Author Archive

Stay Cool – For Your Health!

Posted on: July 18th, 2023

Dr. Joanne Baird

July 2023

We’re well into summer break for kiddos and that means some of the hottest temps of the year.  Life on the beautiful Gulf Coast has us outdoors on the beach, at the pool, and still full steam in summer sports.  And steam is the key word!  Heat and humidity can lead to serious illness. Make sure you’re aware of the causes of heat injury, stay cool and hydrated, know the signs and how to treat someone in distress.

Heat Injury Causes:

Our body cools us during exercise by sweating, but as we perspire, we lose necessary body fluids, resulting in dehydration.  When we are dehydrated it is more difficult to sweat and cool down our body temperature. 

  • Environment:  High humidity over 60%, (every summer day here) makes sweat evaporation difficult, preventing our bodies from cooling themselves effectively.  
  • Clothing:  Dark colored clothing absorbs heat, increasing our core body temperature.  
  • Fitness level/acclimatization: Our bodies need time to adjust to warmer conditions. Gradually move into summer workouts.  This is particularly important for coaches when planning preseason workouts or for anyone beginning a new exercise regimen.
  • Age: Children adjust much more slowly to high temperatures than adults and are more at risk of heat illness. 
  • Dehydration:   Even mild dehydration can impact your performance and prevent your body from cooling itself naturally through sweat.    
  • High body fat:  Athletes with higher body fat have more difficulty cooling themselves.
  • Meals:  Avoid exercise immediately after eating, especially a high protein/high fat meal. Your body requires energy to digest food, increasing body temperature and decreasing the ability to cool yourself.

Heat Illness Prevention:  Take time to adapt to temperatures and humidity gradually, working up to more intense and longer duration work outs.  Schedule your exercise for cooler times of the day. Watch for excessive heat warnings, poor air quality alerts, and if possible, take a rest during days of highest humidity.   Choose light, sweat-wicking athletic wear and avoid full equipment on days when conditions are most extreme.  Grab a hat and sunglasses with UV protection. Don’t forget sunscreen – your body has a tougher time cooling itself if it’s sunburned.  Stay hydrated before, during and after exercise.  Fluid replacement is essential in preventing heat-related illness.

Fluid Replacement Guidelines:

  • 24 oz non-caffeinated fluid 2 hours before exercise
  • Additional 8 oz of water/sports drink just before work out
  • 8 oz of water every 20 minutes even if not thirsty

Dehydration occurs when you lose more fluid than you replace, and even mild dehydration can put you at risk for heat-related injury and illness.  Watch your urine color as a guide for hydration status. Avoid caffeine and ultra energy drinks, as well as serious weight loss regimens.

Signs of mild dehydration:

  • Dry or sticky mouth
  • Dry, cool skin
  • Headache
  • Muscle cramps
  • Dark urine

Signs of moderate to severe dehydration:

  • Very dark urine or not urinating
  • Dry-shriveled skin
  • Irritability or confusion
  • Dizziness or lightheadedness
  • Rapid heartbeat
  • Breathing rapidly
  • Fatigue or listlessness
  • Unconsciousness

Heat injury ranges from Heat Cramps in stomach, arms, or leg muscles – as most any football player or young athlete has experienced in pre-season workouts.  Moderate Heat Syncope or Heat Exhaustion can result from water or salt depletion.  Stretching, hydrating with electrolyte-infused water, removing tight clothing, and cooling off with a fan and shade are all helpful in reducing symptoms.  Heat Stroke is a severe form of heat injury and a medical emergency. Call 911 and apply an immersion ice bath until emergency personnel arrive. 

Navigating heat is part of life nearly all year long on the coast – keep your family cool and healthy out there!

Girls and Sports Specialization – Mix it Up!

Posted on: April 26th, 2023

Joanne Baird, MD

As a former collegiate soccer player and now an orthopaedic sports medicine surgeon, women’s sports have always been dear to my heart.  I’m now mom to a young daughter enjoying her own venture into sports.   At her age, my heart was set on ballet slippers, not cleats.   But by 4th grade, I discovered soccer just as Mia Hamm was starring on our women’s national team.  Nike had an ad starring Mia dancing in the grass, not ballet slippers.  Soccer was fun, freeing, competitive, and everything to me dance was not.  By 5th grade as I juggled both loves, my dance instructor said it was time to focus on one or the other. I picked up my ball and never looked back.   

