Pediatric Sports Injuries – PediaCast 561

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  • Maggy Rule and Alycia Kingcade visit the studio as we consider sports injuries in student athletes. Injuries impact future participation and performance. We cover common types and discuss how to prevent, diagnose, and manage them. We hope you can join us!

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  • Pediatric Sports Injuries

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Dr Mike Patrick: This episode of PediaCast is brought to you by Sports Medicine and Pediatric Emergency Medicine at Nationwide Children's Hospital.

Hello everyone and welcome once again to PDA Cast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 561. We're calling this one pediatric sports injuries. Want to welcome all of you to the program. So, uh, injuries, as you know, are extremely common in children and teenagers and sports participation is a leading cause of these injuries.

Not only do injuries hurt, they also impact the student's ability to continue playing and performing. And, uh, there is some good news in all of this though, and that is. That many sports injuries are preventable and by way of appropriate conditioning, strength, training, athletic technique, and rule-following, you know, these injuries can be prevented at other times.

However, uh, injuries are not easily prevented. They just go along with the territory. Of some contact sports, whether preventable or not, the early diagnosis management and rehabilitation of these injuries is important. So, we can get these athletes back on the playing field. So that is our topic today, pediatric sports injuries and their prevention, diagnosis, and management really with a lens on.

Where do you go when your child is hurt with a sports injury? So, do you go to an urgent care to an emergency department to a sports medicine clinic to your primary care office? Where do you go? And what can you expect? And so that's really going to be our focus today as we consider Pediatric sports injuries in our usual PDA cast fashion.

We have a couple of terrific guests joining us this week. Maggy Rule is an athletic trainer at nationwide children's hospital. She'll be here and Alycia Kingcade is leading the conversation. She is also an athletic trainer with sports medicine and nationwide children's. And then we have a special guest this week, more on that soon.

But first I want to remind you. The information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your health care provider. Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at PediaCast.org. So let's take a quick break. We'll get Maggy Rule, Alycia Kingcade, and our special guest settled into the studio, and then we will be back to talk about pediatric sports injuries. It's coming up right after this.

Maggy Rule is a certified athletic trainer at Nationwide Children's Hospital. She is passionate about supporting student athletes and preventing, diagnosing, and managing injuries that occur during sports participation. So, let's warmly welcome Maggy Rule to the podcast. Thank you so much for being here today.

Maggy Rule: Hi, thanks for having me.

Dr Mike Patrick: Yeah. Thank you for taking time out of your busy schedule to join us. Our second guest this week is a little unusual. It is me for the first time in the 17-year history of this podcast. I will put on my pediatric emergency medicine hat and talk about sports injuries from the lens.

Of acute care in the emergency department and urgent care. And then Alycia Kingcade will lead our conversation this week. She is also a certified athletic trainer at Nationwide Children's. And she also heads up the sports medicine episodes of PediaCast. She organizes them, puts them together, gets the guests together, all that sort of thing.

So, let's also welcome Alycia Kingcade to the program. Thanks so much for pulling this episode together.

Alycia Kingcade: Thanks for having me again.

Dr Mike Patrick: Yeah. Really appreciate all the hard work that you've done. So, I'm going to go ahead and the hand the hosting reigns over to you, Alycia, and let's get going.

Alycia Kingcade: Awesome. Well, thank you, Maggy and Dr.

Mike for being guests on this episode. Got a lot of good feedback from the last one, so I'm excited to get this episode going. So, so for today. I kind of wanted to talk about pediatric injuries, and some of them are specific to the age of the athlete. So, today's episode, I wanted to find out more about injuries that we see specifically in the pediatric or the youth population, seeing as we are pediatric experts at Nationwide Children's Hospital.

So, to start, off our discussion, I wanted to set the stage and determine what would be like, what is the overall definition of youth or pediatric?

Dr Mike Patrick: Yeah, that is a great question. And I think, you know, from a policy standpoint, we've used the age 21 to sort of differentiate pediatric medicine versus adult medicine.

However, there's a lot of blurs in that line. And for instance, when I think about chronic illnesses that start in childhood. Where the specialists really know a lot about that particular disease process. So, things like cystic fibrosis, congenital heart disease, things may get a little bit, you know, blurred in terms of, of who you would think of as pediatricians taking care of those kids and pediatric specialists as well.

I think too, that there's a little bit of a blur for sports medicine in terms of. You know, we certainly see him in the pediatric age range of through high school, but that gets us to 18. So, I think there is some overlap when we get to the college group of folks but then once folks are out of college sports, um, I would say that they probably graduate to adult sports medicine at that point Would you agree with that Maggy?

