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Current Trends in Youth Sports Injuries

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Presentation on theme: "Current Trends in Youth Sports Injuries"— Presentation transcript:

1 Current Trends in Youth Sports Injuries
Jeff G. Konin, PhD, ATC, PT Associate Professor & Vice Chair

2 Objectives of This Course
Identify the epidemiology of injuries sustained by children playing sports Discuss practical injury prevention programs for simple implementation Identify trends in the use of protective youth sports equipment Discuss the impact emergency planning has on reducing catastrophic youth sports injuries Konin Copyright 2009

3 National Center for Sports Safety & Safe Kids USA
Epidemiology of Youth Sports Injuries: Startling Statistics! Approximately 20 percent of children and adolescents participating in sports activities are injured each year, and one in four injuries is considered serious. Children and adolescents who are just beginning a sport or activity are at greater risk for injury. National Center for Sports Safety & Safe Kids USA Konin Copyright 2009

4 Activity No. of Injuries on 1000s(%)
Rank 5 to 14 years of age 12 to 24 years of age 25 to 44 years of age >45 years of age 1 Pedal cycling 332 (13.9) Basketball 440 (20.9) Basketball 256 (14.7) Exercising/track 133 (24.1) 2 Basketball 261 (11.0) Football 28 (13.7) Pedal Cycling 204 (11.7) Recreation sport 112 (20.3) 3 Football 243 (10.2) Exercising/track 172 (8.2) Exercising/track 198 (11.4) Water sport 44 (7.9) 4 Playground equipment 219 (9.2) Soccer 145 (6.9) Baseball/ softball 182 (10.4) Skating/skateboarding 29 (5.2) 5 Baseball/softball 185 (7.8) Recreational sport 102 (4.9) Recreational sport 146 (8.4) Pedal cycling 27 (4.9) Remainder 1,114 (48.0) 958 (45.5) 754 (43.3) 208 (37.6) Total 2,384 (100.0) 2,104 (100.0) 1,740 (100.0) 553 (100.0) National health survey 1999 Konin Copyright 2009

5 Also tobacco, alcohol, psychological distress
National surveillance for sports injuries among US high school student-athletes, 2003 youth risk behavior survey Hootman, JAT 2006* N = 15,214, in 2003 (athletes = 53.7%) High risk dieting behaviors were associated with greater injury rates – fasting, dieting, vomiting Also tobacco, alcohol, psychological distress Konin Copyright 2009

6 Slowly Creeping Up…………..
1.5 million injuries a year with BMX bikes 2.6 million injuries a year skateboarding Over 3 million injuries per year in-line skating 65 thousand injuries per year horseback riding Nearly 68 thousand kids were treated last year for trampoline injuries Konin Copyright 2009

7 Who Manages Youth Injuries?
Parents Coaches Friends Physicians Physical Therapists Athletic Trainers Physical Educators Others Konin Copyright 2009

8 What role does obesity play in today’s youth sport’s injuries?
Konin Copyright 2009

9 Be careful with BMI – people can over or under react!
Here are some celebrities and athletes that the government has deemed "overweight": Michael Jordan: 6'6": 216 lbs: 25 Bobby Labonte: 5'9": 170 lbs: 25 Karl Malone: 6'9": 259 lbs: 28 Yao Ming: 7'6": 310 lbs: 27 Brad Pitt: 6'0": 203 lbs: 28 Keanu Reeves: 6'1": 223 lbs: 29 Cal Ripken: 6'4": 210 lbs: 27 Nykesha Sales: 6'0": 184 lbs: 25 Will Smith: 6'2": 210 lbs: 27 Bruce Willis: 6'0": 200 lbs: 29 Konin Copyright 2009

10 Sports Psychology in Children’s Sports
The mind of a child is highly influenced by the parent and coach! Konin Copyright 2009

11 Abrams, Center for Sports Parenting 2005 “70 percent of kids drop out of sports by age 13, and the main reason is pressure from parents and coaches.” Bob Bigelow, one of the authors of ``Just Let the Kids Play,'' believes the odds of winning a scholarship are even more remote than many other experts say, estimating that just 1 in 300 high school senior athletes will get a fabled “full ride.'' Konin Copyright 2009

