With fall sports around the corner, it's time for a sports physical

Centers for Disease Control and Prevention photo

By Dr. Scott Black
University of Kentucky

The potential benefits of letting your child participate in sports are innumerable, but sports also come with inherent risks -- many of them that can be avoided with a sports physical. 

From the intensity of competitive play to the physical demands of training, athletes face potential injuries that could range from mild strains to more serious issues like an irregular heartbeat.

That’s why a sports physical should be at the top of every annual preseason checklist. Not only are sports physicals often required by states and schools prior to athletic participation, they’re also essential for injury prevention and catching preexisting conditions that could keep an athlete off the field.

What happens at a sports physical? While a sports physical should not substitute for an annual checkup or well-child visit, sports physicals are similar in that a medical provider will perform a physical examination of your child to evaluate if they can safely take part in sports.

The health-care provider may inquire about your child’s medical history by asking about any known medical problems like asthma or diabetes, past injuries like concussions or broken bones, allergies, medical issues that may run in the family, medications your child is taking, including over-the-counter medicines or supplements and their diet. 

The provider will also typically record your child’s height and weight, check their blood pressure, listen to their breathing and heartbeat, examine their reflexes and muscle, bone and joint health and test their vision

If the doctor determines your child’s health is fit for the field, they’ll clear them for competition. Should they identify anything of concern, the provider might offer a treatment plan or refer your child to a specialist for further evaluation.

It’s recommended to schedule your child’s sports physical several weeks prior to the start of the school year. That way, if there is an issue, your child can begin treatment well before the beginning of the season.

Where should we go for a sports physical? Many families go to their primary care providers to get their sports physicals done. Some schools or clinics may offer free sports physicals on a particular day, but that examination may be less personal, especially if your child doesn’t already know the provider.

Do we still need to do a check-up? While a sports physical is similar to an annual checkup, they’re not the same. Annual check-ups are crucial to making sure your child’s development is on track, is up to date on vaccinations and that your child is generally healthy.

A sports physical can’t replace a check-up, but you can ask your provider’s office if they can be done at the same time.

Dr. Scott Black is clinical director of the University Health Service at the University of Kentucky.

Beshear OKs fall sports, says he can't make all the calls; issues and funds executive order to resolve disputes over evictions

State graph, adapted by Kentucky Health News; weekly numbers reflect adjustments made after initial daily reports, including elimination of duplicate cases

By Melissa Patrick and Al Cross
Kentucky Health News

Gov. Andy Beshear said the state will not overturn the decision by the Kentucky High School Athletic Association to allow fall sports in the midst of the highest coronavirus case numbers the state has seen. 

"It's not because I think that it is a good decision or a wise decision," Beshear said at his daily news conference. "But if we're going to defeat this virus, we need people, other than me up here, all over Kentucky taking responsibility to make good and wise decisions."

Pressed for his reasoning, he said, "At some point it can’t be every single decision comes to the governor. . . . We also have to keep our regulations and our decisions in a certain area that people are willing to live with."

Earlier, as he announced his decision, he said, "I have concerns . . . that by starting with some of the most high-contact sports we risk shortened season, we risk what I think can be successful plans to get our kids back in school, that we risk every other sport that's going to follow. But we can't be making every decision for what's best for folks out of the governor's office and it's gonna be incumbent on our superintendents, on coaches, on the different groups to make the wisest decisions that they can."

On Aug. 20, the KHSAA Board of Control voted 16-2 to keep its schedule for fall sports, starting football practice today and games Sept. 11. Cross-country, field hockey, soccer and volleyball will begin Sept. 7. The KHSAA had said its plan was subject to approval by the state Department of Education, the Department of Public Health and Beshear himself. 

Players, coaches and parents rallied Monday on the steps of the Capitol in an effort to get the governor's green light for fall sports with the message: "Let them play," Lexie Ratterman reports for WDRB.  WKYT reports that Republicans in the state House issued a statement calling on Beshear to let the schools play. 

Asked later if he reserves the right to intervene if things are out of control in October, Beshear said, "Heck, yeah, I do." 

Beshear stressed that it will be important for schools to be transparent and do the right thing if and when team members test positive, even if it's the biggest game of the season and the star player is quarantined.

He and Health Commissioner Steven Stack pointed out some of the differences between high-school sports and the Southeastern Conference, which is proceeding with its fall season. The SEC is testing its players three times a week and has stringent requirements that have to be met before a player who has tested positive is allowed to return to the game. 

