Youth Lower Limb Overuse Injuries
Mind Map 2

What are the recommendations for physical activity in the youth population (5-17)?


WHO GUIDELINES

  • At least 60mins of moderate to vigorous-intensity physical activity daily
  • Physical activity of amounts >60 mins daily will provide additional health benefits
  • Most of daily physical activity should be aerobic
  • Vigorous-intensity should be incorporated, inc these that strengthen muscle and bone, at least 3 x week

Why are youth susceptible
to overuse injuries?

Growth and Development Relationship to Sport Injuries

  • boys can grow 8-10cm per year (peak height at 13-14)
  • girls can grow 7-9cm per year (peak height at 11-12)

Growth

  • decreased bone mineral density
  • increased tensile forces on muscle attachments
  • reduced flexibility

Maturation/Development

  • immature structures
  • developing brain which is vulnerable to concussions
  • underdeveloped neuromuscular system
  • mismatch in biological age between athletes

What are the different types of
youth overuse injuries?

Sever's Lesion

Osgood Schlager Lesion

Sinding-Larsen-Johansson Lesion

Osteochondrosis Lesions

  • AIIS, ASIS
  • Lesser trochanter
  • Ischial tuberosity
  • Navicular
  • Patella tendon attachment to tibial tuberosity
    Diagnosis:
  • pain reproduced by isometric knee extension
  • tenderness on palpation
  • pain at patella tendon insertion
  • girls may have reduced hip abduction strength

Treatment

  • Patient education and exercise
  • activity modification
  • Manage training load, pain intensity, psychological factors
  • Exercise training protocols (Rathleff et al)

Patellofemoral Pain

  • Second most common knee pain among adolescents
  • Can last 6-76 months
    Diagnosis:
  • Diffuse anterior knee pain
  • Pain with activities loading the knee eg stairs, squatting, lunges
  • Weak hip muscles
  • Psychological considerations: Anxiety, depression, fearful of movement, catastrophisation

Treatment

  • Education
  • Exercise therapy
  • pain management
  • Address psychological factors
  • Loading training protocols (Rathleff et al.)

How do you minimise the risk of
developing overuse injuries?

Accommodate for Growth and Maturation
IOC Guidelines for training load prescription

  • Small increases/decreases in load
  • Individual / flexible loading
  • Adjust for psychological stresses
  • Schedule recovery

Early specialisation in Young Athletes
What is it? Specialisation that occurs before 12 years of age

Training parameters

  • < 16 hours of training per week
  • Organised sport: 'free play' 2:1
  • training hours not more than age
  • Adhering to evidence based load guidelines

Recommendations

  • education to parents, coaches and athletes of increased risk of harm
  • <12 years old partake in wide range of physical activities
  • 'free play' should be encouraged
  • delay specialisation until after age of 12
  • social, emotional and psychological maturity should be considered in when to specialise

Injury Prevention
Exercise Programs

(Example) PEP Program (Prevent Injury & Enhance Performance)

  • Reduce number of ACL injuries
  • Education, stretching, strengthening, plyometrics, sports-specific agility drills

(Example) Footy First (AFL players)

  • warm up, hamstring strength exercise, balance, landing and changing direction exercises
  • Groin strength, hip strength ex's

Sleep
Diet
Mental health

Clinical Practice Guideline

  • Recommend exercise based prevention programs to reduce knee and ACL injury
  • implement a program before training sessions
  • Soccer players (esp female) should use program
  • Female programs inc proximal control ex's, strength & plyometric ex's
  • Multiple sessions per week, >20mins
  • Should start in pre-season and continue across season
  • Must ensure high compliance
  • Encourage programs for 12-25yo in high risk sport

Burnout

Mental Strain

What are the risk factors?

  • Prior injury
  • Overuse injuries more likely to occur during adolescent growth spurt
  • Lack of lean tissue mass
  • Increase in joint hypomobility
  • Higher training volumes
  • Females
  • Athletes who maintain broader sporting base until older than 12 are more likely to be 'successful' in chosen sport
  • physical harm associated with sport specialisation (overuse injuries)
    Early specialisation can lead to:
  • Lower perception of overall health
  • earlier cessation of sporting activity
  • Burnout
  • less fun
  • Psychological needs dissatisfaction