Prevention of Children’s Sporting Injuries

Prevention of Children’s Sporting Injuries

 

Participation in sport improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork.

Sporting activities can also result in injuries. Some of these injuries are minor and some are serious. Still others result in lifelong medical problems.

Injury rates from children’s sport in Australia are approximately three injuries per one-hundred children per year, with serious injuries being less than one per one-hundred per year. The incidence increases sharply at the age of 14 particularly amongst boys. Very few serious injuries occur to children less than 10 years of age. The more sport a child plays the more susceptible they are to injuries.

Reasons for Concern

Children are Still Growing Young athletes are not merely small adults. Their bones, muscles, tendons, and ligaments are still growing. This makes them more susceptible to injury.

Growth Plates Growth plates are the areas of developing cartilage where bone growth occurs in children. The growth plates are weaker than the nearby ligaments and tendons. What is often a bruise or sprain in an adult can be a potentially serious growth plate injury in a young athlete.

Children Vary in Size and Maturity  Young athletes of the same age can differ greatly in size and physical maturity. Some youngsters may be physically less mature than their peers and try to perform at levels for which they are not ready.

Guidelines for Preventing Sports Injuries

The American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, Canadian Orthopaedic Association, and American Orthopaedic Society for Sports Medicine designed Play It Safe! to help parents, coaches, and children prevent sports injuries.

Principles

“Play It Safe! “ encourages children to:

  • Be in proper physical condition to play a sport
  • Know and abide by the rules of the sport
  • Wear appropriate protective gear (for example, shin guards for soccer, a hard-shell helmet when facing a baseball pitcher, a helmet and body padding for ice hockey)
  • Know how to use athletic equipment (for example, correctly adjusting the bindings on snow skis)
  • Always warm up before playing
  • Avoid playing when very tired or in pain

Proper Training

Young athletes need proper training for sports. They should be encouraged to train for the sport rather than expecting the sport itself to get them into shape. Many injuries can be prevented if youths follow a regular conditioning program with incorporated exercises designed specifically for their chosen sport.

A well-structured, closely supervised weight-training regimen may modestly help youngsters prepare for athletic activities. We can design a program suited to your sport and can liase with  coaches if necessary.

Qualified Coaching

Parents should make sure their child’s coaches have the appropriate qualifications to supervise a particular sport, provide well-maintained safety equipment, and help with proper conditioning for that sport.

Make It Fun

Youth sports should always be fun. The “win at all costs” attitude of many parents, coaches, professional athletes, and peers can lead to injuries. A young athlete striving to meet the unrealistic expectations of others may ignore the warning signs of injury and continue to play with pain.

Coaches and parents can prevent injuries by fostering an atmosphere of healthy competition that emphasizes self-reliance, confidence, cooperation, and a positive self-image, rather than just winning.

8 Tips For Preventing Injuries and Improving Performance

  1. Start at an appropriate level. Many people start a new program at a level that is way too high for their level of conditioning. My advice is  to get some professional advice, taking into account your physical and medical history, age, experience, goals and fitness level.
  2. If you are just doing for health mix it up. There is no one perfect activity. Running for example is excellent for the cardiovascular system but offers minimal strength benefits together with a high level of impact.  Heavy weight lifting will not improve your cardio but will make you stronger.Yoga is great for flexibility but offers less in terms of cardiovascular or strengthening than running or gym. Generally each activity has its good and bad points and biases a particular part of your body.   Doing different things on different days breaks the monotony, allows for adequate recovery and produces a better overall result.
  3. If you want to improve sport performance include other activities. The high demands of sport require flexibility, strength, agility, speed, and endurance. Focusing on each of these components seperately  will result in better overall sporting performance. Even for sports with a high cardio need such as soccer, weight training is esssential. It is possible to get much stronger and faster without gaining weight or detracting from your cardio fitness. Normal gym training does not cut it here so get specialist advice on this one.
  4. Warm up properly. This is rarely done properly. Warmup should include activities that also improve your performance on the field as well as prevent injuries..
  5. To brace or not to brace. Which braces work and which don’t. What is better brace or tape? Bracing and tape are fantastic when used properly and can waste your money or reduce your performance when not. Most braces are useless and tape has to be properly applied.
  6. Sort out the niggling injury. Small aches and pains are sometimes indicative of a much larger problem looming under the surface. The best time to manage something early. Recovery time for tendons can be 12 months if let go too long for example. So if you have a problem it is both time and cost effective to sort it out early. Getting this assessed requires an expert.
  7. Don’t try to figure it out for yourself. Prescribing your own treatment is like representing yourself in court or trying to wire your own roof. If you have a problem get professional advice. When it comes to your health my advice is to give up google.
  8. Get Screened. Even if you dont have a problem it is worth a checkup. We provided an advanced musculoskeletal screening progam which enables us to indentify problems  before they occur.

