Course:KIN366/ConceptLibrary/Childhood Sport Injuries

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Movement Experiences in Children
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KIN 366
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Instructor: Dr. Shannon S.D Bredin
Email: shannon.bredin@ubc.ca
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Sports have been a venue to encourage children to participate in physical activity at a young age. Participation in both organized and recreational sports can begin as early as pre-school age (Sahlin, 1990). It has often been associated with positive benefits both physically and socially in the development of children. However sports are actually the leading cause of injury in adolescents (Cassas & Cassettari-Wayhs, 2006). Children are particularly at risk for sport-related overuse injury because of improper technique, training errors and/or muscle weakness and imbalances (Cassas & Cassettari-Wayhs, 2006). Although there have been increasing numbers of chronic overuse injuries and other acute conditions with children’s sports, parents and coaches seem to accept injury as an unavoidable risk of sport participation (Sahlin, 1990).

Common Injuries and Treatments

There are several prevalent injuries in children’s sports and others that are quite rare. For example, Rotator Cuff Syndrome (injury to the muscles around your shoulder) is uncommon in children whereas stress injuries (repetitive pulling or straining to a muscle or bone) occur quite frequently (Cassas & Cassettari-Wayhs, 2006). Coaches and parents should be aware that any shoulder or elbow pain that persists in young athletes may be a sign of an overuse or stress injury (Cassas & Cassettari-Wayhs, 2006).

Little Leaguer's Shoulder

This injury is unique to overhead sports and children whose bones are still growing (open growth plates). Little Leaguer’s Shoulder is a stress injury to the upper aspect of the arm (proximal humerus) where the bone has not completely formed yet. It is often found in baseball, swimming, gymnastics, volleyball and tennis and usually occurs in athletes around 14 years of age (Cassas & Cassettari-Wayhs, 2006). Young pitchers tend to put increased demands on their shoulder and elbow through pitches such as curveballs and sliders. After receiving a stress injury to this area, the athlete will most likely experience shoulder pain during throwing or overhead activities as well as tenderness over the upper and outside of the arm (proximal and lateral humerus) (Cassas & Cassettari-Wayhs, 2006). Treatment for this injury includes relative rest from throwing for about 3 months, icing and any pain medication if prescribed by a doctor. The injured athlete can also begin strengthening exercises when comfortable and a structured throwing program when pain free through instruction from a professional (Cassas & Cassettari-Wayhs, 2006).

Little Leaguer's Elbow

This injury occurs because of an inflammation of the incomplete bone on the inside aspect of the elbow joint (apophysitis of medial epicondyle) (Cassas & Cassettari-Wayhs, 2006). It is often seen in athletes involved with throwing sports between the ages of 9-12. Most of these children will feel pain on the inside aspect of the elbow joint during throwing and have decreased pitch speed or control (Cassas & Cassettari-Wayhs, 2006). Treatment consists of complete rest from throwing for about 4-6 weeks. Icing and pain medications could also be used to help with the swelling and pain (Cassas & Cassettari-Wayhs, 2006). Gradual and progressive throwing programs may begin after this initial rest period once cleared by a professional (Cassas & Cassettari-Wayhs, 2006).

Osgood Schlatter Disease

This injury is quite unique compared to the others in the sense that the exact cause of it is unknown. It is thought to be secondary to repetitive small injuries or inflammation of the immature bone just below the knee joint (traction apophysitis of the tibial tuberosity) (Cassas & Cassettari-Wayhs, 2006). This injury is common with children who participate in sports that involve cutting and jumping such as soccer, basketball, gymnastics and volleyball. It is usually identified in children between the ages of 10-15 (Cassas & Cassettari-Wayhs, 2006). Patients with this injury have pain and swelling around the knee as well as swelling and tenderness at the bump on the upper aspect of the lower leg (tibial tubercle) (Cassas & Cassettari-Wayhs, 2006). Osgood Schlatter Disease often leaves a permanent mark via a residual bone deformity in the athlete as they age (Cassas & Cassettari-Wayhs, 2006).Treatment consists of rest from painful activities, pain medication and icing to help reduce swelling. This disease is difficult to treat because as mentioned before, the primary mechanism is unknown, however surgical interventions can be performed to remedy the deformity. Post-surgical rehabilitation can include (Baltaci, Ozer & Tunay, 2004):

