Getting Kids Back In The Game
Interviewed by Rasa Fournier
Wednesday - May 11, 2011
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Dr. Robert Durkin
Pediatric orthopedic surgeon at kapiolani Medical Center for Women & Children
Where did you receive your schooling and training?
For undergraduate, I went to UC-San Diego. For medical school, I went to the State University of New York at Stony Brook, then I moved to UC-San Francisco for a residency program in orthopedic surgery. I also did one year of training in pediatric orthopedic surgery in Atlanta at the Scottish Rite Medical Center in 1998. In 2005 I went to the Children’s Hospital of Boston to learn innovative hip surgeries that we now perform here in Hawaii. I am also the medical director of the Bone and Joint Service Line at Hawaii Pacific Health and the division head of orthopedic surgery at Kapiolani Medical Specialists.
What ages do you work with?
I specialize in pediatric orthopedics, so I take care of patients from birth to young adulthood, including congenital deformities (conditions you are born with) and deformity of the bone and joints that develop throughout childhood and adolescence.
Kids are starting younger and younger in sports and that impacts what injuries we’re seeing in the teenage and young adult years too.
What are the most common sports injuries you see?
Aches and pains around joints, especially where large muscles become ten-dons and attach to bone. If you’re still growing, you have a small growth plate at those points - the knee, heel, hip, shoulder, elbow and even around your pelvis and spine - the big joints. These can be aggravated by the combination of repetitive activity and a recent growth spurt.
For most overuse problems, the child’s pediatrician will offer reassurance and prescribe icing, maybe a strap and a stretching program. Children come to our office when that first line of treatment doesn’t seem to work, or if the injury reoccurs, which usually happens because the child kept playing or because they weren’t patient enough to wait until their growth spurt was over.
Overuse conditions are sometimes related to improper warmup, such as not stretching well before or after the game, or by not resting and icing a soreness after sports.
What are some preventative tips?
When you have an injury, think RICE: Rest, Ice, Compression, Elevation. One of the most important things with younger kids in sports is you’ve got to keep it fun - everybody says that and it’s true. The key to kids enjoying sports and also preventing injuries is to mix it up a bit - emphasize playful activities to teach the skills. The cross-training idea is important in adults and it’s important in kids, too. Although focused drills are effective in improving performance in adults, kids will generally respond better to a variety of skill-building activities and to positive coaching focused on enjoyment of the game.
What are warning signs of something more serious?
Significant swelling and restricted range of motion are clues to a more serious injury. The best way to check is to compare it to the other side. The amount of pain reported by a child can sometimes be confusing. Sometimes a child will be crying hysterically even though the injury is just a bruise or a strain. If you see an obvious deformity, poor blood flow, dramatic swelling right away or weakness with loss of motion, that’s something you want to have a doctor check out.
When is it ok to return to sports?
Recurrent injury due to premature return to play with incomplete recovery is a common problem for most athletes. The affected joint should have full, painless range of motion. A little bit of swelling doesn’t worry me as long as they have normal strength, full motion and a stable joint. We’ll usually test them with something indicative of the sport the athlete plans to do. For a runner, the athlete should be able to hop without any difficulty, and they should be able to run 10 yards, pivot and run back without limping. If they can’t do that, they’re not ready to play yet. For a throwing athlete or an athlete with an upper-extremity injury, they should be able to perform several pushups without pain, apprehension or weakness before returning to their sport.
I often hear an injured athlete comment, “The championship is coming up, I’ve gotta be there. The team needs me.” I remind them that their team needs every player at 100 percent. If they are still recovering from an injury and perform at 50 percent, then they aren’t really helping the team or themselves, as they are very likely to be injured again. If an athlete allows time to fully recover despite missing a few games, then the team will benefit from their improved performance and full participation.
Most sports have a graduated program of activity. They have age-appropriate levels, and you need to work through those levels to build strength and flexibility and coordination. Most young athletes need to realize that the injury effectively lowers their ability level until they have fully recovered. Therefore, the athlete needs to work back up to the pre-injury level of the sport as part of the recovery process. If they jump right back in at the same intensity, they will likely re-injure the joint and be very disappointed.
Can you talk about the challenge of dealing with young kids in pain?
Pediatric specialists deal with kids at their level. We’re not talking down to them, but trying to make it understandable at their level. By taking away the uncertainty, you take away a lot of the fear. Pediatric specialists are also mindful of our connection with the parents, which can add another layer of complexity because there are different expectations in the room.
When it comes to sports injuries or fractures, engaging the child and the family in the process of recovery is really important. I can provide handouts about stretching exercises and restrictions, but these recommendations can be forgotten quickly if my young patients don’t take responsibility for their own recovery. I see it as a partnership, and the outcome is more predictable and often shorter than expected if my patient and I work together on getting better. If we don’t follow a common plan, then the recovery can be slower or re-injury may happen.
Overall, I have learned a lot from my young athletes. By working together, my patients and I have been quite successful in getting them back in the game as soon as possible.
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