AAYFL Coaches Clinic 2014 Houston Methodist Orthopedics and Sports Medicine July 23rd, 2014.

AAYFL Coaches Clinic 2014 Houston Methodist Orthopedics and Sports Medicine July 23rd, 2014

Who we are The only facility in Northwest Houston with the expertise to care for all the needs of the athlete of any age Primary Care Sports Medicine Sports Orthopedic Surgery On site x-ray Physical therapy Outpatient Surgery All in one place 8/30/14Houston Methodist Orthopedics & Sports Medicine

Agenda Emergency Action Plans and First aid kit Common injury principles in young athletes Common injuries in collision sports Concussion recognition and management and neck injuries Heat, hydration and Nutrition Pearls for coaches from our coach for keeping kids safe and motivated. 8/30/14Houston Methodist Orthopedics & Sports Medicine

Emergency Action Plans A written document that details what actions are done by whom in the case of an emergency Applies to medical emergencies, environmental emergencies and anything else you want Lets everyone know who does what Common in many organizations Schools, large companies and any other organization where groups of people gather 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Activating Emergency Action Plan Know who is going to call the ambulance What do they need to say Who is bringing the first aid kit Who will direct the ambulance to the field Who is going to take care of the other athletes

8/30/14Houston Methodist Orthopedics & Sports Medicine Calling the ambulance Identify yourself Know your exact location Know the age of the athlete and the type of injury Know the status of the athlete Conscious Breathing Bleeding

8/30/14Houston Methodist Orthopedics & Sports Medicine Calling the ambulance Know the best approach to the field Answer all the questions from the dispatcher Dont hang up until the dispatcher does Have someone designated to meet the ambulance

8/30/14Houston Methodist Orthopedics & Sports Medicine Caring for the downed athlete Remain calm If there is any concern for a spine injury, leave the athlete on the ground with the helmet on Support the head Apply direct pressure to any bleeding areas If the athlete is unresponsive, assess need for CPR and attach AED

Practice Emergency Drills Schedule a drill prior to the season Plan a scenario for the drill Critique the staffs response, duties & actions Obtain support and guidance from your local EMS 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Summary Emergency Action Plans Save Lives Use common sense and remain calm Dont do more than you should Practice your plan!

First aid Equipment and Supplies

8/30/14Houston Methodist Orthopedics & Sports Medicine Equipment and Supplies Available at Practices and Games for trainer or Paramedic Splints Crutches Bandages Automated Defibrillator

8/30/14Houston Methodist Orthopedics & Sports Medicine First Aid Kit Supplies Think about what you need to treat common injuries Remember personal protection Latex or nitrile gloves Antiseptic towels Hand sanitizer Breathing barrier See the list in your handout.

First aid kit supplies Antiseptic wipes (BZK-based wipes preferred; alcohol-based OK) Antibacterial ointment (e.g., bacitracin) Assorted adhesive bandages (fabric preferred) Butterfly bandages/adhesive wound-closure strips Gauze pads (various sizes) Nonstick sterile pads Medical adhesive tape (10-yd. roll, min. 1" width) Blister treatment (e.g., Moleskin, 2nd Skin, Glacier Gel) Ibuprofen/other pain-relief medication Insect-sting relief treatment (e.g., AfterBite) Antihistamine to treat allergic reactions Splinter (fine-point) tweezers Safety pins 8/30/14Houston Methodist Orthopedics & Sports Medicine

Injury recognition in youth sports overview Bruce Moseley, M.D.

8/30/14Houston Methodist Orthopedics & Sports Medicine Objectives Discuss how kids are different Describe some common injuries Discuss Treatment principles Return to play criteria for common injuries

8/30/14Houston Methodist Orthopedics & Sports Medicine Kids are different!!! Bones are pliable Every bone has a growth plate Growing bones are susceptible to injuries. Ligaments commonly stronger than bones Immature brains heal slower than mature brains Kids dissipate heat more slowly

8/30/14Houston Methodist Orthopedics & Sports Medicine Bones Grow from the Ends Growth plates at the wrist and ankles are most commonly injured Every bone has a growth plate Point tenderness near the end of the bone raises concern for bone injury

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Treatment Principles Rest Immobilize anything that hurts at the end of a bone Ice First 2 days for most any injury Compression Ace wrap Elevation Higher than the heart.

