Athletic injuries occur from two different mechanisms. Macrotrauma is a sudden injury from a major force. This could, for example, be due to a fall or hit during play. Macrotrauma can cause fractures, sprains of ligaments, muscle strains and bruises or contusions. Microtrauma is due to repetitive injury over a long period of time and these injuries are also termed overuse. Types of injuries include stress fracture, little league elbow and shoulder impingement syndrome.
Most of the information regarding frequency of sports injuries in adolescents is obtained form records kept on interscholastic high school sports. For all high school sports that boys participate in, the frequency of injury is twenty-seven to thirty-nine percent on an annual basis. Football accounts for the most injuries in boys, while soccer accounts for most injuries in girls. Other sports that contribute to injuries for boys and girls include gymnastics, basketball, baseball, softball, track and field and cross-country.
Ligamental sprains, muscle strains and bruises account for most of the acute injuries. However, overuse injuries are more common in adolescents than acute injuries. Research studies have shown that up to forty-eight percent of adolescent athletes sustained one injury during their playing season. Most of the injuries were considered to be minor where no playing days were lost.
Who is likely to develop athletic injuries
Adolescents may be at special risk for athletic injuries. During the growth spurt, the skeleton must support increased weight and load. As a result, there is increased risk for a severe injury in teens. It is well known that the number of football injuries increase for teenagers as they grow in height and weight. During growth and development, agility, power, speed and motor coordination improve. Girls by age fourteen years seem to stabilize in regard to motor performance while boys improve during the later teenage years.
The increased skill levels in adolescent athletes usually lead to a higher level of competition during sports. Higher speeds and increased intensity of competition may then lead to increased injuries for both boys and girls.
During the growth spurt, lengthening of the bones occurs before growth in the connective tissues. As a result, there may be a relative decrease in flexibility during this period. Girls tend to be more flexible than boys and peak in their flexibility around age fifteen years compared to boys who develop increased flexibility later in adolescence. Decreased flexibility may cause an increased risk for overuse injuries in both boys and girls.
There are other factors that may contribute to a teenager sustaining an athletic injury. These include the following:
There are many different types of athletic injuries. Microtrauma usually causes overuse symptoms. Shoulder impingement syndrome causes shoulder pain in swimmers, tennis players, and gymnastics and in sports where overhead throwing is common including baseball. The rotator cuff muscles in the shoulder help to stabilize the head of the humerus or arm bone in the shoulder joint. Repetitive overuse can lead to inflammation of rotator cuff tendons. This leads to swelling and pain in the shoulder especially with activities that involve the shoulder. Pain is worsened with overhead movements of the arm.
Another type of overuse syndrome in younger adolescents is little league elbow. This is caused by a pulling injury to the medial epicondyle on the lower part of the upper arm bone called the humerus. The teen develops pain on the inside part of the elbow associated with throwing motions. Often it is seen in pitchers, and when little league elbow develops, the pitcher’s performance often deteriorates.
Gymnasts may develop overuse in the wrist. The wrist is subjected to compression forces as the hand is flexed upward. This may produce pain in the dorsal or top surface of the wrist especially so with floor exercises and vaulting. Occasionally some gymnasts complain of pain in the forearm. Usually these symptoms are seen in young adolescent girls who practice gymnastics more than thirty-five hours each week.
Lower back pain may be a symptom of spondylolysis of the vertebrae. Seen in athletes, such as gymnasts, who repeatedly hyperextend their back, spondylolysis is caused by a series of microtrauma to the lower back.
Knee pain can be caused be several overuse syndromes. Patellofemoral syndrome is a disorder where the kneecap does not move in a normal manner when the knee is flexed and extended. Osgood-Schlatter disease, which is seen in growing teens, is characterized by pain below the kneecap. Typically the pain occurs during exercise when the tendon that connects the kneecap to the lower leg bone called the tibia is utilized. Osteochondritis dessicans may also cause knee pain. This problem occurs when a portion of the bone separates from the femur or thighbone. The knee may also feel unstable, lock or swell.
Sever’s disease is an overuse injury that affects the heel bone or calcaneus where the achille’s tendon is attached. Commonly seen in gymnasts, basketball players and soccer players during early adolescence, the teen will feel heel pain and tenderness over the heel. Running and deceleration activities will make the pain feel worse.
Macrotrauma or acute injuries constitute problems including contusions, sprains, strains and fractures. Acute sports injuries are the second most common cause for adolescents to visit hospital emergency rooms, and it is estimated that approximately three million youth are seen in hospitals for sports related injuries.
