Wednesday, October 19, 2011

Little Rocky: Is Boxing Appropriate for Children?

Boxing is becoming an increasingly popular sport in young athletes. Proponents feel boxing teaches children discipline and promotes success. However, these benefits are likely outweighed by the inherent risks of the sport. In a recent policy statement, the American Academy of Pediatrics and the Canadian Paediatric Society contend that the intention to win points for blows to an opponent's head or body or even inflict a knockout makes boxing inappropriate for children and adolescents. Medical literature agrees. There is a significant risk of neurological injury, including deaths, from severe brain injuries.

According to injury databases, young boxers have the highest hospitalization rate among those participating in combat sports. Most commonly, they suffer from facial fractures and closed head injuries (concussions). A study of emergency department visits found 8,700 boxing injuries per year between 1990 and 2008. That's one emergency room visit per hour for 19 years! And injuries are on the rise.

While fractures are the most common injury overall, there is also a high risk of concussion, which are potentially far more dangerous in children than in adults because the brain is still developing. Repetitive blows to the head also put children at risk for structural brain injuries like bleeds, cognitive abnormalities and neurological deficits that can be permanent.

Boxing is a dangerous sport. With recent findings about the dangers of repetitive head trauma, parents should think very carefully about whether their child's participation is appropriate. There are numerous other combat sports, such as martial arts, that can provide a safer alternative while still promoting discipline and physical fitness.

Monday, August 22, 2011

Stress Fracture Season Is Upon Us!!

I've been seeing a significant increase in the number of stress fractures of the legs in the running population.  Unfortunately, this goes hand in hand with marathon training season and the beginning of cross country season.  Keep reading for tips to avoid these injuries.

A stress fracture is an incomplete fracture or crack within a bone, occurring when too much repetitive stress is applied to the bone.  In runners and other athletes, they most commonly affect the metatarsal bones of the feet, the calcaneus (heel), the tibia (shin), the fibula (outside of the lower leg), and the femoral neck (hip).  They occur more often in females than males.

When a bone in the lower extremity is loaded and stressed during exercise, it responds by increasing bone turnover. This involves the removal of old, damaged areas of bone and the production of new bone to replace it.  This happens in all weight-bearing bones in all of us, even with walking.  However, it is supercharged in those who aggressively exercise.  If bone formation cannot keep up with bone removal, an area of weakness develops.  This area can develop into a stress fracture if the bone continues to be loaded over time.  Think of this like bending a paper clip.  If you continue to repetitively bend a portion of a paper clip in the same location, it develops a weak spot.  When the stress is continued, it eventually breaks apart.

Any number of training errors can cause this imbalance of bone turnover.  A common occurrence is the commencement of a new exercise activity or a sudden increase in training.  This may include increasing the frequency, duration, or intensity of your workouts.  Inappropriate footwear for an individual’s foot type and the unforgiving nature of one’s training surface are also other notable factors that may lead to stress injury.  Individual biomechanical abnormalities in one’s running gait may contribute, as may muscle fatigue during long bouts of exercise that lead to compensation changes in the gait.

A stress fracture is characterized by increasing pain at the affected bone over a period of weeks.  It is usually well-localized and made worse by exercise.  Initially, the pain is only present after exercise, but with continued loading it becomes evident during the activity.  Eventually, the area may become sore with regular walking.  If the injury is allowed to progress, it may even cause pain at rest or even at night.  The area will be painful when touched.  There is typically minimal swelling, if any is present at all.

If you are concerned you have a stress fracture, you should come in to the office.  We can assist by confirming the diagnosis using X-ray, bone scan, or MRI, and help to determine the extent of damage to the bone.  Early stress fractures often are not evident on regular X-rays, necessitating further imaging. 

Once a stress fracture is diagnosed, activity modification is essential.  Rest and occasionally the use of crutches will help the bone begin to heal.  Fortunately, a complete discontinuation of activity is rarely necessary.  Low impact cross training and progressive strengthening is important to maintain muscle function and aerobic capacity and to not lose too much ground in training.  Such activities include swimming, deep water running, and cycling.  I will also help determine what errors may have contributed to the stress fracture and how to correct them. Also, I will help guide your safe and successful return to full activity.

Using appropriate footwear, varying your training surface, and alternating a cross training activity with running are all ways to help prevent stress fractures.  Most important is a gradual, progressive increase in running over several weeks as your training begins.  A good core strengthening program and working to correct muscle imbalances may also help avoid problems.

