http://pleasantonweekly.com/print/story/print/2011/05/20/danger-on-the-sports-fields


Pleasanton Weekly

Cover Story - May 20, 2011

Danger! on the sports fields

New awareness keeps young athlete injuries to a minimum

by Glenn Wohltmann

If there's one thing that's changed in terms of youth sports over the last 20 years or so, it's awareness about the potential for young athletes to hurt themselves.

In Little League, for example, there are now limits on the number of throws a pitcher can make, depending on his age.

A big push recently is on the field, according to Dr. David Bell, an orthopedic surgeon and sports medicine specialist who practices in Pleasanton.

"It's a fair thing to say we've done a better job in coordinating care among coaches and the trainers and parents to help the young athletes get diagnosed more quickly, get treated and back to the field," Bell said.

Signs plastered in locker rooms tell teens to report signs of concussion -- one of the biggest concerns not only in football, where they've been common, but in every sport.

"With increased awareness on TV and posts in the locker room and obviously NFL exposure we're seeing more kids reporting concussion when it happens," said Ronnie Mimran, a neurosurgeon in San Ramon who's also the neurosurgeon for the Oakland Raiders. "During football season, it's not uncommon for me to see two or three, even up to five a week."

Mimran said he sees concussion injuries in virtually every sport. Recently, he's treated two water polo players, one who slammed her head on a goalpost and another who caught a spike in the face.

Concussions have always been a part of sports, and at least until recently, Mimran said, reporting has been poor. He said that's a twofold problem because, along with coaches and players not being able to recognize the signs of a concussion, reporting one has been taboo.

"There's pressure from peers not to be pulled out of a game and the terminology we use in terms of a warrior culture -- toughen up, get back out there, don't be a wimp," Mimran said. "It's a huge deal and I think that one of the problems in treating patients like these is we don't know the extent of the problem."

He said coaches can be caught in the middle, stuck between pressure to win a game and player safety.

"There's an inherent conflict that can sometimes sway someone's mind," Mimran said, especially if there's an injury to a star player who could be sent out of the game. "There's a conflict to the coach."

But Bell said there's less of the warrior culture in play these days than ever.

"It's my opinion, working with a lot of different coaches, that the coaches and teams are much more conscientious about injuries to young athletes," he said. "It's a rare coach that resists a thorough evaluation of one of their injured players. Most coaches trust the physician and health professionals to thoroughly evaluate the athlete and let them know when they're ready to play."

In terms of sports injuries, concussions may get a lot of attention, but the National Institute of Health (NIH) says that less severe injuries are far more common. These include sprains and strains, heat-related illnesses like dehydration, heat exhaustion and heat stroke, repetitive motion injuries, and growth plate injuries, which is damage to the areas of developing tissues at the end of long bones in children and adolescents.

"We see many more bone and joint, musculoskeletal injuries than head injuries. Some of the bone and joint injuries are minor but we always check to make sure we know what the injury is and to see that the athlete gets better treatment," Bell said. "They are playing while in a body that is still growing. We want to try to prevent long-term problems from injuries suffered while athletes are young."

While Bell deals with bones and joints, Mimran butts heads, so to speak, with concussions, which he said come in a range in severity.

"The vast majority of concussions, if treated properly, resolve in a couple of days to a week," Mimran said. "In extreme cases, players can deal with the symptoms for the rest of their lives."

In addition to case reports from across the country, Mimran said, "I have a couple of players who stopped playing sports as a result of concussion. These players continue to deal with memory issues, headaches, the ability to concentrate."

While injuries can take place in any sport, football is the one that's received the most attention. Mimran said.

But players can take simple precautions to help minimize the potential for injury.

"Avoiding spear tackling, launching and helmet-to-helmet contact," Mimran said.

"Spear tackling," he explained, is exactly what it sounds like -- using the helmet as a spear to take down an opponent -- and "launching" is leaving the ground for a tackle.

"Those things are on the part of the player," Mimran said. "Having someone on the sidelines who's watching the athletes on a play-by-play basis is important, and that's not standard. The frustrating thing for me is that some teams can have eight to 10 coaches but claim they don't have the budget to hire an athletic trainer."

It's not just men and it's not just high schoolers, either.

"Women's sports are just as subject to violent hits that cause concussions. The prime examples in women's sports are soccer, lacrosse, and I've had one woman rugby player," Mimran said. "You're never too young or too old to have a concussion."

The athletes most at risk are involved in a competition that many don't even consider to be a sport. It's usually played side by side with football: cheerleading.

"Based on some research over the last 25 years, it's competitive cheerleading that leads to severe injuries," Bell said. "These are fatal, disabling and serious injuries, not just sprains and strains. It's really due to the fact that they do these stunts -- it's not just dancing."

Sports can also lead to spine injuries.

"Thank God it's fairly rare. This past football season I only had three or four kids that came in for spine injuries, and certainly serious ones are very, very rare," Mimran said.

With Little League season just about to begin and after last year's injury to a pitcher in Napa, baseball has been the focus of concern, too.

Mike Ragan, a local Little League safety officer, said that position is now required across the country, which is a sign that Little League is paying closer attention to injuries.

"It's a pretty big deal in that each league has a safety director. That safety director sits on the board of every Little League. They're required to do a safety plan each year. Safety, as with everything, I think safety is only as good as the focus that's been put on it," Ragan said. "There's been a huge focus even at the district level."

He said local little leagues has been actively improving its safety protocols for years.

Ragan describes safety "as part of the Little League experience these days."

"When we grew up, safety wasn't really mentioned. I never heard of it as a kid," he said. "But let's face it -- we're all parents first and foremost and coaches second. We care about our kids, we care that they have enough fun. We may say, 'Today, let's rest your arm.' Nowadays, in pitching, there are only so many throws your arm has. That wasn't the case before."

Under current guidelines, 8- to 16-year-olds can throw 50 pitches a day, and 17- and 18-year-olds can throw 105 pitches a day, Ragan said. "If they throw a certain amount of pitches, they're required a certain amount of calendar days' rest."

Ragan stepped into the safety director position last year, promising to "take it up a notch."

I think what's really fun about the role I have now is that the kids can play down the road. We look after the kids first and foremost," he said.

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