Sports Medicine Sports Medicine Sports Medicine

Posted May 5, 2016


Specializing in one sport can be bad for kids
by Michael Popke

If your kids compete in the same sport for more than eight months of the year, David Bell has some advice: Make them take a break.
“Sport specialization is a hot topic in sports medicine, yet there is a severe lack of empirical data that exists about the topic,” says Bell, an assistant professor in the UW’s Department of Kinesiology’s Athletic Training Program and director of the Wisconsin Injury in Sport Laboratory.

So he and his research colleagues decided to do something about it.

The result is a groundbreaking study recently published online by the American Journal of Sports Medicine that has particular relevance for highly specialized athletes in the Madison area who train in one sport for more than eight months out of the year. Bell’s research asserts they are more likely than other athletes to experience overuse knee and hip injuries.

He suggests that kids take four months off from their primary sport to participate in other athletic activities. And Bell recommends against kids playing on multiple teams in the same sport at the same time. Additionally, he adds, it’s critical to properly warm up and cool down, while adhering to injury prevention guidelines listed at, a website developed by the American Orthopaedic Society for Sports Medicine.

The UW study, “Prevalence of Sport Specialization in High School Athletics,” involved surveying 302 student-athletes at two Dane County high schools during the 2014-15 school year.

Bell and his team found that athletes from the smaller school (with an enrollment of about 600) were less likely to specialize in a sport than those attending the larger school (with an enrollment of more than 2,000).

“We definitely expected those results,” Bell says, citing the fact that smaller schools need more multisport athletes to fill out rosters. “It was not surprising, but we are the first people to show that school size influences specialization rates.”

Athletes were chosen based on their participation in soccer, basketball, volleyball and tennis — sports that have high rates of lower-extremity injuries and are commonly played 12 months a year.

Student-athletes at the schools, which Bell does not have permission to name publicly, were surveyed by researchers about their sports specialization and injury history. The student-athletes then were classified into low-, moderate- or high-specialization groups. Of those who completed the survey, 34.8% were classified as low specialization, 28.8% as moderate and 36.4% as high.

Bell and his team have expanded their study to even smaller schools in rural south-central Wisconsin this academic year, and they plan to survey at least 2,000 kids ages 12 and up at several youth sports tournaments this summer.

Bell hesitates to extrapolate from the local results and make sweeping generalizations beyond this region of the state, adding that a national study is required to draw larger conclusions. He also recommends that greater efforts be made to raise public awareness about the dangers of sports specialization and overuse injuries.

For now, the key takeaway from the UW research is that training and competing in the same sport for more than eight months of the year — to the exclusion of other sports — is not healthy for young athletes and could lead to long-term-injuries.

“At some point, it’s okay for a kid to specialize,” Bell says. “But we don’t yet know when that is.”
- See more at:

Posted February 20, 2016

Doctor: "Sports specialization is becoming a national epidemic,"

47 ABC - Winter, Spring, Summer, or Fall. Regardless of the season, young athletes are out there practicing and playing. Thing is in greater numbers they're only playing one sport. "Sports specialization is becoming a national epidemic," said Dr. Gabriel Lewullis, an Orthopaedic Sports Medicine Specialist at Bayhealth.

Dr. Lewullis tells 47 ABC that sports specialization is leading to physical injury. He says the issues stem from the constant year-round use of the same muscles, tendons and ligaments, in strenuous athletic activity. For example, in baseball a pitcher might start preparing for the season in the winter. Play throughout the spring, summer and fall, and continue that same cycle without giving those growing body parts any sufficient rest. Dr. Lewullis tells us this leads to overuse syndrome. "It can range from sprains and strains to actually disturbances in their growth plates to the point where they start to spread because of too much throwing,"

We're told the overuse syndrome can be avoided with ample rest and by playing other sports and taking it easy, a philosophy adopted by Dover Track and Field coach James Solomon. He tells us he helps preserve his athletes through rest and a gradual build-up to competition time exertion, preventing wear-and-tear.

"You kind of tear it down to build it up," and "We just ask them to do activities such as swimming and riding a bike, but not necessarily running and stuff," said Solomon.