"If you're in a public school in the state or you're in a private school, do you have the money and the resources and the ability to secure three tests a week for the students to play sports?" Stack asked. "I think you all know the answer to that."

Stack said there is still much unknown about the long-term effects of the coronavirus, pointing to several studies that show it can affect the heart, including one by a sports cardiologist at Ohio State who says the university's doctors have found that up to 13 percent of college athletes who test positive for the virus develop inflammation of their heart muscles, called myocarditis, which Stack said can result in a range of outcomes from complete recovery to death.  

"You can have sudden cardiac death because you have an irritable heart muscle," he said. "I hope this doesn't happen, but it's just going to take one 16- or 17-year-old to drop dead on the sporting field before someone notices that it's not fictional, it's real."

Evictions and covid-19

Beshear issued a new executive order on evictions that dedicates $15 million of federal coronavirus relief funds to create a Healthy at Home Eviction Relief Fund. He said funding is also available from several other sources.  

The order says landlords must give tenants 30 days' notice of their intent to evict for nonpayment of rent and during that 30 days, the landlord and tenant must meet and try to work out an agreement. The order also says there will be no penalties, late fees or interest charged relating to nonpayment of rent between March 6, when the pandemic arrived in Kentucky, and Dec. 31. 

This stems from three Northern Kentucky landlords' lawsuit challenging the governor's ban on evictions. He said mediation efforts have failed, but the lawsuit is now moot because the executive order it was based on is no longer in effect. 

Beshear said his new order is designed to meet three challenges: making sure Kentuckians don't end up on the street, making sure landlords are being treated fairly, and making sure Kentuckians don't end up with so much debt that they can't dig out of it. 

"Kentuckians cannot be healthy at home without a home," he said, directing Kentuckians who need help with an eviction issue to visit kycovidlegalhelp.org or call 833-540-0242. 

Don't let your guard down

Beshear voiced concern that Kentuckians might get complacent about following preventive measures as schools start to reopen and sports rev up, as they did around July 4 when a surge in cases "almost sent us spiraling out of control." 

He said his worry is compounded because the state is seeing more people trying to get out of quarantine and more people not wanting to help health departments, which are trying to trace and quarantine people who have been in contact with infected Kentuckians.

"Those feelings are natural, but they're harmful," he said. "They could lead to another spike and it would be a spike from where we are right now. This is a war. Whether we win or lose, how many Kentuckians we lose, it's all based on the number of battles that we win, or lose. So please, don't get tired. Let's pick it up. Lives, lives depend on it."

Kentucky has seen more 4,000 new cases in each of the past two weeks. Beshear pointed out that for each of those weeks, with a 2% mortality rate, the state will lose 80 people a week to the virus. 

"They trail the weeks in which we see those cases, meaning it's gonna be a tough month, and next month is going to be a tough month," he said.

Beshear reported four more covid-19 deaths Monday, bringing the state's death toll to 885. The fatalities were a 71-year-old woman from Marion County, a 74-year-old man from Harlan County and an 82-year-old man and a 94-year-old woman from Jefferson County. 

The governor added that while today's death toll was lower than it's been, "We had more deaths announced last week than in any week in which we've been battling this virus," and there are 19 deaths pending in front of the committee that determines if a death is related to covid-19.

The state recorded 373 new coronavirus cases on Monday, bringing its seven-day rolling average to 635. The percentage of Kentuckians testing positive for the virus in the last seven days was 4.77%, a slight drop from Saturday, the last day the figure was reported. Reporting is typically limited on Sundays, and labs are still catching up on Mondays, reducing case figures for both days. 

Reporting to increase

Beshear said the state will put coronavirus information for schools and universities online and update it regularly. He cautioned that because of processes involved, the state's reporting may lag behind local reporting. The state will ask schools to submit data daily "because parents deserve to know," he said. 

The governor reported that 31 school districts had at least one positive coronavirus test and they believe that at least 50 cases are active. He said there are 223 active cases in the state's colleges and universities.

State's first report on colleges and universities; click to enlarge. Click here for report on K-12 schools.    

Stack said that in response to a demand for county-level data, he will work with the state Department of Education to create a simple metric with county-level data that counties can use to inform their decisions, cautioning that such localized data will have severe limitations. 

Stack reiterated that the virus does not respect lines on a map. "If you are next to a county with very active disease, your county could be very active very quickly; when you get hot red, it takes longer to cool off than it does to accelerate up," he said. 