Bracing and Strapping – what works?

Firstly some general rules:

  1. Don’t believe what is written. Many braces are useless and claim to do things that they don’t  do.  Buying an off the shelf brace is really not a good idea.
  2. Get it professionally fitted. If it doesn’t fit properly it may not even work or may be unwearable.
  3. Make sure you understand what your problem is. The brace must also match the injury. It is no good just wanting a knee brace for example. There are around 5 different bracing options for the knee each requiring a professional assessment.
  4. For every brace there is a strapping option. What is best for you needs to be discussed with an expert.
  5. Strapping requires skill, and is not effective if poorly applied

Some common braces are:

Ankle Braces. The main idea of using and ankle brace is to prevent the ankle from spraining which is one of the most common injuries we see. The lateral ligaments are the most commonly involved particularly the anterior talofibular and calcaneofibular ligaments. Using a good quality brace or using correctly applied sportstape is very effective at preventing injury from occuring. We recommend the ASO brace for its ease of application, comfort and effectiveness. If you have ever sprained your ankle or feel that your ankle rolls easily using a brace or learing to tape may well be the solution.

Knee Braces. The knee is a complex structure and whether or not bracing or strapping can be effective depends on several factors including

– what structure has been injured,

– how severe is the injury,

– what sport is the person playing,

Choosing a brace is not a decision you should make for yourself here. there are braces effective for a variety of conditions including ligament injuries (ACL, medial and lateral ligaments) and certain forms of pain at the front of the knee such as patellofemoral pain. We stock the best knee braces available for various conditions, but these need to be individually measured and fitted. If you have knee pain or your knee gives way then a brace may help.

Back Braces. These can be fantastic for relieving back pain and can help prevent pain, especially with bending activities. However not every brace is good for every back, and again you risk wasting your money or even worsening your problem if the choice is wrong..

Injuries to Children – Overuse Injuries to the Growth Plate

Children’s bones are still growing making them prone to injuries to the areas in the bone known as the epiphysis and apophysis. These are the areas on the growing bone that contain growth cartilage. This is the area of the bone that produces new bone cells that allow children to grow.

These injuries are common and if left unattended may result in time off sport.

The most common of these are Severs Syndrome and Osgood Schlatters Syndrome. These are injuries to the apophysis. The apopyhysis is as a bony lump, which the tendons attach to. It is softer in children than in adults.

Severs Syndrome occurs through overstress of the attachment of the achilles tendon at the back of the heel. The age of occurrence is usually between 10 to 12 years of age. The child complains of heel pain. The condition will usually resolve over the next year or so as the growth plate matures. Factors such as flat feet and tight calves can contribute to its onset and if these are addressed will usually aid recovery. Activity modification is sometimes necessary.

Osgood Schlatters Syndrome is caused through overstress on the attachment of the patella tendon on the front of the leg below the knee. The condition will usually resolve over the next year or so as the growth plate matures. Stretches to the quadriceps, correction of biomechanics (such as using orthotics) and activity modification will usually aid recovery.

These injuries always self resolve but may be indicative of poor biomechanics, overtraining or unsuitability for an activity. They respond well to advice and treatment.

A professional assessment is essential. Early diagnosis leads to good early treatment and can have a huge impact on the speed of recovery and may even prevent longer-term problems.

