Overuse Physeal Injuries in Youth Athletes

Stressed or fractured: MRI differentiating indicators of physeal injury

OBJECTIVE

To identify MRI findings that can indicate chronic physeal stress injury and differentiate it from acute Salter-Harris (SH) fracture of the pediatric knee or wrist.

METHODS

IRB-approved retrospective study of consecutively selected knee and wrist MRIs from 32 athletes with chronic physeal stress injury and 30 children with acute SH fracture. MRI characteristics (physeal patency, physeal thickening, physeal signal intensity (SI), continuity of the zone of provisional calcification (ZPC), integrity of the periosteum and/or perichondrium, pattern of periphyseal and soft tissue edema signal, and joint effusion) were compared.

RESULTS

Forty-eight chronic physeal stress injuries (mean age 13.1 years [8.2-17.5 years]) and 35 SH fractures (mean age 13.3 years [5.1-16.0 years]) were included. Any physeal thickening was more common with chronic stress injury (98% vs 77%, p = 0.003). Abnormal physeal SI was more common with SH fractures (91% vs 67%, p = 0.008). ZPC discontinuity strongly suggested chronic stress injury (79% vs 49%, p < 0.004). Periosteal and/or perichondrial elevation or rupture and soft tissue edema characterized most of the acute SH fractures (p < 0.001) and were seen only in 1 chronic stress injury (< 2%). While periphyseal edema was not significantly different in the two groups (p = 0.890), a joint effusion was associated with acute SH fracture (p < 0.001).

CONCLUSION

Chronic physeal stress injury of the pediatric knee and wrist shows higher incidence of ZPC discontinuity and focal physeal thickening compared to SH fracture, reflecting disruption in normal endochondral ossification. However, these findings can overlap in the 2 groups. Periosteal and/or perichondrial injury, soft tissue edema signal, and joint effusion strongly suggest SH fracture and are rarely present with chronic stress injury.

Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review

OBJECTIVES

The aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes.

DESIGN

Retrospective chart review.

METHODS

This retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC).

RESULTS

Non-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34 %). This was closely followed by spondylolysis (28 %). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90 %) and SI-joint related pain (89 %) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50 %). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing.

CONCLUSIONS

An awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.

Lower-Quarter Y-Balance Test Differs by Age: Younger Athletes May Not Be Generalized to High School-Aged Counterparts

Background

Given rising youth sport participation, 8 to 10-year-olds increasingly display comparable lower-extremity injury incidence to 11 to 17-year-olds and require effective return to sport criteria. One such criterion which quantifies dynamic stability is the Y-Balance Test (YBT), though it has not been validated in children under age 11.

Hypothesis/Purpose

The purpose of this study was to examine the performance of 8 to 10-year-old patients on the YBT after lower-extremity injury and determine how these results compare to larger samples of age-grouped athletes within the validated 11 to 17-year-old range. It was hypothesized that 8 to 10-year-olds would display different normalized YBT distances compared to 11 to 17-year-olds.

Study Design

Cross-sectional Study.

Methods

Patients (N=1093) aged 8 to 17 who presented to a pediatric sports medicine practice with a lower-extremity injury and completed the YBT between December 2015-May 2021 were included. Anterior, posteromedial, and posterolateral YBT scores were collected at return-to-sport for affected and unaffected limbs. Scores were normalized to limb length, and composite scores were created. Between-limb differences were calculated in groups of ages 8-10, 11-12, 13-14, and 15-17. Groups were also evaluated for differences by sex.

Results

A rise in performance was observed in unaffected limb anterior reach from ages 8 to 10 years to 11 to 12 years followed by a subsequent significant decrease at older ages (p<0.001). Affected limb anterior reach differed between the youngest group and two oldest groups (p=0.004). Anterior and composite difference were significantly different between the oldest three groups (p=0.014 anterior; p=0.024 composite). No differences were observed between sexes in 8 to 10-year-olds, though 11 to 12-year-old females reached further during all eight distances. In the older three groups, males generally displayed greater between-limb differences.

Conclusion

YBT scores, specifically anterior reach, demonstrated inconsistency by age and sex across a large adolescent cohort. Existing return-to-sport standards should not be used with younger athletes, and individual validation is required.

Level of Evidence

Level III.

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

Trend analysis and prediction of injury incidence in China from 1990 to 2019 based on Bayesian age-period-cohort model

BACKGROUND

Injury is a major challenge to global public health. Analysing the trend of injury incidence in China from 1990 to 2019 and predicting future trends in incidence can provide a theoretical basis for injury prevention and control in China.

METHODS

We collected age-standardised incidence rates of injuries in China from 1990 to 2019 from the Global Burden of Disease 2019 study. We analysed trends using joinpoint regression and age-period-cohort models. A prediction study was conducted using the Bayesian age-period-cohort model.

RESULTS

From 1990 to 2019, there was an increasing trend in transport injuries, a decreasing trend in unintentional injuries and a decreasing trend in self-harm and interpersonal violence. The high-risk age for transport injuries, unintentional injuries and self-harm and interpersonal violence were 20-69 years (relative risk (RR)>1), ≤14 and ≥80 years (RR>1) and 20-24 years (RR=2.311, 95% CI 2.296 to 2.326), respectively. Projections indicate that by 2030, the incidence of transport and unintentional injuries will increase, whereas the incidence of self-harm and interpersonal violence will decrease.

CONCLUSION

The age group with the highest risk of transport injuries, unintentional injuries and self-harm and interpersonal violence were the 20-69 years, ≤ 14 and ≥80 years and 20-24 years age groups, respectively. Transport injuries and unintentional injuries will increase in 2020-2030, while self-harm and interpersonal violence will decrease. These can serve as a basis for developing measures to prevent and manage the impact of injuries.

