Strains, Sprains, and Breaks: The MMI Perspective

Repetitive Sports Injuries in Young Athletes by: Laura Copaken, M.D.

2011-11-03T12:47:00.000-07:00

As a pediatric orthopaedic surgeon, the most common complaints I am asked to evaluate involve overuse syndromes. Theses syndromes cause pain in many areas of the body including the knee, foot, heel, hip, elbow and shoulder--commonly where muscle and tendon units attach to bone via growth centers. Often there is no specific trauma, just progressively worsening pain with activity which usually improves with rest.

These kinds of injuries stem from our children doing more sports, at a higher intensity with fewer or no breaks between seasons. Our society has placed an increased emphasis on competition over recreation and I think this is largely to blame. Little league, youth soccer, football, cheerleading and dance, are all now associated with regional, state and national competitions, rather than just exercise and fun. The kids feel an increased pressure to perform when they are hurting to not miss the big event, or let the team down.

Even in gym class, with new programs to combat childhood obesity and the ever growing tendency for our children to sit in front of a computer or play video games, kids are being asked more frequently to run the mile, the pacer, and lift weights. Often these activities are without the appropriate shoe wear, stretching, safety and individualizing of what is most appropriate for each particular child.

It is important to note that most of these overuse/repetitive stress injuries carry little to no long term detriments to the child. To some degree, they can “play through the pain” but it is not going to go away and if the child is truly limping, it has gone too far. Not to mention that a child “playing through the pain” often changes their mechanics and can risk another injury. It is always important to differentiate between minor achiness that progresses over time and the acute onset of pain.

So you may ask, what is the best way for a parent to help their child avoid or minimize the chance of getting these types of injuries? First encourage and teach appropriate stretching both before and after activities of all major muscle groups. Next encourage light off season training, stretching, light running and swimming. Don’t go from no running, to soccer tryouts where kids are running several miles a practice.

The best advice for parents is to know that each child is different. Participating through pain is okay in some, but not all circumstances and it is hard to know as a parent how to differentiate. It is also sometimes impossible to convince your child to take a break when not coming from the voice of someone other than the parent. Any pain that is persistent, does not go away with a few days rest, is associated with swelling or bruising or starts fairly abruptly should be evaluated. There are no specific time frames for these injuries to go away. The longer the symptoms have been around, the longer they take to go away. Your child can safely return to sports when they can do light jogging, demonstrate equal strength and improved flexibility – all without pain. This can be 3 weeks, it can be 6 weeks or it can be 12.

My best advice to the athlete, “No pain no gain” is not always okay. Be honest with yourself and your coaches/teachers when you are hurting. Often a brief break or avoidance of only certain activities for a short while will help. Every visit to the doctor does not necessarily mean a complete break from sports. Often we can just help ease the symptoms until the big game is over. STRETCH! And remember, performing on an injured or painful limb can often leave you at risk for worse injuries that could be season or even career ending.

Saddle up! Theraputic Horseback Riding by: Beverly Kornides, PT

2011-09-15T12:52:00.000-07:00

Both Washington and Frederick Counties offer opportunities to teach riding skills to people with disabilities. Therapeutic riding is a very beneficial means of exercise and/or rehab for children and adults with a wide range of cognitive, physical and emotional conditions. Currently, the two centers in Washington and Frederick counties are, Star Community Inc. in Hagerstown, Maryland, and Silverado Farm, in Thurmont, Maryland.

Licensed and specialized professionals perform equine assisted activities, often called hippotherapy. Physical, occupational and speech/language therapy treatment strategies utilize equine movements as part of an integrated intervention program to achieve functional outcomes. Equine movements provide multi-dimensional movement, which is valuable due to its rhythmic and repetitive nature. The horse provides a dynamic base of support, making it an excellent tool for increasing trunk strength, balance, overall postural strength and motor planning.

Currently, Star Community Inc. offers equine activities and welcomes their clients’ physical and occupational therapists on site to assist with rehab programs. Their long-range goal is to employ a licensed physical/occupational therapist, who is accredited through the American Horseback Riding Association, to offer full-time therapeutic riding sessions to people with physical and mental challenges.

For more information regarding equine activity programs in your area, contact Ginny Gaylor at Star Community Inc., 301-791-6222, or Debbie Endlich at Silverado Farm, 301-898-3587.

Help With Shoulder Pain - by: Donna Pendleton, PT, CHT

2011-08-25T14:23:00.000-07:00

Shoulder problems become increasingly common in mid-life. Caused by different structural problems, most shoulder complaints can be solved with good orthopedic care including physical therapy.

Most shoulder problems, whether associated with rotator cuff tears, impingement, or sprain can be treated early in physical therapy to work on reducing pain and getting full movement back to the area.

