Chalk Talk with NWH’s Dr. Khabie on sports injuries, Tommy John & Matt Harvey
Chalk Talk with NWH’s Dr. Khabie on sports injuries, Tommy John & Matt Harvey: If your son or daughter is a competitive athlete you’ve probably heard the: “Johnny needs to pick one sport and play year-round” line. Young athletes eager to play a varsity sport and maybe even in college are increasingly subject to the pressures of one-sport, year-round training – and with it the threat of overuse injuries.
Dr. Victor Khabie, Co-Chief of Orthopedic Surgery and the Director of Sports Medicine at Northern Westchester Hospital’s Orthopedic and Spine Institute, told us that 80% of his young athlete patients come in for overuse injuries. We had a chalk talk with Dr. Khabie who offered us a reality check on sports dreams and athlete’s health. Here’s what he had to say:
What is an overuse injury and what are their dangers?
Any injury that occurs from a repetitive activity in sports. We’re not talking about ACL or rotator cuff tears caused by a traumatic incident that require surgery. Stress fractures, muscle strains, tendinitis, patellar mal-tracking, labrum strains and growth plate inflammation are common repetitive stress injuries in young athletes. If it becomes a chronic injury that weakens the muscle and ligament structure and causes a tear that requires surgery and prolonged rehabilitation, you’re out for the season.
Who is most susceptible to overuse injuries?
I see a lot of baseball players, especially pitchers and catchers coming in with elbow injuries. It’s become fairly routine to see 12-15 year olds with micro tears of the ulnar collateral ligament – the same injury that requires Tommy John surgery.
Basketball and soccer players who have to run, jump and change direction get patellar tendinitis. It’s sometimes called “jumpers knee”. And I get a lot of long distance runners and cross country athletes with shin splints and stress fractures.
Does age or gender matter?
My patients are 50/50 girls and boys. We see a lot of soccer and cross-country injuries with girls. Boys are mostly baseball and basketball.
I don’t see a lot of young athletes under 9 or 10. They just don’t play with enough intensity. I start seeing overuse injuries between the ages of 12-17. When kids go through growth spurts they are more susceptible to growth plate fractures. That ends when their growth plates close up, between the ages of 14-15 for girls and 16-18 for boys.
And the symptoms are?
Pain. Swelling. Limping. Loss of function. When a pitcher loses velocity, that’s the kind of function loss you are looking for.
I go by the Red Light-Green Light method. If an athlete can play and has no pain the next day, that’s a green light. If they have pain for a day or two but it resolves with some rest, icing the area and some anti-inflammatories, that’s a yellow light. A red light is when they are still symptomatic after resting for 48 hours. It’s time to get concerned. If it lasts 5 to 7 days, it’s time to see a doctor.
How do you prevent them?
The simple answer is rest. And cross training. The best high school athletes used to be triple lettermen. Now they letter in one sport. Kids are committing to one sport at an early age, they play for multiple teams and they do it year round. If that sport is stressful on an elbow or a knee, it’s going to cause injuries.
So what to do?
We have to encourage a multi-sport culture. You can’t do one sport year round. You have to give it a rest. The first thing I do with a patient is a reality check. Where are you going with this sport? What’s your realistic goal? Who’s driving, you or your parents? Sometimes you can see it in the kid’s eyes. It’s more important to the parents than it is to them. If they’re not in it to reach the highest level then it’s easy. Give it a rest
But what if they want to compete on the next level?
I’ve been around sports all my life so I know how it works and I know how coaches think. I played football at the University of Pennsylvania. I was a team physician for the Lakers, the Dodgers the USC football team and now I’m the team doctor for Pace University. The truth is, if you want to be a Division 1 athlete or even play at a top Liberal Arts college you have to be all-in on one sport. But you can hone in on one sport in your junior or senior year – you don’t have to do it at ten years old.
Don’t college coaches like to see an early focus?
College scouts are looking for athletes. An athlete who double letters can get more attention. Cross training proves you have athleticism and not just a skill. They can teach you how to get to the next level. Look at the NFL draft. General Managers say they are always looking for the best available athlete. There’s always a tight end who may have only caught ten passes his senior year but his 3-cone drill was off the charts at the Combine and the next day his stock is rising. The best athletes on all levels are mutli-sport athletes. College coaches know this.
I’ve noticed that kids tend to improve most during the off-season and by mid-season they’ve peaked. So do you really need fall baseball or winter soccer?
I couldn’t agree more. During the off-season kids mature physically and emotionally and have a renewed energy for the game when they start training for a new season. A football player is never in better shape then the first game. Once the games begin, deconditioning begins. The kids start standing around, going over plays and they spend less time on conditioning. If you noticed your kid looked good on the mound in May and peaked in July, he or she is probably not going to take it to a higher level in September. Wait till next year.
We have to ask this one. Should the Mets shut Matt Harvey down after 180 innings?
He should limit his regular work until the playoffs begin. Put him in his normal pitching rotation so he does not get rusty, but limit him to 3-4 innings per start.
In the playoffs, they should use him normally as long as he feels well. He is a pitcher and should pitch in championship situations, that is what he is paid to do. Who knows when the Mets get back to the playoffs?
Dr. Victor Khabie received his medical degree from Harvard Medical School and completed a fellowship in sports medicine at the world-renowned Kerlan-Jobe Orthopaedic Clinic in Los Angeles, where he served as assistant team physician to the LA Lakers, Dodgers, Kings, Mighty Ducks, LA Sparks, and the USC Trojan football team. He specializes in arthroscopic and reconstructive surgery of the shoulder, elbow, and knee in athletes. He created and has patented an innovative patella alignment brace (“Victory Knee Brace”), and has been featured many times in the national media. More on Dr. Khabie.