A narrative review of little league shoulder: proximal humeral physis widening is only one piece of the puzzle, it is time to consider posterior glenoid dysplasia

Baseball athletes across all levels of play are at an increased risk for upper extremity injury due to the supraphysiologic demands on the shoulder and elbow during overhead throwing. Little league baseball players present with a unique subset of injuries that can affect the growth plate, commonly at the shoulder or the elbow. Ascertaining a diagnosis and plan of care for little league shoulder (LLS) historically focuses on the proximal humeral physis in skeletally immature throwing athletes presenting with shoulder pain. However, while not a current standard of care, posterior glenoid dysplasia is often present in youth baseball athletes presenting with LLS, warranting a shift in the way clinicians evaluate for and treat the youth baseball athlete's pathologic shoulder. Therefore, purpose of this narrative review is 2-fold: first, to describe the current standard of care as it relates to a diagnosis of LLS, and second, to critically describe a comprehensive evaluation process for youth throwing athletes with shoulder pain that includes screening for evidence of posterior glenoid dysplasia. This paper summarizes the current state of the available evidence for anatomic considerations of LLS in the baseball athletes throwing shoulder. Additionally, we provide a framework for clinical evaluation using a multidisciplinary approach to evaluate the entire kinetic chain of the youth baseball athlete presenting with LLS and posterior glenoid dysplasia. A case study is presented to describe common presentations, clinical and objective examinations, and a plan of care from time of evaluation to return to throwing.

Construction of PARI public health education programs for Chinese undergraduates: a Delphi study

Objectives

The objective of this study is to develop a consensus among experts on a comprehensive and scientifically sound physical activity-related injuries (PARI) public health education program specifically tailored for undergraduates.

Methods

This study designed three rounds of expert consultation by using a Delphi method. A panel of 30 experts from the fields of public health education, sports medicine, anesthesia pain, emergency medicine, and emergency nursing participated in the study.

Results

This study successfully established a consensus among experts on the goals, content, teaching methods, and time allocation for the PARI Public Health Education Program for undergraduates. The program encompasses 10 objectives divided into 2 main categories: professional knowledge and skill goals. In terms of content, it includes 5 primary indicators, 22 secondary indicators, and 56 detailed tertiary indicators. Six teaching methods were identified as suitable. Additionally, a typical 60-min educational session was segmented into eight parts, with a proposed time arrangement for each, ensuring comprehensive coverage of all topics.

Conclusion

The consensus achieved in this study on the PARI Public Health Education Program for undergraduates lays a crucial foundation for the advancement of health literacy and proactive health management within this demographic. We presented a comprehensive framework for PARI public health education, integrating diverse learning methods and content areas. This systematic approach not only enriched the resources available for undergraduate health education, especially of PARI but also had the potential to significantly impact the implementation and effectiveness of health promotion strategies.

Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity

Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.

Evidence-based rehabilitation medicine: definition, foundation, practice and development

To determine the definition, foundation, practice, and development of evidence-based rehabilitation medicine (EBRM) and point out the development direction for EBRM. Retrieve the database of PubMed, Cochrane Library, Embase, China national knowledge infrastructure (CNKI), Wanfang, and China science and technology journal database (CSTJ). The search was conducted from the establishment of the database to June 2023. The key words are "rehabilitation medicine and evidence based" in Chinese and English. After reading the abstract or full text of the literature, a summary analysis is conducted to determine the definition, foundation, practice, and development of EBRM. A total of 127 articles were included. The development of 14 sub majors in EBRM are not balanced, evidence-based musculoskeletal rehabilitation medicine (EBMRM) (31 articles, mainly focuses on osteoarthritis, osteoporosis and musculoskeletal pain), evidence-based neurorehabilitation medicine (EBNM) (34 articles, mainly concentrated in stroke, traumatic brain injury and spinal cord injury) and evidence-based education rehabilitation medicine (EBEDRM) (17 articles, mainly focuses on educational methodology), evidence-based nursing rehabilitation medicine (EBNRM) (2 articles), evidence-based engineering rehabilitation medicine (EBENRM) (7 articles), evidence-based traditional Chinese rehabilitation medicine (EBTCRM) (3 articles), evidence-based internal rehabilitation medicine (EBIRM) (11 articles), evidence-based intensive care rehabilitation medicine (EBICRM) (4 articles), evidence-based oncology rehabilitation medicine (EBORM) (6 articles), evidence-based physical therapy medicine (EBPTM) (3 articles), evidence-based cardiopulmonary rehabilitation medicine (EBCRM) (6 articles), evidence-based speech therapy medicine (EBSTM)/evidence-based occupation therapy medicine (EBOTM)/evidence-based geriatric rehabilitation medicine (EBGRM) (1 article). The EBMRM, EBNM and EBEDRM are relatively well developed. The development of EBNRM, EBENRM, EBTCRM, EBIRM, EBICRM, EBGRM, EBORM, EBCRM, EBPTM, EBSTM and EBOTM is relatively slow, indicating these eleven fields should be pay more attention in future.

S.P.O.R.R.T.-A Comprehensive Approach to the Assessment and Non-Operative Management of Overuse Knee Conditions in Youth Athletes

PURPOSE OF REVIEW

The evaluation of a young athlete with an overuse injury to the knee involves a comprehensive approach. There are a number of elements to consider including assessments of skeletal maturity (biologic maturation), workload (training load + competition load), sport specialization status, and biomechanics. The type of injury and treatment, as well as future prognosis, may be influenced by these and other factors.

