Melanie Cole (Host): Sports related injuries in children can be highly debilitating and very painful but learning more about them can help to prevent injuries before they happen. My guest today is Dr. Kelsey Davidson. She’s an orthopedic surgeon at Shriners Hospitals for Children – Chicago. Dr. Davidson tell us a little bit about your background in sports and how it gives you insight into being an athlete.

Kelsey Elaine Davidson, M.D. (Guest): So, I grew up actually spending most of my time doing figure skating. I did that competitively all the way through college and even got to go compete at Nationals once. And then after college I spent a couple of years figure skating professionally. So, I think this helps me relate to athletes and understand a little bit about what they are going through when they get injured. Fortunately, I never required surgery during my career, but I did have injuries that took me off the ice for a few months. And I remember a number of things that I think I can relate to athletes with are first of all, it’s very hard not being able to do something that you love to do and that you are used to doing every day. I think the other big things that kids feel is that suddenly now they are going to get behind the rest of their team mates when they are not able to train and play in competitions. And for most of these guys, what they do with their sport and their team, that’s their friend base and suddenly they are not able to see their friends every day when they are not going to training. So, I think it’s important to remember these things in addition to the injury and I try and remind kids that it’s important to use this time away from the sport to get stronger so that they can go back to the sport once they are healed even better than they were before. And also, to remind the families that it’s still good for them to go spend time with their team mates even if they are not training with them so that they can keep that connection to the sport and to their friends while they are injured.

Melanie: Well you certainly do have exact insight because that is how so many youth athletes feel when they have to miss training, or they can’t be with that friend group. So, tell us a little bit about the field of sports medicine and how is it different from traditional orthopedics?

Dr. Davidson: Yeah, so, just in simplest terms, sports medicine is what typically we treat injuries that occurred during playing sports. But it’s not always jus playing sports. Sometimes these injuries can be acute injuries, or they can be chronic injuries and sometimes they can just be injuries that result in pain when kids are playing sports. But I think what makes sports medicine a little different than other parts of orthopedics is that it tends to focus more on the ligaments which are tissues that connect bone to bone and also the cartilage which is the smooth covering over the end of the bone. And these structures are really important in maintaining joint stability as well as cushioning the joints to protect the bones underneath. I think sports medicine focuses on these and we try and keep the joint healthy and also to try and minimize the risk of pain and arthritis as these kids get older and become adults.

Melanie: What are the types of injuries that you most commonly see Dr. Davidson and as we are talking about youth athletes and so many children today are sport-specific training and really concentrating on one sport and so we see more chronic injuries and overuse injuries. What are the most common ones that you see?

Dr. Davidson: Yeah, so we see a whole range of injuries. Certainly, some of the chronic ones are becoming more common because of the sport-specific focus. But we see a range of injuries from simple ankle sprains to ACL tears or meniscus tears in the knee, shoulder instability or patellar instability. We see injuries called osteochondritis dissecans or OCD injuries that are to the cartilage. And even fractures through the bones or through the growth plates are common in kids.

Melanie: So, we hear about certain injuries and specifically like ACL in girls that play soccer. So, tell us about some of the common conditions and factors that lead to injuries like the ACL or throwing injuries in baseball players. How do you approach those kinds of injuries in children who are still growing?

Dr. Davidson: Yeah, when kids are still growing, there’s a number of factors that kind of set them apart from their either skeletally mature or adult injuries. I think the biggest thing with these is that we have to remember a couple of things. Kids when they are young, are still playing. They want to play hard. They want to push themselves to their absolute max ability and of course, this is going to expect a lot of stress on those bodies to expect them to perform at such a high level. This changes a little bit of the rehab process to really focus on getting them very strong and making the body work together as one unit. Because that is really important in trying to prevent either the initial injury or a recurrent injury. The other part too is that because we are physicians and we can have some foresight for the kids; we have to remember that these knees or their shoulders are going to last them well into adulthood. Because kids don’t tend to think of this. They only think about the game that weekend. And so, we have to try and balance their ability to return to the sport at the highest potential level, but also staying healthy and active and keeping them from having long-term consequences to their joints.

Melanie: Tell us about a patient story, someone you have treated at Shriners who is able to return to sports or you are helping to heal from an injury.

