Common Sports Injuries in Young Athletes

Podcast Transcript

Dr. Richard So, MD:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. Anthony Egger, MD:

Life as a sports parent is a whirlwind of practices and carpools until one awkward landing or heavy collision changes the season. I'm Dr. Ace Egger, an orthopedic surgeon who specializes in pediatric and adolescent sports medicine. Today, we're talking about sports trauma. We'll discuss why a child's injury requires a different approach than an adult's. How to spot the red flags of overuse and the best ways to support your young athletes' recovery. Joining me is Dr. Courtney Nolan. She's a pediatrician at Cleveland Clinic Children's who specializes in pediatric sports medicine. Welcome to Little Health, Dr. Nolan.

Dr. Courtney Nolan, DO:

Thank you.

Dr. Anthony Egger, MD:

Please tell us a little bit about yourself.

Dr. Courtney Nolan, DO:

So, I did my pediatric residency at Akron Children's Hospital, and then I did a fellowship in sports medicine up here at the Cleveland Clinic. And now I am practicing pediatrics and pediatric sports medicine in Strongsville.

Dr. Anthony Egger, MD:

Fantastic. Well, we're very lucky to have you here today, um, to talk about some of these topics. And so, you know, we'll just jump right in. And so, can you give a little bit of background on some of the most common sports injuries that you, that you see in your clinic?

Dr. Courtney Nolan, DO:

Um, one of the most common sports injuries that I see is something called Osgood Schlatter's disease, and that is when the kneecap and the patellar tendon are pulling on the tibia, or the big shin bone where the patella inserts. And a lot of times that's caused by running, running on those indoor tracks, running on those indoor fields, where you just have a lot of pressure, and it starts to pull away at that growth plate and it causes, it causes a bump to start there, and then a lot of pain and discomfort. Another injury that we see very commonly is something called Sever's disease, and it's, it's similar to the Osgood Schlatters in that, again, you have a large tendon, the Achilles tendon pulling on the calcaneus, which is your heel bone. And it's pulling on that growth plate. You don't see quite as much swelling down there, but you get a lot of pain every time they're, they're stepping and, and hurting that heel.

Dr. Anthony Egger, MD:

And so these are more unique injuries to growing children as opposed to adults because of the growth plate.

Dr. Courtney Nolan, DO:

Correct. Adults, we have closed growth plates as adults, but children have larger ones. And while on x-ray, you're not gonna be able to, to see the bone part of the, uh, growth plate. It is there, and it's the weaker part of the bone, and that's where we do see a lot of those injuries in kids.

Dr. Anthony Egger, MD:

And so can these come about from overuse type of injuries?

Dr. Courtney Nolan, DO:

Absolutely.

Dr. Anthony Egger, MD:

And in terms of hidden injuries, obviously, you know, somebody falls and their arms looking a little crooked. Um, you know, those ones I think are pretty hard to miss, but what are some of the hidden injuries that, you know, parents should look for, you know, after a fall?

Dr. Courtney Nolan, DO:

I've seen kids with fractures that don't have a whole lot of swelling or don't have the deformed bone. So if they continue to complain of pain, it's always a good idea to bring them in, let us get an x-ray, see if there's a little hairline fracture there, see if there's something else going on that we need to look at and to take care of for them.

Dr. Anthony Egger, MD:

So pain is obviously a major factor to look out for. Are there other red flags of other damage, you know, whether it's to nerves or blood vessels, um, that parents really shouldn't ignore?

Dr. Courtney Nolan, DO:

Absolutely. If you're seeing any numbness, any tingling, if you're seeing any discoloration, um, on your child's extremity, we definitely wanna see them right away to make sure they're okay.

Dr. Anthony Egger, MD:

And then what about dislocations of different joints? Is that something that needs to go to the emergency room? How does that usually get, um, handled and, or can those be more complicated in kids with open growth plates?

Dr. Courtney Nolan, DO:

They're definitely more complicated in kids with open growth plates. And the fact that when you dislocate, that means that one bone is kind of leaving the joint and it can stretch and damage the tendons, um, which can stretch and damage the growth plate as well. Um, and our concern is, if you're damaging your growth plate, is your bone gonna grow equally to the other one? We all have two arms, two legs, two hands. We wanna make sure that everything is symmetric as the child's growing.

Dr. Anthony Egger, MD:

Yeah, absolutely. And you mentioned as though a tendon can pull a piece of bone away that that growth plate is sort of the weakest link. Can you talk a little bit more about those types of injuries?

