Kids' Wellness Matters Podcast Ep. 21: Keeping Young Athletes Safe and Strong

More than half of school-aged kids in the U.S. report playing on a sports team or taking sports-related lessons in the past year and experts agree that youth sports not only help get kids physical activity, but can have a variety of psychological, social and academic benefits. One downside is the potential injuries that come with playing sports or just being an active kid on the playground. On this episode of Kids Wellness Matters, Dr. Sigi Wolf, attending physician in Lurie Children's Division of Orthopaedic Surgery and Sports Medicine, talks about preventing sports injuries and when to bring your own young athlete into the doctor's office for medical care.

“Strength training does not affect your growth. It does not damage your growth plates. There is no negative consequence on your child's final adult height. And it's safe for kids to strength train even before puberty when their growth plates are really open and they're growing new bones really quickly. And in fact, it actually helps your bone's health to do some strength training. It helps increase bone density, which helps prevent things like broken bones.”

-Dr. Sigi Wolf, MD

Show Notes

• Dr. Wolf recommends indoor and outdoor activities that can be spread out throughout the day to achieve 60 minutes of daily activity that is recommended for kids. Ideas to reach that 60 minute goal include dance parties, obstacle courses, swimming and local community programs.
• Parents should make appointments for pre-participation physical evaluations (PPE) six weeks before a season starts to ensure their children are physically ready for sports. She says family medical history, especially regarding cardiac issues, is essential to share during the exam.
• Specializing in a single sport from a young age (8 to 14 years old) increases injury risks and burnout. Dr. Wolf  encourages sport sampling and multi-sport participation to enhance overall athletic skills and reduce injuries.
• To prevent overuse injuries and burnout children should be encouraged to take one-to-three months off from organized sports annually or split these breaks into smaller periods of time, incorporating one or two days of rest from organized sports weekly.
• Persistent pain in specific areas, changes in form or movement, and compensatory muscle usage are all signs of overuse injuries and require rest.
• R.I.C.E. (Rest, Ice, Compression, Elevation) therapy is recommended for recent injuries to reduce inflammation and pain. Short-term treatment also includes the use of over-the-counter pain medications that can relieve discomfort, but these should be avoided for long term usage.
• Signs of serious injuries include difficulty bearing weight, significant swelling, difficulty breathing, numbness, chest pain, or a pounding heart could necessitate immediate emergency care.
• To prevent sport injuries in children, parents can advocate for strength training in programs, ensure protective gear is properly fitting, and influence children’s behaviors by modeling health habits and self-care. 
• The Knee Injury Prevention Program (KIPP) at Lurie Children's is a neuromuscular training initiative aimed at reducing the risk of ACL and other knee injuries, particularly in adolescent athletes. It promotes healthy movement patterns utilizing exercises that prevent injuries and strengthen muscles and improve coordination.
• KIPP resources are freely available online, making it accessible to community teams and schools.

Transcript

[00:00:00] Dr. Nina Alfieri: Welcome to Kids Wellness Matters. I'm Dr. Nina Alfieri.

[00:00:07] Dr. Rob Sanchez: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Dr. Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:26] Dr. Rob Sanchez: Come on, let us hear it. It's okay. Nina

[00:00:29] Dr. Nina Alfieri: Alright, I'll let it out. I was a golfer back in the day..

[00:00:33] Dr. Rob Sanchez: I like it. Tell me more. Were you, were you decorated, did you dominate?

[00:00:37] Dr. Nina Alfieri: Okay, I was a state champion golfer actually.

[00:00:42] Dr. Rob Sanchez: Okay. All right. Bowing down. Yes. Go, go.

[00:00:45] Dr. Nina Alfieri: That is usually my two truths and a lie story Uh, I story about this to inspire the youth. I actually was the last person probably to get on the team and they didn't cut anyone that year. My first tournament, I shot a 131 and I worked really hard. I got myself down to some pretty low numbers and made it to state. And so I, it's a story of hard work and perseverance. But, yeah, I'm like embarrassed bragging about it. I don't mean, I don't really need to brag about it.

[00:01:12] Dr. Rob Sanchez: I think you should. I mean, come on. that Level of improvement, I mean, that's like Michael Jordan level, like, you know, didn't make the JV team like last to get picked and then just coming out dominating,

[00:01:23] Dr. Nina Alfieri: I guess there is something to be said about the most improved award. How about you? Were you in any sports when you were a kid?

[00:01:29] Dr. Rob Sanchez: I did soccer. I did cross country. They brought lacrosse to my school. I'd never played it before, but I was like, sure, let's do that. I was not. A state champion. but I did have some good improvement. I remember the pride of when I made the varsity soccer team after not quite making the cut the first time around.

