Pediatric Orthopaedics: Dr. David Roberts on the Rewards of His Unique Specialty

Friday, October 17, 2014 7:00 AM comments (0)

dr. robertsFor David Roberts, MD, Pediatric Orthopaedics at NorthShore, helping people was always the goal on the horizon, which is what ultimately brought him to medicine. Once there, it was the challenge and the enjoyment of treating children that brought him to pediatric orthopaedics.

Here, he explains the ins and outs of his unique specialty and how his experience as a father has informed the way he treats his patients and their parents:

What first attracted to you medicine? Was there something that inspired you to go into the field?
I chose a career in medicine because I wanted to help people. There wasn’t one specific moment of realization; it was always what I wanted to do with my life.  

Why did you decide to pursue pediatric orthopaedics as a specialty?

I decided to become a pediatric orthopaedist during the middle of my orthopaedic surgery residency.  During my training, I enjoyed all different areas of orthopaedics so it was hard to pick just one area! Pediatric orthopaedics is unique in that you take care of a variety of conditions affecting all areas of the body, from fractures and congenital anomalies, to scoliosis and spine conditions. It also covers a wide age range, from newborns to young adults.  The diverse nature of pediatric orthopaedics is challenging but that’s also what I enjoy most about it.  And, of course, kids are fun.

What do you like most about your job?
Seeing my patients get better.  Often my patients are in pain or recovering from an injury when we first meet. Seeing them recover and get back to normal, being a part of that, is what I like best about my practice. 

What do you find most challenging?
Encountering overuse injuries in young athletes is difficult.  Young kids are increasingly involved in sports at "elite" levels, playing harder and longer than ever before. Overuse inevitably can lead to chronic and recurrent injuries of various types.  Generally, the cure is simple—rest—but these are some of the hardest conditions to treat given the pressure from coaches, teammates, parents and even the children themselves.  Fortunately with time, rest and realistic expectations, these conditions typically resolve and permit the child to fully return to activities.

What do you think is an essential skill of a pediatric orthopaedic surgeon?
You have to really enjoy working with children.  Treating children is very different from treating adults. Children of different ages require different approaches at interview and examination, which represents the "art" of medicine.  To be truly good at it this, you really have to like working with kids, and this is what I like most about my job.

How is treating orthopaedic cases in children different from adults?
Kids are not just little adults.  From an orthopaedic perspective, treatment of children's conditions can be drastically different than in adults, and not just because we have more cast colors to choose from.

Unlike adults, children's bones are still growing, which means they require special respect and consideration during treatment for orthopaedic conditions.  For example, fractures that typically require surgery for an adult may be treated without surgery in a child because of the ability to correct bone alignment over time with growth.  Other injuries can potentially affect growth and require close monitoring over time for years after injury.  Very young children also may require different treatment for the same type of injury in an adult because a child may be too young to follow treatment instructions.

Within pediatric orthopaedics, you specialize in scoliosis. What inspired this interest?
I specialized in scoliosis because of the positive impact surgery for this condition has on a patient's life.  For many patients with severe scoliosis, the condition is more than just a curvature of the spine.  Severe curves negatively affects self-esteem and body image, which are already vulnerable during the teenage years even for those without scoliosis.  After surgery for scoliosis, these patients literally and figuratively stand taller and straighter. It can make a difference to the rest of their lives.

What are some of the biggest influences on the way you treat your patients?
My own experience as a parent has really informed my practice.  Having a child gives you practical experience working with children but also the perspective of a parent.  I believe it is my duty to care for your child as I would my own.

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Spring into Training with Fewer Injuries

Friday, March 14, 2014 11:44 AM comments (0)

runningSpring is on its way, which means athletes everywhere are emerging from hibernation and throwing on their running shoes. Before you join their ranks, follow along as Adam Bennett, MD, Sports Medicine at NorthShore, answers our sports-injury prevention questions, from what changes you should make to your diet if you’re in training, to what you should do if training starts to hurt:

If you experience pain while in training for an athletic event, what are your options?
The main issue is to determine the cause of the pain. If the cause is muscle soreness, then more rest between runs or training may help. Additionally, some strength training via yoga, Pilates or basic weight lifting may diminish soreness after a workout. If pain persists, seek medical care, which could include X-rays depending on the site and severity of the pain.

