Physiotherapy for children, how it’s different from adult, what you can do

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As the population of child and adolescent athletes grows, so does the number of sports-related injuries. Injuries do and will occur in all sports, and this is especially true for children. What is different for children, however, is the type of injuries they sustain.

Children are not just ‘small adults.’ Differences in bone, joint, muscle, tendon and ligament properties can lead to injuries that need to be managed differently.

Overuse and subsequent wear and tear

Typically, boys play more sports than girls. As a result, injury rates are higher in young males than in young females. Sprains and strains are the most common injuries, followed by fractures and dislocations.

While we generally think of sports injuries as resulting from direct trauma (e.g., a hard tackle/fall or landing incorrectly), research suggests that up to 50% of injuries affecting athletic children stem from overuse. More and more children are participating in year-round sports without seasonal breaks, which allow for the necessary rest and repair of the body.

This is even more common in competitive athletes who are pressured by themselves, their peers, overzealous parents or over-competitive coaches. Various studies isolate single-sport specialization as the primary factor leading to increased rates of injuries in pre-adolescent children. Specializing in one sport makes children twice as prone to injury as children who play multiple sports because of the propensity for injury caused by overuse.

The onset of professionalism in almost all sports is partly to blame for the worldwide cultural phenomenon of early specialization. Icons like Tiger Woods, Andre Agassi, Yao Ming, Rory McIlroy, Lionel Messi and the Williams sisters all paint the same picture: child prodigy with stand-out talent goes on to be the youngest/highest paid star in their respective sport.

What we don’t hear about are the countless others who had the same talent at a young age, but were pushed too hard or too fast by parents and coaches eager to reap the rewards of discovering ‘the next big star’ – be it through a loss of interest, injury or burnout.

Injury differences between kids and adults

There is a lack of education and understanding regarding overuse in both young athletes and their parents and coaches. Overuse injuries result from repetitive use of the same muscle groups and repetitive stress to joints and bones, particularly in years of growth.

Children hitting, pitching or kicking 500 balls a day or swimming/running 10 km a day are favoring the development of specific muscle groups over others. While this may not be a problem for adult skeletons and physiology, a growing skeleton will not fare as well and development will be affected by the imbalances caused by overused muscle groups.

It is important to note some of the following differences between child and adult bodies:

• Children’s bones grow more quickly than their muscles and tendons. Therefore, during a ‘growth spurt,’ placing these relatively shorter, less flexible muscles under repetitive stress will commonly lead to injury.
• In children, ligaments are stronger than the bones they attach to, so common mechanisms of injury (e.g., twisting an ankle) will often result in more serious injuries than expected.
• Children have growth plates that are susceptible to fractures and disruption. If these are not managed correctly, growth disturbances may occur due to incorrect healing.
Common injuries:

Lower back: Stress fractures in the lumbar vertebrae are common in cricket, fast bowlers and high jumpers. These manifest as low back pain.

Knee: Osgood Schlatter Disease affects 12- and 13-year-olds. This disease manifests as knee pain and often a bony bump will develop at the top of the shin.

Sinding Larsson Johanssen Syndrome, more common in males aged 11-13 years, manifests as pain at the bottom tip of the patella (kneecap).

Shin: Shin splints can occur inside or outside of the shin, manifesting as a dull/throbbing ache during/after activity.

Ankle/Heel: Sever’s Disease, affecting 11- and 12-year-olds, manifests as pain underneath and around the heel during or after activity.
Shoulder: Little League Shoulder manifests as vague shoulder pain and generally occurs in children who participate in repetitive throwing sports.
Shoulder instability may manifest as pain and discomfort and result in decreased performance and weakness in the shoulder.

Elbow: Little League Elbow describes the various lesions inside the elbow that child athletes between 12-16 years acquire if they participate in throwing sports.

Osteochondritis Dissecans mainly occurs in the elbow and knee, manifesting as vague joint pain and may have associated swelling, catching, limping or decreased throwing ability.

Growth plate fractures occur mainly in the upper and lower limbs and are usually associated with a traumatic incident.

Symptoms that need to be addressed:

• Re-injury of the same body part: Very few people are born with a ”bad” left ankle or ”bad” right knee – these are acquired through poor management after the initial injury.
• Chronic muscle or joint pain/swelling/disability: Any symptom that persists beyond two to three days after injury, or persists without apparent injury, should be addressed.
• Complaints of pain in an active child during a growth spurt.
• Personality changes in a highly active child.
• Decreased performance in a highly active child.
• Pain at night, fever, weight loss.

What can you do?

Many sports injuries are preventable, especially with correct training and warm-up routines. Setting appropriate limits for the amount and type of training children undergo is necessary to prevent overuse injuries and burnout.

If injuries do occur, parents and coaches should be particularly careful in managing the injuries in young athletes. Be aware, look for warning signs, and promptly seek the best medical care to avoid complications from injury that may otherwise decrease a child’s ability to have fun or compete in sports.

Load management is the main intervention for young athletes complaining of injuries. Once the initial injury has been managed with appropriate rehabilitation and exercise, specific emphasis needs to be placed on the child’s injury prevention programme, appropriate strength and conditioning, but above all ensuring training and play loads are manageable for each individual child.

The author is  a consultant for sports and exercise medicine in Sir HN Reliance Foundation Hospital.

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