Bennington High School

Anaphylaxis (anaphylactic shock) is a severe allergic reaction to venom, food or medication. These severe reactions are typically caused by an insect sting or ingesting foods an athlete may be allergic to. Common food allergies include milk, peanuts, eggs or tree nuts. Anaphylaxis can be deadly, therefore IMMEDIATE treatment is a must. If any athlete has a known severe allergy to any substance, they must carry an EpiPen with them to all events and venues. Athletes should have a pre-participation physical exam from a physician that evaluates a child for any predisposing cardiac conditions and clears them for participating in a sport. If an athlete exhibits any of the symptoms below during exercise, they should promptly be sent to a physician for a thorough medical evaluation. They should NOT be allowed to return to play without documented clearance by a licensed medical physician.

Possible signs and symptoms of anaphylaxis (not all of these have to be present):

• Pale skin
• Rash
• Weak rapid pulse
• Facial, throat or mouth swelling
• Rapid shallow breathing or difficulty breathing

* In the event an athlete suffers a sting or experiences anaphylactic shock, locate their EpiPen and have them
follow the printed instructions on the outside of the container.

1. Remove the EpiPen from the clear storage tube if in one.
2. Pull off the top(usually blue or grey) - don't twist.
3. Roll up shorts/ pants, if possible, to expose bare skin. However, this may go through clothing if necessary.
4. Swing and firmly push tip (usually black or orange) against outer thigh so the device clicks.
5. Hold EpiPen on the thigh for 10 seconds.
6. ALWAYS CALL 911 as the athlete may still develop respiratory compromise and need further care.

For more information visit the Mayo Clinic website on Anaphylaxis

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. To make an appointment, call 402.955.PLAY (7529).

Click here to download a printable version of this Allergies in Sports article. 

Return to play (RTP) decisions following an injury can be challenging. Pain is not always the best indicator of when an injury is healed. Often injuries start to feel better before they are completely healed, stable and ready for activity. During this time, the injured part is still vulnerable and subject to incomplete healing and/ or re-injury. These RTP decisions should be made with input from the physician or athletic trainer, the parent, coach and the athlete.

For optimal healing, follow these criteria for return. If they can’t be completed due to the injury, you are not ready to go back in yet!

What are the criteria for RTP?

• PAIN – Pain is gone as well as any swelling or bruising
• RANGE OF MOTION (ROM) - The injured body part should be able to move in all directions without pain. The motion should be back to normal limits, baseline or that of the other side.
• STRENGTH - Strength helps provide protection to the injured area. All body parts should be functioning normally to withstand the stress of activity. To test strength, resist the motion of the injured joint in a variety of positions and make sure it is pain free and equal on both sides.
• WEIGHTBEARING PROGRESSION - A weight bearing progression would start with the following the steps below in succession. If any of these cause pain, or increase the signs or symptoms of the injury, do not progress. Each step has to be pain free and well tolerated.
  • Standing > Walking > Jogging > Jumping > Running > Sprinting
• FUNCTIONAL MOVEMENTS AND SPORTS SPECIFIC SKILLS – Just because the muscles surrounding an injured area appear strong does not necessarily mean they are ready to handle the demands of sport. Young athletes should be able to complete all activities that mimic the demands of their sport, without any symptoms, before returning to practice and games. These include:
  • Cutting maneuvers at varying speeds
  • Agility in all directions
    • Offensive – athlete chooses path or pattern
    • Defensive - athlete reacts to the movement of someone or something
    • Power exercises - explosive movements (potentially with weighted objects)
    • Sport specific drills - Passing, dribbling, shooting, skating, hitting, etc.
• RESTORE ENDURANCE - Deconditioning is a fear and reality for almost all injured athletes. Cardiovascular (CV) endurance can be diminished in as little as 3-5 days of inactivity. Gradually increasing the intensity and duration of skills and drills can restore CV and muscle endurance. This will help provide the stamina needed for the young athlete to return the full demands of their sport safely.

For mild injuries, all of the preceding criteria may be met quickly (i.e., during the course of the same practice/ game). If able to complete these steps, they may consider returning directly to the practice/ game. If unable to complete, the injury should be evaluated and a treatment plan identified that addresses the above criteria. 

