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Monthly Archives: February 2017

Water Polo

Water polo is an intense sport that requires athletes to tread water and swim for long periods. There is a version for younger athletes that allows them to stand in shallow water or hang onto the side of the pool, but this is illegal in competitive water polo.

Acute and overuse injuries are common in water polo. Acute injuries usually occur when guarding a player or wrestling for the ball. Overuse injuries are often the result of repeated swimming and throwing motions and treading water. As in many sports, the risk of injury increases with age due to the style of play, contact forces, and size of athletes. However, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics (AAP) about how to prevent water polo injuries. Also included is an overview of common injuries.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Athletes with poor stamina are more likely to get hurt both in and out of the water. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should be confident in their ability to swim in close spaces with others. If not, they should begin playing in the shallow end in case they need to stand. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Safety gear should fit properly and be well maintained.
    • Polo caps with ear guards to reduce the risk of ear injury
    • Mouth guards
    • Swim goggles
    • Sunscreen protection (sunscreen, lip balm with sunblock) when swimming outdoors
  • Environment. Pool water should be checked by persons in charge of pool maintenance. Excess chemicals and chlorine may cause eye irritation and skin rashes. Hypothermia may occur when playing in cold water.
  • Rules. Water polo can be very rough. Much of the “contact” takes place underwater, where referees cannot see well. These fouls are often missed and can lead to injury. Parents and coaches should encourage good sportsmanship and fair play. For instance, athletes should never dunk an opponent under the water.
  • Emergency plan. Teams should develop and practice an emergency plan so that team members know their roles in emergency situations in or out of the water. The plan would include first aid and emergency contact information. All members of the team should receive a written copy each season. Parents also should be familiar with the plan and review it with their children.

Common injuries

Eye injuries

Eye injuries commonly occur in sports that involve balls but can also result from a finger in the eye. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. Water polo players should wear swim goggles during practice and competition. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.

Head injuries

Concussions often occur when an athlete gets hit in the head by another athlete (usually from their elbow). A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion is more susceptible to another injury than an athlete with no history of concussion.

Shoulder injuries

Shoulder injuries usually occur from repetitive throwing and swimming motions. This may be due to weak muscles in the back and trunk of the body. Usually rehabilitation exercises focused on good posture and muscles of the shoulder blade and core, icing, medication, and rest are all that is necessary for treatment.

Finger injuries

Finger injuries occur when the finger is struck by the ball or an opponent’s hand or body. The “jammed finger” is often overlooked because of the myth that nothing needs to be done, even if it is broken. If fractures that involve a joint or tendon are not properly treated, permanent damage can occur.

Any injury that is associated with a dislocation, deformity, inability to straighten or bend the finger, or significant pain should be examined by a doctor. X-rays may be needed. Buddy tape may be all that is needed to return to sports; however, this cannot be assumed without an exam and x-ray. Swelling often persists for weeks to months after a finger joint sprain. Ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and range of motion exercises are important for treatment.

Knee injuries

Patellar pain syndrome is a common overuse injury from prolonged kicking and treading water. It causes pain in the front of the knee, sometimes associated with a bump, and can be severe. It is treated with ice, stretching, NSAIDs, and relative rest.

Athletes should see a doctor as soon as possible if they cannot walk on the injured knee. Athletes should also see a doctor if the knee is swollen, a pop is felt at the time of injury, or the knee feels loose or like it will give way.

Swimming

Swimming is a sport in which there is a great diversity among participants. There are both recreational and competitive swimmers, ranging in age from preschool through college. Most swimming-related orthopedic injuries are related to overuse and are seen in competitive athletes. However, many injuries can be prevented. Use the following tips and guidelines to help keep your athlete safe.

Safety tips

The following are ways to help prevent swimming-related sport injuries:

  • Never swim alone. Make sure the area is supervised.
  • Don’t run on pool decks and wet areas. Abrasions and contusions (bruises) commonly occur from careless falls.
  • Don’t dive in shallow water. Avoid diving into shallow pools less than 3 feet deep. This will help prevent serious head and neck injuries.
  • Find out if the starting block is at the shallow end. Swimmers using starting blocks in the shallow end need to be instructed on proper technique.
  • Prepare for emergencies. Plan what you would do if a player is injured in or out of the water. Know how deep the pool is. Know where lifeguards and first aid stations are.
  • Wear the right gear.
    • Properly fitted goggles
    • Swim caps
    • Sandals in the pool area
    • Sunscreen as necessary

Use of physical therapy

Physical therapy often is useful to strengthen weak muscles and stabilize joints. It can also improve a swimmer’s endurance and ability to train. Physical therapy is necessary to treat all of the medical and orthopedic conditions listed below and should be prescribed by a doctor.

