52 july/august 2015 • www.86mag.com

By Michelle cappello, with Dr. Nirav paNDya

photos By toM MiNczeski

h e a lt h & w e l l n e s s

Children’s hospital oakland is providing a UniqUe response to a growing problem

Sports Medicine for Our Kids

I’m the clinical director at Children’s Hospital, Oakland. We’ve always dedicated ourselves to treating children and young people when they injure

themselves. However, ten years ago, our ability to do so reached a higher level when we opened our Sports Medicine Center for Young Athletes, which provides unique levels of care for sports injury and prevention. The center is dedicated to assisting young athletes in recovering from sports-related injuries, as well as preventing such injuries from occurring, in the first place.

The main Sports Medicine Center is at Children’s Hospital in Oakland with satellite facilities in San Ramon and Walnut Creek. The Walnut Creek site has a beautiful 3,000 sq.ft. state-of-the-art, 3-dimension, motion analysis laboratory that can measure for biomechanical indicators that reveal a heightened risk for injuries. The lab can also measure such things as neuromuscular coordination to learn how coordinated an individual is, and specialists can then recommend a targeted training program to improve coordination.

We typically imagine young people to be resistant to injury but the truth is that they are in a transition state. Young bodies must be managed in special ways because bones

and cartilage are still developing, which actually increases their susceptibility to certain kinds of injuries.

I work closely with Dr. Nirav Pandya, who is a pediatric orthopedic surgeon specializing in sports medicine, arthroscopy, pediatric trauma, and disorders of the hip. Dr. Pandya was himself a student athlete while on the University of Chicago’s track and field team and is still in the record books as one of the top 10 jumpers in the school’s history. He became an assistant track coach while in medical school.

Dr. Pandya has noted the trend of sports injuries showing up in increasingly more youthful ages. “It used to be rare to see an 11-year-old with an injured ACL or injured knee,” he said, “But now I might see seven of these in a month.” Then he added, “Rehab for an eight-year-old is a challenge.”

The center is performing a valuable service because changes in the way children and young people now play have caused sports-related injuries to increase ten-fold. It’s become an epidemic. As Dr. Pandya notes, “The kids are not playing in the back yard anymore.” The neighborhood sandlot ballgames and parking lot soccer of previous generations have morphed into highly competitive organized sports leagues.

Kids no longer simply play, they train and compete — often at levels of intensity that make them susceptible to serious injuries.

Another problem is that youthful athletes now seem, too often, to focus upon a single sport to the neglect of others, which eliminates the more balanced physical development that formerly came through cross training when high school and college athletes would play three or four sports. They were on the swim team as well as the soccer team, for example or might have competed in martial arts as well as basketball. Many of the top players — Alice Morgan, for example, and Lebron James — play three sports and should be role models for all youthful sports participants.

Another factor in the increase of sports injuries is the soaring number of females who are now playing sports at the fiercely competitive levels that formerly character-ized male sports. The great increase in the number of serious women athletes has not only become a reason for the growing number of injured players, but because of physiological factors, female athletes are six times more susceptible of getting a torn ACL than are their male counterparts.

When one of the young athletes comes to us with a broken limb or a torn ACL, we

53www.86mag.com • july/august 2015

By Michelle cappello, with Dr. Nirav paNDya

photos By toM MiNczeski

Children’s hospital oakland is providing a UniqUe response to a growing problem

Sports Medicine for Our Kids

connect them with a surgeon who manages them throughout the course of their recovery, and then helps get them back in the field. Dr. Pandya is working on what he calls “the next frontier of treatment” by repairing the cartilage that forms the meniscus cushion between the femur and tibia. The standard procedure when damaged is to replace it with tissue taken from other parts of the body — which he characterizes as “Robbing Peter to Pay Paul.” Dr. Pandya’s goal is to repair the tissue rather than replace it since the quality of the original is better than anything that could be substituted.

We don’t just do things like repairing injured ACLs, we also take steps to prevent injuries from happening. We carry out prevention as a team effort, coordinating athletic trainers, pediatric doctors, orthopedic surgeons, specialists in pediatric sports medicine, physical therapists, primary care physicians, and coaches, all working together to reduce the likelihood of injury.

Members of some local soccer, basketball, or volleyball teams might come to us before the start of the season so we can identify risk factors and, when they are present, to provide whatever training is indicated to reduce the risk or even to eliminate it entirely. We identify some risk factors that are beyond anyone’s control. Hormones, for example, might indicate a predisposition for injury. Structural factors present another set

of risks that can’t be improved by any amount of training or therapy. The risk of injury is increased, for example, if the ACL tunnel is small. There’s nothing we can do make it larger.

We alert young athletes to any risk factors that we can’t control and then instruct them in avoiding specific movements and actions that would threaten the risk. Sports like soccer, basketball, and volleyball involve extreme movements such as cutting, pivoting, and jumping. Certain parts of these movements are the points at which ACL tearing is most likely to occur, so we instruct them in methods of twisting, bending, and landing that minimize potential harmful impact and stress. We are able to measure the precise range of bending in the hip relative to the knee. We’ve learned why females suffer more injuries because it turns out that the normal female body does not bend as easily as the typical male, and there tends to be less accommo-dation by joints and muscles to soften the impact of landings. This plays a big role in ACL injuries. Fortunately, we can train the young athletes, especially the females, to bend a little on landing and thus minimize the risk of injury.

We also evaluate the risk of injury by precisely measuring the angle and degree to which a knee bends during cutting and pivoting movements. We’ve learned that bending the knee inward when landing on one leg following a jump greatly increases

the risk of tearing the ACL or even breaking the knee. We can correct this problem through training by following recommended exercises specifically targeted to strengthen the particular muscle groups and thus greatly reduce the impact associated with those dangerous landings.

Quad dominance, in particular, is a known factor in risk of injury. We can precisely assess the risk by measuring the coordination between three groups of muscles — the quadriceps (quads), the gluteous maximus, and the hamstrings. The risk of knee injury is minimized when the three muscle groups are balanced and any extreme movement doesn’t rely too heavily on only one of them. So we measure the ratios involved in movements. When we understand the risk, we can recommend specific training regimes that will strengthen the weaker set of muscles and provide the balance that is the best defense against injury.

A lot of our effort involves education, because our recommended prevention programs only work when the young athletes actually implement them. Real progress depends upon a team effort as parents, sports medicine specialists, and coaches work together for a common goal. The most efficient and effective way for us to finally make progress with the young athlete is to train the coaches in the required exercises and then encourage them to train their athletes to faithfully do the indicated work.

Dr. Pandya noted the importance of treating the youthful athlete from a broad context of who they are and what their hopes are. The young athlete tends to view sports as an important part of their identity. If we can improve their chances of getting through their youth with their bodies in good shape, they will be able to enjoy a healthy active lifestyle even into their senior years.

Prevention is important because when an ACL is torn, it usually takes a year to restore the injured player to full strength. “An ounce of prevention is worth a pound of cure” is a real truth. The right kind of exercise and training is the best medicine of all.

For more information, go to www.children-shospitaloakland.org/main/sports-medicine-center.aspx. Send comments about the article to editors@86mag.com.