Martial Arts & Competitive Dance – PediaCast 445

Show Notes


  • The sports medicine team returns to the studio as we consider martial arts and competitive dance. We explore benefits, training, participation, injuries and rehabilitation for these increasingly popular activities. We hope you can join us!


  • Martial Arts
  • Competitive Dance




Announcer 1: This is PediaCast.


Announcer 1: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. 

It is Episode 445 for November 12th, 2019. We're calling this one "Martial Arts and Competitive Dance." I want to welcome you to the program. 

We have another sports medicine topic for you this week as we consider a couple of sports that may not immediately come to mind. But they are ones with increasing popularity and participation, which means, of course, that more kids are injuring themselves as they get active.


But we want kids to be active and participate in the sports of their choice. And anything we can do to help prevent injuries and treat the injuries that do occur, the more student athletes we'll have who are improving their health and all the other benefits that go along with sports participation, which we will talk about in the course of our conversation.

So we're considering two sports today, again, that you may not always think about a sports but they certainly are -- martial arts and competitive dance. And not only competitive dance but really performing arts and dance which oftentimes is very competitive as you're trying to get a role and be cast in productions and stay fit as you are dancing in a performance kind of way.

So, all of that, we're going to talk about today with a couple of terrific sports medicine experts joining us, Dr. Drew Duerson is a sports medicine physician here at Nationwide Children's Hospital. And Eric Leighton is an athletic trainer with our Sports Medicine Program. We'll get to both of them momentarily.


First, though I want to mention a common symptom that we see this time of the year, and that is cough. I don't know if you have a cough right now or your kids have a cough or someone that you work with or in your kid's classroom. I'm sure there's someone coughing that you are hearing right now because there's like coughing all over the place.

I don't know, maybe because I work in an emergency department or an urgent care, I hear a lot of coughing. But I really, even when I'm out, shopping, at the grocery store, I hear folks coughing this time of year. And there are lots of reasons for it.

So I wanted to mention that if you do have a persistent cough that's lasting more than a few days, it's really important to see your healthcare provider to find out what the cause of that cough is.

And it's likely, if you just look at the averages, the percentages, the most likely thing it's going to be this time of year is a viral infection. So an upper respiratory infection or the common cold that is causing a cough. And we'll talk in a minute what you do for these kinds of coughs. 


But the most likely thing but, you know, persistent coughs can also be caused by fall allergies which, hopefully, as we're getting in the colder weather, more into sort of a winter pattern at least here in the Midwest, we're seeing a little less of that. But we're certainly see allergies to things inside the home as the heaters are coming on, the windows are all closed up. We're recirculating the air and we have pet dander and dust mites and indoor allergens to deal with.

So allergies are certainly a potential cause of a chronic cough asthma can cause coughing. If you have a fever with a cough that's lasting for few days or you have a fever at the beginning of your cold and a fever went away but now the fever is back. That could be a sign of pneumonia. That's associated with cough. 


And then, as we see kids, especially those who are not being immunized against things like whooping cough or pertussis, even if we rely on herd immunity -- meaning the folks around this community immunity -- to protect us from these things and if other kids are getting pertussis or whooping cough, even if we ourselves have been immunized, immunizations do not zero convert or do not cause protection in 100% of the people who get the immunizations. 

So, in addition to being the majority of us reacting and being protected then against things like pertussis or whooping cough, we do rely on the other people being protected around us. And so, with fewer people vaccinated, we see more people with things like pertussis and whooping cough.

So this is also if you have a child, especially young child with the persistent cough, we do worry about that being a possibility.


So lots of things can cause coughing, not just a common cold. And so, if it's lasting for a few days or it's associated with a high fever that's been there for more than a day or two, or the fever goes away and comes back, then you definitely want to see pediatric provider for that.

So what do you do for these coughs? Well, it really depends on the cause, which is another reason that you want to see someone for this because, ultimately, you want to treat whatever is causing the cough that is the primary way to make the cough go away. 

Because the body when it needs to cough, it's going to cough. You know, the coughs help mobilize mucus, help to bring that up. It protects the airway to keep mucus and mouth bacteria from getting down into the lungs. 

Certainly with the asthma, coughing is associated with bronchospasm or inflammation and muscle tightening in the airways. And so we want to reduce the inflammation, relax those muscles in the airway.

So again we want to treat the underlying cause of the cough which is why it's important to see someone. 


Now, once you do see someone and we determine that maybe it is a viral upper respiratory tract infection, those coughs can last for awhile. So, if you cough for a few a days, it's important to see someone. But then realize if it is a viral upper respiratory infection, there's not a lot you can you do for it. 

That cough is serving a purpose. It's mobilizing mucus, it's helping protect the airway, it's keeping mouth bacteria from getting down and causing pneumonia. And so cough is not always a bad thing. 

The primary treatment then is going to be supportive care, just rest and fluids. Humidified air can sometimes help. And for kids who are older than one year of age, honey can help coat the back of the throat and sort of take that tickle away. 

Although, we do worry in kids who are less than 12 months old, honey can be associated with botulism. So, the young kids have sort of an immature immune system and honey can have botulism spores in it. So, those were less than 12 months old, you do want to stay away from honey.


But older kids and adults certainly sipping honey or honey in a warm beverage like tea can help soothe that tickle that gets in the back of the throat that when you start to talk or you take a deep breath or breathe in cold air, you start coughing. And so, it can help with that.

But again, we want treat cough sort of sparingly because that cough is serving a purpose. But again, if there's that fever, persistent cough, wheezing, difficulty breathing, shortness of breath, you definitely want to see your pediatric provider.

So, I just wanted to take those few moments there to mention cough because, boy, I've been out and about, I've certainly been seeing and hearing lots of people with cough. And parents are always wondering like, "How do we make it go away? What do we do about it?" So, hopefully you found that helpful.