Medical conditions

The following is a chart of different treatments for common medical conditions affecting swimmers.

Condition What to do
Swimmer’s ear Use tight-fitting swim caps. If symptoms of ear pain and/or drainage develop, see a doctor. Swimmer’s ear is usually treated with cleaning, antibiotic drops, and 3 to 10 days out of the pool. Acetic acid drops may help prevent swimmer’s ear.
Pinkeye See a doctor. Symptoms may be caused by irritation from chlorine and other chemicals, but viral and/or bacterial eye infections are highly contagious. Treatment includes prescription antibiotic eyedrops and 3 to 7 days out of the pool.
Athlete’s foot and plantar warts Wear sandals on pool decks and locker room floors to help prevent foot infections. See your doctor if you have a cut on your foot.
Exercise-induced asthma Swimmers with asthma vary greatly in their symptoms. Some do better in the warm, humid environment while others do not. Some find heavily chlorinated pools make symptoms worse. If difficulty breathing, cough, chest pain/tightness, or wheezing is present during swimming, then see a doctor. Every swimmer with asthma should have a personal asthma action plan. Swimmers should always have rescue medicine, such as an albuterol inhaler, on hand in case sudden symptoms occur.
Overtraining (excessive fatigue) This is common in swimmers because of year-round swimming and training. Treatment includes medical and nutritional evaluation and rest from swimming during noncompetition seasons.

Orthopedic conditions

Overuse injuries in swimming are related to repetitive stress to the swimmer’s body. Symptoms of an overuse injury usually include pain or discomfort, muscle weakness, alterations in stroke style, and the inability to keep up intense levels of training. Multiple factors must be considered for proper treatment. Workload, defined as either yardage or pool time, may need to be decreased during a time of injury. An evaluation of stroke technique may identify weaknesses, bad habits, or muscle-tendon imbalances that require correction. Lastly, the genetic predisposition to be excessively loose jointed, flexible, or stiff may require special consideration or treatment.

Condition Description Treatment
Swimmer’s shoulder Is a compression or “impingement” of the rotator cuff tendons caused by repetitive overhead shoulder arcs. Overdevelopment of chest muscles and weak back muscles with progressive muscle fatigue can lead to this injury. Treatment is individualized and must address all contributing factors. Most treatment plans include some form of physical therapy to learn correct posture and exercises to strengthen shoulder blade muscles. Although common for swimmers to do, excessive stretching of the shoulder muscles is not recommended.
Low back pain Common in swimmers and caused by repetitive Rest, medicines, and physical therapy to
turns, rotations, and extended back positions. include core (abdominal, hips, and low back)
Common causes include muscle strains, joint strengthening exercises are the usual
irritation and, in rare cases, stress fractures. treatment.
Proper diagnosis by a doctor is essential to
ensure the appropriate treatment
recommendations are made. X-rays or other
testing may be needed.
Rest, medicines, and physical therapy to turns, rotations, and extended back positions. include core (abdominal, hips, and low back) strengthening exercises are the usual treatment.
Breaststroker’s knee A chronic sprain of the medial collateral ligament (MCL) on the inside of the knee related to the frog kick in breaststroke. Kneecap pain (patellofemoral pain) is also common due to other forms of kicking. Treatment is to rest from these types of kicks.
Foot and ankle injuries Occur from repetitive flutter and dolphin kicking. This places the toes and ankle in an extreme pointed position that strains the top of the foot and causes pain. Treatment is rest, ice, medicines, and strengthening exercises.

Wrestling

Wrestling is the oldest known sport, dating back to prehistoric times. Today it’s the fourth most common sport in which athletes from different schools compete against each other. There are more than 50 kinds of wrestling. The most common types include folkstyle, freestyle, Greco-Roman, sumo, and professional.

As in many sports, the risk of injury increases with age due to the style of play, contact forces, and size of athletes. However, the risk of injuries can be reduced.

