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Injuries among children and adolescents due to excessive recreational exercise continues to grow dramatically. The presentation overuse syndromes is now affecting younger athletes, as they take part of these activities at younger ages.
Most common causes of injuries in children
The pediatric population is at increased risk for various injuries during sports participation. There are multiple reasons:
• Inadequate techniques while performing specific maneuvers as part of the sports discipline being practiced.
• Lack of physical preconditioning due to the growing demand and frequency of games.
• Ignoring the worst symptom any child could present…PAIN! This complaint is underestimated in children, as both the parents and participant succumb to the pressure brought on many occasions by their coaches and peers. This is by far, the most common mistake I see in my practice.
Why the children?
Unfortunately, today’s children and youth do not engage in as much physical activity on a daily in comparison to their parents or grandparents when they were younger. The activities of daily living are becoming more passive and sedentary. At the time of undergoing a sudden increase exercise, the lack of training is a prelude to the greater frequency of these musculoskeletal injuries.
The bones in children and adolescents are constantly growing. The origin of these bony changes occur in the “growth plates”. These are vulnerable areas, not fully fused to the rest of the bone.
Parents, watch for these three conditions!
Little League elbow
Common elbow injury due to excessive throwing. The injury is a result of repetitive stress to the growth plate at the level of the elbow joint. The increased stress on the medial collateral ligament and its bony attachment at the elbow occurs during the acceleration phase of throwing. Athletes may experience pain and inflammation in the elbow. In advanced stages, this condition can progress to small fractures within the growth plate and early arthritis if left untreated.
Osgood- Schlatter disease
This condition is characterized by pain at the bottom and front of the knee, associated with concomitant inflammation in the area. It is caused by mechanical overload in the growth plate of the tibia (tibial tuberosity). It is one of the most common causes of knee pain in children, especially between 10 and 15. Sometimes, bony displacement or fragmentation occurs in the growth plate as a consequence of the repeated shearing forces by the patellar ligament at this site.
Also known as calcaneal apophysitis, the pain is usually at the bony structure located at the back foot or heel. Typical symptoms include pain at the heel (from performing repetitive and intense physical activity). Sometimes, repeated calf stretching with a strong Achilles tendon can induce too much friction at the heel (where the growth plate is), causing inflammation and hence the pain. This happens especially in children between the ages of 7-15.
Early detection of overuse injuries in children and teenagers is important. Direct parental supervision during these recreational sports activities is crucial to control the amount and intensity of the exercises. If these symptoms occur, the patient should have complete rest while using anti-inflammatory medication after proper evaluation by a musculoskeletal specialist. A physical therapy regimen usually proceeds after resolution after resolution of symptoms in order to prevent recurring episodes during the growth spurt span. Parents and coaches should not rush the young athlete to get back in action, the symptoms should completely resolve before a return to play protocol is initiated.