Let's return to our regularly scheduled program. As I mentioned, we have martial arts and competitive dance coming up. I do want to remind you, you can find this program wherever you find podcasts. So, we are in the Apple Podcast app, iTunes, Google Play, iHeart Radio, Spotify, and SoundCloud, also most mobile podcast apps for iOS and the Android.


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Also, if you have a topic that you like us to discuss on the program, it's easy to get in touch. Just head over to and click on the Contact link. If you have a question, you want to point me in the direction of a news article, anything like that. You just have a comment that you'd like the audience to hear, let me know.

Also, I want to remind you the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.


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Let's take a quick break. We'll get our sports medicine experts, Dr. Drew Duerson and Eric Leighton settled into the studio. And then we will be back to talk about martial arts and competitive dance. That's coming up right after this.


Dr. Mike Patrick: Dr. Drew Duerson is a sports medicine physician at Nationwide Children's Hospital and an assistant professor of pediatrics at the Ohio State University College of Medicine.


Eric Leighton is an athletic trainer at Nationwide Children's and the functional rehab leader for our Sports Medicine Program. Both are experts at caring for student athletes participating in martial arts and competitive dance. These represent our topics of discussion today but, first, a warm PediaCast welcome to both of you. Thanks so much for being here.

Dr. Drew Duerson: Good morning.

Eric Leighton: Thank you.

Dr. Mike Patrick: Really do appreciate both you taking time out of your busy schedules. 

So, Dr. Drew, I think I want to sort of define what we mean by sports participation. Because I think as folks think about sports, you think football, basketball, volleyball but not always martial arts and competitive dance. But this really represent participation in sports as well, right?

Dr. Drew Duerson: Yeah, I would agree. So, I think the definition's fairly broad. I think I would say a sports, any physically demanding activity. And I think that really mirrors what the latest edition of the PPE. Really expanded its scope and wanted to include those athletes that are not involved in the traditional sports like you mentioned, football, basketball, baseball.


So, I think, yeah, I mean I would include martial arts and dance. But I think even beyond that, the list goes on and on. You can include skiing, skateboarding, rock climbing, hiking, I think. We really just need to be promoting physical activity for all of our kids and this is a way we can do it.

Dr. Mike Patrick: And there's some physical activities that we might not even think of as traditional sports, things like marching band and theater. And I know we have a Performing Arts Therapy Program here at Nationwide Children's. Eric, tell us a little bit about that program.

Eric Leighton: Yeah. So actually, it's part of the Functional Rehab Program. I'm actually one of the ones who leads the Performing Arts Medicine section. And we do, we deal with everything from musicians, marching bands, theater and, of course, also dance. 

People do think of the traditional sports, football, baseball, track, things like that. But something that all dancers love to hear, too and from our perspective, it is true, dancers are athletes. What they have to do with their bodies is amazing.

Dr. Mike Patrick: Yeah, absolutely.


Eric Leighton: But, like I said, not only just the marching band and the physical moving ones, but even orchestra musicians because of how they have to hold their body, because of how they have to have to sit. For instance, a violin player have to sit forward on their chair with their chin holding that violin down in a certain angle for hours and hours and hours. And it creates certain overuse injuries. So, even the seated musician, there are things that we need to do.

Dr. Mike Patrick: Yeah. And I think it's interesting because a lot of folks who participate in those activities may not think of them as sports. And when they do have an injury don't necessarily get linked up with the sports medicine folks. And yet, they're the ones who really are experts at dealing with repetitive injuries and conditioning the body to do these activities.

Eric Leighton: Yeah, it has actually gotten a lot better though over the past few years. Just as a classic example, my sister was a pre-professional program dancer both before college and in college. Unfortunately, they had a huge sports medicine program and a huge theater and dance program but the two simply would not meet. They kind of held at arm's length, "You're not a sport."


That has changed a lot for the past 10 to 15 years. Performing arts is definitely seen as athletic.

Dr. Mike Patrick: Very important point. Dr. Drew, remind us why participation in these physical activities is so important on many levels? 

Dr. Drew Duerson: Right. I think sports are important for a number of reasons but it gives the young kid the opportunity to get that, like I mentioned, 60 minutes a day, moderate to vigorous aerobic exercise that we should be recommending for everybody. 

So, it gives them that opportunity. There are so many other great aspects about our sports that goes way beyond the fitness part. 

I think on a flipside too, we got to be careful because while we have maybe a baseball player that's going to practice for an hour a day, but are they really getting that 60 minutes of exercise the entire time? They may be sitting in outfield waiting for the fly ball or waiting to get in the batter's box. 

While the martial arts athlete, he may be going to a 60-minute session and from start to finish, he is moving, he is using his muscles, and he's working on his aerobic fitness and all those other things the entire time.


So, sports is just one avenue to get those minutes of physical activity and a number of other great aspects.

Dr. Mike Patrick: We can really see improved sleep. It can help with academics the next day because then you're sleeping better, and paying attention more in school. Of course, there's the social aspects of a sports participation and it's an alternative to screen time that you're really doing something active. And, of course, creating lifelong habits for physical activity, all great things.   

But we can also overdo it, right? There's kind of a middle road balance that we need and you get kids that are now involved  in two or three sports at one time and trying to juggle that and school and their friends and their work-life balance, so to speak. It's really tilted and so, we got to be careful of overdoing it as well.


Eric Leighton: Very much so, yeah, exactly. What you says, sort of the work-life balance that we think of. The same thing goes for these athletes. It's not just to stress yourself constantly being working out or constantly having to put forth effort. But these are also growing young people. There's a lot going on with their body to begin with.

So, the physical activity, the exercise is so important. Like you said, better than the screen time. But the rest, the rest is so important, too. 

And a little shoutout to our dietitian, well, within Nationwide Children's too, but our Sports Med. Fueling, the way to take care of the body, preparing for practice, during practice, after, along with the rest in spare amount.

