As parents we all want our children to be physically active, to pick a sport they enjoy and that also helps them build good skill and fitness. We also want to protect them. We make sure they are careful crossing the street, climbing on the play set, wearing a helmet when riding the bike. We want to protect those precious little noggins.

When we hear of someone suffering from a concussion, we automatically think of Football. Although, this sport does have the highest incidence of concussion rates in sports, it does not have the monopoly on athletic related brain injuries.  Concussions can occur in any sport and need to be recognized and cared for properly.  Surprisingly to most, soccer (especially girls’ soccer) has one of the highest occurrences of concussions other than football and female players have twice the rate to boys’ soccer.

Some claim that heading of the ball is dangerous and this is what is causing the head injuries in soccer. When we look at how these occur however, we find the majority of the concussions are due to contact with other players, head to head causes the most.  Only 24% of concussions occur when making contact with the ball and almost none when intentionally heading the ball.  Improper technique and unexpected contact are what causes the ball contact concussions.  Some have advocated eliminating heading the ball for younger players while others advocate better coaching to make sure the players are heading properly. Wearing headgear while playing soccer is another controversial subject and the results are still too new and too few to say if they will make an impact in decreasing the concussion incidence.

What we do know is that concussion will occur on the soccer field. We need to be able to recognize when this does happen, know how to handle the situation and when it is safe to return to play. This is difficult in a sport that has few stoppages. The coaches, officials and medical personnel on site need to be aware when a collision incident involving the head occurs and watch for signs of a concussion.  The Center for Disease Control and Prevention has designed a program “Heads Up: Concussions in Youth Sports” to help coaches, parents and athletes recognize and deal with the symptoms of concussions.  This can be obtained at no charge via their website.

Do you know the signs and symptoms?

One of the mysteries for most people dealing with concussions is being able to recognize when a concussion, however mild, has occurred and when to seek medical attention. Concussions are “graded” on a scale of 1-3. An important thing to remember is, no matter what the grade or whether the injury happens during a game or outside on your backyard play-set, the child should be examined by a physician.   Here is a simple way to assess the severity of a possible concussion and what to look for:

Grade 1:  This is characterized by some confusion, temporary memory loss, slight nausea, NO loss of consciousness.  The symptoms resolve in 15 minutes or less.  On the field the player may be out of position or slower to react than they normally would. They may not remember assignments or plays. They may complain of a headache.

Grade 2:  This is very similar symptoms to Grade 1 but more severe and lasting longer than 15 minutes yet still NO loss of consciousness.  They may be more irritable than normal.  Play will look similar to Grade 1 but they may get very frustrated and irritated with their play or any other aspects of their environment.

Grade 3:  Loss of consciousness for any length of time is a grade 3 concussion.  It may be difficult to recognize if it is brief and before a coach or medical personnel can get there.  However, if loss of consciousness is even suspected, the child needs to receive medical attention immediately.

When is it safe to play?

The other difficult aspect in dealing with head injuries is when to return to play.  The rules of return are: The athlete needs to be symptom free for 24 hours, at each activity below, before they can move to the next level of activity.  Once the athlete is symptom free for 24 hours at rest they can perform:

  1. Light Aerobic exercises: jogging, stationary bike etc.
  2. Sport Specific Drills/Exercises
  3. Non-contact training – then on to…
  4. Full-contact training
  5. Return to Games

Concussions and head trauma can be the longest lasting injuries in sports causing problems well past the playing days. With proper recognition and intervention we can minimize the impact of these injures and allow our youth to enjoy all sports safely.

Is Your Child Getting Enough Water This Summer?

It should go without saying that living in Arizona makes it difficult for anyone to stay hydrated in the summer. But for young athletes it is particularly difficult.

First, obviously, they are out exercising in extreme temperatures (even in the morning it can be over 98 degrees). Second, their bodies don’t tolerate excessive temperatures the way adults do because they haven’t fully developed cooling mechanisms like sweating so kids can overheat more quickly than adults.  Finally, they will tend to just keep playing and not think about continually drinking to stay hydrated. Kids being kids, (even when they are thirsty) they will just keep-on going not recognizing the first signs of dehydration.

So, aside from just keeping your young athlete from over-heating, sports performance diminishes with even the slightest bit of dehydration. The American College of Sports Medicine (ACSM) reports that even a 2% decrease in total body water results in a decrease in aerobic exercise performance. Although this may not apply as readily to sprinting sports such as basketball, football, or baseball, the ACSM also reports that this same 2% decrease may decrease mental function, a fact that would apply to all athletics.

Even more critical than sports performance is that, left unchecked, dehydration can rapidly accelerate to heat exhaustion and stroke.

