Chapter 25: Preventing and Managing Injuries in Young

Athletes

Cultural Trends

• Significant increase in participation by young children, particularly females– Organized and informal sports and recreation

activities

• Results in an increase in sports and recreation related injuries

• Risk of injuries is inherent in sports

• Young athletes are susceptible because they are continuously gaining motor and cognitive skills

• Questions still arise concerning the appropriateness of youth participation in sports

• Level of training intensity and frequency remains a concern

Where are injuries occurring? The Facts

• More than 3.5 million children ages 14 and under suffer medically treated sports injuries annually

• Collision/contact sports are associated with higher injury rates

• Nearly half of all sports/recreation-related head injuries to children are caused by bicycle, skating and skateboard incidents

• Overuse injuries account for almost 50% of injuries seen in middle & high school

• Sports injuries account for approximately 55% of nonfatal injuries at school

• Most organized sports-related injuries (62%) occur during practice rather than games

• It is estimated that half of all significant sports-related injuries are treated in sports medicine clinics instead of hospitals

• In 2001, approx. 194,000 and 79,300 children (ages 5-14) were treated in hospital emergency rooms for football-related and soccer-related injuries, respectively

• Baseball has the highest fatality rate among all sports for children

• 24,400 children were treated for gymnastics-related injuries in 2001.

Physical Maturity Assessment in Matching Athletes

• Children are at a greater risk than adults for injury– Due to inability to assess risk, less coordination,

slower reaction time and less accuracy

• Rates of injury vary with age and gender• Injury rate is associated more with child’s

stage of development– Youth sports participants should be matched by

physical maturity, size, weight and skill level

• Maturity assessment should be part of the physical examination– Used to protect the physically young athlete

• Commonly used tools– Tanner’s Stages of Maturity

• Stage 1 – puberty is not evident

• Stage 3 – fastest bone growth and is crucial in terms of contact/collision sports (growth plate weakness)

• Stage 5 – full development

• According to the American Academy of Pediatrics– Preadolescent boys and girls should not be

separated by gender in recreational or competitive sports activities

– Separation of genders should occur in collision-type sports once boys have attained greater muscle mass in proportion to height

Physical Conditioning and Training

• Those guidelines and philosophies used by adults should not be imposed on younger athletes who are anatomically, physiologically or psychologically less mature

• Young athletes should focus on developing muscular strength, endurance, cardiovascular fitness and flexibility

• Should work with fitness professionals, coaches and ATC’s (if possible) year-round to maintain fitness and nutrition

• Engage in appropriate conditioning program for 6 weeks prior to beginning daily practice routine

• Athletes should engage in appropriate warm-up (w/ stretching) and cool down with activities

• Practices should be limited to no more than 2 hours

• Strength training can be safe and appropriate for emotionally mature athletes that are able to follow directions associated with a properly designed program– Younger children can also engage in program

(callisthenic in nature) as long as they are able to follow directions and perform activity safely

Psychological and Learning Concerns• Stress as a result of over zealous coaches

and parents is always a concern

• Children do not always understand sports concepts until they have received instruction

• Children usually are eager to please adults– Vulnerable to coercion and manipulation– Coach should be positive and use positive

reinforcement• Allows athlete to develop self-worth and self-esteem

• Not all children are equal in ability– Some children respond to competition while

others shy away

• Attempting to do ones best must be emphasized

• Children must receive instruction – Should be timely

• Emphasize enjoyment of the activity not just winning

• Types of play– Organized vs. Free-flowing

• Adverse effect of adult influences is one potential negative psychological aspect of youth sport participation

• Participation in sports can be taken to extremes – intensive participation relative to intensity and frequency– Demands placed on body and mind– At ages 10-12 a great deal of development is still

occurring cognitively• Ability to comprehend multiple points of view, team

perspective

• Issues may also enter the picture when injury rehabilitation is involved

• Risk factors for psychological complications in the injured child– Stress in the family– High-achieving siblings– Over or under-involved parents– Paradoxical lack of leisure in athletic activity– Self-esteem that is reliant on athletic prowess– Narrow range of interests outside of athletics

Coaching Qualifications

• No federal law requires coaching education at any level

• Training – Degree programs, Boy Scouts, youth sports

coaching programs

• No real standards until 1996

• NASPE is developing accreditation programs

• USOC mandates participation in safety and certification course (American Red Cross / USOC)

• Generally coaches have little or no background in providing safe and positive sports experience

• Should be dedicated to the highest ideals of coaching– NYSCA has membership and levels of

certification focusing on coaching, safety and first aid along with the psychological aspect of sports

• Coaches should have good understanding of child development – physical, emotional and psychological

Common Injuries in the Young Athlete

• Must be concerned with repeated microtrauma that can become compounded, become chronic or even degenerative in maturing musculoskeletal system

• Children are susceptible to same injuries as mature adults

Growth Plate Fractures

• Growth plate– Region at the end of long bones where bone

growth occurs – Determines length and shape of bone

• Trauma could be single acute incident or chronic, overuse, stress related

• Suspected fracture should be referred to a physician immediately– Determine severity and form of

treatment/immobilization

• Must be carefully monitored

• Bone will either not get longer or end up with stimulated growth with injured leg becoming longer than uninjured

• Complicated fractures must be followed up with until skeletal maturity is reached

Apophysitis

• Apophysis– Specialized area of cartilage within growth plate – Often point of large tendon insertion

• Repetitive stress results in inflammatory response– Osgood-Schlater’s and Sever’s disease

• Usually begins at ages 8-15

• Pain generally with activity

• Tenderness is localized with no other significant abnormalities

• Diagnosis from history, physical exam and occasionally X-rays

• Not serious and will resolve over time

• Treatment is directed toward reducing symptoms

Avulsion Fractures

• Bone vs. Muscle development– May result in imbalance and possible injury

• Stresses placed on bones through tendon of contracting muscle may result in pieces of bone being pulled away from point of insertion

• Common sites– ASIS, AIIS, ischial spine, and 5th metatarsal– More common in lower vs. upper extremity

Spondylolysis

• Defect or fracture in bony structures of spine

• Generally the result of repetitive loading

• Occur between ages of 5-10 around the 4th and 5th lumbar vertebrae

• Children often remain asymptomatic and injury is not realized until later in skeletal development

• X-rays are required to determine extent of injury

• Spondylolisthesis involves vertebrae slippage

• Treatment for both centers on healing of defect and treating patient’s symptoms– Physician’s decision– Brace vs. no brace– Flexibility becomes a major factor in rehab

program

Sports Injury Prevention

• For all individuals involved in sports one of the primary goals should be prevention of injury– Involve proper physical and psychological

conditioning– Utilize appropriate equipment (safety) in a safe

environment with adequate supervision– Enforce safety rules

• Be sure participants receive a physical and are cleared to participate

• Instruct participants on fitness and the various components– Performance enhancement and injury

reduction– Encourage proper eating and nutrition

• Work with athletes on acclimatization and hydration

• Be sure plans and guidelines are in place regarding care and treatment of injuries

• Work to create a safe and healthy playing environment

• Be aware of injury prevention guidelines for specific sports