Chapter 25: Preventing and Managing Injuries in Young Athletes

1
Chapter 25 Preventing and Managing Injuries in
Young Athletes
2
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

3

• Questions still arise concerning the
  appropriateness of youth participation in sports
• Level of training intensity and frequency remains
  a concern

4
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

5

• 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

6

• 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.

7
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 childs stage
  of development
• Youth sports participants should be matched by
  physical maturity, size, weight and skill level

8

• Maturity assessment should be part of the
  physical examination
• Used to protect the physically young athlete
• Commonly used tools
• Tanners 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

9

• 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

10
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

11

• Young athletes should focus on developing
  muscular strength, endurance, cardiovascular
  fitness and flexibility
• Should work with fitness professionals, coaches
  and ATCs (if possible) year-round to maintain
  fitness and nutrition
• Engage in appropriate conditioning program for 6
  weeks prior to beginning daily practice routine

12

• Athletes should engage in appropriate warm-up (w/
  stretching) and cool down with activities
• Practices should be limited to no more than 2
  hours

13

• 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

14
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

15

• 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

16

• 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

17

• 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

18

• 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

19
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

20

• 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

21

• 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

22
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

23
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/immobiliz
  ation

24

• 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

25
Apophysitis

• Apophysis
• Specialized area of cartilage within growth plate
  
• Often point of large tendon insertion
• Repetitive stress results in inflammatory
  response
• Osgood-Schlaters and Severs disease
• Usually begins at ages 8-15
• Pain generally with activity

26

• 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

27
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

28
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

29

• Spondylolisthesis involves vertebrae slippage
• Treatment for both centers on healing of defect
  and treating patients symptoms
• Physicians decision
• Brace vs. no brace
• Flexibility becomes a major factor in rehab
  program

30
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

31

• 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

32

• Work to create a safe and healthy playing
  environment
• Be aware of injury prevention guidelines for
  specific sports