

Dr. Chehab:

Yeah. So mix it up, develop your athleticism and become a better blank athlete in baseball, soccer, basketball, whatever.

Dr. Kramer:

It is and that's why all of this strength and agility stuff has started and a lot more kids are doing that. But unfortunately they're doing it in addition to still doing their sport . What they don't understand is just do strength and conditioning to become better at your sport.

Dr. Chehab:

Okay. And so we can lament the, the demise of the three sport athlete forever. And I hope it comes back at some point for the health of our kids moving on to different joints. If we go through the body, we have the elbow the shoulder, and then in the lower extremities we can start with the hip. For instance, what are some of the injuries that are related to being kids and athletic in the hip?

Dr. Kramer:

So once again, you know, there's some growth plate injuries. There happens to be a growth plate that sits at the top of your hip bone that attaches to your hip flexor, which is used in any sport that you do any kind of sprinting running, which is used in almost every sport where you can injure it.

Dr. Chehab:

And what's the injury?

Dr. Kramer:

So you get, it's an aile injury, which is a growth plate injury where you can tend to pull off the attachment of your hip flexor. And once again, the treatment for that is gonna be rest physical therapy and strengthening to prevent it from happening again.

Dr. Chehab:

And how do those patients present?

Dr. Kramer:

Usually with hip pain and the ability inability to accelerate

Dr. Chehab:

And when it, when it pops off,

Dr. Kramer:

Oh, they'll feel it. They feel.

Dr. Chehab:

And do they, are they limping in, are they getting carried in? Usually,

Dr. Kramer:

Usually the first week or two they're on crutches, can't wait bear and actually can't lift their leg.

Dr. Chehab:

And then how long does it take for them to return typically in your experience?

Dr. Kramer:

About four weeks. You know, usually after about two weeks we can start them in therapy and get them moving again. You know, but it's the acceleration stuff that becomes the harder part.

Dr. Chehab:

Okay. And then let's move downstream to the knee.

Dr. Kramer:

Yes. So one of the most common things, the kids all come in with knee pain. One of the things many people hear about's called Oz good squatter which is stress across a growth ac growth plate that's on the front part of your tibia. Kids ac growth plate that's on the front part of your Okay. And now what are, what are some of the more significant serious injuries that you see as a pediatric specialist and particularly a tibia. Kids across a growth plate that's on the front part of your tibia. Kids present with , which is stress across a growth plate that's on the front part of your tibia. Kids present with a bump and this is the overuse injury. Yeah. You know, that every kid has because they're growing and they're overusing it.

Dr. Chehab:

Okay. So, the growing athlete, every growing athlete is potentially susceptible to this odds good slaughter condition. Correct. And they present with a bump in pain. I think I know the answer to this. What's the treatment?

Dr. Kramer:

Rest, rest, you know, and then once again, sorta some therapy to build up your quads you know, the stronger your muscles are around the knee, the less it is. But it happens because these kids have these major growth spurts while they're at their most intense sports.

Dr. Chehab:

Okay. And then let's move finally downstream towards the ankle.

Dr. Kramer:

So one of the most common complaints kids come in is with heel pain. And this is from all the cleats and shoes that they wear. There's a growth plate in your heel. And so once again, it's called seavers  that many people hear about and it's all the shoe they've taken out all the padding in the shoes. So if we could just have gel heel cups in everyone's sports shoes, it would actually help. But most importantly is they need to stretch  stretching. Seems to be a Yeah, you know, these kids are so intense with their sports and not intense about stretching. Okay and it's a problem.

Dr. Chehab:

So if we go around the horn again from elbow, shoulder, hip, knee, ankle just to summarize some of the things you've been saying, it's important to develop some strength around these joints. It's important to rest these joints appropriately so that we're not using them because these kids have these growth plates that are the most susceptible part of their bodies to injury. And repetitive stress is a way that they get injured. Stre flexibility and strength seem to be the key and it's pretty hard to make a kid flexible when they're growing so fast to, I think of it like a guitar. And you're just tightening the strings as the kids grow.

Dr. Kramer:

Correct.

Dr. Chehab:

And so stretching has its limits in the growing kid.

Dr. Kramer:

It does and just, but unfortunately there's no emphasis from the coaches and the parents on the importance of stretching. If you ever watch any team warm up, nobody's checking for nobody's checking for them you know, it's like the big joke. Right.

