Archive for the ‘Eastern Shore Parents articles’ Category

Knee Pain and the Female Athlete

Posted on: November 14th, 2020

By Joanne Baird, MD

(November 2020) Amidst this ongoing pandemic, fall sports are back in full swing. With the disruption of our routine training and activities during the last several months, we are seeing an unfortunate increase in injuries in our athletes across all age groups. Knee pain in female athletes is especially common.

What Kinds of Knee Pain are There?

Anterior knee pain is one of the most common complaints with one of every ten musculoskeletal patients to our office. Adolescent anterior knee pain often occurs in healthy athletes, and can be extremely common in females. Athletes complain of pain in the front of the knee, usually underneath the kneecap ( patella). Pain more distally (upper shin bone area) or proximally (lower thigh) are different conditions related to the tendons or secondary growth centers (apophyses) of the leg including quadriceps or patella tendinitis or Jumper’s Knee, Osgood­ Schlatter Disease, or Sinding-Larsen-Johansson syndrome.

Adolescent anterior knee pain is particularly common after changes in training routine without adequate stretching or strengthening. There is usually no physical abnormality and in most cases it will improve with simple treatments.

The exact cause of knee pain in female athletes oftentimes is not clear. The knee joint is complex and small changes in alignment, training, and overuse can result in pain. The quadriceps (front thigh muscle) muscle helps keep the kneecap within the groove of the thigh bone (femur) . When this muscle is weak it can result in poor tracking of the kneecap, which can irritate the cartilage or aggravate the tendons. This does not usually cause knee swelling, nor do patients complain of clicking, locking, snapping, or giving way.

Anterior Knee Pain in Female Athletes Can Become a Problem with Lack of Training

What are the Symptoms of Anterior Knee Pain?

  • Dull, achy activity related pain that begins gradually
  • Popping when climbing stairs or standing from sitting
  • Pain at night
  • Pain during activities that involve repeated knee bending (jumpin , squatting, running, weight-lifting)

What to do? If your knee pain will not go away after and interferes with activity, see your doctor to examine the knee and rule out other problems with X-ray and potentially MRI if internal joint problems are suspected.

How do I Treat Anterior Knee Pain?

  • Stop and limit the activities that make your knee hurt until the pain goes away
  • Changing training routines
  • Participation in low-impact activities puts less stress on the knee joint (biking, swimming)
  • Weight loss may help if overweight
  • Technique changes with the guidance of a trainer or physical therapist
  • Gradual return to higher impact sports and activities
athlete in physical therapy for knee injury

Physical therapy exercises may be recommended to help improve your range of motion, strength, and muscle endurance. .https://baysideortho.com/rehab-center/

Additionally, ice may relieve discomfort after activities and over-the-counter nonsteroidal anti-inflammatories such as ibuprofen and naproxen may help alleviate pain .

Remember, adolescent anterior knee pain usually improves with simple treatments. Make sure to condition muscles with changes to training and activities to keep the pain at bay. Whether evaluation, treatment or physical therapy if needed – we’re here to help.

* American Academy of Orthopaedic Surgeons: orthoinfo.org

Dr. Baird received her MD from Georgetown University School of Medicine in Maryland, followed by Orthopaedic Residency at Naval Medical Center in San Diego, CA. As a Lieutenant Commander in the Navy, she served as Department Head of Orthopaedic Surgery at Naval Hospital Pensacola since 2011. Dr. Baird joined the Bayside Orthopaedic team this year after completing a Sports Medicine Fellowship at the Andrews Institute in Gulf Breeze, FL.

Know the Warning Signs for Heat Stroke

Posted on: November 2nd, 2020

By Trevor Stubbs, MD

(September 2020) With the normal summer sports routines affected by the COVID-19 pandemic, our children are more at risk for injuries during this upcoming season. Chances are your young athlete had few practices or team activities, so will be returning to the field with less flexibility, strength, and conditioning than they’ve enjoyed in the past.  Unfortunately, parents and coaches are likely to see more injuries like pulled hamstrings or ankle sprains. But they may face even greater health risks – from the thermometer. Heat stroke can be a nearly year-round challenge here in the deep South.

What Kinds of Heat-Related Illnesses are There?

Heat-related illnesses are a spectrum of diseases including heat cramps, heat exhaustion, and heat stroke. Most seen in football players, these symptoms are more likely to occur during practice as opposed to a game. Here on the Eastern Shore, temps are still in the upper 80’s, with humidity that compounds the misery. Heat and humidity are prime risk factors along with obesity, poor hydration, and concurrent infection.

