The Top Nine Questions Parents Have About Kids Sports Injuries

1. How can sports injuries be prevented? Many sports injuries are caused by stress from overuse and from the strains or inflammation around tendon insertions. A few tips to help avoid injuries include:
An athlete should have good nutrition and hydration prior to a practice or a game
An athlete should be well rested and alert.
Most importantly, the athlete should have good pre-season/pre-game training that includes stretching and flexibility skills, strengthening skills for the entire body, balance and coordination skills, plyometric skills and agility skills.

2. How many hours a week should young athletes train? This answer is age and sport specific. The greater the intensity of the sport on the muscle and joints, the more rest is needed. Here is a general guideline:
3-4 years old: 30-45 minutes, two times a week (including games)
5-7 years old: 45-60 minutes, two to three times a week (including games)
8-12 years old: one to two hours, three times a week (including games)
13-18 years old: one and a half to two hours, four to five times a week (including games)
Remember that participating in different sports, instead of the same sport year round, will decrease the risk of overuse injuries. It is recommended to vary practices and strength programs to rotate the different muscles throughout the week. In other words, don’t just run all the time. Mix in weights, jumping and stretching.

3. What can I do after an injury to decrease the severity of the injury? P-R-I-C-E
The best thing to do after an injury occurs is to ice the injured area 15-20 minutes with elevation and compression. Repeat 15-20 minutes of ice every hour to the injured area. Keep the area protected, elevated and use compression in between icings. This should be continued every hour while awake for 48-72 hours.

4. What can I do for my child who is in pain? Ice like described. OTC pain mediciation like ibuprofen or Tylenol (if not allergic) 10mg/kg of nody weight.

5. When do I apply ice to an injury? When do I apply heat to an injury?
Ice: Ice is applied for the first 48-72 injuries. Use ice when there is swelling or as prevention after a workout or game. It is never recommended to use ice before practice or a game. The numbness from the ice may cause the athlete to injure themselves more.
Heat: Heat is beneficial pre-practice or pre-game to an area that is stiff, as this will warm-up the muscles decreasing the risk of muscle strains. Heat is also beneficial when an athlete has dull/achy pain. Never use heat when swelling is present.

6. How long should my child rest before returning to activities? Your child should rest from physical activity until he/she is able to demonstrate pain-free activity. The athlete should be able to walk and run without a limp or pain. There should be no physical evidence of a functional deficit while the athlete is participating in their sport.

7. What is the role of bracing or taping an injured area? An injured area should be protected when there is an unstable joint that needs proprioceptive (body awareness) input and stability. Bracing is a better option than taping, as taping often becomes ineffective after 5-10 minutes of vigorous activity. It is not recommended to brace a joint that has not been previously injured. The brace can “take over” the role of the supporting muscles and in return, the muscles become weaker allowing the joint to be at higher risk of injury. If an athlete is in need of some form of bracing, it is recommended to do a strength-training program to the area to wean off of the brace.

8. Under what conditions should an athlete seek medical attention for an injury? It is never wrong to seek medical advice for your child’s injury. Immediate medical attention is needed when the athlete has:
Inability to bear weight on the inured area after 30 minutes of ice and rest
Obvious deformity of the joint (fracture, dislocation)
Persistent swelling or pain
Inability to return to sport or physical activity without pain
Repetitive injury to the same location
Any doubt about the severity of their injury.

9. How do I know if my child needs orthotics? Children need orthotics when they have a significant underlying congenital foot problem like significantly flat feet or extremely high arches; AND this foot deformity is causing repetitive injuries. Repetitive stress injuries are often caused by faulty biomechanics and can be controlled with functional foot orthotics. You want to discuss orthotic therapy with your physician if your child seems to be getting injured over and over. Other reasons for your child to need orthotics are kinetic chain disorders. This means that their foot type is causes stress injuries in other parts of there body; like their knees, hips or lower back. Orthotics are often prescribed to “perform a tire realignment” on a child’s foot to decrease stress in other parts of their body. The best way to determine the need for an orthotic is a comprehensive biomechanical exam at your podiatrist.

These are the top 9 questions parents ask about their child’s sports injuries. Hope they help keep your kids safe and enjoying all their sports!

Avoid Falls Running on Ice and Snow

Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).

I wonder how many of them were runners? I watched from my window this morning as one of my crazy neighbors fell running on the sidewalk in front of my house. The snow had not even stopped coming down yet! Crazy! Even I ran on the treadmill this morning, and most of my peeps will tell you: I Hate Treadmill Running! Better the treadmill than the emergency room!

Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.

Safety Tips

It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:

Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping. Trail running shoes are better than your regular road shoes.

Run or walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run quickly. Run in high alert!

Run or walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying anything that may cause you to become off balance. This even means leaving your precious water bottle at home

Run or walk "small." Practice your "Chi" running and throw your center of gravity forward. Avoid an erect, marching posture. Look to see ahead of where you step.

When you step on icy areas, take short, shuffling steps, curl your toes under and run or walk as flatfooted as possible.

Run where the path has been cleared. Even in your own yard, remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Don't be stupid like my neighbor and try to run while snow is still flying!

Falling Safely

Even when you practice safe running and walking habits, slipping on ice is sometimes unavoidable. It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.

When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.

People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If it is not a choice to hit the treadmill, practice caustion while running in the snow and ice. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn’t mean it is not broken.

Do Functional Foot Orthotics Work? Yes!

Dear RunDoc: I read in the NY Times that orthotics often don’t work and I should try running barefoot to strengthen my feet. I tried and my feet got a lot worse. I know you wear orthotics and make a lot of them for your patients. Why do you think custom foot orthotics work in your hands?

RunDoc answers: Hmmm….Good question! I read the article in the New York Times and laughed then cried. They are so biased against orthotics that this is bout the tenth time in the last few years they are trying to make them voodoo. Fortunately, they are wrong and there is science behind it.

Many tens of millions of patients have been helped by custom-made foot orthotics over the past 50 years.

There are many studies published in peer reviewed medical journals showing the effectiveness of orthotics in reducing injury and relieving pain.

One of the most important factors creating the need for orthotics is that we usually walk on essentially hard, flat surfaces that do not exist in nature.

Walking or running barefoot does not change the above.

The science of biomechanics relating to orthotics is complicated and requires years of study. This is why you should have your orthotics made by a well-trained podiatrist in biomechanics and even better, one who has an understanding of your specific sport.

The process of getting an orthotic to be most effective is iterative, often requiring serial adjustments. This is because everybody is different and may not tolerate “perfect” biomechanics.

The conditions for which orthotics are prescribed often take years to develop. They are not going to disappear overnight with the use of orthotics.

Orthotics should not be chosen by how comfortable they feel. Often, they are uncomfortable at the beginning because they are “correcting” your biomechanics with an external device and you have to get used to them.

The reason foot impressions (casts) are taken off-weight-bearing is so the foot can be positioned in an optimal shape that will allow it to naturally bear weight on its own. A three dimensional scanner can also be used to get a “true” picture of the foot without a cast.

Orthotics are not arch supports. They guide the foot through a proper gait cycle, allowing the foot to achieve various optimal positions at the correct time and creating a means for shock absorption, weight bearing, and propulsion.

A flat foot by itself is not good or bad. A high arch by itself is not good or bad. How the patient functions with those features is the issue.

If you have been told you need orthotics and you’re in doubt, get a second opinion. If you have orthotics and they are not working, get them adjusted.

Correctly made functional foot orthotics work! I have built my reputation with them.

Run Happy! And in orthotics if you need them!

Acheive Your Fitness Goals!

The most common New Year’s resolution in the United States is to lose weight or improve your fitness. Let’s face it, even for the veteran marathoner or triathlete, the New Year gives us an excuse to refocus or give us just a little kick in the butt we need. We all need a plan to achieve our fitness goals or race success. I woke up on January first and realized it was 21 weeks until Ironman Texas. Wow! That crept up on me! Janet has been blogging for months about the road to Ironman Texas. I’ve been so busy working my butt off and being Mom, it crept up on me. Now it is time to refocus on my fitness goals, so I don’t perish on the streets of Houston on May 21st.

Maybe you are like me, a race is creeping up on you, or maybe you have just gained a few extra pounds from the holidays, or maybe you are like some of my friends who realized running up their stairs they get out of breath. This is a great time of year to refocus on your fitness goals. We all have obstacles; time, energy, financial, and our own self-defeating voice in our heads! Here are some tips that will help you focus and reach your fitness goals in 2011!