Generally, shoulder problems include stiffness and pain, and patients report the pain limiting their ability to lift their arm overhead. It is common for patients to express concern with painful motion, worry that if they lift their arm overhead it will create further damage, and they avoid moving the arm in painful directions.

For patients who have not had surgery, therapy begins with the instructions to move the shoulder to avoid further stiffness. If stiffness is severe and movement is less than 50% of normal, the term “frozen shoulder” is used to describe the stiffness and dysfunction.

Keeping the shoulder moving to avoid stiffness is a good guideline for anyone with shoulder problems who has not had surgery. To aid in restoring motion without pain, the therapist will instruct patients to use a pulley to lift the arm, walk the wall, or lie down and use a cane to lift the arm overhead with more ease by assisting with the uninvolved limb.

Therapy is helpful for shoulder patients. Reducing pain and inflammation with ultrasound, electrical stimulation, manual and therapeutic exercise eases discomfort and movement of the shoulder.

Posture plays a particular role in shoulder comfort. Keeping shoulders back, shoulder blades pulled to the middle of the spine, and your back straight will ease pain considerably. If you sit at a computer or desk during work, try to get out of the chair every hour and move. Refresh your posture by reaching your arms behind your back, reaching overhead, and rolling your shoulders back.

If work involves overhead activities, try to position yourself higher to the work to minimize the overhead reach and take frequent breaks, lowering your arms to relieve the shoulder muscles of strain from working overhead.

Shoulder pain in some cases requires surgery, therapy and recovery time. Most shoulder irritations recover with motion, therapy and postural correction.

Early orthopedic consultation gets shoulder problems on the road to recovery with early intervention and prompt pain relief. Including therapy in the process gives patients the ability to work at home on exercises that stretch, strengthen and relieve pain.

If you have had a shoulder problem, perhaps you can share with us ideas that were helpful in your shoulder recovery. Did you find a particular exercise or home remedy to aid in restoring your shoulder function? Sharing your success story can help others with shoulder problems get on the road to recovery.

Foundations of Preparation for the Athlete by: Randall Krebs, PT

2011-07-26T08:17:00.000-07:00

Even my calluses have blisters! The dog days of summer have my dogs barking in my shoes. I thought my “wheels” were fully inflated, but with these “three-a-day” practices I need my tires changed and balanced with a realignment.

Sharp increases in volume of sport participation or exercise intensity; combined especially with the lack of sleep, poor diet or dehydration may lead to inflammatory conditions, strains or more serious injuries taking the fun out of the fundamentals of sports and exercise.

Preparation with any endeavor, including sports and exercise, is an essential foundation often overlooked. Getting an expert to tailor a strength and conditioning program will give you an edge with both upgrading performance and preventing injury. This process starts with an evaluation that needs to include functional body mechanics. Only after an understanding of which muscle groups or joints are weak or unstable and conversely which ones are stiff or tight along with which sports movement patterns are less than mature or optimal, may a program that will maximize your time and results be effectively designed. Research has clearly demonstrated a specificity to practice and conditioning necessitating the professional designing your program needs to have an intimate understanding of the skills and demands of the activity you wish to safely improve.

Ideally, the program should be periodized over months but practically this happens most often at the more elite levels when trying to peak performance at a certain phase of the year. One of the periods in most programs is rest, but this rest sometimes includes “active rest” to speed recovery and if carefully planned by the professional can include cross training which will enhance confidence and motor success as well.

Lower body pain in children and adolescence is usually related to the growth plate of the bone, especially when growth has been recently rapid. A component of these pain syndromes, however, is that the muscles during these phases usually lag behind the bones and become in comparison, tight and weak.

Education in body awareness and self treatment is the keystone to most successful treatment of painful conditions. Massage, body work, taping and therapeutic electrical stimulation also have a place in controlling pain and facilitating return to full and active lifestyles for our children.

25 Ways To Be Fit: Donna Pendleton, PT, CHT

2011-06-27T07:16:00.000-07:00

25 Ways to Be Fit

Being fit is a life endeavor. Some years will be more successful than others. A lifetime of practicing these few principles will have a powerful impact. You will find getting and staying fit simple and possible when you put these 25 tips into practice.

Live and get fit with everyday tools:

Use smaller dinner plates to control portions and calorie intake. Eat just one serving, and avoid seconds.

Make exercise a regular part of your life. Make friends where you exercise and use these friendships to promote accountability and increase your motivation.

Know what you want to accomplish and visualize the end result of your hard work.

Believe in yourself

Don’t be a wimp or a complainer – most things worth having require some work. Fitness can be fun. Keep good work ethics a part of your plan.

Drink water all day long.

Know when to ask for help.

Maintain your metabolism by eating a healthy snack or meal every three hours. Keep what you eat unprocessed, fresh, and low in sugar.

Forget “will power” – it is about WANT power! How badly do you want it?

Don’t eat processed foods. These foods are high in empty calories that have very little nutritional value to your body and contain chemicals that can be harmful to your health. Think: “if it comes out of a window or a box, it might not be good to eat”.

