By Caleb Nunley, MD
We are fortunate in the Tulsa area to have The Gathering Place and multiple other fun parks. Unfortunately, though, in orthopedics, we see multiple playground injuries. I thought it might be helpful to share some tips on playground safety in hopes of avoiding and preventing some of the most common injuries.
Below are some tips and general guidelines:
1) The child should always wear shoes to avoid splinters and cuts.
2) Sunscreen and plenty of water are important on hot summer days.
3) Make sure the playground has a soft surface underneath the equipment. This needs to extend several feet away from the equipment. This could be rubber, mulch, sand or other materials. The most common emergency room visit from a playground injury is from a fall. Also, check to ensure that the playground is well maintained. Equipment that is poorly maintained may have sharp edges, be unstable or rusty. If the playground equipment is wet, it increases the risk of slipping and falling, and if the equipment is hot, it is a risk for burns.
4) Make sure that the child is playing on developmentally appropriate equipment and utilizes the equipment appropriately.
- Monkey Bars: the child should be using for climbing and not acrobatic stunts.
- Swings: should not be used for jumping off of. Also, make sure children are aware when walking in front of swings.
- Slides: the child should never climb up the front of the slide. (As a parent of a two year old myself, I know this one is especially tough). The child should sit down on their bottom facing forward as they go down and should move away from the bottom of the slide as soon as they reach the ground. An important note is that toddlers should not go down the slide on a parent’s lap. This has been shown repeatedly to be a risk for leg fractures. Fractures/breaks can happen in multiple ways, including when the toddler’s leg is caught underneath the parent, when the child’s leg is caught on the side of the slide, and when the force of the parent accompanying them down breaks the leg.
5) Supervision is likely the most important factor in preventing injuries. This includes providing children guidance on the proper use of equipment, as well as monitoring and adhering to playground safety rules.
We hope you don’t need us, but if there is an orthopedic injury, please give us a call at 918-392-1400! Most importantly, have fun! Stay safe and happy playing!
Knee injuries are commonly seen in sports activities, but also occur in everyday activities. What course of action should you take if you have a knee injury?
Some injuries are caused by a direct blow to the knee, while others are the result of a twisting force often without contact. Fractures of the bones around the knee often require a direct contact mechanism, but many significant ligament and meniscal (cartilage) tears occur due to the twisting force of the injury. Some injuries are a combination of both mechanisms.
Symptoms to pay attention to are swelling, giving way (instability), and catching or locking with movement of the knee. Swelling can be immediately after the injury or may not show up for 24 hours. Giving way with weight bearing suggests a possible ligament injury. Catching or locking symptoms with knee motion is more indicative of meniscal or cartilage tears.
What Should I Do After a Knee Injury?
When a knee injury occurs, initial treatment should be rest, ice, compression, and elevation. Crutches are often helpful if you are unable to bear weight. If significant pain occurs with motion, then a straight leg brace, such as a knee immobilizer, is beneficial. If a bone fracture is suspected due to deformity at the knee, then a trip to the Emergency Room for x-rays is indicated. But most knee injuries do not require immediate evaluation and can wait a few days to be evaluated by a physician. Often times, the exam is more helpful after the initial pain of the injury has settled.
Orthopedic surgeons are specially trained to evaluate and treat injuries of the bone and joint system. They are the specialists regarding knee injuries. Evaluation by the Orthopedist will include the history of the injury, to include the mechanism of injury, as well as discussion of the symptoms of swelling, giving way, and locking or catching.
The examination at this time is very important. Based on location of pain, laxity of various ligaments, and results of certain manipulative tests, an experienced Orthopedist can narrow down the possible structures that have been injured. X-rays are usually taken to rule out subtle fractures or underlying structural problems of the bones. An MRI of the knee may be ordered but sometimes is not needed to establish the diagnosis.
What Will Treatment of My Knee Injury Be?
