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Swimming

 Swimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college. Most swimming-related orthopedic injuries are related to overuse and are seen in competitive athletes. However, many injuries can be prevented. Use the following tips and guidelines to help keep your athlete safe.

Safety tips

The following are ways to help prevent swimming-related sport injuries:

  • Never swim alone. Make sure the area is supervised.
  • Don’t run on pool decks and wet areas. Abrasions and contusions (bruises) commonly occur from careless falls.
  • Don’t dive in shallow water. Avoid diving into shallow pools less than 3 feet deep. This will help prevent serious head and neck injuries.
  • Find out if the starting block is at the shallow end. Swimmers using starting blocks in the shallow end need to be instructed on proper technique.
  • Prepare for emergencies. Plan what you would do if a player is injured in or out of the water. Know how deep the pool is. Know where lifeguards and first aid stations are.
  • Wear the right gear.
    • Properly fitted goggles
    • Swim caps
    • Sandals in the pool area
    • Sunscreen as necessary

Use of physical therapy

Physical therapy often is useful to strengthen weak muscles and stabilize joints. It can also improve a swimmer’s endurance and ability to train. Physical therapy is necessary to treat all of the medical and orthopedic conditions listed below and should be prescribed by a doctor.

Medical conditions

Swimmer’s ear : Use tight-fitting swim caps. If symptoms of ear pain and/or drainage develop, see a doctor. Swimmer’s ear is usually treated with cleaning, antibiotic drops, and 3 to 10 days out of the pool. Acetic acid drops may help prevent swimmer’s ear.

Pinkeye : See a doctor. Symptoms may be caused by irritation from chlorine and other chemicals, but viral and/or bacterial eye infections are highly contagious. Treatment includes prescription antibiotic eyedrops and 3 to 7 days out of the pool.

Athlete’s foot and plantar warts : Wear sandals on pool decks and locker room floors to help prevent foot infections. See your doctor if you have a cut on your foot.

Exercise-induced asthma : Swimmers with asthma vary greatly in their symptoms. Some do better in the warm, humid environment while others do not. Some find heavily chlorinated pools make symptoms worse. If difficulty breathing, cough, chest pain/tightness, or wheezing is present during swimming, then see a doctor. Every swimmer with asthma should have a personal asthma action plan. Swimmers should always have rescue medicine, such as an albuterol inhaler, on hand in case sudden symptoms occur.

Overtraining (excessive fatigue) : This is common in swimmers because of year-round swimming and training. Treatment includes medical and nutritional evaluation and rest from swimming during noncompetition seasons.

Orthopedic conditions

Overuse injuries in swimming are related to repetitive stress to the swimmer’s body. Symptoms of an overuse injury usually include pain or discomfort, muscle weakness, alterations in stroke style, and the inability to keep up intense levels of training. Multiple factors must be considered for proper treatment. Workload, defined as either yardage or pool time, may need to be decreased during a time of injury. An evaluation of stroke technique may identify weaknesses, bad habits, or muscle-tendon imbalances that require correction. Lastly, the genetic predisposition to be excessively loose jointed, flexible, or stiff may require special consideration or treatment.

Water Polo

 Water polo is an intense sport that requires athletes to tread water and swim for long periods. There is a version for younger athletes that allows them to stand in shallow water or hang onto the side of the pool, but this is illegal in competitive water polo.

Acute and overuse injuries are common in water polo. Acute injuries usually occur when guarding a player or wrestling for the ball. Overuse injuries are often the result of repeated swimming and throwing motions and treading water. As in many sports, the risk of injury increases with age due to the style of play, contact forces, and size of athletes. However, the risk of injuries can be reduced.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Athletes with poor stamina are more likely to get hurt both in and out of the water. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should be confident in their ability to swim in close spaces with others. If not, they should begin playing in the shallow end in case they need to stand. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Safety gear should fit properly and be well maintained.
    • Polo caps with ear guards to reduce the risk of ear injury
    • Mouth guards
    • Swim goggles
    • Sunscreen protection (sunscreen, lip balm with sunblock) when swimming outdoors
  • Environment. Pool water should be checked by persons in charge of pool maintenance. Excess chemicals and chlorine may cause eye irritation and skin rashes. Hypothermia may occur when playing in cold water.
  • Rules. Water polo can be very rough. Much of the “contact” takes place underwater, where referees cannot see well. These fouls are often missed and can lead to injury. Parents and coaches should encourage good sportsmanship and fair play. For instance, athletes should never dunk an opponent under the water.

Common injuries

Eye injuries

Eye injuries commonly occur in sports that involve balls but can also result from a finger in the eye. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. Water polo players should wear swim goggles during practice and competition. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Head injuries

Concussions often occur when an athlete gets hit in the head by another athlete (usually from their elbow). A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion is more susceptible to another injury than an athlete with no history of concussion.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

Shoulder injuries

Shoulder injuries usually occur from repetitive throwing and swimming motions. This may be due to weak muscles in the back and trunk of the body. Usually rehabilitation exercises focused on good posture and muscles of the shoulder blade and core, icing, medication, and rest are all that is necessary for treatment.

Finger injuries

Finger injuries occur when the finger is struck by the ball or an opponent’s hand or body. The “jammed finger” is often overlooked because of the myth that nothing needs to be done, even if it is broken. If fractures that involve a joint or tendon are not properly treated, permanent damage can occur.

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays may be needed. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and range of motion exercises are important for treatment.

Knee injuries

Patellar pain syndrome is a common overuse injury from prolonged kicking and treading water. It causes pain in the front of the knee, sometimes associated with a bump, and can be severe. It is treated with ice, stretching, NSAIDs, and relative rest.