Make food choices that are healthy, low in fat and eat plenty of lean proteins, leafy greens, and whole grains.

It’s okay to be a skeptic. Watch out for products that are labeled “health food”. Always read the labels and make an informed decision.

Act now and get the job done. Remember, talk is cheap.

Exercise with people who are in better shape than you. This will encourage you to push your limits.

Never indulge in negative self talk.

Don’t drink calories.

Pay attention to everything you eat.

Get enough rest

Be consistent with your exercise. Exercise three or four times per week for life.

Expect more from yourself.

Never eat or drink high fructose corn syrup. It will spike your blood sugar levels and encourage your body to store fat.

Eat plenty of whole plant foods. Vegetables, fruits, and whole grains are filled with fiber and antioxidants and great for your health and weight control.

Eat breakfast, always.

If you know you deserve better, than go get it. Challenge yourself.

Set specific, measurable goals and track your successful progress.

Life is over before you know it…get ready to make a change, live and eat healthy. Put these practices to the test, it is a great beginning. Print them where you can see them, strive to be focused, determined, and in control of your health. Get fit and stay fit for life.

Here at MMI, we can help you address and recover from injuries or barriers to your “fitness for life” success. We offer state of the art rehabilitation programs and our staff of rehabilitation professionals can individualize your fitness and treatment programs to reach your goals.

Are you struggling with a problem that interferes with your ability to reach your fitness level and stay healthy? Can we offer a suggestion to get you back on the path and moving again toward your goal. Let’s hear from you and let’s team up and get started on a Healthy New You.

Balance Issues Resolved Through Physical Therapy by: Bev Kornides, PT

2011-06-14T06:23:00.000-07:00

Did you know that the #2 reason for patient visits to the primary care physician office is the complaint of dizziness?

Are you dizzy? Lightheaded? Or even tipsy? Do you have a sense of feeling “off balance”?

Pinning down these adjectives can help your physician better diagnosis the problem as it could be related to inner ear, a specific area of your brain, medication or a recent infection that may have residual effects.

For those patients who struggle with a sense of imbalance or disequilibrium, there are simple tests to evaluate one’s level of confidence in doing activities around the house without the risk of falls.

Physical therapists trained in this type of rehab called “Vestibular Rehabilitation” can help the physician with data collection toward nailing the correct cause of the imbalance. Could it be an inner ear problem, central nervous system or other?

Most common patient type in this category are those who suffer with Benign (not life threatening) Paraxysmal (recurrent sudden intensification of symptoms) Positional (related to bodily posture) Vertigo (sensation of rotation/spinning), otherwise known as BPPV.

Repositioning maneuvers, otherwise known as canalith repositioning, are done in the physical therapist’s office and offer a very effective option. Most cases of BPPV can be healed in 1-3 sessions with 80-90% resolution of all symptoms.

During the treatment sessions the patient is educated on the rationale of the canalith repositioning technique and why it works.

Approximately 50% of individuals with BPPV can experience another episode within five years. With their knowledge and understanding of their problem they often can effectively treat themselves.

So… Do you have spinning when you position change?

Does the symptom linger less than or greater than a minute?

Are you phobic about position change?

Don’t be a victim of such a correctable disorder; contact us in the physical therapy department of MMI.

So Your Young Son Wants to Pitch in the Major League. By: Dr. Mark Chilton

2011-05-27T12:53:00.000-07:00

So your young son wants to pitch in the Major League some day. The secret to failure is burly success. No one who will make it to the big league as a pitcher was very successful pitching at Little League or in Babe Ruth.

There are 1000 ways to throw a baseball, but only one correctly. Youngsters rarely have the physical and mental aptitude to apply correct pitching mechanics. They lack balance, leg strength and shoulder deceleration, to name just a few. Inadequate follow through, throwing the ball across the body or with the hand under the ball in full cocking phase, are more frequently seen problems.

But if they are successful at striking out opponents at a young age, despite poor mechanics, then they will pitch more games and develop more habits until their shoulder and elbow fails. It happens every time. It is not just the coach over pitching the youngster, but the player himself, or parent, or teammate who encourage the youngsters malpresence because of previous success.

To be a successful pitcher at the college level or beyond, don’t pitch.

Learn proper mechanics. Learn to reproduce your release position so as to improve accuracy. Remember, pitching has three important aspects just like real estate. They are location, location, location.

When you do pitch, don’t worry about striking out every opponent. It is probably more important at the early stages of pitching to learn to play defense off the mound. When you do pitch, no curve balls before the age of 17. Just work on locating your fastball and maybe a changeup.

Never pitch more than one game per week, never more than 50 pitches per game for little league and 70 pitches per game for older Babe Ruth or high school players. When not pitching, don’t play catcher – the shoulder has only so many throws in it, save them for later.

