My Elbow Really Hurts, and I Feel Like a Wimp!

We hear this comment or one very similar to it on a frequent basis. Good ole’ tennis elbow, also know as lateral epicondylitis. Despite these names, this is not a problem limited to tennis players and does not typically involve the bone on the outside of the elbow named the lateral epicondyle. It is actually a tendon problem. The common extensor tendon on the outside of the elbow is highly involved in gripping, grabbing and lifting. When you shake someone’s hand, this tendon is under a lot of stress. When you lift the coffee mug with a handle, the positioning of your wrist transmits stress to this tendon. When you pull your sheets up to you when in bed, the position and action of the wrist and forearm send stress to this tendon. Finally, when this tendon is inflamed and/or partially torn, it HURTS! I mean, it really hurts. You are not a wimp for complaining about tennis elbow. Fortunately, this is one of my favorite conditions to treat. Why? For many reasons: we usually can cure this problem. Patients are so grateful to see this pain go away. Finally, it’s gratifying to see patients return to things they love to do after successful treatment such as tennis, golf, weight lifting, gardening and even typing!

Turning our attention to treatment options, there are traditional and innovative options. At Impact Sports Medicine and Orthopedics, we specialize in both types:

Traditional:

1) REST and changing the biomechanics- how and how much you lift, grip and grab

2) A wrist splint- yes, immobilizing the wrist and forearm unload the tendon far more than immobilizing the elbow

3) A cortisone injection- in our hands, 90% of patients experience relief with an ultrasound-guided injection. However, since tendon damage is often the cause of the stubborn pain, cortisone, at times, may only provide temporary benefit.

4) Physical Therapy- helpful in changing the biomechanical problems that led to the tendon damage. However, the benefit can be limited if tendon is partially torn.

Innovative:

1) The Tenex procedure- a true game-changing minimally-invasive procedure. This is our favorite option for those patients that have not improved with the traditional treatments. Local anesthesia only, a tiny incision, 2 minutes of tendon treatment with a small probe, no stitches, typically covered by insurance and a 90% success rate. How does that sound? We've loved this procedure for 7+ years.

2) Orthobiologic/”Regenerative” injections- platelet-rich plasma (PRP) and amniotic membrane are very solid choices, utilizing solutions rich in human growth factors to stimulate healing of the tendon.

3) Nitroglycerin patches- placed on the skin over the tendon, these are good choices for those patients needing something extra, but prefer a treatment that is non-invasive. These work by producing nitric oxide in the tissues, which then can be responsible for tendon healing.

In summary, we hate that you have "tennis elbow," but always appreciate the opportunity to treat you. It's our mission to make this common cause of elbow pain leave your life and never return! Let us know if we can help.

-F. Clarke Holmes, M.D.

Will Platelet-Rich Plasma (PRP) Injections Replace Cortisone?

The answer to this question is simple: Yes, No and Maybe. Platelet-Rich Plasma injections have taken the orthopedic world by storm. Why is this? They are safe. They are natural. They can be done in the office in a short period of time. They may prevent surgery in some cases. They can be disease-altering, not just symptom-reducing. Most importantly, in many cases of tendon, ligament and joint problems, they are EFFECTIVE.

PRP injections involve drawing blood from a patient’s vein, typically in the arm. Then, the blood is centrifuged (spun) to separate out the red and white blood cells, while simultaneously concentrating your own platelets. Our platelets are known to have numerous growth factors that serve many beneficial roles in our musculoskeletal tissues. This concentrated solution is then injected under ultrasound-guidance back into an area of damage, such as a partially torn tendon, the plantar fascia or an arthritic joint. We believe that these platelets help to modulate unhealthy inflammation that resides in damaged tissues. This helps over the long-term to reduce pain and subsequently, improve function. In some cases, damaged soft tissue can heal in the presence of these concentrated platelets. In other cases, the deterioration often seen in cases of osteoarthritis can be slowed or halted. Thus, there are some preventative benefits of PRP.

