1. © 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 25: Preventing and Managing Injuries in Young Athletes

2. © 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

3. © 2010 McGraw-Hill Higher Education. All rights reserved. Questions still arise concerning the appropriateness of youth participation in sports Level of training intensity and frequency remains a concern

4. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

5. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

6. © 2010 McGraw-Hill Higher Education. All rights reserved.

7. 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

8. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

9. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

10. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

11. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

12. © 2010 McGraw-Hill Higher Education. All rights reserved. Young athletes should focus on developing muscular strength, endurance, cardiovascular fitness and flexibility Should work with fitness professionals, coaches and ATC’s (if possible) year- round to maintain fitness and nutrition Engage in appropriate conditioning program for 6 weeks prior to beginning daily practice routine

13. © 2010 McGraw-Hill Higher Education. All rights reserved. Athletes should engage in appropriate warm- up (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

14. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

15. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

16. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

17. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

18. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

19. © 2010 McGraw-Hill Higher Education. All rights reserved. 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)

20. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

21. © 2010 McGraw-Hill Higher Education. All rights reserved. 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)

22. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

23. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

24. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

25. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

26. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

27. © 2010 McGraw-Hill Higher Education. All rights reserved. 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 5 th metatarsal –More common in lower vs. upper extremity

28. © 2010 McGraw-Hill Higher Education. All rights reserved. Spondylolysis Defect or fracture in bony structures of spine Generally the result of repetitive loading Occur between ages of 5-10 around the 4 th and 5 th 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

29. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

30. © 2010 McGraw-Hill Higher Education. All rights reserved. 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

31. © 2010 McGraw-Hill Higher Education. All rights reserved. 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