Plus, don’t play on three different travel teams and don’t play year round. Be involved in other activates, especially your school work.

By age 17, your son should have reached the physical and mental maturity to have developed and maintain good pitching mechanics. His shoulder decelerators are strong enough to prevent shoulder and elbow problems and he is probably ready to throw a proper curve ball, not that risk twisting Little League curve.

For more information contact me, Dr. Mark Chilton or Randy Krebs, P.T. for group sessions in pitching mechanics.

Is Your Foot Fracture an Early sign of Osteoporosis? by: Damian Roussel, D.P.M

2011-05-11T06:11:00.000-07:00

Many patients are unaware that unexplained foot pain or foot fracture can actually be an early sign of osteoporosis, a bone thinning disease that is blamed for 1.5 million bone fractures each year.

Osteoporosis is referred to as the “silent crippler” since it often progresses without any symptoms or isn’t diagnosed until a person experiences pain from a bone fracture. This is true because bones with osteoporosis are weakened and normal weight-bearing actions like walking can cause the bones in the foot to break. In fact I see many patients who visit my office suffering from foot pain, who come to find out they actually have a stress fracture without having experienced an injury.

While osteoporosis is most commonly seen in women over the age of 50, younger people and men are also affected. Early symptoms can include increased pain with walking accompanied by swelling. Often times I notice patients don’t seek treatments for their symptoms for weeks or even months thinking the pain will go away.

My advice is, don’t ignore foot pain of any type. Early intervention can make all the difference in your treatment and recovery. If you are diagnosed with osteoporosis, it’s important to protect your feet from stress fractures. I recommend you wear shoes that provide good support and cushioning, such as athletic running shoes. If you are suffering from unexplained foot pain, don’t ignore it. Call our office for a complete evaluation.

The Purpose of Splints as Part of Rehabilitation by Marisa Hombach, OTR/L, CHT

2011-04-12T09:36:00.000-07:00

Splinting is a skill frequently used in hand therapy. There are many reasons why splints are used as part of the therapeutic process. Over the years, the science of splinting has evolved from exclusive use of plaster paris to the consistent use of a low temperature, thermoplastic material. This material allows for a contoured and customized fit with improved comfort for the patient.

Here are just a few of the reasons why splints are used as part of the therapeutic process:

PROTECTION: A custom splint can provide protection following surgery or injury. Immobilization can encourage healing while the ability to remove a splint periodically for active range of motion (when appropriate) allows a patient more freedom than a cast.

REDUCTION OF PAIN AND INFLAMMATION: Symptoms from repetitive motion injuries may be decreased by placing tendons at "relative rest"

SCAR MANAGEMENT: In traumatic injuries such as burns, splints are used to help maintain mobility and avoid shortening of muscular or connective tissue.

JOINT PROTECTION: In a diagnosis such as arthritis, splints can be used to prevent and/or slow further joint deformity and reduce pain by assisting in joint stability.

IMPROVING JOINT MOTION: Splints can be constructed to assist in immobilization of one joint while allowing isolated movement of another joint. Similarly, "mobilization splints" can place a stiff joint into a prolonged, low load gentle stretch to improve mobility.

The hand therapy team at MMI has over 70 years of combined splinting experience. The therapists are educated in proper splinting techniques and the ability to customize the splint to the patient's diagnosis and personal needs. In addition to collaborating with the patient's physician, hand therapists have a working knowledge of anatomy, surgical repair and injury that are necessary to provide the patient with adequate safe movement to avoid stiffness, while allowing proper protection for healing.

Is Back Surgery Right For You? by: Dr. Mark Chilton

2011-03-25T06:45:00.000-07:00

"I'd never get my back operated on!"

"My neighbor, Joe Blow, had spine surgery and he was worse after the surgery. I'd never have my back operated on!"

I hope you never need it, but I had my back operated on because of excruciating leg pain secondary to a herniated disc. It was one of the best decisions I ever made. Most, not all, of my spine surgery patients say the same thing. This is not to suggest surgery should be the first choice, but don't worry about Joe Blow.

People do get worse after spine surgery. Why? Several common reasons:

First, they probably should never have been operated on in the first place. When surgeons stretch the appropriate indications for a procedure to "try" to help a patient who is often begging (yes many patients request spine surgery) for a procedure, the result is failure.

Second, if you smoke, are hurt on the job or in a motor vehicle accident, have psychological issues such as depression, anxiety or bipolar disease, there is little chance you will be improved with spine surgery.

Third, if your pain pattern, neurological deficit, and imaging studies do not all match, you will not get a good surgical response.

Fourth, if you have had years and years of pain or 2, 3, 4 or more previous spine operations, the next one won't help you

Fifth, if you are addicted to narcotic medications, you will not be helped with spine surgery.

Sixth, if you see three or more spine surgeons that say you shouldn't be operated on, and you let the fourth surgeon do the procedure, you will not be helped.