How Do I Know if the Heat is Dangerous?

The symptoms of heat-related illnesses can vary. Heat cramps are painful contractions because of dehydration and electrolyte imbalances. syncope is A temporary loss of consciousness while exercising is caused by heat syncope. Heat exhaustion, the most common of the heat-related illnesses, results in profuse sweating with nausea and vomiting. The most severe of these is heat stroke, a medical emergency that happens once the body’s thermoregulatory mechanisms have failed. These patients are often confused, have a fast heart rate, and are no longer sweating. 

What Are the Best Ways to Beat the Heat?

Knowing the signs is essential to prevent progression of a heat-related illness toward long term complications or even death. Treatments include:

  • stopping the activity
  • moving to a cool and shaded environment
  • rehydrating with water or an electrolyte-containing drink
  • cooling measures such as ice packs, submersion baths, or by spraying water on the skin and using a fan to promote evaporation

If nausea and vomiting make rehydration difficult, the patient may need medical attention for IV fluids.

As distancing guidelines continue, preseason training may be limited and makes an eye toward heat-related illness even more essential.  Look for shade, avoid exercise in the heat of the day and build up intensity gradually with periods of rest.     

We all look forward to sports – and some semblance of normal – this fall! Let’s be vigilant toward the impact of heat on our young athletes. And if sprains or strains are slowing them down – we’re here to help.

  https://www.hopkinsmedicine.org/health/wellness-and-prevention/heat-related-illness-and-young-athletes-3-important-things-parents-and-coaches-need-to-know#:~:text=Staying%20hydrated%20is%20one%20of,and%20after%20activity%20as%20well.

Dr. Stubbs received his MD from Louisiana State University in New Orleans, followed by residency in Orthopaedic Surgery at the University of Alabama at Birmingham. He is Board Certified and Fellowship Trained in Sports Medicine with Lenox Hill Hospital in New York City. He specializes in arthroscopic procedures of the shoulder, elbow, knee, hip, and ankle as well as cartilage restoration.

My Child’s Back Hurts – What’s Next?

Posted on: July 29th, 2020

by Jason Determann, MD

(August, 2020) While more common in adults, pediatric low back pain is almost equally prevalent in younger patients. Common causes include a variety of diagnosis; from muscle strains to scoliosis to disc problems. A pertinent history and physical exam can rule out most serious causes of low back pain. In most cases of nonspecific back pain, home-based exercise, physical therapy, and anti-inflammatory drugs can fix the problem.

Is That Heavy Backpack to Blame?

Does carrying a heavy backpack lead to back problems? Short answer is no. Nonspecific pediatric low back pain seems more influenced by psychosocial difficulties, conduct issues, and somatic disorders than it does mechanical problems, such as carrying a heavy backpack or long-term computer use. Nonetheless, the American Academy of Pediatrics recommends backpacks not to exceed 10-20% of the child’s body weight.

What to Ask Your Child About Their Pain

As a parent, the first step is asking your child to try to characterize the pain. Where is it located? When did it start and how long as it been going on? Is it constant or intermittent? What makes it better or worse? Also try to think if there any other symptoms that coincide with the onset of pain – fevers, poor appetite, weight loss or other symptoms that may or may not be related to your child’s aching back.

Acute back pain can be caused by muscle strains, herniated disks, and spondylolysis (a stress fracture or defect in the arch of the vertebral bone.) Chronic conditions can include inflammatory conditions, alignment problems (such as scoliosis or Schermann’s kyphosis.) Systemic symptoms can be associated with some rare causes of back pain, such as tumors or infections.

When to Seek Help

It is recommended that you schedule an appointment with your child’s healthcare provider if any of the following are present:

  • < 4 years old
  • Systemic symptoms (fever, malaise, etc.)
  • Nighttime pain
  • Neurologic symptoms (pain radiates into legs, numbness, etc.)
  • Self-imposed activity limitations

With a physical exam, we consider spinal alignment and mobility, tenderness, and neurological aspects.  Standard x-rays may be performed to help rule out any bony problem associated with your child’s condition. Depending on those results, bloodwork and other analysis may be involved.  Not all pediatric low back pain involves this level of diagnosis, but serious conditions do exist. We’re here to help sort things out.

https://orthoinfo.aaos.org/en/diseases–conditions/back-pain-in-children/

Dr. Determann received his MD from Louisiana State University in New Orleans, followed by residency in Orthopaedic Surgery at the University of Alabama in Birmingham.  He is Board Certified and Fellowship Trained in Sports Medicine with a specialty in Shoulder & Elbow Surgery.