RECENT FINDINGS

Calculating the percentage of predicted adult height (PPAH) is a valuable tool in assessing overuse injury patterns and diagnoses in youth athletes. Modifiable and non-modifiable overuse injury risk factors require monitoring from clinicians as young athletes mature and develop over time. Training and rehabilitation programs should be adapted to account for these. In this manuscript, we seek to introduce a novel, comprehensive approach: S.P.O.R.R.T. (Skeletal Maturity, Prior Injury Risk, One Sport Specialization, Rehabilitation, Return to Play, Training Recommendations) (Fig. 1). Overuse, non-traumatic injuries to the knee in youth athletes will be presented in a case-based and evidence-based model to provide a framework for a comprehensive approach to the assessment and treatment of youth athletes with overuse injuries.

Training volume recommendations and psychosocial outcomes in adolescent athletes

OBJECTIVES

Researchers have recommended that youth athletes limit their practice volume to the number of hours/week that they are old in years. We examined sport perceptions, burnout, anxiety, and depressive symptoms among youth athletes who did and did not report playing more hours/week of organized sports than their age.

METHODS

Uninjured athletes aged 13-18 years old completed questionnaires documenting demographics, sport participation volume, health and injury history, depressive symptoms, anxiety, burnout, and sport perceptions during a pre-participation physical examination. We grouped participants as those who reported more hours/week in organized sports than their age (exceeds age/volume recommendation) vs. those who reported equal/less hours/week in organized sports than their age (meets age/volume recommendation).

RESULTS

Of 161 participants, 21% (n = 33) were in the 'exceeds age/volume recommendation' group (age = 15.2 ± 1.3 years; 55% female; 18.7 ± 4.0 hours/week) and 79% (n = 128) were in the 'meets age/volume recommendation' group (age = 15.6 ± 1.2 years; 50% female; 10.2 ± 3.4 hours/week). A higher proportion of the 'exceeds age/volume recommendation' group agreed with the statement 'youth in my sport play too many games before college' than the 'meets age/volume recommendation' group (33% vs. 16%; p = 0.03). After adjusting for the effect of age, sport specialization level, and weight, exceeding age/volume recommendations was associated with the perception that youth in sports play too many games before college (aOR = 3.24; 95% CI = 1.26, 8.29; p = 0.01), while burnout (aOR = 0.99; 95% CI = 0.94, 1.06; p = 0.93), anxiety (aOR = 0.97; 95% CI = 0.84, 1.11; p = 0.65), and depressive symptoms (aOR = 0.90; 95% CI = 0.74, 1.10; p = 0.30) were not significantly related.

CONCLUSION

Athletes who spend more hours in sport than their age appear to perceive their competition load during youth sports to be excessive. Coaches and providers should monitor athlete's training hours and perceptions of competition load to offer support and potentially prevent burnout development.

Growth-related sports injuries among young male professional football players in the Netherlands: a prospective cohort study concerning injury incidence, severity and burden

OBJECTIVES

To investigate the incidence, type and location of growth-related sports injuries (GRSI) in youth professional football in the Netherlands. Secondary, to gain more knowledge on the injury severity and burden of GRSI.

METHODS

In this prospective, longitudinal cohort study, 813 players aged 10-18 are included. Data collection is performed by instructing the medical staff of six professional football club academies to register GRSI by means of standardized forms. Training and match exposure are registered individually on a weekly basis. Injury incidence was calculated as number of GRSI per 1000 hours, injury severity as the median number of days lost in categories and injury burden as the number of days lost per 1000 hours.

RESULTS

A total of 62 GRSI were documented in the football season 2021-2022. The total incidence of GRSI was 0.62/1000 hours football exposure. Morbus Osgood Schlatter and Morbus Sever were most common types of GRSI, both with incidence rates of 0.22/1000 hours exposure. About 58.3% of the documented GRSI were classified as major (>28 days lost). Within this group, the mean severity was 55 days time-loss to football.

CONCLUSIONS

GRSI are relatively common in youth professional football. The most common types are Morbus Sever and Morbus Osgood Schlatter. Morbus Osgood Schlatter has the highest injury severity and burden compared to other types of GRSI.

Focused extracorporeal shockwave therapy for youth sports-related apophyseal injuries: case series

BACKGROUND

Apophyseal overuse injuries are self-limited with skeletal maturity; however, they may be a source of significant pain and time lost from training. There is a lack of consensus for its management with the current available treatment, which might lag behind the ongoing development of regenerative medicine. The current retrospective case study aimed to assess the potential effectiveness and short-term safety of extracorporeal shockwave therapy (ESWT) in apophyseal injuries.

METHODS

Data from 22 growing athletes [15 patients with Osgood-Schlatter disease and seven patients with Sever's disease] who received ESWT at a sports medicine unit in a university hospital were reviewed. All patients received low energy (= 0.1 mJ/mm2) level-focused ESWT using electrohydraulic generation technology. The clinical focusing technique was used upon applying ESWT.

RESULTS

The number of sessions received to achieve full recovery ranged from 1 to 3 sessions. The time from treatment initiation to previous activity level was 2 weeks in 14 patients (63.3%), 4 weeks in seven patients (31.8%) and 11 weeks in one patient (4.5%). No adverse events were reported. No recurrence occurred up to 3 months after the last session.

CONCLUSION

ESWT is a potentially safe and effective treatment for apophyseal injuries. It may facilitate an early return to sport activities.

Bone Health in Young Athletes: a Narrative Review of the Recent Literature

PURPOSE OF REVIEW

The aim of this review is to discuss the most recent published scientific evidence regarding bone health in the pediatric athlete.

