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Adult-Free Zone

Sports medicine program targets adolescent injuries

Vol. 23 • Issue 10 • Page 16

U18 Sports Medicine-a comprehensive sports medicine program for pediatric, adolescent and young adult patients-is poised to meet this increased demand. The multidisciplinary program encompasses sports injury prevention and operative and non-operative treatment by pediatric orthopedic surgeons from Joe DiMaggio Children's Hospital as well as diagnostic imaging, including MRI and X-rays, and rehabilitation services at each of its locations in Miramar and Coral Springs, FL.

"We focus on the rehabilitation needs of pediatric and adolescent athletes," shared Whitney Chambers, PT, DPT, OCS, senior therapist, U18 Coral Springs. "'Athlete' is a term we use broadly. To us, an athlete can be a child who is active on the playground or a high school football player. Our patients range from recreational athletes to professional athletes."

The program sets itself apart from other sports medicine clinics by exclusively treating young patients. A 12-year-old girl with a knee injury, for example, will not be sitting in the physicians' waiting room next to a 40-year-old weekend warrior who is experiencing knee discomfort. She also does not have to worry about receiving the same treatment as someone with a hip replacement who doesn't participate in soccer.

"The most unique factor of our program is the understanding we bring to our treatment approach," observed Marcos Davy, PT, DPT, CSCS, physical therapist, U18 Coral Springs. "Injuries occur differently when the patient's skeletal and neuromuscular systems aren't fully matured."

Shift in Sports Participation

Children ages 5- to 14-years-old account for nearly 40 percent of all sports-related injuries that land in the emergency room annually in the United States.

"With single sports concentration, year round focus, less free play and earlier and earlier professional scouting, the rate and severity of these injuries will continue to rise in our pediatric and adolescent patients," shared Jeremy Frank, MD, fellowship trained pediatric orthopedic sports medicine surgeon at Joe DiMaggio Children's Hospital. "Children have historically played three different sports a year, one for each season of the school year."

Children today, however, focus on one sport. "You see scouting on a year-round basis," Dr. Frank told ADVANCE. "There's an emphasis on single sport concentration to stay competitive. And that is harder on these kids' bodies."

Participation in any sport runs a risk of injury. But with a growing focus on practicing in one sport, overuse injuries are becoming as common as traumatic injuries, whether from non-contact sports or from contact sports such as football, according to Tony Milian, MBA, ATC, LAT, director of U18.

As a result, children are susceptible to more traumatic injuries such as a torn anterior cruciate ligament (ACL) or a dislocated shoulder.

Even though just 5 percent of sports injuries involve broken bones, the areas where bones grow in children are at more risk of injury during the rapid phases of growth, according to the American Academy of Pediatrics.

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Dr. Chambers leads patient Ruby Harris through balance exercises.

"With young patients, we need to be mindful that their growth plates are open," shared Dr. Frank. "We need to consider growth plates, for example, when reconstructing an ACL so that the body's growth and development is not affected by any surgical intervention."

Because U18 is tailored for young patients across the board, the radiologists and technicians are pediatric specialists as well. "Pediatric radiologists know kids' bodies and what they are looking for," Dr. Frank said. "A 40-year-old knee and a 9-year-old knee are anatomically different."

Dr. Frank is one of six pediatric orthopedic surgeons employed by Joe DiMaggio Children's Hospital within the Memorial Healthcare System. The scope of the physicians goes beyond sports medicine to treat disorders such as leg length discrepancy or a scoliosis diagnosis.

Additionally, the organization has a community outreach program in which staff members work with parents, coaches, schools, and youth league organizations on proper warm up, stretching and training techniques and injury prevention.

"The goal is to complement what the coaches are doing. We provide the educational piece and serve as a resource if a child gets injured," Milian explained.

According to Dr. Frank, U18 PTs frequently hold clinics with coaches to teach athletes how to land properly, how to build muscle strength and how to prevent injuries.

U18 Program Points

"The success of U18 is predicated on a team effort of highly qualified individuals," Dr. Frank said. "And because we're all physically in one place, there's constant and consistent communication among team members, which is critical to patient care."