8/30/14Houston Methodist Orthopedics & Sports Medicine Definitions Fracture = break Open fracture = break in the skin Closed fracture = no break in the skin Strain Small muscle tear or tear where muscle turns to tendon Sprain Ligament (holds joints together) stretched or torn

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Evaluation History Be able to describe what happened Simple descriptions Hit in knee, heard a pop Tackled and hit back of head on ground How bad was the injury initially? Able to walk off the field Pain with bearing weight Any previous injury like this

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Evaluation Inspection Begins immediately after an injury Limping Holding injured body part Bleeding Deformed arm / leg

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Evaluation Palpation Gently Tender over a bone or joint Is there any deformity Blood flow Capillary refill Run back the Kickoff Numb or tingling

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Evaluation Functional testing Pain is a defense that protects the body DO NOT disregard a players complaint of pain. Compare strength and range of motion with the uninjured side. IF the 2 sides are different, err on the side of caution and dont return to play until seen by physician or symptoms clear

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Evaluation Lower extremity injuries To return to play Bear weight without pain Walk without a limp Duck walk without pain Jog then run without pain Do position specific drills If they cant do the things necessary for a position, dont return to play

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Reporting Most clubs have specific protocols If your club does not --- develop one Protects the athlete Protects the organization Improves communication between coach, parent and physician

8/30/14Houston Methodist Orthopedics & Sports Medicine Reporting Protocol Should include Athlete name Date of injury Type of injury Cause or mechanism of injury First aid applied Parents notified Documentation of others who witnessed the event Identify the person filling out the form

8/30/14Houston Methodist Orthopedics & Sports Medicine Injury Log Helps track type of injury Tracks the athlete who gets recurrently injured Shows length of time lost by injury type If used well, can show change in injury rate if you institute a prevention strategy.

Common Injuries in Collision Sports John Seaberg, M.D.

8/30/14Houston Methodist Orthopedics & Sports Medicine Common Injuries in Collision Sports Collar Bone fracture Buckle fracture Mallet finger Jersey finger Muscle strain Ankle sprain Muscle contusions Joint dislocation Long bone fractures Abdominal injuries Abrasions and lacerations Knee ligament injuries

8/30/14Houston Methodist Orthopedics & Sports Medicine Collar Bone Fracture Fall on shoulder or outstretched hand Usually breaks in the middle Treated with a sling or figure of 8 splint Usually out at least 8 weeks Younger and not throwing may return earlier

8/30/14Houston Methodist Orthopedics & Sports Medicine Buckle Fracture Fall on an outstretched hand Point tenderness usually on the thumb side of of the end of the forearm Sometimes swollen Collapse of one side of the bone Usually casted for 3-6 weeks

8/30/14Houston Methodist Orthopedics & Sports Medicine Mallet Finger Struck on the end of the finger by ball or helmet Tendon pulls a bone fragment off If not treated right, permanent deformity Extension splint for at least 6 weeks

8/30/14Houston Methodist Orthopedics & Sports Medicine Jersey Finger Tendon pulls away from the palm side of the end of the finger Severe pain Often needs surgery Season ending injury

8/30/14Houston Methodist Orthopedics & Sports Medicine Muscle Strain Pull or tear Stretch beyond its limit Treatment is ice, rest, compression Return when pain free and muscle strength is normal Few days to few weeks

8/30/14Houston Methodist Orthopedics & Sports Medicine Ankle Sprain Usually the outside of the ankle Ice, Compression, elevation If unable to walk 4 steps or tender over the ankle bumps, needs an x-ray Need to do position specific drills without pain before return

8/30/14Houston Methodist Orthopedics & Sports Medicine Muscle Contusion Most common in the thigh and upper arm Treat with ice, compression and stretch May heal with a calcium deposit in the muscle

8/30/14Houston Methodist Orthopedics & Sports Medicine Joint Dislocation Fall on outstretched hand or forced pulling back on the arm Severe pain Do not try to relocate on your own Splint and transport to an ER for reduction Finger may return in a week, all others, usually season ending

8/30/14Houston Methodist Orthopedics & Sports Medicine Long Bone Fractures Forearm, upper arm, leg or thigh Usually grossly deformed May have nerve and blood vessel damage Splint for support and send to ER.

