"I Just Got My Bell Rung."

I recently had the opportunity to speak with the coaches of the Tony Glavin Soccer Club about concussions.  The coaches are very interested in the health of their athletes and how best to take care of them if such an injury does occur.   Stories of head injuries have dotted the sports pages and often the front pages quite a bit lately, as more and more athletes, parents, and coaches attempt to understand the injury.  We are figuring out that getting “dinged” or ‘rung” may actually be a more serious injury.

A concussion is a traumatic injury to the brain.  It can occur from a blow to the head or even to the body if that hit causes movement of the brain inside the skull.  It results in any number of symptoms because of a change in how the brain is working.  It does not cause a structural injury, so you can’t see a concussion on a CT scan or MRI.  And you don’t have to get knocked out to have a concussion.  In fact, a brief loss of consciousness doesn’t even mean an athlete has suffered a more severe injury.

Evaluating head injuries can be tricky, as symptoms are often explained away as another illness or injury.  Coaches are often the first responders to an injured athlete, and they should be conservative when it comes to head injuries.  They are taught, “when in doubt, sit them out,” even if they aren’t sure of the diagnosis.  A medical professional, such as a doctor or athletic trainer, should evaluate an injured athlete as soon as possible after a head injury.  The risk of much more serious injury is very high if an athlete suffering from the effects of a concussion is allowed to continue playing and endures another hit.

Not every injury causes the same issues.  The signs and symptoms of concussion vary between individuals.  These can include balance problems, dizziness, concentration and memory issues, drowsiness, mental fogginess, headache, feeling emotional, nausea, irritability, light or noise sensitivity, trouble falling asleep, and vision problems.  If your athlete is describing any of these symptoms after a head injury, get them to the doctor.  Be careful not to judge the severity of the injury yourself.

When a concussed athlete comes into my office, I perform a very thorough evaluation.  I talk with both the athlete and his or her parents about how the athlete is acting.  I examine the nervous system from head to toe.  I include memory and concentration tests, as well as balance and visual tests as part of the visit.  Then we spend a great deal of time discussing the injury and how to minimize the time the athlete is suffering.  Often I have to recommend shorter school days or make changes to the work the student does at school while having symptoms.

Once an athlete is feeling back to normal at rest and then at school, they move through a progression of physical activity to test their readiness to return to sports.  If he or she is successful and does not have a return of their symptoms, I allow them to return to play fully.

Concussion is often an uncertain situation for athletes, parents, and coaches.  A little understanding of the injury helps to decrease the anxiety if you or your athlete gets hurt.  I will be talking more about concussions at the Tony Glavin Soccer Club Parents Meeting on Sunday, September 14^th.  I’ll be able to arm you with more knowledge and answer any questions you have.  Hope to see you there!

Preventing Soccer Injuries

I see a significant number of injuries from soccer in my office.  Most of them involve the lower extremities.  They may be from a traumatic injury like a kick to the leg or a twist to the knee, or may result from overuse.  Sprains of joints and strains of muscles and tendons are the most common injuries, but cartilage tears, fractures and contusions do occur.  Shin splints, patella tendinitis and Achilles tendinitis are the most common overuse injuries.  In these cases, there is no one event that causes the pain.  Instead, the pain builds up over time.  I also see several stress fractures every year.  These occur when the bone becomes weak from overuse.  It’s often pretty tough to distinguish between soft tissue injuries and injury to the bone, so if leg pain does not improve after a few days of rest, you should consult your physician.

Treating soccer injuries can be tricky.  I strive to limit the time lost from training while ensuring a safe return to play.  For most acute injuries, a short period of rest with ice and elevation will do the trick.  For some of the longer term injuries, especially overuse injuries, relative rest is possible.  This means that the athlete can continue to do some modified training while avoiding painful activities.  For example, I will often have players work on drills, but avoid scrimmaging.  Sometimes I have to put them on a bike or in the pool to maintain cardiovascular stamina while avoiding a lot of weightbearing on an injured leg.  Rarely are players completely restricted from activity for a long-term basis.

Prevention of soccer injuries often involves just using common sense.  Use well-fitting cleats and shin guards.  Watch out for mobile goals that can fall on players.  Remember to hydrate adequately.  Maintain proper fitness—we know that athletes who are stronger and more prepared physically have lower risk of injury.  If an injury does occur, returning to play after a player is healed needs to be gradual, progressing through aerobic conditioning, strength training, and then agility training.

Staying fit for the field is easy with proper preparation, but injuries do occur.  Playing through pain is often not the answer.  Never hesitate to consult your physician if you are unsure. 

Arthritis Foundation's Jingle Bell Run Hits the Airwaves

The 2013 edition of the Arthritis Foundation's St. Louis Jingle Bell Run takes place in November at Hollywood Casino in Maryland Heights.  I've been named a medical honoree for the last two years, and part of the job includes a media blitz to help publicize all of our Jingle in July activities.  So I've been visiting the local news stations to talk about arthritis and how fundraising efforts like these help us to conduct research that will help us decrease pain in current arthritis sufferers and decrease risk in those who are yet to develop the disease.

We've visited Show Me St. Louis on KSDK and Fox2News in the Morning to talk about the events.  We even got to cuddle with some mice in a warm-up to this weekend's mouse races in St. Peters.