Maggy Rule: Yeah, I would in sports medicine You know, like you said, there's a little bit of fluctuation in when, you know, they would kind of transition to that adult role, but for our purposes, we really look at it from a are they still growing? Are their growth plates open? Are they at risk for those pediatric type injuries that we see?

Just because we are going to have more experience and knowledge in how they're Those get managed and make sure that they get managed appropriately. And sometimes that can mean that late adolescent, young adult, college age kids.

Dr Mike Patrick: Yeah, yeah, absolutely. And I think one of the differentiating factors to our open growth plates, especially as we think about sports medicine and sports participation.

Kids, you know, up until the point that they're sort of transitioning from high school to college, you know, may still have some, um, open growth plates because they're not done growing yet. And the issue with those is they tend to be the weakest part of the joint. And so, you do have to worry about growth plate injuries, especially, you know, in middle school and high school athletes.

Maggy Rule: Exactly. That's kind of, you know, the approach I always take when explaining to parents of our patients, you know, as, as adults, we hear about somebody tearing their Achilles playing basketball on the weekend or their ACL or some more muscle ligament injury. ligamentous type injuries. But that weakest link for our pediatric patients is, is bony.

It's in that growth plate versus the ligaments and tendons and muscles.

Alycia Kingcade: Yeah. And here at Nationwide Children's Sports Medicine, one of our partners and is with ODU Athletics. So, we do see athletes within the collegiate realm. So, it is kind of that wide variety of. Age per se, and then obviously the most important part is just when are the growth plates open, like you said, but this also doesn't mean that it's anybody that must play an organized formal sport either.

So, I wanted to point that out. It's just kind of anybody that is active that is, you know, outside at recess or going to play with their friends in the park or whatever. Like it's really any active individual, but within sports, We, you know, if you're being, if you're being active, you're, you could have a chance of injury and this is what can occur with this, you know, range of age group, but you guys kind of touched on it a little bit talking about the growth plates and why it's important to be aware of injuries that can occur.

Within this age group, what are the most common pediatric injuries that you see at your job site? You know, being in the ED and the urgent care and being in the clinical setting, just kind of what are, what are different things you guys see?

Dr Mike Patrick: Yeah, I, you know, this, and this always surprises me that I would say the number one sport that I see injuries from, if I had to put like one up on top, you would think it's football, but, but it's not, it's basketball.

And we see so many ankle injuries and broken fingers from basketball. It is definitely a contact sport. So, you know, rolled ankles, basketball, also soccer. You see a lot of ankle injuries there as well, just because, you know, the ankles take a little bit of a, of an extra turn and move a little more than, than was predicted.

So, you can get some stretching and a sprain, but we do want to differentiate that from growth plate injury in the ankle and a broken bone in the ankle. So, we do see a lot of those. Yeah, forearm fractures are also common. If folks fall onto an outstretched arm. So, athletes, you know, you always, if you are, if you, if you have the mental faculties to realize that you're falling, try to tuck and roll.

It's the, the best way to, to save yourself from, from an arm fracture. But we do see those. And then concussions are common in the ED, football, wrestling. Those are pretty common. And then we don't see as many of these in the ER, but sometimes we do, especially in the beginning of a sport season. And that's just repetitive motion injuries, which can be anywhere and affect anyone.

I'm thinking, you know, baseball, pitchers, gymnastics, you know, those kinds of sports. We do see, um, just sprains and strains and, and, uh, muscle, I won't say tears, but you know, strain on the muscles and they come in. At the beginning of their sports season, and then they're in a lot of pain and they think it's an acute injury, but it's really, you know, has been there for a little while.

So, I would say from the ed and urgent care perspective, those are probably the most common.

Maggy Rule: And from the sports medicine clinic side, it's not a whole lot different. It just is a different timing and presentation I would say. So, I think, you know, obviously the emergency room and urgent care are going to catch a few more of those acute, those, those falls on an outstretched hand when somebody's falling, those ankle twists and turns when they snap, crackle, and pop in the wrong direction.

And so typically if we're going to see those, they may be a day or two out from that initial injury. And then we see a lot of the, the overuse, more chronic repetitive stress injuries that Dr. Mike was speaking to as well when it comes to throwers or even, even runners. It can be any sport really that will get some inflammation and growth plates and things like that.

Alycia Kingcade: So, when talking with parents about injuries. It is kind of interesting because they do kind of think like, oh, football, you must see the most injuries here. Or, you know, I think, yeah, basketball, I definitely see that a lot too of the fingers and the ankles. So, it's interesting how, you know, there, and we'll get to that later, but how different sports can bring upon different injuries and those are things to look for.

