Pediatric Sports Injuries Flashcards
(115 cards)
1
Q
most common sports that result in injuries in boys
A
soccer, baseball, football, ice hockey, rugby, XC
* Males have greater risk of injury with age
2
Q
sports with most common injury for girls
A
gymnastics
soccer
basketball
volleyball
XC
3
Q
injury patterns for females
A
More LE injuries, spine injuries, patellofemoral knee pain, overuse injuries
4
Q
injury patterns for males
A
more UE injuries, OCD lesions, fractures
5
Q
ACL injuries
A
- equal between females and males
- M>F skeletall immature
- F>M skeletally mature
6
Q
common types of injuries
A
- contusions
- sprains
- fractures
- strains
- knee and ankle most common location of injury in children
7
Q
risk factors:
A
- Intrinsic Risk Factors
- Extrinsic Risk Factors
- Developmental Factors
- Growth Related Factors
- Muscle-Tendon Imbalances
- Anatomic Malalignment
- Associated Disease States
- Improper Foot Wear
- Training Errors
8
Q
Intrinsic risk factors
A
- Previous injury
- Malalignment: LLD, foot hyperpronation
- Female gender: menstrual cycle irregularity
- Physiological issues
- Psychological issues
- Muscle imbalances/ inflexibility
- Instability/Laxity
- Level of Play/Experience
- Age
- Height
- Tanner stage
9
Q
Extrinsic Risk Factors
A
- Training and recovery
- Equipment
- Poor technique
- Environment
- Sport-acquired deficiencies
- Conditioning
10
Q
lack of psychological and developmental maturity….
A
predisposes on to injury, especially with specialization
- risk of overtraining and burnout
11
Q
positive changes in mental and emotional well-being with physical activity
A
- Decreased anxiety, depression
- Increased concentration, attention, memory, academic
achievement - Strong “athletic identity” have increased self-esteem
12
Q
Physiological Risk Factors
A
- Smaller hearts and lower blood volume → lower stroke
volume and higher heart rate - Lower glycolytic capacity → decreased anaerobic
performance - Slowly maturing nervous system and incomplete myelination of nerve fibers –> Balance, agility, coordination, strength, neuromuscular control
13
Q
Growth related risk factors
A
- Cartilage at a growth plate more susceptible to injury
- Growing bones cannot handle as much stress as mature bones
- Increased risk of injury during growth spurt
14
Q
Why is there an increased risk of injury during growth spurt?
A
- Muscle imbalances d/t asymmetrical growth
- Shortened muscles d/t bones grow faster than muscle
- Decreased proprioception and balance
15
Q
Articular Cartilage and Repetitive Loading
A
- Growing articular cartilage has lower resistance to repetitive loading and can lead to microtrauma to cartilage or growth plate
- Tissue damage can lead to asymmetrical growth and/or early onset osteoarthritis
- Repetitive running or jumping can lead to knee OA and/or disruption to growth plate, leading to altered growth
16
Q
Osteochondritis Dissecans Lesions
A
- Caused by repetitive shearing stresses, often at elbow, knee, ankle
- Segment of subchondral bone becomes avascular and causes small segment
to separate with its articular cartilage and from the surrounding bone to become a loose body
17
Q
Examples of OCD Lesions
A
- OCD of the talus (runners)
- OCD of the capitellum (“Little League Elbow”)
- Shear stress has also been implicated in epiphyseal
displacement
18
Q
Apophysis
A
sit of attachment of the tendon to the bone and represents and ossification center of the bone
- eventually will fuse with maturation but susceptible to overuse injuries while growing
19
Q
apophysitis
A
inflammation secondary to microavulsions at the bone-cartilage junction caused by repetitive motion and overuse at times of rapid growth
20
Q
Where are some places that are especially susceptible to overuse stresses
A
- insertion point for musculotendinous unit –> microavulsion fracture
- Osgood-Schlatter disease at knee
- Sever’s disease at heel
- Little League Elbow at med epicondyle
- Pelvic apophysitis and apophyseal avulsion injury at pelvis
21
Q
What is Osgood-Schlatter Disease
A
- Traction apophysitis of tibial tuberosity
- Occurs during growth spurt: girls 12-14 yo, boys 14-16 yo
22
Q
Osgood-Schlatter Disease Symptoms
A
- TTP and swelling over tibial tuberosity, onset of pain with
resisted knee extension, tight HS/quads - X-ray r/o avulsion fx
23
Q
Osgood-Schlatter Disease Treatment
A
rest, pain management, stretching, modalities, knee pad, infrapatellar strap 6-8 wks
24
Q
When do symptoms improve in Osgood-Schlatter Disease
A
- 4-6 weeks
- resolution about 12-18 months ween growth plate closes
25
Osgood-Schlatter Disease MOI
repetitive running, jumping, cutting, squatting (basketball,
football, soccer, volleyball, track, cross country)
26
what is Sever's Disease
* Traction apophysitis at insertion of Achilles tendon on calcaneus
* Boys (10-12 yo) > Girls (8-10 yo)
* Tight Achilles tendons, tendency to in-toe, forefoot varus
27
Symptoms of Sever's Disease
TTP Achilles tendon, mild swelling, limited and painful
DF, (+) squeeze test
28
Sever's Disease Treatment
rest, pain management, cushioned heel lifts, stretching,
strengthening, gradual RTS over 6-8 wks
29
When does Sever's Disease Resolve
with closure of growth plate
30
Sever's Disease MOI
repetitive running, jumping
31
What is Little League Elbow?