In other covid-19 news Monday:

• Jefferson County again accounted for almost a third of the new cases, 152, Other counties with five or more cases were Fayette, 76; Madison, 29; Kenton, 20; Calloway, 11; Marion, 10; Bullitt, 9; Daviess and Warren, 8 each; Knox, 6; and Boone, Casey, Hardin, Simpson, Trigg and Woodford, 5 each.  
• Kentucky hospitals have 564 covid-19 patients, 149 of them in intensive care and 82 of those on ventilators, Beshear said. 
• In long-term care facilities, active cases numbered 513 among residents and 310 among staff, after four more in each category were added Monday. 
• Beshear reported nine veterans and one staff member have tested positive for the Eastern Kentucky Veterans Center in Hazard, the first veterans' nursing home with an extensive outbreak. He said it has been confined to one hallway of one unit, and all of the cases trace to an aide who is recovering at home. He said all the veterans who tested positive have been moved to the local Appalachian Regional Healthcare hospital, allowing everyone left on the hall to have a single room. He said all veterans in facility will be tested by Wednesday. 
• In child-care centers, 10 more employees and three children tested positive, for totals of 128 staff and 99 kids; 158 facilities have had at least one case. 
• After five students and one staff member tested positive for the coronavirus at Lexington Catholic High School, it switched to virtual learning Monday for two weeks. It opened last week to in-person learning despite Beshear's recommendation to delay until Sept. 28, Valarie Honeycutt Spears reports for the Lexington Herald-Leader.  The local health department also reported one student at Lexington Christian Academy and two students at Sayre School had tested positive.
• Beshear's travel advisory, asking people to avoid traveling to state's with positive-test rates of 15% and to self-quarantine if they do, now applies to fewer states: Mississippi, South Carolina, Texas, Nevada and Idaho. 
• KFC announced suspension of its “Finger lickin’ good” slogan, calling it “a bit off” during a pandemic when people are advised not to touch their faces with unwashed hands. in a YouTube video, the Louisville-based chain blurred "finger lickin’" from some of its old ads and advised, “That thing we always say? Ignore it. For now."
• Senate Majority Leader Mitch McConnell is urging Americans to wear hemp face masks to prevent the spread of coronavirus, Kyle Jaeger reports for Marijuana Moment. He was speaking at the Kentucky-based hemp company Ecofibre on Monday. 
• Kentuckians with children eligible for free or reduced-price school meals have until Aug. 31 to apply to get help with their home purchased groceries, Jack Brammer reports for the Herald-Leader. Jessica Klein, policy associate for the Kentucky Center for Economic Policy, said at a news conference that parents or guardians of roughly 117,000 Kentucky students who qualify have not applied. Brammer reports there is no income limit to participate and persons can apply regardless of their immigration status.  The benefits are called P-EBT, for Pandemic Electronic Benefit Transfer. Click here for more information about requirements and qualifications. 
• Researchers from McGill University in Montreal set out to find out what makes one person more likely than another to believe fake news and conspiracy theories about covid-19. The study, published in Misinformation Review, found that "even after adjusting for demographics such as scientific literacy and socioeconomic differences, those who regularly consume social media rather than traditional media were less likely to observe social distancing and to perceive covid-19 as a threat," Quentin Fottrell reports for Market Watch. The paper concluded that "those that consume more traditional news media have fewer misperceptions and are more likely to follow public-health recommendations like social distancing," Fottrell reports. 
• In their weekly "Covid Watch" article, Deborah Yetter and Grace Schneider of the Courier-Journal reports on how the state determines the covid-19 death count; the reliability of the state's data; death rates for the flu and covid-19 in Kentucky; and issues of immunity and recovery from the virus.

Kentucky High School Athletic Association says it is still planning for fall sports, with details still in the works; board meets Friday

Players wearing masks at Paul B. Cox Stadium at DeSales
High in Louisville (Photo by Jeff Faughender, Courier Journal)

Not only are Kentucky school districts trying to figure out out to get students back into the classrooms in the middle of a pandemic, but they are also looking for ways to safely operate their athletic programs.

Commissioner Julian Tackett of the Kentucky High School Athletic Association told superintendents at the weekly "Special Superintendents' Webcast" July 6 that the association is working toward having fall sports, but cautioned, "What that looks like could change every day."