Cortisone injections, known medically as steroids, have been around for decades. They simply are very strong anti-inflammatories. They can reduce pain and swelling within hours to days of an injection. However, they are known to have catabolic, or “breakdown” effects, meaning, numerous exposures to steroids can worsen the structure and strength of a soft tissue or joint. They also can produce short-term systemic side effects, including fluid retention, headache, insomnia, changes in emotions, skin flushing/redness and increases in blood sugar, particularly in diabetics. Cortisone injections are still used quite frequently to treat tendonitis, arthritis and disc problems in the spine.

Now, back to the question in the title. In our practice, we still use both types of injections. However, the percentage of PRP injections is increasing, while the percentage of cortisone is dropping. Why? We want our patients to have “game-changing” treatments whenever possible. We want conditions to improve over the long-term. We want to stop that deterioration process and to promote healing when possible. Also, we know that in the case of cortisone injections, some patients feel so good, so quickly, that they are prone to re-injure themselves. Thus, short-term improvement, but long-term worsening with some cortisone injections.

Thus, how do we choose what type of injection to recommend to a patient? Here are some examples:

-A 60-year-old woman will be traveling on a bucket-list trip to Italy in one week. Her arthritic knee is painful and swollen, and she needs some quick relief to really enjoy this trip. We choose a CORTISONE injection to provide that relief. She will likely feel better within a few days of the injection and will probably see a benefit for 1-3 months.

-A 35-year-old runner tore his ACL at age 20 and had successful surgery. Now, he has mild osteoarthritis of the knee that is stiff in the morning, aches after long runs and occasionally swells. He is a great candidate for PRP. PRP should help his keep inflammation down, reduce his aches and preserve his cartilage in his knee for years to come.

-A 65-year old woman has had 2 weeks of lateral hip pain after a trip to the beach with frequent walking. She can’t sleep on the side of her painful hip and going up stairs is difficult. We diagnose her with trochanteric bursitis and gluteal tendonitis. A CORTISONE injection here may do the trick. She has an acute inflammatory response and needs some relief to simply sleep better at night and handle her activities of daily living with less pain.

-A 24-year-old recreational basketball player has patellar tendonopathy and pain every time he jumps and lands. Symptoms have been present for 6 months and despite physical therapy, a brace and NSAIDS, he is only 50% better. We offer him 1-2 PRP injections. We need to promote healing of that tendon. We want long-term reduction in symptoms and tissue improvement, so that he can continue to play basketball and with reduced risk of tearing the tendon. Plus, we never inject cortisone in or around certain tendons, including the patellar and Achilles tendons, due to the risk of tendon rupture.

-A 70-year-old has mild to moderate hip and knee osteoarthritis. He can play golf a couple days a week, but relies on frequent doses of ibuprofen after his golf games and on days he plays with his grandchildren. His hoping to avoid joint replacement in his lifetime and knows that long-term use of NSAIDs is not good for his blood pressure, stomach or kidneys. We offer him PRP as a great option, with an injection into the knee and hip joints on the same day. He then will return a month later for his 2nd set of injections. After that, we hope and expect that he will have less pain and better function for 6 to 24 months, while also lowering his chances of joint replacement in the intermediate future. These PRP injections can be safely repeated months to years later, if necessary.

These are everyday examples of how we customize our treatments for patients based on their symptoms, diagnosis and goals. Age of the patient can play a role, but one is never “too old” to have a PRP injection. When head-to-head studies compare PRP to steroid injections, PRP is declared the “winner” the large majority of the time. Thus, we know that for long-term benefits of many joint and tendon problems, PRP is the better choice.

In conclusion, cortisone/steroid injections are not going away any time soon. They still play a role in helping patients in select situations. However, the world of orthobiologic injections such as PRP will only continue to expand as we strive to find more natural and less-invasive ways to treat a variety of orthopedic conditions.

The 5 Biggest Mistakes Inexperienced Runners Make Leading to Injury

1)     Training for a ½ or full marathon when you’ve never run a 5K or 10K- because of variability of muscle types, bone density, running mechanics and the efficiency of oxygen consumption, not everybody was made to run long-distance races. Some great athletes are hardly capable of running 5 miles. Then, you have those individuals who can run a ½ marathon and barely train to do it. If a novice runner, see what your body is capable of first by training for and completing shorter races before attempting much longer runs.