Later, I played soccer at the College of William & Mary while studying pre-med.  Basketball had a season of my attention, even track and lacrosse for a bit, but soccer was always my first love. That passion for athletics made orthopaedic surgery and sports medicine a natural career choice .  Looking back, I realize I was specializing at a young age. Soccer was year round, often on more than one team between club and school.  Fortunately, severe injuries were never an issue beside multiple ankle sprains.  

We know much more now about sport specialization and the detriment to adolescent athletes.

Why is Sport Specialization a Concern?

Most of the research on sport specialization comes from male sports, particularly little league baseball. Injuries increase due to repetitive motion and trauma to the muscles. By playing different sports, a variety of muscles are used and joints aren’t stressed in the same way, which protects a growing athlete.  Additionally, periods of rest are encouraged to allow the young musculoskeletal system to heal and grow properly.

Women Athletes Suffer More Overuse Injuries

There is very little literature, however, on the effects of sport specialization in adolescent female athletes.  We do know, however, that women athletes (not adolescents alone) tend to have more overuse injuries, and severe injuries that require surgery more often than comparable male sports.  Women aged 5-17 sustain a larger percentage of overuse injuries than males and are 3 times more likely to have patellofemoral knee pain (the kneecap).  There are distinct physiologic differences between males and females that contribute to the injury patterns, rates of overuse injuries vs traumatic injuries and the severity of injury that are not yet entirely understood. A recent study further strengthened the connection between injury and sport specialization, finding greater risk of concussions, stress fractures, and injuries overall. 

Overuse Injury Prevention is the Goal

As a former fellow of the great Dr. James Andrews, I carry his passionate concern for the impact of sport specialization and injuries.   Much of his career has been spent benefiting young athletes from advocating pitch count limits in youth baseball to 2010’s STOP Sports Injuries campaign recognizing the importance of injury prevention. 

I hope my daughter falls for a variety of sports like I did.  Athletics are an invaluable experience for girls, building confidence in reaching a personal best, creating priceless team memories, or even taking them to a college playing field and beyond.  My daily goal is not only returning young athletes to the playing field, but preventing injuries before they happen.

April, 2023

Stay Hip to Your Teen’s Aches & Pains

Posted on: April 21st, 2023

Jay Savage, MD

Occasional aches in the hip or groin may not be something to worry about when it comes to your teen.   But chronic hip pain in young athletes that doesn’t improve could be a sign of hip injury, which has become a growing concern particularly in high-impact sports such as soccer, basketball, and football. These injuries can range from minor strains and sprains to more serious conditions such as femoroacetabular impingement (FAI) and hip dysplasia.

What are FAI and Hip Dysplasia?

FAI is a condition in which the bones of the hip joint rub against each other, leading to pain and cartilage damage. This condition can develop in adolescence as the hip joint undergoes growth and maturation. Hip dysplasia, on the other hand, is a condition in which the hip joint is improperly formed, leading to instability and an increased risk of dislocation.

Both FAI and hip dysplasia can cause significant pain and disability in adolescents, particularly those who are active in sports. Dancers, hurdlers, and baseball catchers are among those at risk, with activities that involve the hip moving beyond its normal constraints.

What Are the Risk Signs for Hip Pain?

It’s important for parents, coaches, and dance instructors to know the risk signs in their young athletes and performers:

  • Chronic hip or groin pain that interferes with sports or performance
  • Any history of hip issues in the family
  • The difference between growing pains and chronic hip pain. Growing pains typically occur in children under the age of 10, felt in the legs, knees, or hips at night after an active day.  The child is usually up and about the next day, while chronic hip pain prevents typical activity at a normal intensity.

Hip Arthroscopy for Hip Joint Pain

In some cases, surgery may be necessary to prevent further damage to the hip joint. One surgical technique that has gained popularity in recent years for the treatment of FAI is hip arthroscopy. This minimally invasive procedure involves the insertion of a small camera into the hip joint, allowing the surgeon to visualize and treat the damaged tissues. During the procedure, the surgeon may remove bone spurs or repair damaged cartilage to alleviate pain and improve joint function.