Athletes should see a doctor as soon as possible if they cannot walk on the injured knee. Athletes should also see a doctor if the knee is swollen, a pop is felt at the time of injury, or the knee feels loose or like it will give way.

Wrestling

 Wrestling is the oldest known sport, dating back to prehistoric times. Today it’s the fourth most common sport in which athletes from different schools compete against each other. There are more than 50 kinds of wrestling. The most common types include folkstyle, freestyle, Greco-Roman, sumo, and professional.

As in many sports, the risk of injury increases with age due to the style of play, contact forces, and size of athletes. However, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics about how to prevent wrestling injuries. Also included is an overview of common injuries.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Wrestlers should wear headgear with ear protectors. Mats should be cleaned daily with antibacterial cleaner.

Healthy weight loss

Excessive or improper weight loss can result in various health problems including delayed physical growth, eating disorders, depression, increased risk of infectious disease, and heat illness. Wrestlers may also have less strength, slower reaction time, and less endurance; school performance may be affected too. Extreme exercise or rapid weight loss can contribute to heat stroke, kidney failure, or death.

Junior high athletes are still growing, and most should not lose weight to participate in wrestling. High school and college wrestlers may wish to lose weight to participate at their minimal weight.

When losing weight, athletes should not lose more than 1.5% of their body weight each week. If they lose that amount, they will mostly lose fat. However, athletes that lose any more weight will also begin to lose muscle mass. Losing muscle will make the wrestler weaker.

A healthy diet is important during any period of weight loss. Athletes should eat a variety of foods from all food groups. The diet should also provide enough energy (calories) to support growth, daily physical activities, and sports activities. They should also drink enough fluids to stay hydrated.

Warning: The use of rubber suits, steam baths or saunas, prolonged fasting, fluid restriction, vomiting, drugs, laxatives, diuretics, diet pills, stimulants, ergogenic aids, and supplements for weight loss should be prohibited at all ages.

Skin conditions

The National Federation of State High School Associates 2006–2007 Rule Book states that “if the participant is suspected of having a communicable skin disease, the coach must provide written documentation from a doctor that the condition is not communicable and that the athlete’s participation would not be harmful to any opponent.” It does not list specific skin conditions. However, herpes gladiatorum, methicillin-resistant Staphylococcus aureus, and chickenpox all may cause severe disease, and infected wrestlers should be disqualified.

Common Injuries

Head/face injuries

Nosebleeds occur frequently in wrestling. The bleeding may be stopped by putting pressure on the nose, placing a plug in the nose, or using an pro-coagulant, a medicine that helps the blood clot, into the bleeding area of the nose.

Cuts or scrapes usually occur on the face and often require suturing or glue. Sutures should remain in longer for wrestlers than for non-wrestlers, because of repeated injuries in the same location.

Concussion. Wrestlers with a concussion should not wrestle any more that day. They can return to wrestling only after they are symptom-free and have seen a doctor.

Cauliflower ear is the result of recurrent friction to the ear. It is best prevented with the use of properly fitted headgear with ear protectors during practice and competition. Cauliflower ears should be treated early (within 24 hours) by draining the ear and using compression dressings. They tend to reoccur with further trauma to the ear. Most athletes who have wrestled for many years without proper headgear have them.

Shoulder injuries

Acromioclavicular (AC) separation or clavicle fracture occurs when the wrestler falls on or is thrown directly onto the shoulder on the mat. Treatment of both is rest to allow healing; usually 3 to 4 weeks for AC sprains and 2 to 3 months for clavicle fractures.

Anterior shoulder dislocation is the result of forced abduction and rotation (pulled up and away from the body) of the arm and should be relocated as quickly as possible by the athlete or an athletic trainer or doctor.

Elbow injuries

Elbow dislocation is caused by a fall on an outstretched arm and hand. It should be relocated by an experienced athletic trainer or doctor as soon as possible.

Olecranon bursitis (irritation of the fluid-filled sac that protects the bone) is caused by repeated trauma to the point of the elbow. Swelling of the point of the elbow is the main symptom. It should be treated with rest, ice, compression, and an elbow pad. If that does not work, it may need to be drained and/or injected with medicine.

Knee injuries

Prepatellar bursitis is the result of a fall on a bent knee or from repeated kneeling. The main symptom is significant swelling on the front of the knee. It can be treated with rest, ice, compression, and a knee pad. It may also need to be drained and/or injected with medicine to reduce the swelling.

Patella dislocation is when the kneecap comes out of place causing instant disability and swelling. Treatment is reduction (putting the kneecap back in place) followed by physical therapy to strengthen the thigh and hip. A patella stabilizing brace may also be needed.

Martial Arts

More than 6 million children in the United States participate in martial arts. Martial arts are known to improve social skills, discipline, and respect in children. Children can also improve their abilities to concentrate and focus on activities, as well as bettering their motor skills and self-confidence. Martial arts can be fun and beneficial at any age.

While the martial arts are relatively safe, injuries can happen because there is physical contact between opponents. The following is information from the American Academy of Pediatrics (AAP) about how to prevent martial arts injuries. Also included is an overview of martial arts forms.

