Phone: (281) 628-7442
Fax: (346) 335 9270

Sports Medicine Topics


  1. Trauma to the brain caused by a blow to the head (normally the brain is cushioned by a layer of fluid, but a hard hit may cause the brain to hit up against the skull, causing bruising/swelling.)
  2. Characterized by confusion, memory loss, headache, unsteadiness, nausea, vomiting, lightheadedness, and possibly loss of consciousness – any one of these or all of these can be present.
  3. Most important is that your CHILD NEEDS TO BE TAKEN OUT OF THE GAME RIGHT AWAY AND NOT SENT BACK IN UNTIL CLEARED BY US!  Discuss this with your child in case they are at a game or practice where you’re not present.  It is non-negotiable.
  4. If there has been any loss of consciousness, medical care should be obtained immediately.  Otherwise, the player can be observed for several hours after the injury at home.
  5. Subsequent symptoms can include headaches, fatigue, lack of concentration, difficulty performing in school, nausea, irritability, tearfulness, poor sleep, moodiness.
  6. While most concussions are simple, and resolve spontaneously over the course of several days, concussion symptoms can be prolonged – anywhere from one day to several months until full recovery.  It is hard to predict the course in each individual child.

When to worry:

  1. Increasing headache, recurrent vomiting, radical changes in behavior, unsteadiness
  2. Post-concussive symptoms that are very prolonged or preventing your child from resuming normal activities – i.e. tearfulness, fatigue etc.
  3. Once your child has stopped having any symptoms at all it should be a full 2 weeks before they return to sports, including sports that don’t have contact – they need to rest.  We have a conservative approach.  Our goal is to avoid every seeing second impact syndrome (where a child gets another injury after having a concussion and has a much more serious brain injury).

When to come in:

  1. The day after the concussion occurs, have your child checked and guidelines reviewed
  2. Re-examination once all symptoms have been completely resolved for two weeks – we will help guide you on a return to activities and school.

What to expect/how to treat:

  1. Fatigue, headaches, difficulty concentrating, tearfulness, trouble sleeping.
  2. Initially treat headaches with acetaminophen, once your child has been seen and cleared of serious injury switch to ibuprofen; rest when he/she is tired, and return to activity gradually as tolerated (i.e. shorter school days when they first return).  Counsel your child not to get frustrated if they are unable to do schoolwork for some time, we will help notify the school and teachers of what your child is capable of doing.
  3. Past advice generally consisted of PHYSICAL REST; we now know that MENTAL REST is essential to recovery.  This means no television, reading, schoolwork, video games, or texting until the headaches have subsided.  Your child will not like this recommendation, but will recover faster if followed.

Return to play protocol:

  1. No activity, complete rest until all symptoms have resolved.  Once asymptomatic, proceed to level 2.
  2. Light aerobic exercise such as walking or stationary cycling, no resistance training.
  3. Sport specific exercise- for example, skating in hockey, running in soccer, progressive addition of resistance training at steps 3 or 4.
  4. Non-contact training drills.
  5. Full contact training after medical clearance.
  6. Game play.

If any post-concussive symptoms occur, the patient should drop back to the previous asymptomatic level and try to progress again after 24 hours.

What is Impact Testing?

  1. Objective testing of a child’s cognitive function using a computerized program – it is a way to gauge the impact of the concussion and help decide when a child is ready to return to play.  This is best done when symptoms have resolved, to confirm resolution of cognitive symptoms.
  2. Call us for more information on where to have this done.  Some high schools have begun doing baseline testing in all their athletes.  This should be considered in all athletes competing in contact sports, particularly football, ice hockey, soccer, wrestling and basketball.

For more information, visit www.concussionsafety.com.

Types of head injuries:
SCALP injury: most head injuries only damage the scalp (a cut, scrape, bruise or swelling.) These injuries are common in young children as they learn to walk and climb. Big lumps and bruises can occur with minor injuries because there is a large blood supply to the face and scalp. For the same reason, small cuts may bleed a lot. Applying ice will minimize swelling.

SKULL FRACTURE: Only 1-2% of children with head injuries will get a skull fracture. Usually these are caused by falls from a significant height. Often there are no other symptoms other than swelling at the site of the injury, and perhaps a headache. Most skull fractures occur without any injury to the brain, and they heal easily.

CONCUSSION: A concussion is a mild injury to the brain that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Many children hit their heads without causing a concussion. The most common signs of a concussion can include a headache, vomiting, dizziness, acting dazed or being knocked out. A person does NOT need to lose consciousness to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems or emotional changes for several days to weeks.
BRAIN injuries: These are rare but are recognized by the following symptoms: difficult to awaken or to keep awake OR confused thinking and talking OR slurred speech OR weakness of the arms or legs, OR unsteady walking.