Dr. Mike Patrick: Yeah, very important.

So we're going to talk about martial arts and competitive dance today. Eric, what opportunities exist for student athletes to participate in martial arts. I mean, there's a lot of places where they can get involved with this, right? 

Eric Leighton: Oh, yeah, there are tons of dojos, as they're known. And yeah, from all walks, whether it's karate or kung fu, taekwondo, things like that. So there are tons of studios around. And there's lots of options. You can go really at the very young ages and begin with beginner classes, and intro and learning. 

They work their way up through the ranks, so to speak, and through the levels, learning and then getting into competitions as well. 


Dr. Mike Patrick: Do some schools have these available as well? Or is it more on a community level where you see this?

Eric Leighton: That's more on the community level and maybe some club type of stuff, but you see that more in the public. You don't typically see combat sports like that at all with the schools.

Dr. Mike Patrick: And just like other sports, participation is really more a physical, there's more than just the physical aspect with the martial arts participation, right? There's really sort of that mental, spiritual kind of connection that these kind of activities promote, right?

Eric Leighton: Very much so. One of the key tenants of martial arts is discipline. It's learning how to acknowledge and control yourself, control your emotions, whether you're working with others but working with your instructor. Generally, that's a one-on-one type of activity. It's not a team activity where you have ten other players on the field with you. 


But yeah, it's learning the physical demands, the discipline, the control. 

Dr. Mike Patrick: So this may be something that you have a child who is maybe not interested in other sort of team sports, that maybe this is an activity that you could get them excited about and involved in from a really young age. 

Eric Leighton: Oh, very much so. For instance, my niece is in jujitsu and she's been doing it for years. And at six years old, she's already excelling and progressing very, very well. She's taken to it. 

Dr. Mike Patrick: That is great. So what kind of things do student athletes who participate in martial arts, what kind of conditioning would be important for them to sort of be ready to participate in those activities and to prevent injuries?

Eric Leighton: Well, as Dr. Duerson, cardiovascular health, of course, is very important with martial arts, unlike any other sports. When they're in the dojo, like you said, they may be going pretty solid for the entire time, whether it's a 45-minute or 60-minute lesson. So the continuous use.


So, cardiovascular is huge, endurance. Muscle strength, very important, especially depending on what type it is. For instance, judo is more like wrestling. There's a lot of grappling and throwing. So a lot of the balance and control. With any of them, I would say balance, flexibility is huge because of the maneuvers they have to do and what they have to sustain. 

Dr. Mike Patrick: How would a parent go picking out which of those? I mean, you've mentioned judo. We know there's karate and what was...?

Eric Leighton: Jujitsu. 

Dr. Mike Patrick: Jujitsu.


Eric Leighton: There's taekwondo, jujitsu. There's so many different variations out there.

Dr. Mike Patrick: Does it really matter which one that you pick for your particular child? Are there particular kids that might do better at others or one or another? Or not really? Just pick one already.

Eric Leighton: Yeah, pick one to start off with, especially if they're younger. Yeah, you pick one to start off and kind of see where it goes. There are different requirements based on the type and the style. 

Dr. Mike Patrick: Yeah, like one maybe more strength and other more flexibility. Really, all those are going to be important.

Eric Leighton: They're all going to have a lot of that in there. But, yeah, there are some differences where karate is more of a hand to hand for fighting and defense, where there's more reaching out, striking blocking. Like I said, judo tends to be more of grappling and throwing and more similar to wrestling.


Dr. Mike Patrick: But to some degree, it may just be what's available in your area and what opportunities that you have.

So in order to sort of prepare to do this conditioning, what would be important to really get ready to participate? 

Eric Leighton: To really get ready, I would say work on your endurance, whether it's biking, swimming, running, building up your lung capacity and your muscular endurance. 

Stretching, generally, you cannot stretch too much. Especially our lower extremities, we are so muscle-bound from the hips down. Stretching and flexibility is going to be a key component to preventing a lot of injuries. 


Working on balance as well. Depending again on the discipline, you may spend a lot of time on one foot. For instance, if they're doing strikes or hits or kicks with their foot, you're balancing on one foot while reaching out of your center of balance and really having to control your body so you don't lose your balance and fall out of it.

Dr. Mike Patrick: What kind of things could kids do to sort of work on balance?

Eric Leighton: A really basic one is called just basically like the single leg stand. So if you want to compare to the old Karate Kid movie who is doing the crane maneuver, standing on one leg, holding the other leg straight up in the air and being able to maintain your balance. Start with that. 

Then, you can move from that, once you've mastered standing balance on just the hard floor on single leg, you can move to a soft surface. Put down a thick bath or a beach towel, wad it up. It's dense but soft. Now, try to stand still on that, that's moving. 

Once you've mastered that, then I have a favorite one I love to give a lot of my patients because it require so many muscles to work the other called a single leg toe touch. Stand on one leg. Whichever leg you lift, you lift the same hand. 


So for instance, we're standing on our left leg, our right foot's up, and our right hand is up. Have them reach overhead  kind of like the Statue of Liberty. And what they have to do is they squat and bend over at the same time. Take that right hand all the way to their left foot and back up without losing their balance.

Dr. Mike Patrick: Oh, that sounds difficult. 

Eric Leighton: It's a little tricky and it takes practice. And as you master it, and again, you can move that from a hard surface to a soft surface. Try closing your eyes, which really compromises your balance. As you keep pushing that, your body adapts and gets stronger and better.

Dr. Mike Patrick: I love making up games with kids and this sort of thing would be fun to do, as Simon Says, or have a competition where parents... You can really make this a fun activity, not necessarily training for martial arts participation. 

Dr. Drew Duerson: Sure, right.

Dr. Mike Patrick: But in the back of your mind, you're thinking "Hey, this may benefit them if they are interested in that in the future." 