Ankle Sprains

Sprains to the lateral ligaments of the ankle are the most common sporting injury and account for about 10 percent of all sporting injuries. Not surprisingly this has been well researched and there are well over 100 published papers on preventing ankle injuries.

Over 95 % of these sprains occur to the lateral ligaments of the ankle and are caused by twisting the foot in or inverting the foot. These sprains range from a mild grade one (microscopic damage) to a more severe grade 3 (full rupture) and with more serious grades can even result in damage to the joint or fracture.

In summary this research has shown that a quality brace or properly applied tape is

  1. Effective in preventing a many ankle sprains
  2. Not detrimental to performance

And that Physiotherapy rehabilitation which focuses on a short period of rest and protection of the injured ankle followed by a professionally designed rehabilitation program is

  1. By far the treatment of choice and will promote faster and better recovery than either surgery or no rehabilitation
  2. Effective at preventing further injury

Management of this injury is best performed by a Physiotherapist with skills in this area.

Treatment of heel pain (plantar fasciitis)

This refers to pain coming from the attachment of the plantar fascia at the heel. The plantar fascia acts as a supporting ligament under the arch and helps to strengthen the arch of the foot when we push off. Normal plantar fascia health is maintained by regular activity. Too much or too little can lead to problems with the plantar fascia and pain. Frequently inactive people get this disorder and obesity is a large risk factor.

This can be an extremely disabling disorder and can make standing and walking difficult. It is frequently painful first thing in the morning or after being off your feet when you take a first step.

Although there is no one proven treatment there are several available treatments that are effective in many cases. Steps to management are:

  1. Settle the symptoms. This can be achieved with strapping of the foot, medication and a night splint
  2. Correct the biomechanics. Orthotics are frequently useful however are not always tolerated early especially if the part of the plantar fascia towards the inside of the heel is involved. Tight calf muscles and restriction through the ankle joint can lead to plantar fascia overload and need to be addressed
  3. Strengthen the musculature that supports the foot. The plantar fascia works in conjunction with other foot and ankle muscles and tendons which can be strengthened

 

Making Your Appointment Count (or What To Ask Your Health Care Provider)

How many times have you been to the Doctor or Physio or other health care practitioner and walked away without sufficient understanding of your problem. As health professionals it is our responsibility to provide you with certain information but unfortunately this does not always occur. Next time you see your health care provider go prepared with the following questions and insist on reasonable answers to these.

  1. What is the diagnosis?
  2. How serious is it?
  3. What is its likely prognosis or progression or outcome?
  4. What are the suggested treatment options and what are the risks and benefits of the suggested treatment?
  5. Are there any alternative treatments available or further investigations required to prove the diagnosis
  6. What costs will be involved, how many visits will you require
  7. Can you have some written information about the problem

4 Myths and misconceptions about orthotics

  1. Orthotics are uncomfortable. A common complaint from patients is that they would not wear their old prescribed orthotics because they are uncomfortable. This should NEVER occur and will only occur if the orthotic is too hard or poorly fitted. The older style orthotics were (and sometimes still are) made of a rigid material. Modern orthotics are comfortable and after a short wearing in period you should not even know that they are in your shoe. Our gaitscan orthotics are made of flexible supportive and comfortable material.
  2. You need to see a Podiatrist to get customised orthotics. This was the case 30 years ago now. Many Physiotherapists now receive training in orthotic prescription and most health funds will rebate on customised Physiotherapy orthotics. The gaitscan orthotics we use are accepted by most health funds.
  3. Orthotics will change your foot structure. This is not the case even in children. There is no evidence that orthotics will alter the way a foot grows. Orthotics work by supporting the foot and by changing foot alignment.
  4. Orthotics cannot be used in sport. See part 1. The old rigid orthotics were painful with multidirectional sports, modern orthotics are made for sport and there are orthotics made for running, football and golf.
  5. Orthotics are simply an arch support. This is wrong. The orthotic support support the entire foot and also improves mechanics at the knee, hip and other areas.

