Search for tag: "athletes"

Interviewer: How to handle a knee injury. Dr. Julia Rawlings practices primary care sports medicine and also pediatric emergency medicine, and she is one of the physicians that you would find at the walk-in orthopedic clinic at University of Utah Health. I wanted to talk about knee injuries and young athletes actually. What are some common ways that young athletes can injure their knees? What specific sports or activities do you see?

Dr. Rawlings: Yeah. So it's really common to have a knee injury when you're playing sports, particularly contact sports. But severe injuries, including the ACL, don't always have to be from contact. So we typically see knee injuries that are acute, meaning they happen from a trauma, when you're doing an activity where there's either contact or you change directions quickly, so you're pivoting, you're shifting, you're changing your weight, and the knee can kind of buckle on you and get injured. In people that do more endurance-type sports, like cross country runners, we tend to see more chronic knee pain just from overuse.

Interviewer: Got you. So you kind of covered some of the common injuries to the knee. What could be handled at home without a clinic visit? And then we'll get to when you should perhaps consider coming in.

Dr. Rawlings: Yeah. So starting with an acute injury, meaning that's something you were out doing your sport, you were doing something, and all of a sudden you felt the knee pop, or you twisted it, or something happened. A couple of clues that I would give to go ahead and come in to be seen is, one, if you're having a hard time walking on your leg, then we would really like you to be seen sooner rather than later. We'd like to get X-rays and make sure there's nothing that's broken and then do a good examine and check out the ligaments and the meniscus of the knee.

Another clue is if your knee gets pretty swollen, then that means that there's something significant going on in your knee that should be seen sooner rather than later. Two more other clues, things that I like to ask people about and look for. If your knee feels like it's buckling under you, it's giving out when you walk, then there's the potential that every time it buckles, that we're doing more damage. And in that case, we'd like to get you on crutches and get you into a knee brace. Or if the knee is getting stuck or locked, meaning you can't bend it or you can't straighten it very well without kind of forcing it, those are all things that we'd want to see you sooner rather than later for.

Interviewer: And then when somebody comes into the clinic with some of those more serious symptoms, as you said, what does the clinic do?

Dr. Rawlings: Yeah. So if you have, say, a big swollen knee and we're worried about bigger injuries to the ACL or to the meniscus, something like that, what we would generally do is start off with X-rays, make sure there's nothing that's broken, and then we would do our exam, get a feel for what we think is going on, and then generally get you set up in a knee brace that's appropriate for the injury you have, plus or minus crutches. And then often, patients with significant injuries we'll get set up for an MRI to check out the soft tissue structures, which we can't see on X-ray, and get a definitive diagnosis. And then depending on what we see on our exam, we'll either get you set up with one of the non-operative sports medicine providers for follow-up or our sports medicine surgeons. My practice myself is I typically just let people know what their MRI shows, and then depending on what they need done, I'll then schedule the appointment with the appropriate follow-up person.

Interviewer: And when people come in, how often would you say that they could just come into the clinic and that's kind of it? It's just going to take a little bit of rest, and they're going to recover from their injury.

Dr. Rawlings: You know, it depends a little bit, I think, on the age demographic. So we do see a fair amount of people that come in with an acute knee injury that have just flared arthritis, and they don't actually have an injury to the ligament or something that we would need to do an MRI or surgery for. And those patients we really treat with physical therapy, maybe a steroid injection, and kind of getting them back to functioning, hopefully, so that we can prolong the longevity of their knee. In those cases, then, yeah, all they need really is just that visit in the orthopedic injury clinic and then a follow-up appointment down the road with a primary care sports medicine person or a sports medicine surgeon.

Interviewer: Are there any final thoughts you would want a listener to know about the clinic, or knee injuries, and how to handle that or take care of it?

Dr. Rawlings: I think definitely when in doubt, especially when it's an injury that's happened within the last day or two, come on in. We'll be happy to take a look at it. And if you're getting a chronic injury from training for a marathon, or in kids, they can often get growth plate injuries, again, if they've happened in the last three months, we're happy to see you in injury clinic for more of a chronic developing problem as well.

Interviewer: What are the common mental obstacles athletes face? That's next on The Scope.

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Interviewer: Nicole Deting is a Sports Psychology Consultant, she's worked with Olympic Athletes, most recently the U.S. Ski Teams Free Style Aerialists in Sochi, she has also worked with athletes here at the University of Utah, and is a visiting faculty member in the Exercise in the Sports Science Department at the University of Utah. Let's talk about common mental obstacles athletes face.