What if there is continued pain or difficulty?
Reassess your activity level. If full pain free recovery is the top rung on a ladder, you can’t get there by skipping steps. You will inevitably fall back down and have to start over. Therefore, any pain during these steps in the RTP process will slow down the healing process and lengthen recovery time. The concept of "No Pain, No Gain" does not apply to the injury treatment process. If/when pain returns, stop, rest, and rehab before advancing to the next level, you are not ready to go back in yet! If return is still delayed, seek medical attention to make sure there is no underlying cause that is slowing this RTP process.

For more information visit:
American Academy of Pediatrics
American Medical Society for Sports Medicine
National Federation of High Schools

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. For more information of to make an appointment, call 402-955-PLAY (7529) or Children's Nebraska - Sports Medicine 

Click here to download a printable version of this “Can I Go Back In Yet?” article. 

What is it? 
An acute ankle sprain involves the stretching and/or tearing of one or more ligaments in the ankle. Ligaments are bands of fibrous tissue that connect bones to bones at the joint and provide stability.

Sprains are classified into three grades:

• Grade 1: mild - ligaments are stretched but not torn
• Grade 2: moderate - ligaments are partially torn
• Grade 3: severe - complete tearing of one or more ligaments

Lateral ankle sprains are most common and normally occur with a plantar flexion and inversion movement (commonly referred to as “rolling the ankle”). This movement can also injure the tendons of the peroneal muscle that runs through the outside of the ankle and can be stretched in the process. When ligaments and muscle tendons are stretched, nerves can be damaged. This causes these structures to lose their function and balance is often affected. In children and teens, ligaments may be stronger than the bone. When they are strained, instead of the ligament being stretched/torn, the bone to which they are attached detaches creating an avulsion fracture. At other times, the growth plate can be damaged and compromised. Regardless of the structures involved, these injuries rarely require surgery and often heal with conservative treatment.

What are the common signs and symptoms of an ankle sprain?

• Grade 1: Slight pain and swelling, mild loss of motion. Able to bear weight with little to no loss of function.
• Grade 2: Moderate pain, swelling and potential bruising or discoloration. Moderate loss of motion and strength around the area. Feeling of “looseness” in the joint. Loss of function and potential difficulty with bearing weight.
• Grade 3: Significant swelling and intense pain. Discoloration may be seen. Near complete loss of motion and strength. Decrease in stability leading to a significant loss of function. Often difficult to bear weight. 

What is the treatment?
PRICE is a common acronym that describes an effective method of treatment for at least the first 72 hours post injury

• Protection - Protect the affected area to reduce the chance of further injury. (i.e. slings, crutches or padding).
• Rest - Rest the injured area with modified activity or complete rest. Any pain experienced can slow the healing process and eventual return to activity.
• Ice - Place ice on the injured area for 20 minutes at a time. This can be done several times a day to help control pain and slow or reduce swelling.
• Compression - use an ace wrap or elastic bandage to compress the area and minimize swelling. Start wrapping from the end of the limb up toward the core of the body, being sure to include and extend beyond the injury site. For best results, it should be tighter at the beginning and then looser as it’s applied up the limb. If experiencing and increased pain, numbness, tingling or the limb feels cool to the touch after application, loosen immediately! Always loosen prior to bed as well to avoid extended compromised circulation.
• Elevation - the affected area should be elevated above the level of the heart as much as possible to help limit or reduce swelling. For a lower extremity injury, this might require sitting or laying down.

Crutches may initially be needed if body weight support causes pain. A CAM walking boot or ankle brace may be recommended to provide support to the joint while it heals. An ankle brace for activities is often recommended when returning to activity after an ankle sprain.

Can it be prevented?
Incorporating a proper warm-up and cool-down routine with plenty of stretching. Maintaining or improving flexibility in the ankles and legs. Muscular strength, endurance, and balance training can also be helpful. Wearing an ankle brace can help with preventing recurrent ankle sprains after the initial injury. It's important to note that pushing through excessive pain is risky, especially if it leads to limping. An athlete who is limping is at a higher risk of causing additional injuries.

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. To make an appointment, call 402.955.PLAY (7529).

Click here to download a printable version of this “Ankle Sprains” article. 