[00:01:46] Dr. Nina Alfieri: Sports are so good for kids, The team aspect , the activity. I feel like you learn so much discipline from it. There is also such a focus now on keeping kids safe and recognizing

At that age, their bones and joints are still developing. And so there is a lot of talk now and a lot of research on how to help kids enjoy sports and do it safely.

[00:02:07] Dr. Rob Sanchez: Yeah, absolutely. That's exactly what I talked about with our wonderful expert, Siggi Wolf. Talking about a lot of different things including things like overuse injuries. They actually have a program at Lurie Children's that just focuses on things like knees and preventing injuries to things like ACLs and ligament injuries.. We talked about trying lots of different types of sports. Was golf like the one where you set on that for a while or did you try a bunch? I mean, I obviously did a whole bunch of different ones.

[00:02:32] Dr. Nina Alfieri: I did swimming, diving, I tried running for a bit. Yeah, we were kind of all over the place. We were a big hockey and figure skating family until I kind of settled into golf, Mm

[00:02:43] Dr. Rob Sanchez: Sampling is actually like really promoted, but we're seeing that going away a little bit as certain kids like to pick one sport and do it, almost in isolation . That can actually be shown to. be more prone to injuries. And so we had a really good conversation about how to keep kids safe, how to encourage them to try different things,

[00:03:02] Dr. Nina Alfieri: I love it. Dr. Wolfe is the absolute best and someone who I personally consult a lot for questions for my patients. So this is going to be an awesome episode and one that you're definitely going to want to listen to,

[00:03:13] Dr. Rob Sanchez: Are you hitting the range anytime these days?

[00:03:15] Dr. Nina Alfieri: You know, it is one of my goals in the next few years to get back out and hit some buckets. So, we should bring the kids and take them out.

[00:03:21] Dr. Rob Sanchez: Yeah, maybe we'll be inspired after this episode.

[00:03:24] Dr. Nina Alfieri: Love it.

[00:03:28] Dr. Rob Sanchez: More than half of school aged kids in the U. S. report playing on a sports team or taking sports related lessons in the past year. And experts agree that youth sports not only help get kids physical activity, but can have a variety of psychological, social, and academic benefits. One downside is the potential injuries that come with playing sports or just being an active kid on the playground. Today, Dr. Sigi Wolf joins the show to talk about preventing sports injuries and when to bring your own young athlete into the doctor's office for medical care. Dr. Wolf is an attending physician at Lurie Children's in the Division of Orthopedic Surgery and Sports Medicine. Sigi, welcome. 

[00:04:04] Dr. Sigi Wolf: Thanks so much for having me.

[00:04:05] Dr. Rob Sanchez: To start off, National Health Guidelines suggest kids get at least 60 minutes of physical activity every day. Could you explain what that looks like and how youth sports can play a part in reaching that goal for young children?

[00:04:16] Dr. Sigi Wolf: Yeah, absolutely. We really want kids to be exercising, getting their heart rate up, getting out of breath for about an hour a day. Now, that doesn't have to be all one hour. That could be kind of spread out 10 minutes at the playground before school. You know, maybe you're playing tag with your siblings at home, all kinds of different things, having a dance party. But trying to get to that 60 minutes where they're kind of getting a little bit out of breath and especially three days a week, we want that to be pretty vigorous activity where they might get a little sweaty and out of breath. We also want kids to be incorporating some strength building activity. Now you might be thinking, how is my five year old gonna do strength training? You know, it might be envisioning like CrossFit gym or something like that in dumbbells. But you know what we really want is activities where kids are moving their body to get stronger. So that might be climbing on the playground. That might be doing kangaroo hops or crab walks or bear crawls. Things that are just getting your body stronger. So we want three days of the week to include that.

[00:05:11] Dr. Rob Sanchez: I love those ideas. I know, you know, I have an almost three year old. He's always getting his activity up. But sometimes, you know, you mentioned you do have to get a little creative. Depending on the time of year, they might want to do indoor activities. As well, do you have tips that you talk with families about how to get those heart rate up for indoor activities too?

[00:05:27] Dr. Sigi Wolf: Yeah, absolutely. As we kind of head into this really chilly part of the Chicago winter. Definitely that's at the top of my mind. A lot of things like dance parties indoors, or we'll do like races in my house with my toddler or set up obstacle courses, those can be fun. And then of course there's lots of really fun indoor sports that can happen this time of year. So within your local community, there are tons of options. I have taken my own child to things like swimming classes or indoor soccer, so lots of different ways to get moving.

[00:05:58] Dr. Rob Sanchez: I totally agree. In clinic, I talk with families about local park district options, you know, looking at their local YMCA or other organizations. I'm glad that you're promoting it too. These are all wonderful opportunities. but you did talk about, and we're here to talk about, some of the roles that sports can play. And so, I want to focus on that a little bit too. One of the things that comes, up in terms of the work that we do are things like sports physicals, before enrolling in a sport, the American Academy of Pediatrics suggests that you take your child to a pediatrician for a sports physical before the season starts. So for high school sports, this is required, in most states. Can you talk about why this physical is important and how sports physicals might differ from just a regular school physical.