The following is information from the American Academy of Pediatrics about how to prevent wrestling injuries. Also included is an overview of common injuries.

Injury prevention and safety tips

  • Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for routine well-child checkups.
  • Fitness. Athletes should maintain a good fitness level during the season and off-season. Preseason training should allow time for general conditioning and sport-specific conditioning. Also important are proper warm-up and cool-down exercises.
  • Technique. Athletes should learn and practice safe techniques for performing the skills that are integral to their sport. Athletes should work with coaches and athletic trainers on achieving proper technique.
  • Equipment. Wrestlers should wear headgear with ear protectors. Mats should be cleaned daily with antibacterial cleaner.

Healthy weight loss

Excessive or improper weight loss can result in various health problems including delayed physical growth, eating disorders, depression, increased risk of infectious disease, and heat illness. Wrestlers may also have less strength, slower reaction time, and less endurance; school performance may be affected too. Extreme exercise or rapid weight loss can contribute to heat stroke, kidney failure, or death.

Junior high athletes are still growing, and most should not lose weight to participate in wrestling. High school and college wrestlers may wish to lose weight to participate at their minimal weight.

When losing weight, athletes should not lose more than 1.5% of their body weight each week. If they lose that amount, they will mostly lose fat. However, athletes that lose any more weight will also begin to lose muscle mass. Losing muscle will make the wrestler weaker.

A healthy diet is important during any period of weight loss. Athletes should eat a variety of foods from all food groups. The diet should also provide enough energy (calories) to support growth, daily physical activities, and sports activities. They should also drink enough fluids to stay hydrated.

Once the weight is lost and the desired weight is met, that weight should be maintained. Athletes that maintain their weight have a higher resting metabolic rate than those whose weight fluctuates regularly. As a result, they can eat more without gaining weight.

For more information about a healthy weight loss program contact the National Wrestling Coaches’ Association Internet Weight Classification Program (717/653-8009). Consulting a sports nutritionist also may be helpful.

Warning: The use of rubber suits, steam baths or saunas, prolonged fasting, fluid restriction, vomiting, drugs, laxatives, diuretics, diet pills, stimulants, ergogenic aids, and supplements for weight loss should be prohibited at all ages.

Skin conditions

The National Federation of State High School Associates 2006–2007 Rule Book states that “if the participant is suspected of having a communicable skin disease, the coach must provide written documentation from a doctor that the condition is not communicable and that the athlete’s participation would not be harmful to any opponent.” It does not list specific skin conditions. However, herpes gladiatorum, methicillin-resistant Staphylococcus aureus, and chickenpox all may cause severe disease, and infected wrestlers should be disqualified.

Common Injuries

Head/face injuries

Nosebleeds occur frequently in wrestling. The bleeding may be stopped by putting pressure on the nose, placing a plug in the nose, or using an pro-coagulant, a medicine that helps the blood clot, into the bleeding area of the nose.

Cuts or scrapes usually occur on the face and often require suturing or glue. Sutures should remain in longer for wrestlers than for non-wrestlers, because of repeated injuries in the same location.

Concussion. Wrestlers with a concussion should not wrestle any more that day. They can return to wrestling only after they are symptom-free and have seen a doctor.

Cauliflower ear is the result of recurrent friction to the ear. It is best prevented with the use of properly fitted headgear with ear protectors during practice and competition. Cauliflower ears should be treated early (within 24 hours) by draining the ear and using compression dressings. They tend to reoccur with further trauma to the ear. Most athletes who have wrestled for many years without proper headgear have them.

Shoulder injuries

Acromioclavicular (AC) separation or clavicle fracture occurs when the wrestler falls on or is thrown directly onto the shoulder on the mat. Treatment of both is rest to allow healing; usually 3 to 4 weeks for AC sprains and 2 to 3 months for clavicle fractures.

Anterior shoulder dislocation is the result of forced abduction and rotation (pulled up and away from the body) of the arm and should be relocated as quickly as possible by the athlete or an athletic trainer or doctor.

Elbow injuries

Elbow dislocation is caused by a fall on an outstretched arm and hand. It should be relocated by an experienced athletic trainer or doctor as soon as possible.