But I wanted to touch on the word acute that you said, Dr. Mike, and I kind of wanted to go into. What that is because acute versus chronic injuries because I think that's something that's important to know about and especially within pediatrics and within growth plates and things like that knowing what is an acute versus a chronic injury and like what are some of those injuries in general?

So could you guys both talk about that a little bit of what are acute and chronic injuries within this pediatric population.

Dr Mike Patrick: Yeah, yeah, absolutely. So, there's nothing cute about acute injuries. That's not, it doesn't have anything to do with the word cute as we typically think about it. Acute just means a new injury and Particularly in the very beginning of it, when you have inflammation and pain.

So, you know, if, if I fall and hit my elbow, that's an acute injury. Now, if my elbow is still hurting a month later, then you would call that now a chronic injury. So, it's, it's been there for a while. So, in terms of when you start calling an acute injury, now a chronic injury, that that's, that's a little gray.

I would say that most acute injuries. you know, except for fractures are going to be better in a couple of weeks. So, we usually say seven to 10 days and then reevaluate. But the truth is it's probably closer to two weeks before you're fully back to where you were because your body must, must repair itself.

Um, but when that repair process starts to take longer or you start to have pain over a longer period of time, then we would start to call that chronic. So probably, you know, the one-to-two-week mark, certainly after two weeks, we would start to call that a chronic injury.

Maggy Rule: Yeah. And at that point, you know, some of those initial symptoms you're swelling, being tender, you know, having trouble walking, you know, or, or pushing, putting weight on that, that injury bruising, that kind of stuff will start to get better.

And sometimes they heal up and you can get back to life without a problem. And then, like Dr. Mike said, sometimes they develop into more longer-term chronic injury. Their inflammation kind of sticks around and can cause some less severe, but still bothersome pain and injury. Chronic injuries can also come from just overuse without an acute mechanism, I would say, too.

So, without that, that fall, that twist, that pop, especially in kids and especially when we're talking about going back to talking about growth plates a little bit. There can be a lot of repetitive stress and it can just be from running. So, talking about those kids, just its summer's kicking off.

Everyone's going to be outside running around at the playground, swimming in the pool, doing some different stuff. And, and that alone can cause some, some pain or some chronic injury. So, it's important to. To listen to your body and take that into account as well. The last one, kind of third category, I like to talk about with families and with parents is the, what we call an acute on chronic injury.

And again, it's kind of specific to the growth and development that you see. So, it's a kid that may have had some soreness and pain. You know, maybe limited activity a little bit, but they could push through or tough it out kind of a situation. But then they have that acute that pop, you know, that that twist something happens.

And it's just something to be aware of that. Sometimes, you know. That's why we want to take care of those little chronic aches and pains, because we don't want something bigger to happen from it. Because sometimes that can just require a longer healing time or a little bit different management for the injury.

And we want to get these kids back as fast as we can.

Dr Mike Patrick: Yeah. As we think about acute versus chronic, one thing that comes up often, even in the emergency department and the urgent care centers, is a parent will say, could they have a stress fracture? And I think that's a term that a lot of people may not know exactly what that is.

Maggy, when, when, what, what exactly is a stress fracture?

Maggy Rule: Yeah. So, when it, again, stress fracture, it's going to be in the same vein of a chronic injury. So, there's not one big episode where you fall or twist or do something that causes a pop. that repetitive stress. So typically, we see stress fractures in your shin bone, often from running or a sudden increase in like, oh, it was off season.

I'm not doing much. And now I'm, my training has ramped up and I'm running a lot more, exercising a lot more. And that repetitive stress causes some injury to the bone. If it can, and it's, it's graded, there's stages. You know, depending on how far along in the stress continuum stress reaction process, it is can be how significant it is.

You can certainly just have, you know, again, what we call a stress reaction versus a true stress fracture, and there's a wide range of symptoms and pain and processes that go on with the body that affect where you can be at in that continuum. So, when it comes to stress fractures, it's. It's a, it's a process.

It's not typically an acute injury and it's because of like chronic repetitive stress

Dr Mike Patrick: and when the bone has that stress, it is a little more likely that then you could get an acute on chronic injury when, when that stress fracture becomes a real fracture all the way through the bone because it was weaker in that location.

If it has a particular stress applied to it,

Alycia Kingcade: Exactly. Yeah, these have been great definitions and you guys gave a thorough example for each. What are some examples of, or what are some more examples of acute and chronic injuries just so the listeners know a little bit more of, oh, let's put this definition to something we may or may not have seen yet.

Dr Mike Patrick: Yeah, I'll, I'll let Maggy speak to the chronic injuries for the acute injuries, you know, the ones that we've talked about, you know, fractures, forearm fractures, ankle sprains, those are common. I would also say, you know, things on the skin. So, people, you know, you fall, you make an abrasion, you may get a bruise, you may have a laceration.