RECENT FINDINGS

Pediatric athletes commonly suffer from overuse injuries to the physes and apophyses, as well as bone stress injuries, for which magnetic resonance imaging grading of the severity of injuries may be useful in guiding return to sport. Adolescent athletes, particularly those who train indoors and during the winter season, are at risk for vitamin D deficiency, which has important implications for bone mineral density. However, the relationship between vitamin D status and traumatic fracture risk is still unclear. While the female athlete triad is a well-established condition, the current work has led to the recognition of parallel pathophysiology in male athletes, referred to as the male athlete triad. Recent evidence suggests that transdermal 17β-estradiol treatment in amenorrhoeic female athletes is an effective adjunctive treatment to improve bone mineral density in treatment of the female athlete triad. Young athletes are at risk for musculoskeletal injuries unique to the growing skeleton. Optimizing nutritional intake, particularly related to adequate vitamin D intake and prevention of the athlete triad, is critical to optimize bone health in the young athlete.

Comparison of pediatric performance athlete injuries presenting to emergency departments

OBJECTIVE

Pediatric injuries in performance sports represent a significant healthcare burden and account for over 50,000 annual Emergency Department (ED) visits in the United States. The objective of this study was to characterize and compare pediatric injury presentation across the most common performance sports.

METHODS

The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed for pediatric injuries (3-18 years) related to gymnastics, dance, or cheerleading from 2015-2019. Cases were categorized as children (˂11 years) or adolescent (≥11 years). Injuries were categorized as orthopedic (fractures, dislocations, sprain, strains), non-orthopedic (contusion, internal injury, laceration), concussion, or other/unknown. Case narratives were used to categorize mechanism of injury as contact or non-contact. Appropriate sample NEISS weights estimation was applied for statistical analysis and Confidence Intervals (CI).

RESULTS

A total of 393,110 injuries were observed over the five-year study period, with a mean of 78,622 annual injuries. Gymnastics, dance, and cheerleading accounted for 136,422 injuries, 96,416 injuries, and 160,272 injuries, respectively. Most cases were adolescent (71%; 95% CI: 68-74%) and occurred in a sports-related setting (65%, 95% CI: 57-72%). Gymnastics had the highest proportion of injuries among children (50%) as compared to dancers (25%) or cheerleaders (12%) (p < 0.01). Non-contact injuries most affected the lower extremity (43-68%) and resulted in an orthopedic diagnosis (63-71%), and contact injuries had a higher proportion of injuries affecting the head, neck, and face (29-51%) and non-orthopedic diagnoses (29-38%). Gymnastics had the most upper extremity non-contact injuries (42%) and dance the most lower extremity non-contact injuries (68%) (p < 0.01). Cheerleading had the highest incidence of overall concussions (8%), contact injuries (47%), and concussions due to contact injury (15%).

CONCLUSION

Pediatric gymnasts, cheerleaders, and dancers have important similarities and differences in injury pattern which may lead to the development of sport-specific injury prevention programs for pediatric performance athletes.

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11-14), group 2 (age 15-17), and group 3 (age 18-21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle-trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall-Salvati index, modified Insall-Salvati index, Caton-Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal-Salvati (p = 0.001) index, and Caton-Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton-Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.

Medial Proximal Tibia Physeal Overuse Injury of an Athlete

Overuse injuries are well described for both upper and lower extremities among skeletally immature athletes. To our knowledge, there is no description in the literature of an overuse injury affecting the medial tibial physis that is different from the typical Osgood-Schlatter disease or tibial tubercle apophysitis. In this article we present a 13-year-old athlete with medial proximal tibial widening or epiphysiolysis from overuse playing soccer. We need to be aware that with increased early sports specialization we may see injuries we have not seen before. [Orthopedics. 2022;46(6):e345-e347.].

The Magnetic Resonance Imaging Pattern of the Lesions Caused by Knee Overuse in the Pediatric Population

Background and Objectives: Excessive use of the knee in patients with immature locomotor systems leads to a whole spectrum of morphological changes with possible consequences in adulthood. This study aimed to examine the morphological pattern in magnetic resonance imaging (MRI) that is associated with recurrent pain due to increased physical activity in children. Materials and Methods: This was a retrospective study conducted among pediatric patients treated at the University Children’s Hospital in Belgrade in 2018 and 2019. MRI findings of patients who reported recurrent pain in the knee joint during physical activity and who were without any pathological findings on both clinical examination and knee radiographs were included in the study. Results: MRI findings of 168 patients (73 boys and 95 girls, mean age 14.07 ± 3.34 years) were assessed. Meniscus and cartilage lesions were the most commonly detected morphological findings: meniscus lesions in 49.4%, cartilage ruptures in 44.6%, and cartilage edema in 26.2% of patients. The medial meniscus was more often injured in girls (p = 0.030), while boys were more prone to other joint injuries (p = 0.016), re-injury of the same joint (p = 0.036), bone bruises (p < 0.001), and ligament injuries (p = 0.001). In children older than 15 years, tibial plateau cartilage edema (p = 0.016), chondromalacia patellae (p = 0.005), and retropatellar effusion (p = 0.011) were detected more frequently compared to younger children. Conclusions: Children reporting recurrent knee pain due to increased physical activity, without any detected pathological findings on clinical examination and knee radiography, may have morphological changes that can be detected on MRI. Timely diagnosis of joint lesions should play a significant role in preventing permanent joint dysfunction in the pediatric population as well as in preventing the development of musculoskeletal diseases in adulthood.

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries

BACKGROUND

Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention.

OBJECTIVE

To determine the prevalence of running-related injuries and describe factors related to a history of injury.

DESIGN

Retrospective cross-sectional study.

SETTING

Survey distributed online to middle school runners.

METHODS

Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation.

MAIN OUTCOME MEASUREMENTS

Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age.

PARTICIPANTS

Youth runners (total: 2113, average age,  13.2 years; boys: n = 1255, girls: n = 858).

RESULTS

Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001).

