The Child Athlete Injuries

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The Child Many children are driven to hours of competition which is contrary to their interests. Physical and psychiatric problems result. Many Australian child athletes forgo their formal education for sport which results in a “rudderless” adults post Olympic competition. The age limit for the Olympics is now 16 years. The German Rowing Team at Sydney 2000, emphasized the need to focus on career AND sport( which actually results in better athletic performance). Also children participating in dangerous motor sports can result in serious injury. Introduction Soft Tissue injuries Myositis Ossificans Overuse Injuries Fractures Physeal Fractures Pathological Fractures Stress Fractures Disclocations Hip and Pelvic Injuries Slipped Upper Femoral Epiphysis The Knee Patellar Malalignment Multi-partite Patella Os Good-Schlatter’s Disease Sinding Larsen Johansson Meniscus Anterior Cruciate Ligament Osteochondritis Dissecans Ankle and Foot Problems Tarsal Coalition Accessory Navicular Osteochondroses Freiberg ’s Kohler’s Talus General warning Introduction Sport benefits children. They become fitter (higher VO2 max) and stronger (greater strength). Their participation in competitive and recreational sport is increasing. However injury may occur. It is important to be aware of the nature and cause of injuries, so that the benefits of sport and exercise can be maximized and injuries minimized. Children are not small adults and have their own physiological and developmental parameters (Fig. 1). They are less metabolically efficient than adults, but can significantly improve performance by improved economy of movement and are more prone to heat illness and to disturbances of bone growth from injury. In general, child and youth sport is safe. A study of 1,818 Dutch school children aged 8 to 17 years involved in sport, and followed for a 7 month period showed the incidence of sporting injuries was 22% of which 43% were contusions and 21% sprains. 53% of these injuries did not require any treatment, 15% attended a general practitioner and 16% attended a specialist clinic. 94% did not miss any days school and only 2% required more than 3 days off school. 64% did not require any time off their sporting activities. 22% were away from sport for a week and only 7% were off sport for more than 2 weeks. Other author’s experiences reveal that organised sport is no more or less dangerous than play in other childhood arenas such as the home, school and the road. Age, size and maturity of young athletes is a factor. As size and age increase, the speed and violence of collision and contact is greater, resulting in a greater incidence of injury. One needs to be aware of the enormous variability of growth and maturation of children at a similar point in time. Sports programmes that match children according to age alone, misunderstand this variability. Their injury patterns may differ in type and severity from adults (Fig. 2 and 3). Girls are not anymore or less prone to injury than boys and any sex difference relates to the fact that girls usually choose less violent sports. As one would expect, the incidence of sporting injuries is related to the inherent violence of the sport itself, there being a much high incidence of injury in football compared to tennis or swimming (Figs. 4 and 5). Foul play, recklessness and lack of fitness are all major contributing factors to childhood injuries. These are areas that are amenable to influence by coaches, trainers, parents and teachers. A child’s readiness for sporting competition is decided by their motor skills level, social, sophistication and ability to follow instructions. It is well to remember that sporting ability is not accelerated by early starting. Children do not appear to be at greater risk of head or spinal cord injury (factors of smaller weight, lower speeds or intrinsic properties of the immatur
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  The Child   Many children are driven to hours of competition which is contrary to theirinterests. Physical and psychiatric problems result. Many Australian child athletesforgo their formal education for sport which results in a “rudderless” adults postOlympic competition. The age limit for the Olympics is now 16 years.The German Rowing Team at Sydney 2000, emphasized the need to focus oncareer AND sport( which actually results in better athletic performance).   Also children participating in dangerous motor sports can result in serious injury. ã Introduction   ã Soft Tissue injuries   ã Myositis Ossificans   ã Overuse Injuries   ã Fractures   ã Physeal Fractures   ã Pathological Fractures   ã Stress Fractures   ã Disclocations   ã Hip and Pelvic Injuries   ã Slipped Upper Femoral Epiphysis   ã The Knee   ã Patellar Malalignment   ã Multi-partite Patella   ã Os Good-Schlatter’s Disease   ã Sinding Larsen Johansson   ã Meniscus   ã Anterior Cruciate Ligament   ã Osteochondritis Dissecans   ã Ankle and Foot Problems   ã Tarsal Coalition   ã Accessory Navicular    ã Osteochondroses   ã Freiberg ’s   ã Kohler’s   ã Talus   ã General warning   Introduction   Sport benefits children. They become fitter (higher VO 2 max) and stronger (greaterstrength). Their participation in competitive and recreational sport is increasing. Howeverinjury may occur. It is important to be aware of the nature and cause of injuries, so that thebenefits of sport and exercise can be maximized and injuries minimized.   Children are not small adults and have their own physiological and developmentalparameters (Fig. 1). They are less metabolically efficient than adults, but can significantlyimprove performance by improved economy of movement and are more prone to heatillness and to disturbances of bone growth from injury.   