Transcript Document 7114341

Chapter 25: Preventing and
Managing Injuries in Young
Athletes
© 2010 McGraw-Hill Higher Education. All rights reserved.
Cultural Trends
• Significant increase in participation by
young children, particularly females
– Organized and informal sports and recreation
activities
• Results in an increase in sports and
recreation related injuries
• Risk of injuries is inherent in sports
• Young athletes are susceptible because
they are continuously gaining motor and
cognitive skills
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• Questions still arise
concerning the
appropriateness of
youth participation in
sports
• Level of training
intensity and
frequency remains a
concern
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Where are injuries occurring?
The Facts
• More than 3.5 million children ages 14 and
under suffer medically treated sports injuries
annually
• Collision/contact sports are associated with
higher injury rates
• Nearly half of all traumatic brain/head injuries
to children occur during sports or recreational
activity
• In 2004, nearly 391,800 children were treated
in the emergency room for football or
basketball injuries
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• The most common injuries include sprains,
muscle strains, bone & growth plate injuries, heat
illnesses and repetitive motion injuries
• Children are at higher risk of winter sports injuries
(skiing, snowboarding, sledding)
• Children that do not wear protective equipment
are at greater risk of sustaining sports-related
injuries.
• Most organized sports-related injuries (62%)
occur during practice rather than games
• Nearly ¾ of US households with school-aged
children have at least one child who plays
organized sports
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© 2010 McGraw-Hill Higher Education. All rights reserved.
Proven Interventions
• Children should have access and consistently
use appropriate gear for respective sports
• Children enrolled in organized sports that are
properly maintained assist in injury prevention
• Coaches should be trained in CPR & First Aid
 should also have plans in place to respond
appropriately to emergency situations
• Sports programs with certified athletic trainers
on staff are ideal due to their training in injury
prevention and injury care
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Physical Maturity Assessment
in
Matching
Athletes
• Children are at a greater risk than adults for
injury
– Due to inability to assess risk, less
coordination, slower reaction time and less
accuracy
• Rates of injury vary with age and gender
• Injury rate is associated more with child’s
stage of development
– Youth sports participants should be matched
by physical maturity, size, weight and skill level
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• Maturity assessment should be part of the
physical examination
– Used to protect the physically young athlete
• Commonly used tools
– Tanner’s Stages of Maturity
• Stage 1 – puberty is not evident
• Stage 3 – fastest bone growth and is crucial in
terms of contact/collision sports (growth plate
weakness)
• Stage 5 – full development
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• According to the American Academy of
Pediatrics
– Preadolescent boys and girls should not be
separated by gender in recreational or
competitive sports activities
– Separation of genders should occur in
collision-type sports once boys have attained
greater muscle mass in proportion to height
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Physical Conditioning and
Training
• Those guidelines
and philosophies
used by adults
should not be
imposed on younger
athletes who are
anatomically,
physiologically or
psychologically less
mature
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• Young athletes should focus on
developing muscular strength, endurance,
cardiovascular fitness and flexibility
• Should work with fitness professionals,
coaches and ATC’s (if possible) yearround to maintain fitness and nutrition
• Engage in appropriate conditioning
program for 6 weeks prior to beginning
daily practice routine
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• Athletes should engage in appropriate warmup (w/ stretching) and cool down with
activities
• Practices should be limited to no more than 2
hours
• Strength training can be safe and appropriate
for emotionally mature athletes that are able
to follow directions associated with a properly
designed program
– Younger children can also engage in program
(callisthenic in nature) as long as they are able to
follow directions and perform activity safely
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Psychological and Learning
Concerns
• Stress as a result of over zealous coaches
and parents is always a concern
• Children do not always understand sports
concepts until they have received
instruction
• Children usually are eager to please adults
– Vulnerable to coercion and manipulation
– Coach should be positive and use positive
reinforcement
• Allows athlete to develop self-worth and self-esteem
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• Not all children are equal in ability
– Some children respond to competition while
others shy away
• Attempting to do ones best must be
emphasized
• Children must receive instruction
– Should be timely
• Emphasize enjoyment of the activity not
just winning
• Types of play
– Organized vs. Free-flowing
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• Adverse effect of adult influences is one
potential negative psychological aspect of
youth sport participation
• Participation in sports can be taken to
