Week 8 - young athletes Flashcards
Benefits of exercise for children
Cardiovascular
Metabolic
Immunity
Bone strength
Weight control
Academic Performance
Mental Health
Behaviour
Barriers to PA for children
Reduced physical education time in schools
Reduced focus on learning fundamental movement skills
Competing sedentary attractions
Parental concern regarding safety of outdoor play
Challenges of modern living
Available facilities
Discuss musculoskeletal development
Bones are highly vascularised so recover more quickly than adults
Rapid increase in bone mass during puberty, so high risk of bone tumours during adolescence
Higher type 1 activation - lower muscle fatiguability, lower lactic response, recover significantly faster
Key differences that may pre-dispose to injury
Skeletal fusion incomplete at epiphysis (growth plate)
During/after growth spurts- bones lengthen in advance of soft tissue
Due to relative tissue strength difference children more susceptible to avulsion fractures
Reduced awareness of consequences of actions
Large variations in height and weight at age group competitions
Lack of a certified coach
Training error
Musculoskeletal imbalance
Biomechanics
Footwear
Genetics
Hormonal State
Growth
General
Sport-Specific factors
Discuss MSK injuries in children
Shoulder - clavicle fractures, malunion very rare
Spine - similar to adults (soft tissue/mechanical/spondylolysthesis/scoliosis,
Hip - ?referred, SUFE, perthes, FAI
Knee - osgood schlatters, patellar tendinopathy, meniscal, ACL rupture
Foot - severs, avulsion, lateral ankle injuries (increased risk of avulsion)
Differences in ACL knee injury in children
Differing management in children
Skeletal growth stage assessment
Ethical consideration
Close collaboration with parents
Importance of mental readiness
Consideration to recurrent symptomatic giving way after completing high quality rehabilitation
Careful selection of surgical technique
Soft tissue grafts only
Avoid patellar graft
Physeal-sparing procedures
Prevention implemented early in rehabilitation process
Include sport-specific, falling, partner-specific and play-orientated exercises
Longitudinal study assessing impact of health related outcomes after a youth sports-related knee injury - greater overall and intermediate pain scores, higher BMI, weaker quads and hamstrings, reduced balance
Whats severs disease?
A traction apophysitis
Inflammation of the calcaneal apophysis (growth plate)
Due to repeated traction of Achilles tendon at insertion on calcaneus
Age 7-15y, but can be up to 18y
Boys > girls
2-16% of children aged 8-14y presenting to hospital with musculoskeletal injuries
Onset often at the start of a growth spurt
Associated with high impact sports involving running & jumping
In rare cases can progress to calcaneal avulsion fracture
Apophasis grows more slowly than epiphyseal (growth) plate
The apophysis has more fibrocartilage but less hyaline cartilage than the epiphysis
Vulnerable in adolescence until the plate fuses
Contributory factors:
Immaturity of bone growth plates
Long bone growth in the lower limbs often exceeds that of muscles and tendons
Excessive loading of impact
Repetitive movements in training
Possible muscle imbalance- increased strength of muscles used for running
? Training surface
Diagnosis:
Pain on compression of medial and lateral aspects of heel
Positive squeeze test
Radiography not for diagnosis, but if pain persists despite adequate management and treatment, increases during rest, affects sleep, or is associated with physical changes
Management:
Load management- reduce frequency, intensity & duration of activities
Use of ice or cold packs
Heel raises/cushioning
Orthotics
Taping
Non-steroidal anti-inflammatories
Stretching
Strengthening
Footwear- if possible
Surfaces- if possible
Rehab and RTS ankle injury
Rehabilitation and Return to Sport
Rehabilitation
Acute Phase
Reduce pain, inflammation & swelling (oedema)
Recovery Phase
Restore range of movement
Restore strength- isometric>concentric/eccentric
Restore balance/proprioception/control
Restore normal walking pattern (gait)
Functional Phase
Return to impact
Introduce sport- specific exercises
www.sportsinjuryclinic.net
www.physio-pedia.com
Return to Sport
a) participation
b) performance
c) competition
DO YOU WANT TO LOOK AT CONCUSSION
DO YOU WANT TO LOOK AT CONCUSSION
Other considerations in young athletes
Consent
Injury prevention programmes - showed to be effective in reducing injury rates esp jumping/plyometrics
MSK/caridac screening
S+S - potential to reduce overuse injuries by 50% (Lloyd et al 2013)
Timetabling and load management - performance lifestyle coaches lease with coaches and schools to ensure sufficient time for training alongside eduction
Anti-doping
Social media
Nutrition/hydration/recovery
Psychology - POMS
Early sport specialisaition - no benefit to performance (Klithermes et al 2019), strong benefit over diverse sports participation as early specialisation may lead to reduced motor skill development
Case study:
It is August 2021 and a 15.5 year old Scottish male slopestyle snowboarder has been selected to represent Team GB in all events of the FIS Snowboard World Cup. He has also qualified for the X-Games in Aspen. He has aspirations to work towards the 2026 Winter Olympics and is therefore keen to get excellent results.