CONCLUSIONS

Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

Sports Training Strategy and Interactive Control Method Based on Digital Twins and Wireless Sensor Networks

By combining virtual reality, the digital twin system has been deeply applied in many places. Especially with the upsurge of national sports and more attention to sports, people have also begun a more in-depth study on the strategy of sports training. This paper aims to explore the application of the Brazilian jujitsu training strategy and interactive control method in the new era. Based on the sports skills of Brazilian jujitsu, combined with digital twin technology and wireless sensor network technology, this paper develops a sports training system based on Brazilian jujitsu. It can collect the action information of the trainer and twin it into the simulation system so as to carry out better and more effective confrontation training. The experimental results show that the average delay time is 5.2 ms and the maximum delay time is 6.5 ms, which is less than the limit delay time of 20 ms. Compared with the control group, it achieved quite good results. It shows the effectiveness of the system designed in this paper for trick jujitsu training.

Clinical Measures of Adolescent Softball Players With and Without Upper-Extremity Pain: A Preliminary Study

CONTEXT

Upper-extremity (UE) pain is a concern among softball adolescent athletes. However, research on preseason screening of demographic characteristics and clinical measures among those with and without UE pain among adolescent softball athletes is underreported. This study sought to present functional outcomes and clinical measures of shoulder and hip complex flexibility, range of motion (ROM), and strength in adolescent softball athletes with and without UE pain.

DESIGN

Cross-sectional study.

METHODS

Sixty-seven athletes were assessed at the start of the spring season. The Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire was administered to determine UE function. UE measurements included shoulder ROM, flexibility, and strength; lower-extremity measurements included hip ROM and strength. These variables were reported for players with and without UE pain as mean and SD. Independent samples t tests were performed to analyze differences between the groups.

RESULTS

Thirteen (19.4%) athletes reported UE pain during preseason screening. Mean Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire score among athletes with UE pain was 58.0 (17.6) compared with 97.1 (6.9) for athletes reporting no UE pain (P < .001). Athletes with UE pain presented with significantly less dominant side external rotation ROM (UE pain: 106.5 [10.4], no UE pain: 114.6 [11.3]) and total ROM (UE pain: 163.7 [14.5], no UE Pain: 174.8 [14.3]).

CONCLUSION

These findings inform clinicians on function and preseason clinical measures in adolescent softball athletes who present with or without UE pain. Athletes with UE pain demonstrated lower outcome scores indicating likely impact on overall UE function. These athletes also appeared to demonstrate UE ROM differences compared with athletes without UE pain. Further research is needed to investigate larger sample sizes and positional differences at baseline and throughout the season to determine if clinical measures used in the current study are risk factors for pain and injury.

Risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents: a prospective cohort study of 3 years

Background

Patellar and patellar tendon pain is a common limitation to children’s participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants’ physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents.

Methods

A three-year prospective cohort study was conducted with healthy students who were aged 8–14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS.

Results

We included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01–1.05) and protraction (OR 1.03, 95% CI 1.00–1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73–0.90; sex, OR 1.69, 95% CI, 1.09–2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain.

Conclusions

This study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05349-y.

Internet Survey Evaluation of Demographic Risk Factors for Injury in Canine Agility Athletes

Objective

The purpose of this study was to compare previously identified demographic risk factors for injury in agility dogs, and explore other potential associations with demographic risk factors in new populations, and across different levels of injury severity.

Procedures

An internet-based survey of agility handlers was conducted. The primary outcome was if the dog had ever had an injury that kept from agility for over a week. Demographic information about the dog and handler were recorded. Logistic regression was used to quantify associations between variables of interest with injury history and all models were adjusted for age. Analyses were stratified by geographic location. Final model building was done via backward selection.

Results

The sample included 2,962 dogs from North America and 1,235 dogs from elsewhere. In the North American sample, 8 variables were associated with injury history; dog breed, height and weight, handler age, gender, agility experience, competing at the national level, age dog was acquired, and taking radiographs to assess growth plate closure. In the non-North American sample, 4 variables were associated with injury history; breed, handler age, occupation (dog trainer or not), and handler medical training. In both samples, Border Collies showed a marked increase in injury risk (ORs 1.89 and 2.34) and handler age >65 was associated with lower risk (ORs 0.62 and 0.77). Consistent with previous studies, greater handler experience was associated with reduced risk in the North American sample, but the other sample did not show this pattern, even in unadjusted models. Dog spay/neuter status was not associated with injury risk in either sample.

Conclusions and Clinical Relevance

Dogs with radiographs assessing growth plate closure may have increased injury risk as this population of owners may plan to train their dog harder, and at an earlier age. This finding also poses the question of whether or not growth plate closure is a good indicator of safety for increasing training intensity. Knowledge of what risk factors exist for injury in agility dogs is imperative in determining direction for future prospective studies, as well as creating recommendations to help prevent injury in this population of dogs.

Specialization and Injury Risk in Different Youth Sports: A Bio-Emotional Social Approach

Aims

Sport specialization is an actual trend in youth athletes, but it can increase injury risk. The aim was to determine the eventual correlation between sports specialization and injury risk in various sports, using a biopsychosocial approach.

Methods

169 sport-specialized athletes completed [(38 female, 131 male); overall (11.2 ± 2.7 years), (56.28 ± 15.72 kg), (161.3 ± 15.52 cm)] a self-reported questionnaire regarding sociodemographic (age, gender, educational level), physical-attitudinal, injuries and psychological-attitudinal To analyze data univariate and correlate analyses were used.

Results

Of 169 athletes enrolled, 53% were single-sport specialized (reported participation in one sport and trained > 8 months/year). In team sports (100%, OR = 0.75; p = 0.022) a high risk of having to remain at rest for up to 1 month because of overuse was observed. Males who suffered direct trauma (70%; OR = 1.03; p = 0.006) in the team group (95%, OR = 0.09; p = 0.008) were more exposed to that type of injury, and also the type of specialization figured significantly (p = 0.047). In addition, interoceptive awareness correlates with injury (95%, 1.04, p = 0.01). This study shows that, even though young athletes seem to be at a high risk of becoming injured, early team sport specialization and a high performance level cannot be considered to be the only risk factors.