Eric Leighton: Yeah, another fun game, it's a fun game, kind of like what you just mentioned there. Stand in one foot. Grab your favorite sports ball, whatever it is -- football, basketball, volleyball -- I don't care. Stand on one leg, each of you, 10 to 15 feet across. And then you pass the ball back and forth, change up the speed, bounce it. Throw it just as far as they can reach their hands. Whoever touches down the most for each round of 30 for instance loses.


Dr. Mike Patrick: You know, I love that. See, we need athletic trainers in preschools.


Dr. Drew Duerson: Exactly. Yes, we do.

Dr. Mike Patrick: So once folks are participating, what are some of the common injuries then that you see for those who are participating in martial arts? 

Dr. Drew Duerson: So some of the injuries that I'll see in clinic, really any strain sprain from kind of head down, we're seeing all that. We see concussions as well. But really, I think it varies. We don't see maybe one specific injury pattern. We see a gamut of them. So they are definitely prone for the overuse injuries just like other athletes are because they are spending a lot of hours in the studios.

And then, there's acute injuries, too. Like I mentioned, the sprains, the strains and the contusion. So yeah, I think we see a wide variety.


Dr. Mike Patrick: Would you say that it's important for parents when their kids are complaining? Maybe they're losing interest because now they are having discomfort that's associated with it and sort of aren't excited to go and participate. You really want to intervene early, rather than later, right? 

Dr. Drew Duerson: Yeah, I think to get that athlete back out in the studio as quickly as possible and safe as possible is our goal. And that's the same for really all athletes. 

Again, when I encourage physical activities, we don't want to hold these kids out longer than I need to because this might be the only outlet they have to get that 60 minutes a day of their aerobic exercise. Yeah, I mean, a big component of the overuse injury treatment is obviously rest but we want to make sure we're doing a good job of getting those athletes back out there.

Now, I know this is going to be very stereotypical but I'm sure there are parents with this question in their mind. When you think about traditional karate, you think about someone hitting a block of wood with their hand. And do you see bone contusions or bruises? And can you see fractures or breaks in bones as they participate in this sports?


Eric Leighton: Yeah, sure.

Dr. Mike Patrick: Or is that just on TV?

Eric Leighton: It does that.

Dr. Drew Duerson: In the movies. 

Eric Leighton: In the movies, of course, you go pounding through ten cinder blocks. In real life, not so much. Yeah, sure, like any other sport, any time there's any kind of impact, even as a football player, obviously it's a collision sport, people are running in each other. Yes, things can happen. 

Even soccer, which is not a collision sport but a contact sport, things happen. But in a sport like karate, for instance, where you are striking something on purpose, as you're working your way up to it or if you happen to hit just wrong, yes, of course, there could be fractures.

With martial arts, being that is the type of sport it is, because there is contact, there tends to be a fair amount of contusions, bruising, abrasions, again, from the throwing and grabbing. But those do happen from the impact, especially if they're trying to break things. Which is a hallmark of certain ones like karate or kung fu or things like that where they are trying to through a certain level, a certain goal is to be able to break this. 


Dr. Mike Patrick: And, of course, kids are going to overdo it. 

Dr. Drew Duerson: They're going to see that on TV, YouTube and try do it themselves.

Eric Leighton: Look at this!

Dr. Mike Patrick: And the next thing you know it's swollen and painful and it's time to definitely see someone. 

Your role as leader of functional rehabilitation here at Nationwide Children's, as you're thinking this kind of injuries and getting kids back into activity, what does that mean, functional rehabilitation?

Eric Leighton: Functional rehab is based around working with the injury but not just the injury by itself. We are working on the entire athlete. How all of those systems, how their balance, their control, their stamina, how everything works together to get them back up to that point. 

One of the things that we are experts in is biomechanics. We can look at any sport, figure out what it is, figure out what the demands are in their body, what they need to do to be able to accomplish it. 

And we're also looking for anything that's out of place, especially as young kids are growing. A really common trick we see young athletes as they're growing, they'll go and squat, whether they're squatting to jump or landing from a jump and the knees just knock, cave in towards each other. 


And making sure that, "Okay, hang on, we need to fix that. Before you create another issue, let's straighten that up, and let's practice controlling this." 

Re-engaging certain muscles, make sure we have proper balance of muscles, working on the flexibility. So we work the whole body together. And then, as we get them through their injury as they get more functional, we are literally moving them through that gym back to the full function that they would do, whether it's martial artist, a dancer, a football player, soccer player.

Dr. Mike Patrick: It sounds like this may be even something that you can have an evaluation done before there's an injury.

Dr. Drew Duerson: Very much so. 

Dr. Mike Patrick: As you mentioned, is your form correct? Are you going to be prone to specific injuries based on your specific form? Is there a role for seeing an athletic trainer for that kind of evaluation early on?

Eric Leighton: Definitely, I mean, one of the basic tenets of our job is injury prevention as well and the education. If we can find something before it starts to happen, if we can correct a bad habit, a mechanic before it starts to create the issue, that creates a long-term or an overuse injury that you need to see the doc for, then yes we do that. 


One of the key things we actually do that specifically with our dancers, we actually have a pre-injury or injury evaluation. 

Dr. Mike Patrick: And so, I guess it would be an easy thing to get connected with an athletic trainer if you have one that's affiliated with your school or your particular club or program. But if you don't have that luxury, is this something that you could make an appointment to see sports medicine pre-injury or early on in participation to have that kind of evaluation done. Or will insurance not cover that? 

Eric Leighton: Generally not, I believe. Unless, it's been prescribed or there's an injury.

Dr. Drew Duerson: We have those programs but a lot of it's out-of-pocket expense for our families. But hey, maybe that out-of-pocket expense is a good investment because if you get injured, come see one of us, and X-rays and MRIs and then 12 weeks of rehab, that's costly. 