“Right now we are moving along with playing our regular six sports in the fall, period,” he said. But, he reiterated, that could change rapidly depending on the course of covid-19 infections, according to a state Department for Education news release.

For the last few weeks, Kentucky high-school teams have been able to conduct voluntary workouts under strict guidelines that call for small groups, social distancing and daily health check-ins. That said, the Lexington Herald-Leader reported on July 1 that team workouts have already been halted in three school districts amid covid-19 concerns.

Tackett said it's likely that high-school sports in Kentucky will shut down intermittently due to the coronavirus., Louisville's WLKY-TV reports.

Tackett said many schools are asking about mask use in sports. He said the emerging standard is for masks to be required for everyone except those actually in play, but he noted that they are also allowable for athletes on the playing field. He said mask rules will be made by districts along with their local health departments. “We’ve been told that a statewide answer is not the best idea,” he said.

Dr. Connie White, deputy commissioner of the state Department for Public Health, said student athletes with a fever of 100.4 degrees or covid-19 symptoms would need to be free of fever and symptoms for 72 hours before returning to any type of school activity, and that any sibling living with them would be quarantined along with them, and this barred from school attendance or athletic activities.

Tackett said crowds at sporting events are currently limited to 50, but the association is looking at a 50-percent capacity limit with six feet of social distancing.

To mitigate the limits on spectators, school districts can each get two free cameras for live-streaming sporting events. The release notes that the cameras are worth $5,000 and would cost districts about $2,500 to set up.

Guidance for concession stands and ticket sales will be forthcoming, though Tackett said all food at the stands will need to be prepackaged, with nothing made on-site. He also encouraged districts to be looking at smartphone-based online ticket sales, instead of cash.

Tackett also went over the rules for eligibility: As long as a district verifies enrollment at a particular school, whether for in-person or virtual learning, that student is eligible for sports at that school. If parents choose distance learning for their children when schools are open for in-person attendance, districts still can declare those students ineligible to participate in athletics. Sports participation is a privilege, not a right, Tackett said, and local districts can impose stricter standards.

The release notes that guidance for bands will go out soon and that a Kentucky Music Educators Association representative will be on the July 14 webcast to answer questions about the guidance.

WKYT-TV has published an interactive map of school-start dates for some counties. The Education Department issued more covid-19 guidance this week, "Covid-19 Considerations for Reopening Schools: Workplace Health and Safety."

The KHSAA’s Board of Control will meet Friday and is expected to announce guidelines for the rest of July, Jason Frakes reports for the Louisville Courier Journal in an article about Tackett's discussion with the legislature's Interim Joint Committee on Education on July 7. The board meeting can be found at KHSAA.org.

"We realize that we’re walking a tightrope here," Tackett said. "There’s obviously perceived and, likely, real risks of participation in extracurricular athletics. But we are also in very many communities the No. 1 dropout prevention tool that you have. There are people in our communities that every one of you know would not be participating if there was not an athletics or activities opportunity. We’re trying to walk that tightrope delicately."

Looking ahead to basketball season, Tackett said sports-medicine experts say it's more dangerous than football: "That would surprise a lot of people, but they’re talking about vulnerability to the disease because it’s played inside – the ventilation, how long we practice, how long we play. There’s going to have to be some areas addressed there."

7-day case average rises above 200 again, but hospitalizations are down; Beshear says it's manageable with masks, distancing

Kentucky Health News chart shows daily case numbers and seven-day rolling average for this month.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear announced 229 new cases of the novel coronavirus in Kentucky Wednesday, raising the state's seven-day running average to 204, up from 196 yesterday and 176 on June 21, which was the lowest it had been since May 31.

Beshear again said Kentucky remains in a plateau, meaning that case numbers go up and down within a range. He said as long as the state can stay within that range and has enough hospital, intensive-care and ventilator capacity, its government will continue to manage the pandemic while reopening.

Beshear has said he will look more at hospital numbers, which went both ways Wednesday. He said there are 334 people are hospitalized with covid-19, the lowest number in some time, but the number in intensive care rose to 79 from 70 the day before.

Wednesday's cases raised the state's total to 14,363. Beshear announced one death Wednesday, an 89-year-old man from Laurel County, bringing the state's covid-19 death toll to 538.

"We are currently in a manageable phase with the plateau that we are in," Beshear said. "That doesn't mean there aren't some things we can do better -- we need a lot more people wearing masks."