Normalized Isometric Shoulder Strength as a Predictor of Ball Velocity in Youth Baseball Players

BACKGROUND

Despite increased awareness of factors related to athletic performance and injury prevention, youth and adolescent baseball players continue to report injuries at alarming rates. Upper extremity muscle strength is an integral part of physical assessment and injury prevention in baseball players, however minimal data exists in youth populations. Changes in anthropometric measures, inherent in physically developing athletes, have been shown to impact strength measures, however normalization methodology is rarely reported.

PURPOSE

The purposes of this study were to 1) compare the measurement properties of five potential methods for normalizing isometric shoulder strength in a cohort of 9-12 year old male baseball players and 2) examine the relationship between normalized isometric shoulder strength and ball velocity in a cohort of 9-12 year old male baseball players.

STUDY DESIGN

Prospective cohort study (n=159).

METHODS

Baseline and follow up height, weight and bilateral ulnar length measurements were assessed followed by isometric strength in both the dominant and non-dominant shoulders. Strength measures included scapular plane abduction (scaption), external rotation (ER) at 0°, ER and internal rotation (IR) at 90°. Ball velocity was assessed as a measure of throwing performance. Intraclass correlation coefficients (ICC2,1), standard errors of measurement (SEM) and minimal detectable change (MDC95) were calculated for all strength measures. Repeated measures ANOVA were conducted comparing changes in normalized strength using five separate anthropometric measures: weight, height, body mass index, ulnar length and % of non-dominant shoulder strength. Linear regression models were used to examine the relationships between normalized isometric shoulder strength and ball velocity. Statistical significance was set a priori at α=0.05.

RESULTS

Shoulder strength normalized using ulnar length was the only method that demonstrated excellent reliability (ICC2,1 0.98-0.99) and detected significant changes between strength in each of the four measures tested (SEM 0.39-0.69 Nm). Modest but significant correlations were observed between scaption and ball velocity (r2 = 0.27, p < 0.001) and ER at 0° and ball velocity (r2 = 0.23, p < 0.001).

CONCLUSION

Ulnar length was the most stable and reliable normalization method for assessing isometric shoulder strength in youth baseball players. In addition, normalized scaption strength was the most significant predictor of ball velocity, followed by ER at 0° strength in this population.

LEVEL OF EVIDENCE

Level 2b (etiology).

Internet Survey of Risk Factors Associated With Training and Competition in Dogs Competing in Agility Competitions

Objective: To describe risk factors associated with training and competition in relation to frequency and severity of injuries experienced by agility dogs.

Procedures: An internet-based survey collected data on competition level variables and training level variables. The primary outcome was history of any injury and a secondary outcome considered history of severe injury (injury lasting > 3 months). Logistic regression was used to estimate associations and final models were obtained via backward selection to identify the strongest associations within variables.

Results: There were 4,197 dogs included in this analysis. Injury was reported for 1,737 (41.4%) dogs and severe injury was reported for 629 (15.0%). In the model with competition level factors, jumping 4” (OR: 1.50) or 2–4” (OR: 1.31) over shoulder height compared to jumping 0–2” lower and competing at national events was associated with increased injury risk, while competing 6+ times on rubber matting was associated with lower risk (OR: 0.62). Training level variables associated with injury risk were age starting jump, teeter, and weave training, with the highest risk observed for dogs starting jump training between 3 and 18 months but starting weave and teeter training after 18 months of age.

Conclusion and Clinical Relevance: Many variables thought to be associated with injury risk were not significant in the final model. Starting jump training at an earlier age was associated with greater risk of injury relative to starting after 18 months. It is possible that the high impact of jump training before skeletal maturity may increase the risk of injuries or musculoskeletal conditions. The increased risk of injury in dogs that jump 2–4, or 4+ inches higher than shoulder height may be due to increased biomechanical forces during takeoff and landing. Faster dogs may be at higher risk of injury; handlers planning competition around big events or competing at the national level are likely to have faster dogs, and may be less likely to compete on rubber matting. These data provide valuable current insight into the possible effects that training and competition variables may have on injury risk in agility dogs.

Overview of Sport-Specific Injuries

Athletes are at risk for a variety of injuries not typically sustained in everyday life. The team physician must be capable of not only identifying and treating injuries as they occur, but he or she must be armed with the knowledge to minimize the risk of injuries before they occur. This review serves to provide an overview of the various sport-specific injuries typically encountered by team physicians. Injuries are grouped by body part and/or organ system, when possible. We do not aim to cover in detail the various treatments for these injuries; rather, we hope that this article provides a comprehensive overview of sport-specific injury, and demonstrate the well-roundedness in skills that must be possessed by team physicians.

The Effects of Physical Activity on Physeal and Skeletal Development

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There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport.

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Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton.

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Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint.

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There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration.

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Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.

A Factual Survey on the Injury of Youth Athletes for Prevention and Management

The article's abstract is not available.  

Malunited and malrotated Salter-Harris type I fracture of distal femur managed with circular ring external Ilizarov fixator

A 9-year-old girl presented with malunited Salter-Harris type I fracture of distal femur treated by bone-setter (unreliable-practitioner). Assessment revealed 3 cm limb-length-discrepancy and affected leg was unable to bear weight, knee was stiff with no active-range of motion; radiographs showed displaced sagittally malunited femoral condyle with 163° posterior distal femoral angle (PDFA). Correction planned with circular-ring-external Ilizarov fixator using distraction-osteogenesis through supracondylar osteotomy and gradual anterior opening. Partial weight bearing allowed from first postoperative day on walker. Eight weeks follow-up showed restored anatomical position of femoral condyle and PDFA. During anterior-distraction and angulation correction, tibia subluxated posteriorly, for that assembly extended to tibia which gradually translated tibia anteriorly and reduced knee. Twenty weeks after removal of assembly patient was advised knee-ankle-foot-orthosis. At 40 weeks of frame removal, patient was walking without support and pain. Managing such rare injuries with distraction-osteogenesis technique allows gradual correction and monitoring, till desirable degree of correction is achieved.

Coaches' Attitudes Toward Campus Board Training in Adolescent Climbers in the United States

INTRODUCTION

Campus board training in adolescent climbers is controversial. Evidence, albeit limited, suggests this type of training may lead to the development of finger epiphyseal stress fractures. The purpose of the present study was to investigate coaches' attitudes toward campus board training in the United States.

METHODS

Surveys were sent to 116 coaches at gyms across the United States with affiliated adolescent climbing teams. Outcomes collected included demographic information, training time, campus board use prevalence, coaches' attitudes toward campus board use, and willingness to participate in future research.

RESULTS

Seventy-three coaches representing 3090 adolescent climbers completed the survey. Forty-six coaches (63%) reported using full weight (no foot contact) campus board training in some or all of their climbers. A variety of factors were cited by coaches when deciding which climbers should or should not use the campus board, including physical maturity, climbing ability, and age, among others.

CONCLUSIONS

Climbing coaches in the United States disagree on the use of campus board training in adolescent climbers. Some coaches avoid using this training modality entirely, whereas others believe certain climbers can use it safely. There is lack of consensus in determining who those certain climbers are.

Physical Fitness and Bone Health in Young Athletes and Nonathletes

BACKGROUND

Physical activity (PA) and physical fitness (PF) are crucial for bone health. However, children participating in competitive sports with high PA are at a greater risk of fracture from trauma or overuse. Given the importance of bone development during adolescence, associations between commonly used physical fitness tests with distal third radius (R-SoS) and midshaft tibia (T-SoS) speed of sound by quantitative ultrasound were assessed in adolescent athletes and nonathletes.

HYPOTHESIS

The relationship between physical fitness tests and R-SoS and T-SoS will differ depending on sex and athletic status.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Physical fitness of 285 boys (156 athletes) and 311 girls (74 athletes) aged 10 to 18 years was assessed through strength, speed, agility, and cardiorespiratory tests. Linear regression was used to assess the associations of physical fitness tests with R-SoS and T-SoS.

RESULTS

For boys, favorable associations were observed between physical fitness tests with R-SoS in athletes and T-SoS in both athletes and nonathletes (P < 0.05). For nonathlete girls, favorable associations were found for handgrip (R-SoS and T-SoS, both P < 0.05), whereas the progressive aerobic cardiovascular endurance run, vertical jump, speed at 20 m and 40 m were only favorably associated with T-SoS. For athlete girls, the association between handgrip (P = 0.03), vertical jump, and 4 × 10 m shuttle run (P < 0.05) with T-SoS was significantly related to a bone outcome.

CONCLUSION

The handgrip test and vertical jump were associated with T-SoS in boys and girls independent of sport status. These results suggest that physical fitness is associated with bone health in adolescents, particularly boys, and that the relationship between physical fitness and bone may differ depending on sex and athletic status.

CLINICAL RELEVANCE

Physical fitness tests are simple, easy-to-use tools for monitoring bone health and should be used by sport and health professsionals to promote healthy sport participation and prevent bone injuries.

High Rates of Overuse-Related Structural Abnormalities in the Lumbar Spine of Youth Competitive Alpine Skiers: A Cross-sectional MRI Study in 108 Athletes

Background:

Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes.

Purpose:

To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination.

Results:

Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions (P = .018; R² = 0.116) and end plate changes (P = .024; R² = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age (P = .034; R² = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes (P < .05 for all).

Conclusion:

As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Overtraining and Exercise Addiction

We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

No pain no gain: a survey of use of healthcare and reasons not to seek healthcare by Norwegian climbers with chronic injuries

Objectives

To assess the use of healthcare, and reasons not to seek healthcare, by climbers with a chronic injury.

Method

Retrospective survey.

Setting

Web-based questionnaire.

Participants

667 active climbers (385 with chronic injuries).

Outcome measure

Use of healthcare (including reasons not to seek healthcare if the patient was not attended by health professionals), performance level in sport climbing, onset of a climbing-related injury, site of injury, preferred style of climbing and gender differences.

Result

Of the 667 respondents, 385 had experienced a chronic injury in the past 6 months. Climbers with a chronic injury are reluctant to seek healthcare, and male climbers are less likely to seek healthcare than female climbers. The two most frequent reasons not to seek healthcare were: (1) an assumption that the injury was not serious enough (70%) and (2) a belief that a health professional could not help (60%). Only one in five of the climbers with a finger injury sought healthcare. The more experienced climbers were less likely to seek healthcare than recreational climbers.

Conclusion

Use of healthcare among climbers with a chronic injury is limited and injured climbers self-assess the injury before seeking medical aid. Experience is a strong predictor for not seeking healthcare after an injury. These findings open up the possibility that some of those who do not seek healthcare after self-assessing the injury are underestimating the seriousness of the injury due to lack of confidence in the health professionals’ abilities to help treating chronic climbing related injuries.