1. Know your goals: You need to start with the end in mind. What are your goals? Lose weight? Get faster? Get fitter? Get stronger? Body sculpting? Finish your first marathon? Finish your first Ironman? Whatever they are, start with small focused goals and build to larger ones.
2. Start Simple: Begin with a basic program. Make it a habit, and then you can build from it. Maybe you run for 30 minutes every morning at 5:30 am. Maybe you add a strength work out twice a week. Maybe it is as simple as adding a tempo run once a week. By starting simple, after 21 days you have now made a new habit to build on.
3. Write it Down: A goal not written down is a mere wish. Also, logging your workouts make them more real. It also makes any blank spots much more glaring! There are lots of logs or even phone apps to log your workouts and your nutrition. Use one! Include your goals at the top of each page of your log. I also find it helpful to leave myself sticky notes around the house. When you find a note that says “20 weeks to Ironman” on your bathroom mirror when you get up in the morning that is powerful motivation!
4. Enable Yourself: Make sure your equipment is working well. Time to get that new pair of running shoes. Time to tune up the treadmill and work on your bike. Buy yourself a new toy like a chin up bar or power meter for your bike. New toys make fitness goals even more fun!
5. Make it Fun: Find some workout peeps. Make sure you are having fun even when your muscles are screaming at you to stop. I find a weekly group run or ride, coupled with a weekly mostly social weight workout at the gym, makes the many solitary miles on my bike, treadmill or road a lot more tolerable.
6. Confuse your body: Mix up your workouts. Your body gets stronger and faster with small incremental increases in stress. This means changing speeds, changing routines and scenery to confuse you muscles to get stronger. Throw in a crazy yoga workout, a new routine or just a bunch of hills when you usually avid them. Change your energy levels for better success.
7. Be Committed and Consistent: Every year I see a whole gaggle of new people at the gym in the first week of January, and then they are gone by Valentine’s Day. Fitness goal cannot be reached in a month or two. You have to commit to your goals and work towards them. It may take a year to reach your goals. I started working towards my first Ironman two years ago. Now I am less than 5 months away. Rome was not built in a day. When you feel like quitting, pull out your goals and read them again. Start a mantra, “Pain is temporary and quitting is forever” is the one I use with my middle school cross country running daughter. I personally like, “It’s all about the finish line”. Find one that works for you. It really is true that the hardest part of a marathon is the first three steps out of bed in the morning! You will find that once you get up, the rest is easy!

If you follow these few tips, I promise you will reach your fitness goals in 2011! You will thank me! And I will live though Ironman Texas this year! Run happy and towards your goals!

Carroll Middle School First Cross Country Meet For Alex

This week my 12-year-old daughter, Alex, had her first cross-country meet. Wow! 7th grade. Where did the time go? The States of Texas is so weird with their sports timing. Middle school cross country is December to February. Very strange and I figure we will be freezing for many of the meets, so it will feel just like Rhode Island in November! All joking aside, when she put on her uniform, I almost cried. My heart was so full of joy that my daughter would hopefully experience the same positive affect that competitive running had on my teen years. Most of my happy times as a teen revolved around running and running is so much a part of my life still today.

As for Alex’s first meet, true to form, she found the only gopher hole in the first 100 yards of the race and fell flat on her face (all my Facebook friends that ran with me are laughing, my nickname was “Crash Crane” because I fell so much!), but got right back up and proceeded to pass about a hundred people. She finished 83rd (out of about 300) and did her best time to date. She was very excited and happy. Energized to do it again after the holidays!

So here is a shout out to all Moms who infect their kids with the running bug. Keep it up!
It is a great way to occupy them as teens and positively influence their health choices for a lifetime!

Why Is The Ability To Be Truly Thankful and Happy Elusive To So Many?

This Thanksgiving weekend I sit back and reflect on how thankful I am for all the blessings I have in my life. I have a wonderful family with three healthy and happy girls. My oldest two even did their first triathlon this fall with me. I am blessed with healthy and happy 70+ year old parents who support me and my girls in all our crazy endeavors. I have siblings, who think I’m nuts, but would cross the globe to help me. I have amazing and creative friends who have circled the wagons every time I needed them. I am blessed to be loved by a caring, thoughtful and selfless man who treats me like a princess. I have an unbelievably rewarding and fulfilling career in a profession that not only supports my family, but fulfills my need to be needed and useful in other people’s lives. And I enjoy the ability to run, jump and play (as well as swim and bike) with all my friends and the rest of the crazy marathon running, triathlon trying community. I am truly blessed and remember that daily.