Hip arthroscopy has several advantages over traditional open surgery, including a faster recovery time, less pain and scarring, and a reduced risk of complications. However, it is important to note that not all adolescents with hip injuries are candidates for hip arthroscopy, and a thorough evaluation by a qualified orthopedic surgeon is necessary to determine the best course of treatment.

Stretch and Strengthen – A Helpful Hip Solution

In addition to surgery, physical therapy and other non-surgical treatments may also be effective for managing hip pain in young athletes. Strengthening exercises, stretching, and activity modification can help alleviate pain and improve joint function. Pain medications and anti-inflammatory drugs may also be prescribed to help manage symptoms.

Overall, hip injuries in adolescents can be a challenging problem to manage, particularly in young athletes.  However, with early diagnosis and appropriate treatment, many adolescents with hip injuries can recover and return to their normal activities.

April, 2023

Joint Supplements – Are They Worth It?

Posted on: April 20th, 2023

Jason Determann, MD

No one likes getting older. Period. A healthy and active lifestyle free from pain and chronic disease is on everyone’s wish list.  As consumers, we are eager to find that product to help achieve these goals. Thus, an industry of over 400 over-the -counter joint supplements is designed to help you achieve those goals, or so they say.

Osteoarthritis is the painful condition in which the cushioning cartilage between bones wears away. Supplements often promise to not only relieve but restore joint cartilage itself.

Nutrition and Exercise Come First

Before we get to supplements, let me remind you that nutrition and exercise are far more important than supplements. Let’s assume you have those optimized. Read on.

Joint Supplements

Natural Doesn’t Mean Safe

While most supplements are naturally occurring substances, remember that “natural” does not equal “safe.” Please consult your physician as some of these products can have GI effects, interfere with bleeding, and interact with prescription medications.  Also, the FDA classifies these as “food” and not “drugs”, hence a much less regulatory process on what is in the bottle. As everyday consumers, it’s hard to find, much less interpret peer-reviewed articles and evidence to support or deny the effectiveness of a certain supplement.

Common Options and Studies Behind Them

I’ve included a short list of commonly used supplements for joint health. This list is not intended to be all inclusive.

Glucosamine – A structural component of cartilage, glucosamine exist in may forms. Well studied with mixed results. Not harmful and may improve symptoms of joint pain if related to arthritis. Typical doses 1000ml-1500 mg/day, divided into 3 doses. Often combined with the next supplement.

Chondroitin – A naturally occurring substance in our body that also in found in cartilage. Chondroitin comes in many forms, but I would recommend chondroitin sulfate. This version is most studied with some evidence it may reduce joint pain. 800mg-1200mg/day, can be divided.

MSMMethylsulfonylmethane (MSM) has been touted to alleviate joint pain, reduce stress, and even help with snoring. MSU lacks any substantial evidence to support its claims and long terms effects are unknown.

Hyaluronic Acid – As a component of synovial (joint) fluid, hyaluronic acid is often prescribed in the injectable for for symptomatic knee osteoarthritis. American Academy of Orthopedic Surgeons recommends neither for nor against the use of these injections. No studies have shown similar improvements with the oral form.

From the Kitchen

Omega -3 fatty acids – Healthy fats found in fish that have potent anti-inflammatory properties. Looks for ones that contain “EPA” and “DHA”, a certain type of omega -3. Potential benefits of omega-3 supplements include not only joint health but also cardioprotective (heart) and neurodegenerative (brain) support. Dosages of this supplement vary widely but are often 1-3 grams/day.

Turmeric/Curcumin – A spice from the ginger family, Turmeric (and one of its active ingredients Curcumin) has been shown to block the inflammatory pathway that often leads to joint pain. Turmeric has been well reviewed with mixed evidence, but overall seems promising in reducing pain and increasing function in knees with osteoarthritis. Studied doses for Turmeric/Curcumin range from 100mg/day to 2g/day.

Do Your Research and Consider if Supplements are Right For You

In summary, quality evidence to supplement joint supplements is hard to find. When we find it, it is not uncommon to find a contradictory study. That leaves us with the same problem we started with. Are these supplements worth it? While most nutraceuticals have only minor side effects, it is still worth the time looking at their cost, potential benefits, and possible interactions to see if they are right for you.  We at Gulf Orthopaedics would be happy to help devise a strategy for your joint pain to keep you in the game.