2)     Pushing through pain to get through a run- there’s fatigue, soreness, the muscle burn and then, there’s pain. Concerning pain includes sharp discomfort, pain that results in limping, constant pain and pain associated with swelling. Pain around a tendon or right over a bone is a warning sign. Don’t ignore the “check engine light” that comes on in your body. Learn to recognize the difference between the types of discomfort and seek medical attention when the concerning form of pain is present.

3)     The wrong footwear- this can be shoes that are too old or the wrong type for your foot and particular gait pattern. It’s time for new shoes when there’s visible wear of the tread, especially in the forefoot area (the third of the foot closest to the toes). Shoes should be updated every 300-500 miles or every 9-12 months, whichever comes first. Also, seek a true “fitting” for your shoes. The right size, width and style (stability, neutral, zero drop, etc.) are important choices, and you should avoid choosing the latest “fad” shoe or the one that has the coolest design simply for the fashion statement. Find a quality running store that can help you with these choices.

4)     Training with a partner of a different skill set- it’s generally best to train with someone of a similar skill set and set of goals. Many runners are competitive (whether they admit it or not!), and will push each other at times even on training runs. While this is not all bad, someone training for their first ½ marathon will likely struggle to keep up with someone that has run numerous long-distance races. What’s the net result? The inexperienced runner tries to keep up with the experienced runner in terms of speed, distance and mindset. This is a recipe for injury. If wanting to train with a partner, try to find one that is willing to follow a similar schedule and runs a similar pace.

5)     Making up for lost time- sometimes a training schedule gets derailed. An illness, an injury or a life event knocks a runner off his/her training schedule for a couple of weeks. Race day is nearing, and thus, the runner tries to advance the training schedule by increasing the number of running days each week or jumping ahead and doing more miles or longer runs than what he/she should be doing. Example: it’s late in the training schedule for a ½ marathon, and the longest run you’ve done is 7 miles. You missed 2 weeks of training because of a sinus infection. You jump ahead on the schedule and do 10 miles on a Saturday. Now, your shin is throbbing. Shin splint or stress fracture? Either way, you’re done! No race for you. No running for weeks to months. What should you have done instead? Resumed your training schedule where you left off before the illness. Then, if not ready for this race, postpone and run another one. There are ½ marathons within a region almost every weekend, especially from the late winter until the late spring. Or, you could have still run the race, but adjusted your goals. Maybe you change your mindset to just finishing the race, even it meant walking part of race. The bottom line: skipping steps in your training often results in an increased risk of injury.

At Impact Sports Medicine, we would rather help you prevent an injury, but when one does occur, we are ready to help! Enjoy your running!

Tennis Elbow: The Most Misnamed Orthopedic Condition

Fewer than 10% of patients that have tennis elbow actually play tennis. In addition, the medical term for this condition is "lateral epicondylitis." This also is misnamed. Why? The lateral epicondyle is the bony prominence on the outside of the elbow. This sometimes stubborn condition is not a bone problem, but a tendon problem, actually involving what we call the common extensor tendon. This also can be a very humbling condition. It can cause significant pain with some simple, everyday activities- lifting a coffee cup, shaking hands, pulling your bedsheets, just to name a few. Why you ask? Stress to this tendon is not only related to the weight of a lifted object, but also the arm and wrist position. Certain positions cause overloading of the damaged and/or inflamed tendon. Turning our attention to treatment options, there are traditional and innovative options. At Impact Sports Medicine, we actually specialize in both types:

Traditional:

1) REST and changing the biomechanics- how and how much you lift, grip and grab

2) A wrist splint- yes, immobilizing the wrist and forearm unload the tendon far more than immobilizing the elbow

3) A cortisone injection- in our hands, 90% of patients experience relief with an ultrasound-guided injection. However, since tendon damage is often the cause of the stubborn pain, cortisone, at times, may only provide temporary benefit.

4) Physical Therapy- helpful in changing the biomechanical problems that led to the tendon damage. However, the benefit can be limited if tendon is partially torn.

Innovative:

1) The Tenex procedure- a true game-changing minimally-invasive procedure. This is our favorite option for those patients that have not improved with the traditional treatments. Local anesthesia only, a tiny incision, 2 minutes of tendon treatment with a small probe, no stitches, covered by insurance and a 90% success rate. How does that sound? We've loved this procedure for 6+ years.