- Medial condyle apophysitis
- Overuse injury to medial elbow as a result of repetitive stress, causing separation of physis at medial epicondyle
32
MOI of Little League Elbow
- Baseball pitching/throwing
* Valgus load to medial elbow during acceleration causes traction force to medial elbow; forceful wrist flexion and forearm pronation increase stress to m. attachment distal to physis during throwing; improper mechanics
33
Treatment of Little League Elbow
* rest, pain management, strengthening, stretching, teach
34
How to prevent little league elbow
pitch count
35
what causes pelvic apophysitis
- repetitive overuse of hip flexors (sartorius - ASIS, rectus femoris - AIIS)
- Adolescents with tight hip and thigh muscles
36
Symptoms of pelvic apophysitis
- gradual, dull activity-related pain at front/side of hip;
TTP ASIS or AIIS, pain with resisted HF, pain with passive stretching
HF
* X-rays r/o apophyseal avulsion fx, SCFE, or LCPD
37
Treatment of pelvic apophysitis
rest, pain management, gradual functional rehab, stretching, strengthening, RTS activities once strength and flexibility WFL
38
Epiphysis
- area of growth in long bone
39
what occurs to bone with growth
bone becomes more stiff and less cartilaginous, making it less resistant to impact
40
Ossification center
- points where ossification of the cartilage begins during growth, and there are charts that can be referenced regarding the expected age-range time frames for fusion of growth ossification centers
41
sudden overload of bone can cause...
bowing or buckling
42
epiphysis more susceptible, may shear off causing an avulsion fracture
* Avulsion fx of ACL
* Avulsion fx of ankle ligament * Growth plate fxs
43
longitudinal bone growth
- bone grows in spurts with slower secondary elongation of soft tissue
44
periods of decreased musculotendinous flexibility during growth spurts -->
higher risk for overuse injures
* Girls: 11-13.5 yo, average growth 3.5”/yr at peak
* Boys: 12+ yo, average growth 4”/yr at peak
45
what is the focus in PT during growth spurt?
prevention of overuse injuries
46
What is negatively impacted during a growth spurt?
strength and flexibility
- flexibility decreases leaving tendons taut and at risk for avulsion at the bone
47
what does longitudinal bone growth put a strain on?
muscle
increases risk of micro tears and repetitive strains
48
What can sport specific bulk training cause?
muscular imbalances
increases risk for injury
49
Anatomic malalignment
* Hyperlordosis of the spine
* Femoral anteversion
* Hyperextension of the knee
* Pes Planus
* Hypermobility
* LLD
50
improper footwear can lead to...
LE and foot injuries
51
shoes should...