[00:06:35] Dr. Sigi Wolf: Yeah, absolutely. So the pre participation physical evaluation or PPE for short, we really want that done in your child's primary care doctor's office. So whether that's a family medicine doctor or pediatrician or whoever they see for primary care, the person who knows your child best and your family best is the best person to complete that. Ideally we want that done six weeks before that first practice of the season. Because if we find anything, we want to have time to address it. So let's say that your child goes in and your child's doctor has some concerns about their heart. We want them to have time to see a cardiologist and have everything safe and ready to go before that first practice.

[00:07:15] Dr. Rob Sanchez: Great point. What are some of the things that parents can expect, when they're taking their child in for a sports physical exam?

[00:07:15] Dr. Sigi Wolf: We would expect your child's pediatrician to ask a lot about your child's own history, about their breathing, any signs of cardiac problems, any injuries they've had in the last year or so, any concussions, things that might stop them from participating in a sport. So your pediatrician will go through all those questions and they'll do a little bit more in depth physical exam of your child's bones and muscles and joints and make sure that everything is working well before your child starts that sport.

[00:07:47] Dr. Rob Sanchez: Super important and it's always a little bit more involved but it's also fun because you get to get them like off the table and doing some exercises around the room. So know that they might be getting the chance to move around during the visit too is always helpful for parents. One of the things that also gets brought up, that maybe parents can be aware of is thinking about family history, right? Those are sometimes questions I get asked about like heart conditions or things that might run in the family. What are some of the things that might come up, that families should be aware of to raise with their primary care doctor during those sports, physical.

[00:08:14] Dr. Sigi Wolf: Sometimes families come in and they know that maybe a sibling or aunt or uncle or grandparent has a heart condition, but they're not really sure what it is. So trying to ask those questions of your relatives before you come in, hey what happened with their uncle or, you know, that can be really helpful for your child's doctor to know specifically, and sometimes it's hard in the visit if you haven't asked beforehand. 

[00:08:30] Dr. Rob Sanchez: So kind of thinking about problems that might run in the family, especially with the heart is really important.

[00:08:40] Dr. Sigi Wolf:  Absolutely. And all of that in the goal of, you know, really ensuring that they're able to participate in these sports and do well. It's all about that preparation. So that's certainly one of the first steps. One of the things that we wanted to chat about too is specializing in sports. It can be a bit of a hot topic. Some kids become specialized in a sport at a young age. Can you talk a little bit about this trend and why this early specialization can be a little risky or just some things to watch out for?

[00:09:04] Dr. Sigi Wolf: This is something we have definitely seen a lot of in the last few decades of athletes who at a very young age, as young as elementary school, are being pushed to pick one primary sport that they're competing in year round. And that can be really hard when all of your child's teammates are, you know, gonna do fall ball and then they're gonna do a house league and a travel league, and then they're gonna play the school baseball team, you know, and they're gonna play through a park, district league. Right. And it's hard to not kind of get sucked into that, doing that one sport year round and not feeling like your child's gonna be left behind. But what we've discovered as this trend has grown and grown is that kids who specialize at a young age, especially in that eight years old to 14 years old age group, where they're just doing one sport year round, they have a lot more injuries and a lot higher rates of burnout than kids who are participating in multiple sports or doing what we call sports sampling. We know that by trying multiple sports, it builds your athletic skills. And those athletic skills actually will cross over to your other sport. So let's say that your child does swimming and they also do basketball. Doing both of those sports actually prevents injuries because you can take those skills you learn in one sport and transfer them to the other sport. And in fact, when we look at athletes who play at a Division One college level or professional level, the majority of them play multiple sports through high school, and if you start looking into this amongst the pro athlete world, you'll see that there are a lot of pro athletes who almost went professional in different sports, so that's pretty common. So I think that's something to keep in mind as a parent when you're getting this pressure to have your child be in one sport year round at a very young age.

[00:10:43] Dr. Rob Sanchez: Yeah, and that pressure, as you were mentioning, can sometimes come kind of early on, like when the children are still young. Do you have general tips that you like to offer parents to really allow them to try different sports, allow them to make sure that they set apart time to learn different skills and realize that there's strengths that they can bring to that ?

[00:10:59] Dr. Sigi Wolf: Oh, yeah, absolutely. We see so many what we call overuse injuries in my line of work, where kids are getting injuries from doing something too much and kind of overusing that body area. Or they're getting burnout, right? They don't want to go to practice anymore. They're just kind of feeling tapped out and less interested in the sport. So we want to avoid both those things. So to that end, the American Academy of Pediatrics came out with a new clinical report on overuse injuries, overtraining, and burnout. And part of that was some recommendations about, you know, trying to take two to three months off of any one organized sport each year. And that can kind of help it stay fun and avoid some of those overuse problems like injuries and burnout.