As everything in Kentucky opens at some capacity on Monday, Beshear also urged Kentuckians to  keep six feet of social distance and decrease their daily activities by half -- things he said they will need to do until a vaccine is readily available.

"We don't get to live normal lives right now," he said. "We get to live in our new normal where we manage this virus."

Myrtle Beach a problem for several states

Dr. Steven Stack, the state's public-health commissioner, said two clusters have been identified in Kentucky of people who had vacationed in Myrtle Beach, S.C. He said Horry County, where the city is located, has since declared a state of emergency, just four weeks after its reopening.

“We have now identified both in West Virginia and here in Kentucky numerous people that have returned from Myrtle Beach with covid-19,” Dr. Stack said. “I have to continue to urge and beg folks to be careful. It is not the time to be cavalier because we have a scenario where a place that was just starting the reopening process went from being fine to a state of emergency in three weeks.”

Health officials in Roanoke said Tuesday that the Virginia city was also getting cases from Myrtle Beach. The CovidActNow website estimates that Horry County's virus transmission rate is 1.52, meaning that every 100 infected people infect 152 others. Generally, officials try to keep the rate below 1.10.

Stack said a group of 12 Kentuckians went to Myrtle Beach for three days on June 11 and at least nine of them tested positive after returning. He said the state now believes there is a second cluster tied to the city, as well as a third individual who went there and has since come home and tested positive.

Beshear said, "We're asking people, if you know that there is a place that we can tell you that there are a lot of outbreaks, don't go."

He and Stack are also looking north. The governor said the free, Kroger-sponsored drive-thru testing sites next week will return to Northern Kentucky next week -- as well as Louisville, Lexington and Pikeville -- because of the "disturbing increases" of cases in the Cincinnati area.

In long-term care facilities, Beshear said that since Monday, 31 more residents and 17 more employees have tested positive for the virus, bringing those respective totals to 1,698 and 812. He said six more deaths have been attributed to residents of the facilities.

In other covid-19 news Wednesday:

• The counties with the highest number of new cases Wednesday were Fayette, 40; Jefferson, 32; Warren, 23; and Christian, 20. 
• Beshear announced that in-person help for unemployment claims will be offered by appointment only in several locations. In Frankfort, the state will offer help every day next week between 8 a.m. and 4:30 p.m.; in Ashland and Owensboro, on Monday and Tuesday between 9 a.m. and 6 p.m.; and on July 7 in Somerset and Hopkinsville. He said details for exact locations and how to sign up online would be forthcoming. 
• In Franklin County, a little more than half the people who have been identified as infected with the virus have had no symptoms of covid-19, the county health department tells The State Journal. The county has has 122 cases, 51% of which are asymptomatic.
• A study in Singapore and China found that over half of those with the virus were infected by
  people who hadn’t developed symptoms yet. Another study, in a laboratory, found that the virus can remain infectious in aerosol droplets for up to 16 hours.
• "As contact tracing — an effort to identify anyone exposed to someone with covid-19 — gets underway, Metro Louisville officials are advertising for local hotels to provide rooms in case they are needed to isolate people," Deborah Yetter reports for the Louisville Courier Journal. The purpose is to provide quarantine sites for people unable to isolate at home.
• North Carolina Gov. Roy Cooper said his state will delay expansion of re-openings for three weeks while making face coverings mandatory in public, McClatchy Co. newspapers report.
• Retail alcohol sales jumped 55 percent nationally during the third week of March, when many stay-at-home orders were put in place, according to Nielsen data, and online sales skyrocketed. Kaiser Health News reports on some signs of addiction to watch out for, including big increases in the amount of alcohol consumed; concern expressed by family or friends; changes in sleep patterns; and if drinking is interfering with your everyday life.
• A Centers for Disease Control and Prevention report shows how contact tracing helped control an outbreak of covid-19 after a college spring break trip led to 64 cases, including 60 among 183 vacation travelers, one among 13 household contacts and three among 35 community contacts. "This covid-19 outbreak among a young, healthy population with no or mild symptoms was controlled with a coordinated public health response that included rapid contact tracing and testing of all exposed persons," says the report.
• The future of college athletics in the pandemic will be discussed at 4 p.m. Thursday, June 25 on Zoom. Panelists will be Joseph Fink, a University of Kentucky pharmacy professor who was longtime treasurer of the Southeastern Conference; UK higher-education historian John Thelin; UK Athletics Director Mitch Barnhart; former UK volleyball standout Leah Edmond; and UK alumnus and collegiate sports-marketing pioneer Jim Host. Register here.
• The Kentucky Assisted Outpatient Treatment Program has received a $4 million grant from the Substance Abuse and Mental Health Administration, according to a Cabinet for Health and Family Services news release. The four regional treatment programs serve 192 people with serious mental illness.