Injury prevention and safety tips

  • Instructors. Experienced instructors will teach at a level appropriate for your child’s age and maturity. Lessons should emphasize technique and self-control. Experienced instructors will carefully advance your child through more complex training. Lessons should also be fun. Visit a variety of instructors and ask about their experiences with young children and their teaching philosophy.
  • Technique. An instructor’s emphasis on technique and self-control is very important in limiting the risk for injury. Children should learn to punch and kick with their hands and feet in proper position and using the appropriate amount of force. Kicks and punches with the hand or foot in the wrong position can cause injuries to fingers and toes. Punches or kicks that are too hard can cause pain or bruises. Contact to the head should be discouraged.
    • Equipment. Safety gear should fit properly and be well maintained.
    • Headgear. When the rules allow, protective headgear should be worn for sparring or for activities with risk of falling, such as high jumps or flying kicks.
    • Body pads can help protect against scrapes and bruises and limit the pain from kicks and punches. Arm pads, shin pads, and chest protection for sparring.
    • Mouth guards.
  • Environment. Mats and floors should be safe to play on. Gaps between mats can cause sprained ankles. Wet or worn floors can cause slips and falls.

Common injuries

Scrapes and bruises

Scrapes and bruises are by far the most common injuries seen in the martial arts. They often result from falls onto mats, kicks and punches that are “off target,” or when proper padding is not worn. All scrapes and cuts should be washed with soap and water and bandaged before returning to activity. Bruises are best treated with ice applied for 20 to 30 minutes. They will slowly get better and fade over 2 to 3 days.

Sprains and strains

Sprains and strains become more common as children get older. Ankles, knees, and elbows are the joints most often sprained. Muscle strains usually happen in the front (quadriceps) or the back (hamstrings) of the thigh. Most knee and ankle sprains occur either by landing awkwardly after a jump or by improper contact with a partner. Elbow and wrist injuries happen with falling, punching, or blocking. Muscle strains can occur with trying to kick too high or punch too hard without using correct form or having properly warmed up.

Finger and toe injuries

Finger and toe injuries are often due to the large amount of kicking and punching of padded targets. They may also happen when sparring with a partner. These injuries are usually the result of poor kicking and punching technique. Contact with the target should never be initiated with the fingers or toes. Jammed fingers result from holding the hand in the wrong position (fingers spread) or if the toes are used to hit the target(instead of the heel or top of the foot).

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays are usually needed. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs, and range of motion exercises are important for treatment.

Head injuries

Concussions can occur in martial arts if children fall and strike their heads, or if they are kicked or punched in the head. A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion is more susceptible to another injury than an athlete with no history of concussion. Once a concussion has occurred, it is important to make sure the helmet is fitted properly. If the concussion occurred due to the player leading with the head to make a tackle, he should be strongly discouraged from continuing that practice.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor. The AAP recommends children avoid sports that reward blows to the head.

Types of martial arts

The term martial arts can be used to describe any number of styles or disciplines of self-defense practices. There are many different styles practiced around the world, with the most popular forms being karate, tae kwon do, and judo.

  • Karate (KAH-rah-teh) means “empty hand,” as it
    is normally practiced without weapons.
    Karate is a traditional Japanese form. The hands and feet are trained and prepared for use in a weaponless form of self-defense.
  • Tae kwon do (tahy-kwon-doh) means “the way of foot and fist.” This is a traditional Korean martial art. It is also the most popular. This form highlights discipline, respect, and personal growth and focuses on the use of the feet for powerful kicks in self-defense.
  • Judo (joo-doh) means “gentle way” and is known for a variety of throwing techniques. It uses many methods to control an opponent while on the ground. In many ways it is more similar to wrestling than to the other martial arts.
  • Kung fu (kung-foo) most commonly translates to “hard work” and is one of the oldest forms of martial arts. The term may be used to describe all of the hundreds of Chinese martial arts. Kung fu is mainly a “stand-up” form of the martial arts, known for its powerful blocks. Wushu is the most popular and modern form of kung fu.
  • Aikido (eye-key-do) means “way of harmony.” This Japanese martial art is known as a throwing style. It teaches a nonaggressive approach to self-defense, focusing on joint locks, throws, and restraining techniques, rather than kicks and punches. While aikido may be learned at any age, it is especially popular among women and older adults. Aikido is not practiced as a competitive sport.
  • Jujitsu (joo-jit-soo) means “the art of softness” and emphasizes techniques that allow a smaller fighter to overcome a bigger, stronger opponent. First practiced in Japan, jujutsu is considered a ground fighting or grappling style of the martial arts. Many of the forms have been incorporated into other martial arts such as judo, karate, and aikido. The arm lock and submission techniques have been taught to police all over the world.

Sports Sense

Help your child avoid common athletic risks and injuries by taking a few basic precautions — and tuning out the pressures.

Playing sports is a big part of growing up and going to school for many children. But the pursuit of victory in any activity carries with it risks and responsibilities.

Managing the risks to a child’s health and safety is a duty shared by coaches, parents, and the student-athletes themselves. That’s why it’s important that everyone is clear on what those risks and responsibilities are. The issue extends to school-sponsored sports and athletics, and to recreational activities.

Parents should be aware of the training and competitive practices in each area, notes Joel Brenner, M.D., FAAP, lead author of the new AAP clinical report, “Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes.” “But non-school recreational sports tend to have fewer guidelines and rules,” he says. “Often there are no athletic trainers involved, so parents need to be especially proactive in making sure proper practices are followed.”

Along with the obvious concerns over sports-related injuries, there are three general risks that parents of young athletes should be aware of: overuse injuries, overtraining, and burnout.

Overuse Injuries

Overuse is by far the most common type of sports injury, accounting for as many as half of the total in the United States. An overuse injury is damage to bones, muscles, or tendons that results from the body being worked too hard. This type of injury causes stress to these tissues that takes time to heal.