Olecranon bursitis (irritation of the fluid-filled sac that protects the bone) is caused by repeated trauma to the point of the elbow. Swelling of the point of the elbow is the main symptom. It should be treated with rest, ice, compression, and an elbow pad. If that does not work, it may need to be drained and/or injected with medicine.

Knee injuries

Prepatellar bursitis is the result of a fall on a bent knee or from repeated kneeling. The main symptom is significant swelling on the front of the knee. It can be treated with rest, ice, compression, and a knee pad. It may also need to be drained and/or injected with medicine to reduce the swelling.

Patella dislocation is when the kneecap comes out of place causing instant disability and swelling. Treatment is reduction (putting the kneecap back in place) followed by physical therapy to strengthen the thigh and hip. A patella stabilizing brace may also be needed.

Medial collateral ligament sprain is caused by a direct blow to the outside of the knee. Treatment is usually brace support and physical therapy.

Anterior cruciate ligament tears usually occur from a strong twisting or hyperextension of the knee. A pop is usually heard or felt, and significant swelling occurs within 24 hours. Referral to an orthopedic doctor is required.

Meniscal tears are the result of a twisting injury while weight bearing or squatting. Symptoms may include painful popping or locking, and swelling in the knee. These can be initially managed with rest, ice, compression, and elevation, but most will eventually require surgery.

Back pain

Muscle strains are common causes of back pain. The pain is usually located in the lower back, but if it radiates to the buttock or down the leg it should be evaluated immediately. Once the cause of the pain is identified, rest, bracing, and/or physical therapy may be needed.

Sports Physiology

Refining and perfecting motor skills, developing visual precision, and improving mental sharpness are just a few of the many achievements happening in the young, growing body that contribute significantly to your youngster’s enjoyable and successful reality sports experience. Think about shaking up a soft drink can and not opening the top—there is so much rapid change just waiting to happen in these kids. Sometimes they can sense that they are close to gaining a new skill and they just about burst trying.

Suddenly it happens, and they cheer not only with excitement, but relief. Hopefully you can see that each stage of development varies in the length of time it takes to gain accomplishment with a certain skill and also in the completeness of skills actually developed. Some youth will acquire a skill fairly quickly, while others take longer. Some youth will develop a certain skill very well, while others struggle. That’s why certain kids gravitate toward certain activities—the beauty of the variability of human beings.

Think back to your childhood for a moment. Did you excel at catching and hitting baseballs, or were you hand-eye challenged and avoided that type of activity altogether? Did you throw well, or did you hate dodgeball in PE class when you had to display your lack of ability in front of the whole class? Ah, now you remember. You may see that mirror image in your child, or you may be wondering how on earth he inherited abilities you do not have.

Even with this variability among children of skills for exercise and sports, it is important to allow each child to individually maximize each skill level in his own time before moving on to the next. Each child is unique and should not be pushed faster than the time required to refine a skill needed to acquire a future skill.  Remember not to become impatient and rob your young one of the chance to gain a particular skill that he has been working on so diligently. Sure, your child can occasionally be trying more advanced parts of a sport, but he should not be rushed to get there before the current skills are mastered.

When we were kids in school, next year’s classes were usually built on knowledge from the previous year. Taking calculus before algebra and geometry would not have made as much sense (although for a non–math wizard like me, I am not sure if calculus would have made sense at any time). It is the same with acquiring the different advancing levels of sports techniques, movements, strategies, and training. One step at a time. One throw at a time. One serve at a time. One jump at a time. One kick at a time.

Motor, visual, and mental skills, along with physical growth, only make up part of the overall picture. They are each contributing parts that all fit together. Have you ever searched for that missing piece that allows you to start to assemble the next large chunk of a complicated puzzle? Advancing maturation of the body and brain allow your child to benefit from advancing physical growth.

Sure, these physical changes of growth are obvious. No one is blind to the fact that when friends get your holiday picture this year, Johnny is 6 inches taller than last year’s picture (which is still on their refrigerator). They usually double-check to make sure you did not skip a year. Girls change shape and start looking at boys; boys start to shave, get more muscles, and look at girls.

These physical changes certainly have an effect on their abilities to perform against their opponents as they become stronger, faster, and more skilled. Just growing, however, is not the only answer in the game of sports Jeopardy. Another crucial factor that goes through a process of development is the more invisible chemical realm—physiology, in fancy medical terms.