[00:11:41] Dr. Rob Sanchez: That's so relevant. I feel like I have close friends, who have, you know, children who are doing sports that can be year round. You know, baseball is a common one that I think about. And in terms of overuse, I mean, you're always thinking about the arm, the shoulder. But that can apply to so many other sports too.Soccer, maybe more leg injuries. Swimming you talked about. there's so many different things that can be impacted. And it's good to know that sometimes break is not necessarily from activity, because we want them to stay active, but just from a different type of sport, a different type of focus that they have can be actually recommended and helpful overall.

[00:12:13] Dr. Sigi Wolf: Yes, absolutely. And as you said, Rob, you know, some sports you can't take two or three months off a year. It just doesn't work. Like gymnastics comes to mind. You really need to maintain some of those skills for safety and that strength. But you know, trying to think about, okay, so if I want to have my child take off two to three months a year, can we break that up into eight one week blocks? Right? So maybe around the holidays, they're taking a week or two off. Maybe at the end of the summer, they're taking a week or two off spring break, things like that. So kind of trying to hit that. 8 week mark by splitting it up throughout the year if your sport doesn't allow for that kind of two to three months continuous. But along that same vein, we do want kids to have a day or two off of organized sports a week too, and just have them have the opportunity to play and to recover.

[00:12:55] Dr. Rob Sanchez: And you talked a little bit about, just the notion of kind of sports burnout and I want to ask you a little bit more. That can be tough as a parent to know when to be like, no, we got to go to practice, but then, There's a difference when it seems like they're really losing some of the enjoyment there too. but also could be harder for their overall health and injury prevention and things like that. It'd be great to hear your thoughts on burnout in sports.

[00:13:14] Dr. Sigi Wolf: You know, I think it all comes back to what is the point of sports. Different people have different views on this, right? But I think most of us can agree that we want sports for our kids to be fun, we want them to get new skills, but we also want them to be safe, and we want them to gain sportsmanship skills. So I think kind of focusing on that and viewing the sport through that eye of, hey, is this what this sport is still offering to my child and kind of teaching your child, hey, to listen to their body and to recover and that's part of being an athlete is taking care of yourself. So those are some of my tips, but also that going back to that sport sampling. The more a child is interested in participating and the more things they get to try and find things that are interesting to them, that will also help with that burnout. So thinking about where are all those pressures coming from ?.

[00:14:00] Dr. Rob Sanchez: And that makes total sense. All those are such important ideas as you're thinking about that for your children. But, ultimately can really help prevent injury. And I want to ask a little bit more about that. Maybe a child does pick a sport, they are becoming more involved in it. There might be some concern for some of those overuse injuries that you mentioned. What are some of the signs of an overuse injury? What are things to look out for and what are some of the options for treatment if there is concern for an overuse injury in children?

[00:14:24] Dr. Sigi Wolf: Definitely if you see your child , is having a pain in one area or their knee is always hurting with an activity, or their ankle, or their back, things like that, that don't seem to be going away, that are sticking around for several days that's a sign that your child might have an overuse injury. The other thing that parents will often come in and say to me is their form is changing. So I noticed in volleyball, their overhead serve just seems like they're moving their arms in a funny way. Or, you know, in baseball, you know, I noticed that they're taking a shorter stride when they're pitching. And they seem to be moving their arms in a little bit different way and their velocity is dropping . Or, you know, in gymnastics, like maybe when they're dismounting, they just don't seem that comfortable and they seem to be leaning forward a lot more. Things like that, parents can notice like, Hey, if your form is slipping, is it because you're in pain and your body's trying to get away from the pain?

[00:15:11] Dr. Rob Sanchez: One of the things could be is that there's pain because there's probably some inflammation in a particular major muscle. And probably the concern might be is as you're changing up the form, they're maybe unconsciously using other muscles like accessory muscles to try and overcome that. Is that kind of what's going on there? And why is that something that could be concerning?

[00:15:29] Dr. Sigi Wolf: Yeah, that is absolutely right, Rob. So we oftentimes we'll see where a child has one injury and then it leads to another and another, because they're moving their body in an unhealthy way and they're using muscles in ways that they shouldn't be used. So that's why we always want kids to have really good form when they're doing their sport or activity is to prevent injuries. So that's why we don't want kids when they're limping or they're really distracted by a pain or an injury to be doing a sport at that time. Those are signs to back off .

[00:15:57] Dr. Rob Sanchez: Yeah, having that rest and allowing that main muscle, those main group of muscles to really heal will help out much more in the long run, as opposed to having more of those minor injuries that you mentioned could be of a risk there too. 