But too often competitive pressures, practice and game schedules, and a sense of duty to the team compel many young athletes to ignore or deny symptoms of overuse injuries. Failing to allow these to heal only adds further stress to the painful areas, risking long-term damage.

Also, the “no pain, no gain” and “play through the pain” approach to ignoring the aches and pains of sports can discourage the healing process. A young person’s body is still growing. Bones simply cannot tolerate the high levels of stress common to competitive sports if healing isn’t allowed to happen. In more severe cases, continuing to exercise the overuse-injured area can have serious long-term health effects.

Parents should be alert to these common symptoms of overuse injury:

  • Pain in the muscle, tendon, or bone after practice or a game
  • Pain while playing or during practice (even if the child remains able to play)
  • Pain during play that affects the child’s ability to perform
  • Constant or chronic pain, even when not playing

Overtraining

The drive to succeed — along with the sheer joy many youngsters feel as a result of developing their sports talents — can lead to long hours of practice. That can reach the point of overtraining, and, eventually, overuse injuries.

The best way for parents to address this problem before it occurs is to stay on top of their child’s training schedule. Pay attention to the amount of time, energy, and interest the child applies to training for his or her sport.

Some good rules of thumb for keeping training in line include:

  • Limit your child to a single sport or team activity per season, and the training schedule to no more than five days per week.
  • Be mindful of the weather during summer and winter training seasons. Insist that your child make changes to the schedule if the weather is extreme.
  • Encourage your child to vary training exercises from day to day, if possible. For example, she could alternate formal track-and-field training with swimming.

Burnout

Enthusiasm is just as vital as physical skills in keeping children healthy during athletic seasons. Yet the very things that make sports participation so rewarding can also become overwhelming. When that happens, your child can lose interest in the sport that once gave so much pleasure. This is called burnout.

“Families need to be open in their communications about athletics,” Brenner says. “Parents should understand what the child’s goals are — and make sure the activity is driven by the child’s, not the parents’, goals.”

On a day-to-day level, burnout can produce moodiness, a loss of interest that spreads to other activities, such as academics, and a drop in performance in the sport. But there are physical consequences to burnout as well. These can include:

  • Constant or chronic muscle and joint pain
  • Fatigue
  • Increased resting heart rate

Keeping It All in Focus

The rewards — and lessons — of sports participation are a vital part of growing up for many students. The National Sporting Goods Association reports that every year, more than 45 million children and adolescents take to the fields, tracks, pools, and gym floors.

Many kids dream of athletic glory beyond their present level. But it’s crucial that they understand that less than 1 percent of student athletes reach the professional leagues. Taking on more than the body can handle can put a premature end to the fun of sports.

Football

Football is a fast-paced, aggressive, contact team sport that is very popular among America’s youth. Football programs exist for players as young as 6 years all the way through high school, college, and professional.

Injuries are common because of the large number of athletes participating. However, the risk of injuries can be reduced. The following is information from the American Academy of Pediatrics (AAP) about how to prevent football injuries. Also included is an overview of common football injuries.

Injury prevention and safety tips

  • Supervision. Athletes should be supervised and have easy access to drinking water and have body weights measured before and after practice to gauge water loss.
  • Equipment. Safety gear should fit properly and be well maintained.
    • Shoes. Football shoes should be appropriate for the surface (turf versus cleats). Laces should be tied securely.
    • Pants. Football pants should fit properly so that the knee pads cover the knee cap, hip pads cover the hip bones, the tailbone pad covers the tailbone, and thigh pads cover a good share of the thigh. Pads should not be removed from the pants.
    • Pads. Shoulder pads should be sized by chest measurement. They must be large enough to extend ¾ to 1 inch beyond the acromioclavicular joint. Athletes should have adequate range of motion, and the pads should not ride up into the neck opening when raising the arms.
    • Helmets. The helmet should be fitted so that the eyebrows are 1 to 1½ inches below the helmet’s front rim. The back of the helmet should cover the back of the head, and the athlete’s ear openings should be in the center of the helmet ear openings. Jaw pads should be snug against the athlete’s jaw. The chin strap should be centered over the chin and tightened to prevent movement of the helmet on the head. The helmet padding and chin strap should be tight enough to prevent any rotation of the helmet on the head. Face masks should be attached to the helmets. Additional protection can be provided by a clear Plexiglas shield.
    • Mouth guards can help prevent oral or facial injuries but not concussions.
  • Environment. A safe playing field is level and cleared of debris, equipment, and other obstacles. Field goal posts should be padded.
  • Emergency plan. Teams should develop and practice an emergency plan so that team members know their roles in emergency situations. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Common injuries

Ankle injuries

Ankle sprains are some of the most common injuries in football. They can prevent athletes from being able to play. Ankle sprains often happen when an athlete gets blocked or tackled with the foot firmly in place, causing the ankle to roll in (invert). An ankle sprain is more likely to happen if an athlete had a previous sprain, especially a recent one.

Treatment begins with rest, ice, compression, and elevation (RICE). Athletes should see a doctor as soon as possible if they cannot walk on the injured ankle or have severe pain. X-rays may be needed.

Regular icing (20 minutes) helps with pain and swelling. Weight bearing and exercises to regain range of motion, strength, and balance are key factors to getting back to sports. Tape and ankle braces can prevent or reduce the frequency of ankle sprains and enable an athlete to return to activity more quickly.

Finger injuries

Finger injuries occur when the finger is struck by the ball or an opponent’s hand or body. The “jammed finger” is often overlooked because of the myth that nothing needs to be done, even if it is broken. If fractures that involve a joint or tendon are not properly treated, permanent damage can occur.

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays may be needed. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs, and range of motion exercises are important for treatment.

