ACSP Keynote Talk "Youth Sports: the Promise & the Peril"

7/25/2019 ACSP Keynote Talk "Youth Sports: the Promise & the Peril"

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………………..……………………………………………………………………………………………………………………………………..

School sports & Youth injury:

The promise…..and the peril.

ACSP 201

James MacDonald, MD, MPH

Associate Professor of Clinical Pediatrics

Ohio State University College of MedicineTeam Physician Ohio Dominican University, Beley High School

!sportin!jim" #cjsmonline

Cjsm$lo!.com



%isclosures

" omsTeam 'nstitute" (01)c*)+*" ,oard o- %irectors" http:momsteam.com

" /olters luer # Clinical Jo$rnal of S%ort Medicine &CJSM', Associate (ditor

# U% To Date, A$thor

http://momsteam.com/






%isclaimer

" ) s%ea* (nglish+

# but am an American

" College - Uni

" .esident - .egistrar

" Pants - Tro$sers

" High School - College/" 0oot1all - /////



ationide Children3s 4ospital%i5ision o- Sports edicine

" Pedi sports only )6 docs*

" Academic appts:

# Ohio State University

" Patient mean a!e :17.2 ) 6 8 19*" 1("(00 patient 5isits201(

" C4 %i5ision o- Sports ed

" .o$ghly 2345346

over$se5ac$te

" 1 ;ni5ersity" 1( 4i!h Schools.

<ther.Col$m1$s, Ohio



Pediatric S=Cs at C4

2015 Concussion TotalSports Medicine

Jan-Jun Jul-Dec Total

New Patients 421 689 1110

Follow Up 810 1054 1864

Grand Total 1231 1743 297



" Ho7 s%ort may fail o$r*ids

" )n8$ry %revention in

yo$th s%orts" P$1lic health iss$es

# 9hy s%orts matter for

*ids

# 0ree %lay and 2(erciseis Medicine

/hat e3ll co5er )or*

>'- it $leeds" it leads?

" USA :o$th S%orts C$lt$re # (%idemiology

# Press$res

" Over$se in8$ries" (arly S%ort S%eciali;ation

" Ac$te in8$ries

" Contact s%orts

" Conc$ssion



………………..……………………………………………………………………………………………………………………………………..

The PediAdolescent athlete: 201(

" <4 million children &< # =>' %lay s%orts # ? @4 s%eciali;e in one s%ort

" million %lay team s%orts

" eneral trends # (arly s%ort s%eciali;ation

# M$lti%le teams &eg travel teams'

# :earEro$nd training

# Costs are clim1ing

" ,y 2020" 26@ o- ;.S. pu$lic hi!h

schools ont ha5e anyinterscholastic sports

CBS 2017 %iiori et al.

Sport 4ealth 201 yer et al.



y ho it3s chan!ed

The =ace To ohere in Youth Sports

Bohn <Sulli5an TD% SpeaEer



You can3t start soon enou!h...



4o craFy are youth sportsG

" J$st as* $niversity st$dents

CAA 201 %ata



" 2Tommy John6 S$rgery &UCF

.econstr$ction' increase

=G@ in UCF s$rgeries over

=4 years

" Age - =< 5E >>G # Trend -or increased -reHuency

a!es )16 8 1I* & )19 8 20*&P I 444='

;nder Pressure

ABS 201J pu$lished on line -irst



" Overall estimates of over$sein8$ries vers$s ac$te in8$ries

range &3G E 3'

" Tho$ght to 1e 2$nderestimate6

" I@ hi!her o5eruse injury rate-or pri5ate 5s. pu$lic insurance

" High rates &different st$dies' # ymnastics

# .$nners # S7immers

# Base1all %itchers

Dpidemiolo!y 8 o5eruse injuries

Bayanthi 201(



%e-inition 8 Ko5eruse injury3

" Occ$r d$e to re%etitive 2s$1maimal loading6 of

MSK system

# .est not adeL$ate for str$ct$ral ada%tation to occ$r

" )n8$ry may involve m$scleEtendon $nit, 1one,1$rsa, N str$ct$res, physisapohysis

" UniL$e to yo$ng athletes incl$de

# Apophyseal injuries

# Physeal stress

" (am%les

# OSD, %roimal h$meral e%i%hysiolysis, s%ondylolysis,

OCD *nee5tal$s



" OTS &Age - # =>'

" S%orts in8$red5non

in8$red

" )nde%endent ris* factorsfor over$se in8$ries # Hrs OTS57ee* age in

years O. 4 &=4 #

@43' P I 444=Q

# .atio of OTS R= O. =>&=< # <' P I 44=Q

SportsLspecialiFed intensi5e trainin!

