Monique Thomas’ son had been playing football since he started in Little League when he was 8.
He had never been injured until March of this year when he was practicing for spring football with his Booker T. Washington High team. Now 16, he had caught the ball and was hit from the side — helmet to helmet — by one of his teammates.
He was a little dizzy but he didn’t pass out, and the coach told him to keep playing, said his mother, who did not want her son’s name to be used. After the practice, he was walking “kind of funny,” so one of the athletic trainers evaluated him and realized he had a concussion. He had a headache, but light didn’t hurt his eyes and he never threw up, common symptoms of a concussion.
His mother took him to the University of Miami Sports Medicine Institute, where doctors determined he suffered a minor concussion. While he recovered and is getting scholarship offers to play collegiate football, he runs the risk of getting a second concussion.
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Sports injuries among student athletes are increasingly common, especially in South Florida, where many kids play sports all year round. They’re at risk of developing overuse injuries, and South Florida’s heat and humidity can impact athletes who practice during the summer.
Here, then, are five tips for keeping your kids healthy as they play sports:
In the state of Florida, children must obtain a physical from their primary physician before going back to school. This includes a sports physical.
Dr. Matthew Fazekas, a pediatric sports medicine expert at Joe DiMaggio Children’s Hospital in Broward, part of Memorial Healthcare, champions the idea of a “medical home” — a primary care physician who coordinates all primary care for a child, so the doctor knows the child well. The sports physical, which is a comprehensive review of medical and family history, is vital.
But so is electrocardiogram (EKG) screening.
While some countries mandate EKG screenings, the United States thinks it’s cost prohibitive to do an EKG screening on every child, says Dr. Anthony Rossi, chief of cardiovascular medicine at Nicklaus Children’s Hospital in Miami.
“The leading cause of sudden death among young athletes is sudden cardiac death (SCD),’’ Rossi said. “Every three days in the U.S., a student athlete dies of SCD. Usually there are no advance signs or symptoms.”
The leading cause of sudden cardiac death in young adults — hypertrophic cardiomyopathy — can be picked up only by an EKG screening. In addition, the screening can detect heart defects and electrical problems in the heart. South Florida has seen several cases of sudden cardiac death among student athletes in the last few years.
Both Nicklaus and Joe DiMaggio offer free EKG screenings to student athletes (see box).
According to Gillian Hotz, Ph.D. — director of the University of Miami Sports Medicine Institute’s concussion program — the more contact in the sport, the more the child is at risk for a concussion. Some children take a hit and they’re fine, while others aren’t.
“After you see a hit, it is how they get up: Do they take too long? Is it slow? Are they getting up and are wobbly? Are they going to the wrong side of the field? Are they dazed and confused? Are they repeating themselves?”
Common symptoms of a concussion are headaches, dizziness, problems paying attention, throwing up, nausea, trouble speaking, sensitivity to light and loss of consciousness. A child doesn’t have to pass out to have a concussion; symptoms can be anything that are not typical behavior for that child.
If a child has had a prior concussion, they are at a higher risk of having another. A gradual return to play is important, as well as having children clear certain concussion protocols.
ImPACT baseline testing is important, as it will show what a child’s cognitive function looks like prior to an injury. UM and Miami-Dade Schools have partnered to catalog and treat concussions in local high schools. The baseline testing covers male and female student athletes in football, soccer, wrestling, basketball, baseball and cheerleading. Since the initiative began in 2012, the outcomes of more than 1,000 concussions have been recorded, Hotz has noted.
In addition to UM, Joe DiMaggio operates concussion clinics, and Baptist Health South Florida and Nicklaus have concussion treatment programs.
Heat illness is a spectrum of diseases — from dehydration to heat stroke.
The recent emphasis in sports-specific camps over the last several years could be a reason for increased cases of heat-related illnesses, according to Dr. Fernando Mendoza, medical director at Baptist Children’s Hospital.
Heat-related illnesses are 100 percent preventable if the appropriate measures are taken, Memorial’s Fazekas says. If a child is thirsty, then they are already dehydrated. Heat cramps — such as muscle spasms or sweating — may follow dehydration.
Children should stop, move to a cool place and hydrate. A damp cloth to the face and neck helps. Heat exhaustion causes sweating, clammy skin, a weak pulse, dizziness, headaches and could potentially result in loss of consciousness.