It is NORMAL for you child to be pale and somewhat drowsy and fussy, have a headache, vomit once or twice, not remember clearly what happened, and to get sleepy at the usual times (naps or bedtime.)

Call 911 now (your child may need an ambulance) if:

  • A seizure (convulsion) occurred
  • Knocked unconscious for more than 1 minute
  • Not moving neck normally (caution: protect neck from ANY movement)
  • Difficult to awaken
  • Confused thinking, slurred speech, unsteady walking OR weakness of arms NOW
  • Major bleeding that can’t be stopped

Call your doctor now (night or day) if:

  • You think your child has a serious injury
  • Less than one year of age
  • Any fall more than 3 feet or more on the head of a child under age 2.
  • Neck pain
  • Knocked unconscious for less than a minute
  • Had confused thinking, slurred speech, unsteady walking OR weakness of arms BUT fine now
  • Blurred vision lasts more than 5 minutes
  • Skin is split open or gaping (may need stitches)
  • Bleeding that won’t stop after 10 minutes of direct pressure
  • Large swelling (larger than 1 inch or 2.5 cm in diameter)
  • Large dent in the skull
  • Injury caused by high speed (i.e. car accident), great height (i.e. twice the child’s height), or blow from a hard object (i.e. golf club or baseball bat.)
  • Vomited 2 or more times.
  • Watery fluid dripping from nose or ear while the child is not crying.
  • Severe headache or inconsolable crying.
  • Child can’t remember what happened.

Call your doctor with 24 hours (during regular office hours) if:

  • Headache persists for more than 3 days
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts.)
  • You have other questions or concerns.


  1. Wound care: if there is a cut or scrape, wash it off with soap and water. Then apply pressure with sterile gauze for 10 minutes to stop any bleeding.
  2. Local cold: apply an ice pack wrapped in a wet cloth to any swelling for 20 minutes (big lumps are common, icing will minimize them.)
  3. Observations: Observe your child closely during the first 2 hours after an injury.
  • Encourage your child to lie down and rest until all symptoms have cleared (note: mild headache, mild dizziness, and nausea or a single bout of vomiting are common.)
  • Allow your child to sleep but keep him nearby.
  • Awaken after 2 hours of sleeping to check the ability to walk and talk.
  • It is NOT necessary to awaken a child throughout the night for mild head injuries- if you are unsure, call your doctor for advice.
  • Diet: offer only clear fluids to drink, in case he vomits. Regular diet OK after 2 hours.
  • Tylenol is fine, avoid Motrin or aspirin.
  • Expected course: Most head impact only causes a scalp injury. The swelling may take a week or two to fully resolve. The local headache at the site of impact usually clears in 2 to 3 days.


Heel Pain in the Growing Athlete

Sever’s disease or calcaneal apophysitis is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates of the calcaneus in the heel. It occurs in children ages 7 to 15, with the majority of patients presenting between 10 and 12 years of age

Symptoms include complaints of pain or tenderness in the heel (or heels), discomfort when heel is squeezed, limping, and more severe pain after walking, running or playing sports.

Sever’s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves lots of heel movements and hard shoes such as cleats. It can be associated with starting a new sport, or the start of a new season. It occurs more commonly in children who pronate (feet roll inward), and involves both heels in more than half of patients.


1. Ice the heel(s) well after exercise (until the area is cold and numb!)

2. Stretch hamstring and calf muscles 2-3 times daily (exercises below)

3. REST when pain becomes persistent or moderate (even if it means skipping games or practices.)

4. Anti-inflammatory medication such as ibuprofen.

If symptoms persist, your child may need to see a physical therapist for additional exercises, and/or an orthopedist for orthotics or temporary casting/crutches if pain is severe.

Sever’s disease is self-recovering, meaning, it will go away on its own when the heels are rested or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2–8 weeks. However, pain can recur, for example at the start of a new sports season, several times if it is not taken care of.

Prevention consists of maintaining good flexibility through stretching exercises, avoid excessive running on hard surfaces, and use quality, well-fitting shoes with firm support and a shock-absorbent sole.


(Do NOT do if your child has pain AT REST- i.e. when not using the foot.)

Do the following calf-stretch 2-3 times daily, repeating 5 times per leg and stretching each calf 5 times, holding the stretch 30 seconds each time.

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