The Arthritis Foundation is an integral part of fundraising for research that helps us battle all types of arthritis, from Juvenile Idiopathic Arthritis to Osteoarthritis.  These conditions affect millions of Americans.  Consider donating or better yet, consider joining the Advanced Bone & Joint team at the Jingle Bell 5K run/walk this fall.  It's a lot of fun.  Costumes abound, and there is an all you can eat pancake breakfast that's pretty incredible.  Bring the family and help us win the fight against arthritis!

Computerized Baseline Concussion Testing Continues in the Fort Zumwalt District for a fifth year!

I had the opportunity to speak to the Fort Zumwalt School District School Board Meeting last month to detail the results of the district's ImPACT neurocognitive testing.  The program allows us to ensure that athletes are not returned to the field too soon, helping to decrease risk of further injury.

The conversation was detailed in an article in Mid Rivers Newsmagazine this month.  Congratulations to Fort Zumwalt, as well as Francis Howell and Wentzville, two other districts who have instituted the program.

Advanced Bone & Joint Quick Care Center is available on a walk-in basis!

We are now Advanced Bone and Joint!

If you’ve been around the office lately, you’ve probably noticed us wearing buttons featuring the phrase “Ask me why we are advanced!”  It’s a great question, because we know you have a choice in who you trust to care for your injuries.  We have been asking ourselves the same question a lot lately, along with “why should our patients choose our practice and allow us to help them?” 

It’s not an easy answer, because a lot goes into not only getting you better, but into making sure the experience you have while you are with us is as smooth and enjoyable for you as possible.

When the people who make up St. Peters Bone and Joint sat down and really thought about it, we had many ideas about what makes us advanced and why so many people come back to our practice, and send their friends and family to us.  In our office, everyone with whom you come in contact treats you as a guest.  Not a number.  Not a diagnosis to fix.  As a person, just as we would treat you in our own home. 

We are skilled specialty physicians, with talents that span not only bone and joint injuries, but include management of concussions, overuse injuries, and chronic pain.  What makes us advanced?  We employ cutting edge diagnostic and treatment strategies to get you better.  And we do this with you as our guide.  Every guest’s treatment is individualized to his or her goals and desires. 

Want to run a marathon but have some knee pain?  We’ll talk with you about why you have that pain, how you can fix it, and how you can avoid having it ever again.  Have a shoulder that keeps you up at night?  We’ll show you what is going on, help control the pain, and educate you on how make it go away forever.  Together, we will come up with a plan and help you execute it.  You are in charge.  We are here to help you meet your goals and live your life.  And we hope that while you are with us, you will actually enjoy being at the doctor’s office.

So when it came down to it, we felt the name “St. Peters Bone and Joint Surgery” didn’t illustrate to our guests what makes our practice special.  It tells you where we are, but it doesn’t describe the incredible things that are going on here.  It doesn’t express why we should be your ally in meeting your goals.  So welcome to the new “Advanced Bone & Joint.”  We are happy to be your partner in health.  When the need arises, come on in and let us show you why we are advanced!

Check out the new Advanced Bone & Joint!

Feelin’ Hot, Hot, Hot!

This summer in the Midwest sure has been a hot one.  Thankfully, a break in the oppressive temperatures appears to be here—just in time for the start of the high school fall sports practice season.  While the weather will be relatively cooler, two-a-day practices on days with highs in the 90s and high humidity still put athletes at risk for heat injury.  Fortunately, heat injury is largely preventable with a little common sense.

When an athlete exercises, the body’s temperature is elevated and the body sweats to cool itself down.  Body fluid and critical electrolytes are lost in the process.  If fluids and electrolytes are not replaced, dehydration occurs, increasing the risk of heat injury.

Symptoms of heat injury may include:

·         Cramps

·         Chills

·         Dark urine

·         Dizziness

·         Dry mouth

·         Weakness

·         Thirst

·         Headaches

·         Nausea and vomiting

·         Confusion

Heat-related illness can be prevented.  Athletes should stay hydrated before, during and after exercise.  Light, loose clothing should be worn and skin should be exposed as much as possible.  They should train appropriately to be ready for the heat, usually starting with short, low intensity workouts that may gradually increase over 7-14 days.  This allows the body to get used to the conditions safely. 

Coaches and parents play an important role in prevention, as well.  Each should strive to be able to recognize early signs of heat injury.  Practicing during the early morning or later evening hours decreases risk.  Additionally, workouts should be altered when heat and humidity are high, and when individual athletes are not ready for the heat.

Hydration is the most important way to prevent heat illness.  Athletes should drink at least 16 ounces of water or sports drink one hour prior to exercise.  During exercise, they should continue to drink regularly, about 4-8 ounces every 15-20 minutes.   If an event lasts longer than one hour, or if there will be multiple bouts of exercise in a day (like a tournament), a drink containing carbohydrates and electrolytes should be used.  Most sports drinks will do the trick.  Otherwise, plain water is fine.

If you see any signs of heat illness, you may be dealing with a life-threatening emergency.  Do not hesitate to call for an ambulance early on if an athlete seems to be in trouble.  While you are waiting, begin cooling the athlete by getting him or her to a shaded area.  Consider placing the athlete in a pool of cold water, if available.  If not, placing ice bags or cold towels around the neck, armpits, and groin will help.  Provide cool beverages if the athlete is able to drink.  Act quickly, as these interventions may save someone’s life.