The clinicians treat every active youth imaginable, from the 5-year-old with monkey bar injuries to the high school pitcher with a labral repair. The majority of U18 patients compete at the middle or high school level in sports such as basketball, cheerleading, football and gymnastics.

The PTs have treated a professional skateboarder who needed ACL reconstruction after taking a fall during a half pipe. The PTs also treat players from the nearby U.S. Tennis Association.

Some of their patients have become elite athletes in their sport at age 13 or 14 and are home schooled. They have several people involved with their training, including athletic trainers, travel coaches and of course, their parents. The level of intensity is very high as an enormous amount of pressure is placed on these kids.

"Most of our employees are ex-athletes themselves, which helps to relate to their patients," Milian shared. "Many were injured at some point in their own athletic careers and went through a similar scenario as their patients."

There is a strong mental component to rehabilitation as most kids are facing their greatest physical challenge yet. "It helps that the therapists have endured similar challenges," shared Dr. Davy, a pediatric cancer survivor.

The one-on-one environment allows the PTs to develop a level of trust with the patients. Because they spend so much time in therapy, the patients often begin to unveil problems and issues as they get comfortable over time. The PTs listen to their patients and involve the sports psychologists, the parents and nutritionist as appropriate.

"Rehab can be a frustrating time for many of the kids because they often most identify with the sport they aren't able to perform," shared Dr. Chambers. "Their identity is often linked to their sport. When they are sitting on the sidelines with an injury, they are taken out of their element. I want them to remain focused on how they can get back to that level again successfully."

The setup and culture of the clinic allows the kids to interact with their peers and gain a better understanding of why they are in rehab, which ultimately helps the recovery process, Dr. Davy explained.

"Our patients may get to see someone with the same injury in the next stage of recovery," Dr. Chambers shared. "It's motivating for them."

Kids Will Be Kids

Their clinic possesses a certain energy that can only be achieved in an adult-free environment. Just like Joe DiMaggio Children's Hospital is designed to put patients at ease with colorful walls and toys in the lobby, the environment at U18 was designed with children in mind, according to Dr. Davy.

"The kids thrive in this environment because they are surrounded by others with similar injuries and the same taste in video games and music," observed Dr. Davy. "That does not happen at most places."

The PTs may be working with a child recovering from a playground injury in one session and then addressing the biomechanics of a tennis serve in the next.

This requires the PTs to switch gears-and approaches-quickly and seamlessly between patients. Older athletes can focus on the task at hand and complete 3 sets of 10 repetitions of multiple exercises. The 8- to 10-year-old group, however, often needs play integrated into the therapy sessions in order to meet their goals.

Dr. Chambers may ask her younger patients to name 10 bones in the lower extremity as they progress through sets of wall squats to distract their attention. "I keep them involved, active and learning about rehab," she relayed. "I feel they need to know the bones and joints that are involved in their injuries but I emphasize fun and creativity to make it less of a chore. Educating our patients empowers them to be more involved with their care."

Back on the Field

Because there are so many external factors, determining when a child is ready to return to play is a difficult decision for the clinical team. "We must weigh what the parents and coaches want, what level of play the child is returning to and how the injury has healed," explained Dr. Chambers. "Often the biggest challenge is choosing to hold a patient back from returning to play because her body isn't ready."

But the child's decision holds the most weight. "I need the patient to demonstrate that she is comfortable with her recovery before I can make the call," Dr. Chambers said. "Adolescent athletes are often under pressure from all sides and are fearful of re-injury. It's about the patient and her ability to make a confident and informed decision."

When a patient is nearing the end of therapy, the PTs introduce useful information that the athlete can apply to prevent injuries in the future.

"The biggest reward for me is giving these children and teens a chance to go back out there and realize their dreams, whether it's playing in college or dancing at senior prom," said Dr. Davy. "Education plays a role throughout that process, and I'm fortunate to learn as much from them as they do from me. It's the type of environment where you can grow along with your patients." 

Rebecca Mayer is senior regional editor of ADVANCE and can be reached at


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