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Thursday, June 7, 2012

Some time a go I left you with a promise that I would discuss the 5 most common injuries among young athletes. I am breaking that promise because there is really 4 worth mentioning for this age group. Now before I begin there are a few disclaimers I must mention::
 DO NOT SUBSTITUTE THIS (blog) FOR MEDICAL ADVICE. See a physician:  A REAL ONE!  NOT WEB MD! or Dr. Oz! Preferably one who specializes in sports medicine or an athletic trainer who is qualified to treat, assess and management sport related injuries
  • This article addresses injuries in a unique population: Adolescent athletes
  • Don't rely on ' sports camps' to teach proper training and conditioning. They don't!
  • If your child tells you they 'hurt' especially after hours of practice and playing don't say. "its just growing pains. Man up" Most likely it is a legitimate injury and you are a terrible parent (just kidding)
This is a common site where rookie assessments are made as 'growing pains'! Often hip pain can be referred to the knee. Because these young athletes have not structurally matured, there are injuries to the growth plates that are quite common. Osgood-Shlatters is one of those 'injuries' that can manifest with increased joint stress: especially running and jumping sports. The patella (kneecap) tendon attaches to

 the bone below the knee joint. That bone does not completely harden, so as the the muscle contracts, that force is transferred to this incomplete ossification which can cause pain.

Along with knee pain is the dreaded ACL tear. Now the difference with an adolescent ACL is that when it tears it usually takes a hunk of bone with it! With the increase in kids participating in sports these are becoming more common. This is the one injury where gender plays a big role. Females for example have certain orthopedic predispositions to ACL injuries. One, oddly enough, is too much flexibility at the wrong time. Second is poor hamstring and calf strength. You thought I was going to say quadriceps! Not so. The ability of the female to change direction or decelerate a landing requires a co-contraction(same time)  from the quadriceps and a strong hamstring. Another unique feature is valgus syndrome. Its where the knees 'collapse' inward after landing from a jump. This is bad and should be detrained. Again this is where a trained professional in sports performance should be sought out to fix this early in a young females budding sports pursuits.

Shoulder pain in young athletes is common among overhead sport athletes. The shoulder is inherently unstable, thus making it one of the most vexing of body parts to protect. Nevertheless, the rotator cuff is by far the most popular BUT it is not the primary culprit. When we evaluate a rotator cuff we evaluate mechanics of how the shoulder moves with respect to sport. Often times there are weaknesses that predisposes the RC to injury. In adolescent the offending activity is overuse and poor preseason, and in season conditioning.

Rotator cuff injuries are not as common in this age group as shoulder separation. This is not to be confused with shoulder dislocation. They are NOT the same. Shoulder separation involves the top of the shoulder where the end of the clavicle (collar bone) and scapula (shoulder blade) meet. You can place your index finger directly on top of this joint. Its boney and connected by a series of ligaments. Pain here can be mistaken for rotator cuff pain. Shoulder dislocation is when the humerus bone is displace out of it's socket. This is very painful and causes disability. There is a distinct look to a dislocated shoulder. A normal looking shoulder has a nice 'cap' or mound to it when you look at it from the side, front and back. Image that mound looking 'sunk' in from the side!
Get to a hospital right away if there is not someone on site who can reduce (put back in place) it.

Shin splints is the most annoying of all sport related injuries and the most misunderstood among coaches who actually think it is acceptable to get these pains as part of the sport! And its this mentality that causes unnecessary and preventable injuries such as shin splints. Shin splints is a 'waste basket' term for Anterior tibiaitis. This simply means that the muscle in front of the leg, anterior tibialis is inflamed! It gets inflamed due to it's inability to 'decelerate' foot 'slap'(when the foot lands to the ground after heel strike). This is the easiest to prevent when taught properly. Harder to treat when its full blown during in-season training. The symptoms are innocuous at first during preseason training and this is when it should be treated promptly.

saved the best for last! Who HASN'T had one of the most common rite of passage injuries of all time? The most misunderstood injury in terms of treatment and prevention. There are many degrees of ankle sprains. The most common that puts athletes out for awhile is a grade 2 ankle sprain. This is swelling with some disability and mild to moderate ligament damage. Grade 3 is severe swelling, disability, and possible fracture combined with severe  ligament damage. Its what sportscasters erroneously call a 'high ankle sprain. This is an inappropriate term because the ankle sprains only occur at the ankle and BELOW it!

Now the key is aggressive treatment to prevent what can lead to a functional instability from not addressing stability during the healing phase. I'm still shocked at the conservative approach to ankle sprains since we understand them better and the implications it has in providing stability a far up as the lumbar spine!

 Always ice ankle sprains. Epsom salt in warm water does not work! Ice compression and elevation are key and early calibrated weight bearing and balance training. CAUTION: this should only be done by a trained professional! We have our proprietary technique to reducing ankle sprains as well as treatment protocols. Coaches would do themselves and their athletes justice by coming in and learning how to reduce the risk of this common problem.

"Rule #1 Do no harm to the patient
Rule #2 Be aggressive as you can
Rule #3 See rule #1"
-Gary Gray,PT on my first clinical day and the father of function and world renowned speaker on innovative orthopedic rehabilitation of sport injuries