overuse injuries in adolescents irving raphael md syracuse orthopedic specialists former s.u. head...
TRANSCRIPT
OVERUSE INJURIES IN ADOLESCENTS
IRVING RAPHAEL MD
Syracuse Orthopedic Specialists
Former S.U. Head Team Physician
June 5, 2015
June 5, 2015
YOUTH SPORTS INJURY STATISTICS
• 30 million youth participating in US• HS athletes – 2 million injuries per year• 3.5 mill under age 14 get medical Rx• Age 5-14, account for 40% of sports injuries
treated in hospitals• Overuse - half of sports injuries, mid & HS• By 13, 70% drop out of youth sports• Since 2000 – 5 X increase in serious
shoulder and elbow injuries - throwing
Overuse Injury - Definition
• “Micro-traumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process.”
Stages
• 1. Pain after physical activity
• 2. Pain during activity without restricting performance
• 3. Pain during activity restricting performance
• 4. Chronic unrelenting pain even at rest
RISK FACTORS
• PRESENCE OF GROWTH AREAS• MUSCLE DEVELOPMENT – IMBALANCE• PRESSURE TO COMPETE• IMMATURITY – PHYSICAL AND
EMOTIONAL• PLAYER AGE / SIZE DIFFERENTIAL• YEAR – ROUND PARTICIPATION• MULTIPLE TEAMS
BURNOUT OVERTRAINING SYNDROME
“A series of psychological, physiological and hormonal changes that result in decreased sports performance.” -- chronic muscle or joint pain -- personality changes -- elevated resting heart rate -- chronic poor athletic performance -- fatigue, lack of enthusiasm
COMMON TYPES
• PATELLO – FEMORAL PAIN• JUMPER’S KNEE - OSGOOD SCHLATTER• SOCCER HEEL – CALCANEAL APOPHYSITIS • LITTLE LEAGUER ELBOW • SWIMMER’S SHOULDER• GYMNASTS BACK - SPONDYLOLYSIS• RUNNER’S “SHIN SPLINTS”
OSGOOD SCHLATTER’S
• Painful bump over tibial tubercle• Tender patellar tendon• Aggravated by activity• Sports – running, jumping, twisting• Diagnosis – clinical, radiographic• Worse during growth spurts• Boys more than girls - changing
O.S.G. - TREATMENT
• REST, REST, REST• Immobilization, knee brace• NSAID• Symptomatic – Ice vs. Heat• Self limiting • REST, REST, REST
SEVER’S DISEASECALCANEAL APOPHYSITIS
• Growth area back of heel bone• Pain with activity – running, jumping• P.E. – normal appearance, Squeeze test• Radiographs – normal• Both heels – more than half patients
SEVER’S TREATMENT
• REST, REST, elevate• Medication• Orthotics• Physical Therapy• Icing• Open back shoe• Stretching hamstring & calf muscles
LITTLE LEAGUE ELBOW
• Lateral apophysitis of elbow – avulsion?• Overuse with throwing• Repetitive valgus stress on elbow• Year round single sport• Longer competitive seasons• Training and conditioning errors• Diagnosis – clinical, ?Xray
TREATMENT – L.L. ELBOW
• REST, REST, REST• Icing• Medication• Physical Therapy• Recovery over months• Gradual return to pitching• Throwing – number, distance, velocity
SPONDYLOLYSIS
Female Gymnast Back
Stress fracture of Pars
Interarticularis
Repetitive flexion,
extension, rotation
Pain, Tight Hamstrings
Radiographs, MRI, Scan
Sports at Risk
• Gymnasts• Offensive linemen, football• Weight lifters• Wrestlers• Dancers• Pole Vaulter, High Jumper
Treatment - Spondylolysis
• Restrict Activity - ?Bed Rest• Medication• Brace ?• Surgery rare• Exercise – Abdominal, Hamstring• Pain-free activity – swim, bike
SWIMMER’S SHOULDER
• Overuse, Over-training• Impingement, rotator cuff tendonitis,
biceps tendonitis• Related to stroke• Muscle imbalance• Instability, laxity
Shoulder Treatment
• Rest, “out of the pool”• Medication• Ice, Heat• Physical Therapy• Shoulder muscle girdle strengthening• Scapular Stabilization• Graduated return to swim program
KNEE CAP PAIN
• Patello-femoral pain syndrome• Retro-patellar pain syndrome• Chondromalacia patella• Patellar malalignment Syndrome• Anterior knee pain aggravated by sports,
stairs, walking, jumping, sitting for long periods- “Theater sign”
Treatment – Knee Cap Pain
• R.I.C.E• Exercise – Quadriceps Strength• Physical Therapy• Medication• Bracing, Taping• Orthotics – shoe inserts• Surgery ??
SHIN SPLINTS
• Throb, ache during or after run• “Ramping up” work out• Change in surface, distance, speed• Clinical diagnosis• Excess pronation feet• R/O Stress Fracture, Compartment Syndr• Xray, MRI, Bone Scan, Pressure Measure
Shin Splint - Treatment
• Rest• Ice• NSAID• Physical Therapy• Arch Supports – Orthotics• Slow return to running
EMPHASIS
* INJURY REDUCTION *
PROPER EDUCATION
SUPERVISION
TRAINING
PARENTAL GUIDANCE
EARLY RECOGNITION
INTERVENTION / TREATMENT