Pediatric Sports Injuries
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1 Pediatric Sports Injuries Matt Werd, DPM Past President: American Academy Of PodIatric Sports Medicine Fellow: American College Of Sports Medicine Lakeland, Florida
2 Objectives pediatric athlete Intro Recognize Trends Understand Injuries Pearls
3 Overuse Injuries and Burnout in Youth Sports A Position Statement from the American Medical Society for Sports Medicine Clin J Sport Med 2014;24:3 20 John DiFioriMD, Holly BenjaminMD, J BrennerMD, Andrew Gregory MD
4 Pediatric Athlete Overuse Injuries 1. Underreported in the current literature. 2. Preparticipation exams may assess sport readiness. 3. History of prior injury is an established risk factor. 4. Adolescent female athlete triad- predisposing factor. 5. Parents & coaches should be educated to sport readiness.
5 Encourage: Multiple sports Multiple positions Rest breaks Keep it fun! *Skill development Discourage: Win-at-all-costs Position-specific Overtraining! Burnout Abusive parents/coaches
6 Objectives pediatric athlete Intro Recognize Trends Understand Injuries Pearls
7 Youth sports injuries 60% overuse (apophysitis) 40% traumatic (fx, avn, epiph) Immature musc-skel system Emphasis on: proper technique training habits nutrition attitude
8 Youth sports ACSM Recommendations Running: No greater than 30 min. or 5 kilometers prior to age 14 yrs. Ballet: No pointe position prior to ages Limited explosive maneuvers (ie vaulting). Weight training: Limited and supervised.
9 Sport Specialization in Young Athletes Evidence-Based Recommendations Sports Health May; 5(3): N Jayanthi,MD, C Pinkham, L Dugas, PhD et al High volume of repetitive, sport specific movements predispose injury Injury decreases with each additional year of multisport participation Athletes that specialize LATER in their high school careers do not appear to be more likely to become injured during their collegiate careers.
10 Sport Specialization in Young Athletes Evidence-Based Recommendations Some degree of sports specialization is necessary to develop elite-level skill development. However, for most sports, such intense single-sport training should be delayed until late adolescence to optimize success while minimizing injury, psychological stress, and burnout.
11 Prevalence of Sport Specialization in High School Athletics: A 1-Year Observational Study. Bell DR1, Post EG2, Trigsted SM2, Hetzel S3, McGuine TA4, Brooks MA4., Am J Sports Med Jun;44(6): Feb 26. -Highly specialized athletes were more likely to report a history of overuse lower extremity injuries. -Highly specialized single sport athletes who participate >8 mos/year = increased injury risk
12 More data needed on injury risk among young elite athletes Br J Sports Med Jun;44(7): Steffen K1, Engebretsen L. Injuries are one of the major reasons for youth athletes to drop out of sports. Systematic injury surveillance: *monitor injuries *identify high risk sports *ensure new knowledge on injury trends *guide research on risk factors, mechanism, and prevention.
13 Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop Mar;34(2): Milewski MD1, Skaggs DL, Bishop GA, et al 160 student athletes grades 7-12 Sleep deprivation: <8hr/night were 1.7x risk to have had an injury, vs. those 8hrs. Increasing grade in school: athletes were 1.4x risk to have had an injury
14 The association of sport specialization and training volume in youth athletes participating in youth sports tournaments. Post EG, Riekena JW, Trigsted SM, et al. J Athl Train 2016;51(6 Suppl): S145. -Sport specialization + high volumes of sports training = significantly risk of overuse injuries -Highly specialized youth athletes were 1.59x more likely to report injury vs. lessspecialized counterparts -Athletes who played one sport > 8mos./year were 1.85x more likely to report injury
15 Effects of ball sports on future risk of stress fracture in runners Clin J Sport Med May;15(3): Fredericson M, Ngo J, Cobb K. *Runners who participate during childhood and adolescence in ball sports may develop bone with greater and more symmetrically distributed bone mass, and with enhanced protection from future stress fractures.
16 Objectives pediatric athlete Intro Recognize Trends Understand Injuries Pearls
17 Calcaneal Apophysitis Sever s disease # 1 pediatric overuse injury Insidious onset posterior heel pain Males(10-12) > Females(8-10) Soccer cleats, baseball cleats = negative heel
18 Calcaneal Apophysitis Pain posterior/plantar heel Ankle equinus R/O neoplasm, fx, infection Rest, ice, massage, heel lift, achilles stretching Casting, orthoses, analgesics: occasionally
19 Factors associated with pain severity in children with calcaneal apophysitis J Pediatr May 19, 2015 James AM, Williams CM et al. Cheltenham, Australia Sever s disease patient vs. healthy athlete: 1. BMI increased 2. Taller 3. Pronation increased (higher foot posture index)
20 AVN Metatarsal Head Freiberg s infraction
21 Fractures Youth Sports More commonly misdiagnosed due to physis
22 5th metatarsal base apophysitis Islen s Disease Ages yr Females > males Insidious onset lateral foot pain Tight shoes may contribute TTP styloid process Rearfoot varus, metatarsus adductus may contribute R/O fracture Rest, ice massage, shoe modification / padding Casting, analgesics prn
23 Tarsal coalition Insidious onset flatfoot / sinus tarsi / ankle pain Chronic lateral ankle sprains Limited (< 10 degrees) subtalar joint motion Age group correlation
24 Proximal Tibial Apophysitis Osgood Schlatter s disease Males > females; yrs. Insidious onset anterior knee pain (tibial tuberosity) Pain with palpation of tibial tuberosity Deformity / edema may be present Quadriceps, hamstring inflexibility R/O neoplasm Rest, ice massage
25 Neoplasm Night pain More common in children than in adults Pathological fracture
26 Objectives pediatric athlete Intro Recognize Trends Understand Injuries Pearls
27
28 Pediatric Sports Injuries Matt Werd, DPM Past President: American Academy Of PodIatric Sports Medicine Fellow: American College Of Sports Medicine Lakeland, Florida
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RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT *** - Useful in determining mechanism of injury / overuse
HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age of patient Sport / Occupation - Certain conditions are more prevalent in particular age groups (Osgood Schlaters in youth / Degenerative Joint Disease
Human anatomy reference:
Human anatomy reference: Ankle Restriction: Ankle restriction usually occurs due to poor mechanics which may have developed from a trauma or excessive use into compression such as running or being overweight.
The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes
Critically Appraised Topics Journal of Sport Rehabilitation, 2012, 21, 371-377 2012 Human Kinetics, Inc. The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament
ACL Injury Prevention: Considerations for Children and Adolescents
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chapter Age- and Sex- Related Differences and Their Implications for Resistance Exercise
chapter 7 Age- and Sex- Related Differences and Their Implications for Resistance Exercise Chapter Objectives Evaluate evidence regarding the safety and effectiveness of resistance exercise for children.
Challenges in Return to Play. Emily Harold, MD
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TOTAL REHABILITATION
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4. Counsel patients and families regarding athletic participation, including:
Sports Medicine Primary Goals for this Rotation GOAL: Prevention, Counseling and Screening. Understand the pediatrician's role in preventing sports-related injuries, disorders and dysfunction in children
Evaluation of Gait Mechanics Using Computerized Plantar Surface Pressure Analysis and it s Relation to Common Musculoskeletal Problems
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