Transcript Overuse and other growth related injuries in the young and

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Bolton Wanderers Academy
Jamie Miller - Physiotherapist
Overuse and other growth
related injuries in the
young and adolescent
athlete
Identification,
management and
prevention
Aim of the Presentation
• To make all those who have direct contact
with young athletes aware of the risk of
overuse and growth-related injury
• To give the coaches an insight into specific
injuries likely to occur
• Give some knowledge of how to manage and
prevent these injuries
Academy History and System
• Established in 1998
• Replaced the National Football School at
Lilleshall
• To develop more high quality domestic players
• Includes boys of 9-19 years of age
• 9-16 Schoolboys
• 17-19 Scholars
BWFC Academy System
• U9-16’s train up-to 3 times a week and play
up-to 1 game
• Matches every Sunday at other Academies
across the North of England
• Regular tournaments and International
competitions from the age of 9
• Participation in Training Camps and
Developmental Weekends
BWFC Academy Medical Provisions
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2 Full-Time Physio’s
2 Full-Time Fitness and conditioning Coaches
Part-Time Doctor
8 Part-Time Physio’s
Podiatrist
Chiropractor
Dietition
Overuse Injuries
What is an overuse injury?
• An injury that develops over a period of time
due to too much repetitive activity
• The injury becomes worse if activity is
continued
• It is the result of repetitive and unrepaired
micro-trauma
Overuse Injuries
• Can occur at any age
• Young footballers are particularly vulnerable
– because the body’s skeleton and tissues are still
immature and developing
– Nature and demands of the game
• Will hinder a player’s development
• Can be missed or ignored by coaches and
parents!
Overuse Injuries
TYPICAL ‘BUZZ WORDS’ ASSOCIATED TO OVERUSE INJURIES:
Missing Training
Stiffness
Hurts to touch
Tender
Aching
Goes within hours/days
Pain
Worse at night
Discomfort
Gets worse when playing
No Direct Trauma
Swelling
Painful after
training
Inflammation
Overuse Injuries
4 MAIN CAUSES:
LOAD (amount of playing/training)
TECHNIQUE
POSTURE (growth and development)
EQUIPMENT (playing surface/footwear etc)
Overuse Injuries
Recent Trends and Medical Insight
• Overuse injuries are increasing
• Intense training is starting at a younger age
• Much more physical activity for ‘gifted players’
• Training must be adapted to a child’s
development and age
Growth Spurts
• 10-15 years of age
• Vulnerable time for injury
• Immature bone structure is under immense
pressure from mature muscles
• Muscle tissue matures more rapidly than
skeletal bone tissue
• Growth plates of bones are subject to stress
• Bone grows faster than muscle, therefore
muscles can become tight = reduced flexibility
The Growing Bone!
5 Specific areas of
growth: Articular Cartilage
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Apophysis
Diaphysis
Articular Cartilage
Epiphysis
Metaphysis
The Growing Bone!
The Growing Bone!
• Fractures can occur in the young athlete due to the
line of weakness between the epiphyseal plate and
the formed bone, and the relative weakness of
apophyseal cartilage compared with
musculotendinous complex
There are 3 types of fracture seen in the younger
athlete:
• Metaphyseal fractures
• Growth plate fractures
• Avulsion fractures
Children and Exercise
Physical Development
A basic knowledge of skeletal growth and
development is important in understanding
the many aspects of performance and ability
in sporting activity at different ages – it is also
the key to appreciating many different injuries
that occur in children
Growth Related Injuries in
the Young Athlete
It is during the early and adolescent years that
the body’s muscles and bones develop and
grow. During growth, the soft tissues are
relatively stiffer and stronger than the bones,
which are relatively soft and weak. Therefore,
the young player is particularly vulnerable to
injury during periods of growth
Children and Exercise
Physical Development
• Children grow and develop physically at
different rates and at varying ages
• Not only do they grow at different rates, but
there are also changes in body proportions
that can put limitations on their ability to
perform
• The peak rate of growth occurs at age 12 in
girls and age 14 in boys
Physical & Physiological Demands
of a Young Player
ENDURANCE
COORDINATION
POWER
ACCELERATION
FLEXIBILITY
AEROBIC &ANAEROBC FITNESS
PROPRIOCEPTION
EXPLOSIVE POWER
STRENGTH
BALANCE
AGILITY
Developmental ‘Windows of
Opportunities’
AGE
6-9
7-11
11-14
14-17
15-17
16+
Peak speed velocity
Agility, balance, co-ordination and speed
Peak motor control velocity
Peak aerobic velocity
Peak speed velocity
Peak strength velocity
Developmental Windows of
Opportunities
The early foundation years are often overlooked by coaches
and parents, and therefore the acquisition of knowledge
and skills may be decreased.
Therefore depending on child’s developmental levels, their
lack of skills at a certain age may place them at risk of
injury!
This therefore needs to be address in their training!