In general, child and youth sport is safe. A study of 1,818 Dutch school children aged 8 to 17 years involved in sport, and followedfor a 7 month period showed the incidence of sporting injuries was 22% of which 43% werecontusions and 21% sprains. 53% of these injuries did not require any treatment, 15%attended a general practitioner and 16% attended a specialist clinic. 94% did not miss anydays school and only 2% required more than 3 days off school. 64% did not require anytime off their sporting activities. 22% were away from sport for a week and only 7% wereoff sport for more than 2 weeks.Other author’s experiences reveal that organised sport is no more or less dangerous thanplay in other childhood arenas such as the home, school and the road. Age, size and maturity of young athletes is a factor. As size and age increase, thespeed and violence of collision and contact is greater, resulting in a greater incidence of injury. One needs to be aware of the enormous variability of growth and maturation of children at a similar point in time. Sports programmes that match children according to agealone, misunderstand this variability. Their injury patterns may differ in type and severityfrom adults (Fig. 2 and 3).Girls are not anymore or less prone to injury than boys and any sex difference relates tothe fact that girls usually choose less violent sports.  As one would expect, the incidence of sporting injuries is related to the inherent violence of the sport itself, there being a much high incidence of injury in football compared to tennis orswimming (Figs. 4 and 5). Foul play, recklessness and lack of fitness are all major contributing factors tochildhood injuries. These are areas that are amenable to influence by coaches, trainers,parents and teachers.A child’s readiness for sporting competition is decided by their motor skills level,social, sophistication and ability to follow instructions. It is well to remember that sportingability is not accelerated by early starting.Children do not appear to be at greater risk of head or spinal cord injury (factors of smallerweight, lower speeds or intrinsic properties of the immature spine) (see Chapter 9). Soft Tissue Injuries Soft tissue injuries involving contusions, sprains, and strains are by far and away the mostcommon form of injury n the skeletally immature and tend to be more common in thelower limbs (Fig. 6). A contusion is an injury to a muscle belly. A sprain is an injury to aligament. A strain is an injury to functional areas, ie bone/muscle, musc/tendon, ortendon/bone interfaces. These latter injuries have also been variously described as overuseinjuries, overload injuries or stress related injuries. Figure 6   Definitions Soft Tissue Injuries   ã Contusion  Injury to muscle belly  ã Sprain  Injury to ligament  ã Strain  Junctional injury  Contusions Soft tissue contusions are probably the most common injury in the paediatric athlete. Theinitial response to an injury is a haematoma associated with inflammation. This is then  followed by muscle regeneration. When a muscle fibre is injured, the peripherally placedsatellite cells, which lie between the basement membrane and the sarcolemma, retain somestem cell potential and are mobilised. These are the myoblasts that fuse to form newmyotubes. The regenerating myotubes are very similar to embryonic myotubes, and thesemyotubes possess the cellular components necessary for formation of contractile protein. Ina child with an intact basement membrane, complete healing can be expected. With themore severe injury or advanced age, less complete forms of repair with formation of increased amounts of connective scar tissue occurs. Treatment of contusions is straightforward. Initially rest, ice, compression and elevationare employed. Isometric quadriceps exercises are commenced as soon as the patient isable. Once quadriceps control has been regained, active range of movement is instituted.Shadow weight bearing is allowed and once the patient has recovered 90 degrees of kneeflexion, progressive resistance exercises can being. Physical modalities such as ultrasound,heat and interferential may be pleasing to the patient but do not influence the rate of recovery.It is important to avoid passive stretching of the muscles in any form, as tearing a healingmuscle unit can produce more connective scar tissue. Such connective scar tissue caninterfere with the muscle’s ability to contract efficiently and move through a normal range of motion. A return to sports is dependent upon the demonstration of full strength and fullrange of motion of the injured limb.Myositis-OssificansMyosisits-ossificans traumatica is an unfortunate sequelae of severe muscle contusion.Myositis-ossificans refers to the phenomenon of new bone formation in muscle followinginjury. The quadriceps and brachialis have long been documented as the favoured sites of this condition. It appears most often in the second and third decades, but a lesion in a 5year old following a motor vehicle accident has been reported.Symptoms include pain, swelling and progressive loss of movement. Heterotrophic bone isvisible radiologically at about 3 weeks or can be detected earlier on bone scan. Thetreatment involves rest followed by active mobilization. Passive mobilization is definitelycontraindicated. NSAIDs can be beneficial by suppressing new bone formation Overuse Injuries Overuse injuries are the result of unresolved submaximal stress in previously normaltissues. With increasing participation of younger athletes in sport, such injuries are nowbecoming more common. Apart from the intrinsic demands that such sport places onchildren, thee are anatomic considerations for such injuries in children (Fig. 7). ã Firstly, growing bone has a looser periosteum and tendinous attachments thanmature bone. This means less force can produce traction overload. ã Secondly , the epiphyses and the apophyses are weak links in the bone-tendon-muscle unit, as they are susceptible to tensile overloads.
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