Many knee injuries will heal without surgery. Mild sprains of the collateral ligaments just need protection for a few weeks in a brace and do well. The torn ACL may need surgery, but there is no benefit to early surgery, and waiting a month may help with motion post-operatively. Meniscal tears usually require surgery within the first few weeks. Severe tears of the lateral collateral ligament and posterolateral structures need to be addressed within the first two weeks of injury. Multiligament injuries may require a staged surgical approach. Luckily, these injuries are not frequent.
In summary, knee injuries are common in sports and everyday activities. The majority of these injuries heal without surgery within 6-8 weeks. If symptoms are not improving significantly within a week, then evaluation by an Orthopedic Specialist is reasonable. History of the injury and examination of the knee, with x-ray studies if needed, will help guide the treatment plan. Discussion of the various treatment options can lead to the appropriate plan for each individual patient.
By DiAnne Adams, DO
When it comes to the healing of an injury or condition, having a doctor and physical therapist who work closely together can be extremely beneficial to the patient. At Tulsa Bone & Joint Sand Springs, I work hand-in-hand with our physical therapy team on a daily basis.
In many cases, orthopedic or sports medicine doctors have to refer outside their company to a physical therapy group. Sometimes they are referring to a PT they have never met or perhaps never even spoken on the phone with. However, at Tulsa Bone & Joint, we have a qualified group of PTs on our staff – and at Sand Springs, we are literally under the same roof.
3 benefits to using a sports medicine doctors and PT who work together:
- Improved communication.
I’ve been working closely with Dan Skierski, DPT, manager of physical therapy here at our Sand Springs clinic, for the last year and a half. During that time, there have been countless times when we’ve been able to consult about a patient face-to-face. Since PT visits are usually quite frequent, the PT can help if there has been an acute change between appointments, or they can identify other contributing factors to the patient’s original diagnosis that the patient may have forgotten to mention during the doctor visit.
This leaves out the middle man of a front desk person, nursing staff, etc. This direct communication can often lead to quicker outcomes on treating the patient.
Also, this direct communication increases accountability for the patient. If I ordered PT for a patient, and he only showed up once out of the six weeks that were directed, Dan lets me know. This helps me know how committed (or uncommitted) the patient may be to the healing process.
- Quicker outcomes.
For better or for worse, much of healthcare is driven by what insurance companies require. When it comes to treating injuries, insurance companies try to steer physicians to take the most conservative approach in treating patients.
As a nonsurgical sports medicine physician, I am committed to exploring various options that will help my patients, and one of the most beneficial options is often physical therapy. Insurance companies frequently mandate that before they will cover higher-level imaging (like an MRI), the patient needs to first try six weeks of physical therapy.
There have been times when this approach has actually worked to speed up the process toward needed imaging. Since the PT has a one-hour session with the patient two or three times a week, and I only see the patient for 10 or 15 minutes, the PT has more interaction with and observes the patient’s movements more than the physician. There have been times that I’ve been able to request approval for higher-level imaging just a week or two into therapy thanks to something the PT has noticed and mentioned to me.
This speeds up treatment and allows us to jump through some of that insurance red tape a little quicker.
- Convenience to the patient
It’s very convenient for a patient to be able to see both the doctor and PT in one afternoon. This means less time in the car, less time waiting for appointments, and overall – happier patients!
The next time you’re looking into sports medicine or orthopedic care, consider a group that employs its own PT team. It will no doubt benefit you as a patient in the long run!
As a former collegiate athlete myself, I try to keep the athlete’s best interest at heart. With the recent recommendations from the AMSSM and AOSSM, my job as a sports medicine physician is to help educate athletes, parents and coaches about the dangers of sports specialization at a young age.
According to a study by the American Academy of Pediatrics in 2018, athletes who specialize in a single sport are 81% more likely to experience an overuse injury. However, multi-sport athletes have less potential for injuries, burnout and have a higher likelihood of scholarship opportunities at the college level.
Studies suggest that early sports specialization engages frequent repetitive movement, which leads to higher stress in muscles, ligaments and tendons. In a growing child, this is a perfect storm for injury patterns to develop. This in turn leads to burnout and decreased athletic performance.