The Limping Child

Posted on: March 29th, 2020

Gregg Terral, MD

(May 2019) Limping is a common complaint that prompts parents to seek medical attention for their child. Usually the limp is caused by minor injury that will get better by itself. However, limping that last longer than a week and that is not improving may indicate a more serious condition requiring medical evaluation. The challenge for both the parent and the physician involve the difficulty in young children at describing their symptoms as well as with older children trying to play through their pain even when it is not safe.  As a parent, it’s important to understand a limping child.

What is Causing My Child to Limp?

Injury:

Minor injuries such as contusions, low-grade sprains and strains will resolve quickly. Pain and limping related to more serious ligament sprains and muscle strains as well as traumatic and stress fractures will however persist.

Overuse injuries:

Overuse injuries to various sites of growth can also occur – typically the heel, mid foot, leg, kneecap, as well as the pelvis. These causes of pain fall under the general diagnosis of apophysitis. Patella maltracking as well as patella tendinitis or jumpers knee may also be a concern.

Infection and inflammatory disease:

Viral and bacterial infections can settle in growing bones and adjacent joints causing significant pain at times. Several types of inflammatory disease such as juvenile arthritis can also be a cause.

More Serious Issues Behind a Limp

Other less common causes of leg pain or limping can be related to congenital abnormalities such as a congenital hip dislocation or congenital foot deformities

Legg-Perthes disease is caused by insufficient blood supply to the hip, leading to a flattening of the ball within the ball and socket joint of the hip. This condition usually occurs between the ages of 4 and 10 in otherwise healthy children.

Slipped capital femoral epiphysis occurs just before puberty and is a slippage of the growth plate within the hip socket.

Diskitis is an inflammation of the disc spaces within the spine which can also cause painful limping.

Nervous system disorders create a problem with the nerve signals that control walking. Disorders of the nervous system can cause weakness or tightness in the muscles which can also cause a child to walk differently.

Tumors of various types can grow into bone and soft tissue and cause pain locally.

A thorough history and physical exam by your physician accompanied by appropriate imaging which may include studies such as x-rays, ultrasound, bone scans, MRI, or CT scan can readily provide a diagnosis. Occasionally bloodwork will also be needed to make the appropriate diagnosis and develop a treatment plan.

If your child has an issue lasting more than a few days, we’re here to help.

https://orthoinfo.aaos.org/en/diseases–conditions/the-limping-child/

Dr. Terral received his MD from Louisiana State University Medical Center in New Orleans, followed by residency in the Department of Orthopaedic Surgery at the University of Mississippi Medical Center in Jackson, MS.  He is Board Certified and Fellowship Trained in joint reconstruction.

Parents – Make Your Own Health a Priority for the New Year

Posted on: February 29th, 2020

Jennifer Firestone, MSN, CRNP, FLS

(January 2020) A New Year likely finds you getting kiddos back in the school swing, planning spring sports and more. Where is your own health on that 2020 to-do list?  Parents – especially Moms – often bump themselves down the priority chart.   

As part of our Bone Health Clinic team, I work with patients every day suffering fractures, fragility and the other challenges of osteoporosis.   And it might surprise you to know the exercise habits of your late 20’s -40’s determine whether you’ll be a patient of ours years later. Bone health begins to diminish in our 30’s, if we’re not taking healthy steps to prevent it.

Weight bearing exercises build bone strength, and should be part of an overall routine that’s fun and not too tiring. Burnout and boredom can be the first culprits to a fresh fitness plan. So mix it up with indoor and outdoor options, set a goal like finishing a 5K run and stick with it!

Once you find an accountability buddy and get ready to roll, consider a few tips for a safe and healthy routine.  Don’t buy into the “no pain no gain” notion that exercise should be difficult to be beneficial. Normal muscle soreness fades in 24-48 hours. If you’re experiencing real pain, it should be checked out.

weight bearing exercise is key to bone health

Tips for A New Exercise Routine

  • Ensure Proper Equipment.  New running shoes? Make sure they’re comfortable, supportive and won’t cause calluses or blisters.   Test new exercise gear in the store.
  • Choose a Balanced Exercise Regimen. The best routine includes aerobic exercise, strength training, and flexibility.  The American Heart Association recommends 30 minutes of moderate-intensity aerobic activity at least 5 days per week for maximum heart health.  
  • Always Warm Up.   Warming up increases your heart rate and blood flow, which loosens up muscles, tendons, and ligaments.  
  • Be Sure and Stretch.  Stretching – at the end of your workout – helps our range of motion, how well we move, and limits muscle soreness as well as risk of injury.   
  • Take Your Time.  Strength training is good for muscles and bones – move slowly through the entire range of motion.
  • Stay Hydrated. Water is key!  Drink 16 ounces of water 15 minutes before and just after your workout during cooldown.
  • Cool Down.    Take twice as long cooling down as you did warming up – gradually lessening intensity for the final ten minutes of your workout.