Why is that peace so elusive to so many? I think Blake Mycoskie, the founder of TOM’s shoes and one of my personal heroes, hit the nail on the head in his Thanksgiving blog post, “This Thanksgiving, try to really stop. Sit still. Hold a loved one's hand, and simply be thankful. No matter what your situation, positive or negative, sad or joyful, take the opportunity to truly experience this moment. The stillness. The mystery of this life. For this, and no other reason, I'm thankful.” If you are not familiar with TOM’s shoes, take a look at their website. He gives a pair of shoes away to a needy child every time they sell a pair of shoes. They have given out more than a million pairs of shoes already! Changing lives one pair at a time. Not bad for a 30-something guy from Arlington, Texas!

Happiness and peace of mind does not need to be elusive. Enjoy a still moment. Revel in the people and places around you. No matter what is going on in the circus that is your life, we all have something to be thankful for; even if it is just breathing another day. And for all the runners and triathlete’s who follow my blog, we should all be thankful for the ability to enjoy our sports activities. Always answer the question, “Why do you run?” with the answer, “Because I am blessed that I can!”

Happy Thanksgiving to all! Run happy!

Losing Your Motivation to Run?

Let’s face it. The alarm goes off at 5:30am and there are many days I don’t want to get up and run or bike. My bed is warm and the air is cold. My pillows are so comfortable and missing one work out won’t matter that much. I’m in great shape! STOP! The negative self talk is waxing away at your motivation and suddenly those fitness goals are sliding away.

It’s not hard to stay motivated during the season. There is always a 5K or sprint triathlon every weekend and they fill your calendar. Your “A” and “B” big races are in red on the schedule and that motivates you to get out of bed and even do two-a-days. But now it’s off season for triathlon, and even the fall marathon season is slipping away. The days are getting shorter and colder; and in some areas the snow has begun to fall. Even in North Texas, the mornings are dark and the winter running gear is coming out of the moth balls. Motivation is hard to come by. I’m tired and cold and my morning run has lost its appeal.

What’s an athlete to do? Well, the winter off-season is a great time to mix it up a little. Training has to change from time to time to be effective. We all get stuck in ruts, so the off-season is a great time to try out some new tools. This is the time to build some strength, allow other muscle groups to become more balances and especially allow for recovery from a hard season. It’s the time to build on the hard work of the season and prepare for even greater success in the future! Motivated yet? Me neither, but I find two great tools do help me shake the winter doldrums and get motivated to work towards the next season: goal setting and visualization.

Everyone yawns now; it’s the goal setting lecture…..Wake up! Most of us have goals in our head, but very few have written concise, realistic, timely goals for the next year. A goal not written down is a mere wish! Teaching yourself to write realistic, yet challenging personal performance-oriented goals will allow you to do the work necessary to achieve those goals, allow you to see improved performance, lead to increased confidence, and ultimately lead to greater success as an athlete.

Goal Setting 101
1. Define what you want to accomplish in 2011. It is important to begin with the end in mind. My goal for 2011 is the finish the Texas Ironman and not perish. Good goal! Time goals or a new distance should be realistic. I once had a patient that told me her goal was to finish a marathon a month in the next year. I asked how many marathons she did last year. None. Not a realistic goal!
2. Know where you are right now. How strong are you? Do you have any nagging injuries?
3. Be honest about what you need to develop. I need to get stringer on the bike. What are your weaknesses? Be objective and painfully honest with yourself. Put your ego aside. This is an important step.
4. Set sub goals and segment them. Perhaps you have a time goal, but you also probably have a weight goal, a nutrition goal and a mental goal.
5. Write performance goal for all the sub categories. Be specific and measurable. Don’t say, “I’m going to stop drinking so much beer,” a better goal is to say, “I’m only going to have one beer a night and only on days that start with S.”
6. Commit yourself completely. A goal should be something that leaves you with a burning desire to reach it! I post my goals on a sticky note on my bathroom mirror so I look at it daily. This motivates me. Have a goal card in your pocket and look at it. Keep a training log and make interim goals. This helps you stay focused.
7. Monitor your progress. Listen to your body and do not become obsessed with your goals. Your body will tell you if you need more rest! Injuries happen when we push ourselves too hard. This does not help us meet our goals.
8. Visualize yourself meeting your ultimate goal. I have watched myself cross the finish line of a full Ironman many times in my head. Close your eyes and visualize the starting line and you are feeling great and in the best shape of your life. Go through the race in your head, feeling confident and relaxed. Watch yourself finish strong and feel the rush of achieving you goal. Practice this weekly and your brain will be mentally prepared for success.

Motivation and drive come from constant focus on the destination and then seeing you move through the process to get there. Having a purpose is important or it is really hard to consistently train during the off season. Take some time and work on your goals. Visualize success, and then get out of bed!