So those would all be considered acute injuries, uh, concussions, you know, especially right after it happens, we would call that an acute injury. Those can turn chronic as well. And you can also have complex concussions and need to see some psychology specialists to help you with the recovery from those.

But I would say those are the main ones that we see though. And those repetitive motion injuries are really, a lot of times they do show up Acutely in an emergency room because like at some point you have this pain that that really is chronic, but from the patient point of view, like, well, I was living with it, and I was okay with it and now it's affecting my performance.

And so, in their mind it has become an acute injury and I think that's why they show up in an urgent care and an emergency department. But really, it's a chronic injury.

Maggy Rule: Absolutely. And examples for those chronic injuries. You know, it's, there's a lot of different names and technical terms. It's, it's any of your itises essentially.

So, I can have tendonitis if it's more soft tissue in a tendon. In our pediatric population, we often see what we call an apophysitis or an apophysitis, which is. Chronic, repetitive or chronic stress and inflammation in the growth plate or in a, in a specific part of the bone. So those are going to be our most common chronic injuries and overuse injuries in, in this population.

Dr Mike Patrick: Yeah, and I also would point out from a sports medicine point of view because sports medicine docs are really good at treating and managing repetitive motion injuries There are a lot of other things that maybe folks wouldn't consider sports where these same things happen and so I, you know, as I think about marching band, for example, you know, I think that's a sport really, you know, in terms of repetitive motion and the kind of injuries that you can see and in the adult world, my wife is actually seeing a sports medicine doctor because she has shoulder problems that stem from cross stitching.

And they send her to see sports medicine because it's, it's a repetitive motion and the treatment is the same and, and the sports medicine folks are the, um, are the experts at that. So, there may be sports that you don't necessarily think of as traditional sports, but the injuries occur in the same way.

And the sports medicine folks really are the best folks to see.

Maggy Rule: Yeah. It had, um, E gamers to that as well. We see some, some overuse injuries related to, to that. And, and like I said, it's just being, being active. Anybody that's active can be at, at risk for this or can have these, these issues. It doesn't have to be a quote athlete.

They can be playing outside, just being an active individual.

Alycia Kingcade: Yeah, I was just thinking about Severs disease or Severs disease where you know that there's a pool on that Achilles tendon so the tendonitis and you know if you're if you're a kid and you're running outside and you're going from into summertime you're swimming and then you're going to running on the ground and you're growing like you know there is that that pool back there and then.

You know, all that just kind of encompasses. So yeah, even for, you know, if you're not even playing a sport, like these things occur and, you know, goes, goes back to this age population and growing on top of being active, it just, they all kind of play a role. But are there specific age ranges that you see certain injuries that pop up?

So, with apophysitis, is there a specific age range that you see that more prominently or other types of fractures or something like that?

Dr Mike Patrick: Yeah, I will leave, uh, the, uh, apophysitis to Maggy because we don't generally diagnose that in the emergency department. In terms of, of patterns. You know, I think we do see injuries at all age groups, but maybe the mechanism of injury does tend to be a little bit different.

Those younger athletes, it's often an issue with technique, you know, maybe they're not conditioning properly before their sport. And so, they're a little bit more likely to get an acute injury because they're, they're just not really, their body wasn't ready to have this stress put under it. And then the later kids, especially as they start to specialize on a sport.

Then you're going to see more of those repetitive motion injuries and just because they're using the same group of muscles over and over and over again, and then you can get, you know, a lot of stress placed on it. But I, I think that we do see injuries across the age spectrum, but like I said, the mechanism of those injuries may be a little bit different.

Maggy Rule: And when it comes to the apophysitis, the growth plate inflammation, and some of those more overused, chronic, repetitive motion injuries, obviously growing is going to play a role in when they most commonly happen. the growth plate needs to be open and still growing for there to be a growth plate and there to be inflammation and, and an injury to it.

So that's going to drive it a little bit. You, Alycia, you previously mentioned Severs or Severs disease, which is one of the most common overuse or chronic repetitive stress injuries that we see. And that's going to be inflammation and the growth plate in the heel. And that's going to be a little bit younger.

We're going to typically see that more. Middle school age range, because once you get later into high school, or even some of those young adult type ages, college age kids, that growth plate is closed. So, the, the injury that you're going to have, the diagnosis we're going to make related to pain around your heel is going to be different because you don't have a growth plate there.

And gender can play a role in that too. Obviously, development and growth and bony development, puberty is going to play a role. Girls hit that earlier. So, there's certain injuries they may see, it may be more common in a younger age for, for the female population versus male population.

