Misconceptions About Pediatric Sports Injuries Sometimes Slow Recovery
As one of only 120 board-certified pediatric sports medicine physicians in the country, Mark Halstead, MD, has particular insight into young athletes and the injuries that commonly occur. His experience enables him to address a number of misconceptions that exist regarding pediatric sports injuries.
Among the most widespread of these is that children and teens commonly develop tendonitis. Although it occurs frequently in adults, what may be thought of as tendonitis in children is often more likely to be apophysitis, which is the area of growing bone to which a tendon attaches.
“A big reason for growth plate injuries is overuse. Younger kids’ muscles are stronger than the bones located at the growth centers, and they tend to overpower the area from which the bone grows. That can result in irritation and pain,” says Dr. Halstead, an attending physician in primary care pediatric sports medicine at St. Louis Children’s Hospital. He also was recently elected to serve on the executive committee of the American Academy of Pediatrics’ Council on Sports Medicine and Fitness. “An increase in overuse injuries is a trend we’ve seen in the past 10 to 15 years. Rather than changing sports with the seasons as kids used to do, now they are highly specialized in a particular sport at an early age. They play on multiple teams at once, and there’s been an explosion in year-round training programs. Any or all of these factors may result in an overuse injury.”
For these and other pediatric sports injuries, Dr. Halstead cites several diagnostic and treatment methods that are unnecessary or overprescribed. “Performing an MRI before X-rays is unnecessary, and I certainly don’t need an MRI prior to seeing a patient. X-rays often tell the whole story by themselves, not to mention a good clinical history and physical exam,” he explains. “When it comes to treatment, most injuries don’t need complete immobilization. In fact, it sometimes can hinder recovery because the muscles get tight and the patient will lose range of motion. And complete rest from activity is seldom required. There is usually some type of sports or training that patients will benefit from while they are healing. We like to promote relative rest, which may mean cutting back somewhat or cross training but not always complete cessation of an activity or sport. Patients are often more compliant with this suggestion as well.”
Concussion is another injury with which common misconceptions are associated. Concussion may result not only from a direct blow to the head, but also from a blow to the neck or to some other part of the body that forcefully whips the head back and forth. Loss of consciousness does not always occur – and often does not – with concussion, and a concussion can be present even when obvious symptoms such as headache and dizziness are absent.
“For many years concussions were diagnosed using a grading scale, but today we use a more individualized approach based on symptoms and their severity. For older pediatric patients, there is a computerized neuropsychological test that we can use to aid in our objective assessment,” says Dr. Halstead.
Concussion symptoms may include headache, dizziness, sleep disturbance, difficulty concentrating and a patient feeling as if life is going by in slow motion.
“Some children will have a mild injury but go through a long period of post-concussive syndrome, while others will have significant concussion and have no symptoms two days later,” says Dr. Halstead. “For that reason, there’s no ‘cookie-cutter’ approach to treating concussions. In recent years, however, there’s been a movement toward the concept of concussion rehab – slowly progressing physical activity intensity over several days to ensure symptoms do not recur prior to full unrestricted return to sports. We also advocate ‘brain rest,’ which may include pulling a patient out of school to reduce the amount of brain activity needed and then slowly reintroducing schoolwork and physical activity.”
When it comes to any type of sports injury, Dr. Halstead believes the decision to refer patients to a pediatric sports medicine physician or pediatric orthopedic surgeon should be based on the severity of the injury and the referring physician’s comfort level treating the problem.
“Some pediatricians and family practitioners have a lot of experience and comfort treating sports injuries, while others prefer sending these patients to a subspecialist. I find that physicians know which course is best for their patients. Our goal at Children’s Hospital is to provide whatever level of care is needed for the children referred to us,” he says.
Toward that end, Dr Halstead makes every effort possible to get pediatric patients who need to be seen urgently for sports injuries into his clinic within 48 hours of a referring physician’s request by calling Children’s Direct at 800.678.4357.
To help prevent injury, Dr. Halstead strongly advocates all young athletes have one full, dedicated month each year in which they play no organized sports at all. Instead, they should just be – kids.
“Going outside and playing games, climbing trees, riding bikes, using their imaginations – these are activities sometimes absent from kids’ lives because they spend so much time participating in organized sports. Free play needs to be encouraged, not discouraged. They need time to just have fun and let their bodies rest and recover,” he says.