More health bills pass as legislative session ends; one would require doctor's OK to play student athletes after concussions

By Melissa Patrick
Kentucky Health News

Several more health-related legislation passed in the final two days of the General Assembly's session.

House Bill 524, sponsored by Rep. Addia Wuchner, R-Florence, to prevent and reduce human trafficking, passed without dissent in both chambers and now awaits action from Gov. Matt Bevin.

As often happens in the final hours of a legislative session, some unrelated measures were tacked onto the bill, including non-controversial legislation to more clearly define "serious physical injury" in child-abuse cases involving children under 13.

Several other health-related bills passed in the last days of the session and await action from the governor. Bills passed after the veto period are not eligible to be overridden by the General Assembly, so Bevin's decision on these bills will be final. They include:

HB 333, sponsored by Rep. Kim Moser, R-Taylor Mill, would limit most painkiller prescriptions to a three-day supply for acute pain, and change how synthetic-opioid traffickers are prosecuted.

HB 78, sponsored by Rep. Jim Duplessis, R-Elizabethtown, to require providers of standard mammograms to notify patients if they have "dense breast tissue" when appropriate, because such tissue can hide cancers. The intent of the notice is to allow patients to decide with their provider if they need further screening.

HB 241, sponsored by Rep. John Sims, D-Flemingsburg, would require written clearance from a physician for a coach to play a student-athlete who has been diagnosed with or is suspected of having a concussion.

House Concurrent Resolution 48, sponsored by Walker Thomas, R-Hopkinsville, urges the U.S. Food and Drug Administration to withdraw its proposal to reduce the levels of N-nitrosonornicotine, or NNN, a carcinogen, in all smokeless-tobacco products sold in the U.S. Thomas's district is a home of dark tobacco, used in smokeless products, and Hopkinsville has a plant that makes such products.

Bevin has signed a bill to establish review panels for malpractice cases. SB 4 was controversial, pitting lawyers against doctors such as the sponsor, Sen. Ralph Alvarado, R-Winchester. It passed the House 51-45, with 11 Republicans joining 34 Democrats in voting no, even after substantial changes sought by opponents.

Under the new law, three physicians will say whether a suit against a health-care provider has merit before it could be filed in court. An attorney will chair the panel but not have a vote. The judge in the case would decide whether the panel's opinion could be admitted as evidence.

Also of note, the General Assembly overrode Bevin's veto of SB 91, which will allow judges to order mentally ill adults who meet strict criteria into an "assisted outpatient treatment" program, and confine them if they don't comply.

Girls are more likely than boys to have overuse injuries while participating in high school sports

Overuse injuries make up more than 50 percent of athletic injuries and are most common in children ages 13 to 17. Girls are at a higher risk than boys of overuse injuries while participating in high school sports, according to a study by researchers at The Ohio State University Wexner Medical Center and published in the Journal of Pediatrics. Tendonitis, stress fractures and joint pain are examples of overuse injuries, which happen when athletes perform the same motion again and again.

In the study, Thomas Best analyzed 3,000 injury cases during a seven year period of time associated with 20 high school sports such as soccer, volleyball, gymnastics and lacrosse. Best and his team discovered the highest rate of overuse injuries happened in girls' track (3.82), followed by girls' field hockey (2.93) and girls' lacrosse (2.73). The most common overuse injuries for boys occurred in swimming and diving (1.3).

"These young people spend more time playing sports both in competition and in practice," said Best, an endowed professor in Ohio State's department of family medicine. "So there's a correlation there between the amount of time that they're playing and the increased incidence of injuries."

Over the past 10 years, high school athletic participation and intensity has gone up. Best said some high school athletes spend more than 18 hours per week participating in athletics, and some play more than one sport at a time. The most common site of overuse injuries is the lower leg, followed by the knee then the shoulder, Best said. To avoid overuse injuries, Best recommends varying movement, playing more than one sport and prioritizing rest and nutrition.

"During this point of their lives, this is when girls are developing bones at the greatest rate," Best said. "It's incredible important that they're getting the proper amounts of calcium and vitamin D."