What is it?
Anterior knee pain describes several different conditions that cause pain in the front of the knee. Although each condition is technically different, the treatment and rehabilitation generally remains the same. These conditions include apophysitis, tendinitis, and patellofemoral pain syndrome (PFPS). Note that “itis” means inflammation. When used as a suffix, it means that body part is inflamed.

Apophysitis
An apophysis is the area of a bone where growth occurs. Many apophyses serve as attachment sites for muscles and tendons that function to move a joint. In growing children and adolescents, bones usually grow faster than muscles and tendons, resulting in excessive tension being placed on the apophysis. This tension can cause pain and inflammation at the attachment site. There are two locations in the knee where apophysitis is common. The first location is the tibial tuberosity (bump at the front of the shin bone just below the knee), this is called Osgood-Schlatter's disease (OSD). The second location is the bottom edge of the patella (kneecap), it is called Sinding-Larsen-Johansson Disease (SLJ). Both of these conditions tend to cause pain with running and jumping.

Patellar Tendinitis
Tendinitis describes pain and inflammation in a tendon, the band of connective tissue that attaches a muscle to a bone. Tendinitis in the knee commonly occurs in the patellar tendon, which attaches the quadriceps muscle to the tibial tuberosity. This condition tends to cause pain with jumping, changing directions, or decelerating to a stop when running.

Patellofemoral Pain Syndrome (PFPS)
PFPS involves pain in the front of the knee. It is caused by an imbalance in the structures that hold the knee cap in place on the thigh bone (i.e., some muscles surrounding the joint are weaker and/ or tighter than others). This imbalance causes the back side of the knee cap to rub irregularly on the front side of the thigh bone causing pain. Activities that cause pain are running, jumping activities, stairs, kneeling, or squatting. If this condition progresses, a defect in the cartilage that covers the surfaces of the bones can occur. The athlete then may also experience a painful grating or creaking sensation.

What are the common signs and symptoms of anterior knee pain?

• Pain at the front of the knee, surrounding the knee cap
• Pain with running, jumping, cutting, kneeling, and/ or squatting activities
• Pain often occurs after sudden increases in activity (running more miles)
• In most cases, the specific structure affected will be tender to the touch

What is the treatment?
To be diagnosed with one of these conditions, the athlete should be evaluated by a sports medicine physician or athletic trainer. X-rays may be ordered for diagnostic purposes, but are not always necessary. In some more minor cases, it may be possible to rehabilitate these conditions with just a home exercise program taught by a licensed athletic trainer or physical therapist.

Because all these conditions have a root cause of muscular imbalance, they all are treated in a similar way. Treatment consists of stretching and strengthening the structures surrounding the knee, hip, and core. In the case of apophysitis, stretching of the hamstrings and quadriceps muscle groups is vital. Patellar tendinitis requires stretching and strengthening the same muscle groups, along with those that control the hips. PFPS can be treated by identifying the imbalance to appropriately stretch and strengthen.

Braces/straps may also be helpful in the case of PFPS and patellar tendinitis. A knee sleeve with a buttress to help control motion of the patella (J-brace) may help alleviate symptoms of PFPS. A patellar tendon strap puts some pressure on the patellar tendon to alter the amount of pull that the bones experience may help with patellar tendinitis.

Can these conditions be prevented?
These conditions are all classified as overuse injuries. An overuse injury occurs when excessive loads are placed repeatedly on the body without allowing time to recover. Therefore, gradually increasing activity and avoiding sport specialization at a young age are excellent ways to prevent anterior knee pain. As is the case with all overuse type injuries, early recognition is key. These injuries are generally much easier to resolve when treated early.

Given that these injuries also have a root cause of muscular imbalance, it is also helpful to include a good warm up and cool down involving plenty of stretching as well as general cross training activities that focus on strengthening of the hips and core. It should also be noted that it?s dangerous o push through excessive pain with any of these conditions, especially if the pain is causing a limp. An athlete who is limping is more at risk of injuring something else.

For more information visit:
American Medical Society for Sports Medicine
American Academy of Pediatrics

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. To make an appointment, call 402-955-PLAY (7529).

Click here to download a printable version of this “Anterior Knee Pain” article. 

