Common Overuse Injuries in the Pediatric and Adolescent Athlete

Pediatric strength training: benefits, concerns, and current trends

PURPOSE OF REVIEW

With the advent of social media combined with several large-scale promotions by nationwide gym chains, pediatric interest in strength training has reached new heights during the past few years. While this is a healthy way for young gym users to build strength and stay active, there are significant risks associated with improper utilization of exercise resources. Lack of adult supervision and guidance in the gym can lead to physical injury, inappropriate use of supplements, and body image issues. The purpose of this review is to provide pediatricians with up-to-date information about well tolerated exercise practices for pubertal and prepubertal youth.

RECENT FINDINGS

Current exercise trends may negatively impact both the physical and mental health of participants. Various physical injuries may occur when adolescents use gym equipment incorrectly under inadequate adult supervision. Use of unproven equipment such as waist trainers may cause bodily injury, and social media content on exercising and weight loss can negatively influence adolescent body image. Potential consequences include low self-esteem and uncommon body dysmorphic disorders, such as muscle dysmorphia. Further, the intense marketing of supplements can induce pediatric gym users to engage in inappropriate consumption behaviors. The increasing accessibility of commercial gyms to youth has increased the potential for children and adolescents to be exposed to such physical and mental health hazards.

SUMMARY

Greater knowledge regarding strength training techniques will help pediatricians guide their patients toward well tolerated and healthy gym habits. Caregivers and medical professionals should recognize the necessity of supervision, as well as the dangers of incorrect equipment use and unsafe trends to mitigate risks and maximize benefits of pediatric gym use.

Running Injuries During Adolescence and Childhood

The popularity of running among young athletes has significantly increased over the past few decades. As the number of children who participate in running increases, so do the potential number of injuries to this group. Proper care of these athletes includes a thorough understanding of the unique physiology of the skeletally immature athlete and common injuries in this age group. Treatment should focus on athlete education, modification of training schedule, and correction of biomechanical deficits contributing to injury. Early identification and correction of these factors will allow a safe return to running sports.

Single-Leg Squat Performance in Active Adolescents Aged 8-17 Years

Agresta, CE, Church, C, Henley, J, Duer, T, and O'Brien, K. Single-leg squat performance in active adolescents aged 8-17 years. J Strength Cond Res 31(5): 1187-1191, 2017-More than 30 million U.S. adolescents participate in sport and exercise. Lower extremity injury from sport participation accounts for up to 89% of injuries each year. The single-leg squat (SLS) is a simple clinical tool that assesses lower extremity mechanics often associated with injury risk. To date, there is limited information regarding SLS performance in healthy children. Such information could be useful when assessing youth athletes to determine if mechanics demonstrated are different than is to be expected and puts them at the risk for injury. Furthermore, maturity status is thought to influence motor performance. Currently, there is no information regarding the influence of maturity status on SLS performance in adolescents. The purpose of our study was to determine SLS performance in relation to age and maturity level in adolescents. Forty-five children aged 8-17 years were videotaped performing a series of 10 squats using a standardized protocol. Standing height, seated height, and leg length measures were collected. Investigators scored the SLS test using specific scoring criteria. Adolescents were categorized into 3 maturity levels using a peak height velocity calculation. Multiple linear regression analyses and analysis of variance were used to analyze the data. Chronological age was a significant predictor of SLS performance with younger children having poorer SLS scores. Coaches and trainers should consider the chronological age of the youth athlete when assessing SLS performance. Furthermore, tailored training programs by age may help to address faulty areas, like single-leg stability, and improve overall functional performance.

Common sports-related musculoskeletal injuries presenting to the emergency department

Young athletes are specialising in sports at a younger age, placing the developing musculoskeletal system under considerable stress. Overuse injuries such as apophysitis are chronic in nature and account for a large proportion of musculoskeletal injuries suffered by young athletes; however, with an increased emphasis on success in sport, tendinopathy and fatigue fractures are now being reported with increasing frequency, in the adolescent population. Correct diagnosis and early protection, rest, ice, compression and elevation therapy is critical, along with supervised rehabilitation an expert in paediatric and adolescent sports medicine. Acute traumatic knee injury and ankle sprain account for most acute injuries. Although most are soft tissue in nature, radiography may be useful in specific situations before early initiation of protection, rest, ice, compression and elevation therapy. These injuries will also require follow-up by an expert in paediatric and adolescent sports medicine to confirm the diagnosis and instigate ongoing rehabilitation and/or orthopaedic referral. Many of these injuries are preventable and due consideration should be given to simple prevention strategies.

Overuse injuries in children

There has been a substantial increase in the number of children participating in organized competitive sports, which has led to a surge in the number of both acute and overuse injuries. To prevent further complications such as limb deformity and disability, radiologists must be familiar with typical overuse injury patterns in children. Traction apophysitis, chronic physeal injury, and stress fractures are the principal overuse injuries. This article reviews overuse injuries in children with an emphasis on the role of magnetic resonance imaging in diagnosis, prognosis, and treatment.

Common overuse injuries in the young athlete

Pediatric overuse injury is a common complaint presenting to pediatricians. Overuse injury can affect the soft tissues or bone, and results from an imbalance between training and load to the tissues and recovery time. In the skeletally immature athlete, physeal and apophyseal tissue is particularly vulnerable to overuse resulting in different patterns of injury compared to adults. Awareness of age-dependent patterns of overuse is necessary for proper recognition, treatment, and prevention of injury. This article reviews the most common pediatric overuse injuries with emphasis on risk factors, diagnosis, and treatment. Guidelines for prevention are included, as this is the key component for successful management of overuse injury in pediatric athletes.

Bilateral triradiate cartilage injury: an overuse syndrome in an adolescent football player

The triradiate cartilage is not a recognized site for an overuse injury. We present here X-ray and MRI findings of a young athlete with chronic right-sided hip pain that proved to be secondary to triradiate cartilage overuse injury. MRI also revealed similar but milder findings on the left side. Distal radial and proximal humeral epiphyses, iliac bone, tibial tubercle, calcaneal and proximal 5th metatarsal apophyses are common sites of overuse injuries in the skeletally immature athletes. Radiological findings may resemble a Salter-Harris type I injury, but an insidious onset of the symptoms, absence of acute trauma, and bilaterality of MRI findings may help differentiate these entities.

Pediatric overuse injuries in sports

Overuse injuries in the pediatric and adolescent population are a growing problem in the United States as more children participate in recreational and organized sports. It is not uncommon for children and adolescents to play on multiple teams simultaneously or to be involved in sports year-round. Without adequate rest, the demands of exercise can exceed the body's ability to repair tissues, leading to repetitive microtrauma and overuse injury. Unlike in adults, the consequences of overuse injury in the pediatric and adolescent athlete are far more serious because the growing bones are vulnerable to stress. The ability to identify individuals who are at risk of overuse injuries is key so that education, prevention, and early diagnosis and treatment can occur. Preventive measures of modifying training factors (ie, magnitude, intensity, and frequency of sports participation) and correcting improper biomechanics (alignment, laxity, inflexibility, and muscle imbalance) should always be part of the management plan.