Sports injuries in pediatrics

objectives
- Be familiar with types of sports injuries in children.
- Differentiate between sports injuries in children and. adults.
-Identify growth plate injuries ,apophyseal injuries ,heat related injuries and
hamstring muscle injury.
-Understand how to prevent sports injuries in children.
-Demonstrate the effective physical examination& interventions for Each type of
sports injuries in children.orthopedic injuries occur in children while playing sports.

The most Common Sports-related injuries in kids are two primary types the high
impact injury as fracture or sprain and overuse injury.
So sports injuries can range from scrapes and bruises to serious brain and spinal
cord injuries, most fall somewhere between the two extremes.

The children differ from adults. Children have different physiological capabilities
than adults that can affect their participation in sports. Children are growing, which
result in differences in musculoskeletal system.

These differences are:

1- Pediatric bone has a higher water content and lower mineral content.
2- Pediatric bones are brittle than adult bone.
3- Rich blood supply in pediatric bone.
4- The physis (growth plate) cartilaginous structure that is weaker than bone
predisposed to injury.
5- Ligaments in children are functionally stronger than bone; therefore, children
are more likely to sustain fractures rather than sprains.

Sprains and Strains

• A sprain is an injury to a ligament, one of the bands of tough, fibrous tissue that
connects two or more bones at a joint and prevents excessive movement of the
joint. An ankle sprain is the most common athletic injury.
• A strain is an injury to either a muscle or a tendon. A muscle is a tissue composed
of bundles of specialized cells that, when stimulated by nerve messages contract
and produce movement. A tendon is a tough, fibrous cord of tissue that connects
muscle to bone. Muscles in any part of the body can be injured.
• A twisting force to the lower leg or foot is a common cause of ankle fractures,
as well as ligament injuries (sprains).
Catastrophic Sports Injuries
Many sports, especially contact sports, have inherent dangers that put young
athletes at special risk for severe injuries. Even with rigorous training and proper
safety equipment, children are at risk for severe injuries to the head and neck with
damage to the brain or spinal cord.

Overuse injuries:
Overuse injuries occur gradually over time, when an athletic activity is repeated so
often, parts of the body do not have enough time to heal between playing.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates.
For example, overhand pitching in baseball can be associated with injuries to the
elbow.
Swimming is often associated with injuries to the shoulder.
Gymnastics And heerleading are two common activities associated with injuries to
the wrist and elbow.

Fracture
Growth Plate Injuries
• All children who are still growing are at risk for a growth plate injury. These
injuries are reported to peak in adolescents.
• Growth plate fractures occur twice as often in boys as in girls.
• One third of all growth plate injuries occur in competitive sports, such as football,
basketball, or gymnastics.
• About 20 percent of growth plate fractures occur as a result of recreational
activities, such as biking, sledding, skiing, or skateboarding.

Salter-Harris system

Type I Fractures
These fractures break through the bone at the growth plate, separating the bone end
from the bone shaft and completely disrupting the growth plate.
Type II Fractures
These fractures break through part of the bone at the growth plate and crack
through the bone shaft as well.
Type III Fractures
These fractures cross through a portion of the growth plate and break off a piece of
the bone end.
Type IV Fractures
These fractures break through the bone shaft, the growth plate, and the end of the
bone.
Type V Fractures
These fractures occur due to a crushing injury to the growth plate from a
compression force.
They are rare fractures.

Symptoms
Any child who experiences an injury that results in visible deformity, persistent or
severe pain, or an inability to move or put pressure on a limb should be examined.
Examination, Signs
The area around the end of the broken bone, near the joint, will be swollen, warm,
very tender, and may appear crooked when compared to the uninjured side.
Investigation, Tests
To make the diagnosis, the doctor will examine the child and probably use x-rays
to determine whether a growth plate fracture occurred. Occasionally, request other
diagnostic tests, such as magnetic resonance imaging (MRI), computed
tomography (CT), or ultrasound.

Type I Fractures
• These fractures may result in disrupted bone growth.
• Many can be treated with cast immobilization, but surgical treatment may be
necessary. If surgery is needed, these fractures are often treated with internal
fixation (pins) to hold the bone together and ensure proper alignment.
Type II Fractures
• These fractures generally heal well, although surgery may sometimes be required.
This is the most common type of growth plate fracture.
• Most are treated with cast immobilization.
Type III Fractures
• This Type III fracture of the thighbone (femur) goes through the growth plate and
down into the knee joint. The fracture is fixed in place with screws. This restores
normal joint alignment.
• These fractures are more common in older children. Because the center of the
growth plate has begun to harden, the fracture does not continue across the bone,
but angles down and breaks the bone end.
• A Type III fracture is treated with surgery and internal fixation to ensure proper
alignment of both the growth plate and the joint surface
.Type IV Fractures
• These fractures commonly stop bone growth.
• They are treated with surgery and internal fixation.
Type V Fractures
• These fractures can often be treated with cast immobilization or may require
surgery.
• There is almost always a growth disturbance with these fractures.