compensate for changes in alignment
52
ensure adequate footwear fit
* Toe box: ½ inch between longest toe and tip of heel
* Firm heel counter and adequately grips heel, rearfoot control
* Adequate cushioning, sole flexibility
* Shock absorption
* Feet swell so best to try on shoes toward end of day
53
Playing surface
* Improper playing surface can lead to knee pain, shin splints, stress fractures
* Cleat wear on grass associated with 2.4% increased risk for injuries among female youth soccer players
54
training errors
* Sudden increase in total volume or intensity of activity
* Increased rate of progression * Attempt to participate at level above capacity of individual
athlete
* Several seasons of same sport with few rest periods
* Untrained coaches
55
Sports injury
- can be due to a single macro trauma or repetitive micro traumas
- >50% of sports injuries associated with overuse injury --> underreported since many athletes do not seek medical treatment
56
Common sports injuries
- fractures
- joint injuries
- musculotendinous unit injuries
57
what causes stress fractures
- excessive repetitive loading of WB bones or poor training
- cancellous bone fracture in kids vs cortical bone fracture in adults
58
what is optimal for diagnosing stress fractures
- bone scan
- x ray may not show for 6-8 weeks
59
areas that are high risk for stress fractures
pars interarticularis, medial malleolus, femur, lower
1/3 of anterior tibia, 5th MT head
60
risk factors for stress fractures
Sudden increase in volume or intensity of PA, h/o
previous fx, hard running surface, poor footwear, overtraining, female especially if h/o eating disorder or osteoporosis
61
shaft fractures
- more common in older children near adulthood
- also seen with abuse, falls in toddlers, high trauma
62
greenstick fractures
* Specific to pediatrics
* Force applied to one side of a long bone breaks the cortex on the side of impact and
bends the other
* Causes angular deformity
63
Epiphyseal Fractures
- goes through growth plate
- 20% of pediatric fractures
- cartilaginous growth plate less resistant to shear or tensile deforming force than ligament or bony cortex --> growth plate most susceptible
64
What can epiphyseal fractures cause
angular deformity, LLD, joint incongruity, premature closure
65
who is the common population for epiphyseal fractures
- boys in early adolescence
- macrotrauma
- repetitive microtrauma
66
Salter-Harris Classification
- S: straight across physis
- A: above physis
- L: lower than physis
- TE: through everything
- R: Rammed --> crushed
67
What is stronger than growth plate during growth?
ligaments
68
Most common ligamentous strains
- ankle
- knee
69
who has the greatest incidence of ACL sprains
females about 16 yo in soccer
70
factors contributing to ACL sprain
genu recurvatum, navicular
drop, excessive pronation, hormonal status, level of neuromuscular control,
biomechanical differences including landing mechanics and muscle strength
71
Internal Derangement
damage to joint due to trauma
72
avulsion fractures
muscle or tendon detaches from bone; common in ankle, hip, elbow
73
tendonitis
less frequently seen in kids (apophysis more
susceptible); Achilles tendonitis in dancers
74
Enthesis
- pain and inflammation of connective tissue between ligament, tendon, joint capsule and bone; associated with rheumatologist condition and in overuse
75
muscle strains
injury to muscle or tendon similar to adult, due to excessive stretching or overuse
76
Exertion Compartment Syndromes
due to increases in muscle volume during exercise, symptoms include pain and swelling
77
muscle hernia
soft tissue injury in the groin area where abdominals and adductors attach to pubic bone or in the abdomen; caused by tight fascial or musculotendinous structures or weakness in the abdominal muscles
78
sports injury prevention
* Pre-participation Screening
* Trained Coaches
* Supervision
* Training Periodization
* Proper Equipment
* Environmental Control
* Appropriate Nutrition and Hydration
* Multisport Participation
79
Pre-participation screening
- AAP recommends biannual complete evaluation followed by a limited annual re-evaluation
- performed at least 6 weeks prior to start of sport to allow treatment of any ID'd problems
80
What does pre-participation screening include
- medical history and exam, musculoskeletal exam, body composition assessment, physical maturity evaluation, sport specific functional tests, and assessment of readiness including physical, psychologic and mental health
- may include dynamic functional performance assessments tailored to specific demands of sport
81
Pre-participation screening goals
- determine general health
- screen for conditions that might be life-threatening or disabling
- detect conditions that may limit participation or predispose to injury or illness
- assess maturity and fitness level
- educate athlete/family
- identify appropriate sports
- determine clearance for sport
- ID strengths and weaknesses to determine individualized training plan
82
clearance for sport
- unrestricted for any sport
- no collision or contact
- limited contact or impact
- no contact only
83
trained coaches
- need for coaching has increased; shortage of qualified applicants
- awareness of emotional and psychological development
- decreased risk of overuse injury with strengthening, NM control, flexibility, balance, and task specific training
- various education programs offered online
84
supervision
- adequate supervision from coaches, officials, medical professionals
- injuries incurred with weight lifting are typically due to accidents in weight room
85
proper training
- fitness should be year-round endeavor
- incorporate fun, cooperation, team play, learning
- age-appropriate
86
ideal training incorporates...
