Post on 22-Dec-2015
transcript
OVERUSE INJURIES IN ADOLESCENTS
IRVING RAPHAEL MD
Syracuse Orthopedic Specialists
Former S.U. Head Team Physician
June 5, 2015
June 5, 2015
YOUTH SPORTS INJURY STATISTICS
• 30 million youth participating in US• HS athletes – 2 million injuries per year• 3.5 mill under age 14 get medical Rx• Age 5-14, account for 40% of sports injuries
treated in hospitals• Overuse - half of sports injuries, mid & HS• By 13, 70% drop out of youth sports• Since 2000 – 5 X increase in serious
shoulder and elbow injuries - throwing
Overuse Injury - Definition
• “Micro-traumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process.”
Stages
• 1. Pain after physical activity
• 2. Pain during activity without restricting performance
• 3. Pain during activity restricting performance
• 4. Chronic unrelenting pain even at rest
RISK FACTORS
• PRESENCE OF GROWTH AREAS• MUSCLE DEVELOPMENT – IMBALANCE• PRESSURE TO COMPETE• IMMATURITY – PHYSICAL AND
EMOTIONAL• PLAYER AGE / SIZE DIFFERENTIAL• YEAR – ROUND PARTICIPATION• MULTIPLE TEAMS
BURNOUT OVERTRAINING SYNDROME
“A series of psychological, physiological and hormonal changes that result in decreased sports performance.” -- chronic muscle or joint pain -- personality changes -- elevated resting heart rate -- chronic poor athletic performance -- fatigue, lack of enthusiasm
COMMON TYPES
• PATELLO – FEMORAL PAIN• JUMPER’S KNEE - OSGOOD SCHLATTER• SOCCER HEEL – CALCANEAL APOPHYSITIS • LITTLE LEAGUER ELBOW • SWIMMER’S SHOULDER• GYMNASTS BACK - SPONDYLOLYSIS• RUNNER’S “SHIN SPLINTS”
OSGOOD SCHLATTER’S
• Painful bump over tibial tubercle• Tender patellar tendon• Aggravated by activity• Sports – running, jumping, twisting• Diagnosis – clinical, radiographic• Worse during growth spurts• Boys more than girls - changing
O.S.G. - TREATMENT
• REST, REST, REST• Immobilization, knee brace• NSAID• Symptomatic – Ice vs. Heat• Self limiting • REST, REST, REST
SEVER’S DISEASECALCANEAL APOPHYSITIS
• Growth area back of heel bone• Pain with activity – running, jumping• P.E. – normal appearance, Squeeze test• Radiographs – normal• Both heels – more than half patients
SEVER’S TREATMENT
• REST, REST, elevate• Medication• Orthotics• Physical Therapy• Icing• Open back shoe• Stretching hamstring & calf muscles
LITTLE LEAGUE ELBOW
• Lateral apophysitis of elbow – avulsion?• Overuse with throwing• Repetitive valgus stress on elbow• Year round single sport• Longer competitive seasons• Training and conditioning errors• Diagnosis – clinical, ?Xray
TREATMENT – L.L. ELBOW
• REST, REST, REST• Icing• Medication• Physical Therapy• Recovery over months• Gradual return to pitching• Throwing – number, distance, velocity
SPONDYLOLYSIS
Female Gymnast Back
Stress fracture of Pars
Interarticularis
Repetitive flexion,
extension, rotation
Pain, Tight Hamstrings
Radiographs, MRI, Scan
Sports at Risk
• Gymnasts• Offensive linemen, football• Weight lifters• Wrestlers• Dancers• Pole Vaulter, High Jumper
Treatment - Spondylolysis
• Restrict Activity - ?Bed Rest• Medication• Brace ?• Surgery rare• Exercise – Abdominal, Hamstring• Pain-free activity – swim, bike
SWIMMER’S SHOULDER
• Overuse, Over-training• Impingement, rotator cuff tendonitis,
biceps tendonitis• Related to stroke• Muscle imbalance• Instability, laxity
Shoulder Treatment
• Rest, “out of the pool”• Medication• Ice, Heat• Physical Therapy• Shoulder muscle girdle strengthening• Scapular Stabilization• Graduated return to swim program
KNEE CAP PAIN
• Patello-femoral pain syndrome• Retro-patellar pain syndrome• Chondromalacia patella• Patellar malalignment Syndrome• Anterior knee pain aggravated by sports,
stairs, walking, jumping, sitting for long periods- “Theater sign”
Treatment – Knee Cap Pain
• R.I.C.E• Exercise – Quadriceps Strength• Physical Therapy• Medication• Bracing, Taping• Orthotics – shoe inserts• Surgery ??
SHIN SPLINTS
• Throb, ache during or after run• “Ramping up” work out• Change in surface, distance, speed• Clinical diagnosis• Excess pronation feet• R/O Stress Fracture, Compartment Syndr• Xray, MRI, Bone Scan, Pressure Measure
Shin Splint - Treatment
• Rest• Ice• NSAID• Physical Therapy• Arch Supports – Orthotics• Slow return to running
EMPHASIS
* INJURY REDUCTION *
PROPER EDUCATION
SUPERVISION
TRAINING
PARENTAL GUIDANCE
EARLY RECOGNITION
INTERVENTION / TREATMENT