Knee injuries

Knee injuries commonly occur from cutting, pivoting, landing from a jump, or contact with another athlete. If the athlete feels a pop or shift in the knee, then it’s most likely a ligament injury.

Treatment begins with RICE. Athletes should see a doctor as soon as possible if they cannot walk on the injured knee. Athletes should also see a doctor if the knee is swollen, a pop is felt at the time of injury, or the knee feels loose or like it will give way.

Medial collateral ligament sprains can be treated in a hinged brace and allowed to return to play. Athletes who return to play with a torn anterior cruciate ligament (ACL) risk further joint damage. Athletes with an ACL tear should not return to their sport until the ligament has been reconstructed and they have been cleared by the surgeon.

Shoulder injuries

Shoulder injuries can occur from diving for a ball or from blocking or tackling.

Athletes usually feel their shoulder pop out of place when it is dislocated. Most of the time the shoulder goes back into the joint on its own; this is called a subluxation (partial dislocation). If the athlete requires help to get it back in, it is called adislocation. Risk of dislocation recurrence is high for youth participating in football. Shoulder strengthening exercises, stabilization braces and, in many cases, surgery may be recommended to prevent recurrence.

Pain from repetitive use is common in football, usually due to weak muscles of the back and trunk. Often rehabilitation exercises and rest from excessive blocking or tackling drills are all that is necessary to treat this type of pain.

Eye injuries

Eye injuries commonly occur in football usually due to a finger poking through the face mask. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Low back pain

Spondylolysis, stress fractures of the bones in the lower spine, is due to overuse from high-impact and repetitive arching of the back. Symptoms include low back pain that feels worse with back extension activities. Treatment of spondylolysis includes rest and physical therapy to improve flexibility and low back and core (trunk) strength, and possibly a back brace. Athletes are advised to limit repetitive arching of the spine (blocking and weight lifting) and high-impact activities (running and jumping). Athletes with low back pain for longer than 2 weeks should see a doctor. X-rays are usually normal so other tests are often needed to diagnose spondylolysis. Successful treatment requires early recognition of the problem and timely treatment.

Head injuries

Concussions occur if the head or neck hits the ground, equipment, or another athlete. A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion is more susceptible to another injury than an athlete with no history of concussion. If a concussion has occurred, it is again important to make sure the helmet was fitted properly. If the concussion occurred due to the player leading with the head to make a tackle, he should be strongly discouraged from continuing that practice.

Is Your Child Ready for Sports?

Sports readiness means that a child has the physical, mental, and social skills to meet the demands of the sport. While general guidelines can help you select a sport based on age, it’s important to remember that children develop at different rates. Children are more likely to enjoy and succeed in sports when they have the physical, mental, and social skills required by the sport.

Ages 2 to 5 years

Before age 6 years, most children do not have the basic motor skills for organized sports. Balance and attention span are limited, and vision and ability to track moving objects are not fully mature. Instead, look for other sports activities that focus on basic skills such as running, swimming, tumbling, throwing, and catching. These skills can be improved through active play but do not require organized sports activities. Children at this age have a short attention span and learn best when they can explore, experiment, and copy others. Instruction should be limited, follow a show-and-tell format, and include playtime. Competition should be avoided. Parents can be good role models and should be encouraged to participate.

Ages 6 to 9 years

By age 6 years, most children have the basic motor skills for simple organized sports. However, they may still lack the hand-eye coordination needed to perform complex motor skills and may not yet be ready to understand and remember concepts like teamwork and strategies. Sports that can be adapted to be played at a basic level and focus on basic motor skills are the most appropriate. This includes running, swimming, soccer, baseball, tennis, gymnastics, martial arts, and skiing. Sports that require complex visual and motor skills, quick decision-making, or detailed strategies or teamwork (football, basketball, hockey, volleyball) will be difficult unless modified for younger players. Rules should be flexible to promote success, action, and participation. The sport should focus on learning new skills rather than winning. The equipment and rules should also be appropriate for young children. For example, smaller balls, smaller fields, shorter game times and practices, fewer children playing at the same time, frequent changing of positions, and less focus on score keeping.

Ages 10 to 12 years

By ages 10 to 12 years, most children are ready for more complex sports. They have the motor skills and cognitive ability to play sports that require complex motor skills, teamwork, and strategies. Most experts believe that sports at this level should focus on skill development, fun, and participation, not competition. Most children would rather play more on a losing team than less on a winning team.

Some children in this age group may be starting puberty. During this time, the physical differences between children, particularly boys of the same age, can be dramatic. This can make a difference in what sport is best for your child. Boys who start puberty sooner will be temporarily taller, heavier, and stronger. This may give them a physical advantage, but it doesn’t mean they are more talented and will continue to excel in sports. If possible, they should compete with boys with the same physical ability. Similarly, boys who mature later may experience a temporary physical disadvantage in sports. This should not be seen as a lack of talent or ability. These boys should be encouraged to play sports with less emphasis on physical size, such as racquet sports, swimming, martial arts, wrestling, and certain track events.

Also, growth spurts can temporarily affect coordination, balance, and the ability to perform a skill. Keep in mind that it can be frustrating if this is seen as a lack of talent or effort.

Other Guidelines

  • Get fit and learn a new skill. Encourage your children to participate in activities that promote physical fitness as well as learning sports skills. The activities should be fun and right for their ages.
  • Focus on fun. Choose sports programs that focus on personal involvement, variety, success, and fun rather than competition, strict rules, and winning. It may help them stay interested and want to keep playing.
  • Check out the rules. Equipment and rules should be right for their ages. If not, they should be modified.
  • Make sure safety is a priority. Appropriate setting, equipment, protective gear, program design, and rules of play are important.
  • Keep differences in mind. Prior to puberty, there are very few differences between boys and girls in endurance, strength, height, or body mass, and they can compete together on an equal basis. During puberty, to make sure athletes are well matched in contact sports, consideration should be given to body size and physical maturity as well as chronological age.
  • Proceed with caution. Early specialization in a single sport, intensive training, and year-round training should be undertaken with caution because of the risk of overuse injury, mental stress, and burnout. Playing only one sport may also prevent a child from developing a variety of motor skills that they would learn from participating in several different sports.
  • Wait until your children are ready. Children should not play competitive win/lose sports until they understand that their self-worth is not based on the outcome of the game.
  • Find a good sports program. Get feedback from other children and parents who are in the programs. Try to check out programs before you join them. A sign of a good program is children having fun.

Soccer Safety Tips

Soccer (known as football outside the United States) is one of the most popular team sports in the world. Soccer also can be a way to encourage children to be physically active while they learn about teamwork and sportsmanship.

With the growing popularity of soccer comes a greater number of injuries. However, the risk of injury can be reduced.

Tips to Help Prevent Soccer Injuries

  • Equipment. Players should use the right equipment.
    • Protective Mouthguards
    • Protective Eyewear. Glasses or goggles should be made with polycarbonate or a similar material. The material should conform to the standards of the American Society for Testing and Materials (ASTM).
    • Shoes. Cleats should provide sufficient heel/arch support and grip.
    • Balls. Soccer balls should be water-resistant, the right size based on age, and properly inflated.
    • Preseason Training. There is growing evidence that preseason conditioning and balance training may reduce the risk of anterior cruciate ligament (ACL) injury.
  • Fair Play. Violent behavior and aggressive play increase the risk of injury and should be strongly discouraged. Parents and coaches should encourage good sportsmanship and fair play.
  • Field Conditions. Uneven playing surfaces can increase risk of injury, especially in outdoor soccer. The field should be checked for holes or irregularities. Goal posts should be secured to the ground at all times even when not in use. Follow installation guidelines from the manufacturers and Consumer Product Safety Commission.
  • Heading Technique. The risk of a head injury is comparable to other contact/collision sports, though evidence does not support repeated heading as a risk for short- or long-term cognitive issues. However, to reduce the risk of injury from heading the soccer ball, players should be taught proper heading technique at the appropriate age and with an appropriate-sized ball.
    Excessive heading drills should be discouraged until more is known about the effects on the brain. Also, no recommendations regarding the use of helmets or cushioned pads to reduce head injury in soccer can be made at this time. More research and established safety standards and regulations are needed.

Common Soccer Injuries

Soccer injuries in general occur when players collide with each other or when players collide with the ground, ball, or goalpost. They also may result from nonbody contact, such as from running, twisting/turning, shooting, and landing. The most common types of injuries in youth soccer are sprains and strains, followed by contusions (bruises). Most injuries are minor, requiring basic first aid or a maximum of 1 week’s rest from playing soccer.

  • Ankle & Knee Injuries. Most ankle and knee injuries do not result from contact with another player. Ankle injuries are more common in male players and knee injuries are more common in female players. ACL injuries are relatively common knee injuries. Most of these injuries happen not from coming in contact with another player, but from sudden stops and pivots. ACL injury risk-reduction programs are recommended for female adolescents.
  • Heel Pain. Irritation of the growth plate of the heel bone (Sever’s Disease) is common in youth soccer. This can be treated with calf stretching, activity modification (avoid extra running), heel cups or arch supports, ice, and antiinflammatory medicine.
  • Head Injuries. Concussions are common in soccer. They usually occur when a player’s head collides with another player’s head, shoulder, or arm, or the ground. Females tend to have a slightly higher concussion risk than males. Concussions temporarily affect brain function, although loss of consciousness or blackout may or may not happen. All concussions are serious and need to be evaluated by a doctor before players can return to play. The signs and symptoms of a concussion range from mild to severe and usually happen right after the injury, but may take hours to days to show up. With most concussions, the player is not knocked out or unconscious.
  • Mouth, Face & Teeth Injuries. Soccer is one of the leading causes of mouth, facial, anddental injuries in sports (second only to basketball). Use of protective mouthguards may help reduce the number of injuries.
  • Eye Injuries. Eye injuries are rare, but when they occur they are often severe, resulting in damage to the eye globe or blowout fractures of the eye socket. Protective eyewear is recommended for all soccer players.

Rowing

Rowing is a lifelong, year-round sport that requires dedication and intense training. Rowing on the water, an ergometer, and indoor water tanks along with weight training and running are integral parts of training. In high school and college this sport is also called crew.

Most rowing injuries are due to the repetitive motions of the sport. While not all injuries can be prevented, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics about how to prevent rowing injuries. Also included is an overview of common injuries.

Injury Prevention and Safety Tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routinewell-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should work with coaches and athletic trainers on achieving proper technique.

Common Injuries

Low Back Pain

Low back pain is very common in rowers. It can occur suddenly (from twisting when reaching at the catch or pulling back during the drive) or over time (from repetitive movements or when the back is bent forward). Power used to accelerate the drive portion of the stroke should come from the legs, but if the legs are weak or not used, or the back is in a rounded and slumped position, the back takes the brunt of the stress. Athletes who do not “sit up” enough at the finish of the stroke can also stress the low back. Rowing on an ergometer can increase back strain if there is too much machine resistance or poor technique. Weight training, specifically Olympic lifts (squats, power cleans, and dead lifts), if done incorrectly, and/or lifting the shell (boat) improperly in and out of the water can also lead to back pain.

