By Dr. Lisa Goodman, Pediatric Sports Chiropractor
If you have a child that plays sports, you understand that injuries are not just possible, but likely. A bruise, an abrasion, a broken bone or even a concussion can happen starting as soon as they step onto the field. Growing up in the 80s and playing sports, I was off and told to shake it off or "you're OK" when sustaining an injury during a practice or a game. I am all about 'toughing it out' in an important game or race, but it is crucial that kids, parents and coaches understand when not to just 'rub some dirt on it'. As a pediatric sports chiropractor and parent of two teenage boys - here are my tips for evaluation, home care, professional care and return to play for four common sports injuries.
1. Ankle Sprain
By far the most common sports injury in the pediatric population is the ankle sprain. Commonly seen in basketball, soccer, lacrosse, football and skateboarding, ankle sprains vary in from mild to severe. However, all ankle sprains should be taken seriously and treated - because if left to heal on their own you are nearly guaranteeing repeat, chronic sprains in the future. These are fairly easy for a parent, child or coach to identify. The mechanism of injury is usually a contact/trauma or non contact rolling of the ankle. Ankle sprains generally roll inward causing pain on the outside of the foot, ankle or lower leg. Important: if your child cannot bear any weight or take four steps, an X-ray is indicated immediately to rule out a fracture. Once a fracture is ruled out, treatment may commence with removal from training, passive movement, elevation, compression, ice and therapy. You may want the help of an athletic trainer or sports chiropractor to determine the grade of the ankle sprain and a treatment plan. At our practice we utilize RockTape on all ankle sprains to provide pain relief, compression and decrease swelling. We also implement chiropractic extremity adjustments, manual therapy (like the Graston Technique) and infrared laser therapy. The primary goal when treating an ankle sprain is proper bone and joint alignment and strong ligament healing.
2. Knee Pain
Commonly seen in sprinting sports, running, skiing and gymnastics, knee pain can also vary from a simple myofascial strain to a catastrophic ligament tear (i.e. ACL rupture). Important red flags associated with knee pain include swelling, inability to bear weight, walk and inability to fully bend or straighten. If your child has those symptoms they should be evaluated by a sports medicine specialist (orthopedist or chiropractor) who will perform a thorough exam and likely order X-rays or MRI. If your child is experiencing mild to moderate knee pain or injury that is preventing them from fully participating in sport, or other normal childhood activities, there may be a simple solution. Myofascial pain in growing kids is very common. Sometimes associated with 'growing pains' when bones are growing faster than muscles can keep up with, myofascial pain includes muscle, ligament, tendon or fascia pain. Myofascial knee pain is incredibly common and can be incredibly painful. Diagnosed conditions such as MCL or LCL sprains, patellar tendonitis and Osgood Schlatter's disease are all type of myofascial knee pain. The great news is that in our practice we can test for and treat all of these conditions utilizing chiropractic adjustments, manual therapy, infrared laser therapy, kinesiology tape and of course active rehab. The primary goal when treating knee pain kids is proper alignment and healing to prevent premature degeneration.
3. Shoulder Pain
Routinely seen in swimming, tennis, baseball, softball and lacrosse, shoulder injuries can also vary from mild to extremely severe. Kids tend to have excess mobility in the shoulders which can predispose them to dislocation, which is a very serious adverse event. In the event of a dislocation, relocation as soon as possible is important for a favorable outcome. In addition the entire arm needs to be assessed for fracture or nerve injury. Other severe injuries including shoulder separation, clavicle or humerus fracture can occur commonly with a fall on an outstretched hand (foosh injury). If your child cannot move the arm over head or reach behind their back after sustaining trauma these outcomes should be suspected and evaluated by a sports medicine professional. More commonly what we see are rotator cuff strains. The rotator cuff is a set of four muscles that provides movement and stability to the shoulder. These muscles are easy to strain but do not necessarily heal quickly on their own. Particularly if the patient in question has poor posture or sleeping habits. We spend a lot of time assessing our patient's habits outside of our office when treating shoulder injury. As a matter of fact, we also teach our patients better ergonomics for sleeping, using a phone or tablet and even doing chores to help strengthen their shoulders and prevent injury. Our main goal with shoulder rehab is to educate our patients on posture and ergonomics to prevent re-injury.
4. Low back pain
The most common spine injury that we treat in kids and teens is low back pain. We see this in all sports but commonly in golf, wrestling, lacrosse, hockey and volleyball. Low back pain in this population is generally chronic and due to the repetitive nature of many of these sports. Yes, chronic. Odd to use that word with kids, but when left untreated - and many kids underreport low back pain - it can become worse and worse until they finally let a parent know. This is also a good reminder that kids generally do not make up pain, if they mention it to you - do them a favor and seek a consult from a sports chiropractor. All of these sports tend to keep kids in flexion, or bent over forward. Our approach to this type of back pain would be chiropractic adjustments, manual therapy, massage and kinesiology tape as well as active rehab and education. There are some cases of acute injury in the lower back seen in sports like gymnastics and equestrian. The load produced in these sports can cause a few types of fracture that would need to be evaluated on X-ray. Our goal with treating lower back pain is to alleviate it altogether, but sometimes during a heavy competition season, we are able to manage it to a level where kids can continue to play and fully heal during the offseason. Every plan is completely tailored to the athlete in front of us.
How long should my child stay out of training?
This is a great question. My typical recommendation for return to play is if the child can gradually increase activity to the desired 'game speed' without pain, continue on that trajectory. Ie. a soccer player with an ankle sprain or knee injury should start with walking pain free. During subsequent training days or weeks they would graduate to jogging, then running, then sprinting, then running while cutting and finally practices with contact. Once those can all be done pain free or in a 'greenlight' pain zone they may return to play. This may explain why an ankle sprain may sideline your athlete for anywhere from one to 6 weeks or more.
What is greenlight pain?
Sometimes an injury will not heal without a challenge or stress placed on it. Sometimes we recommend returning to play when there is remaining tenderness or discomfort. How do we know when to train through pain? Greenlight pain would be described as tolerable and not made worse during practice or at the end of practice. In fact, sometimes greenlight pain improves during activity.
How do I know if my kid is exaggerating?
In my experience as a pediatric sports chiropractor, kids rarely exaggerate pain. In fact, they generally minimize pain (as do parents and coaches) because they want to play! If you think your child is exaggerating, my advice is not to point the finger at them, rather ask detailed questions about their injury, pain and what is preventing them from returning to their sport. Their answers should clear it up - and perhaps point you in a better direction to either seek professional injury care or discuss a plan with a coach or athletic trainer.
Lisa Goodman, DC, CCSP, CACCP founded Washington Park Chiropractic in 2006 in Denver, Colorado. Dr. Goodman is a Certified Chiropractic Sports Physician (CCSP) and Certified Prenatal and Pediatric Chiropractor (CACCP). She is TPI-L1 certified through the Titleist Performance Institute. She is also a CrossFit Level 1 and CrossFit Kids Certified Trainer. Dr. Goodman incorporates sports chiropractic techniques with prenatal and pediatric patients. She is a subject matter expert for Logan University's Masters of Science in Integrative Pediatrics program. She is a member of the ACA Pediatrics Council and the ACA Sports Council. Areas of special interest include golf biomechanics, youth athletes, ankle and wrist injuries, instrument assisted soft tissue techniques, strength training, and pediatric fitness. Stay connected with Dr. Goodman on Instagram @washparkchiro or @lisakgoodman