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Common Injuries in Kids Sport

COVID-19 has had a big impact on the social and physical health of our children. As restrictions are starting to ease, most kids are eagerly awaiting a return to sport. It looks like NSW could be returning to community sport as early as the 25th of October.

This means kids are going from very little physical activity to a big spike in activity. These spikes in activity increase the risk of injury, especially in those kids that are going through a big growth spurt. Beside traumatic injuries, overload and/or a sudden growth spurt are major contributors to adolescent injuries. Overload can occur from continuous exposure to high levels of physical activity with inadequate rest or a sudden increase in the amount of physical activity in a short period of time. The latter is likely to be the issue when kids returning to sport in the coming months.

Today we are discussing the common injuries involved with kids in sport, what symptoms to look at for and a quick guide to managing these injuries.


Apophysis Injuries

An apophysis is a growth plate that provides a point for a muscle to attach. This area of bone is only present in children and closes at the end of puberty. The apophysis is the area between solid areas of bone and where a muscle-tendon attaches to the bone. It is one of the bone’s growth centres.

Apophysitis is is an inflammation of the apophysis, caused by a traction force on the bone and bony attachment of tendons. As a child’s growth spurt occurs, bone growth occurs more rapidly than that of the muscle-tendon. As a result the muscle-tendon gets tighter relative to the length of the bone, and this causes increased traction (pulling) force on the apophysis. This increased pulling irritates the growth plate which then results in inflammation. In adults, the tendon is what takes the brunt of the load. However in children, the apophysis is the weakest link between the muscle-tendon-bone complex, so it is more likely to get injured.

Sever’s Disease

Also known as Calcaneal Apophysitis, Sever’s is a common condition causing heel pain in young active children. It usually affects children between 8-15 years of age. It is caused by an inflammation of the growth plate at the calcaneus (heel bone). The Achilles tendon attaches to the calcaneus. Next to this insertion, the apophysis exists which is where bony growth occurs at the heel.

Symptoms of Sever’s to look out for:

– Pain and tenderness to touch at the base of the heel
– Pain worsens with increased intensity of exercise
– Walking with a limp, which is particularly worse after exercise
– Insidious (gradual) onset of pain. Almost never provoked by a traumatic incident
– Pain resolves with rest

Management of Sever’s Disease

Treatment is dependent on the severity of your child’s symptoms. The symptoms will resolve as your child matures, however there are some things you can do to reduce the symptoms and restore function sooner. Symptoms can resolve anywhere between 2 weeks to 3 months. This can be influenced by whether your child continually provokes their symptoms.

– Load Management – reducing the amount or frequency of the aggravating activities/sport. This may include less intense sessions, shorter sessions, or less frequent sessions so there is more recovery time between activity
– Low intensity calf strengthening exercises. Gradually increase to higher intensity exercises as symptoms allow
– Using orthotics may correct secondary foot alignment
– Stretching or rolling of the calf muscles and the plantar fascia

Osgood-Schlatter’s Syndrome

Osgood-Schlatter’s is a common adolescent injury causing pain at the upper-most part of the tibia (shin). The patellar tendon crosses over the patella (kneecap) and attaches to the tibial tuberosity at the top of the shin. This attachment allows for your quadricep to contract causing your knee to straighten. The repetitive strain of the quad pulling on the growth plate during running and jumping causes an inflammation of the apophysis at the tibial tuberosity.

Symptoms of Osgood-Schlatter’s to look out for:

– Swelling or increased size of the tibial tuberosity
– Pain and tenderness to touch at the tibia tuberosity (as seen in the photo)
– Pain worsens with increased intensity of exercise, particularly running and jumping
– Pain resolves with rest

Management of Osgood-Schlatter’s Syndrome

Treatment is dependent on the severity of your child’s symptoms. Symptoms can resolve anywhere between 2 weeks to 3 months. This can be influenced by whether your child continually provokes their symptoms. Pain management is one of the most important management strategies for Osgood-Schlatter’s:

– Load Management – as above, limit exercise volume, frequency and intensity to what pain allows
– Stretching or rolling out the quadricep, hip flexor, hamstrings and calves
– Low intensity quadricep strengthening exercises. Gradual introduction of higher intensity strengthening exercises as symptoms allow
– Icing the tibial tuberosity for 20 minutes at a time throughout the day
– Non-steroidal anti-inflammatory medications, i.e. ibuprofen and naproxen

Sinding-Larsen-Johansson Syndrome

This is less common then the two injuries above. Sinding-Larsen-Johansson (SLJ) Syndrome is a condition affecting the inferior pole of the patella (kneecap). The patellar tendon attaches to the inferior pole of the patella before it travels down to attach at the tibial tuberosity on the tibia (shin). Repetitive strain of the quadricep causes in inflammation of the inferior pole of the patella. This injury is very similar to Osgood-Schlatter’s, however the site of pain is higher than that of Osgood-Schlatter’s.