Infirmary Health, Gulf Orthopaedics Partner with Bayside Ortho

Posted on: January 5th, 2023

January 4, 2022

Fairhope, Ala. – Infirmary Health and its orthopaedic specialty clinic, Gulf Orthopaedics, are proud to announce a strategic affiliation with Bayside Orthopaedics & Sports Medicine. The team at Bayside Orthopaedics includes Joanne Baird, M.D.; Joey F. Carter, M.D.; Jason R. Determann, M.D.; Leslie V. Rush, III, D.O.; A. Jay Savage, M.D.; and T. Greg Terral, M.D.

Together, with the team at Gulf Orthopaedics, these experienced and trusted physicians will provide the latest, most advanced surgical and non-surgical treatment methods, specializing in trauma and sports medicine, shoulder replacement, hip replacement, knee replacement, spine, foot-ankle treatment and interventional pain management.

“In 2021, Infirmary Health partnered with some of the best orthopaedic surgeons in the region, and we are excited to grow and extend that partnership by adding the physicians and team from Bayside,” said Mark Nix, President & CEO of Infirmary Health. “Through partnerships like this one, Infirmary Health continues to fulfill its vision as the FIRST CHOICE for healthcare in the Gulf Coast region.”

“After 45 years, this seems a natural growth in our long time philosophy of patient care,” said Bayside Ortho’s Jason Determann, MD.  “Leading edge treatment and technology take a joint effort, and we couldn’t have a better partner than Gulf Ortho.”

Gulf Orthopaedics now offers nine locations in

  • Fairhope
  • Foley
  • Brewton
  • Daphne

  • Midtown Mobile
  • Hillcrest Road
  • Tillman’s Corner
  • Saraland
  • Jackson

To schedule an appointment please call (251-435-BONE) or (251) 928-2401. Learn more about the physician team and services offered at and

Gulf Orthopaedics is an affiliate of Infirmary Medical Clinics (IMC). IMC serves the entire Gulf Coast region with more than 60 medical clinics covering more than 50 specialties. IMC continues to expand its network of quality physicians and medical clinics in an effort to further bolster Infirmary Health’s position as the FIRST CHOICE for healthcare in the region.

Women, Exercise, and Bone Health

Posted on: May 21st, 2022

Joanne Baird, MD

Regular exercise has been part of my life since college. As part of a nationally ranked soccer team at William & Mary, we ran drills every afternoon. And on weekends, I hit the trails around Williamsburg as a great stress release from class.   My routine over the last 20 years has grown from roads to reps – with circuit training, yoga, and paddle boarding thanks to life here on the Gulf Coast.

William & Mary Women's Soccer Team 1999
College of William & Mary Women’s Soccer Team 1999- Joanne Elston #23

We all know the benefits of exercise, like improving muscle strength and endurance, reducing risk of stroke or heart disease, and preventing unhealthy weight gain. But exercise isn’t just a value-add to life. For women, exercise and bone health are inseparable. Regular physical activity is essential to building and maintaining healthy bones. In fact, we’re losing bone strength every day if we’re inactive. Sedentary isn’t an option.

Our bones are naturally growing weaker over time if we’re not doing something to maintain bone density. Osteoporosis is a condition that leads to fragility and the potential for fracture, most prevalent in women after menopause.  This bone-thinning disease creates risk of broken bones, which can seriously limit mobility and independence.  We also tend to lose muscle as we age – a conditioned called sarcopenia.  Those who develop osteoporosis or sarcopenia are considered frail: more likely to fall and more likely to break a bone. 

Bone Health – Use it or Lose It

Our bones benefit from exercise just as muscles do – it makes them stronger.  Young girls and teens should begin exercising and eating well to build strong bones. As we age, we focus on maintaining bone strength.  Because a bone is a living tissue, it changes over time in response to the forces placed on it.  How does bone density grow?  As muscles move over bones when you exercise, they get the signal to produce more bone mass. Consider it a healthy nudge!  Bones build and become denser – a benefit that increases as you add good nutrition, including adequate calcium and Vitamin D.   