If you experience a new, acute onset of pain over a bone with activity that tends to worsen with continuation of the activity, you may be on your way to developing a stress fracture.  A short period of rest with low load cross training may allow the bone’s remodeling to catch up and may only result in a few days or weeks of lost time.  If you’ve rested and continue to note pain or the pain is worsening, it is probably time to get it checked out.  You should not attempt to run through this pain!  This may lead to a complete fracture and more time lost from training.  If caught early, some of my patients with stress fractures are healed and back on course in a matter of four to six weeks.  If more severe, the recovery can take months.  The majority of stress fractures heal with time, and with the help a good sports medicine specialist, training errors will be corrected and you will be back on the road in no time.

Monday, July 25, 2011

Welcome Fleet Feet Marathon and Half Marathon Training Team Members!!

Congratulations to the over 400 hearty individuals who have made the commitment to train over the coming weeks for the inaugural St. Louis Rock 'n' Roll Marathon and Half Marathon and numerous other fall races around the country!  You have chosen to work toward a goal that only a small percentage of the population can say they've attained.

Thank you for visiting the website.  I am the team physician for the Fleet Feet Marathon and Half Marathon Training Teams.  I have served in this capacity for the last two years, and was Medical Director for St. Louis' previous premier fall race, the Lewis and Clark Marathon, from 2007 to 2010.  Personally, I have completed three half marathons and was a member of the training team myself for this spring's Go! St. Louis Half Marathon.  I have designs on my first full marathon in 2012.

My office is located in St. Peters, Missouri--just a short jaunt over the river.  I have had numerous St. Louis County runners visit for various issues, and my training as a Primary Care Sports Medicine Specialist gives me keen insight into the mind and body of runners.  I am one myself.

Check back often for posts about common injuries and conditions that affect distance runners.  I will be in attendance at the half marathon kick-off meeting this Saturday.  Stop by and say hi.  Don't be shy about asking questions.  I will also be at a few of the training runs to evaluate your nagging aches and pains, to help decide if an injury is something you may be able to run through or if it may need further attention.

I am honored to be a part of the Fleet Feet Training Team program.  I pledge to work hard to ensure that every runner has the chance to cross that finish line and taste glory (and the beer at the tent at the end of the race.)

Sunday, July 17, 2011

Concussion Awareness in the Fort Zumwalt District

Here's a recent article in the Suburban Journal about the Fort Zumwalt School District's implementation of preseason concussion testing for all football players.

I am the medical director of the concussion program for Fort Zumwalt, and we have expanded preseason ImPACT computerized neurocognitive testing to all football players and cheerleaders in the district for the upcoming season.  In addition, ImPACT testing is performed at Clopton and Louisiana High Schools in Pike County.  Starting this summer, all high school athletes in all sports will be tested during the preseason in the Francis Howell School District.  Just like in the NFL, we will be able to test athletes after they sustain a concussion and compare the scores to their baseline performance to help guide a safe return to the field.

The school districts in St. Charles County and points northward are on the cutting edge of concussion evaluation and management and are to be commended!

Use Caution With Sports and Energy Drinks In Children and Adolescents

The American Academy of Pediatrics recently published a report regarding the safety of energy and sports drinks in young athletes. Both types of drinks have become increasingly popular in children and teens, due to aggressive marketing and endorsement by professional athletes and celebrities. According to the AAP, there is a lot of confusion about these products and the differences between them. Some athletes are using energy drinks, which contain large amounts of caffeine, after exercise when their only goal is to rehydrate.

Sports drinks contain carbohydrates, minerals, electrolytes, and flavoring, and are intended to replace water and electrolytes lost through sweating during exercise. However, these drinks contain a large amount of sugar and should be reserved only for after prolonged exercise--usually for more than an hour. They should not be used for routine meals and snacks due to their contribution to obesity and tooth decay.

Energy drinks, while very popular in teens and young adults, are never to be used by children. A standard energy drink contains as much caffeine as 10-14 cans of cola. Caffeine is addictive and has no nutritional value. Just like in coffee, caffeine is a stimulant--a drug--and should not be used by children. They often contain additional substances such as guarana and taurine, which are also powerful stimulants. Use of large amounts of energy drinks have shown to contribute to heart problems in teens.

So what should young athletes drink after games and practices? The answer isn't all that surprising: good old water! Water does the job to replenish fluids lost through sweat. For bouts of exercise under an hour, water is all that is necessary. Sports drinks have unneeded sugar that may contribute to obesity, especially when used routinely.

To read the full report from the American Academy of Pediatrics, click the link below: