Combating Overuse Injuries

Back injuries and pain in adolescents attending a ski high school

This study compared overuse injuries, small abnormalities, and pain alone in different types of skiing and activity levels. Subjects were 45 ski high school athletes aged 15-19 years. We found the back and knees significantly more prone to activity-related injuries and pain than other body regions. Thirty subjects (67%) had low back pain on the first examination, and 17 had pain caused by overuse of the back. This was more frequent among active, young competitive boys in the cross-country skiing group, with mature height less than 99%, than among noncompetitive boys in the same group or among the alpine skiers. Neck pain was reported only by girls. Eight subjects had low back pain related to small abnormalities. The subjects were given counseling about training and physiotherapy. The 1-year follow-up found a significant reduction in back pain due to overuse injuries (from 17 to 3 subjects) and indistinct neck pain (from 10 to 2) but no reduction in pain in those with small abnormalities in the low back. Low back pain was common in young athletes, particularly in cross-country skiers. Excessively rapid progression of training and faulty technique increased back pain complaints from 36% when entering the school to 67% at the first examination. A proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced the low back pain problems to 29% of subjects 1 year later in spite of a maintained high activity level. A minimum entrance requirement to conditioning seems mandatory for students attending a ski high school.

Musculoskeletal rehabilitation and sports medicine. 4. Miscellaneous sports medicine topics

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses physiatric duties as a team physician, preparticipation physical examinations, ergogenic aids, heat-related illness, pediatric sports injuries, female sports injuries, and sports medicine topics pertinent to geriatric and physically or mentally challenged athletes. New advances covered in this section include use of creatine, guidelines for the preparticipation examination, sudden cardiac athletic death, pediatric and female anterior cruciate ligament injuries, the female athlete triad, spine screening in Down syndrome athletes, and "boosting" in athletes with spinal cord injury.

Pediatric sports injuries: when to refer or x-ray

When any athlete presents for evaluation of an injury, the history and physical examination is of paramount importance in establishing a differential diagnosis. A radiograph is often used to confirm a diagnosis or to reassess an injury following treatment failure. There are certain drawbacks involved with getting a radiograph including cost, inconvenience, radiation exposure, and misinterpretation. Therefore, the radiographic evaluation of the injured athlete should be used only as clinically necessary. The benefits of getting a radiograph, to allow assessment of the severity of the injury, and thereby allow a more appropriate and aggressive treatment and rehabilitation program. The skills of history taking and physical examination presented in this article should make it easier to decide when the child athlete needs a more comprehensive and aggressive evaluation including radiographic studies.

Pediatric and adolescent sports injuries

Scholastic-age sports are generally safe, and major musculoskeletal injuries are uncommon. Injuries are proportional to the athlete's age, size, and type of sport. Significant knee injuries do occur, especially during adolescence, and they require prompt, accurate diagnosis and specific treatment. The team physician plays a major role in injury prevention and management.