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Injured athletes need complete evaluations

Q : My daughter sprained her ankle playing soccer and continues to have pain many weeks later. Where is the best place to have her evaluated?

A: You could start with your pediatrician. In all likelihood rest and limitation of activity will be advised initially. It can be difficult to determine how much rest is enough, and when something more proactive, such as targeted physical therapy or occasionally surgery, might be indicated. At this juncture it can be helpful to seek consultation with a pediatric sports medicine physician.

Pediatric sports medicine is a field of medicine involved in treating sports related injuries in children and adolescents. It also involves prevention of sports related injuries including overuse injuries and promoting healthy and safe physical fitness.

There are many different fields of medicine that can provide care in pediatric sports medicine. This may include physical therapists, sports medicine primary care providers, and sports medicine trained orthopedic surgeons. Training and skill sets vary depending on the field of specialization the pediatric sports medicine provider has. Carrie Tingely Hospital at the University of New Mexico provides a full service, multidisciplinary clinic to care for children or adolescents suffering from any sort of injury. They have many providers including brace experts, physical therapists, and physician providers that specialize in total care of the active child. Doctors Andrew Veitch and Gehron Treme are the orthopedic surgeons instrumental in the development of this clinic. Dr. Veitch contributed the content for this article.

Conditions treated include musculoskeletal injuries in both an operative and non-operative fashion in children and adolescents participating in sports, as well as general health, nutrition, psychological well being. Commonly treated injuries include the knee, shoulder, elbow and hip. These can be acute traumatic injuries or overuse injuries. For overuse injuries, a prolonged period of rest, avoiding activities that cause discomfort, or cross training are the mainstays of treatment. For acute injuries, it may be best to seek more immediate medical evaluation, in the event that surgical intervention may be the quickest route to a full functional recovery.

A child can sustain a sports injury at any age and most providers specializing in this field are willing to see patients of any age. You should consider seeing a sports medicine physician when your child sustains an injury that produces severe pain or loss of function.

Often these injuries can be overuse injuries, which cause chronic pain, and may limit participation over a period of time, rather than one traumatic event.

Evaluating an injured athlete starts with a complete assessment of how the injury occurred and what the problem is. After taking a history, a through physical examination of the injured body part is performed to assess the injury. This may include imaging studies like an x-ray or MRI to help confirm the diagnosis and rule out further injuries that can be hard to determine on physical exam.

Listening skills are very important in determining the short and long term goals of the injured athlete, as well as the intent and determination of the athlete to return to activity.

First and foremost is listening to how the child thinks they are doing and how they feel about return to activity. Next is determining the range of motion, strength, and function of the injured body part. It is the provider’s responsibility to make sure the child is able to safely protect themselves, and minimize the risk of re-injury. Part of effective therapy is determining what is working and what is not in the treatment process.

Nutrition and a healthy lifestyle are very important to a full recovery. One must involve the parents and the child so everyone is working to the common goal of safe return to their desired activity. If necessary, this may involve care by their primary care provider or even a sports nutritionist.

Despite all this, some young athletes will get reinjured. Counseling a child who gets re-injured is complicated and often times emotional. Involving their support group of parents, family, coaches, teammates and friends is helpful, as is setting realistic goals and expectations. This might include considering whether they should re-focus their efforts to a different activity, in order to promote their long-term physical, psychological, and emotional well being. As your child’s strongest advocate, you should feel comfortable seeking consultation with a pediatric sports medicine physician for injuries which are impacting your child’s quality of life.