Alycia Kingcade: Maggy, I wanted to round back and go back to what you had mentioned a little bit earlier about specific sports.

So, you mentioned with apophysitis and seeing that and, you know, seeing that as more of like a chronic injury with repetitive something. What kind of specific sports do you see in clinic that are causing certain injuries?

Maggy Rule: So, I like to, I put the, put the caveat out there. We have seen all injuries in all type of athletes.

So, but there are specific sports that you're going to have. More common injuries with I mean, I think some of the best examples are your throwing athletes So your little league shoulder or literally little league elbow those names in and of themselves kind of give you an idea of what sports we tend to see those with so those are going to be in your throwers, but that's also any overhead athlete So it can be common in your volleyball tennis swimming with that repetitive motion so Sports that are predominantly lower body like your soccer or your track athletes that aren't throwers, they are not going to have as many shoulder injuries or those shoulder injuries are going to be more acute and they're going to come and see Dr.

Mike in the E. D. because it's going to be a fall, put my hand out, caught myself type of injury. So. When it comes to specific sport, the level of contact, I know we talked about basketball, we often sometimes see more contact injuries than football. You're, the rate is going to be higher in either of those versus swimming for a contact injury, just because they're, you know, generally a non-contact sport.

Alycia Kingcade: And then, Dr. Mike, I wanted to know a little bit more about Without going into incredible detail, because you could talk about concussions for a very long time, but I wanted to ask about specifically your previous PDACAS episode, PDACAS CME, specifically 033, the sports related concussion. Can you talk a little bit about that?

Because you mentioned concussions earlier, and I feel like that's a common one that parents always have questions about, and there's just continuous, you know, Knowledge and, and education being coming out about concussions. So, can you talk a little bit about that and in that episode?

Dr Mike Patrick: Absolutely. I, you know, concussions, the management of concussions really has changed over the last 10 years.

And so, if you go back in the archive of PediaCast and find a concussion episode, that's, that's more than 10 years old, you're not going to get the right advice because you know, science changes and so you want to make sure that you are listening to the latest thing and uh, the sports related concussion episode that we did with Dr. Stephen Cuff, episode 33 was a really good one and uh, was, was very up to date. The biggest change has been that we used to recommend like total rest for folks with concussion, like you just need to lay on the couch and not do your schoolwork. Don't participate in anything. Just set and let your brain heal.

But then what we found out was that the kids who did that and followed our advice. That the concussion symptoms lasted longer, like the brain wants to work and the, you know, when you're working the brain, it's more likely to heal itself and put the neurotransmitters back where they're supposed to be.

And all those things. So, you do have to do it safely though. So, we want to return folks, you know, to their brain working and doing things. But we also don't want them to hurt themselves. And so, when you do have a concussion, your judgment is, isn't, is not quite as great. Your reaction time may not be as good as it usually is.

Uh, you may make decisions that aren't the best. And so, a subsequent injury when you are Healing from a concussion is a very real possibility. And of course, we want to return kids to play at the healthiest way possible. We don't want them to get another concussion on top of the concussion that they're, that they're getting over.

And so that supervised return to play is also going to be important. And we talk about that as well in that episode. And I will put a link in the show notes of over at PediaCast.org. So folks can find that episode easily. We also have a playlist over on SoundCloud that I wanted to mention.

And we'll put a link to that too. It's all the sports medicine episodes that we do. We put into a playlist over at sound on SoundCloud. And so, there's really a ton of them. Some that folks may not be familiar with, but I think are important. We did an entire episode on ankle injuries. That's PDA cast three 64.

We did a one on martial arts and competitive dance. Of course, we've done concussion. Not only the CME one is really aimed at providers who manage concussions. We also have one called concussion recovery and return to play. That was PediaCast 501. And I'll put a link to that in the show notes as well.

We've done throwing injuries. We've done functional rehabilitation. So, there's a lot of great content in sports medicine. If you want to find that all in one place, just go over to SoundCloud and look for that playlist.

Alycia Kingcade: Yeah, this is a great resource and obviously why we want to be doing some episodes specific with, within sports medicine so that, you know, it is a different realm and specific to sports, so.

Yeah, so it's great to be able to be on these episodes and go through specific topics that we're hearing from parents so we can address these questions and get out some education. So, thanks for sharing that and putting the link out there. So, we've gone a lot over about what Injuries occur and when we can commonly see them happening within the pediatric population.

I think one question that I have for both of you would be where should these athletes go for the diagnosis and the management of these sports injuries? Obviously, we, we have experience from ED and the urgent care. We have experience from the clinic. I think parents want to know where and when do we go, because I think that that's a big, okay, I have an ankle sprain, do I go to the urgent care?