Dr. Chehab:

What are some of the more significant series of injuries that you see as pediatric specialist and particularly a sports specialist? What are some of the more problematic injuries that you can see?

Dr. Kramer:

So probably the biggest one are fractures. And I think that occurs with any sport. You know, whether you're sliding into first base diving for the volleyball, playing soccer, you know, if you have a fracture and if it displaces your growth plate, it's a surgical problem.

Dr. Chehab:

Okay. So if we look at the growth plate, we have these, these stress related conditions that can occur generally not resulting in fracture, but around the elbow and the hip. Not uncommon for the muscle to pull it off and then potentially be a problem, particularly in the elbow. But a fracture where there's force that displaces the growth plate makes the bone crooked and makes it crooked through the growth plate. I mean, that's a problem. We could see that from the outside. Correct. And then what do you, what, what do you have to do on the inside? What are you trying to do when you do the surgery?

Dr. Kramer:

So the most important thing is to realign the growth plate. Growth plate is pretty resilient, but you have to warn the parents and the kids that there is a potential that the injury has injured the growth plate, meaning, you know, it can affect the length, it can make, you know, your bones grow crooked and these are things we have to watch for. We have ways of correcting them later but things you have to watch for. Yeah.

Dr. Chehab:

So obviously preventing it and, and so putting it back in alignment is one of the prevention strategies from having a crooked or shortened bone as the kids continue to grow. And god forbid it does happen, there are some techniques that can help correct it on the back end. Correct. Okay and so where do you see some of these displays growth fractures, most commonly growth plate fractures.

Dr. Kramer:

Probably in some of the more high intense sports. I mean you'll see it in the full context. Sports, you see it a lot in football you know, soccer, you know, even basketball for a non-contact sport there's a lot of contact that goes on under the hoop. Yeah. You know, and then you get sort of your not organized sports. You get your skateboarders, your skiers. Right. You know, so it's a whole nother world. And of course every parent asks me about a trampoline. Yep. You know, now that there's such a high incidence of all these trampoline parks. Yeah. Which is everybody's favorite winter sport in the Chicagoland area. And all summer long and it's just amazing the number of injuries.

Dr. Chehab:

So what are some of the trampoline safety tips? I mean, obviously you go to trampoline park, it goes against every single trampoline safety tip there is, but what are some of those?

Dr. Kramer:

Correct. So if you think about it, it's supposed to be one person at a time on the trampoline that doesn't work. So at the trampoline parks, it's multiple kids and then they throw balls at each other. There's dodge ball on the trampoline. Yeah. And you know, big kid bouncing little kid is always a big one when they're not bouncing in sink, which lasts, you know, everyone's so has fun for the first 10 seconds and then everyone's on a different, bouncing out of sync causes lots of problems. Yeah.

Dr. Chehab:

And there's just so much energy stored in that trampoline and that kid up in the air who meets the energy coming up towards him and the trampoline is in big trouble. Correct. And I think people have a misperception that it's flying off the trampoline where people get injured.

Dr. Kramer:

Not always, oh, it's on the trampoline 

Dr. Chehab:

It's always on the tram trampoline. And, and so these safety nets aren't really keeping kids safe. Right. It's really the one person on the trampoline at the time.

Dr. Kramer:

it's kid. Right.

Dr. Chehab:

And I'm sure you probably see some pretty significant injuries, even some catastrophic injuries.

Dr. Kramer:

Yes. Yeah, between trampolines and then the summertime it's all the playgrounds.

Dr. Chehab:

Okay.

Dr. Kramer:

You know? Yeah. So that's sort of some of the younger kids and that leads to a whole  other world of fractures.

Dr. Chehab:

So all these locations on the basketball court, on the soccer field or the contact sport field, football on the cross, trampoline parks, the playgrounds, these are locations where people can get, or young kids can get injured in these growth plate fractures where they can cause a disruption in the shape of the growth plate. What are some of the common locations in the body where kids can develop growth plate? What are the most common places you see it?

Dr. Kramer:

So the biggest, is it everywhere? It can be everywhere. I think the most common place we see it is probably in your distal femur, which is the top part of your knee. because that can cause a leg length difference, which is the most obvious Yeah. You know, problem down near your ankle. So there are many ankle fractures depending on the amount of displacement that do need surgery to realign them. The wrist. We see lots of growth plate injuries, but I don't think we see as much growth plate or rest.

Dr. Chehab:

Why is that thing a good thing?

Dr. Kramer:

I just think it's the resilience of the growth plate at the wrist. 