12 Unrealistic expectations of parents
In Northern California today: > There are about 2,000 club soccer teams > There is a decline in the number of multi-sport athletes as kids specialize in one sport to maximize their scholarship chances. Konin Copyright 2009

13 Cold Hard Facts The Northeastern University Center for the Study of Sport in Society found that, of black teens, 66 percent believe they will ultimately play pro ball. Konin Copyright 2009

14 Behavioral Response Of Injury The Injury Itself
The stressor, loss of self-control Konin Copyright 2009

15 Behavioral Response to Injury Emotional Responses
Denial Anger Frustration Bargaining Depression Acceptance Konin Copyright 2009

16 Educate The Athlete… and the parent!
First – assess parental knowledge in general and current disposition Explain facts about the injury Realistic expectations of recovery Importance of psychological skills as a part of the rehabilitation process Allow athlete to educate you Konin Copyright 2009

17 Case Study How would you counsel a 12 year old child and parents referred to you with OSD and wanting to return to playing basketball? Topics might include: learning what the MD told them, their goals, their realisms, their timeline, what they googled, child’s interests, compliance, motivation, past experiences Konin Copyright 2009

18 Protective Equipment:
Rules, benefits, considerations & knowledge

19 Purposes of Protective Equipment
1. Dispose & absorb forces 2. Limit anatomical movement 3. Support joint structures 4. Support musculotendinous structures 5. Enhance proprioceptive feedback 6. Secure protective pads Source: JG Konin et al, in The Athlete’s Shoulder, 2nd Ed, 2009 Konin Copyright 2009

20 Protective Equipment Guide
Does the equipment protect the area of concern appropriately? Can the athlete perform the skills required for his/her sport and position while wearing the device? Will the device maintain proper anatomical alignment? Is the device potentially hazardous or injurious to other participants? Is the device legal by the rules and regulations of the sport? Source: JG Konin et al, in The Athlete’s Shoulder, 2nd Ed, 2009 Konin Copyright 2009

21 Commotio Cordis: Incidence by Sport
Blunt trauma during 20mSec window, VFib 15% survive commotio cordis events Konin Copyright 2009

22 Commotio Cordis Optimal Management
Chest protectors, softer balls, etc have all been proposed Consensus is be prepared with an AED! Konin Copyright 2009

23 Mouth Guards Stock, mouth formed, and custom-fitted
Required for lacrosse, ice hockey, football, field hockey Recommended for basketball & soccer Konin Copyright 2009

24 Concussions in Children
Konin Copyright 2009

25 Mechanisms of Injury Concussion Cumulative effect!!!!!!!!!!!!!
Acceleration-deceleration forces result in shearing forces which distort the vascular and neutral elements of the brain – chemical cascade Cumulative effect!!!!!!!!!!!!! Konin Copyright 2009

26 S & S of Concussion Physical Symptoms Headache Vision difficulty
Nausea Dizziness Balance Difficulties Light sensitivity Fatigue Emotionality Symptoms Irritability Sadness Nervousness Sleep disturbances Cognitive Memory loss Attention disorder Reasoning difficulty Konin Copyright 2009

27 Post-concussion Syndrome (PCS)
Vary in symptoms & length of presence Always have medical professional assess and determine safety for clearance Do not go by athlete comments alone Beware of physician shopping Konin Copyright 2009

28 Various Scales Used to Grade Concussions
Grade 1 (mild) Transient symptoms; no LOC; symptoms and mental status abnormalities resolve within minutes Grade 2 (moderate) Transient symptoms; no LOC; symptoms and mental status abnormalities last longer than minutes Grade 3 (severe) Any LOC

29 Source: JAT 2004 Position Statement
People working with younger (pediatric) athletes should be aware that recovery may take longer than in older athletes. Additionally, these younger athletes are maturing at a relatively fast rate and will likely require more frequent updates of baseline measures compared with older athletes. Source: JAT 2004 Position Statement Konin Copyright 2009

