SAT., JUN 3, 2006 - 1:49 AM Helping kids avoid, and heal, sports injuries JEN SCOTT CURWOOD For the State Journal Contact Jen Scott Curwood through daybreak@madison.com.

Two years ago during a soccer game, fifth-grader Jenni Kaderabek was taken down from behind by an opponent. Her knee was swollen, but no one realized the extent of her injury.

Following surgery to remove scar tissue, Jenni, now a seventh-grader at Toki Middle School in Madison, embarked on months of physical therapy and strength conditioning. Her doctors say the tear won't heal but is stable.

Fresh from competing in a five-game tournament recently in Rockford, Ill., she has her confidence back. "I can run faster now than before I got hurt," she says.

Every year, nearly 30 million children and teens in the U.S. participate in organized sports, and that number is rising every year. Few doubt the benefits of sports - from the intense physical activity to the sheer camaraderie - but there's a downside. According to the National SAFE KIDS Campaign sponsored by the Children's National Medical Center and Johnson & Johnson, 30 percent of parents report that their child has been injured playing a team sport; and nearly a quarter of these parents say that the injury was serious.

Before you rethink signing your child up for sports, though, consider that the Centers for Disease Control and Prevention estimate that nearly half of the sports injuries that occur in children are preventable. Parents and coaches can guide young athletes in taking the critical steps necessary to stave off injuries. But then, should something happen, thorough rehabilitation is the key to getting back in the game sooner rather than later.

A survey from the National Federation of State High School Associations found that nearly 53 percent of high-schoolers participate in athletics. Last year, too, the number of participants in high school sports increased for the 16th consecutive year and reached 7 million for the first time. Clearly, a substantial number of teens must deal with either the potential for or the threat of getting hurt; that's why it's critical to take steps to prevent an injury in the first place.

Tom Kaufman, head coach of both the boys' cross-country and track teams at Madison West, says it's important that athletes come into the season with a certain degree of fitness: "The early weeks can be difficult if your legs aren't conditioned to withstand the challenge." Many school sports teams offer off-season workouts just for that reason.

Kaufman also emphasizes the role of appropriate footwear: "Running shoes, for instance, need to match the biomechanics of your feet." He encourages his athletes at West to visit one of several Madison- area stores that specialize in running shoes. While he chose not to name a certain one, the staff at stores such as Movin' Shoes or Fleet Feet are often able to analyze a runner's movement and give appropriate recommendations. Kaufman adds that teens need to get past the cosmetic appeal of the shoes.

Lastly, consider core strength and posture. Dr. Mark Timmerman, chairman of the Sports Medicine Clinic at Dean Clinic, explains that this refers to the muscles in the trunk and pelvis. "It seems that the underlying issue behind many injuries, even extremity injuries like shoulder and knee problems, is a weak trunk or pelvis," Timmerman says. By developing a strong core, athletes don't have to compensate by overusing their arms or legs. As a result, they'll encounter fewer injuries.

Janeen Hellenbrand, a physical therapist and Pilates instructor at Meriter Hospital, emphasizes that core strength is linked to posture. "Alignment is the foundation for movement," she adds. To ensure good posture, keep your chest up, shoulders back and abs in.

Hellenbrand estimates that 60 to 70 percent of the injuries she sees are due to overuse. "Overuse injuries develop from abnormal, repetitive stress," she explains. These may include stress fractures, shin splints and tendonitis. Hellenbrand adds that many of these types of injuries can be traced to improper biomechanics.

Timmerman adds that one of the most common injuries for teens, especially girls, is patellofemoral, or kneecap, pain. He links this to a lack of core strength, which is the foundation for correct movement and movement.

The second type of injury is one that is acute; these include fractures and sprains as well as a stretch or a tear in a muscle or tendon. This is what Jenni Kaderabek encountered with her partial ACL tear. Unlike overuse injuries, acute injuries are often the result of a single twist or collision.

A sports injury will often entail visiting a sports medicine doctor for a diagnosis; from there, rehabilitation can involve anything from rest or cross- training to physical therapy or surgery.

Timmerman stresses the concept of "relative rest." He adds that, "Complete rest is almost never a good idea because the athlete gets weak and possibly bored." By employing cross-training activities and making modifications in sports participation, the athlete can maintain activity while allowing their injury to heal.

"We used to focus on rest, ice and anti-inflammatory medications, but we rarely suggest these things now," Timmerman says. "Inflammation is a part of the healing process and taking Ibuprofen may interfere with that. Instead, carefully restrengthening an injured area is the key to resuming physical activity without reinjury."

Timmerman knows the role that doctors play as well. "I think it's critical for doctors that treat young athletes to understand how important it is to them to continue their activity if at all possible," he says. Timmerman adds that doctors should compromise and work with their patients in this area. "They need to trust their doctors and be willing to go in for an evaluation before the problem worsens."

The goal of rehabilitation is not only to heal the injury but to improve athletic performance as well, according to Hellenbrand. As a physical therapist, she agrees that it's important to keep a sidelined athlete busy. Parents and coaches can facilitate the healing process "by focusing on what they can do, rather than on what they can't," she said.

But depending on the severity of the injury, an athlete may not be able to get back to the previous level of competition. Following surgery to remove scar tissue, Jenni embarked on rehab soon after. As member of the Madison 56ers Soccer Club U-13 premier team, she was eager to get back in the game. First Jenni completed extensive physical therapy; next came work on her balance, flexibility and overall strength.

A former UW-Madison soccer player, Wyttenbach is the sports performance trainer for the Madison 56ers. Along with her husband, Craig, a former UW-Madison football player, she operates LIFTraining on Madison's West Side. Jenni says that at first she was really scared about her injury and prognosis, but now, nearly two years out, she's running faster than ever, adding that, "Mara made it feel all better."

If serious injury occurs to a joint or to the spine at a young age, Timmerman says, post- traumatic arthritis could develop later in life. Hellenbrand said that prolonged abnormal wear and tear will worsen any injury with time - that is, unless the biomechanics are corrected.

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