Youth Sport Injuries

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Youth Sport Injuries

• Approximately 10 of the 30-35 million American
  children playing organized sports each year will
  be injured
• Sports injuries may be responsible for 20 of
  Emergency room visits
• Children who abandon active sports for videogames
  place themselves at risk for obesity and diabetes
• Specialization in one sport at an early age
  places them at tremendous risks for early
  osteoarthritis from significant repetitive
  injuries

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The youth athlete is different
Youth Sport Injuries

• Psychological
• Coordination
• Forces generated are different
• Open growth plates
• Muscle-ligament attachments
• Training
• Coaching

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Youth Sport Injuries
Overuse injuries increased 4x since 2000 Account
for 30-50 of all injuries

• Chipped bones
• Growth plate injuries
• Little league elbow
• Knee joint injuries
• Back injuries
• Pathologic fractures

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Chip Fracture

• Elbow injury
• Chip fracture pull-off of attachment of throwing
  muscle)
• Treatment is controversial
• Surgery vs. Cast

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The Growth Plate

• 15 of reported injuries
• Vulnerable 10-12 female, 13-15 male
• Only 2 of growth plate fractures develop a
  growth problem

13 y/o
16 y/o
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Little League Shoulder
Repetitive overhead activity Quarterback,
Pitcher, Big server in Tennis Widening of growth
plate (force pulls it apart)
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Gymnasts Wrist

• Wrist pain and swelling
• 33 females
• 22 males
• Widening of the growth plate
• May show partial growth closure

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Little League Elbow

• Result of repetitive muscular contraction of
  flexor mass
• Risk related to type and number of pitches
• Microfracture may injure joint cartilage
• X-ray, MRI diagnostic

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Knee

• Articular ball-bearing Cartilage injury
• Localized injury.. to blood supply
  osteochondritis dissecans to bone and
  cartilage
• Affects joint mechanics
• May separate as loose body or joint mouse with
  destruction of cartilage
• .. degenerate to arthritis

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SPONDYLOLYSIS SPONDYLOLISTHESIScrack in
the back
Stress fracture of the back
Overuse disorder at vulnerable site
Common cause of back pain

• Gymnasts
• Cheerleaders
• Weight lifters
• Middle line backers
• Wrestlers
• Crew
• Hockey

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Herniated disc

• Difficult to establish diagnosis
• Sciatica, reactive scoliosis, buttock, thigh and
  low back pain
• Result of repetitive back flexion and high impact
  activity
• X-rays usually normal
• MRI positive
• Early degenerative changes may persist into
  adulthood

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Hallmark of Overuse

• Pain decreases with decreased Activity
• Night and rest pain Badness

Continuous pain without activity..
Rule out fracture through tumor
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Management of Overuse

• Immediate cessation and splinting (Rest 2-6
  weeks), NSAIDs
• Return to everyday use (non-sports)
• Strengthening, stretching, flexibility (after all
  pain is gone)
• Encourage multiple sports involvement
• What starts out early as a minor injury, if left
  untreated may become a serious injury by jr high
  or high school

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Goal- Sports Participation

• Avoid early specialization
• Avoid overtraining
• Avoid Pain

Avoid Radar Guns
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Upsides far outweigh downside

• Develops leadership
• Builds social skills, teamwork development and
• Lifelong friendships
• Special Olympics instills self-esteem for motor
  and cognitively challenged
• Center for Disease Control cites more kids seen
  for sports injuries than automobile accidents,..
  however the majority of injuries in young
  athletes are minor and self limiting

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Our responsibility

• Assist the athlete to achieve their goals injury
  free
• Monitor, modify activities, diminish risks
• Enrich environmental factors i.e. sports
  equipment, shoes, training
• Protection from substance abuse
• Injury prevention

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ACLanterior cruciate ligament

• Connects anterior leg to posterior thigh
• Primary stabilizer of the knee
• Females gt males 2-6x when in same sport
• Non contact injury
• 50,000 high school female injuries
• Felt to be related to alignment, muscle and
  ligament difference
• 3-D biomechanical research

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3-D Biomechanical-EpidemiologicalCoupled Research

• Hypothesis
• Pre-screened females with subsequent ACL injury
• demonstrate decreased neuromuscular control
• Knee valgus
• increased joint loading
• would predict ACL injury risk
• Method
• 205 female athletes
• 9 subsequently suffered confirmed ACL tears
• Prospectively measured neuromuscular control
• Statistical analysis
• isolate predictors of risk
• athletes who subsequently ruptured their ACL

Tim E. Hewitt Ph.D. CCHMC Human Performance
Laboratory
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Components of Predicted Injury Risk

• Knee valgus (knock knee) angle and torque
  (rotational force from ground) were primary
  predictors
• With 75 accuracy we were able to predict ACL
  injury
• Using statistical models we were able to predict
  injury with 95 accuracy

Clinical Relevance

• Increased dynamic valgus and abduction loads
  increased risk of ACL injury
• DNA

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Dynamic Neuromuscular Analysis Training

• Dynamic
• Fast paced
• Neuromuscular
• Drill optimal patterns
• Analysis
• Coaching and feedback
• Technique perfection

• Has been shown to increase knee stability
• Has decreased knee injury rates in female
  athletes

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Youth Sport Injuries
Stop the epidemic

• Pre-season Health screening
• Identify any risk factors i.e. strength/flexibilit
  y imbalances, anatomical malalignment
• Provide protective equipment and playing
  conditions
• Sport specific training
• Avoid specializing too early in single sport or
  position
• Dont allow them to play hurt
• If hurt allow adequate time for recovery

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