Spine surgery should not be the first nor the last option for your pain. Make sure your spine surgeon is Board Certified in Neurosurgery or Orthopaedic Surgery. Thoroughly discuss your procedure and options with your surgeon. And make sure your pain isn't coming from some other ailment like arthritis of the spine or hip, diabetes affecting the nerves, or other reasons that only well qualified doctors can eliminate as causes.

2011-03-10T17:37:00.001-08:00

Training Visit For Middletown High School Girls Softball Team With Beverly Kornides, PT - Hagerstown Office

2011-03-10T06:39:00.000-08:00

In keeping with MMI's philosophy of service to the community and prevention of injury through patient education, I met with the Middletown High School Girls Softball Team on Saturday, March 5, 2011. The goal was to speak to the players, coaches and interested parents on the subject of proper stretching and strengthening for injury prevention.

I was invited by the parent of one of my patients who knew of my ability to connect with young adolescents and impress upon them the importance of taking care of their bodies, and preparing their muscles for a season of softball practices and games five days a week.

Most informed parents and coaches understand that overuse injuries are on the rise as statistics show that greater than thirty percent of repeated trauma injuries were in the age group of 15 to 24 year old females. Fifty percent of this age group was middle and high school female athletes. While sixty-two percent of organized sports injuries occur at the athlete's practices.

Many of the girls participated in strength training, usually at the school. Although having good intentions, I discovered that in these athletes many of the primary muscles that help with longevity and tolerance in the game were neglected in this training. Major deficits occurred including limited core building and posterior shoulder and mid-back strengthening exercises. Stretching, likewise, was found to be less than optimal.

A strong core - the muscles in your abdominals, back and glutes - gives you stability, power and endurance. If your core muscles can't support your pelvis it will drop which causes your hips, knees and ankles to lose proper alignment. When this happens you can't efficiently absorb forces and your muscles fatigue quickly. This could lead to common problems encountered by athletes such as anterior knee pain, shin splints, low back pain and foot pain or even fractures.

A strong mid and upper back and posterior shoulders allows one to hold proper form while running and playing as well as when sitting in the classroom. How many of our youth spend so much time with bad posture, rounding shoulders while on the computer, phone or video games. This sets up postural muscle imbalances that have been linked to rotator cuff problems, neck and low back pain and common baseball ailments such as "Little League Elbow.

Finally, the players learned the importance of stretching and flexibility. Flexible muscles are more efficient. Gains in strength and endurance allow muscles to recover more efficiently and lessen the chance of breakdown or "repeated trauma" complaints.

So, with that knowledge now, GOOD LUCK GIRLS. . . have a fun and safe 2011 softball season!

Pediatric Injury in the Spring and Summer- A note from Dr. Laura Copaken

2010-04-09T12:48:00.000-07:00

Injuries in children are greatly influenced by weather and season. One study of over 15,000 children demonstrated that emergency rooms visits for trauma in children peak in the month of June. While each season has it’s most common culprits—football injuries in the fall, sledding and snowboarding injuries in the winter, playground, trampoline, and lawn mower injuries in the spring and summer—as a pediatric orthopedic surgeon, I see far more fractures that require surgery in the spring and summer. As these months are upon us, parents should be aware of the most common injuries, ways to minimize the risks, and what can be expected if your child has the unfortunate experience of sustaining one of these injuries.

When I was a resident, when sleep was at a premium, I used to joke that if we could just get rid of backyard trampolines, scooters, motorized vehicles for children and monkey bars, I would be far more rested. The fact is, though, that our children are going to participate in all of these activities, and we can not always protect them. I, myself, was the proverbial “wild child.” As an ex-gymnast and thrill seeker, I have had more than my share of fractures. People used to differentiate between my twin sister and me by who had the cast on at that time. I am convinced that my family helped finance my orthopedic surgeon’s back yard pool and that my parents were fearful that social services were going to knock on their door at any moment. Accidents happen and are terrifying for both the child and parent, but knowing how to recognize a more serious injury and what to expect can alleviate some of that fear.

Lawn Mower Injuries
Spring comes, grass grows and the lawnmowers come out. Lawn mowers are a highly unrecognized source of significant injury to our children. Between 1990 and 2004 there were 140,700 lawn mower related injuries in children with a mean age of 10. These injuries included lacerations, soft tissue injuries, burns and fractures. Many of these injuries required surgical intervention ranging from repair to amputation. These injuries can be devastating with a high risk of infection, soft tissue and bone loss or growth arrest of the susceptible growth plates in small children. When it comes to injuries from lawn mowers, prevention is the key. Many standards of safer product design have already been instituted including ways to prevent feet and toes from coming into contact with the blades, shielding of hot mower parts and a default setting which prevents mowing in reverse. This last feature can be overridden, but should require the operator to turn around to do so and therefore view any potential little feet behind the mower before operating it in reverse. Product safety is one thing, but what can a parent do to prevent this injury? First, children should not be playing outdoors while the lawn is being mowed. Be obsessively aware of where your children are while you are operating this dangerous equipment. Children tend to dart around quickly and enquiring little hands and feet like to check out moving parts. Next, ride along mowers may seem like a fun ride for you and your kids, but usually there are no safety belts and even with the best intentions, a child can fall under your direct supervision and come in contact with a moving blade or metal part which is hot enough to burn them.