8/30/14Houston Methodist Orthopedics & Sports Medicine Abdominal Injuries Spleen is the organ we worry about the most Left upper part of abdomen Will cause shoulder pain of damaged Kidneys also easy to damage Severe stomach pain after a blow Needs to be evaluated in an emergency room

8/30/14Houston Methodist Orthopedics & Sports Medicine Abrasions and Lacerations All bleeding stops It stops faster with direct pressure Remember to wear gloves. If the edges of the wound are apart without being touched, it needs stitches If bleeding is controlled, in general the athlete can continue to play if the wound is covered. Dont expose other athletes to patients blood

8/30/14Houston Methodist Orthopedics & Sports Medicine Knee Ligament Injuries ACL and meniscus tears can happen in young kids Most commonly plant and twist or blow to a knee with the foot planted Often feel a pop Almost always requires surgery to be a competitive athlete

8/30/14Houston Methodist Orthopedics & Sports Medicine Tendon Attachments Achilles tendon Severs disease Patellar tendon Osgood Schlatter disease Pain that is worse with activity. Sometimes has swelling Treat with rest and stretching activities. Ice after games

Concussion recognition and management Greg Seelhoefer, MD

8/30/14Houston Methodist Orthopedics & Sports Medicine Concussions A brief alteration in brain functioning caused by trauma. Does not have to be a blow to the head Does not require a loss of consciousness. Imaging tests (CT scan, MRI) are normal

8/30/14Houston Methodist Orthopedics & Sports Medicine Concussions Grading concussions does not help and can make a serious injury seem mild Returning to play before symptoms have cleared increases chances for recurrent concussion and second impact syndrome No evidence protective gear (headgear, mothgaurds) prevents concussions

8/30/14Houston Methodist Orthopedics & Sports Medicine Concussions How do you know if someone has had a concussion? All based on symptoms Dazed Confused Slow to respond Dizzy Headache Nausea Vomiting Unable to remember new things Unable to remember the hit or recent parts of the game Blurred vision, Ringing in the ears 8/30/14Texas Sports Medicine Center

8/30/14Houston Methodist Orthopedics & Sports Medicine Initial evaluation ABC Just say hi Consider C-spine injury in any athlete with a head injury and altered level of consciousness or any neck pain Ask them what happened IF they dont remember, ask someone else Memory for the event may never return

8/30/14Houston Methodist Orthopedics & Sports Medicine Assess Brain Function Orientation Who they are Where they are When they are Responsiveness Alert Groggy Pupils equal?

8/30/14Houston Methodist Orthopedics & Sports Medicine On the Field Ask if they have any neck pain Immobilize first, then ask Just use hands initially Ask them to move arms and leg Dont move any extremity or body part for them. IF no neck pain, able to move all extremities and answers questions well, allow them to stand slowly and walk off the field with assistance

8/30/14Houston Methodist Orthopedics & Sports Medicine On the Sideline Continually reassess Repeat the questions you asked on the field. Take away his helmet If symptoms are worsening, send to the emergency room

8/30/14Houston Methodist Orthopedics & Sports Medicine When to Return No child who gets a concussion should return to play the same day. Nope not ever Very little research is done on children younger than 12 with concussions We know high school age kids are more susceptible and take longer to recover than college or pro athletes

8/30/14Houston Methodist Orthopedics & Sports Medicine When can the Athlete Return No symptoms at rest and with exertion Return to play slowly Jogging Running Non contact drills Contact drills Full activity Drop back if symptoms recur at any level

8/30/14Houston Methodist Orthopedics & Sports Medicine When in Doubt Hold them out

The unconscious athlete

8/30/14Houston Methodist Orthopedics & Sports Medicine The Unconscious Athlete An unconscious athlete has an unstable neck fracture until proven otherwise Assess ABCs IF breathing and has a pulse Stabilize the neck and do not move the patient. Wait for EMS arrival If not breathing or no pulse Log roll while stabilizing the neck Begin CPR until help arrives.

8/30/14Houston Methodist Orthopedics & Sports Medicine Cervical Spine Injuries Contact sports place the cervical spine at risk Incidence has decreased since rules outlawed spearing Most injuries are still due to axial load Fracture of the neck can cause paralysis, death

8/30/14Houston Methodist Orthopedics & Sports Medicine Neck Injury Symptoms Pain in neck Decreased range of motion Pain, numbness or weakness in the arms Spasm of neck muscles Bowel or bladder problems Unequal grip strength

8/30/14Houston Methodist Orthopedics & Sports Medicine Neck Injury Treatment If concerned about a fracture, immobilize and transport for evaluation Whiplash Strain of the ligament going down the back of the neck Stinger Stretch of the nerves supplying the arm Shooting pain or arm may feel dead for a few seconds May return if symptoms completely clear Needs eval if recurrent