30 Source: JAT 2004 Position Statement
Because damage to the maturing brain of a young athlete can be catastrophic (ie, almost all reported cases of second-impact syndrome are in young athletes), athletes under age 18 years should be managed more conservatively, using stricter RTP guidelines than those used to manage concussion in the more mature athlete. Source: JAT 2004 Position Statement Konin Copyright 2009

31 Source: JAT 2004 Position Statement
F/U Guidelines Avoid meds – only acetaminophen from MD Avoid ingesting alcohol, illicit drugs, or other substances Instructed to rest, but complete bed rest is not recommended Eat a well-balanced diet that is nutritious in both quality and quantity An athlete should be awakened during the night to check on deteriorating signs and symptoms only if he or she experienced LOC, had prolonged periods of amnesia, or was still experiencing significant symptoms at bedtime Source: JAT 2004 Position Statement Konin Copyright 2009

32 Prospective randomized experimental study
Recovery patterns of athletes reporting posttraumatic headache following sports-related concussion Register et al, JAT 2006* Prospective randomized experimental study 375 concussed high school and collegiate athletes average age /- 1.87 Self-reported graded symptom checklist (GSC) Days 1,3, & 7 post injury data collection Conclusion: young athletes reporting PTH following a concussion endorse a higher number of symptoms and demonstrate decreases in neurocognitive performance when compared to those not reporting PTH Thus, headache is a sign of incomplete recovery Konin Copyright 2009

33 Concussion Gender Differences in Youth Divine et al 2007 MSSE*
Female athletes have higher severity o symptoms and longer recovery rates This was only seen when comparing non-helmeted athletes Unsure of reasons why Konin Copyright 2009

34 Concussion Management
What would you say is the most practical and affordable method of decision-making following a concussion for those settings without large budgets and personnel resources? Konin Copyright 2009

35 Younger Athletes Slower to Recover from Concussions, Studies Show
posted 02/02/09 5:45 pm                              ROCKVILLE, Md. - Every year more than 300,000 people report getting concussions from sports. But experts say millions more likely go undiagnosed. And while we see professional athletes like Super Bowl quarterback Ben Roethlisberger bounce back, for kids and teenagers it can be a long road to recovery. Konin Copyright 2009

36 Rotator Cuff and Periscapular Muscle Strength in Adolescent Male Baseball Players Kelp-Lenane et al. JOSPT 2008* Assessed strength relationship for y/o male baseball pitchers – Tanner 2 or 3, pitching for 2 years, no pain PS muscles were significantly weaker than RC muscles in dominant and non-dominant of all subjects Strength differences do not appear to be a result of pitching – are we doing the right thing in rehab? Rotator Cuff and Periscapular Muscle Strength in Adolescent Male Baseball Players Kelp-Lenane et al. JOSPT 2008* Konin Copyright 2009

37 Shoulder Injuries Konin Copyright 2009

38 AC Joint Sprain Downward force on the acromion process
Must be strong enough to displace AC ligament With excessive force, can eventually displace CC ligaments (Conoid & Trapezoid) Debate as to the exact grading criteria, not important – functional limitations are! Konin Copyright 2009

39 Acromioclavicular Joint Disorder
X-rays to determine grade G I-II sling, pain relief 5-7 days G III non-op unless cosmetic concerns -Weightlifters -Bathing suit appearance Konin Copyright 2009

40 Surrounding awareness
Rationale: Acute comfort Surrounding awareness Theoretically approximates a joint that will not heal on its own – therefore it provides comfort with partial tears Konin Copyright 2009

41 Clinical Pathway for AC Sprain
Control pain, usually minimal inflammation Avoid distraction activity Progress with functional exercises as tolerated Expect pain for a long time! Resultant instability not common regardless of profession/career/sport Bottom Line: Let pain & function dictate: don’t “over treat” or “over advise” Konin Copyright 2009

42 Will shoulder braces work? Functional?
Konin Copyright 2009

43 Elbow Injuries Konin Copyright 2009

44 Little League Elbow Medial epicondylitis and adolescents
8-10 y/o ~ bone weakest component 15-18 y/o ~ muscle/tendon/tissue weakest component Mid 20s and up ~ muscle and/or ligament weakest component Age tells you what structure is involved Konin Copyright 2009