If symptoms worsen, the person should immediately go to a hospital to be treated for heat cramps and heat exhaustion.
Heat stroke is the most severe of the heat illnesses. Symptoms are a very high body temperature (103 or higher), hot skin, confusion, dizziness or loss of consciousness. You should call 911 and put a damp washcloth or ice packs on the person. All this can progress fairly quickly depending on exertion.
There are some ways to prevent heat-related illnesses:
▪ Do not be outside during the hottest hours of the day — 10 a.m. to 2 p.m.
▪ Exercise in the early morning or late afternoon.
▪ Make sure young athletes are supervised.
Heat-related illnesses aren’t the only problem young South Florida athletes face.
Playing a sport for many hours a day from a young age puts them at risk of overuse injuries.
Kids are starting younger, playing longer and not playing multiple sports like they used to, says Dr. Roger Saldana, a pediatric orthopedic surgeon at Baptist Health’s Miami Orthopedics & Sports Medicine Institute, who’s seen a spike in kids getting hurt in the past five to six years.
Among the most common injury sites: soccer players’ knees, swimmers’ shoulders, gymnasts’ wrists and back, dancers’ feet, football players’ elbows and knees, and baseball players’ elbows and shoulders.
Indeed, pitchers are increasingly having “Tommy John Surgery” — or UCL surgery — in their elbow at younger ages.
Athletes need to focus on healing and recovery when they deal with injuries, said Dr. Lee Kaplan, director of the University of Miami Sports Medicine Institute.
To prevent injuries, they should be eating healthy, hydrating and getting lots of sleep. He says it’s better to be under-trained than just a little bit overtrained.
Dr. Craig Spurdle, a pediatric orthopedic surgeon at Nicklaus Children’s Hospital, says cross training is important, as different muscles are used so the body can handle the impact of an athlete’s main sport.
“Listen to your body; pain is there for a reason,” Saldana adds. “Kids shouldn’t be playing through pain. Resting, stretching, and learning proper techniques are key in preventing injuries.”
Girls’ knee injuries
While overuse injuries are prevalent in both genders, knee injuries disproportionately affect girls and women.
Anterior Cruciate Ligament (ACL) injuries are particularly prevalent in female athletes, with girls three times more likely to be affected than males the same age, Spurdle says.
ACL injuries are caused by landing or twisting wrong, said Dr. John Zvijac, an orthopedic surgeon and sports medicine physician at Miami Orthopedics & Sports Medicine Institute, part of Baptist Health South Florida.
Half the time someone tears their ACL, they also tear something else in their knee — such as the meniscus or the inside or outside ligament.
The most devastating of knee injuries is an ACL tear, as it affects an athlete’s season, psyche and body.
But the most common knee injury in women is patellofemoral disorder, in which pain occurs in the front of the knee. It is rarely associated with damage in the knee, as it’s more of a muscle imbalance problem.
There are a few reasons why this muscle imbalance — caused by one muscle around the kneecap overexerting itself to keep the kneecap in place — is specific to female athletes. Anatomically, women are more “knock kneed,” which puts more stress on the ACL. Women also can hyper-extend their knee. The muscle imbalances also can be caused by lack of weight training.
If you’ve experienced anterior knee pain — getting out of a car, going up and down stairs — at the front of your knee, then you need to do weight training. A common misconception is that knee braces will help, but they increase muscle imbalance and people become dependent on them, said Zvijac.
Prevention programs should incorporate weight training and strengthening. Nicklaus Children’s Hospital and Baptist Health South Florida have ACL prevention programs.
Where to get help
Baptist Health South Florida offers an outpatient concussion program and an ACL prevention program at Miami Orthopedics & Sports Medicine Institute in Coral Gables and Miami Beach. For information about the concussion program, call 786-596-6520.
Joe DiMaggio Children’s Hospital offers concussion clinics at its Memorial facilities in Hollywood, Coral Springs, Weston and Boca Raton, as well as free EKG sports screenings. To schedule an appointment for an EKG, call 954-265-3437. To schedule an appointment at the concussion clinic, call 954-538-5566.
University of Miami’s Sports Medicine Institute’s concussion program has two locations — one at the University of Miami Hospital and one at the Lennar Foundation Medical Center in Coral Gables. To make an appointment, call 305-243-2074.