  • Isometric exercises involving contraction of the quadriceps, hamstrings and gastrocnemius muscles
    • These exercises help to prevent the degradation of muscle fibers that is common after surgery
  • Closed-kinetic-chain exercises involving concentric/eccentric procedures
    • Contraction of one muscle while stretching the opposite muscle (ex. contract quadriceps while stretching the hamstrings)
    • Duplicates the actual demands placed on a patient’s knee during “real world” activities

Sever's Disease

Sever’s Disease is caused by inflammation of the immature heel bone (calcaneal apophysitis) however this is usually secondary to repetitive micro-injuries or overuse of the heel (Cassas & Cassettari-Wayhs, 2006). This injury is commonly seen in basketball, soccer, track and other running activities. Sever’s Disease usually manifests as tenderness after squeezing the sides of the back of the heel bone (Cassas & Cassettari-Wayhs, 2006). There are a variety of treatment methods for this injury. The effectiveness of each method may vary between patients but most injured players can be expected to return to play after about 3-6 weeks (Cassas & Cassettari-Wayhs, 2006). Treatment can consist of (Micheli & Ireland, 1987):

  • Icing (Cassas & Cassettari-Wayhs, 2006)
  • Gastrocnemius-Soleus stretching exercises
  • Dorsi-flexion strengthening under supervision of physical therapist
  • Discontinuation of running sports while child remains symptomatic
  • Prescription of heel lifts, foot orthotics or molded soft orthotics
  • Arch tape job for temporary relief during play (Hunt, Stowell, Alnwick & Evans, 2007)

Other Injuries

Other commonly injured areas in children are the ankle, knee, hand, wrist, elbow, shin, calf, head, neck and clavicle (Adirim & Cheng, 2003). Aside from these however, contusions and strains are the most common injuries sustained by young athletes (Adirim & Cheng, 2003). Contusions are bleeds into the muscle and soft tissues, similar to a bruise. Strains are caused by stretching or exerting a muscle beyond its limits (Adirim & Cheng, 2003).

Reasons for Vulnerability

There are several reasons that children are quite vulnerable to sport injuries however it largely stems from their bone maturation. The cause of overuse injuries in young athletes is linked to the unique and vulnerable phase of muscle and skeletal development of childhood (Gerrard, 1993). Children’s bones are softer and more porous while their tendons still have greater strength. This can lead to a greater likelihood of fracture because the tolerance limits of the growth plates may be exceeded by the mechanical stress of sports like football or by the repetitive loading required in sports like gymnastics (Maffulli, Longo, Gougoulias, Loppini, & Denaro, 2010). Other potential reasons for susceptibility to sport injuries include:

  • Children have larger heads proportionately (Adirim & Cheng, 2003)
  • They may lack the complex motor skills needed for certain sports until after puberty (Adirim & Cheng, 2003)
  • They may be too small for protective equipment (Adirim & Cheng, 2003)

Gender Differences

Prevalence of Anterior Cruciate Ligament (ACL – knee ligament) related injuries have increased in young athletes recently, especially in sports such as basketball, soccer and football (Adirim & Cheng, 2003). ACL injury occurs most often in non-contact circumstances during activity that involves slowing down or changing the direction of forces. Children are increasingly participating in sports where the mechanisms for this injury are more common, especially girls, who are more vulnerable to ACL injury (Adirim & Cheng, 2003). Girls may be more vulnerable because of a smaller ligament, less strength and conditioning, differing playing mechanics during sport as well as anatomical alignment (Adirim & Cheng, 2003). Also, female patients experience a greater percentage of sprains and contusions and fewer fractures compared to their male athlete counterparts (Damore, Metzl, Ramundo, Pan & van Amerongen, 2003).

Effects on Development

Effects of childhood sports injuries have the potential to linger into the adult years. At a young age, injury to the growth plate (physis) can result in limb deformities and leg length discrepancy, depending on the injury (Maffulli, Longo, Gougoulias, Caine & Denaro, 2011). Also, sport training, if of sufficient duration and intensity, may lead to serious changes of the growth plate and in extreme cases produce growth disturbance (Maffulli et al., 2010). Although evidence indicates sport injuries to the growth plate could cause issues such as length discrepancy, angular deformity and altered joint mechanics, incidence of long term health outcomes of childhood sport injuries is still largely unknown (Maffulli et al., 2010).