Dr. Lewullis tells us victims of overuse syndrome won't suffer long-term if the issue is addressed quickly. He says the biggest concerns are children not speaking up because of the pressure they might feel from some parents or coaches who often have one thing on their minds winning a college scholarship for athletics. Dr. Lewullis says the injuries could affect adolescents as well as teenagers.

Specific rules in place by the Delaware Interscholastic Athletic Association (DIAA), the governing body of high school athletics help to limit the development of overuse syndrome. We're told rules state that teams cannot practice for over two hours per day on a school day and three on a non-school day. Open gyms are allowed as well as preseason activities, as long as they do not include sport-specific drills. We spoke to Dover High Athletic Director Aaron Harris to see how exactly these rules are enforced. He told us, "They're enforced here at your school site. The athletic director is in charge of enforcing them and the DIAA is over the athletic director."

After a rules violation is reported, it is up to the DIAA Executive Director and the Board of Directors to hand down penalties.

Posted January 30, 2016

Tendon pain linked to type 2 diabetes

By Shereen Lehman

(Reuters Health) - Exercise is important to managing type 2 diabetes, but the condition may also make a person prone to tendon pain, which can interfere with exercise, researchers say.

Based on an analysis of past studies, researchers found that people with type 2 diabetes are more than three times as likely as those without the disease to have tendon pain, known as tendinopathy. And people with diagnosed tendinopathy have 30 percent higher odds of having diabetes.

The findings may indicate a problem healthcare providers need to be aware of, the study’s senior author said. “People with diabetes are more likely to develop tendinopathy, but the opposite is also true - people with tendinopathy are more likely to have undiagnozed diabetes,” Jamie Gaida told Reuters Health in an email.

“Tendinopathy is a problem for two key reasons,” he said. “First, feeling pain during movements that load the tendon is unpleasant, and second, having a painful tendon stops you being physically active.”

People with diabetes “should absolutely be physically active, as it is one of the most effective treatments for diabetes,” said Gaida, an assistant professor and physiotherapist at the University of Canberra in Australia.

Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.

One past research review has also linked diabetes and increased risk of tendinopathies, the authors of the new study note in the British Journal of Sports Medicine.

To examine the relationship further, Gaida and colleagues reviewed 31 previous studies. Twenty-six of them focused on people with type 2 diabetes while five focused on people with diagnosed tendinopathy.

When they combined and reanalyzed the data in all the studies, Gaita’s team found that people with type 2 diabetes were 3.67 times more likely to develop tendinopathy compared to control participants without diabetes. People with tendinopathy were 1.3 times more likely than controls to have diabetes.

The study team also found that people with diabetes were more likely to have thickened tendons, which is often seen in tendinopathy. And people with both tendinopathy and diabetes typically had been diagnosed diabetic for longer than those with diabetes but no tendon problems.

“The risk of tendinopathy increases with the number of years that you’ve had diabetes,” Gaida said.

Physical activity is one of the most effective treatments for diabetes and tendinopathy can be one of the worst things for diabetes management as it stops physical activity, he said, adding that people who develop tendon pain should seek medical advice early for the speediest recovery.

“Physiotherapists/Physical Therapists are uniquely skilled to help you recover from tendinopathy and return to your chosen activity,” Gaida said.

People with diabetes shouldn’t see this study as a reason to stop exercising, stressed Dr. I. Martin Levy, director of the orthopedic surgery residency program at Montefiore Medical Center in New York.

Levy said that people with diabetes should take a measured approach to any type of exercise or activity. “I think whatever exercise program that you are going to take, use common sense, and start off slowly.”

People sometimes “launch themselves too aggressively into exercise programs and hurt themselves,” he said. “Any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing results of your exercise to determine if in fact you are having any problems from the exercise program that you are on.”

Gaida said the risk of tendinopathy for anyone can be minimized by gradually increasing activity levels and the rate of progression should be slower for someone with diabetes.

Gaida also noted that good control of blood sugar levels can minimize the increased risk of tendinopathy in people with type 2 diabetes.

Posted January 17, 2016

Symptoms Of Concussion Last 21 Days Longer In Teen Hockey Players Who Are Physically Less Mature

Male ice hockey players who are less physically mature have a higher risk of prolonged symptoms from concussion, a new Hasbro Children's Hospital study suggests. On average, the less mature players took 21 days longer to recover — nearly 40 percent longer — compared to their more mature peers, researchers say.