Nicole Deting: There's actually two that I...

Interviewer: Just two?

Nicole Deting: Just two.

Interviewer: Okay.

Nicole Deting: That I would say are the most predominant. I've been doing this for 16 years now, and within that 16 years two have risen to the surface in that almost every single athlete I've ever worked with are dealing, or struggling, with these two primary issues.

Interviewer: Alright can I guess?

Nicole Deting: Yes.

Interviewer: The fear of failure, fear of injury?

Nicole Deting: You're very close.

Interviewer: Very close but not right?

Nicole Deting: Very close but not right.

Interviewer: Okay what are they?

Nicole Deting: Well the first one is anxiety, and that anxiety might come from fear of injury, or fear of failure, but anxiety related to performance so, "Am I going to be good enough? Can I do what I'm trying to do?" So whether it's a performance timing anxiety in terms of being good enough that day, or an injury, or a re-injury, or failing, or even a fear of success, it all kind of gets lumped under that anxiety category.

Interviewer: Okay.

Nicole Deting: And that's absolutely one of, actually that one is the most predominant issue I guess I would say that I would deal with, and so there are a lot of mental skills that I'll teach athletes in order to help deal with their anxiety levels before performance.

Interviewer: What's the second one?

Nicole Deting: Second one is confidence, that usually surprises people.

Interviewer: Sure because these athletes sure look confident don't they?

Nicole Deting: Absolutely, I work with some of the best athletes in the world, I mean athletes hear at the University of Utah they're Pac 12 athletes, they've really done well. The Olympic Athletes they're some of the best in the world so when I tell people I deal with a lot of confidence issues they're pretty typically surprised yet I will also tell you that there's confidence issues in all of us regardless of whether we're elite level performers, or...

Interviewer: Tell me about it.

Nicole Deting: ...going to our job every day, right? We all question ourselves, and I think that...

Interviewer: When you leave sometimes you're like, "Oh boy I was just a waste today."

Nicole Deting: Right? Or, "Can I do this?" Or, "Oh my gosh I have all this pressure on me, am I going to be able to do what I've been asked to do?" And so confidence is something that I deal with quite a bit.

Interviewer: So anxiety and confidence are the two big things. So, when you're working with somebody what are some of the things you do to overcome these two things? Are they very different or kind of the same for both issues?

Nicole Deting: Well what's interesting is that they are two very distinct issues but they're very closely related. For example, if you're really nervous about something you're probably not too confident about it. The more confident you feel the less nervous you will likely be so they do influence each other. Does that make sense?

Interviewer: Yes it does.

Nicole Deting: Okay, so there are two separate concepts, there are training methods for each one of them separately to help, but a lot of training methods that I will work with, with athletes helps both of them. So for example, if I'm teaching an athlete methods to deal with their anxiety, and to get themselves under better control, once they learn those they are naturally going to feel more confident to go into their performance because there anxiety is under control.

Interviewer: Got you.

Nicole Deting: So there are ways to kill two birds with one stone, which is a very cool part of our field.

Interviewer: So does this apply to athletes of any age?

Nicole Deting: Any age, all abilities, all sports, both genders, you name it, absolutely.

Interviewer: Sure, so let's talk about, let's go into like a parent that has a child as an athlete for example, you know and they choke when they step up to the plate to play little league baseball.

Nicole Deting: Sure.

Interviewer: What's something that parent could do to help that child?

Nicole Deting: Well first of all I'd ask the parent, "Where did they learn that? Where did they learn to be so nervous?" And the parent...I would challenge the parent to take a hard look at themselves because a lot of anxiety is we don't...We learn how to be nervous we're not born nervous, we're not born with anxiety we learn that, and typically we learn that by watching the most significant people in our lives, whether that be parents, or coaches, or friends, at one point those friends become more significant, so any significant person, and so if I find out that one of the parents has a lot of anxiety then I talk to the parent about their anxiety, and how it manifests, and what they do about it, and I can use some of those similar things with their child. So that's where I'm going to start.

Interviewer: Got you.

