young athlete

Question 1

importance of youth sports

Answer 1

• Leadership skills
• Self-esteem
• Healthy lifestyle habits (active)
• Reduced depression

Question 2

young athletes

Answer 2

ncludes both children and adolescents
* Girls: Child (11 and under) adolescent (12-18)
* Boys: Child (13 and under) adolescent (14-18)
* Immature skeletal anatomy
* Immature emotional development
* Development (maturation)
* Timing, rate, and magnitude vary
* Not consistent between body systems

Question 3

skeletal differences in young athletes

Answer 3

Bones less dense, more elastic (especially during growth spurt= transient mineral shortage)
Greenstick Fx

Question 4

open physis

Answer 4

weakened area. saltar harris fx

Question 5

apophysis

Answer 5

Insertional point for tendon/ligament
Apophysitis and avulsion common
Secondary growth center: opens ~ 9, closes ~ 22yo

Question 6

fastest growth rate

Answer 6

During a growth spurt, bones can grow faster than the soft tissues can adapt = increased injury risk

Question 7

sampling age and goal

Answer 7

6-12, develop fundmental skills
Running, Jumping, Throwing, Catching
Physical Literacy Across Sports
Rotate Through Sports and Positions
Example: Learn to throw

Question 8

specialization of youth

Answer 8

age 13-15
goal: sport and position specific skill acquisition

Proficiency of Movement
Fine Tune Technique
Example: Learn to Pitch (how to throw a curveball

Question 9

investment of youth developement

Answer 9

Age: 16-18
Goal: Skill Mastery
Proficiency of Movement
Increase Pitch Velocity
Improve Shooting Accuracy
Example: Throw a curveball with accuracy

Question 10

definition of sport specialization

Answer 10

Original Definition (Hill 1987):
“Participation in a single sport to the exclusion of other sports”
Expanded Definition (Hill 1987, Hill 1989, Jayanthi 2013):
Participation in a single sport >8 months per year
High intensity training and competition within that sport
Participation in multiple leagues throughout the year

Question 11

problem with early specialization

Answer 11

$2 Billion in Healthcare expenditures & growing
Increased Injury Risk (Bell 2018)
Burnout (Myer 2015)
Impaired physical/social development (Myer 2015)

Question 12

surgical sport injury cases < 13 yo

Answer 12

2004-2009: 117 ± 32
2010-2014: 212 ± 70

Question 13

impact

Answer 13

70% participate in some type of organized sport
Average age of specialization is 8 yo (<12 = early)
Encouraged to have a primary sport by 2nd grade
The average child today plays fewer than 2 sports
Questions:
Why is early specialization occurring?

Question 14

why? follow the money

Answer 14

Youth sports is now a $15 Billion industry
Year round availability of:
Sport specific lessons/training
Competitive travel teams
Competitive club teams
Showcase tournaments

Question 15

causes of early specialization

Answer 15

Be cautious of interpretation
Some concern for injury risk, pt education is working
Parents Unaware of Recommendations
Coaches Unaware of Recommendations

Question 16

does early specialization lead to sport success

Answer 16

Unrealistic Expectations: 0.5% of HS athletes make it to the Pro level

Question 17

early sspecialization injury risk summary

Answer 17

Limited Evidence Suggests
High Sport Specialization is Associated with Higher Risk of Overuse Injury
81% more likely ~ Double the risk
No evidence to support early specialization in most sports
Multi-sport may even reduce risk

Question 18

injury prevention programs

Answer 18

Education is the best we have right now
Less than 10% studies include under 18
90% of athletes are under 18
Children are not small adults

Question 19

recommendations: AOSSM

Answer 19

Monitor closely if:
participate more hours per week than their age
>16 hours per week of intense training
Single sport athletes should have break periods involving diverse neuromuscular training
Promote multisport participation
Patient education

Question 20

recommendations AMSSM

Answer 20

Prior injury
High-risk injury
Menstral dysfunction
Diversify sports

Question 21

apophysitis

Answer 21

Traction injury to the apophysis in growing individuals
Cartilaginous that ossify during skeletal maturation (injury does not impact longitudinal bone growth)
Overuse
Repetitive explosive movements: running, jumping, throwing

Question 22

apophsitic common locations

Answer 22

Common locations:
Tibial Tubercle: Osgood-Schlatter’s
Inferior Patellar Pole: Sinding-Larsen-Johansson
Calcaneus: Sever’s
Medial Epicondyle: Little league elbow
Little league Shoulder: traction injury to the proximal humeral growth plate

Question 23

apophysitis treatment

Answer 23

Activity to tolerance (modify if needed)
Unless growth plate involved
Muscle length
Muscle strength
Symptom management
Chopat strap
It will go away with rest and as the apophysis matures

Question 24

avulsion fx

Answer 24

Traction injury resulting in fracture
Childrens ligaments/tendons are stronger than their pliable bones
Ligament/tendon tears rare in children, more likely to avulse
Same mechanism as acute tendon ruptures in adults
Sudden pop with pain, localized over bony insertion
+/- laxity

Question 25

avulsion fx common areas

Answer 25

Common areas:
Medial epicondyle (instead of UCL injury)
Tibial spine (instead of ACL injury)
Iliac Crest/ASIS/AIIS/Ish Tuberocity
Tibial tubercle
5th met
Calcaneus

Question 26

avulsion fx treatment

Answer 26

Treatment:
Conservative management usually successful
Rest/immobilization similar to typical fx management
ORIF if:
Conservative management fails (non union)
Displaced too far to heal
If growth center is damaged: deformity
Much more concerning in younger than older

Question 27

conclusion preventio is key

Answer 27

Prevention is key
Injuries to growth plates/growth centers can result in maldevelopment/malalignment with significant long-term consequences
Significant deformity may require multiple surgeries and typically results in early joint degeneration = lots of downstream costs to healthcare system
Poorer results for knee and ankle