Age and Sex Differences in Overuse Injuries Presenting to Pediatric Sports Medicine Clinics

Pediatric overuse injuries present with a gradual mechanism of onset and an underlying pathogenesis of microtrauma. We evaluated the clinical presentation of pediatric sports injuries to determine if differences exist between age and sex. A retrospective chart review was performed over a 6-year period; 6593 overuse injuries were included with the mean age of 13.4 years. Males presented with a greater proportion of apophysis, physis, and articular cartilage injuries ( P < .01). Females presented with greater bone, tendon, and "other" injuries ( P < .01). Children <9 years of age demonstrated apophysis and physis injuries. Conversely, children older than 15 years of age presented with tendon, bone, bursa, and other ( P < .01) overuse injuries. A significant number of pediatric athletes in this cohort reported playing through pain prior to clinical evaluation. Injury prevention programs need to educate children, and a red flag should be raised when pediatric athletes are participating with pain.

Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.

[Bony knee injuries in childhood and adolescence]

While fractures around the knee are known to be rare, physicians have encountered a rise in the frequency due to the increased participation of children and adolescents in high-impact sports at a younger age. Even if the treatment of fractures in some cases resembles that in adults, the diagnostics and treatment in childhood and adolescence require a hígh level of experience in order avoid possible sequelae and to enable early recognition. Thorough diagnostics using clinical and imaging investigations as well as a precise weighing up of the treatment are essential to minimize differences in leg length and axial malpositioning of the leg. A decision between conservative and operative treatment is made for both the femur and tibia depending on the type of fracture. Decisive is the degree of dislocation of the fracture. In operative treatment, the axis conform reduction and subsequent stress stable treatment are particularly decisive. Avulsion trauma, bony avulsions of the intercondylar eminence and patellar injuries are also treated conservatively with immobilization or surgically with the aid of various fixation techniques, depending on the degree of dislocation.

The Effects of Endurance Sports on Children and Youth

In the United States, youth participation in sports continues to increase yearly. This increase in participation, in conjunction with the trend toward early sports specialization and year round training, has led to a similar increase in athletically developed injuries. These injuries vary in nature and acuity, with the type of injury often related to the athlete's age, sport, and level of training. Endurance athletes are at an elevated risk of injury as they frequently push their body to the limit during their arduous training. Pediatric endurance athletes can be particularly vulnerable, especially to overuse injuries, given their unique and ever-changing physiological state. It is important to understand the specific challenges facing not only the physical, but also the emotional well-being of these pediatric endurance athletes to maximize performance while minimizing injury and potential long-term sequelae.

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001-2013

BACKGROUND

Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits.

METHODS

A retrospective analysis of the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5-18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators.

RESULTS

School injuries accounted for 21% of unintentional injury-related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5- to 18-year-olds. Middle school-aged youth (10-13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11).

CONCLUSIONS

Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school-based injuries demonstrate that school-based injuries are a notable opportunity for future prevention efforts.

Off-Training Levels of Physical Activity and Sedentary Behavior in Young Athletes: Preliminary Results during a Typical Week

The level of physical activity (PA) and sedentary behavior (SED) off-training of young athletes may reveal the quality of recovery from training and highlight health related issues. Thus, the aim was to identify and describe young athletes' PA and SED off-training, according to daily life activities. Eight athletes (15.7 ± 2 years, 1.72 ± 0.6 m height, 62.9 ± 10.2 kg) of a sport talent program wore on their waist a tri-axial accelerometer (ActiGraph^® wGT9X-link, Shalimar, FL, USA) at 30 Hz for 15 consecutive days, and reported their schedule. A two-step cluster analysis classified three groups according to sedentary PA and MVPA. The Sedentary (56.9%), presented the highest sedentary PA (mean [CI], 37.37 [36.45⁻38.29] min/hour); The Hazardous (19.4%) had the lowest values of sedentary and MVPA (10.07 [9.41⁻10.36] min/hour and 8.67 [7.64⁻9.70] min/hour, respectively). Balanced (23.7%) had the highest MVPA (28.61 [27.16⁻30.07] min/hour). Sedentary had the lowest count of home time associated (20%) and higher school (26%) time when compared to the Hazardous (13%). The Balanced showed the highest count of school (61%) and home time (47%). Different profiles for young athletes revealed alarming behavior in the associations with sedentary PA, sitting and SED breaks, which may influence performance and health.

Effectiveness of interventions for treating apophysitis in children and adolescents: protocol for a systematic review and network meta-analysis

Background

Overuse injuries are reported to be more common than acute trauma in children and adolescents, causing pain and reduced function. The most common is apophysitis - a traction injury to the apophysis in growing individuals. The duration of symptoms reported in the literature is between 6 weeks to 6 months or more. The objective of this systematic review and network meta-analysis is to compare the effectiveness and safety of all available treatments for any type of apophysitis in children and adolescents.

Methods/Design

We will conduct a systematic review to retrieve all relevant studies applying a comparative design. Searches will be made in the Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and SportDiscus databases and via reference searching. The efficacy of treatments will be compared with respect to the outcomes 1) time to pain-free activity and 2) risk of subsequent injury. Risk of bias assessment will be made using revised tool for assessing risk of bias in randomized trials for Randomized trials and Robins-I tool for non-randomized trials. We will explore if different treatment comparisons are sufficiently similar in terms of effect modifiers (transitivity assumption) with the aim to conduct network meta-analyses for randomized and non-randomized studies separately. A treatment hierarchy will be obtained using the surface under the cumulative ranking curve (SUCRA) and mean ranks, visualized using rankograms. We will use the CINeMA software to apply the modified version of Grades of Recommendation, Assessment, Development and Evaluation (GRADE), developed specifically to evaluate the quality of evidence in network meta-analysis.

Discussion

To date the comparative effects of interventions for apophysitis seem to rely mainly on expert opinion. We aim to identify all comparative treatment designs described in the literature and synthesize data when possible. We will use the estimated treatment effects between injury locations to provide guidance in managing apophysitis.

Trial registration

PROSPERO ID number: CRD42018083746.