Nicole Deting: But then what I'm going to do is talk to that kid and just say, "Okay how does it feel? How do you know you're nervous? What does it feel like?" Typically we're going to get you know, "Oh, I can't breathe and I feel like I'm going to vomit," or you know something like that, and then, "I question whether or not I can do it." And so then I might work on teaching them ways to better control their physiological signs. So to control some of the movements in their body, and if they're shaking how to control that shakiness, but then also giving them some thoughts in their head about why they can perform what they're going to perform. Most likely they're stuck in, "I'm not going to be able to do this." So I'm going to challenge them to give me reasons why they are going to be able to do that, and then really get their mindset in a different space. So dealing with the anxiety, helping them learn to control themselves also increases confidence, and then we can work specifically on confidence as well.

Interviewer: We could talk for a long time about all of this, how long do you work with an athlete generally?

Nicole Deting: My goal with every athlete I work with is to work myself out of a job.

Interviewer: Yeah sure.

Nicole Deting: I want them to become so good mentally they don't need me anymore, so I work really hard to foster independence with each athlete. So when they come to see me I usually give them what I call home fun, not homework, homework sucks nobody likes home work.

Interviewer: See that you're rethinking again, right.

Nicole Deting: Exactly, yup.

Interviewer: So how can I fail, how can I succeed?

Nicole Deting: Exactly, home fun, and so home fun is basically a strategy that I teach them prior to them leaving and they go work on that strategy and become better at it. At the end of the day the athletes are the ones out there competing, I can't be there every single competition for every single athlete at the end of the day it's just them out there and they need to have these strategies in place in order to be more mentally tough. So how long I work with an athlete it depends on what that athlete needs.

Interviewer: Yeah.

Nicole Deting: But I work hard to foster independence as quickly as possible.

Interviewer: Yeah, it's not something you learn overnight.

Nicole Deting: No it's not something you learn overnight. You do have to practice.

Interviewer: Any resources on the web you could point somebody to that might be interesting.

Nicole Deting: My website.

Interviewer: Okay, that's a good place to go what is it?

Nicole Deting: Yeah my website www.headstrongconsulting.com

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Interviewer: Do you have a tendency to get stuck in the suck? We're going to talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: So as a sports psychology consultant I'd imagine when you watch a game on T.V., you're probably watching it a little differently than the rest of us. I guess what I'm getting at is when you watch an athlete can you see if their having some sort of a mental issue that's preventing them from succeeding?

Nicole Detling: Well, I would say first of all if I know that athlete really well, yeah, it's pretty easy for me to see if it's an athlete that I'm working with.

Interviewer: Sure.

Nicole Detling: Some athletes are really good at the poker face and you can't tell if they just scored the game winning score of their life or they just had something amazing happen or if they just had something really horrible happen so they approach performance pretty consistently. Others we can all see when some people melt down, right?

Interviewer: Yeah.

Nicole Detling: But I would say having done this for so long, I'm probably watching sports a little bit different than most people. I love watching sports. In fact, it's the only thing that's ever on my T.V. I often get people asking me if I watch shows, and I haven't even heard of half of them.

Interviewer: Sure.

Nicole Detling: Like if that was on during any game, the answer's "no." But typically, yeah, it's interesting because I'll watch sport and I can really appreciate the physicality of the sport so the grace, the power, the strength. It's so amazing to me what people can do with their bodies, but I can never pull that away from really assessing what's going on with them mentally, and I really like to watch games and look for physical versus mental mistakes. Having the training that I have, I can usually pick out if its just a physical mistake. Physical mistakes sometimes just happen. We just have errors sometimes.

Interviewer: Like in a football game, somebody misses a catch.

Nicole Detling: It depends, right?

Interviewer: Yeah, how would you tell the difference?

Nicole Detling: So sometimes that's just a physical mistake. Well, a lot of times, probably the layman's way to do it if you're interested in starting to do this is watch their reaction afterwards which you don't always get on T.V. because the T.V. might change to something else, right?

Interviewer: Sure.

Nicole Detling: But if you have an opportunity, just watch that player for just a moment. If you don't get that opportunity, watch that player on the next play and see what they do. Did they miss a block? Did they run a wrong pattern? Did they something else? How many more plays happen before that athlete gets another chance? And if you know a team pretty well and the way a coach is going to coach, it's easy to point some of those things out and find them so it's interesting because you can always see it on their face, on their body language, the shoulders slumped, the head goes down. How quickly do they pick that back up?

Interviewer: Really? Interesting.

Nicole Detling: For many athletes, they make one mistake and they get stuck in the mistake mentally. Why did I do that? That was so stupid. I know better. And they really beat themselves up and that typically results in another mistake and then another mistake and then another mistake, and they spiral downward.