Dr. Courtney Nolan, DO:

Absolutely. And that is called an avulsion fracture. And those are pretty common, especially if we are looking at stress fractures or overuse injuries. That tendon keeps pulling on the bone, just like we talked about with Osgood Schlatter's or with Sever's. And so it just keeps pulling and pulling and pulling. And then eventually that weak spot where the growth plate is, sometimes it will just pull off and then we definitely need to treat your child for that.

Dr. Anthony Egger, MD:

Are there sports that are more common that these types of avulsion injuries happen in?

Dr. Courtney Nolan, DO:

We can see avulsion fractures in all of the different sports, but commonly we'll see them in football. You'll see a hip avulsion fracture from when they're just running and running and running or they get hit and they're stopped and that force just has to go somewhere and that tendon can just pull the bone right at that growth plate.

Dr. Anthony Egger, MD:

And what about like in baseball?

Dr. Courtney Nolan, DO:

In baseball, we often see overuse injuries, um, as a little league elbow type of picture. And that's where you're gonna get pain and swelling, um, on the inside of their elbow. And it's really important that that little leaguer does take rest and, um, allows their body time to heal so that they don't develop an avulsion fracture in the elbow requiring surgery.

Dr. Anthony Egger, MD:

And how can, you know, parents sort of tell the difference between, you know, a stress fracture that's developing versus, "Oh, my legs are tired from practice."

Dr. Courtney Nolan, DO:

So I notice a lot when it's just, "I'm tired from practice and I need a break." They're sore, but there's not the severe pain. You don't have a spot where it hurts. It's generalized pain. A lot of times you'll notice it after practice or at bedtime at those times of the day where if you have a stress fracture, if it's developing, it's going to be more point tender and you're really gonna see that there. It's gonna be during the sport more so than after the sport, even though they will continue to have pain. Um, it's just really kind of the timing and the area of the pain. And if you have any questions, I would always encourage you to see your doctor and ask them about it.

Dr. Anthony Egger, MD:

Yeah. I think in those cases, you know, sometimes getting an x-ray to prove that, hey, is there not a stress fracture there or sometimes even advanced imaging, but I think you're right on the head that point tenderness is, is a major, um, component as opposed to sort of more global, um, soreness and things like that. And obviously we want our kids to be active, but how do we know if they're doing, you know, too much?

Dr. Courtney Nolan, DO:

They're doing too much if they're getting burnt out, if they're getting recurrent injuries, if they're not giving themself time to heal.

Dr. Anthony Egger, MD:

Talked about burnout. I think that's super important. Can you delve into that a little bit more and what are some of the signs of burnout that you see in some of these kids?

Dr. Courtney Nolan, DO:

So burnout is a concern, especially in, in even early adolescents, but the later adolescent athletes, um, they start to lose interest in their sport, but a lot of times we, as parents, have put a lot of pressure on them. We've put a lot of money into their sport. We have put a lot of time and energy ourself into the sport, and our child feels that they need to continue to push through that sport, not just for themselves, but for us. And if you start to see your child's losing focus, just not interested in going anymore, having a lot of recurrent injuries that may or may not have a source. They may have a sore elbow, and then they might have a sore wrist, and then their knee might be sore, but nothing's found on x-ray, nothing's found when you go into the doctor. It may just be that your child's needing a break from that sport.

Dr. Anthony Egger, MD:

Yeah, and so do you recommend them taking breaks or playing different sports and not hyper-specializing in one sport at a younger age?

Dr. Courtney Nolan, DO:

Absolutely. I think that all children should get the opportunity to see what sport they like, um, to see what sport they fit into. And when you do start to play a single sport year round, you do run a very high risk of overuse injuries because you're using your body the same way. If you're doing different sports throughout the year, even if it's just two sports, you're going to use your body, your muscles, your bones in different ways, which helps keep them active. It helps keep them strong, but it helps keep them from getting overused.

Dr. Anthony Egger, MD:

Yeah, I think there's a lot of great data now looking at professional athletes and how they use other skills from sports they developed as, you know, younger kids developing hand eye coordination and different things like that. So I completely agree with you. You know, not only trying to prevent injury in terms of, you know, limiting overuse, but are there different things they can do with equipment or shoes or different things to try and prevent these type of injuries?

Dr. Courtney Nolan, DO:

Absolutely. Having the proper equipment for your child's sport, I would say is, is the number one way to help them out. Um, if your child has flat feet, putting shoe inserts into their cleats, making sure they have the right cleats for the sport that they're playing and just making sure that their needs are met.