2) Regenerative injections- platelet-rich plasma (PRP) and amniotic membrane are very solid choices, utilizing solutions rich in human growth factors to stimulate healing of the tendon.

3) Nitroglycerin patches- placed on the skin over the tendon, these are good choices for those patients needing something extra, but prefer a treatment that is non-invasive. These work by producing nitric oxide in the tissues, which then can be responsible for tendon healing.

In summary, we hate that you have "tennis elbow," but love the opportunity to treat you. It's our mission to make this common cause of elbow pain leave your life and never return! Let us know if we can help.

My Heel is Killing Me! What is This and How Do I Get Rid of It?

In middle-age individuals, 90% of the time, heel pain is caused by plantar fasciitis. The plantar fascia is a soft-tissue band, technically a ligament, that supports the hindfoot and midfoot. It is quite prone to inflammation, degeneration and tearing. Let’s quickly dive into this common cause of heel pain.

How Does it Present?

·       Heel pain, often sharp, with the first few steps out of bed and after a long day on your feet

·       Pain when rising from a seated position after prolonged sitting, such as in a car

·       In endurance athletes, pain during and after exercise

·       Tenderness on the bottom of the foot, specifically at the heel where the plantar fascia originates

Why Did I Get This?

·       Age- middle-agers are prone to this, as they are very active, but their rate of tissue breakdown exceeds their body’s repair rate. This is why younger individuals do not typically get this problem. They have a faster healing rate.

·       Poor footwear- shoes that are flimsy, too old or generally unsupportive contribute

·       Weight- gaining weight or being overweight overloads the tissue at the lowest point of our body

·       Too much activity/overuse- runners, walkers, and athletes repetitively load the plantar fascia, and at times, are in a situation of overuse or too much, too soon

·       Poor biomechanics- tight or weak calf muscles, a high arch or flat foot or a foot that excessively pronates or supinates can all contribute

How Do I Treat It?

Patience is the key. This condition may require a month or a year of treatment. Recovery can be slow. The underlying risk factors listed above must be corrected. What works for one patient may not be the best treatment for another. Care must be individualized.

·       Rest- yes, this is a dirty, four-letter word for many patients. Plantar fasciitis will NOT improve as long as one continues to run, walk or exercise to the same degree. Sometimes, activity modification will work- fewer miles, less frequent high-impact exercise and/or trying something lower impact such as biking or swimming

·       Improve the footwear and minimize going barefoot- remember with shoes, you often get what you pay for. Don’t go cheap!

·       Physical Therapy- helps most patients, can be curative for those with mild cases. Will not get the job done by itself for moderate to severe cases

·       Orthotics/Inserts- over-the-counter or custom. OTC ones are less expensive and worth a try for mild cases. Custom are more expensive but more beneficial for most patients. Orthotics alone will not cure plantar fasciitis. Other treatments must be combined

·       Anti-inflammatory medications- helpful in mild cases caught early. Not helpful in more severe cases or in patients that have had the problem for months or longer

·       Cortisone injections- occasionally helpful, occasionally harmful. We rarely utilize these, as they don’t promote healing, only reduce inflammation and can increase the risk of further tearing of the fascia. NEVER get a series of 3 cortisone injections as recommended by some.

·       Regenerative injections- very helpful for most. These are meant to “heal the heel!” Platelet-rich plasma, amniotic and umbilical cord injections introduce numerous growth factors to the area to promote tissue regeneration. These are game-changing injections and ones we have provided under ultrasound-guidance successfully now for many years.

·       Surgery- we favor a minimally-invasive procedure called the Tenex procedure. Tiny incision, local anesthesia only, no stitches required with minimal healthy tissue disruption. The “old-school” surgeries require larger incisions and involve “releasing”/cutting the fascia off the bone, are less successful, higher risk and have been abandoned by most orthopedic surgeons

In conclusion, heel pain affects a high percentage of middle-age Americans and can range from a nuisance problem to a disabling one. The key here is to seek care early and from someone who can customize a well-constructed treatment plan for you that has a variety of quality interventions. We are here to help!

