Paediatric Sport and Exercise Medicine Committee

Question 1

What is the J curve when it comes to exercise and risk of infection?

Answer 1

People who exercise moderately may experience fewer illnesses than those who do not exercise at all. However, athletes training at higher levels may be at a greater risk of infection.

Question 2

How do you decide whether an athlete should return to play during a time of illness?

Answer 2

Use the neck check. If symptoms are confined to above the neck, then athletes should be able to participate as long as they are able to. If there are systemic symptoms, they should not exercise until symptoms have resolved for a period of 7-14 days.

Question 3

What is the single most important complication of infectious mono in the athletic population?

Answer 3

Splenic Rupture

Question 4

When is the period with the highest risk of splenic rupture in a patient with mono?

Answer 4

The first three weeks of illness (day 4 to 21)

Question 5

How long should athletes be excluded from sport participation if they have infectious mono?

Answer 5

Athletes with IM should be excluded from sport participation for a minimum period of three weeks beginning from the onset of symptoms or from the time of diagnosis if the timing of onset is not clear

Question 6

A teenager wants to resume sports after infectious mono. He has waited 3 weeks. What 4 criteria need to be met in order to go back to sport?

Answer 6

1. Resolution of symptoms
2. Normalization of all laboratory markers
3. Resolution of splenomegaly, confirmed ideally on ultrasound
4. Resolution of any and all complications (i.e. fatigue, airway obstruction from enlarged tonsils)

Question 7

How is the etiology of low back pain different in young athletes compared to adults?

Answer 7

Youths tend to have more structural injuries while disc pathology and muscular strain are uncommon

Question 8

What are four risk factors that predispose adolescents to back injuries?

Answer 8

1. Muscle imbalances
2. Inflexibility
3. Structural differences of the spine
4. Improper training

Question 9

What is spondylolysis?

Answer 9

Stress fracture to the pars interarticularis

Question 10

What is the management of spondylolysis (3)?

Answer 10

1. Avoid painful activities (extension)
2. Physiotherapy
3. Some will recommend custom thoracolumbar orthoses or lumbar braces

Question 11

This type of fracture is caused by repetitive spinal flexion and extension. Injuring the ring apophysis results in this type of fracture that may posteriorly displace into the spinal canal, along with the intervertebral disc

Answer 11

Vertebral body apophyseal avulsion fracture

Question 12

What are three indications for surgery for a young athlete with disc herniation?

Answer 12

1. Cauda equina syndrome
2. Progressive neurologic deficit
3. Refractory pain