What can orthotics be used for?

Orthotics can be used to treat a variety of conditions including

– Foot pain including metatarsal pain

– Heel pain including plantar fasciitis

– Lower leg pain including “shin splints” and Achilles tendon pain

– Pain at the front of the knee or patellofemoral pain

What types of orthotics are there?

There is a large range of orthotics available ranging from off the shelf to fully customised. What is likely to be best for you is best determined by your health care professional

Cutting Edge Knee Injury Research News Pain at the Front of the Knee

Patellofemoral pain syndrome describes several common problems at the front of the knee. Pain typically occurs with activity and often worsens while descending steps or hills. Sitting can also trigger pain. The likely cause is related to poor movement of the knee cap in the groove underneath it and it is often caused by muscle tightness or weakness.

In a recent study in the British Medical Journal it was found that Physiotherapy was able to produce 45% better pain reduction that a group treated with medication and required up to 300% less medication. This approach worked on all ages.

Physiotherapy management may include:

  • Targeted strengthening and flexibility exercises
  • Custom foot orthotics
  • Taping and/or knee sleeves
  • Home exercise plans
  • Footwear recommendations
  • General fitness and weight loss programs

Some tips for travelling with a team.

Travelling with a team presents a considerable challenge for all involved. It involves working in close proximity to others for an extended length of time, often for long hours under difficult conditions.

Be organised and plan. Understand the destination and what facilities will be available. What is the climate, how well adapted are the athletes to the climatic conditions at their destination. What is the food and water supply like?

Where are the hospitals and medical support services if they are required. Researching for a good physio in the area if you don’t have one travelling with you, can really assist. It is really risky to treat things you are not qualified to. At least take a contact number of someone you can call if there are problems.

What facilities will you be provided with for the athletes. Does your medical kit have enough supplies to last the trip. What are the medical requirements of your athletes. Young people who are not experienced travellers can easily forget medication, braces etc

When you get there set yourself up early and don’t forget to look after yourself. I travelled with a group once where some of the staff went on a bender the second night. This is a poor example to the athletes and does not allow you to deal with a midnight emergency or even function well the next day. It is hard enough with travel and lack of sleep without compounding things

Finally teach the athletes to be responsible, independent and accountable. Give the athletes a list of things that they must take. This ensures that they don’t share towels, that they wear thongs in public showers (tinea prevention) and that they have remembered their braces and medication. Make them accountable for their behaviour and their own organisation, remember you are not their servant.

ACL prevention – New Research

 
New Study Finds Men and Women Use Different Leg and Hip Muscles During Soccer Kick; May Help Explain Higher Risk of ACL Injury in Females; Improve Prevention Approach

Injuries to the anterior cruciate ligament are  amongst the most common in sport and amongst the most serious. In spite of advances in surgical technique and rehabilitation over the last decade the rehabilitation is still slow with athletes usually taking more than 9 months to return to sport and more that 2 years to regain full performance with 25 -50 percent never reaching their pre-injury performance. As well it is clear that:

Most of these athletes will come to develop osteoarthritis of the knee later in life, with up to 50% showing radiographic OA changes at 10 years following the injury.

Significant differences in knee alignment and muscle activation exist between men and women while kicking a soccer ball, according to a study published this month in the Journal of Bone and Joint Surgery. Data reveals that males activate certain hip and leg muscles more than females during the motion of the instep and side-foot kicks the most common soccer kicks which may help explain why female players are more than twice as likely as males to sustain an Anterior Cruciate Ligament (ACL) injury.

Prior research shows that females are more prone to non-contact ACL injuries than males, by a factor of 2 to 8 times, regardless of the level of play.

“By analyzing the detailed motion of a soccer kick in progress, our goal was to home in on some of the differences between the sexes and how they may relate to injury risk,” said Robert H. Brophy, MD, study author and assistant professor of orthopedics, Washington University School of Medicine in St. Louis. “This study offers more information to help us better understand the differences between male and female athletes, particularly soccer players.”