Or do I go to, if I fractured my arm, you know, where do you go? Can you wait, like, not wait for a fracture, but where do you go immediately versus when can I wait for an injury to happen and when they occur? So, what's so can you guys talk a little bit about that with kind of the time frame and where to go?

Dr Mike Patrick: Yeah, I can definitely see how that would be so confusing for parents and I think In the moment when you're trying to make this decision, I would say phone a friend and if you're on the sideline, look for the athletic trainer, ask your coach, like, is this something that I can see my doctor tomorrow or do I need a sports medicine specialist or do I need to go to an urgent care and emergency room because those folks that are right there where you are, they're the ones who see these injuries over and over and over again.

And so, they get a lot of good feedback of where was the right place to go… that was convenient… and maybe doesn't cost a lot of money. Uh, you know, certainly going to an emergency room is going to cost a lot more than going to an urgent care center, which is going to cost a lot more than going to see your regular doctor.

So, I would say just getting that advice. And, uh, if, if it's, you know, happens while you're practicing or there's not an athletic trainer, that's, that's locally available is to call your doctor because your doctor has someone that's on call and they can help you. You know, ask you questions and try to figure out where it's hurting and exactly what happened and, and can advise you on the right way to go.

Now, having said that, um, I would say if you're worried about a bone fracture, that's one that really shouldn't wait because we'd want to get that splinted, but we also don't want to splint an extremity unnecessarily. And so, you know, you need an X ray and probably the sooner that happens, the better if it's an obvious fracture, like, you know, the arm doesn't look straight anymore.

Then you want to go to an emergency department because you're probably going to need that bone set and that's going to need sedation. And must happen in an emergency room. If there's not an obvious fracture, it just hurts, but everything looks okay. An urgent care is probably all right, because in that case, you know, you still may have a fracture that needs to be set.

But they can at least get the x ray, get the splint on. And if it does need that, transfer you to the emergency department or depending on the fracture itself, it may be seeing orthopedics tomorrow and they can set the fracture in their clinic, especially during flu season when the emergency room is just so crazy busy with sick kids.

Sometimes the orthopedic doctors for fractures will be like, well, you know, we'll, we'll fix it tomorrow, but just split it now. So again, a visit to the urgent care may be a little bit better there. You know, cuts that need stitches is going to be something that needs to be seen right away. A lot of urgent cares can handle that.

Emergency departments certainly can handle any suturing that would need to be done. You know, a lot of folks do come in for ankle injuries. I'm not sure that you would have to do that unless it's Like you can't bear weight on your ankle at all. And you know, you're worried, could there be a big, bad ankle fracture in that case, you would want to see someone sooner.

But if you're just, you know, if it hurts when you walk, but you can bear weight, you don't feel like your ankle slipping and, you know, doing weird things when you're walking, it just hurts. And it's swollen. That may be something you could wait on and get an x ray as an outpatient, and it be managed within primary care office or a sports medicine clinic.

But, you know, of course, there's also peace of mind and a lot of parents and it's often the parents driving where we're going to go, and parents want to sleep well that night and have some more information. And so, you know, I would say then an urgent care is probably better than the E. D. If there's, if you're not really worried about a fracture, a concussion where someone like loses consciousness at the, at the site, or they aren't quite sure who they are, where they are.

Probably ought to go to an emergency room just in case you need a CT scan of the head. Not all those kids are going to need that. And a lot of times by the time they get to the ER, they're feeling better. And, uh, we don't need to do that, but I'd say those are the, the main ones for the emergency department.

I, the, the vast majority, I think of injuries probably could wait for the clinic.

Maggy Rule: Yeah, I would agree wholeheartedly with everything that, that Mike has said, as parents, it can be really tough to make that decision in that moment of, of stress and seeing your child in pain or having injury, or, you know, if it is at a sporting event, the emotion of the sport gets wrapped up in all of that, and it can be really hard to, to decide on next steps.

Whenever you have an athletic trainer at your disposal as a resource, you know, ask your coaches, ask the site, you know, if your school has one, reach out, they are going to be, you know, the most helpful resource in helping you make that decision. And if it's any concern for fracture, like you said, any concern for fracture, something doesn't look right, you know, you have a cut, laceration, bleeding, those all need to be addressed.

For Pretty immediately, but you know, your ankle injuries, they can sometimes be uncomfortable, they can be swollen, they can have some bruising right away, but they can wait and be seen in clinic in the next, you know, over the next day or two, whether that's calling your primary care office and seeing what their availability is again in that cold and flu season, it may be really tough sometimes for them to See an ankle injury, working it in with every everything else they have, and that's where sports medicine comes in.

We're going to be a resource for you to help with that. And we want to help and see those injuries.

