Dr Melanie Cole (Host): Welcome to Long Lived Childhood, a pediatric health and wellness podcast presented by Rady Children's Health. I'm Melanie Cole, and today we're talking about pediatric sports injuries, helping keeping your young athlete safe from injuries. Joining me is Dr. Matthew Schmitz. He's a professor of orthopedic specializing in adolescent sports injuries, including hip and knee surgery at UCSD and Rady Children's Health San Diego.

Dr. Schmitz, thank you so much for being with us today. First start by telling us a little bit about the prevalence of youth sports injuries and what you see every day as the most common injuries that affect our young athletes.

Dr Matthew Schmitz: Yeah, that's a great question. I think that the prevalence of sports injuries is going up and part of that is because we're seeing increased numbers of kids, both male and female participate in sports. And so what we commonly see are your normal bumps and bruises and, and sprains what we're seeing an increased rise of knee injuries, specifically ligament injuries, and that's what we try to keep an eye on.

Some of the things that don't get better with a little bit of rest and some therapy.

Dr Melanie Cole (Host): So what are some of the most common factors that lead to an injury for our youth athletes? We know that ACL injuries in girls are on the rise. Tell us a little bit about what predisposes them so then we can talk about prevention.

Dr Matthew Schmitz: Yeah, so there's a number of, risk factors that can predispose you, some that you can modify, and some that aren't modifiable. There are certain body structure types that probably put you at a little bit of an increased risk of. Tearing your ACL, but what we can modify is some of the warmup patterns in undergoing some ACL prevention programs.

So plyometric exercises to properly warm up and learn how to jump and land specifically in your jumping mechanics. Those are the things that can be modified and can help reduce the risk of knee injuries specifically in our female athletes, that we do see an increased prevalence in those teenage patients.

Dr Melanie Cole (Host): A big issue, Dr. Schmitz with youth sports is. You and I both know this chronic overuse from sports specific training and we know our young athletes when they're dedicated and I have a son that's a gymnast and I know that he wanted to do it year round and I was like, no, you've got to do something else.

Because doing rings year round, you're really, gonna mess with your wrists and your elbows and your shoulders. So. We know that these athletes really want to do that sport year round. Speak a little bit about that overuse training and how we're really looking to, reduce some of that sports specific training, to look at some cross training and other things that they can be doing on the off season.

Dr Matthew Schmitz: Yeah, that's a great point. We know that overuse, and I think specifically it comes from early sports specialization, which I think is an issue that's becoming more prevalent in today's society. When I grew up doing youth sports, you'd switch from baseball to football to basketball, and what people don't realize is that you're using different muscle groups during those different sports, as opposed to just playing soccer year round or just playing baseball year round.

We're lucky here in Southern California that we have the weather that you can play certain outdoor sports year round. But that early sports specialization is really, is what does lead to the overuse injuries because you're not cross training. So for any of our athletes, I try to encourage them to be a multi-sport athlete.

What a lot of people don't realize is that when you start playing a sport at a young age, when you look at the professional leagues. A majority of those professional athletes were actually multi-sport athletes as youths. And so people didn't just play football. If you look at a majority of your NFL football players, they were also very ent in basketball and baseball as young athletes.

And so I really try to encourage the athletes I take care of to, participate in more than one sport. 'cause that way you're training different muscle groups. you decrease your overall risk of injury from playing the same sport year round. We know that, the overuse is becoming a major issue.

And really the only treatment we have for overuse injuries is underuse or rest. And so trying to get kids to back off when they've already gone past that threshold of having an overuse injury is very difficult. But I think cross training helps prevent those overuse injuries.

Dr Melanie Cole (Host): I agree, and it does help, and even to mix it up with exercise, strength training, yoga, all of these other things that they can do on those off seasons, really help to prevent some of those. Now let's talk a little bit about equipment, Dr. Schmitz, because. It's always been our thought that, oh, well, if you're playing football and these helmets and the pads are really gonna protect you, certain sports don't really have equipment that protects you.

Cheerleading, gymnastics, some other ones. But what about the equipment? Do we, as parents and coaches trust that equipment to keep our kids safe, or do we know that there are also safety precautions we need to take because the equipment isn't gonna do it all?

Dr Matthew Schmitz: I think the equipment should not be relied on to do it all. I grew up playing football, also played a lot of rugby when I was younger, and the tackling techniques are different between. Football and rugby because of the lack of pads in rugby. And what you're seeing in, a lot of your major football states, professional and collegiate, is that they're trying to teach their, athletes to tackle more, to not be reliant on the equipment that the equipment shouldn't be used.

And so, so de decreased injury, we. Focus more on proper techniques and not being focused on some equipment, being able to protect us. 'cause it's there to protect from small injuries, but it shouldn't be used as a weapon, if you will. And it's better to have a proper technique than to, to rely solely on equipment.

Dr Melanie Cole (Host): I agree. It's really important to hear you say that as an orthopedic surgeon now. If our children do get injured on the field, they get injured somehow. First line treatment, whether it's coaches or athletic trainers, or the parents themselves at home, what are we doing? Is rice still what we do?

Do we add the movement on the end? Now, tell us a little bit about just first line for your basic kind of injuries that, you know, a twisted ankle, something that our kids might experience, a lot.

Dr Matthew Schmitz: Yeah, sure. So, when we look at first line treatment, I think first. If there's not some sort of big deformity, if something's not broken and needs acute care, then your, typical strains and sprains. I think Rice is a good acronym and that's rest, ice compression and elevation. And so we know that, especially in that acute early phase, the first.

