Top 'top threes' for managing paedictric and adolescent sports injuries

Dr Eleanor Tillett, Honorary Consultant in Sport & Exercise Medicine at the ISEH and Medical Advisor for the National Ice Skating Association along with Terassa Taylor-Kaveney, Specialist Musculoskeletal Physiotherapist at the ISEH and Team Physiotherapist for the National Ice Skating Association recently ran an ISEH Masterclass on the diagnosis, treatment and management of common sports injuries seen by children and adolescents.

Here they give their top 'top threes' for managing paedicatric and adolescent sports injuries.

Common Injuries:

1. Bone/subchondral: greenstick fractures, avulsion fractures (eg ischial tuberosity – they pull off the bone rather than tear the muscle/ligament), osteochondroses (eg Os Good Schlatters)
2. Traction apophysitis: insertional tendon problems (eg Severs at the Achilles tendon)
3. Soft tissue overload pain due to movement dysfunction: eg patella-femoral pain syndrome

Key Pathophysiology:

1. Physes, apophyses and articular surfaces have low resistance to repetitive loading leading to microtrauma to the cartilage or underlying growth plate
2. Weakness at apophyses which are vulnerable to avulsion
3. Mismatch of growth in bone and musculotendinous structures leading to increased tension through the musculotendinous tissues.

Injury Risk Factors:

1. Previous injury
2. Growth spurt / imbalances in growth, strength and flexibility
3. Sporting; higher training volumes, close scheduling of multiple competitions, early sports specialisation

 Management Principles:

1. PRICER (Protection, Rest, Ice, Compression, Elevation, Rehab)
2. Decision to play on (in competition) or decision on training status
3. Imaging required if unable to weight bear, persistent symptoms or red flags.

 Key Management Considerations:

1. Predisposing factors for injury; biomechanics, flexibility, stability, neural dynamics, fatigue, technique
2. Training capabilities; activity modification, cross-training
3. Other factors; overall activity load, psychological, parental, coaching

 Concussion:

1. Assessment; use Child-SCAT-3 
2. Management

• Must not return to play (RTP) on same day as suspected concussion
• Should not RTP before returned to school, symptom free & medically cleared
• Graduated return to school
• Graduated RTP
• No worsening of symptoms with each stage

       3. See Zurich Consensus Statement for further details Clin J Sport Med 2013;23:89–117

 Strength Training:

1. Effective; correlates with improved physical health status, beneficial to athletic potential and becoming a functionally physically active youth / adult
2. Safe when implemented appropriately
3. Guidance:

• No minimum age but must be capable of following instruction eg 7-8 years
• All sessions supervised by appropriately qualified trainer
• Initial focus on safety & technique
• Consider reducing training load during peak height velocity (female ~ 11 yrs / male ~ 13 yrs)

 Last Thoughts:

The majority of paediatric and adolescent sports injuries are self-limiting and mild but….

• What about if they are an up & coming athlete and there is pressure to perform?
• Our primary role is to protect their long term health
• What about long term health risks if they associate physical activity with pain?

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