Dr. Anthony Egger, MD:

And so when these injuries occur, you know, a lot of times we hope that it's, hey, a non-operative small thing, but are there certain things that trigger you to say, "Okay, hey, maybe this needs to see a

Dr. Courtney Nolan, DO:

Surgeon?" A lot of times swelling and pain if, if it's out of proportion to what I would expect for the way that the injury happened, um, most of the time we'll start out by doing an exam and most likely getting some x-rays to see what's going on in the bones. The x-rays don't show us though if there's any injuries to the muscles, any injuries to the tendons. So, you know, through that physical exam, it gives us a better idea of if we need to order advanced imaging like a CT or an MRI, um, or if the x-ray is showing a certain type of fracture, we would definitely want to get them over to the orthopedic surgeons to have them evaluated for possible surgery.

Dr. Anthony Egger, MD:

And what is the role in physical therapy in your practice for trying to get these kids back, uh, for certain injuries?

Dr. Courtney Nolan, DO:

Physical therapy is amazing. Um, it really does help the kids in the areas that they're weak. Um, no kid is absolutely perfect in their muscles and how they're using them and how they're running in their gait and physical therapy can definitely take that injury, strengthen up the areas that were weaker and help them just be a better athlete overall as well.

Dr. Anthony Egger, MD:

Yeah, I think flexibility plays a huge role in that too. And a lot of kids, um, you know, I know when I was much younger, I was always, you know, very, very tight and that, that tightness, as you said, can sometimes lead to those avulsion fractures. So I think focusing on flexibility and in addition to strengthening is, is huge for physical therapy. And then, you know, not only the physical component of, you know, returning back, um, after an injury, but there's obviously a huge mental component. Um, we had mentioned burnout as one of the, you know, mental aspects too, but how do you sort of counsel athletes and parents, um, on the mental aspect of getting back into sport?

Dr. Courtney Nolan, DO:

So absolutely. As their body is healing, they may be nervous, they may be anxious about going back and having the same injury occur or having a new injury that might hold them out for the same amount of time or even longer. And it's making sure that, that they're ready to go back, honestly, and having those hard conversations and seeing where they're at mentally, are you okay to go back? Um, and I know we've been focusing on growth plates, but even when you're talking about concussions, making sure that they're, they're ready to go back and that they're not nervous. A lot of times if an athlete goes back before they're ready, they're going to sustain another injury because they're not gonna play to the same ability or they're going to shy away and that's when they're gonna take another hit, that's when they're gonna step wrong, that's when something else is gonna happen.

Dr. Anthony Egger, MD:

Yeah, I completely agree. I think a lot of times, you know, even if the x-ray looks normal, there may be some strength deficit or mental deficit that we need to overcome, um, in terms of getting them back onto the field. Is there anything else outside of, you know, the training, so specifically looking at, you know, diet or supplementations, um, that can help speed up healing or prevent injury?

Dr. Courtney Nolan, DO:

Honestly, eating a good, well-rounded diet is the number one from my pediatrics and pediatric sports medicine perspective. I don't think you need to go out and buy all the fancy supplements or anything like that. I, I tell my little kids, you wanna have a rainbow plate, you wanna have some green, you want some colors, you don't wanna have just a light brown plate or a, a beige plate. Um, so you really wanna be eating a little bit of everything and that's gonna help keep your body strong, making sure you're getting your milk or your chocolate milk to keep those bones strong so that the muscles and the tendons have a strong scaffold to pull on when the kids are exercising and just, you know, meeting your child's needs and helping them out.

Dr. Anthony Egger, MD:

What about vitamin D supplementation?

Dr. Courtney Nolan, DO:

Um, up here in Cleveland, it is a good idea in the winter. Um, if you lived in Hawaii or you're living in Southern Florida, you probably would be okay. But up here, we do see quite a bit of vitamin D deficiency, so it is not a bad idea to give your child about 400 international units of a vitamin D supplement.

Dr. Anthony Egger, MD:

Well, thank you very much for being here, Dr. Nolan. We truly appreciate you providing your insight and expertise, um, to our listeners. Um, is there anything that you would like to give as a parting wisdom to them?

Dr. Courtney Nolan, DO:

I would just like to thank you for having me here today. This was a wonderful experience, and if anybody has any questions about their athletes, um, or any concerns, definitely reach out to us and we can evaluate them and see if there's anything we need to do to help them out.

Dr. Anthony Egger, MD:

Great. Thank you so much. And thank you for joining me to learn how we can protect our young athletes. If you would like to schedule an appointment with Dr. Nolan or another pediatric orthopedic specialist here at Cleveland Clinic Children's, please call 216.444.2606. Again, that's 216.444.2606.

Dr. Richard So, MD:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the little health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.