Interviewer: So the key really is to forget it. That was then.

Nicole Detling: The key is to move on.

Interviewer: Moving on to something else.

Nicole Detling: That's exactly right, and that's something I talk about a lot is the most important play in any sport is always the next play.

Interviewer: Yeah.

Nicole Detling: The same is true in life. The most important play in life is always the next play. We might hate what just happened. It might have sucked. We might have looked like a complete moron out there, but you can't change it. So what I talk about is embrace the suck which basically means...right? You embrace the suck so you take a minute and you say well that sucked, but don't get stuck in the suck. And so what that means is you're focusing forward. The most important play is the next play. Not getting stuck in the suck means OK, I can't change that now but I can do something about the future. What's the next play? What am I going to do on the next play? So let's go back to the football analogy. Let's say that a receiver doesn't get another ball thrown to them for awhile, but he does have a job on the next play. He can do that job and do it well on the next play, and each next play he does when he does his job well will help him move past that mistake that he made five, ten plays ago.

Interviewer: I would have a hard time believing that. I'm not trying to be argumentative, but to me it would be like now's the time I've got to catch another ball. I blocked perfectly these past three times. I blew that last block.

Nicole Detling: Yep, and you are 100% right and that's where a lot of athletes go to in their minds and that's when they start making mental mistakes. So even if he missed that ball and it's just a technical error, it was not a mental mistake, chances are his next mistake will be mental, and that's the stuff I work on is teaching them to focus forward so that they don't make a mental mistake again. There's no mental mistake or mental error that's made after that. The common thought process is now I have to do it, now I've got to do it. And typically trying too hard often results in more mistakes.

Interviewer: So you'd be better off just forgetting it.

Nicole Detling: You'd be better off forgetting it.

Interviewer: Just really trying to not even think about it.

Nicole Detling: Absolutely, you'd be better of forgetting it, but easy to say, hard to do.

Interviewer: When you make a mistake, a lot of times that could be an opportunity to learn and you analyze it as such, but could that be detrimental?

Nicole Detling: It could be because you could still get stuck in that so athletes who have a tendency to do that, what I tell them to do is you take a moment, embrace the suck, oh that sucked, OK, acknowledge it. It did. It's OK to say that sucked.

Interviewer: Do you need to say why?

Nicole Detling: Nope.

Interviewer: OK.

Nicole Detling: What you do need to do though and this is the key part, and this is what most people... Everybody gets stuck in that suck for a minute, right? Everybody says that sucked. We all do that. We got that part down. The part we don't have down is that the next part which is the most crucial part, and that's do you fix the mistake? So you very quickly just go back, you don't even have to run the entire play through your mind, but take that moment where you made the mistake and do an image of doing it correctly. What do you need to do to do it correctly? So if it's a technical error, your fingers were curled, take a moment and see your fingers in the position they should be in to catch the ball. See yourself doing it correctly. That sets you up for success in the future. There's a lot of research that shows what imagery does for our bodies, and it actually programs our muscles for the action that we are seeing in our mind so if we replay a mistake, we are more likely to repeat that mistake the next time we play.

Interviewer: Mm, the key is to change the mistake.

Nicole Detling: The key is to change the mistake so see yourself doing it correctly, and if you can see yourself doing it correctly over and over and over, you're reprogramming, and the program is stronger so that the next time you have that opportunity, you're more likely to succeed. Of course, there's no guarantee, but it does increase the chances of success.

Interviewer: Are there any other tricks to not getting stuck in the suck?

Nicole Detling: There are all kinds of tricks for not getting stuck in the suck. Absolutely, that's a big one is focusing forward, focusing on the next play. You also have replaying and doing it correctly so you're reprogramming. For a lot of people it's the self talk, alright well that was just a mistake. That kind of stuff happens. Everybody makes mistakes. I got it on the next one. And that's going to go back to maybe some confidence training. It's one thing to say I'm going to get the next one...

Interviewer: Yeah, it sounds so easy.

Nicole Detling: It's another thing to believe it, right? And so if you're not one of those people who has a tendency to be able to believe that, that might be something you'd either want to work on or choose a different strategy. OK?

Interviewer: OK.

Nicole Detling: There could be different scenarios where getting out of your own head. A lot of athletes will go into the vacuum and that's something I notice too when I'm watching. If an athlete who tends to be vocal or will cheer on their teammates all of a sudden gets quiet after a mistake, they are over-analyzing and are stuck in their heads so get out of your head which basically means start cheering for your teammates.