Recommendations and Prevention

Little Leaguer's Shoulder and Elbow

For both Little Leaguer’s Shoulder and Elbow, the main contributors to shoulder and elbow pain are believed to be pitch types, pitch counts and pitching mechanics. However it has been shown that breaking pitches (pitches that do not travel straight like a fastball) and pitch counts produce a significantly greater risk of elbow and shoulder pain in young athletes (Lyman, Fleisig, Andrews & Osinski, 2002). The change-up pitch however, has been demonstrated to be a safe pitch for 9-14 year old baseball pitchers and is recommended over a curveball or slider (Lyman et al., 2002). Therefore, based on this information, to prevent the development of Little Leaguer’s Shoulder and Little Leaguer’s Elbow in the future, it is recommended that (Lyman et al., 2002):

  • Pitchers between ages 9-14 do not throw curveballs or sliders
    • These pitchers should use fastballs and change-ups exclusively
  • Baseball organizations may consider limiting pitchers in this age group to 75 pitches in a game and 600 pitches in a season
  • Pitchers should not be allowed to by-pass these regulations by participating in more than one league at a time
  • All organized throwing sessions should be monitored by a coach or parent
  • Full-effort pitching should be limited

Other Recommendations

The most important step to preventing injuries in childhood sports is for the coaches and parents to understand that children are not little adults (Gerrard, 1993). They have very unique structures and specific areas are quite vulnerable to injury with lasting effects on their development. Coaches should make it a point to understand the developmental process of children so as to not expose them to any environments during their sport participation that may hinder them in the long-term. For example, during puberty it is highly recommended to reduce the training load imposed on young athletes to take into consideration the adaptations in their body and musculoskeletal structure such as asynchronous development of bone and soft tissue (Gerrard, 1993). Other recommendations include proper pre-season screening of all the athletes. This includes detecting any conditions that may predispose a child to injury, identify any past problems that may require rehabilitative therapy, and an overall health check-up (Adirim & Cheng, 2003). This pre-season conditioning can be extremely helpful, for example, balance testing can be a strong indicator of ankle stability and future ankle injury (Roach & Maffulli, 2003). Finally during competition:

  • Special care should be taken towards fair matching of size, weight and height of the athletes (Roach & Maffulli, 2003)
  • Appropriate supervision at events (Roach & Maffulli, 2003)
  • Properly fitted equipment (Roach & Maffulli, 2003)
  • Limiting external pressure from coaches and parents (Roach & Maffulli, 2003)

References

  1. Adirim, T. A., & Cheng, T. L. (2003). Overview of injuries in the young athlete. Sports Medicine, 33(1), 75-81.
  2. Baltaci, G., Özer, H., & Tunay, V. B. (2004). Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease. Knee Surgery, Sports Traumatology, Arthroscopy, 12(2), 115-118.
  3. Cassas, K. J., & Cassettari-Wayhs, A. (2006). Childhood and adolescent sports-related overuse injuries. Am Fam Physician, 73(6), 1014-1022.
  4. Damore, D. T., Metzl, J. D., Ramundo, M., Pan, S., & van Amerongen, R. (2003). Patterns in childhood sports injury. Pediatric emergency care, 19(2), 65-67.
  5. Gerrard, D. F. (1993). Overuse injury and growing bones: the young athlete at risk. British journal of sports medicine, 27(1), 14-18.
  6. Hunt, G. C., Stowell, T., Alnwick, G. M., & Evans, S. (2007). Arch taping as a symptomatic treatment in patients with Sever's disease: A multiple case series. The Foot, 17(4), 178-183.
  7. Lyman, S., Fleisig, G. S., Andrews, J. R., & Osinski, E. D. (2002). Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. The American Journal of Sports Medicine,30(4), 463-468.
  8. Maffulli, N., Longo, U. G., Gougoulias, N., Caine, D., & Denaro, V. (2011). Sport injuries: a review of outcomes. British medical bulletin, 97(1), 47-80.
  9. Maffulli, N., Longo, U. G., Gougoulias, N., Loppini, M., & Denaro, V. (2010). Long-term health outcomes of youth sports injuries. British journal of sports medicine, 44(1), 21-25.
  10. Micheli, L. J., & Ireland, M. L. (1987). Prevention and management of calcaneal apophysitis in children: an overuse syndrome. Journal of Pediatric Orthopaedics, 7(1), 34-38.
  11. Roach, R., & Maffulli, N. (2003). Childhood injuries in sport. Physical Therapy in sport, 4(2), 58-66.
  12. Sahlin, Y. (1990). Sport accidents in childhood. British journal of sports medicine, 24(1), 40-44.