OVERUSE INJURIES IN ADOLESCENTS

IRVING RAPHAEL MD

Syracuse Orthopedic Specialists

Former S.U. Head Team Physician

June 5, 2015

June 5, 2015

OLYMPIC MOTTO

CITIUS

ALTIUS

FORTIUS

OLYMPIC MOTTO

CITIUS - FASTER

ALTIUS - HIGHER

FORTIUS - STRONGER

OUTLINE

• WHY ARE WE CONCERNED??

• SPECIFIC INJURIES

• WHAT DO WE DO ABOUT IT??

Who’s At Risk?

• Soccer• Basketball• Football• Lacrosse• Volleyball• Skiers• Gymnasts• Cheerleaders

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

OSGOOD SCHLATTER

ECTOPIC BONE – TIBIAL TUBERCLE

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

• Medial Tibial Stress Syndrome (MTSS)

• Tibial Periostitis

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

What do we do about overuse injuries in adolescents ??

• Athletes• Coaches• Parents

EMPHASIS

* INJURY REDUCTION *

PROPER EDUCATION

SUPERVISION

TRAINING

PARENTAL GUIDANCE

EARLY RECOGNITION

INTERVENTION / TREATMENT

Questions?

Thank You

RAPHAELMD.COM