Dr. Davidson: Sure. So, I actually had a 10-year-old girl. She was a competitive high-level gymnast and she presented to me with elbow pain for about one month but didn’t really have an injury to that elbow. She described having pain when she was moving the elbow or when she was trying to put weight on that arm when she did handstands or back handsprings and just a few days before she came in, she was also noticing some swelling in the elbow, which is pretty uncommon. She was an otherwise healthy girl and when I examined her, I noted the swelling as well as an inability to fully move that elbow. We got x-rays of the elbow which looked pretty normal, didn’t see anything too unusual. So, we went ahead and got an MRI which shows us the cartilage and soft tissues around the elbow much better. And what we noticed was an osteochondritis dissecans or OCD lesion which is damage to the cartilage as well as the bone just underneath it. And that lesion had actually fallen off of a joint and was floating around. Given that that piece had come off, we decided to do surgery and we did this arthroscopically, which means that we made small little incisions around the elbow and we used a special camera and instruments that allow us to look inside the joint. And we found that piece which didn’t look like it was in very good shape, so we removed it and then we made small little tunnels inside the base of the lesion which allows stem cells and healing factors to come into that lesion and formulate some scar tissues to fill in the hole. After keeping her off of that arm for about three months and having her work with the physical therapists here; we allowed her to slowly return back to gymnastics and I’m really happy to say that thanks to the team here at Chicago Shriners Hospital; she has now been back at her sport for nine months and is doing well and has no symptoms.

Melanie: What a great story. That’s excellent to hear that there are so many ways to help children that you know we want our kids Dr. Davidson to be involved in sports and when injuries take them out of the sports; it’s hard to watch when your child is unhappy about that. What do you tell kids and parents about return to play after an injury and if a child comes home with a little ache and pain from soccer or baseball; what do you tell them about early treatments, things that they can do at home?

Dr. Davidson: Yeah, so usually what I tell them when they are returning to sports, because they have been off of it for so long; is that you can definitely expect some of these aches and pains. Sometimes their muscles aren’t quite as strong, or they are not used to doing these certain maneuvers again and so it’s common that they get some muscle soreness and some achiness when they are trying to go back to where they were. Most of the time, if this pain improves by the next day, it’s not concerning. Parents can treat it with ice and ibuprofen, sometimes kids like massages to sore muscles. All of that’s okay. The big things that we worry about as physicians is if we start noticing swelling in the joints again or if they are having pain that’s not going away after a day or two.

Melanie: Tell us a little bit about the team approach to care at Shriners Hospitals for Children, how families can see therapists and orthopedic surgeons and their psychological care especially with sports today. So, tell us how this can happen all in one place.

Dr. Davidson: Yeah, we are really fortunate to have all of these people here and immediately available to us, particularly in the clinic when we are first meeting kids or when we are following them up after surgery. We always have a physical therapist or an orthotist which is a person who does bracing in clinic with us, so we can have the therapist see the kids in the clinic at the same time. They can teach them how to use crutches or teach them exercises to do at home right after surgery. But the other integral part of our team are the social workers who can help coordinate getting supplies for the kid at home, help them with setting up school work to do at home or making accommodations for them at school. Psychologists can actually be quite important as well after a big injury. Sometimes kids are afraid to go back to their sport because they are afraid of reinjuring themselves and it can be really helpful to have somebody to talk to about this fear. The other thing that I think is very unique to us here at Chicago Shriners Hospital is that we have a gait lab and that allows us if we have real concerns about how a patient’s performing a specific maneuver and how it might be affecting their joint; we can do a gait analysis that looks really closely at how the joint is moving and can maybe change how we treat or how we rehab the patient.

Melanie: Wrap it up for us Dr. Davidson, because it’s really great information and there are so many parents that have so many questions about sports today and what’s safe for children and how often they should be training and what types of training. Wrap it up with your best advice about prevention of sports injuries, your best advice for staying active and in the game.

Dr. Davidson: Yeah, we always want kids to be active absolutely. I think it’s good for them to be active and stay healthy. But the sport-specific focusing we have noticed that it does increase these chronic injuries. So, usually what we recommend is allowing kids to participate in other sports or being involved in other even not organized sports but activities outside of their main sport so that it allows them to keep their whole body in shape. And it’s not doing the same repetitive motion over and over again. A number of sports are starting to recognize this and are starting to create limits to certain things such as baseball with pitch counts or even gymnastics now is starting to consider limiting the number of back hyperextensions that their athletes do to minimize these chronic injuries. I would recommend that the kids listen to their coaches, work with trainers to really maintain good form when they are doing their sports. Those things will really help minimize their chances of getting a chronic injury that could take them out of their sport completely.

Melanie: It’s great information Dr. Davidson. Thank you so much for joining us and for sharing your expertise as an orthopedic surgeon and an athlete, a figure skater to help parents understand how to prevent some of these sports injuries before they happen. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children – Chicago. For more information please visit www.shrinerschicago.org, that’s www.shrinerschicago.org. This is Melanie Cole. Thanks so much for listening.