Trampoline Injuries
I googled “trampoline injuries” to see what I would find. The answer: over 550,000 references. In 2004, the Consumer Product Safety Commission found that more than 89,000 people were sent to emergency rooms with trampoline-related injuries. A study by the Hasbro Children's Hospital in Rhode Island, found that spring and summer are the time when trampoline injuries hit their peak, and 91% of them happen at home. Some of the more common injuries include fractures of the ankles, wrists, and elbows, concussions, spinal injuries and there have even been six reported deaths since 1990. Contrary to common belief, nearly three quarters of these injuries occur while the child is on the trampoline mat itself and less than 25% are from falls off the trampoline. Mechanisms of injury include falling on the mat, falling onto the springs or metal
supports, colliding with other jumpers, and falls off the trampoline. The majority of these injuries (83% by one University of Utah study) occur when there is more than one jumper at a time on the trampoline. This same study found that 37% of the injuries are in children under the age of six. The American Academy of Pediatrics advocates against the use of home trampolines, but if your children have access to one and are going to use it, there are ways to promote a safer environment. First, parental supervision, alone, will not prevent injury, but it may prevent some of the more common misuses of the device. The most common misuse and the most common cause of injury is having more than one jumper at a time on the trampoline. The lighter weight child is more than five times as likely to be injured in this scenario. Some believe that if we could enforce the following of this one rule, we could dramatically decrease the number of trampoline injuries. Next, spotters who are big enough to catch or slow the fall of a child are recommended on all sides of the trampoline. To this same end, a surrounding net may decreased the injury rate, but this has not been extensively proven. Next, if possible, place the trampoline jumping surface at ground level over a pit. Finally, all supporting bars and springs should be well padded.

Playground Injuries
The National Center for Injury Prevention and Control states that each year in the United States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries with children ages 5 to 9 being at the highest risk. This being said, play is an essential component of healthy development in children. Playgrounds provide an opportunity for children to develop motor, cognitive, perceptual and social skills. So, what can you do as a parent? First, supervise children at all times and intervene when there is pushing, shoving, and crowding around equipment. Next, make sure playground equipment is age appropriate. Maximum fall height should be five feet for preschool-aged children and seven feet for school aged children. Finally, avoid playgrounds with asphalt, concrete, grass, and solid surfaces under the equipment. Look for surfaces of hardwood fiber, mulch chips, pea gravel, fine sand or rubber to a depth of at least nine inches. Despite my best efforts, my child has an injury. No matter how careful we are and how safety conscious we are, accidents do happen. Most children under five don’t understand “faking it.” If they are limping, or do not want to use their arm, something is probably wrong. Rest, ice, compression (or immobilization), and elevation are useful, but if the child has persistent complaints, take them to be evaluated either at the ER or urgent care center or pediatrician or orthopedic surgeon. If there is bruising or swelling, there is likely a real injury. Children are much more likely to crack through the weaker growth plates or bones then to tear ligaments or tendons typical of an adult sprain. In fact, any child with open growth plates who is tender directly over that growth plate should be treated as a fracture even in the presence of negative x-rays. Growth plates look like a black line on an x-ray as does a fracture, and sometimes we treat based on our clinical exam alone. Generally these types of injuries can be treated with a cast alone. Some injuries are more obvious. If there is obvious deformity or any bleeding in the area of a deformity, go immediately to the ER and do not stop for snacks on the way. If your child will need surgery or sedation, it is much safer on an empty stomach. When and if possible, stabilize the arm or leg or wrist on a board or by just wrapping a heavy blanket around it. The less it moves, the less pain your child will have. In children, deformities from fractures can often be treated under sedation in the emergency department and then casted. The most common of these would be fractures of the wrists and forearms and those of the shin bones and ankles. The wonderful thing about growing bones is that they remodel. As long as the bones are aligned within certain acceptable ranges, the bones will remodel as they grow and straighten out over time. Exceptions to this are fractures around the elbow and fractures that include joint surfaces. Many of these fractures may need surgical repair and stabilization. Finally, any fracture that has a laceration in the skin over it, must be considered an “open” fracture. This means there is contact between the outside environment and the bone. These fractures are at high risk for infection will almost always require IV antibiotics and debriding or cleaning in the operating room. These are considered surgical emergencies and should be transported directly to the hospital emergency room. Spring and summer are a wonderful time of outdoor activities, but every parent should be aware of the risks, talk to their children about safety, and have a plan should injury ensue.