Hit those new fitness goals gradually – and keep going.   The benefits of exercise begin to diminish in two weeks and completely disappear in 6-8 weeks.  Track your progress, prevent injuries, and pat yourself on the back.   Healthy bones depend on overall fitness. Wishing you a well and wonderful New Year!

Jennifer Firestone received her Bachelor of Science in Nursing from Jacksonville State University followed by her MSN from the University of Alabama at Birmingham.  With a specialty in aging, Jennifer is part of Bayside Orthopaedic’s Bone Health Clinic team – creating personalized treatment plans to reduce the overall fracture risk, accelerate healing, prevent subsequent fractures and break the fragility cycle.

The Truth about Growing Pains

Posted on: January 29th, 2020

Dr. Jason Determann

Has your young one ever complained of general aches and pains… that have you stumped? The phenomenon we call “growing pains” is one of the most common causes of recurrent musculoskeletal discomfort in children. First described by a French physician in the early 1800s, we have spent nearly two centuries trying to get a better grasp on the exact cause and best treatment for such a common problem.

What Exactly are Growing Pains?

So what are growing pains?  The syndrome is described as intermittent pain, usually in the lower extremities, that occurs late in the day or early evening. The pain is typically gone in the morning and not worsened by physical activities. Discomfort with growing pains usually begins between the ages of 3 and 6, with the average age around 8 years old. Despite the coined term “growing pains,” there’s no direct connection to rapid growth.

The search for a cause hasn’t been completely successful.  Theories include:

  • generalized hyperlaxity (loose ligaments,)
  • psychological stress that leads to somatic symptoms
  • deficiency in blood flow
  • low vitamin D levels
boy having back examined

How Do I Know if Growing Pains are Something More?

The diagnosis is one of exclusion. Simply stated, “Everything checks out OK.” A few highlights:

Characteristic Typical Findings
Pain Location Bilateral
Lower Extremity (calves, thighs, shins)
Timing/Onset Late afternoon/evening
Resolution by morning
Intermittent
Not activity related
Severity Improves with massage, over the counter analgesics Does not increase in severity over time
Physical Exam Normal

The first thing we’ll do is look at a full medical history with a thorough physical exam to determine any other potentially serious causes of pain.  That might include fever, malaise, or decreased appetite. If your child can’t put their weight on a leg or has an altered gait (walk), we’re dealing with something beyond growing pains.  Any recent viral illnesses, rashes or travel are clues to alternative diagnosis as well.

If the physical exam is normal, we typically don’t need any further workup to make the diagnosis.  X-rays or bloodwork may be ordered to rule out a more serious condition. These can  include developmental abnormalities, infections, growth plates conditions, or even a remote injury or trauma.

What Relieves Growing Pains?

When the diagnosis of growing pains is made, often reassurance is the only treatment rendered. Some studies have found benefit to stretching the quadriceps, hamstring, and calves. Most children get relief with massage to the areas of pain, as well as the addition of heat. Over the counter medications such as acetaminophen or ibuprofen can alleviate some the pain and discomfort.

At the end of the day, the term “growing pains” describes a specific, benign pain syndrome in young children.   Even though we still don’t know much about the underlying causes, there’s no need for long-term concern.   If you have any doubts whatsoever – we’re here to help you sort it out.

“Though he may stumble, he will not fall. For the Lord upholds him with His hand.”  Psalm 37:24

Jason R. Determann, MD

Dr. Determann received his MD from Louisiana State University in Baton Rouge, followed by residency in Orthopaedic Surgery at the University of Alabama in Birmingham.  He is Board Certified and Fellowship Trained in Sports Medicine with a specialty in Shoulder & Elbow Surgery.

Sport Specialization: Is it Safe? Is it Necessary?

Posted on: December 29th, 2019

Albert Jay Savage IV, MD

(June 2020) Youth sports have surged across the country, and a weekend drive around Eastern Shore ballparks proves we’re part of that trend.  By all accounts, the physical, mental and emotional benefits of individual and team sports are well documented.  From a sports medicine perspective however, this boom in youth sports has raised some alarm:   increasing “sport specialization” at a young age means an increase in youth sports overuse injuries, too.

Doesn’t My Child Need to Focus on One Sport?