He is in 5th year of school with the aim of applying for the highly competitive computer games technology degree at Abertay University. His application will depend on his Highers results in 5th year, prelims and finals. He has dyslexia and normally sits exams with a scribe.
He has had a season off snowboarding following a right ACL reconstruction with hamstring graft, and in July passed his final tests (medical, physiotherapy, performance preparation and coach) to return to snow, however has yet to do so. His physiotherapist is keen to monitor his strength with isometric testing every 3 months.
He has built excellent strength in performance preparation sessions in the gym, but will need to maintain this long term, both to support his graft, and to perform in his sport. At present in the pre-season he to attends the gym in Stirling 3x weekly.
He has type 1 diabetes, monitored with a continuous glucose monitor, and self-administers the right dose of insulin at the same time each day. He keeps his insulin at the right temperature in the fridge. His health is otherwise good though with this background condition he takes every precaution against COVID-19.
His coach is looking into him to returning to training on glaciers with the GB squad. The next trip is late September staying in a small hotel near the Stubai Glacier in Austria. As a minimum to be part of the squad he needs 100 days per year on snow.
Sports Medicine Doctor
Physiotherapist
Performance Preparation Coach
Performance Lifestyle Coach
Divide into 4 groups
Consider your priorities for the athlete over the next year
What do you need to know about slopestyle snowboarding before the meeting?
What do you need to know about his studies?
What do you need to know about his health?
What do you need to know about the locations he will travel to?
What might be important to the coach, athlete and parents?
What evidence or information might be useful for each specialty to bring to the meeting?
Case study It is August 2016 and a talented female 15.5 year old curler is selected to join the GB women’s team. She has previously competed up to European level. If the team win the Scottish Championships in February 2023 they will qualify for the World Championships in Beijing in March 2017. It is also anticipated that they will compete in PyeongChang in February 2018.
She is in 5th year of school and studying her Highers with the aim of applying for Medicine at Edinburgh, Oxford or Cambridge which will potentially depend on her results in both 5th and 6th year.
Early in the summer she was seen in physiotherapy for a patellar tendinopathy in her left (lead) leg. This responded well to a heavy slow resistance training programme led by the performance preparation coach. She continues to attend the gym 3x weekly and is monitored by physiotherapy.
She is a Type I diabetic that is well managed. She is able to check her own blood glucose levels and self-inject insulin at the same times each day.
Sports Medicine Doctor
Physiotherapist
Performance Preparation Coach
Performance Lifestyle Coach
Divide into 4 groups
Consider your priorities for the athlete over the next year
What do you need to know about slopestyle snowboarding before the meeting?
What do you need to know about his studies?
What do you need to know about his health?
What do you need to know about the locations he will travel to?
What might be important to the coach, athlete and parents?
What evidence or information might be useful for each specialty to bring to the meeting?