[00:16:08] Dr. Sigi Wolf: Absolutely. And something we go through a lot in sports medicine, and I know that in primary care and urgent care and the ER, they do a lot too, is hey, maybe if your child has an injury, we'll What can they do? Maybe they've injured their ankle, but can they still work on their core? Can they still do sit ups? Can they still do plank holds? Can they still lift weights when they're sitting in a chair? What ways can they still stay involved in their sport while respecting their body so it's not just all or none?

[00:16:33] Dr. Rob Sanchez: What are some of the treatments that parents might expect if they are able to bring them into their doctor in terms of recommendations

[00:16:38] Dr. Sigi Wolf: For more minor injuries, sometimes we'll talk about RICE, which is an acronym that we use for rest, ice, compression, and elevation. You know, resting from the things that are really aggravating the pain, putting ice on. My favorite way to apply ice, and there's some research data behind this, is to put the ice on for 10 minutes, with something like a thin paper towel or something to protect the skin from the direct ice. Take it off for 10 minutes and then put it back on for another 10 minutes and that can really help. Compression, especially for things like ankle injuries, putting something that's got a little bit more support can help. And then elevation, so if something's really swollen, putting it up above your heart. Putting like a leg up on pillows when you're laying down on the couch, or putting your arm up on something if your wrist is swollen. Those kinds of things can really help.

[00:17:21] Dr. Rob Sanchez: common questions that I get are, should I ice it? Should I heat it? How does that all work? And I also get questions about the elevation. Like, what is the role that it plays? Is it the blood flow? Is it the swelling? How do you talk to families about what we're aiming to do with those rice therapies?

[00:17:36] Dr. Sigi Wolf: It can be hard to know what to do in the moment. So typically ice is my go to if your child has had an injury in the last few days to maybe up to two weeks. Let's say they got hit really hard by another player, you know, got hit in the shin with a field hockey stick, whatever it might be. Ice is kind of helpful with helping bring down that inflammation. Now, If your child has been dealing with some pain for a while, say they're having low back pain, sometimes putting on heat can help relax those muscles that might be tight and spasming. So I'd say generally putting ice on if the injury is more recent and heat on if the injury's been happening for a while, but of course do what feels best for your child and your child's body.

[00:18:17] Dr. Rob Sanchez: Makes a lot of sense. And especially, as you mentioned, with the ice, always have a thin layer or something in between just to protect the skin over the area that's been injured too,

[00:18:25] Dr. Sigi Wolf: absolutely.

[00:18:26] Dr. Rob Sanchez: And then with elevation, what exactly are we aiming to help out the body do there as it looks to heal from an area that might be a little injured or swollen.

[00:18:34] Dr. Sigi Wolf: We know that when things get swollen in the body, you can get a lot of inflammation, you can get bleeding or bruising in the area. And so, when you put that body part up above your heart, it helps to bring that fluid, that swelling from the tissues, back to the heart through something called the lymph system, which is why compression helps as well. But that lymph system collects extra fluid around the body that has come out of the blood vessels through things like swelling or bruising or getting hit in the area. So putting things up just helps gravity, assist that lymph system in collecting that extra fluid and making your child less swollen and less painful.

[00:19:09] Dr. Rob Sanchez: Yeah. It makes sense. I always think of it in terms of traffic when we think it's about blood vessels. There's like an accident. Hey, we want to open up all this space for people to rush there and get through, but then once they're there, we got to give them a chance to get out of there too. And so I think of it as the elevation as a way to help clear that up after so much of the body has been working to help that injured area as well.

[00:19:26] Dr. Sigi Wolf: That is a great metaphor, Rob. I'm gonna have to take that from you. That's awesome.

[00:19:30] Dr. Rob Sanchez: Yeah, I use it with some of my families too. and then as the body's healing, common things, might be certain medications that could be helpful. So, anti inflammatories. Can you talk through the difference between things like Tylenol, Ibuprofen or Motrin, and then longer acting, stuff like Aleve or Naproxen. How do you approach those and how do you talk to families about those medicines that can sometimes be helpful?

[00:19:49] Dr. Sigi Wolf: Certainly if your child has had an injury that just happened, you know, they fell or they got hit by something, taking a medicine like Tylenol or Ibuprofen, which is also called Motrin and also called Advil, which can be confusing, those medicines can help with that pain in the short term. Now, anti inflammatories are those medicines like Ibuprofen, which is also Motrin,which helps decrease inflammation as well versus Tylenol does not do as much of that. That can be helpful but what we want to make sure is that kids are not taking that for more than two weeks without having that injury or that pain checked out. So generally two weeks is about the max that I would want a child taking an over the counter pain medication. One medication that can be good for more adult sized children is Aleve, which is also called Naproxen. It's available over the counter. That works the same way as ibuprofen, Motrin Advil, but it lasts for 12 hours instead of for six hours. So that can be a nice option if you have an adult sized child who has some pain from an injury and you don't want them to have to take a medicine while they're at school. But again, it works the same way as those medicines, so you don't want to take it at the same time.