Yet another benefit of exercise is better balance and coordination.  As we age, balance helps to prevent falls and the broken bones that may result.  Studies find one fracture (not caused by trauma like a car accident or blow) often leads to another.  The “fragility cycle” is the downward slide we all want to prevent.

What’s the Best Exercise for Strong Bones?

Most all exercise offers positive health benefits.  Yoga and Pilates lengthen muscles and boost mental health and focus.  Swimming, kayaking, hiking, or anything outdoors soaks up healthy Vitamin D while toning muscles, too.

The two types of exercise we recommend most for building strong bones are weight-bearing exercise and strength-training exercise.  Improving bone strength is site-specific. For instance, walking boosts bone strength in arms and spine but not the wrist.  For stronger hands, wrists and arms, resistance bands are a better option.

Have you ever had a Pilates instructor remind you to “keep your shoulders in your back pockets”?  Women tend to slump as we age, yet good posture is essential to the health of our entire musculoskeletal system.  Postural stretching and strengthening not only prevents slumping, but the spine fractures some older people may suffer from simply bending over to tie shoes or pick up something off the floor.  

Weight-Bearing Exercise

Weight-bearing doesn’t mean lifting weights, but any activity you do on your feet that works your bones and muscles against gravity. When your feet and legs carry your body weight, more stress is placed on your bones, making your bones work harder. Pushups and plank position are easy (equipment free!) options with great results.  

Examples of weight-bearing exercise include:

  • Brisk walking and hiking
  • Jogging/running
  • Dancing
  • Jumping rope
  • Hopscotch
  • Tennis, pickleball, and ping pong
  • Team sports, such as basketball, soccer, and volleyball
  • Stair climbing

The more weight you place on bones, the greater the bone-strengthening benefits.  Jogging and jumping rope would top the list.  However, if you’ve been diagnosed with thinning bones or qualify as frail speak to your doctor about what type of physical activity is best for you. 

Strength-Training Exercise

During strength-training activities, resistance is added to movement to make muscles work harder and, over time, become stronger.  Even though muscle mass is the primary focus of resistance exercises, the stress on bones results in bone-building capacity.   

Common types of strength training include weight machines, free weights, and exercises (such as push-ups) that use your own body weight. Elastic bands are inexpensive, travel easily, and can also be used to add resistance to exercises.

A general guideline for strength training is to exercise each major muscle group at least twice a week. Be sure to rest for a full day between strength sessions.

Other Forms of Exercise

I encourage my patients to add non-impact exercise to the mix not only for strength but balance training benefits.  Did you know the top complaint that sends a patient to their doctor is dizziness? Followed quickly by… lack of energy.  Menopause again is a primary culprit.  A body in motion stays in motion, and a body at rest stays at rest.  That old physics lesson applies to our lives today, and the need for healthy movement to fuel the energy to… keep moving!   Building flexibility and balance not only feels good, but strengthens muscles, heart, and lungs.  If you have a musculoskeletal condition, such as arthritis, that limits your weight-bearing activities, swimming, cycling, and chair exercise are great alternatives.  

How Do I Start a Bone Health Exercise Plan?

Thirty minutes of weight-bearing activity, four or more days a week, is an effective gameplan for bone health.  Choose something you enjoy!  You won’t stick with it otherwise.   Those 30 minutes of exercise can be done in one stretch or broken up into shorter intervals. A 10-minute brisk walk three times a day (if that fits your scheduled) is a smart way to get started. Have a dog? She’ll love it!

If walking outdoors isn’t an option, climbing stairs indoors or even walking in place qualifies, too.  

To really reap the benefits of exercise, flexibility and balance training should be in the mix.  Just as I’ve added strength training and yoga to my passion for running, you should commit to plenty of time for stretching and balance-building moves to the end of your workout.  Not only will you reduce the risk of injury but taking time to stretch thoroughly clears the mind before you hit the rest of your day.

Don’t let your aspirations get ahead of your capabilities.  Before choosing any activity, consider your risk of falling. Talk to your doctor or physical therapist before developing an exercise program, especially if you’ve been diagnosed with severe osteoporosis.  Spine compression can happen with upright weightlifting, and you should avoid any exercise that bends or twists the back. Stationary bikes and rowing machines are not the best options. Opt for chair and corner wall exercises instead. 