Contusions or bruises may occur at any body site from head to toes. Concussion is the most common head injury seen by sports physicians. A concussion is defined as a transient alteration to the athlete’s mental status due to head injury. Loss of consciousness is not necessary. Concussion is graded from one to three depending on the severity. Symptoms of grade one concussion included transient confusion such as inattention, inability to maintain a coherent stream of thought or carry out goal-directed movements. There is no loss of consciousness and symptoms usually resolve in fifteen minutes or less. Grade two concussion is more severe. Here there is no loss of consciousness, but there is transient confusion, and the symptoms last more than fifteen minutes. And grade three concussion does have loss of consciousness.
An example of contusion to the foot is seen in football players and runners who suffer turf toe. Pain and swelling of the great toe may occur. Often there is blood under the toenail, and this causes pain.
Sprain occurs in supporting tissues including ligaments and tendons. The most common sports injury is the sprained ankle. Ankle injuries comprise up to forty-five percent of all basketball injuries and about twenty-five percent of all injuries in volleyball. The ankles consists of three bones and two joints; ligaments hold the joints together and provide stability. A sprain occurs when an abnormal movement of force causes the ligaments to be stretched or torn. There is pain, swelling and often bruising on the outside of the ankle.
Sprain or even torn ligaments occur not uncommonly in the knee joint in athletes. The anterior cruciate ligament is strong tissue, and it connects the femur to the tibia while it helps to stabilize the knee joint. When the athlete has a sudden directional change, a strong force can be placed on this ligament causing a tear or rupture. There may be a popping sound that is followed by pain, swelling and instability.
A muscle strain can be caused by excessive contraction or overuse of a muscle group. Marathoners frequently have muscle strain often in the hamstrings located on the back of the thigh, quadriceps on the front of the thigh or the calves. Symptoms usually include pain. Quadriceps injuries are most common in soccer, rugby and football players.
Fractures may occur in most bones in adolescent athletes especially in collision sports such as football. Appropriate athletic equipment will help to prevent fractures. Long distance runners may trip and fall landing on an outstretched hand. A fracture of the radius, the lower arm bone, will produce the symptoms of pain, swelling and deformity. Basketball players can sustain fractures to fingers, and football players may get rib fractures. Most fractures will be painful; swelling is usually present while deformity does not always occur.
How are athletic injuries evaluated
Injuries are evaluated depending on the extent, location and severity. For example, a coach or trainer may evaluate grade one concussion. An adolescent with grade two concussion is removed from the contest, examined on site and then usually seen in follow up by a clinician prior to return to athletics. And a teen with grade three concussions is transported immediately to a medical facility for evaluation.
Although clinicians should see all potential fractures, some sprains, strains and contusions need not have medical evaluation. A teen should ask his or her family, coach, trainer or physician if there is any question whether an injury should be evaluated.
How are athletic injuries treated?
Treatment of athletic injuries will depend, of course, on the nature of the injury. The treatment of these injuries would comprise a large textbook. One should remember the mnemonic RICE. Sprains and strain may be treated with Rest, Ice, Compression and Elevation. Obviously one needs to be certain that the teen does not have a condition that requires more extensive treatments.
It is important to mention “second impact” syndrome which is an entity seen almost exclusively in athletes who are younger than twenty-one years. Repeated head injury to adolescents can result in a serious condition where there is sudden severe brain swelling. Usually there is a history of a prior head injury, and the athlete has returned to sports before all symptoms from the first head injury have cleared. Even though the second head injury may be relatively mild, the athlete is stunned, collapses and becomes comatose. Within two to five minutes, the teen may be critically ill. Prevention of this catastrophic injury includes heading the clinician’s advice not to return to practice until symptoms from the first injury have dissipated.
How are athletic injuries prevented?
The following are some of the strategies that may help teens prevent athletic injuries:
Parents should recall the following strategies to help prevent athletic injuries in adolescents:
Athletic equipment, competition, exercise, foot injuries, growth and development, head injuries, knee disorders, obesity, shin splints, sports, stress fractures, X-treme sports safety
Most of the information regarding frequency of sports injuries in adolescents is obtained form records kept on interscholastic high school sports. For all high school sports that boys participate in, the frequency of injury is twenty-seven to thirty-nine percent on an annual basis. Football accounts for the most injuries in boys, while soccer accounts for most injuries in girls. Other sports that contribute to injuries for boys and girls include gymnastics, basketball, baseball, softball, track and field and cross-country.