48 to 72 hours that can help with some of the symptoms. I think that motion is good. I do think that motion for your muscle injuries helps because it helps with the stiffness, but anti-inflammatory, a little compression in eyes can help with the early symptoms. What we wanna be, aware of is if that those symptoms are not getting better in 48 to 72 hours, then maybe it is something a little bit more serious that needs to be looked at and isn't gonna get better on its own with a little bit of conservative management.

Dr Melanie Cole (Host): Yeah, that's great advice. And what if it is something just a little bit more serious? When is it we know that? What are we looking for as far as red flags, swelling, redness, pain, inability to. Move that joint and then what do you do for our children? What if they do need surgery or you know, tell us a little bit about that process.

Dr Matthew Schmitz: you hit it on the head. I think that swelling, inability to move the joint, those are concerning things, especially if they don't resolve in a couple or three days. Luckily a majority of kids that come to see me don't have to go to the operating room, even though I'm a surgeon.

And so my first thing is we frequently get x-rays. We examine the patient to try and figure out what is the source of discomfort or what is the cause of the pain. A majority of that can be treated with proper physical therapy or changing in mechanics, and so frequently I, I'll, prescribe physical therapy to help work on strengthening or increasing motion and avoid the operating room.

It's only when there's certain things like an ACL tear that we know it's not gonna heal itself, or things that have failed to respond to conservative management with physical therapy that then go to the operating room. But my first goal is to avoid going to the operating room for any of my youth athletes is to try and get 'em back on the field with conservative management.

Whether that be just a little bit of rest and anti-inflammatories versus formal physical therapy is our next step.

Dr Melanie Cole (Host): Dr. Schmitz, as you and I were discussing a little bit about. A youth athlete's dedication when they really dig into their sport, they don't wanna miss, no matter what it is, they wanna get back on the field. If you do have to do something. Surgically or otherwise interventional, what do you do about return to play?

How do you work with the parents? About yes, it's okay that they can get back into this easily. They can ease back into it. And you mentioned physical therapy, so speak a little bit about the process for return to play and what you tell parents every single day.

Dr Matthew Schmitz: so first off, anytime that I operate on someone I, discuss with the family what the basic timeline is on getting back, and then I stress the importance I Could not do what I do without the assistance of the physical therapist that I work with. I tell my athletes and the physical therapists know this, what they do in working with athlete is far more important than what I do from a surgeon standpoint.

And that's getting that athlete prepared to go back to the sport of choice. And so it's a process as you go through the healing process, depending on the type of surgery that you have. But we set a timeline beforehand based on what the injury is in the surgery, and then we work with the therapy and the athlete to make sure that they're meeting certain guidelines and meeting milestones as they go back to sport.

Because what you don't wanna do is go back too soon before you've returned to your full strength, because that can put you at risk of further injury or re-injury and. Therapy is absolutely critical for us to getting our athletes back, but having that conversation upfront with the entire family and explaining to the athlete and their parents, this is the expected recovery.

Here's what you have to do as an athlete, because I tell folks, you can't go to therapy twice a week. You can't do anything twice a week for 45 minutes to an hour and get better at it. Therapy involves. Going to physical therapy, but then taking those exercises and, and doing them every day on your own so that you can make a full recovery and get back.

And so setting those expectations from the beginning is important, but then also working with the athlete and their parents about the timeline on getting back and what maybe their fears are or what they're excited to get back to, what they're nervous about getting back to and working through some of those psychological aspects that become a big component of the return to sport aspect.

Dr Melanie Cole (Host): Wow. What a great point you just made, because that psychological aspect is such a. Important part of getting back to return to play. And as we wrap up and you're giving us so much great advice, Dr. Schmitz, what do you tell parents that are nervous about sports injuries and prevention?

And then for the parents whose kids did get injured, as you just said, that's psychological aspect. Give us your best advice here on preventing sports injuries so that we as parents with kids in sports don't have to be worried all the time.

Dr Matthew Schmitz: Yeah, I mean, I'm a parent of two teenage daughters that participate in sports as well, and I grew up playing sports and I think there's, there's so many benefits to being active in, participating in, either team or individual sports from a personal standpoint, what it teaches you about leadership and grit and prepares you for life.

And so I try to tell my families that that. We can't keep our kids in a bubble forever. We have to let them experience life and sporting is part of that and recovering from injury is a part of that. And so as we go through the injury and, kind of recovery process, I think it's important for the athletes to talk to friends that have been through the injury process as well.

So they have someone that they. Talk to about their fears that can help them overcome those fears of return to sport. But once you meet certain criteria based on your strength and your range of motion and and your timeline from surgery, at some point you have to get ready to take the training wheels off.

And that can be scary for parents. Or athletes, young athletes. But working back in gradually and having that crutch of your comfort group that you can talk to, whether that's other student athletes or your friend group or your parents, is important to be able to, talk openly about what your fears are and help you overcome those fear.

Dr Melanie Cole (Host): Great advice. Dr. Schmitz, thank you so much for joining us today and really sharing your incredible expertise. Parents have so many questions about youth sports, so thank you again for joining us, and thank you for tuning in to Long Lived Childhood, a pediatric health and wellness podcast, brought to you by Rady Children's Health.

Together we can keep kids happy, healthy, and thriving. If you enjoyed today's episode, please consider downloading, subscribing, rating, and reviewing long lived childhood on Apple Podcast iHeartRadio, Spotify, or Pandora. Your support truly means a lot. I'm Melanie Cole. Thank you so much for joining us today.