What is it?
Hip impingement is a condition characterized by the development of bony spurs, or outgrowths, of either the head of the thigh bone (Cam type), the edge of the hip socket/ pelvic bone (Pincer type), or both (combined type). These spurs cause pinching and rubbing of the labrum of the hip (acetabulum) and prevent the joint from moving smoothly during activity, both of which cause pain. FAI is caused by abnormal development during growth in childhood. Although athletes may notice symptoms earlier than non-athletes due to increased activity, exercise does not cause FAI.

What are the common signs and symptoms of hip impingement?

• Pain can occur in the groin or outside of the hip. Can be a sharp stabbing pain or a dull ache. Tends to occur when walking or flexing the hip.
• Stiffness
• Limping
• Decreased Range of Motion

What is the treatment?
Avoid activities that cause pain. Referral to an athletic trainer or physical therapist to improve range of motion and strengthen the hip muscles may help improve pain. If non-surgical treatment methods are unsuccessful, surgery to remove the spurs and labral tears may be warranted.

Can these conditions be prevented?
Strong hip and core musculature can help prevent this condition from developing. Be sure to include conditioning and general strength in the athlete?s exercise regimen.

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. To make an appointment, call 402-955-PLAY (7529).

Click here to download a printable version of this “Chronic Hip Pain” article. 

Little league shoulder is an injury to the growth plate in the proximal humerus (upper arm bone). It is typically caused by repetitive stress or micro trauma to the shoulder area. This is commonly seen in adolescent baseball pitchers as well as any athlete who uses an overhead motion on a regular basis, such as tennis and volleyball players. This stress to the growth plate is usually seen in the young growing athlete between ages 11-18. Once the athlete stops growing and the growth plates are closed the likelihood of this type of injury diminishes.

Signs and Symptoms
This injury is often characterized by a gradual onset of pain in the throwing shoulder. Common signs and symptoms include:

• Tenderness over the area of the top of the shoulder
• Focused pain with a throwing or serving motion
• Pain that can be felt for hours or days after throwing
• In pitching, pain worsens in the late cocking or deceleration phases
• May be associated with decreased velocity and control of pitches or serves.

Causes & Risk Factors
There is typically not one traumatic event that causes this injury. This injury is commonly found in patients who throw 4-?5 days a week on average. Risk of little league shoulder increases with throwing too much at a young age. It is more common in adolescents who have a lack of muscle strength in the shoulder and upper back.

Other risk factors include:

• Not following pitch count guidelines
• Not allowing rest between heavy throwing sessions
• Throwing breaking/ curve balls at too early of an age
• Increased high loads of torque
• Not properly warmed up prior to pitching
• Throwing through pain

Treatment & Outcomes
Initial treatment may consist of non-steroidal anti-inflammatory medications (i.e. ibuprofen) and ice to relieve pain. The most important treatment for this condition is rest. A physician may recommend a prescribed amount of rest in order to allow for proper healing and restoration of normal arm function. The healing process may take several months. For severe cases sometimes a sling will be provided to completely alleviate stress to the shoulder. Once symptom free, it is important that a graduated throwing progression be followed. This progression allows for slow, increased increments of stress reintroduced to the growth plate. If too much stress occurs too quickly ? the symptoms are likely to return. With proper treatment, there is usually no permanent disability associated with this injury.

Injury Prevention
Some basic precautions can go a long way in preventing this type of overuse injury. Consider the following:

• Appropriately warm up by running, stretching, and an easy gradual throwing progression
• Pitchers rotate to other positions that don?t require hard throwing (ie: 1st/ 2nd base)
• Maintain appropriate conditioning of the arm, core, and hips through year round fitness
• Maintain appropriate lower extremity flexibility (especially the hip flexor)
• Follow recommended pitch counts for pitchers (see below)
• Take active rest days to perform physical activities other than throwing (see below)
• Avoid throwing and pitching through discomfort and pain
• Avoid pitching on multiple teams with overlapping seasons
• Use proper throwing and pitching techniques - emphasize control, accuracy, and good mechanics

For more information visit:
Little League – Pitching Rules
American Academy of Pediatrics
American SportsMedicine Institute

Consult your primary care physician for more serious injuries that do not respond to basic first aid. As an added resource, the staff at Children’s Sports Medicine is available to diagnose and treat sports-related injuries for youth and adolescent athletes. To make an appointment, call 402-955-PLAY (7529).

Click here to download a printable version of this “Can I Go Back In Yet?” article.