Monday, August 7, 2017

Why Injury Prevention is Crucial for Sports Participation in Children and Adolescents

Although I primarily focus on the developmental aspect of pediatric physical therapy, one of the big epidemics in the pediatric health care world right now that I continue to face constantly are youth sports injuries. This blog post is going to focus on youth sports injuries, how it affects kids of different genders and ages, and what we can do to prevent further injuries.

Children participating in competitive athletics have grown over the past few decades, which leads to specialization and competition in early childhood years. This specialization early on, combined with decreased physical ability and preparedness, predispose these children to significant injuries that will affect them physically and mentally. The intensity of youth sports predisposes these children to overuse injuries, such as patellofemoral knee pain, and more severe disabling injuries, such as ACL tears and concussions. Unfortunately, while awareness of these injuries may not be new news, we continue to see kids at a younger age be affected by these injuries, and some sports programs do not have a injury prevention program for their participants.

In a study comparing males versus females ages 5 to 17 in regards to pediatric sports injuries(1), girls tend to experience more overuse injuries compared to traumatic injuries, while the opposite is seen in boys. Girls tend to sustain more lower extremity and spine injuries as compared to their boy counterparts, while the boys tend to sustain more upper extremity injuries. Girls are three times more likely to experience patellofemoral pain than boys, while boys are two times more likely to experience osteochondritis dissecans and fractures as compared to girls. Something interesting to note from this study is that they found that the percentage of girls and boys who suffered an ACL injury was about equal...it's not just a girl's injury after all!
In another study comparing age groups of children 5 to 12 years old versus adolescents 13 to 17 years old(2), children in general tend to experience more traumatic, bony upper extremity injuries, while adolescents suffered more overuse soft tissue injuries to the chest, hip, pelvis and spine. Children seem to be diagnosed more commonly with fractures while adolescents were diagnoses with injuries such as ACL tears, meniscal injuries, and spondylolysis. Out of the children treated for spine injuries, most of them were female and due to overuse.

I'm not saying that we should pull all of our kids out of their sports and activities. I grew up playing almost every sport in the book and I'm so thankful that I did - I would not have had any interest in physical therapy if it hadn't been for my athletic upbringing! Instead, I want to push injury prevention programming. Every sports team, club, camp, and group should have some sort of program that promotes proprioceptive and plyometrics as part of an injury prevention program. But the challenge here is, how can we make it fun, especially for our younger population? Here are some exercises(3) I've disguised as "playtime activities" you can do to prevent injury!

- "Silly Jumps" aka Wall Jumps: Have them jump up and down on the toes with arms overhead, with the focus on soft, symmetrical landing. I'll play some music loudly so they jump up and down as high as they can, then I'll turn it down and show them my "quiet jumps" to the soft music. It's fun because they get to jump up and down super high when the music is loud, and it challenges their dynamic balance and reaction times because they have no idea when I'll turn the music down to switch to "quiet jumps!"

- "Fire Jumps" aka Jump tucks – For this one, they are jumping from a standing position and bringing the knees to chest, with the focus on soft knees and symmetrical landing. I'll have them run in place and when I yell "FIRE!" they will all jump where they are and try to bring their feet up as high as possible so their feet don't catch on fire!

- "Target Jumps" aka Standing Broad Jump – Have them bend their knees to around 90°, takeoff and land with both feet, and land with a 90° bend at knees, with the focus on soft, symmetrical landing and landing with knees bent. If you have multiple kids, you can make this into a contest and see who can jump to the target line (tape on the floor) without falling down. If they fall down, they are out of the game! Start the target line so that it's close so the kids can get comfortable with the motion. If all the kids make it past this line, move the line farther away. Keep doing this until they can't reach it at all.

- "Side Jumps" aka bounding in place – Have them jump off of one leg to the side and landing on the opposite leg, bend knee to 45-90° for takeoff and landing, with the focus on soft landing and landing with knee bent. Place fun targets on the ground for motivation!

- "Ballet Jumps" aka 180°s - This is where they perform a squat, then do a vertical squat jump with 180° rotation in the air, with the focus on soft, symmetrical landing and landing with knees bent. To add a more dynamic component to it, I'll make them wait until I say "JUMP!"and I'll speed up or slow down when I say it.

- "Bunny Hops" aka Double Leg Hops – This is a target jump/standing broad jump but done consecutive times forward, with the focus on soft, symmetrical landing and landing with knees bent. This can also be a race if you have multiple kids! Just make sure they know how to do it properly and with good form before they race :)

- "Side Hops" aka Single Leg Lateral Hop – Have them balance on one leg, then hop from side to side. The focus should be on minimal vertical displacement, soft landing and no collapsing of the knee in towards midline of body. If you see the knee collapsing in, do not perform this activity. This means that their hip musculature are not quite strong enough to handle the dynamic load of the single leg lateral hop. To progress this exercise, increase the distance traveled.

- Single Leg Forward Hop - Same as the Side Hop, but instead they are moving forward. The focus should be on minimal vertical displacement, soft landing and no collapsing of the knee in towards midline of body. If you see the knee collapsing in, do not perform this activity. This means that their hip musculature are not quite strong enough to handle the dynamic load of the single leg forward hop. To progress this exercise, increase the distance traveled.

References:
(1) Stracciolini, A., Casciano, R., Levey Friedman, H., Stein, C. J., Meehan III, W. P., & Micheli, L. J. (2014). Pediatric sports injuries: a comparison of males versus females. The American journal of sports medicine, 42(4), 965-972.
(2) Stracciolini, A., Casciano, R., Levey Friedman, H., Meehan III, W. P., & Micheli, L. J. (2013). Pediatric sports injuries: an age comparison of children versus adolescents. The American journal of sports medicine, 41(8), 1922-1929.
(3) Irmischer, B. S., Harris, C., Pfeiffer, R. P., DeBeliso, M. A., Adams, K. J., & Shea, K. G. (2004). Effects of a knee ligament injury prevention exercise program on impact forces in women. The Journal of Strength & Conditioning Research, 18(4), 703-707.

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