Age and Bone Health Fitness

Adolescents and Young Adults

Healthy bones start in the lunchbox. Childhood is the age when bones are building, and it’s critical we fuel our children’s bone density during these years of rapid growth. A diet rich in Vitamin D and C from leafy greens, veggies and dairy is key. The skeleton that lasts our lifetime is essentially developed between the ages of 10 and 18 years old!  In fact, our peak bone mass in maximum strength and density is reached in our late 20’s. 

Weight-bearing exercise during the teen years is essential to reach maximum bone strength. A teen’s physical activity should include 20 to 30 minutes of weight-bearing exercise at least 3 to 4 days each week.


By our mid-20’s, physical activity alone can no longer increase overall bone mass dramatically. Exercise now is all about preventing or slowing bone loss, maintaining muscle mass to preserve and strengthen surrounding bone, and reducing the risk of falling. Both men and women also need good nutrition, calcium, and Vitamin D to preserve their bone mass.

Women and some men in middle age may require hormonal supplementation (estrogens or androgens) to improve or maintain bone mass as they age. For older people, however, these hormones are generally not recommended. Typically, bone-building medications are better options for those with significantly weakened bones.  

Fractures in elderly adults are most common in the wrist, spine, and hip. All can have long-term consequences that may include permanent disability. The statistics are troubling. Six months after a hip fracture, only 15% of those over 50 can cross the room without assistance.  And of that same age group, one in four of those who fracture a hip will die within the following year. *

Body Weight and Bone Health

When people lose weight, they also lose bone. Low body weight at any age is associated with a greater risk for bone problems and fractures.

Very low body weight has serious red flags for women.  While sports and exercise are healthy activities for girls and women of all ages, too much of a good thing can quickly become health-threatening.  Is your daughter too focused on being thin? Consumed with exercise? Have a friend who fits this description?  Long-term health problems and bone damage could be at risk without intervention. 

If young women exercise excessively, they can lose enough weight to cause hormonal changes that stop menstrual periods (amenorrhea). This loss of estrogen — the hormone that is necessary for maintaining bone mass — can cause bone loss at just the age when young women should be adding to their peak strength.

A woman who misses several menstrual periods, sustains a stress fracture in sports, continuously focuses on her weight, or has a distorted body image should see her doctor right away.


Exercise and healthy bones are a winning combination at every age.  While bone-building for children and adolescents and bone-preserving for adults, exercise is just one element of a program to prevent bone loss and reduce the risk of fracture.  Make sure you understand your individual risk for osteoporosis (Bone Density Scans should start by age 50), know your genetic factors and family history, and feed your body what it needs. A balanced, calcium-rich diet, adequate Vitamin D, and a healthy overall lifestyle (limited alcohol or nicotine) are key ingredients in bone health for a lifetime.

 *Bone Health Foundation

 American Academy of Orthopaedic Surgeons/AAOS

Elbow Pain? What Parents Should Know

Posted on: September 1st, 2021

Jason Determann, MD (September, 2021) Fall baseball is back in swing along with elbow aches and pains for young throwers. The throwing motion creates repetitive stress that often leads to a variety of both simple and complex conditions. Understanding the disorders that lead to elbow pain in children may help explain why your little guy or girl starts holding their elbow.

First of all, don’t think you’re alone. Nearly 30% of 8-12 year old baseball players will have elbow pain. That number jumps to 45% by age 14. While tendons and ligaments may be strong, they’re still growing. Growth plates around the elbow are called a physis: cartilaginous connection of immature bone often making up the weakest link that can lead to throwing problems

Little League Elbow

Little League Elbow is one of the most common conditions that affects the pediatric growth plates. Also called medial apophysitis, the inflammatory condition stems from repetitive traction or pull from the muscles and ligaments on the inside growth plate.  The inside bump on the elbow will likely be sore to the touch, but should improve with a period of rest, ice, and over the counter NSAIDs such as ibuprofen or naproxen.

Another condition is known as Osteochondritis Dissecans : fragmentation of elbow cartilage and bone due to a repetitious compressive load.  Loss of motion and symptoms such as locking or catching in the elbow are usually involved. X-rays are needed to confirm the diagnosis and often MRI is used to determine the severity of cartilage injury.

