Are there injuries that adolescents get more than adults?
Are there injuries that adolescents get that adults don't?
What happens if an injury doesn't get treated properly?
I've been diagnosed with this condition- what does it mean?
There are a range of conditions that it is important for adolescent physiotherapists, adolescent athletes , parents and coaches of adolescents to be aware of.
Not only are there conditions that occur only in adolescents, but there are also those that have their peak occurances in adolescents and injuries that if not treated appropriately when they occur in an adolescent can lead to life long problems.
We've designed this page as a quick research snapshot ground of all the latest up to date research on some of these conditions.
If there is a condition you're curious about that you don't see below or you want more information let us know in the contact us box below.
ADOLESCENT ONLY CONDITIONS
- AVOID STRETCHING! Don’t add more traction to a traction injury.
- Include eccentric calf strengthening ‘off stretch’ (decline or flat);
- Load modification;
- Addressing biomechanical factors, both locally & globally;
- Temporary use of a heel raise (1-2wks) & use of ibuprofen & green tea.
- One study has found that arch taping to correct pronation was effective in treating sever’s (Hunt 2007).
Osgood Schlatter’s Disease
What is it?
It is classified as an apophysitis of the anterior aspect of the tibial tuberosity (ATT). The diagnosis is essentially clinical but does radiology have a role? OSD was initially thought to be due to repetitive traction of the patellar tendon on the distal insertion, causing a bony fragmentation in the secondary ossification centre and transitory necrosis. However, this fragmentation has been found to be normal (Ducher, 2010) and instead, the presence of neo-vessels within the end of the patella tendon has been suggested as the hallmark feature of a pathological tendon.
This may be linked to compressive forces, through chronic micro repetitive trauma or a traumatic event such as a fall on the knee. Furthermore, some stages of ATT maturation seem to be more vulnerable to the development of severe OSD, with a reduction in pain with advancing skeletal maturation, with stage 2 being the critical stage where the symptoms are heightened.
What does the research say?
- Avoid stretching the area.
- Include eccentric exercises
- Load modification
- Biomechanical factors
- Taping may be effective
So clinically what should I do?
What are the benefits of OSD patients undergoing imaging? A colour Doppler ultrasound can detect neo-invasion and determine the stage of maturation of the ATT, which may provide the patient with a more accurate guide to management; a symptomatic stage 2 ATT could require complete rest to prevent the neo-invasion, whereas stages 3 and 4 can be managed with training load modification only. Therefore, an ultrasound scan may add some practical information to help develop the care plan of certain patients.
If you think you have Osgood Schlatters, it's best to see a physiotherapist who can help you develop an individualised program that suits you and your symptoms.
Sailly, M., Whiteley, R. & Johnson, A. (2013). Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter’s disease: a case series with comparison group and clinical interpretation. Br J Sports Med, 47, 93-97. doi: 10.1136/bjsports-2012-091471
PEAK IN ADOLESCENCE
What is a wry neck?
Wry Neck has many types, the facet joint wry neck occurs mostly in younger patients from 12-30 and can come ‘out of the blue’ from something simple and every day such as turning over in bed, or brushing your hair. The facet joints get ‘locked’ or stuck, typically around C2/C3, C3/C4 region, the muscles surrounding the area then spasm in response to the pain, increasing the pain levels and restricting the neck movements.
What are the symptoms?
Sudden onset sharp pain on one side of your neck with a minor incident or mechanism causing the pain. Inability to straighten your head due to pain and muscle spasm resulting in rotation and side lean through your neck away from the pain.
Do I need to see a doctor?
Generally not, a physiotherapist can utilise evidence based treatments of gentle spinal mobilisations (not manipulations) to ‘unlock’ the affected joint often resulting in almost immediate complete relief.
How long will the pain last?
Adolescent wry necks respond well to conservative treatments like physiotherapy, and after treatment should feel greatly improved. Symptoms can last up to a few days in a lingering way such as minor pain on looking at the roof, but the severe symptoms should not last for more than 24-48 hours.
What is a shoulder dislocation?
Shoulder dislocations and shoulder instability is common in adolescent athletes, particular those that play contact sports such as rugby or wrestling. The shoulder joint is very mobile, but as a result its stability is not as strong as some other joints with less range. The incidence of shoulder dislocation peaks in adolescence before decreasing.
A shoulder can move completely out of the socket, called a dislocation, or it can move partially out of the socket and then spontaneously relocate itself, called a subluxation. The shoulder joint is a ball and socket joint- however unlike the hip joint it is much shallower, it has lots of ligaments and other structures that assist in both its range and stability. More than 90% of dislocations are anterior (towards the front). This occurs when the arm is elevated above and behind the body. Less than 10% are posterior (towards the back) dislocations. Posterior dislocations occur when a load is placed across an arm which is placed in front of the body.
When should I see my Sports Physiotherapist?
As soon as possible after your injury: definitely in the first week after your injury. The sooner you see your Sports Physiotherapist the sooner your rehabilitation can start.
Do I need an MRI?
In about 95% of cases, just talking to you will enable us to diagnose a shoulder dislocation, then our physical examination will further confirm our diagnosis, so generally, an MRI is not necessary to diagnose a shoulder dislocation. But an MRI can give us information about other structures that might also be damaged and also help in planning for surgery, if surgery is needed. Often you will need a plain X-ray after your shoulder is relocated to confirm that it is in place and also to check for fractures.
Do I need a shoulder reconstruction?
