Overuse Injuries Mary Solomon, D.O. Rainbow Babies and Children s Hospital Cleveland, OH 440-914-7865 1
Goals & Objectives Become Aware of Common Overuse Injuries Back Knee Leg Shoulder Elbow Early treatment & Refer to physician Prevention Guidelines Sports Participation & Conditioning Prehab & Rehab 2
Sports Participation & Injury Overuse Injuries Repetitive stress leads to tissue breakdown Pain that does not go away: growing bones 50% of all athletic injuries Young athletes may not handle increased training volume / intensity as effectively as older athletes 42% increase in overuse injuries in HS athletes who participated year-around vs. 3 or less season athletes Dalton Sports Med, 1992; LeGall AJSM 2006; Cuff Clin Peds 2010; Rose Med Sci Sports Exerc 2008 3
Sports Participation & Injury 7.2 mil HS youth 2007-2008 4.2 mil 3 mil Previous injury risk future injury Survey 450 HS athletes 53% prohibiting injury Varsity > JV LE > UE Days of Restriction: 1-3 31% 4-7 23% 8-14 15% 15-21 7% >21 24% Brooks, et al. Identifying previous sports injury among high school athletes. Clin Pediatr. 2009; 48:548
Sport Injury Risk Factors for the Youth Athlete Extrinsic Risk Factors Intrinsic Risk Factors Nonmodifiable Nonmodifiable Sport played (contact/no contact) Previous injury Level of play (recreational/elite) Age Sex Position played Weather Time of season/time of day Potentially modifiable Rules Playing time Playing surface (type/condition) Equipment (protective/footwear) Joint stability Potentially Modifiable Fitness level Pre-season sport-specific training Flexibility Strength Balance/proprioception Psychological/social factors Emery CA. Risk factors for injury in child and adolescent sport: a systemic review of the literature. Clin J Sport Med. 2003; 13:256-268.
Injury Prevention: Pre-habilitation Early Pre-participation exam Complete rehabilitation of injuries Proper conditioning no sudden increases Safety equipment pads / protective cups Supervision / Guidance / Coaching Appropriate rules, location, etc Proper Matching of Athletes Age, maturation, weight Pearce PZ. Prehabilitation: preparing young athletes for sports. Curr Sport Med Rep. 2006; 5:155-160
Injury Prevention:Pre-habilitation Know ability level at the start of season Follow exercise according to sport s time shifts & substitutions Plan sport specific drills Recognize MORE BETTER
Common Overuse Sports Injuries Back Upper Extremity Shoulder Elbow Lower Extremity Knee Ankle
Initial Treatment Initial treatment Protection: crutches/brace Rest: out of play Ice: 20 minutes every 3-4 hours Compression: ACE bandage Elevation: injured joint above level of heart Refer to sports medicine for further treatment 9
Spondylolysis Overuse injury Motion risk: Repetitive hyperextension Extension w/ rotation Gymnasts: 11-17% 4x greater risk Endurance athletes: runners & soccer players Rotation through low back Stress Fracture Repetitive stress Bone healing << stress Bono CM. J Bone Joint Surg 2004; Stinson JT.Clin Sports Med 1993
Spondylolysis
Spondylolysis Treatment Eliminate Pain Rest Ice &NSAIDS Rehabilitation Strengthen core muscles Flexion exercises extension Hamstring & hip flexor stretching Activity modification Brace RTP avg 8 weeks (4-16 wks rest) >95% return to high-level sports
Core Strengthen: Plank
Core Strengthen: Bridge
Core Strength: Hip Abductor
Stress Fracture Pain in a bone that worsens with activity w/o history of injury Swelling at point of pain Point specific pain with running, jumping, pounding Exam & xrays: low vs high risk Rest, immobilization, casting, surgery Bone strength < performance demand
Return to Running 4-8wk gradual progression of distance & effort 5 10 min warm up & cool down & stretching Alternate run & walk intervals 3 days/wk Off days: low impact & strengthening Ice afterwards Upon completion: 10% rule
