Dr. Peter Fabricant of HSS addresses sports injuries in young athletes and the growing concern of opioid medication prescriptions. HSS has developed a pain management system with patient safety at the focal point of recovery. Check out the article below!
Participation in team sports and athletic activities has numerous benefits for young people. In addition to promoting physical fitness, sports can boost kids’ self-esteem and help them learn the value of collaboration and teamwork.
Injuries do happen, though, and seeing one’s child hurt and in pain can be agonizing for a parent. According to estimates, more than 50 million young people, ages 6 to 18, participate in organized athletic activities, and almost one-third are injured seriously enough each year to miss practice or a game.
Common Sports Injuries
As sports medicine physicians, we see a wide range of orthopedic injuries. Depending on the severity of the injury, surgery may be required. The most common injuries that may require surgery include:
- ACL tear: The anterior cruciate ligament, commonly called the ACL, is one of the major ligaments that help stabilize the knee. Cutting and pivoting sports such as soccer, basketball and tennis put players at greatest risk for this injury. Skiers are also prone to ACL injuries.
- Meniscus injury: The menisci are two disc-shaped pieces of cartilage between the thighbone and shinbone that serve as shock absorbers in the knee. A torn meniscus most frequently occurs in contact sports such as football. It can also tear from a sudden twisting movement that affects the knee, such as jumping or landing forcefully.
- Cartilage Injury: The smooth cartilage on the ends of the bones allows the joints to glide smoothly. Acute or chronic injuries to the cartilage may need to be repaired or resurfaced to prevent early arthritis.
- Patella (kneecap) dislocation: This injury can occur from a direct blow to the knee. It can also result from a sudden change in direction at high speed when one’s leg is planted on the ground, putting the kneecap under stress. This may also cause an injury to the smooth cartilage of the knee as the patella shifts out of (and back into) place.
- Shoulder dislocation: This is a common injury among athletes who participate in contact and collision sports, such as football. It may require surgery, especially if an athlete experiences repeated shoulder dislocations or has an injury to the bony shoulder socket.
- Fractures: A fall or severe blow to a bone can cause it to break, and a fracture may be treated with or without surgery depending on the specific injury and age of the athlete. A stress fracture, which is a very small crack in a bone, is another common injury among athletes. Most often occurring in the weight-bearing bones of the lower leg and the foot, it frequently affects runners, as well as athletes playing repetitive impact sports such as soccer and basketball. Most of the time, rest and nutritional consultation are prescribed for a stress fracture. For very severe cases, or in the event a stress fracture doesn’t heal, surgery may be needed.
Treatment Options and Opioid Considerations
At HSS, when a child or teen is hurt badly enough to require hospitalization or surgery, safe, evidence-based practices for pain management are a top priority. We work with the Department of Anesthesiology to ensure that patients receive the appropriate pain medication, in the proper dose, for the right amount of time. This allows us to adequately treat pain without overprescribing opioid medications.
Over the last two decades, the use of opioid narcotic medication has increased dramatically in the United States, becoming a pressing public health problem. This has been alarming to health care providers, as well as to patients and their parents, who are now paying close attention to the opioid crisis.
Most sports medicine physicians and other health care practitioners now realize that when treating children and teens, opioid medication is not appropriate for common injuries such as a sprained ankle or knee. We prescribe rest, over-the-counter analgesics, ice and elevation of the injured limb to help control pain and enable healing.
However, there are times when opioid medication is one of the tools in our pain management arsenal. For very serious injuries that require surgery, such as a bad fracture or torn ligament, prescription opioid medication is highly effective when used appropriately and with other modalities as needed to treat postoperative pain. We seek to prescribe the lowest dose possible for the shortest amount of time. In this scenario, the prescription is medically necessary.
When prescribed appropriately to treat pain after surgery, opioid medication has not been shown to be addictive. However, with all the news coverage, many parents are worried and highly reluctant to see their child receive narcotic medication after surgery.
We seek to educate parents that pain that is poorly controlled after surgery could lead to a more serious pain situation and even slow the healing process if a joint becomes stiff or a patient is unable to participate in physical therapy. Rehabilitation is a critical factor in healing after surgery for a torn ACL, fracture, shoulder dislocation or other serious injury. Without appropriate pain management early on, the patient may end up experiencing so much pain that he or she will need to take a greater amount of narcotic medication for relief.
Evidence-Based Pain Management at HSS
At HSS, we have studied pain management in depth to develop safe, evidence-based practices. The result is a multimodal pain management system for patients who have surgery. Our model has various facets:
- Patient and parent education so they know what to expect. We want them to understand that it’s normal to experience pain after surgery, and the goal is to make it manageable so that patients are comfortable and able to rest and recover.
- Longer-lasting regional anesthesia. HSS anesthesiologists use nerve block anesthesia during surgery that lasts longer, and this limits the amount of narcotic pain medication (and their side effects, such as nausea) needed after the procedure.
- Pain medication after surgery. It’s not uncommon for patients to be prescribed opioid medication for the first few days after surgery. After day one, parents and patients are advised to assess their pain to determine if narcotic medication is still needed, or if a lower dose might be appropriate. At this point, acetaminophen or ibuprofen may be sufficient for pain control. If the patient is at home, parents should feel free to contact their physician’s office for additional guidance.
- Maintaining good practices. Once the patient goes home, it’s important to engage in good practices that not only promote healing, but reduce the need for pain medication. These practices include rest, ice, elevation and activity modification. Kids often feel the need to resume their activities quickly; it’s important for them to listen to their body and give themselves time to heal.
Each patient is an individual, and people experience pain differently. Some recover more quickly than others. Good practices, including appropriate medication for pain, using ice and getting adequate rest, give patients the best chance for a full recovery with the least amount of discomfort.