Interviewer: Interesting.

Nicole Detling: Talk out loud. Yell things. Get out of your head, and many times just the act of getting out of your head gets you back in the present moment where the current play is happening and then you're out of that past mistake.

Interviewer: Final thoughts on getting stuck in the suck?

Nicole Detling: I would say embrace the suck but don't get stuck in the suck. Use the strategies. Understand that getting stuck in the suck really sucks, but there are ways to get out of that suck.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences radio.

Interviewer: It seems like unfortunately every year you hear a story about a student athlete, a young athlete getting heat stroke, getting really sick or dying at times. As a parent of, perhaps, a young athlete that's in a summer program or football training camp for the fall, even in August. What should you look for and what should you know, what would you want that person to know?

Dr. Madsen: That's a great question, you know kids in the summer, as you mentioned, are in a lot of sports camps and if you're a kid in a sports camp, the number one thing you want to do is impress the coach. That's what you're trying to do, you know. So you're getting out there and even if you're feeling lightheaded, you're still pushing yourself, you want to look like you're working hard and that's where kids really run into problems, and I think that's where you can really see some issues with heat stroke and heat exhaustion, are kids who are really trying hard, it's 100 degrees outside, they're playing football, they're in pads, whatever the situation is.

So the number one thing to watch for is let our kids know if they're feeling lightheaded, if they're feeling dizzy, to sit down and take a break because those are the first symptoms of heat exhaustion, as they start to feel nauseated, lightheaded. If they get to a point where they feel like they're passing out, if they look to you like they're just not responding well, that's when it becomes really serious and we get really concerned.

Interviewer: And hopefully a coach recognizes that as well and is not going, Madsen, man up.

Dr. Madsen: Exactly. Hopefully coaches are aware of it, but you've got to figure too, these coaches have 30, 40, 50 kids out there. They can't watch every one and know exactly what they're feeling so, yeah, hopefully they're aware, but definitely the kids, they need to let the coach know when they're just not feeling quite right.

Interviewer: Is there anything that would tell me that maybe my kid might be more or less susceptible to heat exhaustion, or heat stroke as somebody else, I mean, does it vary person to person?

Dr. Madsen: There's definitely some variability's. Certainly if you've got a little more weight, if you're a little heavier, that's going to increase your risk of heat exhaustion or heat stroke. If you've had problems in the past, that's something to be aware of as well. Obviously, depending on the type of sport the child is participating in and if they're wearing a lot of pads, exercising a lot, doing a lot of sprints, things like that where they're getting their body temperature up, those are situations where you need to keep a close eye on them as well.

Interviewer: All right, what do I do if I suspect heat exhaustion, maybe we should even say, what's the difference between heat exhaustion and heat stroke, and what should I do then?

Dr. Madsen: Yeah, so that's a great question. So that question often comes up, what is heat exhaustion mean, what is heat stroke? So heat exhaustion is when your body temperature gets up, I think we've all experienced that, you're lightheaded, a little big nauseated, just not feeling quite right. Heat stroke is when it gets dangerous, we're talking body temperatures of about 105 degrees and in that situation we're often times seeing people pass out, they're unresponsive. That's when they're at risk for organ failure and that's when it gets very serious, so once it gets to that point, just even the lightheadedness, dizziness, get in the shade, try and cool down, drink some water, try and get that person cooled down with a fan, something to try and get the body temperature down.

Interviewer: Pour water on their head, is that fine?

Dr. Madsen: Sure, absolutely. Pour water on their head, you know one thing you can do to really get the body temperature down quickly is with ice packs. Don't put ice directly on the skin but if you've got it in some sort of a pack you can put it in the arm pits, there's a lot of blood flow through there so you can get the body temperature to cool down fairly quickly, and if it's really serious where they're just not responding to you, if they're very confused, in that situation I'd get them to the hospital. Call 9-1-1 and make sure you get help for them.

Interviewer: It's nothing to mess around with at that point.

Dr. Madsen: Exactly. Once they're not responding or they're just not very responsive to you then it's much more serious.

Interviewer: Should you err on the side of caution if you have a question?

Dr. Madsen: Absolutely, err on the side of caution, you can always call the EMTs there, they can take a look, they may even check their body temperature, see how they're looking and maybe say, hey, he's okay, probably doesn't need to go to the hospital, but certainly, especially in sports camps, err on the side of caution.

updated: August 6, 2021
originally published: September 24, 2013