By Dan Murphy
With many of our readers, and their children, returning to outdoor winter sports like ice skating, skiing, and snowboarding, we spoke to Dr. Eric Small, from Mount Sinai Doctors, Westchester, to discuss common winter sports injuries, and ways for parents to detect when they happen, and how they can be avoided.
Dr. Small has over 20 years’ experience practicing sports medicine exclusively and is the only board-certified Pediatric Sports Medicine Physician in Westchester County. He also serves as team physician for local high schools and colleges and sets policy regarding sports injury management and return to play protocols.
“Kids don’t participate in winter sports year-round, and as a result, we see acute injuries from falls, like fractures, dislocations and concussions. The most common injury from a fall is a fracture, but adults and children can experience different types of fractures.”
“A typical fracture for an 8 to 12-year-old is called a growth plate fracture. This type of fracture occurs when they fall on their wrists. Sometimes, this type of fracture is hard to diagnose, and parents think that because the wrist isn’t swollen there isn’t a fracture. But often, these types of growth plate fractures get missed, so it’s important to come in for an X-Ray to make sure,” said Dr. Small.
“There is a unique bone in the wrist called the Scaphoid bone, that can get fractured and doesn’t get diagnosed. Sometimes this results in the base of the thumb not healing properly and could result in having to wear a cast for 6 to 8 weeks. And if it isn’t diagnosed at all it could become a dead bone and surgery will be required, and they may never recover full strength and function.”
“It’s important not to miss this type of fracture, so if your kids are out skiing or snowboarding or ice skating, and they fall and feel some pain, an x-ray or other type of imaging is recommended,” said Dr. Small.
“I also see many shoulder injuries in skiers and snow boarders, who frequently dislocate their shoulder. Sometimes it pops out of place and with some kids it becomes a recurring injury, especially if they also play football or soccer and then go into winter sports. The shoulder for these types of athletes can become unstable and we recommend rehabilitation therapy to strengthen the muscles around the rotator cuff. If they don’t strengthen the muscles around the shoulder then dislocations will keep happening,” said Dr. Small, who recommended resistance band exercises, and internal and external rotation exercises, which will help strengthen the shoulder and rotator cuff.
“With shoulder dislocations, your child should be assessed for strength in the muscles around the shoulder to determine shoulder stability. For many kids under the age of 16, I see recurring dislocations happening within 3-6 months, if they don’t get physical therapy or treatment,” said Dr. Small.
Concussions are also another common winter injury that Dr. Small sees in patients and wants parents to be on the lookout for. “Concussions are an important but sometimes confusing winter injury. A concussion is defined as a trauma to the head, neck, shoulder, or chest that results in a series of symptoms, but there must be a cognitive deficit. 95 percent of all concussions occur as a result of trauma to head. The mechanism is that the head whips back during the injury and that injures the brain. The most common symptom is headache. When you hit your head you may have immediate headache and dizziness but there may not be a cognitive feature until one week later. In 90 percent of concussion patients, we see confusion and cognitive deficits right away. Parents need to be aware of the symptoms, and if their child has had a recent head trauma, they should stop skiing or doing any other winter sports until they are evaluated. And parents need to be on the lookout to see if the symptoms arise after a few days.
Neck pain is another symptom to be looking for after a hit to the head or other area after a hard fall. Kids may suffer a compression fracture in the neck bones and should have a X-ray/CT scan taken to assess for a compression fracture or disc herniation.
Dr. Small said that the public is now more aware of concussions than five years ago, but suggested treatments are different. “Some emergency rooms and pediatricians want total brain rest,.. That will make it worse. We need to decrease screen time on computers and phones, but you can go back to school in one to two days and begin light walking at that time. Too much rest isn’t good with a concussion. There should be relative rest and computer breaks and less time on our phone, but no need to shut everything down.”
Frostbite is another winter injury to be cautious of. “If the hands or ears are exposed to extreme cold without protection, we see frostbite in our patients. Layering clothing and always wear gloves, mittens and cover your ears and nose. If you get your feet wet while skiing, sleigh riding or skating, change your socks. You don’t want to have cold feet outside for long periods of time. Protection of the outer layers of the skin is the best prevention.”
Frostbite victims experience poor circulation and are more common with patients that have underlying conditions or are on ADD medication. For those patients, the more exposed they are to the cold, the more their skin can become hypersensitive if not treated. Don’t put your body at risk if you are outside for long periods of time, prepare for it by dressing properly.”
One myth that Dr. Small wanted to debunk is that helmets prevent concussions. “Helmets don’t prevent concussions; they prevent skull fractures. Just look at all the NFL players who experience concussions, they are all wearing helmets.”
Dr. Small says the best way to prevent concussions for winter sports athletes is tostrengthen your back and neck muscles.
Who is at risk for concussion? “Those who have had a prior concussion, and those with a learning disability and ADD. In addition, this subset of patients, once they have the concussion typically have prolonged symptoms.”
Dr. Small said that while many people have been exercising at home for the past 18 months during COVID, “we are seeing some of the same overture injuries because they are jogging and doing push-ups and sit ups at home. We see a lot of stress fractures and tendinitis. People are staying active but in a different way. They are doing the same exercise over and over again.”
Dr. Small recommends all parents, “when in doubt come in and have your child see their physician. It’s better to hear your doctor say it’s not a concussion or a fracture, than to sit on the symptoms for a month. Some of these injuries are hard to detect without an x-ray and if not treated they can get worse.”
Dr. Eric Small, MD FAAP, CAQSM is a nationally recognized expert in Primary Care Sports Medicine and Pediatric Sports Medicine at Mount Sinai Doctors. With over 20 years practicing sports medicine exclusively, Dr. Small is the only board certified Pediatric Sports Medicine Physician in Westchester County. His practice focuses on sports injuries and concussion management. As team physician for local high schools and colleges, he sets policy regarding sports injury management and return to play protocols.