Ligamental sprains, muscle strains and bruises account for most of the acute injuries. However, overuse injuries are more common in adolescents than acute injuries. Research studies have shown that up to forty-eight percent of adolescent athletes sustained one injury during their playing season. Most of the injuries were considered to be minor where no playing days were lost.
Who is likely to develop athletic injuries
Adolescents may be at special risk for athletic injuries. During the growth spurt, the skeleton must support increased weight and load. As a result, there is increased risk for a severe injury in teens. It is well known that the number of football injuries increase for teenagers as they grow in height and weight. During growth and development, agility, power, speed and motor coordination improve. Girls by age fourteen years seem to stabilize in regard to motor performance while boys improve during the later teenage years.
The increased skill levels in adolescent athletes usually lead to a higher level of competition during sports. Higher speeds and increased intensity of competition may then lead to increased injuries for both boys and girls.
During the growth spurt, lengthening of the bones occurs before growth in the connective tissues. As a result, there may be a relative decrease in flexibility during this period. Girls tend to be more flexible than boys and peak in their flexibility around age fifteen years compared to boys who develop increased flexibility later in adolescence. Decreased flexibility may cause an increased risk for overuse injuries in both boys and girls.
There are other factors that may contribute to a teenager sustaining an athletic injury. These include the following:
- Hazardous playing fields
- Poor conditioning
- Competing while injured or fatigued
- Poor nutrition
- Poor physical fitness
- Inadequate supervision
- Stress
- Weather conditions
- Inadequate, poorly fitted, improper safety equipment
- Teams set by age rather than size
There are many different types of athletic injuries. Microtrauma usually causes overuse symptoms. Shoulder impingement syndrome causes shoulder pain in swimmers, tennis players, and gymnastics and in sports where overhead throwing is common including baseball. The rotator cuff muscles in the shoulder help to stabilize the head of the humerus or arm bone in the shoulder joint. Repetitive overuse can lead to inflammation of rotator cuff tendons. This leads to swelling and pain in the shoulder especially with activities that involve the shoulder. Pain is worsened with overhead movements of the arm.
Another type of overuse syndrome in younger adolescents is little league elbow. This is caused by a pulling injury to the medial epicondyle on the lower part of the upper arm bone called the humerus. The teen develops pain on the inside part of the elbow associated with throwing motions. Often it is seen in pitchers, and when little league elbow develops, the pitcher’s performance often deteriorates.
Gymnasts may develop overuse in the wrist. The wrist is subjected to compression forces as the hand is flexed upward. This may produce pain in the dorsal or top surface of the wrist especially so with floor exercises and vaulting. Occasionally some gymnasts complain of pain in the forearm. Usually these symptoms are seen in young adolescent girls who practice gymnastics more than thirty-five hours each week.
Lower back pain may be a symptom of spondylolysis of the vertebrae. Seen in athletes, such as gymnasts, who repeatedly hyperextend their back, spondylolysis is caused by a series of microtrauma to the lower back.
Knee pain can be caused be several overuse syndromes. Patellofemoral syndrome is a disorder where the kneecap does not move in a normal manner when the knee is flexed and extended. Osgood-Schlatter disease, which is seen in growing teens, is characterized by pain below the kneecap. Typically the pain occurs during exercise when the tendon that connects the kneecap to the lower leg bone called the tibia is utilized. Osteochondritis dessicans may also cause knee pain. This problem occurs when a portion of the bone separates from the femur or thighbone. The knee may also feel unstable, lock or swell.
Sever’s disease is an overuse injury that affects the heel bone or calcaneus where the achille’s tendon is attached. Commonly seen in gymnasts, basketball players and soccer players during early adolescence, the teen will feel heel pain and tenderness over the heel. Running and deceleration activities will make the pain feel worse.
Macrotrauma or acute injuries constitute problems including contusions, sprains, strains and fractures. Acute sports injuries are the second most common cause for adolescents to visit hospital emergency rooms, and it is estimated that approximately three million youth are seen in hospitals for sports related injuries.
Contusions or bruises may occur at any body site from head to toes. Concussion is the most common head injury seen by sports physicians. A concussion is defined as a transient alteration to the athlete’s mental status due to head injury. Loss of consciousness is not necessary. Concussion is graded from one to three depending on the severity. Symptoms of grade one concussion included transient confusion such as inattention, inability to maintain a coherent stream of thought or carry out goal-directed movements. There is no loss of consciousness and symptoms usually resolve in fifteen minutes or less. Grade two concussion is more severe. Here there is no loss of consciousness, but there is transient confusion, and the symptoms last more than fifteen minutes. And grade three concussion does have loss of consciousness.