Sport specialization has been defined as “year-round intensive training in a single sport, at the expense of other sports.”  Some parents reading this may be skeptical , as conventional wisdom suggests young athletes determined to “up their game” as they age will fall behind if not working consistently on their skills.    However, a quick dive into current research reveals some surprises:  (1) most players in Division 1 athletics did not pursue early specialization, (2) baseball pitchers from colder climates that do not throw year-round tend to excel over those from warmer climates, and (3) early specialization may actually decrease the likelihood that an athlete will reach an elite level.

Furthermore, studies find overuse injuries consistently linked with the following risk factors: (1) a high level of sports specialization, (2) playing their sport for more than 8 months of the year, and (3) playing their sport for more hours per week than their age. 

child throwing baseball

Tips to Prevent Youth Sports Overuse Injuries

Most overuse injuries can be prevented with proper training and common sense.

  • Learn to listen to your body and listen to what kids are telling you.
  • Remember that “no pain, no gain” does not apply here. 
  • These young athletes are not just little adults.  They have growing bones and soft tissues and are susceptible to different types of injuries.
  • Follow the 10 percent rule. In general, you should not increase your training program or activity more than 10 percent per week. This allows your body adequate time for recovery and response.

From a parent’s perspective I want my kids to enjoy playing sports –and to soak up the character traits and teamwork skills that healthy competition offers.  From my former athlete perspective, I know the value of hard work in reaching their greatest potential.    But all of us as parents can agree in the goal of safety first and foremost. Nothing is achieved when our children are sidelined with preventable injuries. 

The debate over single sport injuries is likely to grow along with the options and enthusiasm for youth sports overall.  I encourage parents and coaches to learn more – some great resources can be found at the American Orthopedic Society for Sports Medicine website, www.sportsmed.org.

Dr. Savage received his MD from the University of Alabama at Birmingham, followed by residency at the UAB Department of Orthopaedic Surgery. He is Board Certified and Fellowship Trained in Sports Medicine.

A Repetitive Problem – The One Sport Injury

Posted on: October 29th, 2019

Gregg Terral, MD

( August 2019) Summer break is over, kids are back in school and fall sports are in full swing from elementary to high school. With more and more young athletes under 12 focusing on just one sport and training year-round, we’ve seen a growing number of our younger patients with what’s called a “one sport injury” caused by repetitive movements.  The condition is called apophysitis.   

What Causes the One Sport Injury?

The apophysis is a growth plate that provides an attachment site for a muscle to attach to bone via a tendon. Apophysitis occurs due to repetitive or chronic traction at either the origin or insertion site. This is because the growth cartilage present in this younger age group is the weak link in the muscle-tendon unit and is prone to injury. Continuous stress can lead to injury with pain and swelling.

The knee is the most commonly seen site of apophysitis where the patellar tendon attaches to the upper tibia. Other common sites are the Achilles tendon at the heel, the lower part of the kneecap, the outer side of the foot), the inner elbow (Little League elbow), and shoulder (Little League shoulder). Runners, sprinters, and soccer players are especially prone to locations in the pelvis causing hip or groin pain.

child throwing baseball

Among athletes between the ages of 5 to 14, overuse injuries impact:

  • 27% of football players
  • 25% of baseball players
  • 22% of soccer players
  • 15% of basketball players
  • 12% of softball players *                                   
  • *American Academy of Orthopaedic Surgeons

How Can We Treat Overuse Injuries?

We treat all types of apophysitis with a period of rest, ice, activity modification, and potentially physical therapy depending on the condition severity. Depending on the location, a variety of straps, braces, and orthotics can aid in providing comfort, protection and stabilization of the involved site. Healing time varies from a few days to weeks or months depending on a patient’s willingness to rest and avoid contributing activities.

What Parents and Coaches Can Do

  • Have a pre-season wellness check to determine any health concerns that could lead to injury
  • Warm-up and cool-down before and after athletic activities
  • Use correct sport specific equipment
  • Train in proper techniques like throwing or running
  • Hydrate!  Drinking plenty of water maintains health and minimizes cramps
  • Play different positions or sports throughout the year to minimize overuse injury risk
  • Don’t  play with pain – allow time to rest and heal

Keeping those growing bones, joints and muscles healthy ensure the ultimate goal: a healthy lifetime love of sports, too.

Dr. Terral received his MD from Louisiana State University Medical Center in New Orleans, followed by residency in the Department of Orthopaedic Surgery at the University of Mississippi Medical Center in Jackson, MS.  He is Board Certified and Fellowship Trained in numerous specialties including trauma-related musculoskeletal injuries and joint reconstruction.