Apophyses
Are growth plates that add shape and contour rather than length to
a bone?
– Are often sites of muscle attachment?
– Avulsions at the apophysis are common in older children and adolescents.

Osgood-Schlatter Disease (Knee Pain)

Symptoms
-Knee pain
-Swelling
-Tenderness below the kneecap
that Symptoms are worsen the activity may require rest for several months,
followed by a conditioning program.
In some patients, Osgood-Schlatter symptoms may last for 2 to 3 years. However,
most symptoms will completely disappear with completion of the adolescent
growth spurt, around age 14 for girls
and age 16 for boys

Sever’s Disease: is an apophysitis of the calcaneus. The same presentation of the

Osgood-Schlatter disease but it involves the heel.
Osteochondritis dissecans

• the growing articular cartilage is susceptible to shear, and other stress forces
repetitive shear forces of the heel can cause microdegeneration of articular
cartilage forming loose bodies that float around major joints. This condition is
most common in the hip, knee, shoulder, and ankle.
• The treatment is symptomatic, the rest allow eventually resorption of the loose
bodies"
Little Leaguer's elbow"
Repeated pulling can tear ligaments and tendons away from the bone. The tearing
may pull tiny bone fragments with it in the same way a plant takes soil with it
when it is uprooted. This can disrupt normal bone growth, resulting in deformity.

Symptoms
"Little Leaguer's elbow" may cause pain on the inside of the elbow. A child should
stop throwing if any of the following symptoms appear:
-Elbow pain
-Restricted range of motion
-Locking of the elbow joint

Repetitive Motion Injuries

-Painful injuries such as stress fractures (a hairline fracture of the bone that has
been subjected to repeated stress) and tendinitis (inflammation of a tendon) can
occur from overuse of muscles and tendons. Some of these injuries don’t always
show up on x rays, but they do cause pain and discomfort.
-The injured area usually responds to rest, ice, compression, and elevation (RICE).
Other treatments can include crutches, cast immobilization,

Heat-related illnesses include:

• dehydration (deficit in body fluids)
• heat exhaustion (nausea, dizziness, weakness, headache, pale and moist skin,
heavy perspiration, normal or low body temperature, weak pulse, dilated
pupils,disorientation, and fainting spells).
• heat stroke (headache, dizziness, confusion, and hot dry skin, possibly leading to
vascular collapse, coma, and death).
• Heat injuries are always dangerous and can be fatal. Heat related injuries are a
particular problem for children because children perspire less than adults and
require a higher core body temperature to trigger sweating. Playing rigorous sports
in the heat requires close monitoring of both body and weather conditions.
Fortunately, heat-related illnesses can be prevented.

Hamstring Muscle Injuries

-Hamstring muscle injuries — such as a "pulled hamstring" — occur frequently in
athletes. They are especially common in athletes who participate in sports that
require sprinting, such as track, soccer, and basketball.
-A pulled hamstring or strain is an injury to one or more of the muscles at the back
of the thigh. Most hamstring injuries respond well to simple, nonsurgical
treatments.
Anatomy
The hamstring muscles run down the back of the thigh. There are three hamstring
muscles:
-Semitendinosus.
-Semimembranosus.
-Biceps femoris.
Cause Muscle Overload:
-Muscle overload is the main cause of hamstring muscle strain. This can happen
when the muscle is stretched beyond its capacity or challenged with a sudden
load.

•Hamstring muscle strains often occur when the muscle lengthens as it contracts or
shortens. Although it sounds contradictory, this happens when you extend a
muscle while it is weighted or loaded. This is called an "eccentric contraction.“

•During sprinting, the hamstring muscles contract eccentrically as the back leg is
straightened and the toes are used to push off and move forward. The hamstring
muscles are not only lengthened at this point in the stride, but they are also
loaded — with body weight as well as the force required for forward motion
.
•Like strains, hamstring tendon avulsions are also caused by large, sudden loads.
• Athletes who participate in sports like football, soccer, basketball.
• Runners or sprinters
• Dancers
• Older athletes whose exercise program is primarily walking.
• Adolescent athletes who are still growing

Symptoms
•notice a sudden, sharp pain in the back, lead to a quick stop.
•Swelling during the first few hours after injury.
•Bruising or discoloration of the back of your leg below the knee over the first few
days.
•Weakness in your hamstring that can persist for weeks.

Examination
Patient History and Physical Examination

•because of a sudden pain in the back of the thigh that occurred when exercising.
•During the physical examination, ask about the injury and check thigh for
tenderness or bruising. palpate, or press, the back of your thigh to see if there is
pain, weakness, swelling, or a more severe muscle injury.