Not necessarily: some people do extremely well without surgery, but most people do end having surgery due to instability of their shoulder. Young men under the age of 22 have around a 90% chance of re-dislocating their shoulder if they play a high risk sport. If you do re-dislocate, there is a 100% chance of doing it a third time. Some surgeons suggest that all adolescent boys who dislocate their shoulder should have surgery after the first dislocation. However, recent research has shown that correct shoulder bracing after the initial dislocation and significantly reduce the rate of re-dislocation and therefore the need for surgery.
What is a stress fracture?
A stress fracture is a break in the bone caused by repetitive stresses and overuse often associated with sports participation not typically a single event. It begins as a stress reaction or weakness in the bone that with continued repetitive stress continues to break down the bone until a partial fracture in the outer surface of the bone occurs. It is because of the repetitive movements and high demands of sports that there is increased pressure on the facet joints and through to the pars interarticularis a small part of bone within our spines. They press against each other during lots of activities like jumping, running, twisting, flicks, cartwheels, handstands. During adolescence this pars interarticularis is elongating and it is in this age that it is most prone to injury. Most commonly the fractures occur in the lumbar spine area around L4 and L5 but it may also occur at other levels.
What are the symptoms?
It predominantly causes pain on one side of the back versus the centre of the back. The symptoms usually start as mild pain which gradually worsens with running, jumping, and kicking activities. Spinal movements which commonly cause pain are arching backwards, twisting at the waist, or straightening up from a bent forward position. Pain is typically worse with sports and improves with rest. Athletes will often rest for a few days or weeks and feel better, but the pain returns when they resume sports.
Do I need an x-ray?
A pars stress fracture generally will not show up on a plain x-ray unless it has been there for quiet some time. Whilst bone scans and MRI’s can assist in diagnosis they’re not necessary in all instances as physiotherapists will be able to diagnose you based on your symptoms and presentation without any scans.
What should I do if I have back pain like this?
You should book in with your sports physiotherapist as soon as possible. If treated quickly and promptly with both appropriate rest and deep muscle strengthening and rehabilitation stress fractures can be managed well. The longer the pain is left untreated, the longer the treatment needs to help meaning a month of rest could turn into a year of no sport.
Patellofemoral Pain Syndrome-
Patellofemoral pain means pain under or around your kneecap. Patellofemoral pain is very common in sporty chicks, especially in sports where your knee is bent. It is often even worse if you have weight through your leg when your knee is bent.
Can you think of sports you play where you are standing and bending your knee? What about running, netball, touch football, hockey……etc.
Can you think about other times in the day when your knee is bent or you are standing and bending your knee? How about sitting at your desk at school, or going up and down stairs?
Patellofemoral pain is called an overuse injury. This means that your kneecap gets used too much or is overloaded. Sometimes overuse can occur when you don’t recover well enough from sport. So why do some girls get pain and others don’t, when they play the same amount, or even less sport?
Well….most often this is related to the way your legs line up and the way your move when you bend your knees. Check yourself out in the mirror. What way do your knees face? What way do your feet face? If you look side on, do your knees bend backwards?
Now, what happens when you stand on one leg? Do things change? What happens to your pelvis …does it stay level? What happens if you squat on one leg? Any changes? What about your knee…does it fall inwards? What’s your posture like? Is your pelvis still level? What about your feet…Do they still have an arch?
Did you know that your alignment and the way you move are often worse when you grow? All these things can affect your kneecap and cause pain. So…..if you do a lot of sport, don’t recover well, your legs don’t line up well, especially when you squat on one leg, and you have grown- you may get patellofemoral pain.
How does the kneecap work?
The kneecap (or patella) is a little bone that sits inside the quadriceps muscles- the big muscle on the front of your thigh. Its job is to make your quadriceps work better. Your quadriceps goes from your hip bone to the top of your shin bone. If your thigh, knee and shin are all in a straight line, everything works really smoothly, but if your knee falls in when you stand or squat, your kneecap pulls to the outside of your knee, trying to keep your quadriceps in a straight line, this can cause pain. Can you see how that works? Try it yourself- have a look in the mirror, or use some mathematics- vectors and angles!
How so I know if I have patellofemoral pain?
Well, usually you will get pain under or around your kneecap. The pain will be worse when you play sport, run, jump, squat, go up or down stairs and walk, stand or sit for ages. It is important for your sports physiotherapist to do a full assessment to work out whether it is patellofemoral pain or something else.
What should I do if I get patellofemoral pain?
The first thing you need to do it stop or ease back on anything that makes your knee pain worse. Icing your knee can also help. You need to see your sports physiotherapist ASAP so they can work out if you are doing too much or are not recovering well enough. They will also check if your legs don’t line up well, especially when you are moving and playing sport, and also whether growth has affected any of these things. Once they have worked out exactly what is going on, they will work out how best to treat you.
What does the treatment involve?
Usually you have to modify your activity or sport a bit. Usually you will be given some exercises to help your legs line up better. The muscles you will work on the most are your:
VMO (that’s the little one on the inside of your kneecap)
Gluteus medius (the one on the side of your butt which helps to keep your pelvis level and stops your thigh bone and knee falling inwards).
Sometimes your sports physiotherapist will give you exercises to help keep an arch in your foot- these muscles are called tibialis posterior and peroneus longus. Your physio might tape you kneecap and/or foot to put you in a better position to help your muscles work better. You might get a deep massage on your tight thigh muscles and you may be referred to a podiatrist to get some inserts for your shoes or give you some advice on what shoes are best for you. After all that, your sports physiotherapist will help you to get back to playing sport, making sure that you don’t get patellofemoral pain again and teaching you what to do if you do get pain again.