How to prevent burnout and overuse injuries:
- Limiting repetitive movement in sport and training, for example, high pitch counts during practice and games.
- Preseason conditioning programs and 2+ hours a week in injury prevention training can reduce the risk of injury.
- Plan on periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors.
- Ideally, give yourself two consecutive months/year away from the specialized sport to allow the body to recover.
- To reduce the likelihood of burnout, emphasis should be placed on skill development rather the competition or winning.
Multi-sport athletes tend to be better athletes and have the potential for collegiate scholarships and professional contracts. Encourage your athlete to have fun, and remember: If they are not, they may be suffering from burnout or an overuse injury.
By Tony Jabbour, MD
All of us want our children to succeed. Many of us have children who have been playing a sport most of their lives and show potential for a college athletic scholarship. Sometimes it seems parents and coaches will go to great lengths to try to ensure their child can continue playing that sport, even when a physician has advised against it. They’re even willing to enter a risky game of Russian Roulette to ensure the child continues playing the sport.
More than 30 million children and teens participate in a variety of sports in the U.S. each year. Not surprisingly, about 10 percent will sustain an injury, sidelining them. Most injuries are simply mild strains or sprains. Some injuries, however, are devastating injuries, such as fractures, concussions, or major ligament injuries.
The highest rate of injuries in athletes occur in contact and collision sports. American Football, a collision sport, probably accounts for the majority of emergency room visits. Football injuries can include spine injuries, concussions, major knee ligament injuries, and shoulder dislocations.
Certified athletic trainers and sports medicine physicians’ goals are to provide a safe place to play and to assure safe return to sports after an injury. However, it seems the goal of some parents is to keep your athletic teenager in the game at all cost.
Our sports medicine team at Tulsa Bone & Joint works diligently with the athlete and the coaches to help return the athlete to play when it is safe to do so. The sports medicine physician makes the un-biased recommendation of whether or not an athlete can return to play, and coaches and parents usually agree.
Sometimes, though, parents seek other professional opinions to get clearance for their athlete to play. It seems like these parents are playing Russian Roulette with their child’s injury. Russian Roulette, by definition, is an activity that is potentially very dangerous. These parents’ primary goal is to keep the athlete playing yet another football game, instead of thinking of the dire, long-term consequences of their decision.
Here are the two injuries I see parents play Russian Roulette with their child’s injuries:
- ACL Injuries.
In regards to a torn knee ACL, usually we recommend that the athlete stop playing pivoting sports for a season until surgical reconstruction. When the ACL tears, it will not heal on its own. As a matter of fact, when the knee becomes unstable after an ACL tear, there is a very high likelihood that the athlete will cause more extensive knee cartilage damage upon return to playing. The more cartilage is damaged, the more arthritic changes will occur at a young age.
After the athlete is sidelined, many parents begin “shopping” for another physician that will clear their child to play again. Usually the second opinion doctor will put the athlete in a functional ACL brace that offers the athlete a false sense of security. However, the brace will not stop the athlete from damaging the knee further. It seems that the second opinion physician is just trying to appease the parent.
Unfortunately, many of these athletes that return to play with an unstable knee will damage more cartilage in their knee. This decision by the parents to return to play will cause lifelong problems for that athlete and will ultimately limit their sports’ career.
- Traumatic Shoulder Dislocation.
When a collision athlete develops a traumatic shoulder dislocation, the decision to stop playing for a season is best. A collision athlete with a dislocated shoulder has a 90 percent chance of re-dislocating his shoulder upon return to play football. If that shoulder is stabilized surgically, there is a 90 percent chance of not having a re-dislocation.
Unfortunately, some parents want their teen to keep playing, and they obtain a brace from another doctor. Sadly, just like with ACL injuries, I have seen many collision athletes sustain a second shoulder dislocation upon return to play. With subsequent shoulder dislocations, the athlete damages more cartilage and is destined to develop shoulder arthritis at a young age.
I recommend that parents ask the sports doctor many questions when their child is injured. Most importantly, ask yourself if the sports doctor is taking into account the potential lifelong consequences of your child’s ill-advised early return to play.