Alycia Kingcade: Yeah, that was, yeah, that was very thorough. Yeah, I think that parents really can get frazzled in the moment, like you guys said, and I think it really comes down to, is it life threatening? Does it need to be stabilized?

And those are going to be the more immediate places to go. And can you wait, and can you wait till the next day or two? Like you said, Maggy, and, and there's really like different places you can go. There's lots of options, which is awesome that we have tons of resources around us to be able to do that.

But specifically, you know, just when you get to primary care or sports medicine, or, you know, wherever you go the next day or two, they're going to be able to provide returns to activity. And that's also another important is. Being able to return safely is the next part of it. So, you know, can you wait, what are you getting back to?

Those are kind of parts that go into it. So, kind of wrapping up, I wanted to kind of go into a little bit about what the experience is like going to your different job sites. Just so that parents are aware of, you know, if, especially for parents that have never had a child who has been injured before, what does the process look like to go to clinic, to go to the ED, you know, and just kind of walking them through that a little bit.

Obviously, it depends on the injury, and it depends on a couple different things, but just kind of walking them through what can you likely expect for, if your child comes to this site. For Maggy, let's start with you within the sports medicine clinic.

Maggy Rule: Yeah. So, we really want to be accessible for families and an option for them.

So, when it comes to seeing us in our sports medicine clinics, they're outpatient clinics. So, we do have a location down by the main hospital, but we have locations throughout. Columbus to again, be accessible for families to come and see us. And, you know, we've, we've tried to, to do things like being able to schedule online and things like that.

So, to make it easy for, for families to come see us. And then when they do come see us, our goal is really to make that visit a one stop shop for their injuries. So, they leave not only knowing what is going on with the injury and with their body but setting them up for success moving forward from there.

So, when they come in, you know, they're going to start by seeing an athletic trainer who's going to get their history, do any brief exam or testing. If they're being seen for a concussion, there's going to be a little bit more comprehensive testing that the athletic trainer is going to take them through.

And in their basic evaluation, and then they're going to collaborate with the physician, with the doctor on ordering some x rays. So, Dr. Mike had mentioned outpatient. x rays or imaging if they can wait. So, we do those in our clinics on site. So, if they haven't been seen by an outside hospital or one of Nationwide Children's emergency rooms or urgent cares, we'll get some x rays and during the visit and then the doctor will see them, and they will be able to review those x rays.

They'll do their full physical exam and then be able to talk about Concerns, diagnosis, plan of care, and that plan of care we like to do as much as we can in the office, so if that does require a cast, we're going to do it in your visit. If that's a brace, if it's a walking boot, if it's crutches, anything like that, or if it's a home exercise program, it's, alright, this is just one of those overuse injuries, we need to give it some time and we need to give you some stretches to do.

Here's what those stretches look like, and here's how often you do them. And any other questions or education that they have, if from that point they need further care, we have, you know, a very collaborative relationship with a lot of departments here. So, if that's scheduling an MRI, or they need to go see orthopedics because it's a more complicated fracture, or they need to go to physical therapy for some more specific rehab, we're going to get all that set up before they leave.

Alycia Kingcade: And Dr. Mike, can you talk a little bit about what the process would look like in the emergency department or the urgent care?

Dr Mike Patrick: Yeah. So, from an urgent care and emergency medicine standpoint, it's, it really can look different depending on where you go. And the reason for that is. That we can't predict how many people are coming in.

So, you know, we don't have appointments. So, you must just come in and see how busy it is, which if it's not busy, you'll get right in and right out. It's fantastic, but that is not the usual. Usually, the emergency room is a very busy with lots of patients. And so, it's going to take a lot of patience also on the part of parents because you really are going to have a wait.

Now, in the emergency department, in the urgent care is to some extent, and we do triage so that the folks who have the more critical need are going to go first. And so, you know, if it's a broken bone that is deformed, so your arms not straight anymore, you're probably going to get right back and not have to wait too long in the, in the, in the waiting room.

On the other hand, if your, if your arm hurts and you're not sure if it's broken and you know, you have good circulation in that arm and it looks straight and you're not in a crazy amount of pain, then you may have to wait a while. And sometimes that weight can be, you know, two or three hours before you get back to a room, just because if there's, you know, a hundred kids.

In the emergency department. It just takes a while to cycle through them. And so, I would say patience is going to be really a big thing. Also, if you are in that situation and things are changing, you want to make sure that you let the nursing staff know that. So, you know, if your kid came in and their pain was a three and now it's an eight, let somebody know, because they can at least get him some pain medicine while you're continuing to wait.