As children continue to grow, the concern of ulnar collateral ligament injury (UCL) comes into play. This ligament is the primary stabilizer of the inside of the elbow and is needed in overhead athletes. This ligament can get strained, develop partial tearing, or even complete tearing in severe cases. Due to sport specialization at a young age and year-round competition, the incidence of UCL problems in pediatric throwers is rising.

Elbow Injury Prevention

Regardless of the problem, the first step is a simple one: stop throwing!  Most elbow pain in children we encounter stems from overuse: the body is telling our child it needs a short break. This break can range anywhere from 2 to 6 weeks, and is often shortened with NSAIDS and physical therapy. Continuing to play or throw through the pain should be avoided to prevent even more serious injury.

In sum, the key treatment to elbow pain in children is prevention. We all share this responsibility. Emphasis should be placed on an adequate warm up and cool down. Additionally, proper throwing mechanics should be taught at a relatively early age and constantly re-evaluated. Most youth leagues, including ours here on the Eastern Shore, have pitch counts per game, week, and season. Adhering to these guidelines is critical to maximizing the health of your child’s arm.

Beat the Backpack Blues

Posted on: August 5th, 2021

Dr. Joanne Baird (August 2021) Can you believe we’re turning the calendar already? Back to school is around the corner. August brings excitement, a busier schedule (especially for parents), a return to academic and sporting activities, heavy backpacks, and computer time.  We can still avoid the aches & pains of back to school with thoughtful conditioning and healthy habits!


Injuries often occur when athletes suddenly increase the duration, intensity or frequency or their activities.  Before organized sports begin, young athletes should gradually increase activity toward a higher fitness level, especially if out of shape from other summer activities. Proper technique is important, and coaches are great resources in a conditioning plan.   In addition, our Gulf Coast temps stay peak-of-summer hot well through August, so staying properly hydrated is critical to preventing heat-related illnesses. Finally, a healthy, well-balanced diet is key in optimizing bodies and brains for a new school year.  

Back Pain Prevention

Even with the growth of laptop learning, millions of children each year are walking to school with a backpack full of heavy books and materials. This backpack strain can often impact the back, neck, and shoulder muscles.  Usually, the discomfort is short-term but heavy weight to the back can produce lingering issues.  

  • Distort the natural curves in the middle and lower backs, causing muscle strain and irritation of the spine joints and rib cage.
  • Lead to rounding of the shoulders.
  • Cause a person to lean forward, reducing balance and making it easier to fall.
  • Habitually carrying backpacks over one shoulder will strain muscles to compensate for the uneven weight and the spine will lean to the opposite side.  This muscle imbalance can cause muscle strain, spasm, and back pain.

A smart guideline is to limit the weight of the backpack to 10-15% of your child’s body weight.   Usually, pain will diminish with a period of rest, and there is no evidence backpack use can lead to permanent injury or structural spinal deformity.   

Helpful Hints to Prevent Backpack Strain

  • Choose a pack with lightweight material (nylon vs leather), padded back, wide (2-inch adjustable shoulder straps and individualized compartments.
  • Help distribute weight from shoulders with a hip strap or waist belt.  
  • Consider a separate bag for the laptop or heavy electronics.
  • Use both shoulder straps and wear the backpack on the back rather than over one shoulder.
  • Pack the heaviest objects into the backpack first so they are carried lower and closest to the body and distribute the load between compartments.
  • Lift the backpack using the leg muscles, keeping close to the body.
  • Try not to lean forward when walking. If this is necessary, it’s time to lighten the load.

In sum, what’s the backpack bottom line? If your child complains of discomfort, reduce the weight. Have them carry only what is necessary and encourage frequent trips to the locker during the day.  Back to school brings enough butterflies…without aches and pains, too!

*for more information: AAOS/

Youth Sports? Best to Mix it Up

Posted on: April 6th, 2021

Joey F. Carter, MD

(April, 2021) Need a sure sign of spring? You’ll find it on Saturday mornings at the ballpark and soccer fields these days.   Some of these young athletes may be playing not just during a traditional season but year-round, with club travel leagues starting as early as 7.  But is sports specialization in children a healthy choice?