In order to be properly hydrated during practice and at game time, it is important that your child drink enough fluids beforehand.  It is recommended that as early as 4 hours before vigorous exercise, athletes should take-in at least 1-2 cups of fluids. The urine color should then be monitored 2 hours later.  If the urine color is still darker than a light yellow, another ½ to 1 cup of beverage should be ingested.  Drinks with proper amounts of sodium (e.g., Gatorade) or pre-game meals containing sodium can aid in fluid retention and stimulate the athlete to drink enough to be fully hydrated.  During the game, how much to ingest will depend on many variables including the sport, weather conditions, and size of the athlete.  Therefore, the ACSM recommends that athletes monitor weight change during practice and games.


Now, we all know that weighing a kid before, during and after practices and games isn’t always practical. So a good rule of thumb to keep water, and electrolyte, levels up during exercise is to drink fluids every 10 to 15 minutes during activity. If it is particularly hot make sure to have the athlete take in water as well an electrolyte replacement drink. Parents, it is a good idea to teach your kids to drink at regular intervals.

After exercise, it is essential to replenish the body’s fluid and nutrient levels. Under normal circumstances, normal meals and drinks will restore proper hydration levels. However, if the athlete has to rehydrate quickly (e.g., play the second of a doubleheader on 2 hours rest), a faster remedy will need to be used. To accomplish this, weight loss should be measured and about 3 cups of fluid should be ingested for every pound lost. Light amounts of foods and drinks containing sodium will also be helpful to promote fluid retention.

 Signs of dehydration to watch for in your child are:

  • Fatigue
  • Nausea
  • Headaches
  • Cramping
  • Difficulty in coordination
  • Excessive thirst

Hydration is as important for optimal performance as practice and good equipment. Carrying out this vital task properly ensures that your athlete has the proper nutrients during key times in the big games and, more importantly, that they learn good habits to function healthfully and avoid injury for the rest of their life.



American College of Sports Medicine. Exercise and Fluid Replacement. Med Sci Sports

Exerc. 39(2):377-390, 2007.


Does your neck hurt reading this? Spending alot of time on the computer can cause shoulder, neck and mid-back tightness and pain. That can lead to other problems like pinched nerves, compensations and muscle degeneration. Other times you might experience muscle tightness and spasms from a sports injury or ‘over-doing it’ either in the gym, on the playing field or just in the garden!  Trigger Point Dry Needling (TDN) can alleviate chronic and acute pain.

TDN is a treatment for muscular tightness and spasm which commonly follows injuries and often accompanies the degenerative processes. This muscular tightness and spasm will cause compression and irritation of the nerves exiting the spine. When the nerves are irritated, they cause a protective spasm of all the muscles to which they are connected. This may lead to carpel tunnel, tendonitis, osteoarthritis, decreased mobility and chronic pain.

How does TDN work? Small, thin needles are inserted in the muscles at the trigger points causing the pain referral. The muscles then contract and release, improving flexibility of the muscle and decreasing symptoms.

This is definitely a helpful therapy technique that relieves pain for many people. If you think it might help you, contact Foothills Sports Medicine–North Central Phoenix or Old Town Scottsdale for a Rapid Recovery® assessment.

Hint: It has nothing to do with a gun.

A trigger point usually consists of a small band of muscle which feels knotty. It is sometimes painful when touched, but the pain is often referred to another area of the body. A trigger point in the shoulder, for example, might cause a headache.

What causes a trigger point? Acute trauma or repetitive micro-trauma may lead to the development of stress on muscle fibers and the formation of trigger points. Trigger points are thought to be due to an accumulation within deep muscle of the waste products of physical activity. This causes localized muscle tension and spasm which may make the points feel like small nodules.

Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, hip and pelvic girdle.

Trigger points may manifest as tension headache, jaw pain (TMJ), tinnitus (ringing in the ear), decreased range of motion in the legs, low back and neck pain. Trigger points have also been found to be related to shoulder pain, carpal tunnel, sciatica, hip/knee pain and foot/ankle pain. Usually, a physical therapist will ‘feel-out’ a hypersensitive bundle, or knot, of muscle fiber associated with a trigger point. Hands-on pressure of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response.

Physical therapy has been shown to be one of the most effective treatments to inactivate trigger points and provide prompt relief of symptoms. Physical therapy treatment, such as the strain/counter-strain technique, ischemic compression, cupping, massage, myofascial release, active release techniques, electrical stimulation, ultrasound, joint mobilization therapy and corrective exercises, are used to ease the tension, numbness and pain associated with trigger points.

The key to success with trigger point symptoms is to be consistent with therapy and to know what caused the tightness in the first place so that you can avoid it in the future.