Using eight to 10 video cameras, 21 retroreflective markers and 16 electrodes simultaneously, researchers measured the activation of seven muscles (iliacus, gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, hamstrings and gastrocnemius) in both the kicking and supporting legs; as well as two additional muscles (hip adductors and tibialis anterior) in the kicking leg only. Five instep and five side-foot kicks were recorded for each player. Muscle activation was recorded as a percentage of maximum voluntary isometric contraction.

They found that male players activate the hip flexors (inside of the hip) in their kicking leg and the hip abductors (outside of the hip) in their supporting leg more than females.

In the kicking leg, men generated almost four times as much hip flexor activation as females (123 percent in males compared to 34 percent in females).

In the supporting leg, males generated more than twice as much gluteus medius activation (124 percent in males compared with 55 percent in females) and vastus medialis activation (139 percent in males compared with 69 percent in females).

“Activation of the hip abductors may help protect players against ACL injury,” said Dr. Brophy, a former collegiate and professional soccer player and past head team physician for the former St. Louis Athletica professional women’s soccer club. “Since females have less activation of the hip abductors, their hips tend to collapse into adduction during the kick, which can increase the load on the knee joint in the supporting leg, and potentially put it at greater risk for injury.”

Brophy said that although the study does not establish a direct cause-and-effect relationship between muscle activation and knee alignment and ACL injuries, the data “moves us toward better understanding of what may contribute to differences in injury risk between the sexes and what steps we might take to offset this increased risk in females.”

The current research in the area of ACL injury prevention has shown some promise. For example, in 2008, the Centers for Disease Control and Prevention published a study that found a new training program called the Prevent Injury and Enhance Performance (PEP) program, was effective in reducing ACL injuries in female soccer players. Developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation PEP is an alternative warm-up regimen that focuses on stretching, strengthening and improving balance and movements and can be conducted during regular practice time and without special equipment.

“Programs focusing on strengthening and recruiting muscles around the hip may be an important part of programs designed to reduce a female athletes’ risk of ACL injury,” said Dr. Brophy. “Coaches and trainers at all levels, from grade school through professional, should consider using strategies that demonstrate potential to prevent these injuries.”

Low Back Pain – What Exercise Works Best

We are frequently asked this question from patients who want to sort through the myriad of options ranging from pilates, yoga, core stability and hydrotherapy. Each of these approaches has some value in certain situations but NONE ARE SUITABLE FOR ALL PROBLEMS. The problem is that not all back pain is from the same source so the approach to treating needs to be different for each case. Each person’s problem requires an individually tailored solution. It is at worst risk and often simply ineffective to start a program until you know what the exact source of the problem is.

A Physiotherapist who is skilled in low back pain management (and I reckon about 10 percent of Physiotherapists out there have the necessary skills) can direct you according to your individual needs. If you want your low back assessed professionally we can provide you with an individually prescribed program. Mention this email when you book in and we will give you 3 months free access to our rehabilitation gymnasium.

LOW BACK PAIN – the latest evidence

Low back pain (LBP) ranks as a leading cause of disability. Despite increased attention to the problem over the past three decades, annual healthcare costs related to LBP continue to rise at rates exceeding inflation. Research has shown several effective approaches for prevention of low back pain and disability, and these approaches are available to you through Advanced Physiotherapy and Injury Prevention.

The Old Approach: It is commonly held that 90% of individuals suffering from  low back pain will feel better in 90 days. For this reason, it used to be considered that rest was enough unless the pain did not settle. This approach assumes that the body heals itself. The problem with this is that many cases of low back pain reoccur or do not settle.

A Promising Alternative:  With back pain comes loss of muscle strength or deconditioning. It this is not addressed the back will be weaker after the first incident causing the pain not to settle or for it to reoccur at a later date. Professionally guided exercises aimed at restoring muscle strength can be successful at reducing pain, improving performance and preventing future LBP.

In a study of 895 chronic low back pain patients treated in a physiotherapy it was found that recurrence rate dropped by 67%.

Among the modern studies that have shown positive results, common elements tend to be that low back strength  strength was improved and movement was encouraged.

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