Paediatric Sports Medicine Grant
The Paediatric Sports Medicine Grant encourages residents and fellows to improve their clinical skills in musculoskeletal medicine and broaden their experience with sport medicine topics, particularly those unique to the paediatric age group. The $500 grant is awarded annually by the Sports Medicine Special Interest Group to residents and fellows looking for elective training in paediatric sport medicine. The recipient will be announced at the section’s business meeting during the CPS Annual Conference.
Upon completion of the elective, grant recipients must submit a report to their program director and to the Sports Medicine Special Interest Group. The report (maximum of 500 words) should outline details of the elective, goals/objectives of the elective, and how the elective has changed/affected the recipient’s training and career. Reports will be shared with other grant applicants on the CPS website in the language of submission and may help facilitate electives in sport medicine for other residents.
Submission deadline: March 31
- Be CPS members.
- Arrange an elective in sport medicine of at least four (4) weeks in duration and the elective must be with a preceptor who is willing to formally evaluate the resident during the elective.
Applications must be submitted to email@example.com a minimum of six (6) months prior to the start of the elective.
Submissions must include:
- A letter of intent (200-300 words) outlining the details of the elective, specifically stating why you are interested in doing this elective and what you hope to gain from the experience; and
- A letter from the preceptor of the elective must accompany the application.
Liane Heale - 2013
I was delighted to receive the Canadian Paediatric Society (CPS) Sports Medicine Grant and completed my elective with Drs. Laura Purcell and Wade Elliott at the David Braley Sport Medicine and Rehabilitation Centre in Hamilton and the Elliott Sport Medicine Clinic in Burlington, Ontario. Both clinical settings provided a broad range of clinical experiences that improved my approach to musculoskeletal injuries across the lifespan, expanded my physical examination and procedural skills, and reinforced the importance of promoting a healthy active lifestyle.
While Dr. Purcell has an exclusively paediatric practice, Dr. Elliott sees patients from all age groups and I managed patients from age five to age eighty-five. The wide variety of patient presentations helped me broaden my differential diagnoses for common complaints. For example, we ruled out a slipped capital femoral epiphysis in a 13 year-old who presented with knee pain, whereas a similar presentation in a 50 year-old runner was diagnosed as iliotibial band syndrome. In addition to developing broad differentials, I became much more comfortable with the management of the most common sports-related injuries for each age group within their patient populations.
When it comes to physical examination skills, most residents will report that the musculoskeletal system is underrepresented in our medical school training. This elective greatly improved my examination skills. Drs. Purcell and Elliott were exceptional teachers and used a combination of clinical experience and evidence from the literature to guide the physical examination techniques that would be most helpful for each patient presentation. I was also able to perform a few joint injections – an important skill that I’m hoping to improve with my upcoming pediatric rheumatology rotation.
A large part of Dr. Purcell’s patient population is young athletes who have suffered concussions. With the media attention that concussions have received lately, I found it encouraging that a number of sporting leagues now require evaluation and clearance by a physician before the athlete returns to play. It was rewarding to apply the new return to play guidelines, which seem to strike a good balance between the athlete’s desire to get back in the game and a safe recovery interval. Observing the physical and emotional costs of improperly treated concussions reinforced the importance of taking concussions seriously and ensuring athletes are managed appropriately from the outset. In addition to gaining a new perspective on a hot topic, I became much more comfortable with the pediatric neurological examination because patients received thorough examinations at all visits.
Finally, I’m a firm believer that physical activity and exercise prescription are among the best medicines that we have in our repertoire. It was inspiring to see the 80 year-old man who is active with cycling in the summer and cross-country skiing in the winter and doesn’t need to take a single medication. For me, this reinforced the health benefits of physical activity and healthy lifestyle, both of which come at no cost to the health care system; I will strive to promote these with my paediatric patients.