2010 SECAC Resource Fair

2010-03-19T08:50:00.000-07:00

The Mid Maryland Musculoskeletal Institute will be attending the 2010 SECAC Resource Fair on Saturday March 20, 2010. The Resource fair is from 10 am until 2 pm at Rock Creek Elementary. It will be a great resource for families with children with special needs. Below is more information about the SECAC fair. We hope to see you there!!

The Frederick County Special Education Citizens Advisory Committee (SECAC) is hosting its annual Resource Fair on March 20, 2010 at Rock Creek School from 10:00 a.m. – 2:00 p.m. The school is located at 191 Waverley Drive in Frederick, MD. SECAC’s main purpose is to advise the Board of Education and the Director of Special Education and Psychological Services on issues relevant to special education in Frederick County Public Schools. In addition, it hosts an annual Resource Fair that provides information and opportunities for parents and community members to attend workshops relative to services available to families of children with special needs. The Parents’ Place of Maryland will present two workshops: “Making Your Health Plan Work for You” and “Managing the Maze: Record Keeping,” while The Arc of Frederick will be presenting “Educational Advocacy, Information, and Referral.” Dr. Scott Winget is also presenting a workshop on “Understanding Temperament Differences,” in which he explains ways to match strategies to an individual’s behavioral style. In addition, vendors will be present and available to answer questions and provide additional information on services available to these families, including, but not limited to, camps, equipment and therapeutic services.

The ARC of Frederick County will provide a sibshop for brothers and sisters of children with special needs to celebrate the many contributions made by siblings. Siblings ages 6 – 11 may participate in this program from 10:00 a.m. – 1:00 p.m. during the Resource Fair. In addition, the YMCA of Frederick County will provide an Activity Center at the fair for children in attendance to participate in arts and crafts activities.

Walkersville High School Band Boosters will be selling food at the fair and the Rock Creek Graduation Committee will be hosting a bake sale.

For more information or to register for a workshop, contact Susan Donoghue-Rick at 240-236-8744 or email susan.donoghue-rick@fcps.org.

Information from Frederick County Public Schools at http://bhs.sites.fcps.org/node/306

Pediatric Occupational Therapy

2010-03-05T08:18:00.000-08:00

The pediatric team at Mid Maryland Musculoskeletal Institute (MMI) would to like announce the addition of Jennilee Ambush, MS, OTR/L. Jennilee is a pediatric occupational therapist who has been working with children in a clinical setting for 3 years. Jennilee received her undergraduate degree from the University of Maryland and her Masters of Science in Occupational Therapy from Shenandoah University. During her studies, Jennilee participated in a day rehab program at Children’s Health Care of Atlanta for pediatric brain injuries. Jennilee was part of a team that provided children with intensive therapy in one on one and group settings.

Jennilee will be able to develop customized therapeutic plans for children whether their needs range from minimal to maximal support. Jennilee specializes in sensory integration, fine motor coordination, self care difficulties, and visual/ perceptual skills. She has experience in sensory processing disorder, hand writing, ADHD or ADD, stroke, and rehabilitation after a traumatic event. Jennilee is excited to be working with area children and helping them reach and surpass their goals.

To schedule an appointment with Jennilee or if you have any questions please contact the pediatric therapy department at 301-694-8311 ext 145.

Jennilee will also be at the Parent Support Group meeting which is Monday March 8th from 6pm-7pm at 184 Thomas Johnson Drive, Suite 104!!

Take Care and have an injury free weekend :)

Upcoming Events- MMI's Pediatric Neurologic and Orthopaedic Support Group

2010-02-25T11:09:00.000-08:00

March Support Group Meeting

When: Monday March 8th from 6pm-7pm
Where: Suite 184 Thomas Johnson Drive, Suite 104
Topic: What Is On Your Mind??

Mid-Maryland Musculoskeletal Institute has created a Pediatric Neurological and Orthopaedic Support Group. The Pediatric Team at MMI has developed the support group to provide information, educate, and offer a forum for local families of children with congenital or developmental orthopaedic or neurological problems. Monica Johnson, DPT, MMI’s pediatric physical therapist, and Jennilee Ambush, MS, OTR/L, MMI’s pediatric occupational therapist, will be integral parts of the support group. Dr. Johnson explains, “we hope this program will allow families from the Frederick area to meet other families that have similar concerns, as well as be a source of education and support.”

The support group will meet once a month, on the second Monday of the month at MMI’s Pediatric Physical & Occupational Therapy office located at 184 Thomas Johnson Drive, Suite 104.; The meetings will grow and develop based on the group’s interests. The meetings will include guest speakers, facilitated discussions, and question and answer periods. Recognizing that some parents may need to bring their children, crafts and activities will be provided to entertain the children who may attend.