So that's going to be important. We do want to make sure that kids are comfortable, even if you're waiting to see a doctor. Also, if they need something like a sedation to get their bone straightened back out again, it's going to take a while to do the sedation, to watch them afterward. I mean, you're probably going to spend the rest of your day there.

And, uh, uh, there's just not, unfortunately, a way to get around that. The orthopedic doctors who are going to set the bone, they might be in the operating room and, uh, must wait. You must wait until they're done there before they can come down. There might be three fractures ahead of you, especially in the summertime when we see a lot of kids with broken bones.

So, it's just a matter of, of having patience and understanding that the people caring for you really do care about your kid. Like when you're waiting that long, it can be easy to feel like they don't care about me. You But we do, we care about everybody and it's just a matter of, of treating the kids who need it more urgently first.

But then, as I always tell parents, once I'm in the room, I'm yours. I'm not going to rush through to get to everyone else just because there's a ton of people in the waiting room. Like you've got my full attention. Let's figure this out. Let's do what's right for your kid. We appreciate your patience in waiting, but now that I'm here, I'm here.

And I think that that's a good expectation to have. I think most people who work in urgent cares and emergency rooms are frustrated, just like parents are, that folks must wait so long. And if in a perfect world, we would just have. An unlimited number of rooms and unlimited number of staff and could handle whatever comes at us.

But that's just not practical to, you know, to have all those people sitting around then when, when nobody is coming in. So, it's, it's tough to balance. I think you're going to have a smoother experience when you can go to a clinic and have a time that you're supposed to be there. Certainly, especially later in the day, things can get backed up.

A pro tip for parents. If you are scheduling a medical appointment of any kind, I always try to schedule first thing in the morning because you're, it's more likely that things aren't behind at that point. Whereas if you go, you know, if your appointments at three o'clock in the afternoon, you might have a little more of a weight depending on the cascade of, of issues that have, that have come in before you.

But I think that that's another reason why we say like, if you got to go to the emergency room, go to the emergency room, but if it can wait, let it wait. And again, the best way to know which of those things to do if you're unsure is to, is to call your doctor, ask your coach, ask the athletic trainer. They can give you some, some good advice there.

Alycia Kingcade: Yeah. Thank you, guys, for clarifying that process. I think I've heard from parents like frustration if their kid, you know, sprains their ankle and then they end up going to the emergency room. Cause you know, like to a parent, you know, your child's injured. So, I'm sure that it's, that, you know, it's, it's a very.

Urgent thing. I want to take care of things. But yeah, I think it, I think they don't realize, you know, if it's not, like you said, Dr. Mike, like if it starts out at a three, you know, they're going to take somebody who is like an eight or a nine or, you know, first, you know, and especially if it's busy. So, I think.

Maggy did a really great job at clarifying like all the different steps in clinic, which I think is going to be helpful for parents to know so that they know like, oh, in a clinic you can get an x ray and you can, you guys do casting and bracing. And I think parents are pleasantly surprised to know like what all we can do in clinic.

So. So yeah, but I, yeah, so I think that this episode is really filled with a lot of things that I've, I have personally heard parents have questions about, and I think you guys answered thoroughly and very clarifying or clarified very well. So, I know that parents will appreciate that too. So, but I wanted to thank you guys for being on here.

All the information you gave was helpful. Awesome. And you guys are rock stars. And I know that parents will be just happier knowing that, you know, oh, this is so good. I needed to know this information if their child gets injured. So that's why we do this. So, it's good. So, thank you guys.

Dr Mike Patrick: Yeah. Thank you. You did a great job leading the conversation. Really appreciate all your work.

Maggy Rule: Yeah, thanks for having me. This was great.

Dr Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks to our guests this week, Maggy Ruhl, athletic trainer at Nationwide Children's Hospital and the leader of our conversation, Alycia Kingcade with sports medicine, also at Nationwide Children's.

Really appreciate both of them. Taking time to put this information together for all of us. Don't forget you can't find PDA cast wherever podcasts are found or in the Apple and Google Podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, YouTube, and most other podcast apps for iOS and Android, our landing site is PediaCast.org.

You'll find our entire archive of past programs there. Along with show notes for each of the episodes, our terms of use agreement, and the handy contact page. If you would like to suggest a future topic for the program, reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.

You'll find us on Facebook, Instagram threads, LinkedIn, and Twitter. X, simply search for PediaCast. Also, don't forget about our sibling podcast, PediaCast CME. It is similar to this program. We do turn the science up a couple of notches and offer free, continuing medical education credit for those who listen.

And that is not only for doctors. We also provide credit for nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers. And since Nationwide Children's is jointly accredited by all those professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements.

Shows and details are available at the landing site for that program, PediaCastCME.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME. Thanks again for stopping by and until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long, everybody.

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