& the risE o- injuries

Bayanthi et al. 201(J ABS



D risE -actors -or o5eruse

" i'Can yo$ %ic* a main s%ort/ ii' Did yo$ L$it other s%orts to foc$s on a main

s%ort/ iii' Do yo$ train > months in a year/

Bayanthi et alJ ABS 201(



=isE actors -or <5eruse 'njuries

TA,MD 2 Cate!oriFation o- =isE

actors -or <5eruse 'njury

Copyri!ht N 201( Clinical Bournal o- Sport edicine. Pu$lished $y Mippincott /illiams & /ilEins. 1

<5eruse 'njuries and ,urnout in Yout

h Sports: A Position Statement -rom

the American edical Society -or Sp

orts edicine

Di0iori, John P Ben8amin, Holly J

Brenner, Joel regory, Andre7

Jayanthi, eer$ Fandry, reg F F$*e, Anthony

Clinical Jo$rnal of S%ort Medicine

&='R@E4, Jan$ary 4=

doiR =4=4G5JSM44444444444444<4

Sport SpecialiFation

http://journals.lww.com/cjsportsmed/Fulltext/2014/01000/Overuse_Injuries_and_Burnout_in_Youth_Sports___A.2.aspx










" UCFA athlete s$rvey& - G<'

# &Age - =G' male5female

" >> %artici%ated in # @

s%orts as yo$th" 4 did not s%eciali;e in

one s%ort I =

" 4 of the CAA

athletes had a %arent atcollegiate or %rofessional

level

Darly sport specialiFationO

hat -orG

A$stract presented 201+ ASS. %iiori

and

CBS 2017 uitHuit" %iiori

CAA 201 %ata



D5en orse -or the omenG



Scholarships:

the >arro Qate?



………………..……………………………………………………………………………………………………………………………………..

Alternati5es to sport

specialiFation



Concussions LL epidemiolo!y

" @> million %ediatric S.Cs 5yr =

" ? 34 of HS foot1all %layers

don6t re%ort5season

" Almost G of HS s%orts

in8$ries are conc$ssions

" .ates in HS s%orts@R # oot$all .710000 ADs

# ,oys 'ce 4ocEey (.710000

ADs

# ,oys MAR 7.010000 ADs

# Qirls3 MAR +.(10000 ADs

# Qirls3 Soccer +.710000 ADs

# ,oys3 Soccer 1.910000 ADs

1ABS 20122CBS 2007+ABS 2012

7Pediatrics 2010(ABS

Pediatrics 201(

" 'njuries )total* Eids )6 8 1+*

# oot$all 1.(10000 ADs # ,ase$all 1.610000 ADs

# ,oys Soccer 1.610000 ADs



………………..……………………………………………………………………………………………………………………………………..

'3m not a doctor $ut ' play one in the

mo5ies…



………………..……………………………………………………………………………………………………………………………………..



………………..……………………………………………………………………………………………………………………………………..

Youth -oot$all:

the scope o- the sport

CBS 201+



………………..……………………………………………………………………………………………………………………………………..

CTDOpractice & research !aps

Castellani" Ma$oratory 'n5estiation201(



………………..……………………………………………………………………………………………………………………………………..

=epetiti5e 4ead 'mpacts:

cause -or concernG" C$m$lative Head )m%acts

&2S$1conc$ssive 1lo7s6'/

# HS5College =444 head im%acts5season

# :o$th &age <' =44 head im%acts5season

" Can generate im%acts eL$ivalent to collegiate

athletes

" Animal Models" Changes in 9hite matter

" Conc$ssion Dose5.es%onse Model



TacElin! in -oot$all

" TacElin! is most common

acti5ity at time o- injury

" ajority o- concussions

result -rom tacElin!$ein!

tacEled" 'ncidence o- concussion

loer in practice than

!ames # B$t there are many more

%ractices

# )n yo$th &not HS5College'

meas$red head im%act

forces are higher in %ractices

=ecommendations

" %ecreasin! o- contact

practices decreases o5erall

num$er o- head impacts

o5er the course o- a season

" Dmphasis on proper

tacElin!

techniHueen-orcin! rules

" G%elay onset o- tacElin!

until a certain a!eG

" 'mportance o- ha5in! ATCs

present at schools

Pediatrics 201(AAP Policy Paper on TacElin!



4elmetless tacElin!GGG

" CAA D= Athletes

" 3 cases53 controls

" )m%act sensors

" )nterventionR # 3 min 7ee*

%reseason, = 7ee* in

season, helmetless

tac*ling drills

" O$tcomeR > less

head im%acts

BATA 201(



=u!$y" -oot$all….-oot$all" ru!$y

M =u!$y Mea!ue



" Youth 'ce 4ocEey" O$tcome meas$resR

# Sym%tom d$ration %ost

conc$ssion > d

" )nde%endent varia1les # Age, gender, 7eight

# P$1ertal category scale &PCS'

# ota1ly early PCS

stron!est predictor o-

prolon!ed symptoms

among 1oys & - =4='

O. - G &=, =>3'Q(P < 0.21)

Contact sports: is a!e all that mattersG

riF" Bournal o- Pediatrics 201



………………..……………………………………………………………………………………………………………………………………..