Previously called a "contact sport," the American Academy of Pediatrics now categorizes hockey as a "collision sport."  Terminology aside, just ask any mom: Hockey can be dangerous. Two out of every 100 players between the ages 12 and 17 suffer injuries requiring a visit to the ER, according to USA Hockey Magazine. And, among young ice hockey players, concussion is the most common injury, according to the authors of the current report. It represents more than 15 percent of all injuries for 9- to 16-year-olds and nearly a quarter of all injuries for male high school players.

Led by Dr. Peter Kriz, a sports medicine physician, a research team further investigated the links between physical maturity and risk of prolonged concussion symptoms in teen ice hockey players. They evaluated 145 ice hockey players between the ages of 13 and 18 who were treated for concussion at three New England hospitals: Hasbro Children's Hospital, Boston Children's Hospital, and South Shore Hospital. Along with symptoms of concussion, the researchers assessed disparities in age, size, and physical maturity level. The study ran from Sept. 1, 2012 through March 31, 2015.
Primarily, the researchers were looking for duration of concussion symptoms. Their evaluations relied on neurologic examination, neurocognitive testing, and the standardized Post Concussive Symptom Score. Importantly, the team measured each teen's physical maturity not by age but by using the traditional Pubertal Developmental Scale.

After analyzing all their data, Kriz and his colleagues discovered maturity level and weight mattered a lot when it came to concussion.
Playing Up

Results indicated about half of all players had prolonged concussion symptoms, which was 28 days or longer. Most (about 87 percent) had symptom resolution within three months (90 days), though the average duration of concussion symptoms was 44.5 to 48.7 days.

For male teens, those who were less physically mature took longer to recover than those who were more physically mature — 54.5 days versus 33.4 days. In fact, a Pubertal Category Score of “early” was the strongest predictor of prolonged symptoms among males.

For female teens, heavier weight increased the odds of experiencing prolonged symptoms.

Because of equipment costs, hockey players are not always stratified by age, and so younger, less physically mature players often oppose older players with increased strength, power, and speed, the authors explained. Younger players are at a distinct disadvantage and therefore more likely to get hurt.
Importantly, despite their actual ages, 65 percent of the freshman male ice hockey players were in the early stages of pubertal development.

The authors concluded teen athletes who play collision sports should compete in leagues grouped by relative age and also be discouraged from “playing up” on varsity teams. Typical symptoms of a concussion, according to the Mayo Clinic, include headache, temporary loss of consciousness, confusion, dizziness, nausea, vomiting, slurred speech, and fatigue. Any athlete who is still experiencing symptoms should not participate in sports.

Posted January 15, 2016

Young Runners at Risk for Bone Loss

Poor nutrition, low hormone levels also part of a “Male Athlete Triad.”
By Amby Burfoo

In 1993, researchers first proposed a Female Athlete Triad among some athletes, including distance runners. The triad is a syndrome of three interrelated conditions: poor nutrition, amenorrhea, and low bone mass. Experts have now published a paper online in the journal Sports Medicine proposing a similar Male Athlete Triad consisting of poor nutrition, low male hormones, and low bone mass.

Again, runners are among those at risk (along with wrestlers and gymnasts). Why? In part, because runners may aim for extreme leanness in their quest to get faster, and running does not provide optimal bone strengthening. (The gold standard sports for bone development are basketball and soccer, which require substantial amounts of running and lateral movement.)

In fact, several studies have shown that athletes in sports that emphasize leanness are up to 25 times more likely to exhibit eating disorders than non-athletes in the general population. Additionally, when overtrained, some male endurance athletes exhibit declines in testosterone of up to 40 percent (although their T levels remain within the “normal” range.) Both insufficient diets and low hormone levels could contribute to poor bone health.
The authors believe that the prevalence of male triad “is less common than in female athletes.” Nonetheless, it’s a concern, particularly among boys aged 13 to 15, when major bone growth occurs. Most males reach full bone development at about age 20.

“I have seen aspects of the triad in male athletes of all ages and sports,” said Adam Tenforde, M.D. and lead author of the study. “When conducting a study in high school runners, I was surprised to find 20 percent of male runners had low bone mineral density scores.”