Symptoms of Sinding-Larsen-Johansson to look out for:

– Swelling or increased size of the inferior pole (bottom) of the patella
– Pain and tenderness to touch at the inferior pole of the patella
– Pain with running, jumping, climbing stairs and kneeling
– Pain resolves with rest

Management of Sinding-Larsen-Johansson

Treatment is dependent on the severity of your child’s symptoms. Symptoms can resolve anywhere between 2 weeks to 3 months. This can be influenced by whether your child continually provokes their symptoms. Pain management is one of the most important management strategies for SLJ:

Load Management – as above, limit exercise volume, frequency and intensity to what pain allows
– Stretching or rolling the quadricep, hip flexor, hamstrings and calves
– Low intensity quadricep strengthening exercises to maintain strength in lower limb
– Gradual introduction of higher intensity strengthening exercises as the pain settles
– Icing the inferior pole of the patella for 20 minutes at a time throughout the day
– Non-steroidal anti-inflammatory medications and corticosteroid injections if needed

Shin Splints/Tibial Stress Syndrome

Shin pain is the most common musculoskeletal injury in running and running sports. As high as 20% of runners develop shin splints. It is also very common among adolescence. Shin splints affects the anterior (front) and/or medial (inside) portion of the bottom two-thirds of the tibia (shin bone).

Shin splints is caused by overtraining and poor foot/leg mechanics. This can affect three main areas around the shin:

Muscle

Due to overuse/overtraining, the muscles around the shin may become injured due to excessive stress being placed on those muscles. The main culprits are the tibialis anterior and tibialis posterior muscles.

Tenoperiosteum

The outer-most layer of bone is called the periosteum. Tendons attach to this periosteum which is therefore known as the tenoperiosteum. Most cases of shin splints have an element of irritation of the tenoperiosteum.

Bone

If shin pain is ignored and training continues despite increasing pain, eventually the bony structure can be involved. This can lead to a bone stress reaction, and if the excessive loading continues then a stress fracture can develop.

There are two main regions that can be affected:

Anterior Shin Splints

Anterior shin splits or anterior tibial stress syndrome affects the front of the shin bone and is caused by the tibialis anterior muscle. This muscle is responsible for lifting your foot during the swing phase of running and then slowly lowers your foot back down to the ground as it strikes the ground.

Medial Shin Splints

Posterior shin splints or medial tibial stress syndrome affects the posteromedial (inside rear) portion of the shin bone and is caused by the tibialis posterior muscle. The tibialis posterior is involved in controlling the medial arch of your foot when you land, take weight and push-off from the ground with your foot.

Symptoms of shin splints to look out for:

– Dull ache around bottom two-thirds of your shin
– Pain worsens each time your foot strikes the ground when running
– Early stages: pain present at the beginning of activity then settles down
– Later stages: pain can remain during exercise and may last hours to days later
– Very tender to touch on the bottom two-thirds of the inside or front of your shin

Management of shin splints

Again, load management through activity modification is the key to managing shin splints. It is important to reduce provocative activities/sport as shin splints can develop into more complicated issues such as stress fractures, which will delay recovery drastically.

– Reduce or cease provocative activities until pain settles. Usually for 2-6 weeks. Cross-training (eg. exercise bike) is encouraged to maintain fitness
– Graded running retraining program as symptoms settle
– A lower limb strengthening program is critical to correct lower limb control and biomechanics
– Good footwear and/or orthotics to prevent re-injury


Avoiding Injury As Your Kids Return To Sport After A Break

The key to reducing the risk of your children picking up injuries as they get back into sport and exercise over the next few months is to gradually re-introduce your kids back into regular exercise. Starting off with 2-3 days of activity spread out across the week is an easy way to transition kids back into sport.

Even before formal sport training and competition returns, it’s a great idea to go for a run with your kids 2-3 times a week, especially if they haven’t been doing any running during lockdown. Graded exposure to running will allow bones, tendons and muscles to prepare for the demands of sport.

Throwing in a high intensity workout in the week with some leg strength and jumping exercises will help with the higher intensity component of sport as well. If your child has recently had a growth spurt then using a foam roller or stretching to increase muscle flexibility is also helpful.


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