45 What is your comfort level in advising with respect to preventing throwing injuries for little league baseball pitchers? 9-10 years 11-12 years 13-14 years Pitches per game 50 75 Pitches per week 100 125 Pitches per season 1000 Pitches per year 2000 3000 Proof?????????? Konin Copyright 2009

46 Preventing Injuries in Throwers with the Core and Hips
LE Flexibility (Used as part of an overall warm-up) Ipsilateral hip extension Hip IR/ER (Lack of IR will force truck to open early and increase stress on medial Elbow and /or anterior shoulder) Core Training for Throwers Abdominal Bracing /Drawing in maneuver Prone Cobra Progression LE Balance/Proprioception* Standing Pulls - ant/post/lat pull (Weak gluts cause the hip to drop leading to drop of shoulder) LE Functional Strength Training** Wind-Up/Lunge with twist Lunge with twist Step-Ups with twist *Functional exercise that is multiplanar, incorporates the lumbo-pelvic-hip core complex and can be challenged with proprioceptive input from unstable surfaces, eyes closed, etc ** Lunge strength will help deceleration injuries to the shoulder Konin Copyright 2009

47 Serape Effect Konin et al ATT 2003 Deficits in measurable active & passive hip extension, active hip flexion with pain (Kouvalchouk Rev Chir Orthop 1998) Konin Copyright 2009

48 Epicondylitis Considerations
Strings too loose Grip too large Poor technique Konin Copyright 2009

49 Wrist Ligament Sprains
“It is only a sprain” Avoid Grip Strength Activity! Konin Copyright 2009

50 Jersey Finger Pulling against fixed object Lifting with tips of finger
Laceration Crush Injury Amputation Konin Copyright 2009

51 Mallet Finger * Usually a result of blunt trauma Konin Copyright 2009

52 Muscle Strains Quadriceps & Hamstring Update
Konin Copyright 2009

53 Treatment of Hamstring Strains
THE RISK FACTORS: Muscle weakness, decrease muscle flexibility, lack of proper warm-up, fatigue, improper flexor/extensor strength ratio, increasing age, menstrual disturbances, previous injury Can we prevent ALL of these? Konin Copyright 2009

54 To Stretch Or Not To Stretch
Systematic search articles, of which 14 used a control group. Five suggested prevention, six suggested no difference but three suggested increased injury. The positive studies had warm-up as a co-intervention. Shrier I, Clin J Sports Med 1999, EBSM 2002 Konin Copyright 2009

55 Wenos & Konin J Strength Cond Res. 2004
Controlled warm-up intensity enhances hip range of motion. In a field setting, it is estimated that a warm-up of 70% of HRR would duplicate the muscle readiness equivalent to an RER of 1.00 before PNF stretching. Equivalent to 4 minutes of a light aerobic activity Konin Copyright 2009

56 The Impact of Stretching on Sports Injury
Stretching before or after exercise is not associated with a reduction in total injuries Produces small, statistically non-significant reductions in muscle soreness 5th day post injury tendon exhibits weakest tensile strength (right about the time one starts to “feel better”), then progressively gets stronger each day Thacker et al, Med Sci Sports Exer 2004, Herbert & Gabriel, BMJ 2002 Konin Copyright 2009

57 The Child’s Knee Konin Copyright 2009

58 Ligament Injuries - ACL
 200,000 new ACL injuries per year History Majority are non-contact injury with knee in extension (70%) Hemarthrosis within a few hours Audible pop in 50% More common in females - risk is at least 5X higher among women than men and the gender difference is even higher at the elite levels Konin Copyright 2009

59 Kramer et al JAT 2006, Lie et al 1997, Smith et al 1993
Factors associated with anterior cruciate ligament injury history in female athletes Increased generalized laxity Decreased ITB flexibility Previous ankle injury Menstrual cycle changes A decreased protective role of dynamic knee stabilizers (quadriceps and hamstrings) A diminished ability to resist anterior shear with muscle contraction. A smaller ACL than men A narrower intercondylar notch than men Wider Q-angle Wider hips/pelvis Increased foot pronation Kramer et al JAT 2006, Lie et al 1997, Smith et al 1993 Konin Copyright 2009