When asked about why MMI decided to start this new initiative Dr. Johnson explained that the idea came from interacting with many of her patient’s family members. “Many parents would see other families coming in and out of the building and they would ask questions and want to know where the other parents were getting the equipment for their children. I also had families giving me information about local resources and we began to develop the idea of bringing these groups of people together.” Dr. Johnson explained the group is open to families who have both orthopaedic and neurological concerns. “These concerns can include anything from intoeing and outtoeing, sports and overuse injuries, abnormalities of legs and feet, to developmental delay, Cerebral Palsy, Down’s Syndrome, etc”... she explained. MMI hopes that the group will help bring local parents and families together in a supportive and educational environment. “We hope that this new program will be a valuable asset to families, give them a renewed energy, and really allow them to build friendships and relationships that will assist them in caring for their children.”

The meetings are open to families of MMI patients and community members who may have an interest in the neurological and orthpaedic care of their children. Interested individuals can register by email or telephone. Please contact MMI at 301-694-8311 ext 178 or email at mmipediatricsupportgroup@gmail.com.

Just in time for the Snow!!

2010-02-09T12:15:00.000-08:00

The good news is that fifteen minutes of snow shoveling counts as moderate physical activity. The bad news is that researchers have reported an increase in the number of fatal heart attacks among snow shovelers after heavy snowfalls. This rise may be due to the sudden demand that shoveling places on one's heart. One study determined that after only two minutes of shoveling, a sedentary man's heart rates rose to levels higher than those normally recommended during aerobic exercise. Shoveling can be made more difficult by the weather; Cold air makes it harder to work and breathe, which adds some extra strain on the body.

With the most recent snow, and now upcoming snow, we thought you might find these tips helpful. To get a good handle on snow shoveling follow the safety tips below!!

1. Individuals over the age of 40 or those who are relatively inactive should be especially careful

2. If you have a history of heart trouble, do not shovel without a doctor's permission.

3. Do not shovel after eating or while smoking

4. Take it SLOW!! Shoveling (like lifting weights) can raise your heart rate and blood pressure dramatically; so pace yourself. Be sure to stretch out and warm up before taking on the task.

5. Shovel fresh snow! Freshly fallen, powdery snow is easier to shovel than the wet, packed-down variety.

6. Push the snow as you shovel. It's easier on your back than lifting the snow out of the way.

7. Don't pick up too much at once. Use a small shovel or fill only one-forth or one-half of a large one.

8. Lift with your legs bent, not your back. Keep your back straight. By bending and sitting into the movement you'll keep your spine upright and less stressed. Your shoulders, torso, and thighs can do the work for you.

9. Do not work to the point of exhaustion. If you run out of breath take a break. If you feel tightness in your chest, stop immediately.

10. Dress warmly. Remember that extremities such as the nose, ears, hands, and feet need extra attention during winter's cold. Wear a turtleneck sweater, cap, scarf, face protection, mittens, warm socks, and waterproof boots.

12. If one needs to pick up the snow rather then push it then breathe out as you are picking it up. This puts a whole lot less stress on the heart.

We hope this makes your snow shoveling a little easier.

Enjoy the Snow :)

Take Care,

Michelle

**Disclaimer- The above information is not a substitute for medical advice or an evaluation. If you have an injury, chronic ache, question, etc please contact your doctor.**

***Information provided by Beverly Kornides, PT, and MMI's Director of Rehab

The Beginning!

2010-01-28T08:23:00.001-08:00

Hello Everyone!

Welcome to the NEW Mid Maryland Musculoskeletal Institute Blog. We are very excited to be starting this blog and hope you will find it informative. We hope to be able to give you inside information on various orthopedic topics as well as give you an inside peek into the MMI perspective. Here is some background information about the Mid Maryland Musculoskeletal Institute (MMI).

MMI is your single source for musculoskeletal care located at 86 Thomas Johnson Court, Frederick, MD. If you are from Frederick, you are probably familiar with Thomas Johnson Drive since there are many medical practices located on the street. MMI has 11 doctors and many rehabilitation specialists that are able to offer patients specialized treatment for a wide variety of musculoskeletal conditions. Our providers specialize in the following areas:

Spine Care
Sports Medicine
Hand Surgery
Foot and Ankle Care
Pediatric Orthopedics
Rheumatology
Physical Medicine and Rehabilitation
Total Joint Replacements
General Orthopedics
Occupational Medicine
Physical Therapy
Pediatric Physical and Occupational Therapy
The Therasuit: Intensive Physical Therapy for Children
Infusion Treatment and more

We are just beginning our venture into blogs, twitter, and facebook but we hope to reach out to the Frederick community and surrounding areas.

For more information about MMI check out our website at www.mmidocs.com

or call us at 301-694-8311 or toll free 1-800-349-9386

Wishing you the best,

Michelle