Preventing Adolescent Injuries

Growth And Sports

It is very unlikely that a muscle will tear while your body is at rest. However, tight muscles (and their tendons) that haven't lengthened or changed with the growing bones* may tear or strain as movement puts greater stress on them. Since movements in sports tend to be more intense and larger than movements in daily life, sport becomes an opportune time for the bones to fracture and the muscles and their connecting tissues to tear.

* During adolescence, bones can grow 4 inches or more in just one year.

The keys to protecting adolescent players on the pitch: ► proper preparation for play (nutrition, hydration, rest, a good training program); ► good warm-up and cool-down routines, and ► awareness of the body changes during adolescence (i.e. rapid and sporadic growth spurts, changes in body weight distribution, sudden awkwardness, etc.).

Good preparation to prevent injury can also keep players in the game. Playing regularly itself (with intermittent rest periods and suitable cross-training) can maximize the overall health benefits of participating in sports like football.

Stretching: How Important Is It?

There are always arguments in the literature about whether players should or should not stretch. Does stretching prevent injury? The reality is that stretching is only one element of a proper prevention program. The goal: to address any tight muscles and shortened tendons that may put the body at greater risk for injury.

Here are some examples of how stretching may help:

  ◊  Stretching is very important during adolescence. Not only because your muscles may not grow at the same rate (speed) as your bones, but also because as we grow, the mechanics of our bodies may not keep pace with the body's changes. In other words, stretching can help keep your joints in good alignment, important both for good body mechanics and for preventing future irritation of the joints.

  ◊  Tight muscles can pull on developing bones in a manner that may encourage bones to break (i.e. avulsion fractures*). This effect may also be related to bone "weakness" as the body changes and grows. Stretching can decrease the muscle's resting tension and improve its elasticity, which could reduce the likelihood of such events.

* An avulsion fracture occurs when a piece of bone pulls off from the rest of the bone in the area where the tendon attaches to it.

  ◊  Tight (and weak) muscles, present due to things like neuromuscular conditions, previous physical trauma, spinal defects present from birth, and growth, may also encourage changes in the position of your bones as you grow (i.e. scoliosis*) or influence other muscles to become tight (or overworked) to compensate. These changes can affect things like joint alignment, fatigability, the potential for re-injury, and, in the case of the ribcage, the efficiency of how we breathe. Stretching is a good early treatment option.

* Scoliosis is an abnormal curvature of the spine to the side. Spines with scoliosis often have more than one curve (i.e. there may be a compensating curve to the opposite side), may demonstrate abnormal rotation of the spine, and may be associated with curves in other directions (i.e. kyphosis where there is a forward curve in the spine).Scoliosis can affect the alignment of the pelvis and the ribcage as well.

  ◊  You also have to look at how muscles respond in general, at all ages.

    ●  Any injury to the body usually causes the muscle to tighten to protect the area (called muscle guarding), whether it actually needs protection or not. Regular stretching can keep these muscles in a more normal resting posture.

    ● Even in "healed" injuries, those where scar tissue has developed in a muscle (scar tissue is often dense and inelastic), stretching can help prevent another tear by:

       ► improving the alignment of the scar, which improves its elasticity and, therefore, its reaction to the stress placed on the muscle

       ► helping to normalize the tone* of the muscle that may still be present after injury

       ► balancing the relationship of the muscle (agonist) to muscles that work in the opposite direction (antagonists), to similar acting muscles (synergists), and to agonist or antagonist muscles on the other side of the body.

* Muscle tone here refers to an increase in the unconscious contraction of a muscle or part of a muscle. It can increase after physical trauma or due to things like irritated nerves.

◊ Stretching is also a treatment for pain.That's because muscle tightness can:

    ● cause pain by itself

    ● lead to the pinching of joints and nerves

    ● prevent the blood flow or lymphatic drainage necessary to remove the excessive edema or accumulated blood* from an injured area of the body. In other words, tense or tight muscles may decrease or resist the necessary circulation.

* Edema indicates fluid that accumulates outside of the blood vessels. The lymph system helps to remove excessive fluid that is in the gaps between tissues and filters it before returning it back to the blood.

◊ Muscles can, temporarily at least, "stiffen up" due to positions that the body stays in for a while (i.e. with sitting on a plane or bus for several hours).Such tightness can limit the length of your strides when you run or affect how smoothly and efficiently your body moves on the pitch.

* Instead, you might stretch the calf muscles using a belt strap while sitting with your leg straight (less compression into the ankle joint).

The Growth Plate

Certain growth plate fractures may affect how the body continues to grow (total or partial growth arrest)*, especially if not addressed correctly. Common reasons include:

    ■ fractures that destroy circulation to the growth plate

    ■ fractures that are severe

    ■ fractures that result in abnormal bone growth across the gap of the growth plate.

* One example is a fracture of the growth plate at the lower part of the thigh bone. In these fractures a decrease in limb length of more than 1 cm (compared to the other limb) may occur in over 40% of patients; the thigh bone may also change its original angle in about 33% of patients.

Existing Diagnoses: Revealed In the Adolescent Athlete

Certain types of childhood (or birth) deformities may finally reveal themselves in adolescence:

   ◊ Developmental hip dysplasia: in most cases of this disorder, the socket of the hip fails to develop completely and does not cover the femoral head (or ball) of the hip joint as much as it should. This can lead to hip dislocation (the ball coming out of the socket) and early signs of arthritis.

   ◊ Tarsal coalition: a condition where 2 or more normally separated bones in the foot, at the midfoot or rear foot (heel), fail to divide into the expected individual bones. The result is decreased movement at the ankle or midfoot—as there are fewer joints to move. There is also a tendency toward flat feet (usually between the ages of 8 and 15), a history of multiple ankle sprains, or, simply, pain in the middle of the foot.In adolescence x-rays usually uncover this problem when doctors are looking at an unrelated injury (or thought-to-be unrelated injury); otherwise this condition may be symptom-free and remain unnoticed.

   ◊ Slipped Capital Femoral Epiphysis (SCFE): There are also injuries that tend to be more common in adolescence like Slipped Capital Femoral Epiphysis (SCFE), where the upper growth plate (physis), located at the ball of the hip joint, fractures or weakens, sometimes over time, and the top of the round ball of the hip appears to slide off the neck of the femur (kind of like an ice cream scoop sliding off of a cone) [Figures 1, 2].

 

 

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