And if you're taking those medicines every day for more than two weeks, it can certainly upset your stomach. It can cause problems with headaches. It's not good for your kidneys. So it's something we don't want kids taking every single day for more than two weeks.

[00:21:13] Dr. Rob Sanchez: What are some of the concerning signs for major injuries or more significant injuries where it might need more urgent evaluation, like in the emergency room or something sooner, like with a sports medicine specialist.

[00:21:23] Dr. Sigi Wolf: Definitely if your child is unable to put weight on that extremity, you know, on that limb, let's say that they're having a hard time, like picking up a ball with that arm or they're limping. Those would be signs. You definitely want to take them into medical care. If you see that there's a lot of swelling, a lot of puffiness in one area, a lot of bleeding, those are signs that you want to go in. Any kind of like deformity, like if you're seeing their leg looks crooked, their arm looks crooked, anything, that's where you want to go in and get an X ray. And of course, anything with the teeth, right? If you're worried a tooth might be broken, you definitely want to go into care.

So those things you can watch out for. And then, it can be hard as a parent to know, do I need to take my child to the emergency room or not? Of course, if you see your child at practice or at a game, they're not breathing well, if they get hit and they're unconscious or they just don't seem like themselves, kind of out of it, those would be reasons to go straight to the emergency room. If you saw that they were weak or they couldn't feel their arms or legs normally like, hey, this feels kind of sleepy or tingly or numb that would be a reason. Any chest pain or like a heart rate that won't slow down, like they feel like their heart is pounding out of their chest, that would definitely be a reason to go take your child to the emergency room.

[00:22:32] Dr. Rob Sanchez: One of the things that of course we want to talk about is how to try and hopefully prevent some of those sports injuries.You know, we know that one way to help is through strength or resistance training. Could you walk us through what a typical strength training program might look like for kids or for older children too?

[00:22:47] Dr. Sigi Wolf: So, I love strength training. It's become more and more popular in youth sports, which has been great because we've seen that injury rates are going down for all kinds of sports, even for things that people don't traditionally think of benefiting from strength training like cross country runners. So we know that pretty much all professional athletes incorporate strength training into their training regimens and it helps prevent injuries from a really young age by building what we call physical literacy, knowing how to move your body and kind of building all those key skills that we know kids need to be healthy, active adults. Things like throwing, catching, running, kicking, jumping. Building physical literacy is really key to being a healthy athlete and adult. So things that we can do as parents to kind of help our kids gain those skills is strength training. Strength training is just a way to say any kind of exercise that is designed to increase your muscle strength, your muscle power, or your muscle endurance. So, how heavy of something can your muscle lift? How fast can you lift it? Endurance, meaning how long can you lift it? Or how far can you run? Things like that. And there's so many ways to do that. So, like we talked about, it might be just bodyweight exercises like climbing on the playground or you know, doing sit ups or push ups or for younger kids, things like bear crawls or frog hops, things like that. And then, it also could incorporate some equipment, things that we think of more traditionally, like lifting weights or using exercise bands. So those all fall under the umbrella of strength training.

[00:24:12] Dr. Rob Sanchez: Super important, especially as a former cross country runner. I remember being in the weight room and doing some of those training stuff. And it's great to hear that's being incorporated even more and more, for younger children

[00:24:21] Dr. Sigi Wolf: As this evidence has come out, we're seeing more and more sports that are developing specific strength training regimens to protect their athletes and prevent injuries. So strength training regimens are going to look different based on your sport. So if you're a cross country runner, you might be doing a lot more strength training of your legs and your core and your hips. But if you are a baseball athlete, you might be doing more with stabilizing the muscles around your shoulder blades, doing more with your core. And even your legs and hips, since a lot of throwing power really needs to come from your lower body and core. Strengthen your rotator cuff muscles around your shoulder. So every strength training regimen is going to look a little bit different. Most sports now are coming out with some great programs to help maximize performance and lower injury rates. So it's been awesome to see in recent years .

[00:25:03] Dr. Rob Sanchez: I sometimes talk with families and clinic about. The role of strength training and some of the concerns that it could affect growth. There used to be an idea that it could stunt a child's growth. Is there any truth in that? And how do you address that in conversations with parents?

[00:25:17] Dr. Sigi Wolf: Thank you for bringing that up. That is a really common myth. And parents ask me about this every single week in clinic. So no, strength training does not affect your growth. It does not damage your growth plates. There is no negative consequence on your child's final adult height. And it's safe for kids to strength train even before puberty when their growth plates are really open and they're growing new bones really quickly. And in fact, it actually helps your bone's health to do some strength training. It helps increase the bone density, which helps prevent things like broken bones.

[00:25:47] Dr. Rob Sanchez: Some of the injuries that we also talk about in prevention is making sure that we're using protective gear. and some of those injuries can happen where we're not using it the right way. Can you describe some of the gear that should be worn, how to wear it, and are there some types of protective gear that isn't really necessary too?

