The Younger Athlete

Growing children and teenagers are at a higher risk of various injuries at certain times in their development as different growth plates become ‘active’. Because many children are extremely active and participate in high intensity activities that include running, jumping, hoping and fast change of direction on a daily basis, the rapidly growing areas, which are more sensitive to the extra strain and stress, become inflamed and irritated.

There is also a large and increasing group of kids that are over weight and if not exercising enough are weak while increasing load through weight gain the growing growth plates are also put under an excessive amount of stress.

Factors that increase the load on these growth plates include:

• Short or tight muscles
• Muscular weakness
• Poor movement skills/coordination that creates excessive twisting along the leg and pulling at the muscle/tendon attachments.
• Large volumes of high intensity exercise
• Weight

In the past these injuries were managed with prolonged periods of rest and inactivity and you still hear this advice being handed out routinely, even by health professionals, but this is unnecessary and even counterproductive as inactivity has consequences:

• Muscular weakness and tightness
• Joint stiffness
• Loss of endurance
• Reduced bone strength
• Loss of movement skills and coordination.

All of which can make the underlying issues worse.

Physical activity, on the other hand, promotes healthy development of a child’s bones, muscles, ligaments, cardiovascular system (heart and lungs) and coordination.

The goal of physiotherapy initially is pain relief and to educate the importance of managing physical activity loads but not terminating all physical activities. Theses conditions are ‘self-limiting’, when they’re sore reduce the less important activities first then if necessary reduce further until the pain is controlled. Once pain decreases to a manageable level, physiotherapy will involve specific range of motion exercises, strengthening, biomechanical analysis and reintroducing activity.

Overall in these conditions, the goal is to maintain or improve participation in physical activity which will optimise the child’s social, physical and emotional development.

Two commonly recognised injuries in younger athletes are Osgood-Schlatter’s Disease where pain develops at the attachment of the tendon in the front of the kneeand Sever’s Disease where pain develops in the back of the heel at the insertion of the Achilles’ tendon. In addition to these common injuries there are several hip Injuries which should always be considered serious until proven otherwise. These hip injuries are Hip Dysplasia, Hip Impingement, Slipped Capital Epiphysis and Perthes Disease.

The word “disease” can produce some anxiety so it is important to understand that OSD and Sever’s are common conditions and can be managed with specific therapeutic exercises and minor modifications in overall physical activity.

Osgood-Schlatter’s Disease (OSD)

Studies have identified that 10% of children who commence physiotherapy for knee pain have OSD (de Lucena et al 2010). OSD is the result of repetitive movements creating tensile force producing inflammation or stress where the patella tendon attaches to the growth plate at the tibial tuberosity. Growth spurts in adolescent’s are normally between the ages of 8-13 for girls and 12-15 for boys. These rapid periods of growth correlate with the onset of OSD. These age groups are also very active in nature. Highly repetitive activities during sport, school, play and social participation can increase the likelihood of developing OSD. Common risk factors alongside repetitive forces include increased tightness of the quadriceps muscles, and the ratio between quadriceps strength to hamstring strength.

Sever’s Disease

Sever’s disease is a common injury to the calcaneus (heel bone) in growing children, and early adolescence. Excessive repetitive forces cause changes to the growth plate at the heel bone near where the Achilles tendon inserts resulting in pain. Symptoms will include verbal complaints of pain at the heel from the child. Limping or changes in gait also indicate the possibility of a child having pain from Sever’s. It is important in these cases to ask the child why they are limping and encourage them to point out their area of pain. The child may complain about pain in either one foot or both feet either during and/or after any physical activity.

The goal of physiotherapy initially is to help with pain relief and educate the importance of managing physical activity loads but not terminating all physical activities. Once pain decreases to a manageable level, physiotherapy will involve specific range of motion exercises, strengthening, load modification, and a biomechanical analysis.

Overall in both conditions, the goal is to maintain or improve participation in which will optimise the child’s social, physical and emotional development.