Growing Pains
Are you 14 and limping first thing in your morning? Does your 13-year-old son constantly complain of knee pain? If you answered yes, then you’re in luck, we have answers for you!
Did you know that adolescents are predisposed to different injuries than adults? Did you know that a particular mechanism of injury may result in a different pathological condition in an adolescent athlete compared with a mature athlete? Many biological and physiological factors occur during adolescence that affect bone, cartilage and muscle, all of which play important roles in contributing to injury during adolescence.
Let’s take a look at some of the common adolescent sporting related injuries, the contributing factors leading to development of such injuries, and how physiotherapy can help you Bounce Back to your Best.
The definition of adolescence is a young person aged between 12 and 17 years of age, however there is vast variability in defining this specifically. During this time, developmental growth is rapid and many changes take place physically, physiologically, neurologically and emotionally. The physical processes of growth, combined with the volume and intensity of training and competition can all greatly impact the types of injuries adolescent athletes experience. Playing sport in the adolescent years has numerous health benefits, yet can also involve risk of injury and can also lead to excessive loading of tissue already undergoing stress from developmental growth.
Lack of complex motor skills, coordination and balance, which often occurs in adolescence, along with biological changes taking place at cartilage, bone and soft tissue, together combined with repetitive load and training volume, may all contribute to adolescent injury. As bones grow at a faster rate than soft tissues, this often presents with an imbalance between strength and flexibility, and therefore more tension being placed on growth plates, apophyses, muscle tendon units and joints. This increase in force can place certain structures at risk of injury (Merke, Jayanthi).
“All these events acting singly or together make the immature musculoskeletal system less able to cope with trauma situations and repetitive biomechanical stress”
(Micheli, Gerrard as cited in Costa).
Simply put, sport related injuries can be classed as acute or repetitive/overuse in nature. An acute injury occurs when a particular force, accident, trip, fall or collision results in an injury such as a fracture, ligament sprain or muscle tear. Oftentimes we can’t prevent these as much. An overuse injury, however, progresses slower and worsens with sustained and repeated activity, often as bones and tissues are developing, combined with the load of training and physical activity. These types of injuries can be prevented. So let’s take a look at some common overuse injuries, why they occur and how to manage them if they do
Bone stress injury
Bone stress is defined as signs and symptoms relating to a mechanical breakdown of bone tissue and surrounding membrane in response to repetitive overload. Incidence rates in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21% (Beck). The number one risk factor for developing a bone stress injury is doing too much too fast. In other words, physically doing more than the bones are capable of withstanding. Bones remodel and remineralise in response to load, so to load bones safely it is advisable to gradually and slowly progress in terms of intensity and volume. As you can see in the Capability-Load See Saw diagram, when the actual load being placed on tissues outweighs the actual capability of the tissues, is when there is a high risk of injury.
Bone stress injury is usually diagnosed with an MRI scan to confirm the nature and extent of the stress being placed on the bone. Following the diagnosis, an initial period of rest of anywhere from six to eight weeks is usually prescribed, depending on a range of things such as location of injury and other contributing physiological and nutritional factors. Following this, a nine week return to training plan is advisable when returning from a bone injury. Whilst resting from impact activity, physical, biomechanical and lifestyle related risk factors should be addressed in order to avoid reinjury. This is where guidance from a healthcare practitioner is important. Guidance regarding load management is essential for recovering from, and preventing recurrence of bone stress injury. Your healthcare practitioner will advise on a gradual, consistent and varied return to exercise program which is essential in preventing recurrance. Another essential factor to consider regarding bone health in adolescent years is nutrition. Bones need adequate nourishment and minerals to adapt to physical activity, not only in the short term but also long term. Performing at our best includes looking at physical, physiological, emotional, nutritional and social aspects during adolescence. Below are the factors which are important to consider when addressing adolescent bone stress injuries.
Variation in physical activity is important to help keep bones adaptable and strong. Your healthcare practitioner can guide you on what things you can include in your training program. Some things to consider including in your training:
Lateral movements
Cutting drills
Stair climbing
Swimming
Strength exercises
Most importantly: recovery
Apophysitis Injury
Apophysitis is another common overuse sporting injury presenting in adolescents. It occurs when an increased traction of the tendon attachment takes place at the ossification centre (soft part) of the bone. It commonly presents when the athlete undertakes an increase in sports related activity, particularly jumping and running, combined with rapid physical growth. There are four common sites for this injury to occur. Usually, this injury occurs at soft areas of the bone where strong, force producing muscles attach via tendon.
Common areas for apophysitis
Iliac Crest (front of the pelvis)
There are two major points at the front of the pelvis where this injury can occur. The first is the attachment of the sartorius muscle which is higher, and the second is the attachment of the rectus femoris, or quadricep muscle which is slightly lower on the pelvis. Symptoms are anterior pelvic pain which is worse after running and kicking sports such as soccer and football. Usually it worsens over a period of two to eight weeks.
Ischial Tuberosity (back of the pelvis at the ‘sit’ bone):
The ischial tuberosity of the pelvis is the major attachment of the hamstring muscle complex. These injuries are common amongst soccer players and female gymnasts. Symptoms can include pain with sitting, running up hill, and stretching the hamstring often makes the pain worse.
Knee pain
Anterior knee apophysitis, or Osgood Schlatter disease, is a common cause of anterior knee pain in the skeletally immature athletic population. Onset coincides with adolescent growth spurts between ages 10 to 15 years for males and 8 to 13 years for females. Symptoms include anterior knee pain that is tender to touch, worse when stretching the quadricep muscle, and often is painful after periods of activity.
Common sports seen in association with the condition include:
· Basketball
· Volleyball
· Sprinters
· Gymnastics
· Football
Heel pain
Sever disease, or calcaneal apophysitis, is a common cause of heel pain in the skeletally immature athlete. Sever disease occurs when repetitive strain is placed on the heel bone (calcaneus) by the force of the achilles tendon which is the extension of the calf muscle. The force is increased after periods of rapid growth and increased activity. Symptoms usually include pain at the back of the heel, which is worse after running or jumping.
So what can be done:
To start with, looking at activity load, along with analysing biomechanics and movement patterns are a good place to start when it comes to managing apophysitis injuries. These are extremely common injuries and in many instances athletes can continue training to a certain extent, provided that the injury is managed and volume of training is closely monitored. A strength program is often prescribed to help improve functional deficits found in the assessment, along with empowering patients to manage their injury with adequate recovery and rest periods.
How we can help adolescents with their sporting injuries
At Back to Bounce Sports Physiotherapy, we love to support our younger athletes with their sporting journey and the injuries that may present along the way. We work closely with the athlete and their parent/caregiver, school and sporting teams and other healthcare practitioners to ensure a coordinated and team care rehabilitation plan. If you or your adolescent child has an injury they need help with, wants to prevent injury, or needs guidance about managing load, you contact our clinic for further information or make an appointment to see our team by clicking BOOK NOW below.
Stay tuned for our upcoming blog regarding Netball Injury Prevention and what you can do to help prevent knee and ankle injuries!
References
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