As parents we feel proud when our children take an interest in sport, especially if we enjoy it in our lives and see the benefits it brings. But children and growing teenagers are susceptible to injuries and we must be aware of some of the factors that can cause these injuries, and ways we can help to reduce them amongst this age group.
It is important to realise that children have different sports injuries than adults, this is due to the growing nature of the musculo-skeletal system and, therefore, the way physical loads and stresses affects the growing body. Some injuries can have a long term affect on the maturation of the joints and muscles and, therefore, need to be taken seriously and nipped in the bud. Often these injuries are seen as ‘growing pains’ and kids can have them for a number of months before they see someone. If your child complains of pain during and after sport it is always worth getting it checked.
At Primary School kids can often be participating in many different sports; at school, club and sometimes regional level. When taking a weekly account of their training, they often have a training schedule on par with an elite athlete, and sometimes without the recovery time!
By Secondary school children often specialise and only play one sport with high intensity.
With the combination of high loads of sport and their growing systems, we would always suggest getting a second opinion if your child complains of pain during or after sport.
Studies in the USA have found that the three most common sites of injuries in adolescents under the age of 18 are the ankle, knee and back injuries. These injuries are often related to high levels of sport and early specialising (only playing one sport rather than keeping a balance with other sports).
(which are classified as sudden injuries that can take a child to A&E)
Acute injuries are often related to team and contact sport. Knees and ankles are the most common areas with these types of injuries, and orthopaedic surgeons are operating on many more ACL ligaments than ever before. Girls are 3-5x more likely to sustain a serious knee injury than boys.
If your child plays a contact sport or a team sport you can put some strategies in place that have been shown to significantly reduce the occurrence of these injuries.
Norwegian research (Odd-Egil Olsen and colleagues) shows that a good warm up and some additional training skills that were performed weekly, reduced handball injuries in 15-17 year olds by half. Exercises consisted of improving awareness of the knees and ankles, and they were repeated before each training session.
From 10-18 years as a child develops in their teens they often have balance and co-ordination alterations as well, because muscles becoming tighter as the bones grow faster than the muscles. These factors can make twisting/cutting and jumping manoeuvres more challenging and, therefore, more susceptible to injuries.
These tend to get missed more frequently. I often see young patients, months after they first felt any symptoms, and they have played through the pain until it is too severe. Pain at the beginning can often be mistaken for growing pains.
Growth plates are the areas of developing cartilage situated at the end of a bone. This is where bone growth occurs in children. The growth plates tend to be weaker than the ligaments and tendons. Repetitive load can lead to injury of the growth plate and can therefore potentially disrupt the normal growth of the bone.
Muscle injuries can often lead to a rupture of the site of attachment rather than a tear in the muscles, like a quadriceps avulsion from kicking a ball.
Jumping and high impact sports can lead to overloading of the patello-femoral joint as it is still growing. The 2 most common conditions are Jumper’s knee, or Sinding-Larsen-Johannson disorder, and Osgood Slatter’s Syndrome, one affecting the top of the knee cap and the latter affecting the tibial tuberosity.
Over use injuries are treated with similar concepts:
- Early management involves icing, relative rest from sports
- Physiotherapy treatments e.g. ultrasound to control inflammation and pain.
- Working on flexibility, strength and muscle balance in the knee.
- Looking at the alignment of the feet may well be advised, as flattened arches can often cause the knee to change its alignment. This may involve orthotics or foot supports.
- Once the symptoms have settled then gradual return to sport , with perhaps a modified amount of training, and the symptoms normally settle down with time
Other overuse injuries in adolescents are:
- Severs disease at the Achilles
- Pars Stress fractures at the lower back
- Epiphyseal end plate disruption at the hip
- Patello femoral pain
- Elbow pain
- Shoulder pain
Guidelines for parents:
- Always get a second opinion if your child has been complaining of pain for more than a couple of weeks (obviously sooner if it is more severe), especially after activity.
- Often at the end of a season, or their school year, they will be tired and therefore prone to injury.
- Get your child checked if they train hard but are regularly tired or ill, this could be a sign of over training and tiredness.
- Changes in training schedule, especially increased training, can be linked to injuries.
- Warm up properly.
- Balance work, to build the awareness of the body especially knees and ankles in team sports.
- Try not to specialise too early and keep up a good mix of other sports.
- A conditioning programme to work on strength and flexibility.
Catching things early is key to success and reduction of long term damage to growing joints and muscular tendinous connections.
At JYphysiotherapy we can put all rehab programmes into place and guide you through an injury.
Example of a programme of warm-up exercises
used to prevent injuries by Odd-Egil Olson & Colleagues
(30 seconds and one repetition each)
- Jogging end to end
- Backward running with sidesteps
- Forward running with knee lifts and heel kicks
- Sideways running with crossovers (“carioca”)
- Sideways running with arms lifted (“parade”)
- Forward running with trunk rotations
- Forward running with intermittent stops
- Speed run
(One exercise during each training session; 4 minutes and 5×30 seconds each)
- Planting and cutting movements
- Jump shot landings
(On a balance mat or wobble board, one exercise during each training session; 4 minutes and 2×90 seconds each)
- Passing the ball (two leg stance)
- Squats (one or two leg stance)
- Passing the ball (one leg stance)
- Bouncing the ball with eyes closed
- Pushing each other off balance
(all exercises were demonstrated by a physiotherapist before participation which is recommended in this article)