In most cases, there’s a simple solution. "The key is to address any nutrition deficit,” Tenforde told Runner’s World. “This can be accomplished by increasing overall energy intake or reducing total training effort. As a fellow runner, I recognize that reduced training is not always an easy solution, so I would focus on nutrition: three meals per day—no skipping breakfast—healthy snacks, and eating in the recovery window after workouts.

“The key for both young female and male runners is to develop a healthy attitude about eating and sports. The mindset should be, ‘I am fueling myself.’ It should not be about controlling calories or eating only ‘the right kinds of foods.’ Teens should try to consume 1300 milligrams of calcium a day and 600 international units of Vitamin D. Carrying portable snacks can help. Also, sleep cannot be ignored. Especially in the high-performing runner, it’s challenging to balance the demands of school, running, and other activities.”

Posted January 7, 2016

Alabama's medical tent invention could be the new Gatorade
Compiled by John Hickey

College football's biggest invention/marketing breakthrough since Gatorade could be on display to a nationwide audience in the national championship game Monday when Clemson and Alabama meet in Glendale, Ariz.

The Crimson Tide are bringing with them a small collapsible tent designed primarily by four Alabama mechanical engineering students. It allows the Alabama medical crew to quickly create a space on the sidelines to diagnose and treat an injured player.

Nobody else has anything like it, just like when Florida was a step ahead of the game when the school developed atorade 50 years ago to help Gator athletes replenish the elements lost to sweat during rigorous sport activities. There is only one of the tents now, the prototype, but it's all the buzz.
``It almost seems too simple,'' Jared Cassity, one of the co-inventors, told ``You look at it and think, why didn't we have this before?''
The plan is make sure everybody has one going forward. A patent on the design has been filed for, and training staffs at other schools are flooding Alabama with inquiries about the tent, which is both light (70 pounds) and has light (the synthetic material allows light in while affording a modicum of privacy) and is quickly accessed, setting up in 10 seconds when needed.

The end result? No more TV pictures of an athlete writhing in pain. A kind of mini-M*A*S*H, if you will.

``I think everybody recognizes it's a difficult space to do a medical evaluation,'' Jeff Allen, who oversees the sports medicine training staff for Alabama's athletics department, said. ``The first 10 minutes or so after an injury are critical in terms of getting an accurate diagnosis, and that type of environment presents some challenges, plus there's a component of just medical privacy for the athlete.''

Oh, and one more thing. They've figured out that they can sell advertising space that's visible when the tent sets up.
Of course they have.

Posted January 7, 2016

Understanding and preventing ACL injuries
By By Scott Sailor, EdD,

USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the first column of the new year from Scott Sailor, the president of NATA.

The ACL tear is the most devastating knee injury for all sports in terms of time loss from play and long-term consequences. Damage to the anterior cruciate ligament (ACL) can happen in any sport, but research suggests that athletes who participate in football, basketball and soccer are at greater risk.
The ACL runs diagonally in the middle of the knee and provides rotational stability. The ACL is only one of the ligaments inside the knee joint, and almost half of all ACL tears are accompanied by damage to other ligaments or cartilage in the knee. The most common ways to injure the ACL (approximately 75 percent) include non-contact injury mechanisms such as quick changes of direction and landing.

Numerous research studies suggest female athletes are more prone to ACL injuries. Probably the top reason is that they have different movement patterns during quick changes of direction and landing. Other possibilities could be because of differences in muscular strength or physical conditioning, but it could also be caused by gender differences in lower leg alignment and the effect of estrogen on ligaments. While there is no definitive research that links gender to ACL injuries, female athletes may want to put extra focus on preventative techniques, especially if they play sports that involve a lot of jumping or sudden changes of direction.

One of the most concerning aspects emerging from current research is that joint injuries, such as those resulting from ACL tears, are one of the biggest risk factors for developing osteoarthritis. According to the Osteoarthritis Action Alliance, up to 50 percent of those diagnosed with an ACL or meniscus tear will develop osteoarthritis 10 to 20 years after the injury.

Because we know ACL tears are painful, involve a lengthy rehabilitation process and can lead to long-term health consequences such as osteoarthritis, it’s important to consider preventative measures that can reduce your risk of ACL injury.