Overtraining
• Overtraining and overuse injuries are directly
related to training volume and intensity
• It can occur when there is an imbalance
between exercise and recovery
Common Growth Related Injuries
FOOT & ANKLE:
• Severs Disease
KNEE & SHIN:
• Osgood Schlatters Disease
• Sinding-Larsen-Johansson Disease
• Shin Pain
• Chondromalacia Patella
Common Growth Related Injuries
HIP:
• Perthes’ Disease
• Slipped Capital Femoral Epiphysis (SCFE)
BACK:
• Spondylolsis (Parr’s Fractures)
Severs Disease
• Inflammation and damage of the achillies
tendon attachment into the heel
• Typically seen in ages of 7-10 years
• Second most common osteochondrosis seen
in the young athlete
• Presents at time of rapid growth
• Caused by an excessive traction pull on the
bone
Severs Disease - Management
This will always settle, usually within 6-12 months!
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Activity modification, until pain-free
Heel-raise
PRICE (on acute onsets)
Stretching of calf muscles
Looked at biomechanically
Strengthening exercise for the ankle
plantarflexors
Osgood Schlatters Disease
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Most commonly seen injury and may persist for upto 2 years!
Occurs at the patella tendon attachment into the
growth plate on the tibial tuberosity of the knee
Extremely common in the young athlete at the time
of a growth spurt!
Will be painful over the tibial tuberosity, which will
be aggravated by exercise
Caused by repeated excessive pull by the tighter
quads on the immature bone structure
Osgood Schlatters Disease
Osgood Schlatters:
Osgood Schlatters Disease Management
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Activity modification (will help reduce pain)
PRICE (for acute episodes of pain)
Stretching of the quads and soft-tissue work
Correction of biomechanical abnormalities
Orthotics
Siding-Larsen-Johansson Disease
• Similar condition to Osgood Schlatters
• Affects the inferior pole of the patellar at the
superior attachment of the patella tendon
• Multiple micro-trauma to patellar tendon
insertions
• Much less common than Osgoods Schlatters
• Management is similar principles to that of
Osgood Schlatters
Sinding-Larsen-Johansson:
Chondromalacia Patella
• Articular cartilage of the patella is eroded by
excessive wear and tear at a young age
Perthes Disease
• Osteochondrosis affecting the femoral head
• Can present as a limp or ache in the groin,
thigh or knee
• Usually only occurs on one side
• Typically affects children aged 4-10
• May be associated with a delay in skeletal
maturation
Perthes Disease - Management
The condition usually resolves and return to
sport is when the player is symptom-free. A
long-term concern may be the development
of osteoarthritis
• The age and severity of the condition will
affect the management
• Rest from aggravating activities
• ROM exercises
Slipped Capital Femoral Epiphysis
(SCFE)
• A SCFE may occur in older children, aged
between 12-15
• Occurs typically in overweight boys who tend
to be late maturers
• The slip may occur suddenly, or most
commonly gradually
• There is a widening of the growth plate and
the vascular supply may become
compromised
• This needs immediate surgical intervention!
SCFE
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SCFE
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Spondylolysis (Pars Fracture)
• Most troublesome and common type of back
pain
• Stress fracture of the Pars Interarticularis (often
referred to a Pars Fracture)
• Occurs because of continual hyperextension and
rotation of the lumbar spine
• Generalised low back ache and leg pain
• Pain is aggravated by lumbar extension
• Common in young cricketers (bowlers)
Spondylolysis (Pars Fracture)
Spondylolysis:
Stress Fracture
Stress Fracture
Spondylolysis - Management
• Restrict athletic activity
• Stretching programmes
• Strengthening programmes
There is not a set period of time, but when
aggravating maneuvers are pain-free and
there is no local tenderness, a gradual
progression to the back full activity over 4-6
weeks should be started, with pain as a guide
Prevention Strategies
• Understanding: Coach, Parents, Player and
Medical Team
• Avoid excessive, repetitive and monotonous
exercises
• Use of proper technique, equipment and
playing surface
• Monitor flexibility and growth rate
• Training sessions to fit to developmental age
and skill base!
Our Prevention Strategies
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Biomechanical Screening
Monitoring of flexibility and growth spurts
Orthopaedic Assessment
Growth prediction
Conditioning work
Educate players, coaches and parents and
work closely with them
Take Home Messages and Conclusions!
• Be aware of overtraining and overuse injuries
• Keeping your ‘eyes and ears’ open is an important
factor in recognizing an overuse injury. Potential
problems can be minimised by early recognition and
prompt action
• Be aware of developmental times of growing children
and ‘Windows of Opportunity’ to maximize your
sessions and reduce possible injury
• Sometimes ‘less is more’!
• Be aware off the tight, aching and stiff player who
complains of no direct trauma
Take Home Messages and Conclusions!
• Be aware of ‘hot spot’ areas of the body:
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Back
Hip
Knee
Heel
• Knowledge of the processes of growth and
development will enable you to make more
informed decisions about training
sessions/programmes and procedures for
children
THANKYOU!