Common back injuries include muscle strains/spasm, facet pain, lumbar disc disease, and stress fractures. Treatment of these injuries includes rest, ice, and/or heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). Pain that lasts for more than 5 to 7 days should be evaluated by a doctor. Warning signs of a more serious injury include severe pain, numbness or tingling down the legs, bowel or bladder problems, or leg weakness.

Athletes can help prevent back injuries by:

  • Strengthening the abdominal, gluteal, hip, and buttock muscles
  • Using proper technique: proper positioning at the catch and finish, pushing with the legs and not the back, not opening up too quickly during the drive, and proper adjustment of the boat rigging

Wrist Injuries

Wrist tendonitis (also known as intersection syndrome) is the most common wrist injury seen in rowers. The feathering hand (the inside hand that twists the oar) is more frequently injured due to repetitive extension of the wrist to get the blade in and out of the water.

Common symptoms include pain, weakness, swelling, and creaking of the wrist. Icing the wrist after activity and use of NSAIDs can help with pain and swelling. Strengthening the shoulder blade muscles and proper technique/feathering can decrease the risk of injury.

Taping the wrist to avoid excessive wrist extension during feathering may also help. Use of a wrist brace when not rowing can give rest to the arm. Sometimes complete rest is needed to allow the area to heal.

Knee Injuries

Knee injuries may occur when the knees are flexed and loaded at the catch. Knee pain can also occur with improper technique during weight training, particularly squats. Patellofemoral stress syndrome (kneecap pain) and iliotibial band syndrome (pain at the outside knee) can occur with increased loading and too much knee bend at the catch. Immediate treatment consists of the use of ice and NSAIDs. Core body strengthening, especially of the hip rotators, should be part of treatment. Modifying the shoes or foot stretcher position and decreasing knee bend at the catch can decrease symptoms.

Rib Pain

Rib pain can occur in the muscles, in between the ribs, or on the bone. Muscle strains can occur with repetitive use and pull on the same chest muscle. Athletes with weak back muscles but strong chest muscles may place uneven loads on the muscles or bone, causing pain. Repetitive motions can load the bone and cause a stress reaction or stress fracture. Rowing with hatchet blades may increase the forces on the chest wall.

Bone pain associated with rib stress fractures can occur when rowing, when at rest, or with deep breathing. X-rays are usually normal if symptoms have been present less than 3 to 4 weeks, so a bone scan or magnetic resonance imaging (MRI) may be needed to diagnose a rib stress fracture. Ice and pain medicine may help with initial pain.

Treatment includes rest, strengthening of the surrounding muscles, and evaluation of rowing technique. Not sitting up enough at the finish, pulling into the rib cage too much at the finish, or reaching too far at the catch may predispose rowers to rib stress fractures. Boat rigging should be evaluated and changed if necessary. Sometimes rowers will switch sides of the boat (starboard or port) to decrease stress on a certain side of the chest.

Blisters

Blisters are a common problem in the novice rower. They usually occur along the heel of the palm or just below the fingers at the junction of the palm. Blisters are often caused by friction from pulling and feathering the oar. In more experienced rowers, calluses form where blisters once were.

Blisters can become infected, especially after exposure to dirt or river water, so proper care of them is necessary. Signs of infection include swelling and redness around the area, pus drainage, and increasing pain. Blisters should be kept clean and dry. Hand washing and use of antibacterial ointment are helpful. Fluid-filled blisters should be drained but the overlying skin kept intact to protect the surface from further damage.

Tape can be used to cover blisters and prevent new ones, but care should be taken as the tape itself may cause a new blister to form. Tape should never have wrinkles, should wrap around the entire hand, and should be larger than the blister being covered. Gloves are not practical while rowing.

Track Bites

Track bites are irritations that occur on the back of the calves when the legs hit the slide at the finish. Scrapes, blisters, and bleeding can occur. Taping the area, readjusting the foot stretchers and slide, and not jamming the legs down at the finish can prevent this injury. Care should be taken to prevent infection.

Running

Running, as a sport, can involve a number of different forms, including the following:

  • Cross-country. A sport in which teams of runners compete on long-distance road running courses.
  • Track and field. A sport that includes track events, like sprints, distance running, hurdles, and relays, and field events that involve throwing and jumping.
  • Marathon. A long-distance (about 26 miles) road running event.
  • Triathlon. A 3-part event that includes swimming, cycling, and running. Distances vary depending on the age of the athletes.

Running injuries are common and there can be a variety of causes. Running injuries can be caused by improper training (for example, doing too much too fast), mechanical problems (for example, high arch or flat foot), or previous injuries. Other causes may be the environment (for example, uneven or hilly terrain; hot or cold weather conditions) or previous injuries. While not all injures can be prevented, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics about how to prevent running injuries. Also included is a list of common running injuries.

General injury prevention and safety tips

Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.

Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport- specific conditioning. Also important are proper warm- up and cool-down exercises.

Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should work with coaches and athletic trainers on achieving proper technique.

Nutrition. Eating healthy and the right amount of calories is important. A good rule to follow is to eat an extra 100 calories for every mile run.