Dr. Mike Patrick: Yeah, and then you're not participating in the sport, and you have paid your club dues.

Dr. Drew Duerson: Exactly.


Eric Leighton: Or travel, you know.

Dr. Mike Patrick: Yeah, absolutely. Well, we'll have links in the show notes to the Functional Rehabilitation Program here at Nationwide Children's and the Performing Arts Therapy Program for folks who are interested in more information. We'll be sure to put those in the links in the show notes for this Episode 445 over at

Dr. Drew, I think sort of strains and sprains and repetitive use injury, sort of what we've call soft tissue injury because it doesn't involve the bone. It's more ligaments, tendons, muscles. Those kind of injuries are pretty common in all sports, but in martial arts, we are definitely going to see that. How do you treat those? 

Dr. Drew Duerson: Well, I think our first job is diagnosing the problem. So we might be the first medical professional they see and we need to figure out what actually happened. I mean, you could lump these kids in to a big bucket, strain-sprain-contusion, but what did they actually do and how bad was it? 


Because you could have a degree, a severity. If you have mild sprain, okay, we treat that conservatively. Maybe minimum rest, protect them in a brace of some sort. We get them moving, keep them moving, get them started in something like functional rehab right away. 

Or maybe it's that severe sprain. Now, we're talking more of a tear, that may be treated a whole lot differently. And that might go a different route and they need to see an orthopedic surgeon to have something actually fixed.

So that's our big job is trying to figure out the problem so we can get them in the right place and then too, protecting them. So contusion's obviously okay, you've got a contused forearm. We need to protect that. And sending them right back into the studio and continue to contuse that arm, that's not a great idea. 

So we got to come up with a way to  get them back out there, quickly, safely, but also protect them from a recurrent injury. I think that's a big issue that we run into.


Dr. Mike Patrick: We also have a lot of pediatricians and primary care providers who listen to this program and they see a lot of these injuries when they first occur, whether it's in the pediatric office or an urgent care center. What are some advice on the immediate management when they're swelling? I mean the purpose of inflammation is try to heal the body but our bodies kind of overdo it and create a lot of discomfort. What are some strategies for reducing swelling and discomfort?

Dr. Drew Duerson: I think most people know the RICE mnemonic. Some people would even call that the PRICE mnemonic, and add "protection" in there, too. 

There is no great science behind ice. We've been using ice for decades but we still encourage it because that is a good way to prevent inflammation, swelling and then the pain that results. But like you mentioned, that's our body's way of healing too, so you can go a little bit too far with it as well. 

But yeah, I would say for anybody that's on the frontlines, urgent cares, pediatricians, still following that guide is a good way to start. Because it's really helping to manage the patient's pain so they can function, go to school.

And then, again, try to get them moving in something like functional rehab or physical therapy. When they're in too much pain, then they can't really do what they need to do to start making their way back into their sport. 


Dr. Mike Patrick: And remind us, what does RICE stand for?

Dr. Drew Duerson: Yeah, so Rest-Ice-Compression-Elevation. So, it kind of makes sense, obviously, if you're doing something that hurts, don't do it. So that's the Rest part. Ice, we talked about. Compression, again, mostly working on trying to prevent further swelling.

Dr. Mike Patrick: But not compression so much that you're cutting off circulation. 

Dr. Drew Duerson: Yeah, right. So we got to balance that. 

And then the Elevation, so elevation's another way to try to prevent swelling. I think one of the common misconceptions is "I brought my foot up, but then my heart's still three feet above where my foot is." So you got to elevate it above your heart to let gravity start to help reduce some of that swelling.

Dr. Mike Patrick: And kids do spend a lot of time sleeping. So making sure it's elevated when you're in bed overnight is important. A lot of times, kids wiggle around in bed and then their legs and arms are dangling of the edge of the bed and down. And then, they're a lot more swollen in the morning. So, kind of pay attention to the sleeping positions as well. 

So this is a question in a lot of people's minds. Like, okay, you got the ice thing, but then you also hear about warmth and like when do you do ice versus heat and when do you switch over?


Dr. Drew Duerson: Again, I don't think there's great science behind ice but we use it. I usually tell folks to use ice after activities. So again, it's going to help prevent swelling, inflammation, and pain. So, a good time to that is after a sport, practice games or maybe after functional rehab, physical therapy session. We might a bag of ice. 

When we tell someone to use ice, it's 15-20 minutes on, maybe up to every hour you can use that ice. And then I tell people heat is better early on. So earlier in the day, if you have tight muscle, muscle cramp, sore muscle it gets the blood flowing. So it helps loosen muscle, so maybe before that practice or game or before that functional rehab session, maybe you're warming the muscle to loosen it and get it better prepared for that physically demanding activity.


Dr. Mike Patrick: Great, that makes a lot of sense. So ice causes constriction or decreases blood flow, and the warmth is going to cause dilation and increase blood flow to the area. And if you have inflammation, you don't necessarily want to increase blood flow to the area because the inflammation could get worse, which is what heat could potentially do. 

Dr. Drew Duerson: I think a lot of people use the ice maybe too much. I think early on is key. So right after the injury, that's when the ice is probably going to be the most beneficial. Three months after an injury probably not doing a whole lot there. 

So at that point, I'm telling the patient, really, what makes you more comfortable? Is it ice? Is it heat? Alternating the two? At that point, it's really just whatever.

Dr. Mike Patrick: Comfort is what you're looking for, great.

Dr. Drew Duerson: Yeah. 

Dr. Mike Patrick: Well, all right, let's move to competitive dance. There are lots of opportunities for student athletes to participate in dance and sports. Eric, what are some of those ideas?

Eric Leighton: Well, with dance, just like the martial arts, again, there are studios all over the place. So your younger kids, the boys and girls have lots of opportunities to, again, take the intro classes and work their way up. 