The Top 3 Activities that Lead to Summer Injuries in Adults

What are the top 3 activities that lead to summer injuries for adults?

1) Yard work- often a situation of doing too much at one time. Repetitive bending, lifting, pushing and trimming frequently lead to low back, neck, shoulder and elbow issues. Our advice- spread the work load among several family members and among several days. Instead of 4 hours of work on one day, divide the work load into 2-3 days. Get as close as you can to something you are lifting or trimming. Doing these with your arms further away from your body can overload the spine, joints and tendons. 

2) Tennis and golf- these are great warm-weather sports, but lead to a elbow tendon and low back problems quite frequently. The same concept discussed above applies: avoid overuse situations. Play 9 holes instead of 18 on some days. If you are a middle-ager, don't expect to play 72 holes on a weekend and not feel some aches and pain. With tennis, consider playing with a 2-handed backhand. Play some doubles, not just singles, as this can decrease your reps, but lead to similar enjoyment of the game. 

3) Running and power walking- many love just being outdoors for these fitness activities, while others are starting to train for 1/2 and full marathons in the fall. A couple of pieces of advice: if training for a race, follow a program/regimen. 12 weeks to train for a 1/2 marathon, 18 weeks for a full. To all: update your athletic shoes every 9-12 months or if any wear is present on the tread. Also, make sure your other shoes are supportive. Flimsy sandals and flip-flops lead to foot, ankle and knee problems, especially if these areas are already being stressed by other fitness activities. When it comes to summer shoes, to some degree, you get what you pay for. A quality pair of sandals or flip-flops will run you $50-$100. 

Enjoy the summer!

The Guide to Regenerative Injections

Dr. Holmes’ Guide to Regenerative Injections

Regenerative injections are those specifically utilized to promote healing of damaged tissue, reduce or eliminate unhealthy inflammation and slow or halt the progression of soft tissue and joint deterioration. We now use them regularly for tendon problems including tennis elbow, golfer's elbow, the rotator cuff, the high hamstring, patellar and Achilles tendons. We also have seen great success in treating osteoarthritis of the knees, shoulders, hips, thumb and great toe joints. Plantar fasciitis, ligament and muscle tears are great candidates for regenerative injections as well. 

·      Platelet-Rich Plasma Injections

o   Blood obtained from an arm vein is centrifuged for 15-20 minutes, isolating the platelet-rich plasma

o   Platelets are very rich in our natural growth factors (healing agents), and are concentrated 6-10 times their natural concentration

o   Under ultrasound-guidance, the PRP is injected into the damaged tendon, ligament, fascia, joint or muscle

o   Great option for tennis elbow, golfer’s elbow, small rotator cuff tears, small patellar tendon tears, high hamstring tendon tears, Achilles tendon tears, plantar fasciitis, etc.

o   Widely-used also for osteoarthritis of numerous joints

o   PROS: very natural and safe (your blood); used in orthopedics for ~10 years, Dr. Holmes has used for 7 years; numerous medical studies confirm significant benefit; 2-3 areas can be injected at one time; long-term benefit for most patients

o   CONS: these work gradually, over weeks to months; increased pain after the procedure for 2 days to 2 weeks; immobilization required with a splint or boot for some injections

o   UNKNOWNS: length of benefit (can be months to years); number and frequency of required injections. 1-2 injections initially for most soft tissue problems; 2-3 initially for arthritis/joint problems

·      Amniotic Membrane Allograft Injections (brand- AmnioFix)

o   Utilize one of the placental membranes (these cover the fetus during pregnancy) to form a product containing numerous types of growth factors

o   Intended to reduce inflammation, reduce scar tissue formation and enhance healing

o   The membrane undergoes a rigorous purification and sterilization process, and is stored as a dehydrated powder; sterile saline is added to become an injectable solution

o   Great option for plantar fasciitis (#1 use), tennis elbow, golfer’s elbow, small rotator cuff tears, small patellar tendon tears, high hamstring tendon tears and small Achilles tendon partial tears

o   PROS: very safe, with no significant reportable adverse effects; Dr. Holmes has used for 5 years; no rejection, despite not being one’s own tissue; no blood draw required; typically less post-procedure pain than PRP

o   CONS: probably not as effective for joint pain/arthritis; otherwise, same cons as PRP