This elective was an outstanding learning experience and I’d like to thank Drs. Purcell and Elliot, the staff of the David Braley and the Elliott Sport Medicine Clinics, and the CPS Sports Medicine Section for providing me with this opportunity.
Eric Koelink - 2010
I would like to thank the Canadian Paediatric Society’s Sports and Exercise Medicine Section for providing me with the opportunity to pursue an elective in the field of paediatric sports medicine. Over my four weeks working at the David Braley Athletic Centre at McMaster University in Hamilton, Ontario, I was able to see a wide spectrum of both paediatric and adult sports medicine patients. The D.B.A.C. also had on-site physiotherapy and access to x-rays and MRI through McMaster University Medical Centre, making it a convenient service for facilitating the assessment and management of sports injuries. My time was spent in the outpatient setting, working with two inspirational physicians with different training backgrounds.
Dr. Laura Purcell is a paediatric emergency medicine physician and diplomat of the Canadian Academy of Sport and Exercise Medicine (CASEM). She is also the current president of the Paediatric Sports Medicine and Exercise Section for the CPS. Working with her was a thoroughly rewarding and invaluable experience, and I hope to emulate not only her academic qualifications but also her professionalism, compassion and expertise. Over the span of four weeks an eclectic patient population presented to her clinic, with ankle sprains, Sever’s apophysitis, ACL tears, concussions and stress fractures incurred in a variety of recreational and competitive athletic settings. With each case Dr. Purcell demonstrated appropriate assessment techniques and talked through the salient points impacting her approach to diagnosis. As a learner, I appreciated the time taken to explain the rationale behind certain clinical decisions, and will use this model for future practice. The majority of patients were managed with various braces and physiotherapy. However, for those more complicated cases, we were fortunate to have a surgeon available for referrals in the same clinic.
Dr. Devin Peterson is an orthopedic surgeon who also works out of the David Braley Athletic Centre, seeing both paediatric and adult sports medicine patients. In his busy clinics we saw a (naturally) more surgery-oriented clientele, with cases of ACL tears, SLAP lesions, rotator cuff tears and dislocated shoulders with Bankart or Hill-Sachs lesions. Radiologic findings on x-ray, ultrasound and MRI were reviewed and relevant anatomy discussed in detail to better distinguish pathology from normal appearance. Dr. Peterson’s proficiency and attention to detail set a high standard which I sought to uphold in my clinical encounters. I truly appreciated the time and effort Dr. Peterson put into reviewing each case and discussing its management going forward.
With the help of two superb teachers and the CPS Sports and Exercise Medicine Section, my confidence in assessing and managing sports-related injuries in both the paediatric and adult populations has improved tremendously. I plan to put this new-found knowledge to good use as I pursue my fellowship training in paediatric emergency medicine at the Hospital for Sick Children. I also plan on completing a fellowship in sports medicine through CASEM, allowing me to continue practice in this growing field and to work with such highly qualified colleagues as Drs. Purcell and Peterson.
Michelle Jackman - 2008
I would like to thank the CPS Paediatric Sports and Exercise Medicine Section for awarding me the 2008 resident bursary. This award allowed me to pursue an exceptional elective experience in paediatric sports medicine.
I had the opportunity to work with highly trained sports medicine physicians across the country. My preceptors included Dr. Laura Purcell in London, Ontario, Dr Claire Leblanc at the Stollery Children’s hospital in Edmonton, Alberta and Dr Connie Lebrun, medical director of the Glen Sather Sports Medicine Clinic at the University of Alberta. My preceptors offered unique perspectives through their expertise in paediatric sport medicine, paediatric emergency medicine, paediatric rheumatology and adult sports medicine. This exposed me to the true depth and diversity of paediatric sports medicine as a specialty.
You may ask, “How will an elective in sports medicine help me be a better paediatrician?” Thanks to some of the patients that I assessed during my rotation, I’ve compiled a fun quiz to illustrate that sports medicine is much more than examining knees and diagnosing Osgood- Schlatters!