UK researchers find surprising differences in teens' concussion symptoms and physical and emotional effects

University of Kentucky researchers have discovered surprising differences in symptoms student athletes experience following a concussion, a particular concern as high-school football season nears.

Lisa Koehl, a doctoral candidate in the university's Department of Psychology, and Dan Han, director of the Multidisciplinary Concussion Program at UK HealthCare, drew from a UK database of patients with brain injury and drew a sample of 37 athletes aged 12 to 17.

Koehl said in a press release that 22 of the 37 participants had emotional symptoms after suffering concussions. Among those with such symptoms, 23 percent also had sensitivity to light, while 14 percent had sensitivity to noise. Of the teens who did not have emotional symptoms, 13 percent had light sensitivity, but none of them had noise sensitivity.

Han said said participants who reported anxiety were 55 percent more inclined to have attention difficulties than those who didn't report anxiety. Teens who were irritable or aggressive were 35 percent more likely to report issues with attention those those who were not irritable.

The two groups did not show differences in how many experienced "loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of the severity of concussion," the press release says.

Koehl said the research helped them understand how physical and emotional symptoms in concussion patients interact, with each causing the other in different cases. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery," Han said. (Read more)

Teens sensitive to light or noise after a concussion are more likely to suffer anxiety or depression, UK study finds

Teens who are sensitive to light or noise after a concussion may also have increased emotional symptoms, such as anxiety or depression, according to a study at the University of Kentucky.

“While most people recover from a concussion within a week, a number of factors affect their recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes,” co-author Lisa M. Koehl said in a news release. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school.”

The study followed 37 athletes, ages 12 to 17, who had persisting symptoms for an average of 37 days following a concussion. They were checked for post-concussion changes in physical, emotional and cognitive symptoms. The study determined that there were no differences in the severity of concussions in the group, and that a family history of psychiatric problems did not affect post-concussion emotional symptoms.

But it did find that teens who are sensitive to light or noise after a concussion may also be more likely to have emotional symptoms, including irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions.

Of the 37 athletes studied, 22 had emotional symptoms, and of this group, five (23 percent) were sensitive to light while three (14 percent) were sensitive to noise. Of the 15 athletes with no emotional symptoms, only two (13 percent) were sensitive to light and no teens were sensitive to noise, according to the release.

"Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability," said co-author Dan Han. "While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion."

The researchers presented their findings at the American Academy of Neurology's Sports Concussion Conference in Chicago in July. Click here for more information about concussions.

Ensure children's eye safety during fall sports season

Children are back in school, playing sports, and parents can take precautions to ensure their children's eye safety as they compete.

Although many parents are unaware of the risks posed to their child's eye safety, about 40,000 eye injuries take place in the United States during sports or recreational activities each year, says Prevent Blindness America. Some sport-related eye injuries lead to vision loss, with almost one-third of them occurring in children between the ages of 5 and 14, says the Kentucky Optometric Association.

“Eye injuries are the leading cause of blindness in children in America, and most injuries occurring in school-aged children are sports-related,” Benton optometrist Dr. Laurel Van Horn said in a KOA release. “The results of an eye injury can range from temporary to permanent vision loss, so it’s important that parents take the proper steps when their children play sports.”

Almost 90 percent of these injuries are preventable with proper use of eye protection on the playing field, says Van Horn. To prevent such injuries, the KOA provides the following tips for eye and vision safety while playing sports: Always wear protective eyewear, do not rely on street eyewear for protection, and refer to the American Society for Testing and Materials standards when shopping for protective eyewear. Click here to learn more or find an optometrist in your area.

Tips to keep children safe from the dangers of summer heat

While enjoying time with family on the boat, at church picnics, in the backyard or at the beach, be sure to keep kids safe during the summer heat.

Heat can trigger three major illnesses, says Dr. Eric Kirkendall of Cincinnati Children's Hospital Medical Center. “Heat stroke, heat exhaustion and heat cramps are reactions caused by exposure to high temperatures combined with high humidity.”

The most serious reaction is heatstroke, which is a life-threatening emergency that should be treated immediately by parents and then by medical professionals. Symptoms can include hot, flushed skin, high fevers (over 104° F), confusion, and even seizures.