Some start as young three and four years old, with basic movement classes and learning that. And then, as you get further along, as they move into the higher ends of dance into more demanding dance, the competitive side, as you mentioned Dr. Mike, but also there's also certain studios that are based competitive and some that are based more as performance. 

So, not all are going to competitions and conventions all the time. They are in a pre-professional program, for instance, and they are working their way up. And they perform as their main goal versus competitions. 

Dr. Mike Patrick: And so many opportunities. I even would consider like cheerleading and school dance. You know, the cheer dance kind of teams, that would be included in this category. But then also the Dancing with the Stars kind of thing, ballroom dancing and tangos, and salsas, and all those things, right? 


Eric Leighton: Yeah, they all require the same commitment. It requires a lot of hours. One of things that Dr. Duerson mentioned earlier was the overuse injuries. One of the things I always caution my dancers and the parents about as we're working with things, I always remind them that, kind of allegorically, dancers wind up with overuse injuries similar maybe in nature to the way a factory worker does. 

Now, a factory may repeat the same motion 1,400 times an hour for ten hours a day. A dancer doesn't quite do it that limited, but they may do the same 15 to 20 seconds of a piece of a part of a dance over and over. Within a one-hour rehearsal, they may do that 30 times. 

Especially as a group, everybody starts off and go, "Nope, nope, stop. Everybody go back to one." You were ahead or you missed that one turn right there. Everything has to go together. And so, they will repeat the same set of maneuvers multiple times a night. And then, the closer they get to a competition or to a show, the rehearsal time goes up. Everybody starts rehearsing more and more and more and more. 


Dr. Mike Patrick: And the stakes are great. Because an injury, it takes a person out. There may not be someone who's really prepared to step in because they haven't gained those skills yet. 

Eric Leighton: Exactly. When the other part of that too is let's say when there's a competition or a show, if you've been casted as a certain part and if you can't key yourself on the floor, keep yourself in the studio. If you have to bow out, there's an understudy waiting to take your place in some cases.

So the competitive nature of it, the drive...

Dr. Mike Patrick: So there's competition even in performing arts. 

Eric Leighton: Oh, very much so. Very much.


Dr. Mike Patrick: And do many schools have athletic trainers with their performing arts program? Is that something that's usually done? I guess I haven't really made that connection in my brain and then I think well maybe schools haven't made that connection either. Or am I wrong about that?

Eric Leighton: As far as the studios and stuff?

Dr. Mike Patrick: Well, yeah, yeah, or even just drama clubs.

Eric Leighton: Well, drama clubs is something like that. I mean, generally, there may be some athletes or some kids whether in the drama club or the band who may avail themselves of the athletic trainer at school. 


Dr. Mike Patrick: Like they have that connection on a personal level.

Eric Leighton:  If they would go and ask and say, "Hey, can you help me out with this?" I did something to myself within band camp or this or having to carry around a sousaphone." They can definitely ask and get in there. It may not be first natural choice for them. They may not think of it that way, but they can.

Dr. Mike Patrick: So, for the drama teachers out there across the United States listening  to this program, reach out to your school's athletic trainers. 

Eric Leighton: Talk to them, start that conversation. Yeah, let them know. Say "Hey I've got young kids or students that are doing physical stuff too and demanding. Could you help us out? Maybe you can come talk to them and help them out, or if somebody needs something."

Dr. Drew Duerson: I'd say these guys are great resources and they're not utilized enough. So, that's my first question for a lot of patients when I'm trying to get them out the door. Do you have an athletic trainer that you can go to and do some of this rehab work. Because obviously, it's convenient, free, and it's going to be...

Dr. Mike Patrick: Yeah, your tax dollars are paying for the athletic trainers at the school. 

Dr. Drew Duerson: A lot easier on your family.  


These guys, they do an excellent job. They're sometimes limited obviously in time, and space but they do an excellent job. And I think majority of the time I'm seeing these non-traditional athletes coming in, they have just really not the recognition that the athletic trainers there and I try to open their eyes to that opportunity.

Dr. Mike Patrick: So for young folks, who may be interested in athletic training as a career, I know this is kind of a path into the weeds here a little bit. But I think folks would find it interesting, I mean if we need more athletic trainers in the school so we need to train more athletic trainers. And so if someone is interested in that as a career choice, what kind of training and education is involved?

Eric Leighton: The way it works is it's a case certification programs through the universities and colleges that have a certified athletic training program. What they would do is, through their freshman year as they're interested in it, they'll be taking certain core classes. Also, during their freshman year, they do some observation time, making sure that they really get the lay of land and what it takes. 


There's a certain amount of practices, certain amount of coverage and they do a lot of following and a lot of work. Then there's the application process. They get in and then starting their sophomore year, it's an intensive program working its way up through masters and beyond, where they are learning sports medicine and athletic training. 

Dr. Mike Patrick: Very interesting career. I'm sure you loved what you do. 

Eric Leighton: Oh, I do. I have so much fun. I get to run around in gym and play with kids all day, so not bad at all.


Dr. Mike Patrick: So in terms of preparing for competitive dance, I think it really mirrors what we talked about with martial arts too, right? Where flexibility and strength training and balance are all going to be important.

Eric Leighton: Very much so. For dance, when you think of flexible and balance, you tend to think of like gymnasts and dancers. They have that wherewithal to do that, but they work very hard at it. 

And flexibility is always key. One of the things about dancers, maybe even more so in some degrees than other traditional athletes, they have to do amazingly powerful, strong, huge maneuvers. And, oh yeah, by the way make it look graceful and easy and smile while you're doing it. 



It takes a ton of effort. And like I said, just the hours they have put in of rehearsing over and over and over, making sure they do that. So, the strength, the stamina, the flexibility is huge because of the demands of what they do with their body.