extremes – intensive participation relative
to intensity and frequency
– Demands placed on body and mind
– At ages 10-12 a great deal of development is
still occurring cognitively
• Ability to comprehend multiple points of view, team
perspective
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• Issues may also enter the picture when
injury rehabilitation is involved
• Risk factors for psychological
complications in the injured child
– Stress in the family
– High-achieving siblings
– Over or under-involved parents
– Paradoxical lack of leisure in athletic activity
– Self-esteem that is reliant on athletic prowess
– Narrow range of interests outside of athletics
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Coaching Qualifications
• No federal law requires coaching education
at any level
• Training
– Degree programs, National Body of Sports
certification programs, youth sports coaching
programs
• No real standards until 1996
• NASPE developed National Standards for
Athletic Coaches
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• NASPE National Standards (continued)
– Not a certification program or single national
assessment
– Helps other organizations provide coaches
with education, evaluation and aid in program
design to meet needs of prospective &
practicing coaches
• USOC mandates participation in safety
and certification course (American Red
Cross / USOC)
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• Generally coaches have little or no
background in providing safe and positive
sports experience
• Should be dedicated to the highest ideals
of coaching
– NYSCA has membership and levels of
certification focusing on coaching, safety and
first aid along with the psychological aspect of
sports
• Coaches should have good understanding
of child development – physical, emotional
and psychological
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• Other Coaching Certification Programs
– American Sport Education Program (ASEP)
– Program for Athletic Coaches Education
(PACE)
– Also available through individual National
Sport Governing Bodies (NGB’s)
• For example, the United States Soccer Federation
(USSF)
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Common Injuries in the Young
Athlete
• Must be concerned with repeated
microtrauma that can become
compounded, become chronic or even
degenerative in maturing musculoskeletal
system
• Children are susceptible to same injuries
as mature adults
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Growth Plate Fractures
• Growth plate
– Region at the end of long bones where bone
growth occurs
– Determines length and shape of bone
• Trauma could be single acute incident or
chronic, overuse, stress related
• Suspected fracture should be referred to a
physician immediately
– Determine severity and form of
treatment/immobilization
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• Must be carefully monitored
• Bone will either not get longer or end up
with stimulated growth with injured leg
becoming longer than uninjured
• Complicated fractures must be followed up
with until skeletal maturity is reached
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Apophysitis
• Apophysis
– Specialized area of cartilage within growth
plate
– Often point of large tendon insertion
• Repetitive stress results in inflammatory
response
– Osgood-Schlatter’s and Sever’s disease
• Usually begins at ages 8-15
• Pain generally with activity
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• Tenderness is localized with no other
significant abnormalities
• Diagnosis from history, physical exam and
occasionally X-rays
• Not serious and will resolve over time
• Treatment is directed toward reducing
symptoms
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Avulsion Fractures
• Bone vs. Muscle development
– May result in imbalance and possible injury
• Stresses placed on bones through
tendon of contracting muscle may result
in pieces of bone being pulled away from
point of insertion
• Common sites
– ASIS, AIIS, ischial spine, and 5th metatarsal
– More common in lower vs. upper extremity
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Spondylolysis
• Defect or fracture in bony structures of
spine
• Generally the result of repetitive loading
• Occur between ages of 5-10 around the 4th
and 5th lumbar vertebrae
• Children often remain asymptomatic and
injury is not realized until later in skeletal
development
• X-rays are required to determine extent of
injury
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• Spondylolisthesis involves vertebrae
slippage
• Treatment for both centers on healing of
defect and treating patient’s symptoms
– Physician’s decision
– Brace vs. no brace
– Flexibility becomes a major factor in rehab
program
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Sports Injury Prevention
• For all individuals involved in sports one of
the primary goals should be prevention of
injury
– Involve proper physical and psychological
conditioning
– Utilize appropriate equipment (safety) in a safe
environment with adequate supervision
– Enforce safety rules
• Be sure participants receive a physical and
are cleared to participate
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• Instruct participants on fitness and the various
components
– Performance enhancement and injury reduction
– Encourage proper eating and nutrition
• Work with athletes on acclimatization and
hydration
• Be sure plans and guidelines are in place
regarding care and treatment of injuries
• Work to create a safe and healthy playing
environment
• Be aware of injury prevention guidelines for
specific sports
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