June is National Scoliosis Awareness Month, and at Le Bonheur Children’s Hospital, we see 465 patients each year with scoliosis – a condition where the spine has a side to side curvature greater than 10 degrees. Pediatric Orthopaedic Nurse Practitioner Leslie Rhodes, MSN, PNP-BC, says that because scoliosis causes no pain, it can be hard to detect with an untrained eye.

Signs of Scoliosis
Most scoliosis patients that Le Bonheur sees are referred by their primary care physician who has detected a slight curve at the child’s annual exam. But there are a few things parents can do to watch for scoliosis.

Rhodes says to have your child stand up straight and look at his or her shoulders and hips. If the spine is curved, one shoulder might be higher than the other. Hips might might be unaligned, too. You can also have your child bend over at the waist while standing to look for a slight hump near the ribcage. This is also a sign of scoliosis.

“I tell my patients that having scoliosis doesn’t hinder you from being a normal kid,” said Rhodes. “They can still play sports and do all the things their friends do.”

Treatment
However, scoliosis must be monitored over time. The most common type of scoliosis does not require any treatment. Curvatures ranging from 10-25 degrees are observed frequently with X-rays to assess for curve progression. If the curve progresses to 25 degrees or greater, a brace – worn 23 hours a day – is the first line of treatment. Though it won’t fix the spine’s curve, it might prevent it from worsening.  If the curvature worsens to 50 degrees or greater, surgery might be necessary.

Visit our website to learn more about the Campbell Clinic Spine Center at Le Bonheur Children's Hospital.

It’s the height of football season when injuries among students and young players are quite common. We took some time to speak to Dr. Derek Kelly, orthopedic surgeon with Campbell Clinic, regarding what parents should know about neck injuries and what to do if their child experiences one. Here’s what he had to say.

What type of sport presents the highest rate of neck injuries to kids and young adults?

High energy sports place children and adolescents at the highest risk of neck injuries.  By far the most common sport in our area related to these injuries is football. But neck and spine injuries do occasionally occur in other sports like gymnastics, cheerleading and hockey.  In addition motor-powered sports like dirt bike and ATV racing place kids at a high risk for these injuries, but the number of spine and neck injuries we see each year from racing sports are lower due to the lower number of participants in these activities.

What do parents need to know about preventing neck and back injuries?

The only sure way to prevent neck and spine injuries related to high energy sports is to avoid the sport all together.  However, sports provide many positive benefits for children and adolescents including physical fitness, team participation, leadership skills, sportsmanship and discipline.  Therefore, care should be taken to ensure proper safety.  First, participants in these activities should take all precautions allowed by the sport including use of the proper safety equipment. 

Specifically, football players should wear helmets with face shields and pads.  Also, football players should be taught; and should practice, proper and safe tackling techniques.  Many neck injuries in junior high and high school football occur as the result of improper spear tackling. This occurs when the player lowers his head just before tackling another player and drives his flexed head and neck into the body of another player. This type of tackle places extreme stress on the structures of the neck and places the spinal cord at risk for injuries.  A tackler should always “see what you hit."  This means, the tackling player should keep his head up throughout the entire tackle to ensure no force is placed on a flexed neck.

What's the first thing a parent/spectator should look for in a child that might have been injured on the field during a contact sport?  How should the child be handled/moved if injured?

An injured player should not be moved until they are assessed by a trainer or medical staff member.  Most football injuries are minor sprains or strains of the joints or muscles and are considered routine aspects of the sport.  However, some injuries are quite severe and should be handled carefully.  An injured player should first be assessed for the ability to breathe.  If a player is not breathing, or is unresponsive, the medical staff should be alerted immediately to begin life saving measures and arrange for rapid transportation to the nearest emergency facility.  Any player with altered mental status (confusion, amnesia, dizziness) should be evaluated by medical personnel.  These symptoms could be a concussion or mild brain injury. In most instances, players with these symptoms should not return to play during the same game in which the injury occurred.

Any player with inability to move the arms or legs, even if complete function returns in a short time, should not return to that game and should not return to play until evaluated by trained medical personnel.  If the player is unable to move the arms or legs or is unable to feel sensations in the arms or legs, they should not be moved until evaluated and stabilized by medical personnel. This typically involves neck bracing and securing the injured player to a spine board for transportation to the hospital.  The helmet and pads should not be removed on the field and should remain in place until the injured player arrives at the hospital.  The face shield can be removed if there is a concern over the player’s ability to breathe or if oxygen has to be given.  Many neck  and spinal cord injuries can be successfully treated, often with partial or complete recovery of function, if the injured player is managed correctly at the time if injury.

If there is any concern about the severity of an injury, always assume it is worse than it might appear.  There is always a strong desire from the player, teammates, coaches and fans to have the player return to play as soon as possible. Paying careful attention to symptoms like altered mental status and temporary burning, numbness or weakness in the arms and legs and seeking appropriate medical care can prevent season-ending, career-ending and even life-ending injuries.