One of the other things, when we have interns and residents and physician assistants students with us and some of our own come upstairs in the floor with us, generally, what we see a dancer do with their body. When I talk about mechanics, how we should move, compared to traditional athletes, most of what dancers do -- if we were to pull up a textbook of what we expect an athlete to move like -- we're like "Oh no, don't, no, stop that." 

We're looking at them the way they have to move their body. The way they shape their body and tell that story and create those shapes and dance is not traditionally what we want to see. It does cause stress on the body. So the way they take care of themselves is extremely important.


Dr. Mike Patrick: From a parent who's interested in getting involved in dance, what are some other things that they can do to help with strength training, let's say?

Eric Leighton: With strength training, a lot of dance because of the balance, because of the way they have to move and the spins and all these. 

Core and core control. You got to be going after flexibility, keep going after that. But core control and balance. All kinds of balance drills, the ones we mentioned earlier into as you're working your way up through the levels, as you start as a young dancer and work your way up. Learning all the basics of the turning, and spotting, controlling your body. 

But balance is a huge thing. You have balance, which for those who just to kind of define it, balance is being able to stand still. So, for instance, I mentioned earlier, standing on one leg, doing the flamingo stance and being able to stand there. That's balance. 

Agility on the other hand, that's balance while you're moving. Think of it like running buck. As they're running through the field, they're changing direction at all times, but they're staying in control. That's agility. A dancer needs that in spades.


Dr. Mike Patrick: And the flexibility then is important because agility parts are moving as you are try to keep your balance and propel in a particular direction and then joints can move the wrong way.

Eric Leighton: Very much so.

Dr. Mike Patrick: And cause the sprains and strains that we talked about before. 

Eric Leighton: And that's part and parcel of the whole thing. It takes so much practice to do that. So it's the hours. And that's part of what it takes -- so the core strength, the flexibility, your balance, your agility. But then, it's putting in the hours. That's where the discipline comes from, too.

Dr. Mike Patrick: And then, the strength too in the extremities, if you are moving partners in some of these dance teams, you've got folks that you're putting up on your shoulders. And I mean strength training is going to be important for some of them as well. What are some of the earliest stages that you can get kids involved in strength training?

Dr. Drew Duerson: So I think a good start is as early as the family want. I think there's a big misconception that kids cannot perform strength training and it's going to cause problems in their growth plates and stunt their growth. I think that's been disproved for years. 


Really, when the kid can listen, obey, and develop mentally, is safe to perform the exercise, go for it. So, really it's starts from kids getting tummy time. So infants on their belly, that's exercise for them. So it really, I think, starts from infancy and important for really every stage of life.

Dr. Mike Patrick: Yeah, and training with weights is safe for young kids too, right? With supervision...

Dr. Drew Duerson: For sure.

Dr. Mike Patrick: And using proper techniques? 

Eric Leighton: Very much, yeah, exactly. The technique is really important, making sure that they're at the right angles, not creating a problem while they're trying to get stronger.

Dr. Drew Duerson: I think a lot of it can come without weights, right? So just body weight. So, we don't need a gym. We don't need fancy equipment. We don't need heavy weights or really any extra resistance. Just using their body weights and mastering that is going to be difficult enough for most of our kids. 

Dr. Mike Patrick: And push-ups, pull-ups, set-ups, those kind of things.


Eric Leighton: Oh, yeah, we use resistance strength. For a lot of younger kids, I usually don't suggest what we call Olympic lifting -- getting the free weights out and the squat bar and weights that are moving around like that.

Using body weight like Dr. Duerson said, resistance. One of  torture devices for a lot of my kids -- and I have an entire program based around dancers and gymnasts -- is the big exercise ball, the yoga balls. There's a program you can do on that is just you and your body weight. It'll take you about 45 minutes to go through it and it'll just smoke you. 

Dr. Mike Patrick: Good points. So in terms of treatment of injuries with tiens, I think we really mentioned the strains and the sprains and the soft tissue injury kind of stuff. 

One thing we haven't mentioned that we do see sometimes with these activities is head injuries. If you fall and hit the ground -- and I know we can do an entire show and we have before on concussions -- but when kids do hit their head, Dr. Drew, what are some of the things parents and coaches should keep in mind? 

Dr. Drew Duerson: So I guess this could be an entire talk itself. But I think, yeah, the answer is really any athletes at risk for concussion, knowing what a concussion is, what are those concussion-related symptoms, are important. So really, it's always safe if you have a head injury. 


And I think a big another misconception is you don't have to hit your head to have a concussion, right? Anything that causes your brain to move too much force and too quickly inside your skull can cause a concussion. So, if you have that injury, whether it's a head injury or not and you have suspicion, that the kid needs to be set out and evaluated. That's probably the most important thing. 

And know that symptoms don't always happen right away. They can evolve over time. So just because the kid doesn't have a headache right after the head injury, it may come hours later. So that kid needs to be monitored and evaluated.

Dr. Mike Patrick: And particularly in dance, you mentioned you don't necessarily have to hit your head to have a concussion. But when your head is spinning around and you're flexing at the neck, extending at the neck, if things move quickly in one direction, that brain inside the skull can move around. And that's really what causes concussions. 


Dr. Drew Duerson: Right. Like your car accidents, whiplash-type injuries, so a lot of moving parts, a lot of moving people, and things can happen.

Dr. Mike Patrick: And, again, you're really better off if you suspect a problem, having things check out sooner rather than later. 

Eric Leighton: Always, yeah, make sure.

Dr. Mike Patrick: And really get the advice of a physician before you return to play.

Dr. Drew Duerson: Yeah, and that's another key part. Diagnosis is one thing but also getting that athlete back safely, is another thing. So knowing when they're ready and knowing the protocol to go through to get them back, and the stages they have to complete once they are back to feeling closer to their baseline.