·      Amniotic Fluid Injections (brand- Catalyst PDA-HAF)

o   Very similar to amniotic membrane injections, but often stored in a frozen form and thawed immediately before injection

o   Contain over 200 different growth factors

o   Great option for soft tissue as well as joint problems such as osteoarthritis

o   PROS: theoretically, a more powerful amniotic product than a dehydrated membrane

o   CONS: more expensive than the dehydrated membrane product

·      Alpha-2-Macroglobulin Injections

o   A natural substance found in our bloodstream

o   Blood drawn from the patient, centrifuged, manually separated and then placed in a separation pump to further isolate and concentrate the A2M

o   45-minute procedure done in one office visit

o   Functions as a “protease inhibitor,” binding the inflammatory proteins that cause the degradation of cartilage in the joint

o   Utilized to reduce pain, inflammation, halt the progression of osteoarthritis and provide “longevity” to the joint

o   PROS: very safe and natural substance; presumed long-term benefit, less post-procedure discomfort than other injections; two to three injection sites can often be chosen with one procedure

o   CONS: newest type of regenerative injection; very few medical studies proving effectiveness thus far, but studies are underway; frequency of injections not known at this point (likely every 6-24 months)

With any of these injections, all forms of ORAL and TOPICAL anti-inflammatories must be stopped for 1 week before and 2 weeks after, as to not interrupt the initial healing cascade initiated by the injections. This includes:

·      Advil/Motrin/ibuprofen

·      Aleve/naproxen

·      Aspirin- any doses above 81 mg

·      Mobic/meloxicam, Celebrex/celecoxib, Voltaren/diclofenac

·      Fish oils/Omega-3 fatty acids

·      Turmeric

·      Oral green tea

·      Glucosamine/chondroitin

·      Arnica

COST: Regenerative injections are rarely ever covered by insurance. Although we closely monitor their coverage status, in the current climate of healthcare and insurance companies reducing their coverage of even typical treatment measures, we do not expect these injections to be covered in the near future.

With rising deductibles, many patients pay out-of-pocket for traditional treatment measures as well. Thus, a regenerative injection may ultimately be a similar out-of-pocket cost to traditional treatments but more clinically effective and cost-effective over the long-term.

A patient should view these injections as an investment into the long-term health of their tendons, fascia, ligaments and joints.

We are here to serve you! 

F. Clarke Holmes, M.D. 

THE ANATOMY OF A LEADER: MY VIEW AS A SIDELINE PHYSICIAN, COACH & PARENT

Over the past 20 years, I’ve served as a coach for youth sports, a team physician working the sidelines & courtside and as a parent of two young athletes. It has been enlightening to observe those athletes who are particularly skilled in their leadership capabilities. I’ve learned that being a leader can take on many forms. There is not a “cookbook” formula, but it is obvious that every type of team needs leaders to succeed. Here are some of the various types of leaders and their attributes.

  • The Encourager - this leader can do so from the field/court or the bench. He (spoken generically, “she” can apply in all situations as well) may be a starter or rarely see playing time. Either way, he’s the one leading the cheers, picking up his teammates when they are down on the ground, congratulating one after a big play or consoling a teammate after a mistake. This type of leader is often an extrovert and tends to be less focused on his own performance.
  • The Leader by Example - this person is often on the quiet side. He doesn’t lead by cheers or many words, but is frequently a workhorse. She is obedient and respectful with her coaches and rarely steps out of line. A coach often asks her to demonstrate various drills during practice. Other players begin to emulate this athlete, and the domino effect has a very positive effect on the team.
  • The Star - this leader is a “gamer.” He wants the ball when the game is on the line. “Ice water in his veins” is a phrase often assigned to this athlete. She inspires her teammates as she does not hesitate to make a big play during a key portion of the game. Even though a excellent player, to effectively be a leader, the “star” must still remain humble and do things on the game or practice field to make his teammates better.

Every team needs leaders. A championship often team has all three types described above. Even if not a winning team, it’s still important to have various type of leaders emerge on each team. These leadership skills often spill into other types of endeavors, perhaps in the academic or business arena. During the formative years, these leadership skills may help your child resist some negative forms of peer pressure.