If you notice signs of heatstroke, call 911 immediately, cool off the child as quickly as possible by sponging the entire body with cool water, elevate feet to counteract shock and have the child drink cool, not cold water, while waiting for Emergency Medical Services to arrive, said Kirkendall. Do the same if treating the child for heat exhaustion, although it is not necessary to call 911 or a physician unless symptoms continue.

Heat exhaustion is less severe, but also requires medical attention. Symptoms include lots of sweating, nausea, dizziness, fainting or weakness. Heat cramps occur mostly in the child's abdomen and legs, especially the calf or thigh muscles, but symptoms do not include a fever.

Parents can take many steps to keep children safe by keeping them hydrated with water, limiting their time outside during extremely hot weather and encouraging inside breaks when they do play outside, said Kirkendall. Click here for more information.

Eye doctors warn about danger from fireworks, even sparklers; optometrists provide safety tips

The Fourth of July goes hand in glove with firework displays. Most families protect parents and children against the dangers of fireworks, but thousands still visit the emergency room every year, many with eye injuries.

According to a report from the U.S. Consumer Product Safety Commission, about 9,600 people were treated for injuries due to fireworks in U.S. emergency rooms during 2011; it says 17 percent of those injuries were to the eyes, and about 45 percent of those eye injuries involve children age 15 or under. Most eye injuries were bruises, cuts and other diagnoses that included foreign objects in the eye, and one in six fireworks-related eye injuries result in permanent vision loss or blindness, says the American Academy of Opthalmology.

“Celebrating the Fourth of July with fireworks is a great tradition, but safety needs to be the top priority,” Dr. Jon Shrewsbury, an optometrist in Beaver Dam, Ky., said in a Kentucky Optometric Association release.  “Children are especially vulnerable to injury from fireworks, particularly sparklers since they are handled at such close range.”

The innocent-looking sparkler can be very dangerous, especially to children, who are most likely to play with them. They heat up to 2,000 degrees or hotter, and are the primary cause of fireworks-related visits to emergency rooms. In addition to not allowing younger children to play with sparklers or fireworks and ensuring that older children are supervised by an adult when doing so, the KOA offers these tips to help protect and preserve eyesight during firework season:

· Discuss firework safety with children and teens prior to the Fourth of July holiday.
· Never leave them unsupervised near fireworks.
· Wear protective eyewear when lighting and handling fireworks of any kind.
· Store fireworks, matches and lighters in a secure place where children won’t find them.
· Be aware of your surroundings, and only light fireworks when family, friends and children are at a safe distance.

“If a firework-related eye injury does occur, always follow up with a full optometric eye exam,” Shrewsbury said. “An optometrist will help ensure that the injury heals correctly and will continue to monitor for future vision problems.” To find an optometrist in your area, click here.

Task force recommends changes to protect safety and health of middle school students who play interscholastic sports

The boys of North Marshall Middle
School of Benton, Ky., after winning
a Christmas tournament last year.

Beth Musgrave of the Lexington Herald-Leader reports that the state Task Force on Interscholastic Athletics at the Middle School Level announced its preliminary recommendations this week to address concerns about young athletes' health and safety. It seems that middle school sports in Kentucky have never had the advantage of being governed by a unified code of rules and policies like their counterpart in high school sports. This has led to a confusing mish-mash of guidelines that the legislature is setting out to get right in the coming year.

Preliminary task force recommendations include requiring all middle school teams to follow high school rules on physical exams, medical coverage, concussions and practicing during extreme heat, and requiring the tracking of injuries and incidents for all sports. The task force also suggested that the Kentucky Board of Education look to create a single governing body, like the Kentucky High School Athletics Association that governs high school sports, to oversee all middle-school sports. Wilson Sears, executive director of the Kentucky Association of School Superintendents and a task force member, told Musgrave that the recommendations represent "real progress." (Read more)

Task force to consider middle-school sports regulation

A task force made up of legislators, educators and athletic officials will examine what guidelines should be in place for sports at the middle school level, which are not regulated in Kentucky.

The task force was created by the 2012 General Assembly to "discuss 'best practice' guidelines for middle school sports and to take into consideration non-profit organizations that oversee some individual teams," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

"It remains to be seen" what the task force could recommend, Rep. Bob Damron, D-Nicholasville, told Spears. But Damron, who sponsored the resolution creating the task force, said "in the long run that's probably a good direction to have one entity standing for middle school athletics."

The Legislative Research Commission will name task force members by Aug. 1. Recommendations to legislative committees are expected by Dec. 7. (Read more)