OVERUSE INJURIES IN ADOLESCENTS IRVING RAPHAEL MD Syracuse Orthopedic Specialists Former S.U. Head Team Physician June 5, 2015.

OVERUSE INJURIES IN ADOLESCENTS

IRVING RAPHAEL MD

Syracuse Orthopedic Specialists

Former S.U. Head Team Physician

June 5, 2015

June 5, 2015

OLYMPIC MOTTO

CITIUS

ALTIUS

FORTIUS

OLYMPIC MOTTO

CITIUS - FASTER

ALTIUS - HIGHER

FORTIUS - STRONGER

OUTLINE

• WHY ARE WE CONCERNED??

• SPECIFIC INJURIES

• WHAT DO WE DO ABOUT IT??

Who’s At Risk?

• Soccer• Basketball• Football• Lacrosse• Volleyball• Skiers• Gymnasts• Cheerleaders

YOUTH SPORTS INJURY STATISTICS

• 30 million youth participating in US• HS athletes – 2 million injuries per year• 3.5 mill under age 14 get medical Rx• Age 5-14, account for 40% of sports injuries

treated in hospitals• Overuse - half of sports injuries, mid & HS• By 13, 70% drop out of youth sports• Since 2000 – 5 X increase in serious

shoulder and elbow injuries - throwing

Overuse Injury - Definition

• “Micro-traumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process.”

Stages

• 1. Pain after physical activity

• 2. Pain during activity without restricting performance

• 3. Pain during activity restricting performance

• 4. Chronic unrelenting pain even at rest

RISK FACTORS

• PRESENCE OF GROWTH AREAS• MUSCLE DEVELOPMENT – IMBALANCE• PRESSURE TO COMPETE• IMMATURITY – PHYSICAL AND

EMOTIONAL• PLAYER AGE / SIZE DIFFERENTIAL• YEAR – ROUND PARTICIPATION• MULTIPLE TEAMS

BURNOUT OVERTRAINING SYNDROME

“A series of psychological, physiological and hormonal changes that result in decreased sports performance.” -- chronic muscle or joint pain -- personality changes -- elevated resting heart rate -- chronic poor athletic performance -- fatigue, lack of enthusiasm

COMMON TYPES

• PATELLO – FEMORAL PAIN• JUMPER’S KNEE - OSGOOD SCHLATTER• SOCCER HEEL – CALCANEAL APOPHYSITIS • LITTLE LEAGUER ELBOW • SWIMMER’S SHOULDER• GYMNASTS BACK - SPONDYLOLYSIS• RUNNER’S “SHIN SPLINTS”

OSGOOD SCHLATTER’S

• Painful bump over tibial tubercle• Tender patellar tendon• Aggravated by activity• Sports – running, jumping, twisting• Diagnosis – clinical, radiographic• Worse during growth spurts• Boys more than girls - changing

OSGOOD SCHLATTER

ECTOPIC BONE – TIBIAL TUBERCLE

O.S.G. - TREATMENT

• REST, REST, REST• Immobilization, knee brace• NSAID• Symptomatic – Ice vs. Heat• Self limiting • REST, REST, REST

SEVER’S DISEASECALCANEAL APOPHYSITIS

• Growth area back of heel bone• Pain with activity – running, jumping• P.E. – normal appearance, Squeeze test• Radiographs – normal• Both heels – more than half patients

SEVER’S TREATMENT

• REST, REST, elevate• Medication• Orthotics• Physical Therapy• Icing• Open back shoe• Stretching hamstring & calf muscles

LITTLE LEAGUE ELBOW

• Lateral apophysitis of elbow – avulsion?• Overuse with throwing• Repetitive valgus stress on elbow• Year round single sport• Longer competitive seasons• Training and conditioning errors• Diagnosis – clinical, ?Xray

TREATMENT – L.L. ELBOW

• REST, REST, REST• Icing• Medication• Physical Therapy• Recovery over months• Gradual return to pitching• Throwing – number, distance, velocity

SPONDYLOLYSIS

Female Gymnast Back

Stress fracture of Pars

Interarticularis

Repetitive flexion,

extension, rotation

Pain, Tight Hamstrings

Radiographs, MRI, Scan

Sports at Risk

• Gymnasts• Offensive linemen, football• Weight lifters• Wrestlers• Dancers• Pole Vaulter, High Jumper

Treatment - Spondylolysis

• Restrict Activity - ?Bed Rest• Medication• Brace ?• Surgery rare• Exercise – Abdominal, Hamstring• Pain-free activity – swim, bike

SWIMMER’S SHOULDER

• Overuse, Over-training• Impingement, rotator cuff tendonitis,

biceps tendonitis• Related to stroke• Muscle imbalance• Instability, laxity

Shoulder Treatment

• Rest, “out of the pool”• Medication• Ice, Heat• Physical Therapy• Shoulder muscle girdle strengthening• Scapular Stabilization• Graduated return to swim program

KNEE CAP PAIN

• Patello-femoral pain syndrome• Retro-patellar pain syndrome• Chondromalacia patella• Patellar malalignment Syndrome• Anterior knee pain aggravated by sports,

stairs, walking, jumping, sitting for long periods- “Theater sign”

Treatment – Knee Cap Pain

• R.I.C.E• Exercise – Quadriceps Strength• Physical Therapy• Medication• Bracing, Taping• Orthotics – shoe inserts• Surgery ??

SHIN SPLINTS

• Medial Tibial Stress Syndrome (MTSS)

• Tibial Periostitis

SHIN SPLINTS

• Throb, ache during or after run• “Ramping up” work out• Change in surface, distance, speed• Clinical diagnosis• Excess pronation feet• R/O Stress Fracture, Compartment Syndr• Xray, MRI, Bone Scan, Pressure Measure

Shin Splint - Treatment

• Rest• Ice• NSAID• Physical Therapy• Arch Supports – Orthotics• Slow return to running

What do we do about overuse injuries in adolescents ??

• Athletes• Coaches• Parents

EMPHASIS

* INJURY REDUCTION *

PROPER EDUCATION

SUPERVISION

TRAINING

PARENTAL GUIDANCE

EARLY RECOGNITION

INTERVENTION / TREATMENT

Questions?

Thank You

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