Strategies for Pediatric Sports Rehabilitation. Marc Sherry PT, LAT, CSCS, PES

Transcription

1 Strategies for Pediatric Sports Rehabilitation Marc Sherry PT, LAT, CSCS, PES

2 4 Pediatric Rehab Goals 1. Create athlete centered / parent supported treatment and education 2. Understand differential diagnosis for pediatric athletes 3. Rehabilitation program to return athletes to pain-free function and sport 4. Focus on LTAD Minimize chance of re-injury or compensatory problems

3 Our goal is to pitch on the varsity team as a freshman. We have been doing the exercises. The team needs her back as fast as possible They won t have a chance without him 1. Create athlete centered / parent supported treatment and education

4 Advantages of the patient centered / parent supported approach: Empowers the patient Makes the patient feel that they are the primary concern Establishes ownership of the rehabilitation program and guidelines Avoids parent-child conflicts

5 How. Talk to the kids as patients and parents as parents Direct your eye contact to the patient Don t ask parents what/how the athlete is feeling Involve parents in treatment to assist not to supervise If needed ask parents to wait in the waiting room (summary report) Watch out for the over-invested, overprotecting, and over-programming parent

6 2. Understand differential diagnosis for pediatric athletes Knowledge communication (MD & PT) Response to treatment can be an effective diagnostic tool Accurate differential diagnosis will determine your tolerance for continued play

7 3. Rehabilitation Approach and Progression Treat the cause not the symptoms car analogy Dynamic and static posture and alignment Fundamental movements Force reduction before force production Injury mechanisms Develop Athleticism Sport biomechanics

8 Treat the cause not the symptoms 15 yo male bball player with patellar tendonitis modalities and antiinflammatory treatments for the tendon, direct stretching and strengthening of the quad

9 Treat the cause not the symptoms Cause = valgus and anterior knee alignment during squats and landings Tight calf musculature doesn t allow for normal dorsiflexion during triple flexion Lateral hip weakness allows femoral IR RX = proximal hip strengthening, calf stretching, neuromuscular and proprioceptive drills

10 Dynamic and Static Posture Tension vs. Tightness Does the athlete have tight hamstrings or an excessive anterior pelvic tilt? Too often we stretch tension More often we should strengthen antagonists

11 Dynamic and Static Posture lower limb pronation plantar fascitis, achilles tendonitis, medial tibial stress syndrome knee valgus ACL injuries, medial hamstring problems, ITB excessive ant. pelvic tilt spondys, hamstring injuries, hip impingement scapular winging shoulder impingement, TOS, bicep tendonitis

12 Fundamental Movements Squat: single and double leg triple flexion, stable spine ankle-knee-hip

13 Fundamental Movements Lunge forward and lateral

14 Force Reduction Eccentric Control Triple Flexion + alignment Bending while landing vs. Bent landing

15 Force reduction or lack thereof

16 The Seven Elements of Athleticism Strength Core Balance Dynamic Mobility/Flexibility Agility Coordination Speed Power

17 Sports Biomechanics Assess biomechanics to assess for abnormal and compensatory stress

18 4. Focus on LTAD Don t let short term sport success affect long term athletic development Develop objective criteria based on evidence and stick to it. 11 year old strikeout king is often the HS 2 nd baseman The next game will always be the biggest game. Perfect practice makes perfect Healthy kids make healthy adults

19 Kubler-Ross's five stages of Injury 1. Denial - education 2. Anger - focus on the future, not the past, let them know you care 3. Bargaining - have strict criteria, one game make-break theory 4. Depression - try to involve athlete in team activities, screen 5. Acceptance - provide means for success and progressive goals

20 Gambetta Sport Age - Training Sequence

21 Questions Marc Sherry PT, DPT, LAT, CSCS, PES