%ou! Casa" orey Strin!er 'nstitute

ABS 201+

U V 27+ )1990 8 2010*W

Contact Sports: 's

Concussion all that

mattersG



………………..……………………………………………………………………………………………………………………………………..

>irst" Met3s ill All the Mayers?8 the Bard

"Crystal Dixon, et al v. Pop Warner Little!holars, "n!.

# >….. a$out the -ailure to coach the injured

plainti-- in proper tacElin! techniHue and

hether there as a conscious disre!ard-or his sa-ety $ased on the e5idence

presented.?

" La#$a%ers in &D # Bill to s$s%end coaches 7ho ret$rn %layers

s$s%ected of conc$ssions on to %laying field



Social edia & >4ornets3

ests?" $n safety

" OscarsSo9hite " ConcussionsCTD

" Xaccines

" Paleo %iet

" ,iEe 4elmets

" CrossLit

" <pen Access



………………..……………………………………………………………………………………………………………………………………..

The concussion Kcrisis3:

Crisis

Science

Business

Litigation

Ris

!erce"tion

#e$ia

%$&ocac'

Scienti-ic D5idence %isseminated V ,alance



………………..……………………………………………………………………………………………………………………………………..

>You don3t need a eatherman to

Eno hich ay the ind $los?

" S$rvey 1y the S%orts and 0itness )nd$stry

Association and the Physical Activity Co$ncilR

# 4= %artici%ation in organi;ed foot1all 1y %layers

aged < E = 7as G %ercent 1elo7 that in 44>" ational 0ederation of State High School AssnsR

# Partici%ation in high school foot1all 7as do7n @

%ercent in 4=E4=@ com%ared to the

44>E44G season

/SB 201+



/e35e $een talEin! a$out this a lon!

time

0oot1all has 1ecome soft li*e o$r

co$ntry has 1ecome softV



………………..……………………………………………………………………………………………………………………………………..

=elati5e =isE

" 297 children5teens died from g$ns 4=4=

" +I children I = died in MNA6s 4=@

" 16 0oot1all Season 0atalities, 4=3@

# )ndirectR =4 &Mean - 5last decade'" SCD - <

" (HS - @

" Sic*ling crisis - =

# DirectR &Mean - @5last decade'

" head

" s%inal cord

" = organ1 Childrens %e-ense und" 2 C%C"+ orey Strin!er 'nstitute



" Preseason training # .esistance training

" rad$al increase in

vol$me5intensity # .$le of =457ee*

" Ho$rs57ee* in OTS I Age

" Stretching/ # Considera1le de1ate

&%ro1a1ly not'

" PreE%artici%ation Mtraining &eg 0)0A=='

" PreEseason conditioning

" ec* strengthW

conc$ssion %revention

Pedi 'njury Pre5ention



Pediatric =esistance Trainin!

reduces Eids3 sports injuries" Heidt et al, AJSM 444

" He7ett et al, AJSM =GGG

" Mandel1a$m et al, AJSM 443

"Cahill et al, AJSM =G>" He8na et al, CSCA J =G>

" Olsen et al, BJSM 443

" 9edder*o%% et al, Scand J Med Sci S%orts, 44@

# And it3s sa-e

ai!en$aum et al. ,BS 201(



" Systematic .evie7

" :o$th &< # =>'

" & - @' incl$ded

"(ffects # 2moderate6

" M$scle strength

" Nertical 8$m%

# 2small6" Finear s%rint s%eed

" Agility

" S%ortEs%ecific %erformance

" 'deal trainin! re!imen # Period @ 7ee*s

# 3 sets5eercise

# < # > re%etitions5set # )ntensity >4 # >G &.M'

# @ # mins rest5set

" X m$scle strength

" Sessions57ee*Y # Begin 7ith , move to

Pediatric =esistance Trainin!

'mpro5in! per-ormance

,BS 201 ,BS 201(



" Ficensed medical %rofessional in USA" 4 USA HS has 2some6 and @

have f$ll time=

" Fin*ed to in8$ry red$ction

# 4= AAP ational Conference

# HS girls 1as*et1all and soccer # Schools ithout ATC had in8$ry rates

" =@ higher in soccer

" = higher in 1as*et1all

# .ec$rrent in8$ry rates

" 3 higher in soccer " G higher in 1as*et1all

# Conc$ssion rates" >43 higher in soccer

" 3 higher in 1as*et1all

Athletic Trainers )ATCs*

htt%R55777%ediacastorg5theEs%orts

EmedicineEteamE%ediacastE@@5

1

B Athl Train 201(2AAP Con-erence 2012

http://www.pediacast.org/the-sports-medicine-team-pediacast-332/








………………..……………………………………………………………………………………………………………………………………..