Heat Injuries Christian Schupp, MD 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14 Heat Injuries A completely preventable injury A very common injury Usually bothersome, but can be deadly 3 different phases: Heat cramps Heat exhaustion Heat stroke Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Cramps Dehydration causes localized electrolyte problems Adequate hydration is usually preventative Can occur in any muscle, but most common in the calf Stretch, ice and hydration are the keys to successful treatment Muscles that are cramping are more susceptible to tears / strains

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Cramps: Hydration Daily weights (pre- and post- exercise) Fluid replacement 20-24 fluid ounces of water or sports drink for every pound lost >5% weight loss = serious dehydration Urine color

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Exhaustion More serious, but not life threatening Usually caused by volume loss from sweating that is not replaced Body cannot maintain adequate blood flow to brain, heart, kidneys

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Exhaustion Symptoms Headache Nausea / vomiting Irritability Cool, clammy or hot and sweaty skin Muscle cramps Thirst Low blood pressure

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Exhaustion Treatment Cool place Loosen clothes Fans, wet towels, Ice Elevate legs Encourage fluids Electrolyte solutions are better absorbed. Acclimatize more slowly Return to play 1-2 days, but should have a doctors note

8/30/14Houston Methodist Orthopedics & Sports Medicine Heat Stroke Rare Deadly Most common cause of death in the high school and NCAA Bodys ability to regulate heat is gone Risk factors Temp over 95 with 75% humidity Can occur at much cooler temps Out of shape athlete, poorly acclimatized, prior problems Long periods of strenuous exercise or short periods of intense exercise Dehydration Korey Stringer (1974-2001)

8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Symptoms of Heat Stroke Extreme body temperature Altered level of consciousness is key! Irritability, incoherent, glassy stare, etc Rapidly progresses to seizures and coma Definition = core temperature >104 Rectal temp is the only reliable source Steve Bechler (1979-2003)

8/30/14Houston Methodist Orthopedics & Sports Medicine Treatment of Heat Stroke MUST COOL THEM DOWN IMMEDIATELY Shade or air conditioning Remove clothes Ice to groin, arm pits Treat for shock by elevating the legs Nothing to drink Get to the hospital as soon as possible.

Nutrition principles for adolescent athletes Christian Schupp, MD

Nutrition Basics Athletes need a balanced diet 55-60% carbohydrates Starches like breads Fruits and vegetables Most readily available fuel source No more than 30% fat Fats contain more than twice as many calories per gram as protein or carbs 10-15% protein 8/30/14Houston Methodist Orthopedics & Sports Medicine

What about protein supplements? Not necessary and not helpful Bodies can use no more than about gram per pound 100 lb boy can use about 35-40 grams of protein per day Too much protein causes bowel trouble and dehydration. 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Pre-Game Meals Pre-Game meals should be part of a sound nutritional program and contain foods that are well tolerated by the athletes. There is no particular food that will magically give an athlete special energy, strength, or endurance

8/30/14Houston Methodist Orthopedics & Sports Medicine Goals of a Pre-game Meal Provide adequate energy intake Allow for an empty stomach & upper bowel at time of play Provide an optimal state of hydration Cause minimal upset of G.I. tract Provide familiar foods

8/30/14Houston Methodist Orthopedics & Sports Medicine What to Avoid? Fatty foods Roughage / high fiber Protein Caffeine/Carbonation

Click to edit the outline text format Second Outline Level Third Outline Level Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline Level Eighth Outline Level Ninth Outline LevelClick to edit Master text styles Second level Third level Fourth level Fifth level Fat Fat delays empting of the stomach 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Roughage / fiber Increase the need for defecation

Protein Slower to digest Must be metabolized into fuel in the liver Not an efficient fuel source Can lead to dehydration GI upset 8/30/14Houston Methodist Orthopedics & Sports Medicine

8/30/14Houston Methodist Orthopedics & Sports Medicine Caffeine/Carbonation May increase urine output and upset the G.I. tract

Ideal Pre-game Meal 8/30/14Houston Methodist Orthopedics & Sports Medicine Complex carbohydrates Pasta, breads and fruits Small portion of veggies Small portion of lean meat

Conclusion Encourage a balanced diet throughout the season Focus on hydration Make the pregame meal at least 2-3 hours before the game Do not encourage protein supplements Focus on hydration Athletes plate TEAM USA (google) 8/30/14Houston Methodist Orthopedics & Sports Medicine

Questions???

AAYFL Coaches Clinic 2014 Houston Methodist Orthopedics and Sports Medicine July 23rd, 2014.

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