- strengthening
- flexibility
- NM control
- balance
- CV exercise
- task specific training
87
Proper protective equipment
* Protective: helmets, goggles/eyewear, padding, mouth guards, proper footwear, auricular protection * High quality equipment that is properly fitted, appropriate for sport
* PT and/or ATC may fit or modify equipment
* PTs may fabricate specialized equipment (orthotics, splints, braces)
88
hydration
* Kids require more liquid per body weight
* AAP: water breaks every 5-10 min if >82º
* ACE: 3-8 oz water every 20 min of play in 9-12 yo and 11-16 oz if >12 yo
* ACSM: 13.5-16.9 oz prior to running, water break every
35-45 min in football
* Thirst is not a valid indicator
* Every lb (16 oz) lost should be replaced by 2C (16 oz)
* Monitor content of sports drinks
89
environmental control
* Well-lit and safe environment, free from obstacles, smooth/even,
shock-absorbing surfaces, equipment modifications for injury prevention
* Age-appropriate, scaled appropriately for size
* Accommodate for temperature and humidity, modify exercise if >75º
90
Children have a harder time regulating temperature due to greater surface area: body mass
- acclimatize slower
- greater heat gain on hot days
- greater heat loss on cold days
- produce less sweat and less evaporative heat loss
- at greater risk for heat exhaustion
91
multisport participation
* Multisport participation can be protective against overtraining/burnout and sports injuries
* If adequate rest between daily activities and/or seasons, athletes are likely to participate in sports longer
* May be at risk if fail to get adequate rest between daily activities and/or seasons as in
with poor periodization
* If athlete plays ≥2 sports that emphasize the same body part, at risk for overuse injury
* Important to monitor for signs of overtraining/burnout
92
Sport Specialization
* Reality: 1% of young athletes age 6-17 will achieve elite status in basketball,
soccer, baseball, softball, or football.
* Greater risk of overuse injury/fracture during peak height velocity
93
risks of single sport specialization
* Adverse psychological stress * Premature withdrawal and burnout
* Higher rates of injury >13 yo and athletes competing at higher levels
94
pediatric rehab considerations
* Ultimate LTG to RTS in safe manner with minimal risk of further injury
* Criterion-based vs. time-based
* Age-appropriate modifications
95
PT interventions for sports injuries
* Strengthening
* Aerobic Conditioning
* Modalities
* Splints/orthotics
* Pain management
* Specific Examination Measures
96
Who is safe to do resistance training
- children > 8yo when supervised
97
Strengthening considerations
- development
- emotional maturity
- supervision at all times
- technique
- home program
- concentrate on flexibility during growth spurt
- avoid adult weight machines
98
Why do kids need supervision at all times when strength training
- to decrease risk of accidental injuries
- to get regular feedback on technique
99
strength training technique
* Goal to develop good lifting techniques at early age
* Dynamic warm up
* Appropriate volume/intensity
* Avoid 1RM
* Low weight, high reps/sets
* Non-ballistic movements
* Move through full ROM
* Limit eccentric work
100
strength gains in post pubescent kids
similar gains to adult
101
strength gains if prepubescent
lack androgens for hypertrophy therefor gains are neuromuscular based
102
aerobic training
3-4x/week, 40-60 min, 85-90% HRmax
103
anaerobic training
2x/week
90% HRmax
less than 30 seconds
104
considerations for anaerobic training
- temperature
- impact of body mass ratio
- Kidd less able to use muscle glycogen, less able to produce lactic acid, produce sweat, and acclimatize slower
105
Modalities
* US/Interferential: contraindicated over growing
epiphysis
* Strong precautions with diathermy and TENS
* Ice: 15-minute intervals, do not apply to multiple
areas to avoid widespread vasoconstriction
* Hot pack: with supervision and never lying on it
106
Splints/ Orthotics
- support and protect joint
- ensure proper brace application/wear
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pain medication
- monitor use
- watch for toxicity and abuse
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return to play
* Adequate tissue healing
* Resolution of impairments
* Adequate muscle strength (85-90% sound side)
* Functional/sports-specific
performance within 85-90% sound side
109
Recommendations from AAP
* Age-appropriate, fun games/training
* 1-2 days/week off from organized activity for rest and participation in other activities
* 2-3 month per year break from specific sport to focus on other activities, cross-train
* Modify endurance events (triathlons/races)
* 10% rule for training progression – no more than a 10% progression each
week
* Educate athletes/families on recognizing when appropriate to slow down or change training methods
110
Athletes with disabilities
- lower overall fitness
- same activity needs
- pre-participation screenings the same except more thorough exam for potential medical risks
- identify if prone to additional injury
- classify athlete based on type and severity of disability based on international and national classification systems
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athletes with disability: improved overall health
- decreased physician visits
- hospitalizations
- decubitus ulcers
- medical complications
112
athletes with disability: physiological benefits
- decreased body fat
- increased muscle strength and endurance
113
athletes with disability: psychological benefit
- increased self-concept, self acceptance, perceived physical appearance/self esteem
- lower levels of depression
114
what is the injury rate for athletes with disabilities
same rates as those without disability
115