60 Neuromuscular Training May Assist in Preventing ACL Injuries
3/6 studies reduced ACL injury in females Question of consistencies, cost & time of implementation, compliance issues Some evidence that proprioceptive and balance exercises improve outcomes in individuals with ACL-deficient knees Improvements in joint position sense, muscle strength, perceived knee joint function, and hop testing were reported post intervention No adverse effects with intervention Too few studies to safely confirm Hewett et al, AM J Sports Med, 2005 Cooper et al, Res Sports Med 2005, Engebretson and Bahr BJSM 2005, Hammill et al JAT 2006 Konin Copyright 2009

61 ACL Injuries in Children
ACL deficiency in the skeletally immature has resulted in a high incidence of secondary meniscal injuries, degenerative joint disease, and symptomatic instability in both sports and daily activities. Skeletally immature athletes are in fact much less likely to limit their activities and adapt to ACL insufficiency than skeletally mature counterparts. Graf et al 1992, Mizuta et al 1995, McCarroll et al 1994 Konin Copyright 2009

62 ACL Prevention Programs
PEP Program Dr Mandelbaum et al. Santa Monica No cost SportsmetricsTM Dr. Noyes et al Cincinnati Sports Medicine Fees & certification The 11 Developed by FIFA F-MARC (Medical Research Centre) Konin Copyright 2009

63 ACL Prevention Program
We use PEP (Prevent Injury Enhance Performance) Highly specific 15-minute training session that replaces/compliments the traditional warm-up 2-3x weekly The Goals of the Program are to: 1) Avoid vulnerable positions 2) Increase flexibility 3) Increase strength 4) Include plyometric exercises into the training program 5) Increase proprioception though agilities Konin Copyright 2009

64 Konin Copyright 2009

65 Appear to play a role – may always be in question
What About Knee Braces? The “Breaking Point” Appear to play a role – may always be in question 7mm 12mm 15mm 5mm Pietrosimone et al JAT 2006, Naiibi & Albright Am J Sports Med 2005, McDevitt et al Am J Sports Med 2004 Konin Copyright 2009

66 How Common are Ankle Injuries?
Most common sports injury 85% of ankle injuries are sprains 85% of sprains involve lateral ligaments 20% - 40% lead to chronic symptoms Konin Copyright 2009

67 What Do You Need To Know About Ankle Sprains?
Most common risk is previous ankle sprain Supervised rehabilitation with proprioception intervention reduce risks of repeat Balance training improves sensorimotor control in athletes with previous injury Effect seems to be limited to those with previous injury, where postural control, position sense and postural reflexes are reduced Appropriately applied brace or tape does not hinder performance Taping or bracing can reduce incidence for recurrence of ankle sprains in athletes with previous ankle problems Unclear if high top shoes reduce the risk of injury Thacker et al, AM J Sports Med 1999, Bahr R. EBSM 2002 Konin Copyright 2009

68 High Ankle Sprain (SYNDESMOTIC)
Tib-Fib Sprain (anterior/posterior) Mechanism of injury is fixation and rotation Treatment is difficult due to lack of good support for this area internally & externally Konin Copyright 2009

69 Managing The High Ankle Sprain
Be patient! Tell the athlete to be patient! Tell the parents to be patient! Tell the coach to be patient! Konin Copyright 2009

70 Failing to Plan = Planning to Fail
Emergency Action Planning Build from existing templates & models Follow nationally and regionally accepted standards of policies & procedures Identify key steps – don’t guess What key components should be included? Who are the stake holders? What expenses might exist? Konin Copyright 2009

71 Field Safety Uneven playing surfaces
Surfaces with greater than normal friction, ie old hardwood courts Slippery playing surfaces, fields with puddles Improper illuminated lighting for night events Irrigation systems not completely buried Baseball dugouts without proper protection from hit balls Fences and that surround fields with protruding parts Goalposts and other fixed apparatus that are not properly protected with padding Konin Copyright 2009

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