Dr. Chehab:

And then in the elbow we talked about the throwing ones, but in the traumatic injuries on the elbow, are they through the growth plates typically, or not quite

Dr. Kramer:

Probably a combination. So one of the more common injuries we treat is a distal humorous fracture that's not through the growth plate, but these baseball injuries and some of those, those are through the growth plate. Okay.

Dr. Chehab:

And you know, obviously these injuries will take a kid out of sports for a period of time. We never want them to happen in the first place. So what are some of the key prevention strategies, not just in terms of stretching and strengthening, but what are some of the pearls that parents and coaches need to know in order to keep our kids the healthiest they can be and reduce the risk of injury as much as we can?

Dr. Kramer:

Right. Well I think the key is, I mean obviously we've got this sports specialization and the coaches and parents need to, you know, encourage the kids to do more than one sport. It will make you a better athlete overall. I think the strength and conditioning is key. You know, your flexibility, your speed and agility, you know, just as an athlete, not sport specific is the key to actually keeping you safe and healthy. You know, it's like I tell all these kids, most of these injuries are a blip in your season and not career ending and they need to keep that in mind that, you know, it's not the end of a career when we have most of these injuries

Dr. Chehab:

Okay, but obviously preventing them is a, is a big deal. So I remember when coming into practice getting a few pearls off of a stop sports injury campaign, which was launched by the American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine and, and the Pediatric Orthopedic Society in North America because we were seeing this epidemic of youth sports injuries and overuse in specialization. And they would say things like one sport per season and one league per sport.

Dr. Kramer:

Correct.

Dr. Chehab:

And a day off a week, a month off a year. And it seems like the common thread is don't push these kids too hard.

Dr. Kramer:

Right. It's a problem.

Dr. Chehab:

And do you see us being able to unwind this? I mean there's a whole industry around youth sports where people are making their livelihood off of year round sports participation, you know, off-season training, off-season baseball, traveling and, and, and, and, and how do we kind of put the genie back in the bottle? How do we help coaches and parents and, and the athletes themselves understand that, that there may be some detriment to this approach that we've developed over the past decade or two of this hyper sports specialization.

Dr. Kramer:

I think it's hyper sports specialization also at a much younger age. There was an article in Time Magazine about these parents spending lots of money to travel around the country for their 10 year old athlete to play in elite leagues, you know, and hoping to get looked at and it's just gotten out of control. Yeah. And I think we need to really push the multi-sport athlete. And I do agree doing one sport each season. Mm-Hmm. <affirmative> especially as they get older would be great. Yeah. But each sport makes that harder and harder. Yeah.

Dr. Chehab:

I mean it's a it and

Dr. Kramer:

It has to come from the top. So until it comes from the coaches, the same coach who says in high school, I want you to play multiple sports but don't miss off-season conditioning training for my sport. Yeah. And it's a lot of pressure and it has to come from the coaches and the parents to get to the kids.

Dr. Chehab:

So do you think it's a matter of just treating orthopedists, educating the parents and the coaches or what more do you think could be done? 

Dr. Kramer:

Think that we gotta start at the top with the coaches

Dr. Chehab:

At the top. Top. Like college level coaches, pro coaches or Absolutely. Or high school coaches are worse. Absolutely. I think

Dr. Kramer:

It's everywhere. I think it's at the top because I think now every young kid now sees themself playing at the elite level. Yeah. You know, the number of kids now they're eight years old and they're telling you they're gonna play in the M L B, the N F L, you know, the W N B A, the N B A and you're like, okay, slow down. And I think sports, one of the things I learned, it used to be all about fun and exercise and now it's all about achievement. Hmm. And it really has sort of changed it. So there's kids that wanna play sports in high school that can't, because they haven't played travel sports for five years leading up to it. Right. And it's a problem.

Dr. Chehab:

So if we can expand opportunity for kids to enter into new sports, do you think that would be helpful? I

Dr. Kramer:

Think it would be helpful. Yeah, you know

Dr. Chehab:

So, I think it's so interesting what you said about achievement and the emphasis on achievement and how that's contributed to some of the problems that we're seeing in youth sports.

Dr. Kramer:

And I think what it does this sense of you're only a good athlete if you're achieving something good causes anxiety in the kids. Yeah, which leads from the parents and the coaches and it's all part of this culture of Right. The no pain, no gain doesn't really work for the kids. But they feel like it needs to and it just pushes them and it needs, at some level, sports needs to be fun and great exercise. Yeah and a team building. Yeah and that's really what you wanna get out of sports.