>Team sports no !uarantee o- eZercise?

!rc"i#es o$ Pediatrics and !dolescentMedicine 2010

Archi5es o- Pediatrics and Adolescent edicine

2010



………………..……………………………………………………………………………………………………………………………………..

2010



" ChildEdriven %lay # Fearn to 7or* colla1oratively

# Fearn at o7n %ace

# Fearn creativity

# Practice decisionEma*ing # Practice ar1itration

# Avoid 1$rno$t, stress

" <4 mins MNPA more li*ely

;nstructured ree Play



" Farge & - @@3' 1irth

cohort st$dy, Bra;il

" )nde%endent varia1le - # SelfEre%orted %hysical

activity ==, =3, => yY

" De%endent varia1le - # Cognitive %erformance

&9eschler Ad$lt

)ntelligence Scale' => y

" Age => Highest MNPA

tertile did 9O.S( than

lo7estZ

DZercise is edicine: -or Eids3 $rains )or*

D5erythin! in moderation

SSD 201( <$jecti5e measurement at 1I



………………..……………………………………………………………………………………………………………………………………..

Met3s uanti-y the ,ene-its



/hich is the pediatric pu$lic health

Kcrisis3 o- our timesGSacrificing football pads

for…...iPads



" )ncrease amo$nt of $nstr$ct$red

free %lay &0P'Time in 0P as m$ch as organi;ed

s%orts &OS'

" Do not s%end more ho$rs %er 7ee*

%laying s%orts than yo$r age

&eg =4 year old sho$ld %lay I=4 hrs OTS'

" Do not s%eciali;e in one s%ort 1efore

late adolescenceY

" Do not %lay s%orts com%etitively

yearEro$nd" Ta*e at least one day off %er 7ee*

from s%orts training

eepin! it -un

'very e# ex!eptions to this rule



" Over$se in8$ries # Nery common

# (ntirely %reventa1le

" Ac$te in8$ries

# Conc$ssions [ more

" :o$th s%orts c$lt$re # Fet *ids 1e *ids

" Alternatives to s%orts

# The 1enefits of free %layZ

" Fet6s *ee% *ids active [ safe

SportsOthey3re Kmudlicious3



2One of the fe7 moments

of ha%%iness a man *no7s

in A$stralia is that moment

of meeting the eyes of

another man over the to%sof t7o 1eer glasses6

*ru!e Chat#in, +he onglines

ThanE you

#sportin!jim #cjsmonline

=e-erences



………………..……………………………………………………………………………………………………………………………………..

=e-erences" Hyman, M Until it H$rts &4=4' [ The Most (%ensive ame in To7n &4=' Beacon

Press

" Di0iori J, et al Over$se )n8$ries and B$rno$t in :o$th S%ortsR A Position Statement from

the American Medical Society for S%orts Medicine Clinical Jo$rnal of S%ort Medicine

4= R @ # 4

" Jayanthi A, FaBella C., et al S%ortsEs%eciali;ed )ntensive Training and the .is* of

)n8$ry in :o$ng AthletesR A Clinical CaseEcontrol st$dy AJSM 4=3 %$1lished onEline

" Myer D, Jayanthi , Di0iori JP, et al S%orts S%eciali;ation, Part ))R Alternative Sol$tions

to (arly S%ort S%eciali;ation in :o$th Athletes S%orts Health 4=< %$1lished on line

firstR DO)R =4==5=G=@>==3<=>==

" Meehan 9P, Fandry F Tac*ling in :o$th 0oot1all AAP Co$ncil on S%orts Medicine [

0itness Policy Statement Pediatrics 4=3 =@<R e==G # e=@4

" Fesins*i M, Pries*e O, ranacher U (ffects and DoseE.es%onse .elationshi%s of

.esistance Training on Physical Performance in :o$th AthletesR a Systematic .evie7

and MetaEanalysis Br J S%orts Med 4=< %$1lished on line firstR DO)R =4==@<518s%ortsE

4=3E4G3G

" 0aigen1a$m AD, Floyd .S, MacDonald J, Myer D Citi$s, Alti$s, 0orti$sR Beneficial

(ffects of .esistance Training for :o$ng Athletes Br J S%orts Med 4=3 %$1lished on

line firstR DO)R =4==@<518s%ortsE4=3E4G<=

" Kri; PK, Stein C, Kent J, et al Physical Mat$rity and Conc$ssion Sym%tom D$ration

among Adolescent )ce Hoc*ey Players Jo$rnal of Pediatrics 4=< %$1lished on line

Documents

ACSP Keynote Talk "Youth Sports: the Promise & the Peril"