1. On your first day of the elective, you meet Justina, a 16-year-old competitive soccer player referred to you for a six month history of right knee pain, made worse with activity and relieved with ibuprofen, rest and icing. There is no history of trauma, fevers, and weight loss, diarrhea or morning stiffness. The knee exam is consistent with patello-femoral syndrome and X-rays are normal. What do you do next?
a. Give her a corticosteroid injection.
b. Send her to a physiotherapist with specific orders.
c. Tell her to take up swimming instead of soccer.
d. Give her crutches and advise non-weight bearing for six weeks.
2. You meet JD, a 15-year-old native boy who has been experiencing right knee pain and swelling for 6 weeks. In addition, pain started in both his heels three weeks ago. Some relief is provided with ibuprofen, rest and icing. He reports a one week history of red, painful eyes. What mode of imaging would likely be most helpful in this case?
a. MRI of sacroiliac joints
b. CT of sacroiliac joints
c. plain X-rays of shoulders and knees
d. bone scan
3. Austin is an 8-year-old boy who has had bilateral ankle pain since his soccer season started 4 weeks ago. The pain is worse with running. Your diagnosis is:
a. Bilateral sprained ankles
b. Calcaneal Apophysitis or Severs disease
c. Allergy to exercise
4. Suzanne is a 10–year-old girl who presents with a 10 day history of bilateral foot pain, swelling and heat. She has experienced two similar episodes in the past year. One episode occurred two weeks after she fell on her outstretched right hand. She has visited the emergency on three occasions for persistent pain despite no fracture on x-ray. What is your diagnosis?
a. Systemic Lupus erythematosus
b. Complex regional pain syndrome
c. Peripheral neuropathy
5. You are asked to assess Jonah, a 14-year-old boy regarding tall stature and advise re: safety of strength training. What are the contraindications to strength training in this age group?
a. Marfan’s syndrome with aortic root pathology
b. Pectus excavatum
c. Ehler’s Danlos
d. > 6 hours/week of watching the World Wrestling Federation
6. Liz is a 14-year-old girl who fell off her horse and sustained a concussion. Two weeks later, she asks you when she can resume horseback riding. What is your approach?
a. Perform the SCAT concussion symptom score
b. Sell the horse
c. Start riding but get a new helmet
7. Andrea is a 10-year-old competitive swimmer whose best stroke is the butterfly. She comes in to see you because of left shoulder pain. What will be an important part of her management plan?
a. Shoulder girdle stabilizer strengthening program
b. Local physical therapy modalities including ultrasound
d. All of the above
8. Lara is a 15-year-old competitive gymnast who has had amenorrhea for one year. On dietary history you find she is restricting her calories to only 30% of her required daily intake. What is the most important investigation to perform before she leaves the office?
a. Orthostatic vitals and a 12-lead EKG
b. CBC, Electrolytes, renal and liver function studies
c. Beta HCG
d. Dexa bone scan
ANSWERS: 1:b, 2:a, 3:b, 4:b, 5:a, 6: a, 7:d, 8:a
Since completing my exams in paediatrics, I have taken a position in the Pediatric Endocrinology division at Children’s Hospital of Western Ontario, in London, Ontario. I work with a variety of children including those with Type I and 2 diabetes, obesity, eating disorders and other endocrinopathies. Exercise and healthy diet is one of the management cornerstones to all of these conditions. This approach has given me many opportunities to help my patients through my sports medicine experience.
I hope this article has stimulated your interest in paediatric sports medicine, and I encourage you to set up an elective. You will gain valuable knowledge and experience to bring with you to any subspecialty or practice of paediatrics.
Metzl, Jordan D. Sports Medicine in the Pediatric Office, American Academy of Pediatrics. 2007.
Micheli, Lyle J and Purcell, Laura. The Adolescent Athlete: A Practical Approach, 2007.