Eric Leighton: And one of the key things we actually do at functional rehab, so when let's say Dr. Drew sees a concussion patient, maybe he puts them on rest, puts them on academic restriction for a couple few days to take away the stimulus, let things calm down. Once we start getting to that point, is going through that process, if they have an athletic trainer in school who could help them guide them, we do that. 

If not, quite often, I will see people. That's an actual type of a functional rehab visit, concussion rehab. And we take them step by step through it. Sometimes, we're monitoring down to the vitals and things like that and making sure we can progress them through those stages without symptoms coming back properly and safely get them back.


Dr. Drew Duerson: I think another key thing is keeping these kids moving. So the first 24 to 48 hours, it's good to have that mental and physical rest. But after that, I think allow kids to move. Aerobic exercise is good for those kids, whether it's going on a light jog or walk, stationary bike ride. Keeping those concussed athletes within their limits symptoms is a good thing. And it's actually showing that's returning some of our athletes back to sports.

Dr. Mike Patrick: And this is where science is evolving, because it wasn't that many years ago that we said you need complete rest and just lay on the couch and do nothing for a solid week regardless. And then, we found some of these kids, their symptoms lasted longer because of that.
Eric Leighton: And one of the things you mentioned too earlier, Dr. Mike, is somebody gets hurt and then they feel like, oh, and they start to kind of getting out of it, they start to decide they're just going to sit and not return. Well, whether it's a bony injury, muscular injury, tangent, or concussion, the sooner we get them moving and getting back... These are athletes. Their identity is being an athlete and being able to do that. 


And the sooner we can get them back and keep them involved in that mentally, that helps. That helps the mood, it helps everything, it keeps them from getting into that funk of, "I'm not able to do what I do." 

Dr. Mike Patrick: And from a sports medicine program in general here at Nationwide Children's, we're really fortunate to have such a great multidisciplinary team. So it's not just the sports medicine physicians and athletic trainers, but we really even have sport psychologist and you've mentioned nutrition before. So really, fantastic program that we have here. 

Dr. Drew Duerson: Right, yeah. I think it's a big team. So like you said, there's physicians, there's athletic trainers but it goes beyond that -- so dietitians, strength and conditioning coach, psychology. I mean, it's definitely a team approach here. I think the people behind the scenes, they should not go without mentioning too -- so the clinic assistants and all the nursing people. So we all work hand and hand and really closely.


Eric Leighton: Also, we can't forget also, our department collaborate all the time with sports physical therapy.

Dr. Drew Duerson: Right.

Eric Leighton: So for instance, if I had a kid who's had an ACL surgery. He'll spend the first three to four months in physical therapy. Then, they cross deck over to us and we all work together to take him through all the stages to get him back. So that's a big part of family, too. 

Dr. Mike Patrick: And a good working relationship with the orthopedic surgeon, in case...

Eric Leighton: Oh, very much.

Dr. Mike Patrick: Surgery is indicated.

Dr. Drew Duerson: Most of the time, they're just down the hallway, always open to help us and easy consults.

Dr. Mike Patrick: Great. And we'll put a link in the show notes for the Sports Medicine Program here at Nationwide Children's, again in show notes for this episode, 445. And then, of course, our athletic trainers are in schools all around Central Ohio, right? 

Dr. Drew Duerson: Correct, yeah.

Dr. Mike Patrick: And high school and colleges, too.

Dr. Drew Duerson: That's right, yeah. So we have contract with schools, and we have... I don't even know the number. Eric, you might know how many...

Eric Leighton: I would say 16 or 17 high schools plus...

Dr. Drew Duerson: And it seems the number of athletic trainers on our staff continues to grow.


Dr. Drew Duerson: We're very outnumbered as physicians. So yeah, they're all over the place at all different levels. And again, those are the first line people that are really working hard and really I think a great resource. 


Dr. Mike Patrick: Great. We really appreciate both of you taking time to talk with us today about martial art and dance. Dr. Drew Duerson and Eric Leighton with the Sports Medicine Program here at Nationwide Children's Hospital, thanks so much for joining us today.

Eric Leighton: Thank you.

Dr. Drew Duerson: Thank you, yes.



Dr. Mike Patrick:  We are back with just enough time to say thanks once again to all of you for taking time out  of your day and making PediaCast a part of it. Really do appreciate that. 

Thanks once again to our guests, Dr. Drew Duerson, sports medicine physician here at Nationwide Children's, and Eric Leighton, athletic trainer with our Sports Medicine Program.

It never fails. Once we turn off the microphones after the interview, we always forget to mention something because there's always so much to think about with each of these topics. 

And a couple of things that came up in our discussion after the interview, Dr. Drew wanted folks to know that another important thing with martial arts participation is really that issue of discipline and respect and greeting one another humanely and with a bow and that sort of thing, which is really a tradition with many of these martial arts programs that really stem from Eastern philosophies.

And just that the whole respect and honor and discipline thing can be so important for kids as they're growing up and extend then as an influence into other activities and relationships that they have outside of martial arts. And that's another important aspect of it that he really wanted to get across. 


And then, Eric had another thought on dance. And that is just the importance of rest for folks who are in competitive and performing arts kind of dances. Usually, they are go-getters and just want to dance, dance, dance every single day, practice, practice, practice, perfecting their art and their performance. And he just wanted to remind you that you really do need to take a break and rest your body as part of being whole and being able to compete without injuring yourself. 

And he just always reminds folks that what happens on Mondays on Broadway is the lights go out and all the actors and the dancers take a break. And the principals are not dancing every single day. They may be there for the Friday night, Saturday night performances, Thursday night. But not always for the matinees, certainly not on Tuesdays and Wednesdays.

And so dancers are human too, and your body needs a break and that is an important part of being a successful dancer and not injuring yourself, getting lots of rest. 


So a couple of other points there that they wanted to bring up, that we did not mention in the course of the interview because there are all so many other things to consider and on their mind.   

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