[00:26:04] Dr. Sigi Wolf: This is going to really vary from sport to sport. It's important for parents to think about that for their child's individual sport or activity. Really, one of the biggest things that we see is equipment that is not fitting kids well is a risk for injury. So if your child has, let's say, a bike helmet and the bike helmet is too small and it's sitting too high up on their head, that's not going to protect them. If it's too big and it's shaking around, well, if they fall off their bike, that might fall off or slide to the side and they might, hit their head and get a skull fracture in that area where the helmet is not sitting correctly. So make sure that whatever equipment your child needs for a sport that it is well fitting and appropriately sized and not damaged.

[00:26:43] Dr. Rob Sanchez: And I think about that for, you know, my children are still young, but I don't know what kinds of sports that they might be involved in. I'm always worried that they might choose hockey as a sport, which is not something I grew up with. But I imagine there's a lot of parents out there who might have their child involved in a sport where there might not be as familiar with the equipment involved in it and things like that. And I usually talk with them about looking for videos that can help ensure that proper fit, how it's supposed to look, are those kinds of tips that are sometimes helpful or, you know, resources where parents can look to make sure that they're using the right protective gear for their kids?

[00:27:12] Dr. Sigi Wolf: Yeah, and coaches as well as sporting goods stores, can be really good sources of information on that of, are things fitting correctly? Most sports organizations also have standards for what equipment they want for each age group. So that can be helpful too to look that up for your relevant sporting organization.

[00:27:29] Dr. Rob Sanchez: That's also really helpful too mouth guards. Are those also something that's really helpful, especially for any kind of contact sport as well?

[00:27:35] Dr. Sigi Wolf: Mouth guards are awesome. We know that athletes are 60 times more, that's six zero, 60 times more likely to suffer harm to their teeth if they're not wearing a mouth guard. Now, mouth guards can be expensive because a lot of places will offer custom ones or things like that. What's really important is that the mouth guard fits your child. So that can certainly be kind of one of those boil and bite ones that you might have gotten at a sporting goods store growing up. A custom one, what really just matters is that it fits your child and that your child puts it in their mouth. That's much, much more important than if it's a custom one from a dentist or if it's one from a sporting goods store.

[00:28:12] Dr. Rob Sanchez: So good to know. I always see like professional athletes with their mouth guards and things like that. I always think of like Steph Curry . Every time I see that it's like a small little public health service announcement to be like, Hey, make sure your child's using it too cause the pros are using them.

[00:28:24] Dr. Sigi Wolf: Yeah, and it doesn't help, right, if it's just hanging out the corner of your mouth or things like that. it has to actually be in

[00:28:30] Dr. Rob Sanchez: place. In the right place is where it needs to be. Yeah, for sure. During timeouts, it's okay. But during the game, it's where you want it.

[00:28:36] Dr. Sigi Wolf: absolutely.

[00:28:37] Dr. Rob Sanchez: Sometimes I have families ask about things like braces, for certain joints. So elbows or knees? How do you of approach and talk about those kinds of things? How to balance the services that those things might offer, but also emphasizing the importance of good form and good strengthening programs, too.

[00:28:51] Dr. Sigi Wolf: So I always worry a little bit when an athlete comes in wearing a knee brace or an elbow brace or something like that, that they have purchased themselves. Because I wonder what pain they're in. pushing through and how that's affecting their form and what other injuries they might get. I'd say those kind of things are okay to try like elbow braces or knee braces that you might pick up at your local drugstore. But if your child's needing them on a consistent basis, that's a sign that you should probably take them in to see a doctor or talk to their coach about their form and see if there's anything that they're doing in particular that might be aggravating that.

 Some sports teams and some schools are very fortunate to have certified athletic trainers at the school or on the sideline, and those can be great sources of information for if you're not sure if an injury needs help or needs to see a doctor, that is a great person to start with and to ask if you have that available to you.

[00:29:44] Dr. Rob Sanchez: One thing that my listeners might be thinking about is great, I'm talking about how to be active and healthy for my children, but as a parent, how can I model that kind of behavior myself? Man, it's been a little while since I've gotten my heart rate up for more than 30 minutes in a given week. you know, we know that parents can also model these healthy behaviors when it comes to sports and physical fitness. can you share some advice or examples of how parents can do that?

