Treating the young: consideration from childhood to adolescence

By AAPSM on 10th of December 2013 at 8:44am | Share on Facebook
www.aapsm.org.au / articles / treating-the-young-consideration-from-childhood-to-adolescence

We need to consider different factors when patients enter into the clinic. Foremost in my mind is the age of the athlete. Being a younger athlete has its advantages; the ability to recover is so much greater. However we still need to understand that there are inherent risks with being so young.

Articles

We need to consider different factors when patients enter into the clinic. Foremost in my mind is the age of the athlete. Being a younger athlete has its advantages; the ability to recover is so much greater. However we still need to understand that there are inherent risks with being so young.


Firstly we need to consider that adolescence is an important time for social development, so maintaining the opportunity to be with friends and building self-esteem is paramount, it is also a crucial time for physical development, more specifically for tendons. It is our job to make a correct diagnosis and implement the most effective rehabilitation program to ensure social and physical development has a chance to prosper.

During adolescence we need to consider the risk associated with growth. This unfortunately doesn’t always enter into the equation when coaches and parents send kids out to play sport. There is a susceptibility of joint cartilage being injured with repetitive stress at these young ages. Articular surfaces, apophyses and physes all have a higher risk of injury during the younger years, Osgoods, Sever’s and Iselin’s syndrome are the most commonly associated sites to stress. These injuries are all associated with overuse; increased traction during growth, repetitive load and weakness.

During secondary school the demand of sport increases, whether it’s wanting to play different sports with friends, or an increase in team competition; due to state and national representation. Movement specific training and high volume is introduced with little rest, and hence overuse. If we couple this with growth, where bone growth far outweighs muscles adaptive capabilities, muscular tightness, global stiffness and lack of coordination, we see the onset of fatigue much earlier, hence an overwhelming chance of injury occurring.

So how do we deal with this? Of course we need to be subtle in our approach, identifying the cause of any injury is the first step, and if overuse or too much exercise is a glaring factor, then explain why this, coupled with growth is something we need to control. Do we encourage sports coaches or probably more realistically parents to monitor the growth of our younger athletes, and if there is a large change over a small period then reduce activity?

We know that being young means we have lower muscle endurance but a greater capacity to recover or short distance. This may mean we train our adolescence in short sharp bursts with less rest for shorter timed sessions. We need to also take into consideration that their adaptive capabilities to temperature extremes is limited, so higher fluid intake and shorter sessions make sense.

To top all this off we have not even considered the menstrual cycle and the affect it has on our growing female athletes.

So here are my tips for training adolescence:

1.    Keep workouts interesting, with age-appropriate games and training, to keep practice fun. High volume is not necessarily better.

2.    Take time off from organised or structured sports participation 1 to 2 days per week to allow the body to rest or participate in other activities.

3.    Permit longer scheduled breaks from training and competition every 2 to 3 months while focusing on other activities and cross-training to prevent loss of skill or level of conditioning.

4.    If there is a rapid growth period or a prolonged period of fatigue then a reduction in exercise load is paramount.



Overuse injuries in Children and Adolescents
John P DiFiori, The Physician and Sports Medicine. Vol 27 no. a January 1999

Hawkins D, Metheny J. Overuse injuries in youth sports: biomechanical considerations. Med Sci Sports Exerc 2001; 33 (10): 1701–7

Harris SS. Readiness to participate in sports in care of the young athlete. In: Sullivan JA, Anderson SJ, editors. Care of the young athlete. Rosemont (IL): American Academy of Orthopaedic Surgeons, 2000: 19–24