What causes shin splints and what is the best way to deal with them and still be able to exercise?
First order of business is to make sure that your shin splints are in fact, shin splints. Other causes of shin pain include muscle strains, stress fractures and tendinitis. "Shin splints" is a painful condition that occurs when the muscle attachments pull on the periosteum (a membrane that covers bones) of the tibia, which leads to inflammation and pain. If you do have shin splints, anti-inflammatory over-the-counter pain relievers, intense stretching, deep tissue massage, gait analysis, modifying the type of shoe you wear and rest days in your training program all may help diminish your symptoms. Formal physical therapy is an effective way to implement all of these strategies.

Are sports and recovery drinks after a workout or training better than simply drinking water? Do they aid recovery?Sports drinks contain glucose and electrolytes, which need to be replenished after sweating during training or exercise. Sports drinks are probably not essential for exercise lasting 20 minutes or less. For exercise lasting longer than 20 minutes, research shows improved performance when utilizing fluids that contain glucose and electrolytes. Research also indicates that ingesting carbohydrates and protein within 10 minutes of an intense workout improves recovery. I don’t have brand recommendations but I believe it’s a good idea to replenish with a drink that uses natural flavors and sweeteners and avoids ingredients like high fructose corn syrup. Certainly anything with caffeine, which might dehydrate the athlete, is a bad idea. Please tell your kids not to drink soda pop after exercise.

Is it better to consume protein drinks or food sources of protein after a workout for muscle recovery?
I would guess they are about equivalent. The advantage of a drink is that you replenish fluids as well.

If you have an injury in your arms or wrists, such as tendonitis, what exercises could you do to increase strength without causing further injury? 
This is a tough scenario but there are things you can do. Specifically putting resistance in your mid-forearm and keeping your hands and wrists relaxed can allow you to work out the major muscles of your upper body without irritating the tendons in your wrists. If you’re having trouble figuring out how to pull this off try working with a personal trainer a couple of times and have him or her show you.

For those training for a marathon, half marathon or triathlon, do you have any diet and training recommendations?
My first recommendation is to consider implementing rest days as part of your training. I often suggest athletes work longer and more intensely one day and then allow for complete rest the next day. If that is too much rest, consider a two-days-on, one-day-off schedule. Rest days allow for replenishment of glycogen stores in the muscle cells and fluid losses to be replaced adequately. As a result, athletes typically feel better on workout days and can push themselves even harder, which ultimately leads to a better performance on race day.

In terms of a daily diet, avoiding fried foods, caffeine and alcohol is likely to bring benefit. If you sweat a lot, you may need to add salty foods to your diet. This is especially important if you cramp easily.

For those not in training but who still want a great workout, what would you recommend?
High-intensity interval training is likely the most effective way to improve overall fitness. For my patients who are frustrated with their ability to lose weight, I often suggest they incorporate high-intensity interval training into their workout routine. Crossfit is a popular example, which works for some, but there are many ways to do this type of training. 

If you are concerned about the risk of injury during strength training as an older athlete, what should you do? Are lighter weights with more reps better? Or, should you increase weight and reduce reps?
Most people don't realize the importance of resistance training to overall health. My only concern about injury is if you had arthritis in any of your upper extremity joints (shoulder, elbow, wrists). If you do have arthritis in these joints, then lighter weights would be preferred. If you continue to lift to the point your muscles become sore the next day, it is unlikely you will lose significant muscle mass. My only suggestion is to vary the weight, repetition or motion of your regimen so your body won’t adapt as easily. This will ensure maximum benefit from every session. 

