Transcript Chapter 25: Preventing and Managing Injuries in Young Athletes

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 footballrelated 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) yearround 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