[00:30:06] Dr. Sigi Wolf: You know, it's kind of like eating vegetables. So if you eat vegetables in front of your kid, there is some data that long term your child will eat more vegetables, even if they don't want to interact with the vegetables on their plate. So we know that active parents tend to have much more active kids in the long term who become active adults, which is really important for long term health. You know, I live a very busy life. I have a child. I'm a parent. I work full time. It can be hard to get some exercise in, especially when we're in the winter in Chicago. But I think always remembering some physical activity is better for your health than none. So even if you can't So, even if you can't hit those guidelines for adults, just trying to get in something maybe it's that you're going to take the stairs at work. Maybe you're going to park a little bit farther away. Maybe you're going to do a dance party with your kid, right? Or you're going to do something fun outside if it's a little bit nicer. I keep saying, go to the playground. But here in Chicago, we're lucky to have a lot of great walking paths, like the Lakeshore Path, the 606 Trail. So trying to walk or bike when you can. Or if you're going to stores and they're going to be three blocks apart, maybe you can walk between them instead of driving. So I think trying to think about how you can move kind of in your day to day life can be helpful. And then, you know, as a parent, there are really cool adult sports leagues that you can join. There's a lot of adult soccer leagues or softball or volleyball or my brother plays in a hockey league, you know, things like that. That can be really fun for parents and good role modeling of how to be an active person your whole life. Other things I've done in my family, like we've participated in some local 5Ks or done dance parties at home. We're lucky to have some good public pools in Chicago. And then actually through the Chicago Public Library, there are free passes to a lot of the museums that you can just check out on the app. So I've taken advantage of that too. So that's kind of nice, just getting in some walking, walking around museums here locally when it's really cold. 

And I would just add if you're injured as a parent, take care of yourself, right? So don't have your kids see you limping everywhere, you know, go get that taken care of, right? So I think that parents. need to model healthy behaviors for their kids. And sometimes it's hard as a parent because we're all trying to prioritize our kids. And it's hard to remember that what we do matters as well.

[00:32:12] Dr. Rob Sanchez: I wanted to focus on something that is unique to Lurie Children's. The Lurie Children's Institute for Sports Medicine offers the Knee Injury Prevention Program, KIPP. It's a neuromuscular training program designed to reduce the risk of ACL injuries or anterior cruciate ligament injuries, especially among adolescent athletes. Can you explain KIPP to me a little bit and talk about some of the goals of that program?

[00:32:33] Dr. Sigi Wolf: Yeah, so KIPP is a phenomenal program. It's run through our sports medicine department and It's a neuromuscular training program. So what that means is that it's training your body to move in healthy ways without you having think about it. So things like we know that girls especially teen girls when they land they tend to have their knees come forward over their feet and collapse inward. Well, that's a big risk factor for doing things like tearing your ACL or spraining your ankle. So what this KIPP program does is it's a six week program where it strengthens your muscles. And your balance. So through things like hamstring stretches and lunges and squats and things like that that train your body how to move in healthy ways so that when you're playing basketball and you jump up and land, you're landing in a healthy way and you're not going to trip and fall. tear your ACL or injure your ankle or your knee. So it's a very cool program. There are a lot of neuromuscular training programs like KIPP around the country run through different institutions, but we have seen how much these programs, this strength training really helps with developing those healthy movement patterns and preventing injury.

And then also we have a program called KIPP for Coaches which is where coaches can learn how to take their team through a 10 minute warm up program with these KIPP exercises. So a lot of local sports teams have adopted this and it's all free on the website and it's got great videos. It's pretty easy to use.

[00:33:57] Dr. Rob Sanchez: Another thing that commonly folks ask about is how warm up should be done and, you know, prior to practices and, you know, games and things like that. Are there some favorite tips that you'd like to share there, too, in terms of really good warm up practices, depending on the sport?

[00:34:10] Dr. Sigi Wolf: In general, when you're warming up, you want to have some bigger dynamic movements. So things like squats, lunges, jumping jacks, kind of get all your muscle groups moving, get your blood flowing. And then after the warmup, that's usually when you'll do some of those bigger muscle exercises things like maybe a burpee, overhead press, things like that, and then moving on to those smaller muscle groups like calf raises or bicep curls. And one big change, Rob, from when you and I were kids is now we've realized that it's better to stretch at the end of a practice or a game rather than at the beginning. Because sometimes we saw that kids were over stretching muscles that weren't warm and were getting injured, so now we recommend stretching but at the end of your child's game or session our understanding and you know, recommendations are evolving and it's, Thanks to the work that you do, thanks to the, evidence that we have from sports medicine, orthopedic researchers that are really trying to give us the best advice, remind us that all of these areas are connected, and to really promote different best practices, that parents can utilize with their kids and also incorporate into their daily lives. And so I want to say thank you for all of the work that you do. Thank you for sharing all of your wisdom and advice with us during this episode. I know it's got lots of wonderful, tidbits for our listeners to take away. And as always, thanks for being a wonderful colleague, here at Lurie Children's.

Thanks for having me, Rob. It's been a pleasure.

[00:35:27] Dr. Rob Sanchez: Thanks for listening to Kids Wellness Matters.

[00:35:32] Dr. Nina Alfieri: For more information on this episode and all things kids wellness, please visit LurieChildrens.org