Tips to Parenting an Athlete

What Parents Can Do to Create a Positive Youth Sports Experience

  • Support for your child must be unconditional.
  • Be patient for the process, and enjoy it.
  • Understand how the developmental progression works for sports skills.
  • Be knowledgeable that many of the developmental milestones for sports skills cannot be accelerated beyond their natural limit.
  • Realize that physical, chemical, and mental development all affect ability and all progress along different timetables.
  • Support achievements as they occur. This will reduce pressure to achieve skills that are not quite ready.
  • Remember, your child has his or her own likes and dislikes and should be able to participate without pressure to choose a certain activity.
  • Remember that there are developmental patterns for chemical changes that allow your child to be able to progress in training intensity when it is time.
  • Understand the extra changes that occur in the puberty transition from child to teenager.
  • Don’t overreact to normal developmental processes and changes that occur during puberty and may temporarily affect ability.
  • Understand the profound developmental effect of a firm positive foundation of self-esteem on future performance and ability to handle competitive pressure.
  • Redefine success and make sure performance disappointments are not seen as failures that the child might take personally.
  • Teach your child that winning means a lot more than a gold medal (you first have to believe that yourself).
  • Encourage your child any way you can.
  • Find more things your child is doing right than things to criticize.
  • Support by being visible at their events.
  • Keep your comments positive without a lot of addenda or stipulations.
  • Help your children take some responsibilities for their sport without making them feel overwhelmed with duties.
  • Watch for warning signs of burnout or avoidance.
  • Remember your child is a child, not a child-sized adult.
  • Help your child set realistic goals (not your goals).
  • Allow changes in sports, and encourage exposure to different sports.
  • Instill a sense of value in exercise and fitness regardless of structured competition.
  • Communicate sincerely and often with your child about his or her desires.
  • Help your child build a strong sense of self-worth and identity that is not dependent on the sport itself or level of achievement.
  • Provide positive momentum by celebrating reality successes as often as possible.

Tips to Coaching Your Team

What Coaches Can Do to Create a Positive Youth Sports Experience

  • Redefine success.
  • Be knowledgeable about the sport you are coaching.
  • Be knowledgeable about the age group you are coaching.
  • Understand the unique developmental skill patterns of that age group and make adjustments for that skill level.
  • Remember that the inability to perform a certain skill may just be a lack of developmental timing, rather than a true lack of ability.
  • Reinforce and refine the skills that are achieved without pushing too quickly for other skills.
  • Give kids small tasks to learn to increase chances for accomplishment.
  • Be enthusiastic and genuine.
  • Make kids feel comfortable so they are not afraid to try new skills.
  • Let everyone play and substitute players frequently.
  • Focus your verbal support on what skills they do right. Then your coaching support can more easily be directed at making constructive corrections in other skills.
  • Understand chemical development so you do not train a child like an adult, risking overtraining and injury.
  • Know the limitations of aerobic development so you can maintain a solid aerobic base without overtraining, and concentrate on technique.
  • Use caution in warmer conditions and hot environments and take frequent water breaks.
  • Know when the circumstances are appropriate for weight training.
  • Make your rewarding statements sincere.
  • Have realistic expectations and communicate them so the active youngster can see improvement and acknowledge accomplishment more frequently and be more protected from societal pressure to perform for an ultimate prize.
  • Be alert for signs of overtraining and burnout.
  • Keep kids motivated with positive feedback.
  • Remember the importance of positive effects on early psychological development.
  • As kids progress, give meaningful input on winning and losing and emphasize that every practice and competition is an opportunity to learn and improve.
  • Teach how to learn from successes, disappointments, and everything in between.
  • Do not coach by intimidation.
  • Be a good role model.
  • Instill good sportsmanship (they are watching your example).
  • Teach good fundamental skills that the child can use to build on with the next coach or activity.
  • Foster a sense of self-worth and confidence in the child or teen.
  • Emphasize effort and accomplishment more than winning.
  • Gear the activity toward fun and a positive experience.You may be the very coach that helps inspire a child to stay involved in a sport and truly maximize his or her potential for reality success.

Diving

int. This can be treated with rest, ice, and nonsteroidal antiinflammatory drugs. Taping or bracing the wrist can also prevent further injury.

When divers reach for the water and attempt to grasp their hands for entry, they occasionally hyperextend the thumb. This causes a sprain to the base of the thumb. Symptoms include pain, swelling, instability, and weakness of the thumb. This can be treated, and may be prevented, by taping the thumb while diving. Occasionally, a custom thumb splint or even surgery is necessary to stabilize the thumb.

Low back pain

Spondylolysis, stress fractures of the bones in the lower spine, is due to overuse from arching or extending of the back. Symptoms include low back pain that feels worse with back extension activities. Back or reverse dives are often more painful. Treatment of spondylolysis includes rest from diving, physical therapy to improve flexibility and low back and core (trunk) strength, and possibly a back brace. Athletes with low back pain for longer than 2 weeks should see a doctor. X-rays are usually normal so other tests are often needed to diagnose spondylolysis. Successful treatment requires early recognition of the problem and timely treatment.

Disc injury may cause low back pain that occurs with flexion—including pike and tuck dives. The pain is usually worse on one side, extends into the buttock, and occasionally down the leg. Disc-related pain can also occur with sitting, lifting, jumping, and twisting. Successful treatment requires early recognition of the problem and timely treatment.

Knee injuries

There are thousands of jumps in practice for each dive seen in competition. Jumping causes pressure on the kneecap and can result in pain in the front of the knee. Patellar tendonitis (also called jumper’s knee) causes pain
just below the kneecap. Treatment requires identifying and addressing the causes of the pain.

The number of dives performed; dry land training; poor flexibility; strength imbalances; and malalignment of the hips, knees, and feet can also contribute to knee pain. Because corrective shoes, orthotics, and knee braces aren’t practical while diving, physical therapy, patellar taping, and training modifications are the mainstays of therapy.