Dr. Chehab:

I remember hearing a statistic about the number of kids leaving sports by, you know, ninth grade. It's a pretty shockingly high number.

Dr. Kramer:

It is and I always tell the kids, just because you're not on a team sport doesn't mean you shouldn't be doing sports. And it's a big problem because they sort of get shunned. You know, if you don't make the basketball team, then you're never playing a sport again. There's so much else out there. Yeah. And they need to look at some of these more, you know, and I think that's why some sports like martial arts and this whole ninja craze has actually helped the kids give them a sport to do. Yeah.

Dr. Chehab:

And then you know, finally what, in terms of pediatric development, you know, do you see any sort of innovations on the horizon that may help kids prevent these injuries? Do, do you see any treatments that might be innovative or is it just kind of a matter of good old fashioned advice of of you know, moderation, you know, nothing in excess. I mean where, where do you see it it going where we can help the young pediatric athlete

Dr. Kramer:

Do think we've gotten better at like speed and agility and strength and conditioning And you'll talk to most of these kids that are athletes are doing that now. They have like classes. They all have speed and agility coaches and strength coaches. So it's better. Yeah. But instead of it sort of in place of your sport, it's in addition to and so there needs to be a better balance there.

Dr. Chehab:

Do you think there's an appropriate age to begin speed and agility training and strength training? And is is it eight years old? Is it 18 years old? You know,

Dr. Kramer:

I think that's the hard part. Yeah. I mean I always tell the kids, you know, eight to 12, like it should be body weight training only. Yeah. You know, there's nothing like the eight year old is working out with his parent in his basement lifting weights and you're like, okay, not a good idea <laugh>. You know, but it needs to be sort of, and I think those kind of, you know, standards would help like a lot of body weight exercise early on before you start lifting weights would help a lot.

Dr. Chehab:

Okay. Okay. So just to summarize, we've covered a ton of ground, but the common denominator is the growth plate. Yes. And, and these kids are not many adults. They're kids with different anatomy and we have to respect that anatomy to help prevent injuries for these young kids. Most of them, if they're having problems with their growth plate, you said we'll present with pain. Pain and, and it's not a suck it up buttercup issue. We have to be pretty sensitive to their pain and allow for rest and not push them like we might a more mature adult athlete because of these growth plates.

Dr. Kramer:

I thought it'd be one of, that's one of the things to teach the parents and the coaches see the warning signs. Okay pull the kid if they're having a little pain, you know, let them rest before kind of pushing them. And it's always a problem when it's your best athlete, your best person and they don't wanna do that. Yeah. And that comes from the coaches and the parents and the kids. I think the kids get pressured. They don't ever wanna tell their parents they're in pain. Right. Right. And I think that's a big part of this like it needs to be okay that we see the warning signs and then get them better before it becomes a big problem.

Dr. Chehab:

You know, just hearing you say that the, you know, the culture around concussions has changed significantly where people are now self-reporting concussive symptoms and we were worried that athletes wouldn't because we're moving from play. But when they recognize the dangers of having an unrecognized concussion, you know, thankfully that hasn't happened And, and so maybe we can change the culture around elbow pain and shoulder pain and knee pain and ankle pain that happens in these kids because it is a sign that hey, the growth plate's getting overstressed and it could lead to a more significant injury. And that it's okay for kids to come forward and say that. And the coaches need to be receptive and the parents need to be receptive as opposed to trying to push them through the pain. Like, like no pain, no gain doesn't apply kids.

Dr. Kramer:

Right but I think the kids wanna push themselves through because they don't want anyone to see them as, you know, soft or soft and not strong enough. And you know, they're afraid they'll lose their spot on the team like that's all part of the like mental part of it but it needs to be, that's why coaches and parents need to help recognize it.

Dr. Chehab:

So Andrea, any other parting thoughts?

Dr. Kramer:

I think sports is such an important part of growing up and learning life lessons and we've had significant benefits from it, you know, as we grew up. And I want all these kids to appreciate the good parts of it. And most importantly, with all of these pediatric sports injuries that you know, we are here to help guide you and help you both get stronger and become better athletes.

Dr. Chehab:

My guest today is Dr. Andrea Kramer. Andrea, thanks so much for being on OrthoInform.

Dr. Kramer:

Thanks for having me.

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