Return to Running: Prevention 10% Rule Gradually increase training NO abrupt changes in routine Training Duration: how long Frequency: how often Intensity: how hard
Return to Running: Prevention Screen for cause of Stress Fracture Training error Assess gait mechanics athlete triad Menstrual dysfunction Osteopenia Caloric deficiency Vitamin D & Ca 2+ screen
Shin Splints: Medial Tibial Stress Syndrome Bilateral pain in distal 2/3 of tibia Pain @ start of exercise Improve w/ activity Worse afterwards Running on incline or hard surfaces Sudden change Activity / training Footwear with poor arch support
Shin Splints: Medial Tibial Stress Syndrome Stress reaction of fascia, periosteum, bone at muscle insertion site Treatment: Reduce activity Ice massage NSAIDS Strengthen / flexibility of heel cord & dorsiflexors Orthotics RTP as tolerated
Gastrocnemius & Soleus Stretch
ROM Exercises
Patellofemoral Stress Syndrome Generalized anterior knee pain w flexion Difficult to pinpoint location of knee pain Pain with prolonged sitting, stairs, sports Chronic & recurrent Exam & Xrays Alignment / Weakness Poor patellar tracking Quadriceps & core weakness High or low arches
Patellofemoral Stress Syndrome Treatment: ACTIVE rest / rehab Ice NSAIDS Strengthen VMO, hip flexors & abductors Stretch quads, hamstrings, hip flexors Orthotics Taping Bracing: patellar stabilization brace
Straight Leg Raise & Hip Flexor
Quadricep Stretch
Hamstring Stretch
Hip Flexor Stretch
Osteochondritis Dissecans Repetitive microtrauma fatigue fracture loss of blood supply cartilage separation Elbow or knee pain Insidious dull pain progressive, activity related Chronic, non-specific joint pain + / - swelling Locking/Catching : loose body Loss of motion is a poor sign
Osteochondritis Dissecans
Apophysitis: Pain at a growing bone Growing bones are less resistant to stress in comparison to adult bones Bone ache at muscle attachment site Swelling and bruising may be present Chronic and without specific injury Worse with exercise, better with rest Pain with extension (straightening)
Apophysitis: Pain at a growing bone Occurs all over the body: Knee Knee cap Ankle Elbow If the pain continues to present after rest, refer to sports medicine physician
Osgood-Schlatter Pain below knee or at knee bump Quadrieps muscle attachment Pain with running, jumping, knee extension Rapid growth phase 11 13 12 14 Bilateral 20-30% Avulsion Fracture Surgery
Osgood-Schlatter
Osgood-Schlatter
Sinding-Larsen-Johannson Pain at bottom of knee cap Tight quadriceps muscles Pain with running, jumping, knee extension 10-12 years old Avulsion Fracture Surgery
SLJ Radiographs
Sever s Heel pain Pain with running, pounding Cleated sports 9-12 years old
Sever s
Calf Stretch Calf Raise
Treatment STRETCH Ice NSAIDS Rest Refer to physician Xrays, Exam, PT & Bracing
Little League Shoulder Chronic anterior shoulder pain that limits performance Baseball & Softball Pitch count, throwing Months in sport Position played Swimmers Yards covered, practice time Weeks out of water Dryland routine Volleyball & Tennis
Little League Shoulder
Safe Return to Sport May return to play when the following are obtained: Full Range of Motion Full Strength Normal Stability Maintain exercises Encourage time off from sports to prevent injury Rest 1-2 d / wk Rest weeks during year Rest month(s)?
Summary Sports injury predisposes to future injury Pre-habilitation programs prevent, educate & advocate for growing athlete Gradual progression of sport & return to sport allows for safe participation Core strengthening, cross-training, proprioceptive skills are beneficial Initial treatment for injury: PRICE
Questions? Rainbow Sports Medicine 440-914-7865 Dr. Briskin, Dr. Solomon, Dr. Weiss Kelly Westlake, Medina, Fairlawn Solon, South Euclid, Mentor All ages (4-94!) Concussion, exercise related complaints, musculoskeletal overuse and acute injuries, performance related issues, nutrition, fatigue 47