An example of contusion to the foot is seen in football players and runners who suffer turf toe. Pain and swelling of the great toe may occur. Often there is blood under the toenail, and this causes pain.
Sprain occurs in supporting tissues including ligaments and tendons. The most common sports injury is the sprained ankle. Ankle injuries comprise up to forty-five percent of all basketball injuries and about twenty-five percent of all injuries in volleyball. The ankles consists of three bones and two joints; ligaments hold the joints together and provide stability. A sprain occurs when an abnormal movement of force causes the ligaments to be stretched or torn. There is pain, swelling and often bruising on the outside of the ankle.
Sprain or even torn ligaments occur not uncommonly in the knee joint in athletes. The anterior cruciate ligament is strong tissue, and it connects the femur to the tibia while it helps to stabilize the knee joint. When the athlete has a sudden directional change, a strong force can be placed on this ligament causing a tear or rupture. There may be a popping sound that is followed by pain, swelling and instability.
A muscle strain can be caused by excessive contraction or overuse of a muscle group. Marathoners frequently have muscle strain often in the hamstrings located on the back of the thigh, quadriceps on the front of the thigh or the calves. Symptoms usually include pain. Quadriceps injuries are most common in soccer, rugby and football players.
Fractures may occur in most bones in adolescent athletes especially in collision sports such as football. Appropriate athletic equipment will help to prevent fractures. Long distance runners may trip and fall landing on an outstretched hand. A fracture of the radius, the lower arm bone, will produce the symptoms of pain, swelling and deformity. Basketball players can sustain fractures to fingers, and football players may get rib fractures. Most fractures will be painful; swelling is usually present while deformity does not always occur.
How are athletic injuries evaluated
Injuries are evaluated depending on the extent, location and severity. For example, a coach or trainer may evaluate grade one concussion. An adolescent with grade two concussion is removed from the contest, examined on site and then usually seen in follow up by a clinician prior to return to athletics. And a teen with grade three concussions is transported immediately to a medical facility for evaluation.
Although clinicians should see all potential fractures, some sprains, strains and contusions need not have medical evaluation. A teen should ask his or her family, coach, trainer or physician if there is any question whether an injury should be evaluated.
How are athletic injuries treated?
Treatment of athletic injuries will depend, of course, on the nature of the injury. The treatment of these injuries would comprise a large textbook. One should remember the mnemonic RICE. Sprains and strain may be treated with Rest, Ice, Compression and Elevation. Obviously one needs to be certain that the teen does not have a condition that requires more extensive treatments.
It is important to mention “second impact” syndrome which is an entity seen almost exclusively in athletes who are younger than twenty-one years. Repeated head injury to adolescents can result in a serious condition where there is sudden severe brain swelling. Usually there is a history of a prior head injury, and the athlete has returned to sports before all symptoms from the first head injury have cleared. Even though the second head injury may be relatively mild, the athlete is stunned, collapses and becomes comatose. Within two to five minutes, the teen may be critically ill. Prevention of this catastrophic injury includes heading the clinician’s advice not to return to practice until symptoms from the first injury have dissipated.
How are athletic injuries prevented?
The following are some of the strategies that may help teens prevent athletic injuries:
- Have a sports preparticipation physical examination
- Before each training or sports event, warm up and then cool down afterward
- Do flexibility exercises
- Play within safe ranges for one’s age and size
- Use proper and well fitted equipment
- Keep oneself physically fit
- Begin training one to two months before the sports activity is to begin
- Gradually increase one’s training time but not more than ten percent each week
Parents should recall the following strategies to help prevent athletic injuries in adolescents:
- Encourage teens to participate in several different sports
- Insist coaches adhere to appropriate training principles
- Modify rules for adult games so they are appropriate for adolescents
- Ensure contests are supervised carefully and rules strictly enforced
- Be careful not to emphasize winning beyond safety
Athletic equipment, competition, exercise, foot injuries, growth and development, head injuries, knee disorders, obesity, shin splints, sports, stress fractures, X-treme sports safety
3 comments:
Athletic injuries are a pain in the but and this is a great resource to help break it down. Thanks for this
Essentials of Athletic Injury Management
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