What is Sports Specialization?

The past twenty years have brought a significant shift from unstructured free play and school-based sports to what’s called “sport specialization.” The numbers are astounding:  close to 30 million children between the ages of 6 and 18 and close to 60 million in organized programs are participating in year-round sports.   

Conventional wisdom may lead us to think kids will fall behind their peers if not putting in the “10,000 hour rule” of practice making perfect.  But the growing intensity of this early specialization may lead to more harm than good. The American Orthopaedic Society for Sports Medicine * has found the trend alarming enough to define a list of risk factors associated with overuse injuries in young athletes.

Know the Risk Factors for Overuse Injuries

  1. Participation in intense training and/or competition in their sport more than eight months per year.
  2. Participation in one sport to the exclusion of others or free play.
  3. Playing their sport for more hours per week than their age.

Do any of these hit close to home?   Overuse injuries we see in young athletes include knee disorders with soccer, basketball, and volleyball players. Shoulder injuries include “Little League Shoulder” due to repetitive pitch counts for pitchers and the intensity of throws catchers must make during a game.  “Little League Elbow” often results from high-throwing volume.  Racket sports and gymnastics also fall into the year-round sport specialization/overuse injury loop. 

Mix it Up – and Don’t Forget Free Time Too

Finding the right balance in training and competition is a tough topic for coaches and parents, who may feel pressured to keep up… and keep their child’s spot on the team.    Clearly, our children find enormous benefit from individual and team sports – with physical development, socialization, teamwork, and a strong work ethic.  But too much of a good thing also leads to psychological burnout and loss of motivation. What’s the answer? Limit practice, ensure plenty of rest, and keep it fun! Mix up other sports, and find time for free play, too.   We all want our children to succeed on the field of play – without preventable injuries. 


Ankle Pain? Don’t Tough it Out.

Posted on: March 29th, 2021

Joanne M. Baird, MD

(February 2021) Training for early spring sports unfortunately brings some quite common injuries. We see ankle strains and sprains in children and teens whether from overuse, lack of conditioning, or just because they are back on the field of play again!

What Sports Produce the Most Strains?

Ankle sprains are common, especially in sports that involve cutting like soccer or lacrosse. In addition, these ankle-impacting sports usually involve uneven ground. A sprain occurs when the strong ligaments in the ankle stretch beyond their limit and tear.

Most ankle sprains are minor and will heal with home treatment including rest, ice and elevation.  If serious swelling and pain make it too painful to walk, seek medical attention.  Severe sprains that are not properly treated early on and rehabilitated appropriately can potentially weaken the ankle and make it prone to reinjury.   

How Do I Know if I Have an Ankle Sprain?

The lateral ligaments on each side of the joint are impacted in ankles strains and sprains as the foot or ankle twists unexpectedly.   We grade sprains on the amount of tearing, from mild and microscopic to high ankle sprains that may require surgery.    


  • Swelling
  • Bruising
  • Tenderness to the touch
  • Instability – when there is a complete tear of the ligaments
  • May hear or feel a “pop”

A severe sprain may feel much like a fracture or broken bone, and you should have a physician examine the ankle as soon as possible.  How much can you move? Where is it tender? A physician may call for X-rays to rule out a fracture.

How Do I Treat a Sprained Ankle?

Most ankle strains and sprains are treated successfully without surgery – even a complete tear.   Home treatments include the RICE protocol:

R = Rest your ankle by not walking on it.  Crutches may be recommended for a few days.

I = Ice immediately to help with swelling.  Use 20-30 minutes, three to four times a day, do not apply ice directly on the skin.

C = Compression dressing with bandages or ace wraps to immobilize and support the ankle.

E = Elevate the ankle above the level of the heart as often as able in the first 48 hours.

Non-steroidal anti-inflammatory medications, like ibuprofen or naproxen, can help alleviate pain and swelling.  For moderate or severe sprains your doctor may recommend a removable boot or air-cast and sometimes a cast may be recommended.  Physical therapy and rehabilitation exercises are important to prevent stiffness, improve strength and prevent chronic ankle problems.  Balance training – or proprioception – will ensure a steady return to action.  No need to just grin and bear it– we’re here to help!