As a parent or coach, realize that leaders may be born, or they may be made. If you exhibit leadership in your own arena, your children will take notice. Recognize the personality of your child or player and tap into his skill set to develop their particular leadership style. Also, realize that a child or young athlete may be a leader in one field and a follower in another. That is not a weakness, but just a reality. If an athlete gives his best effort in all that he does, then one or more of these leadership styles will often develop as positive bi-product.

Get busy leading!

F. Clarke Holmes, M.D.

Impact Sports Medicine and Orthopedics 

Should My Son Play Tackle Football?

"Should my son play tackle football" is a question I receive on a very frequent basis. Parents are more concerned than ever about the risks that come with playing this collision sport. The first question I ask the parent in return is "Does your son really want to play tackle football?" Football is a rigorous, gladiator-style sport. It often pushes boys towards their limits with regards to commitment, fear, body contact and fitness level. These "pushes" can be a positive thing for your son, but if he is not enthusiastic about playing this sport, then your question has been answered. I strongly discourage participation in football if your son doesn't want to be on that field. 

Here are the reasons your son SHOULD play football:

  • He becomes part of a team, something bigger than himself. Bonding is often very high among football teammates, as they adopt an "in the trenches together" mentality
  • Courage, dedication, loyalty, sportsmanship and confidence are valuable character traits that often develop with a successful football experience
  • Improved fitness levels- football is a sport requiring endurance, speed, quickness and power, with some positions emphasizing more of these traits than others
  • Mentoring- many football coaches become like father-figures to young men, teaching them important life lessons while teaching them football as well

Here are the reasons your son should NOT play football:

  • First and foremost, he doesn't want to play
  • The risk of injury. Here are some important injury-risk considerations:
  1. Size and strength deficits- if your son is physically less developed than many other peers competing in football, then his risk is increased. If the team or league is allowing 140 lb. boys block and tackle 225 lb. boys and vice-versa, then the smaller boy's risk is much greater. In the youth leagues, rules are often in place to reduce this effect. In the high school environment, it is up to the coaches to ensure the safety of the smaller athletes.
  2. Concussions- we could create an entire blog on this subject, but in a nutshell, concussions are common at all levels of football. Contrary to most conditions in medicine, concussion symptoms in younger football players often last longer than those more mature. New evidence is suggesting that the earlier the age one starts having concussions, the greater the risk of long-term problems such as memory deficits and depression, just to name a few. Also, the multiple concussions likely create a cumulative effect, meaning several concussions in a relatively short period of time create more long-term damage than one concussion or a few concussions separated by many years. Simply put, someone playing tackle football for 10 years is much more likely to have more concussions, whether diagnosed or not, than one playing for only 3 years. Improved equipment such as helmets and better tackling techniques may reduce the severity and risk of concussions, but no equipment or rule adjustment can significantly reduce or eliminate concussions. 
  3. Orthopedic Injuries- minor contusions and sprains are part of the game for nearly every player and heal without consequence. However, some fractures and ligament sprains, although appropriately treated, leave football players with long-term pain and dysfunction. For example, despite a successful ACL-reconstruction surgery after an ACL tear, 50% of athletes have knee arthritis within 12 years of the injury. In addition, repetitive microinjury to the back likely leads to an increased risk of disc problems in the cervical and lumbar spine. 

When weighing the risk of injury as it relates to football participation, consider not only the immediate impact of injury, but also the long-term implications of concussions and orthopedic injuries.

If there is an opportunity to play flag football, then I encourage one to play this version for as long as possible. In my opinion, tackle football is a sport that be re-joined or joined for the first time at a later age, perhaps 9th or 10th grade without a major roadblock to success. Years of tackle football does not necessarily guarantee success at higher levels such as high school or college. In fact, beginning tackle football at a young age can lead to burnout or injuries that derail one's ability and desire to continuing playing into middle and high school. 

In conclusion, the decision of whether your son plays tackle football or not must be one thoughtfully considered by and discussed among the athlete and his family members. Risks and benefits for your child should be carefully weighed.

F. Clarke Holmes, M.D.

Impact Sports Medicine and Orthopedics, PLLC