If you’re concerned about ACL injury, start by talking to your school’s athletic trainer or other sports medicine specialist. They should be able to help you identify any muscle areas, such as weak hips, that could lead to increased risk. They can also work with you to develop a preventative training program that incorporates balance, agility, strength and flexibility exercises specifically designed to lower the risk of ACL injury. Research suggests that when done correctly, these preventative programs help reduce the risk of ACL and other traumatic knee injuries by more than 50 percent.

The Osteoarthritis Action Alliance has created a helpful handout with suggested exercises to help prevent ACL injury. Research shows the most effective programs are performed two or three times per week for 10 or 15 minutes. That’s a relatively small time commitment that you could easily incorporate into existing exercise routines.

Still wondering if you really need to add preventative exercises into your strength and conditioning regimen? Consider this added bonus: All the exercises suggested to prevent ACL and other knee injuries are also associated with a general increase in athletic performance. Not only can you reduce your risk of knee injury, but you could improve your vertical leap, aerobic fitness and sprint speed. And who doesn’t want to run faster and jump higher?

Posted December 16, 2015

3 steps to perfect posture

Your mother was right… you need to stand up straight! Despite this near-universal admonishment, we’re a nation of slouches. Far too many of us continue to fall into poor postural alignment, which unfortunately worsens with age. In fact, it is reported by the American College of Sports Medicine that 85 percent of all adults will experience lower back pain, which is most commonly attributed to poor posture.

In an era of which smart phones and tablets control our day-to-day, it’s easy to blame this phenomenon on technology. Forward head posture is now being referred to as “text neck” due to the common misalignment of the head/neck when viewing a device in front of your abdomen. But your poor posture can’t all be blamed on technology. What are the real causes of misalignment?

Postural stress is a result of poor communication between opposing muscle groups of a joint. Certain muscle groups become overactive/tight, pulling a joint too aggressively in one or more planes of motion. This means the opposing muscle groups are equally underactive/weak and therefore inhibited. The result causes ligaments, joint capsules, and other soft tissues of the body to experience overwhelming stress in one direction creating an asymmetry. The key is to promote balance and maintain straight lines throughout the body.

Here are three easy steps to correct you posture:


How do you spend most of your day? Office jockeys tend to have a very protracted head/neck from leaning over a computer, while jobs that require more standing often result in hip and back dysfunction. Sometimes an acute feeling of pain or discomfort is stemming from another area of dysfunction; the pain shows a compensatory strain, which then creates a new/additional issue. The most effective route is to consult a specialist such as chiropractor, physical therapist, or fitness specialist to assess you current postural alignment. Health professionals can much more easily detect and correct these issues than you can.

After addressing what the underlying issue is, action must be taken to help correct a misalignment from worsening. The name of the game is injury prevention. Detect and correct before something gets debilitating. More often than not, a specific exercise protocol can do wonders in a matter of just a few weeks. Health professionals will often prescribe movements to better unwind these stressed areas by strengthening weaker muscles that have previously been underactive. Strength and conditioning professionals and physical therapists will often compile a routine that can be completed two to three days a week in a supervised facility. Often times they also share a series of less intense movements, which compliment this work from home. Other times a physical adjustment is need by a chiropractor who may also supply some exercises for additional homework.

After a professional diagnosis and you begin a routine of corrective exercises, don’t stop! The most difficult aspect is staying committed to your maintenance program. Constant mindfulness throughout the day is your best bet to keeping your curves healthy and pain-free. An easy way to do this is to start from head to toes and recognize where your body is positioned.

*Head/neck is vertical/straight

*Shoulders are pulled back and slightly downward

*Lower abdomen and glute muscles slightly active protecting the lower back
*Hips remain pointed forward, not contorted
*Knees track straight or slightly outward of the middle toes
*Ankle is stacked vertically with ones weight being displaced evenly throughout the foot

A supervised fitness program consisting of strength training, stretching, and mobility is the optimal means to attack poor body positioning. This can be a great learning experience to better understand how you may have developed particular imbalances based on muscles used in association with your lifestyle. It’s critically important to pay attention to these muscles and to try to adopt better posture. If not, you run the risk of injuries such as herniations, bulging discs, and long-term muscle pain in the lower back and hip flexor muscle groups.
And that can be a pain in the butt – literally.

AJ Lamb, CSCS, CSS, PES, is a training manager at Motivate Fitness in Ambler, Pa. H