For more information on keeping your young athletes healthy, join us on Thursday, March 20th from 7:00-8:30 p.m. for a Sports Medicine Symposium at Highland Park High School. We invite you to join us for a discussion on how to keep young athletes in optimum health and prevent injuries. For more information, call Matt Castle at 224-765-2090. 

 

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Staying in Shape: Exercise and Sports Safety for Kids and Young Athletes

Friday, July 12, 2013 1:59 PM comments (0)

Frequent exercise is an important part of keeping your kids happy, healthy and fit. Starting a fitness routine early can be a great way to teach your children how to live healthier lives for years to come. Whether your child is an athlete or just starting out, preventing injury is the key to keeping fitness safe and fun. 

Adam Bennett, Family and Sports Medicine at NorthShore, shares some of his suggestions for getting your kids interested in fitness and keeping exercise novices and young athletes safe and injury free.

kidsfitnessWhat are some good ways to motivate children to exercise if they are not naturally athletic or have not expressed an interest in participating in team sports?
Getting kids to exercise is often a tough challenge. Having your child choose a sport, no matter how obscure, may help encourage them to stay active—anything from fencing to yoga to bowling is worth a try. Other parents have had success by allowing their inactive kids to earn TV or video game time by spending time exercising. That said, most kids like doing what their friends are doing, so consider finding out if their friends play sports and encourage them to participate. Lastly, children learn by example. If you exercise, your child just might want to join you.

If a child has been fairly inactive, how should exercise be introduced to avoid injury?
It’s best to error on the side of a gradual transition. Kids of all shapes and sizes who have not exercised regularly are at risk for overuse injuries if they rush into activity too quickly. Exercising every other day is a great way to give your muscles, tendons and bones enough time to recover and prevent injury. Altering the type of activity might also be helpful, with perhaps one day of swimming followed by a game of basketball or a bike ride the next. 

How much water should children drink during exercise in the summer? Is water better than electrolyte replacement fluid?
Avoiding dehydration in the summer is very important. If your child is an athlete who will be at outdoor practice regularly during the summer, one easy way to avoid it is to weigh your child before and after exercise, especially during two-a-days. Athletes need to make sure they are drinking enough water to recover their pre-activity weight. If they haven’t, they might be dehydrated. Athletes should also be told to watch the color of their urine. A light yellow or clearer means they aren’t dehydrated. 

Water is fine for exercise lasting 20 minutes or less, but supplementation with water, electrolytes and sugar is essential for optimal performance and recovery when exercising for longer than 20 minutes, especially if the exercise involves intense exertion.

Are two-a-day practices safe for kids?
It’s not an ideal schedule to avoid overuse injuries and dehydration. If there is no pain or sign of injury, it’s a safe schedule, especially if children and coaches are vigilant about preventing dehydration. Most coaches are knowledgeable about proper conditioning and training programs and choose a program that gets their players fit without causing harm.

What can you do to prevent injury in young athletes?
Soreness that resolves itself after a day or two is common; however, pain that seems to be getting worse with each practice may be a sign of an overuse injury. Any swelling of joints, catching or locking of joints might also indicate a more serious injury. To prevent injury, a day of rest between workouts is wise. If the young athlete is a runner, mixing things up and trying some biking or swimming to cross train will give joints a break. 

If a young athlete is already suffering from some overuse injuries, like tendonitis, how can he or she prevent more serious injury? Can training continue? 
Overuse injuries can be a real problem in children who play multiple sports during the same season. During a sports season, dedicated days off from activity will help avoid further injury. In the summer or during off-season, regular exercise that is similar to the sport played may help avoid overuse injuries once their season starts up again. If injuries persist, physical therapy may be required.

Is a marathon safe for a younger runner?
If he or she is comfortable running long distances and distances are gradually increased during a supervised running program; there is no pain during training and there are days off to recover, it’s likely safe for a younger runner to participate in a marathon. Keep in mind, however, that a marathon is an intense endeavor which puts the body through unnatural stress. As such, a 10k or even a half marathon may a good alternative for younger runners before undertaking a marathon. 

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