Treatment in acute stage

•RICE. The RICE protocol is effective for most sports-related injuries. RICE
stands for Rest, Ice, Compression, and Elevation.
•Rest. Take a break from the activity that caused the strain. Your doctor may
recommend that you use crutches to avoid putting weight on your leg.
•Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice
directly to the skin.
•Compression. To prevent additional swelling and blood loss, wear an elastic
compression bandage.
•Elevation. To reduce swelling, recline and put your leg up higher than your heart
while resting.
•Immobilization. may be recommend you wear a knee splint for a brief time. This
will keep your leg in a neutral position to help it heal.

PT in subacute stage
•Once the initial pain and swelling has settled down, physical therapy can begin.
Specific exercises can restore range of motion and strength.
•A therapy program focuses first on flexibility. Gentle stretches will improve your
range of motion. As healing progresses, strengthening exercises will gradually be
added to your program. when it is safe to return to sports activity.

Points to prevent muscle strain including:

•Muscle tightness. Tight muscles are vulnerable to strain. Athletes should follow a
year round program of daily stretching exercises.
•Muscle imbalance. When one muscle group is much stronger than its opposing
muscle group, the imbalance can lead to a strain. This frequently happens with the
hamstring muscles. The quadriceps muscles at the front of the thigh are usually
more powerful. During high-speed activities, the hamstring may become fatigued
faster than the quadriceps. This fatigue can lead to a strain.
•Poor conditioning. If muscles are weak, they are less able to cope with the stress
of exercise and are more likely to be injured.
•Muscle fatigue. Fatigue reduces the energy-absorbing capabilities of muscle,
making them more susceptible to injury.
Rehabilitation
•After surgery, you will need to keep weight off of leg to protect the repair. In
addition to using crutches, you may need a brace that keeps hamstring in a relaxed
position. How long you will need these aids will depend on the type of injury.
•physical therapy program will begin with gentle stretches to improve flexibility
and range of motion. Strengthening exercises will gradually be added to your plan.
•Rehabilitation for a proximal hamstring reattachment typically takes at least
6months, due to the severity of the injury. Distal hamstring reattachments require
approximately 3 months of rehabilitation before returning to athletic activities.

Pediatric training
• Children can benefit from training regimen improve strength,
endurance, and skills to participate in sports

Thermoregulatory capability
low exercise economy, diminished sweating capacity, and less cardiac output at the
same workload compared with adults. Consequently, children have been regarded
as an at-risk group for not only decrements of physical performance but also heat
injury during physical activities performed in conditions of high ambient
temperature. Recent investigations that have directly compared thermoregulatory
responses to exercise in the heat in children and adults have challenged these
traditional concepts. These findings imply that no maturational differences exist in
thermal balance or endurance performance during exercise in the heat, nor that
child athletes are more vulnerable
to heat injury.

Cardiovascular training
A prepubescent child does not increase his maximum oxygen uptake significantly
with training. Therefore, the child performance in running long distance improves
with low- intensity , long duration training. Short intense workouts, such as
interval training, have not been shown to improve performance in children

Strength training
Because prepubescent children lack the androgens to build muscle bulk, it was
formerly thought that they could not benefit from weight training

Other considerations nutrition, relation between weight and height body

composition, a level of maturity to follow directions and accept supervision, stage
of growth.
How to prevent injuries
• Make sure that child has consistently uses— proper gear for a particular sport.
This may reduce the chances of being injured.
• Make warm-ups and cool downs part of child’s routine before and after sports
participation. Warm-up exercises, such as stretching and light jogging, can help
minimize the chance of muscle strain or other soft tissue injury during sports.
Warm-up exercises make the body’s tissues warmer and more flexible. Cool down
exercises loosen muscles that have tightened during exercise.
• Make sure that child has access to water or a sports drink while playing.
Encourage him or her to drink frequently and stay properly hydrated. Remember to
include sunscreen and a hat (when possible) to reduce the chance of
sunburn, which is a type of injury to the skin. Sun protection may also decrease the
chances of malignant melanoma—a potentially deadly skin cancer—or other skin
cancers that can occur later in life.
• Learn and follow safety rules and suggestions for child’s particular sport. You’ll
find some more sport-specific safety suggestions below.

Basketball
• Common injuries and locations: sprains; strains; bruises; fractures; scrapes;
dislocations; cuts; injuries to teeth, ankles and knees. (Injury rates are higher in
girls, especially for the anterior cruciate ligament (ACL), the wide ligament that
limits rotation and forward movement of the shin bone.)
• Safest playing with eye protection, elbow and knee pads, mouth guard, athletic
supporters for males, proper shoes, water. If playing outdoors, wear sunscreen and,
when possible, a hat.
• Injury prevention: strength training (particularly knees and shoulders), aerobics
(exercises that develop the strength and endurance of heart and lungs), warm up
exercises, proper coaching, and use of safety equipment.

Football
• Common injuries and locations: bruises; sprains; strains; pulled muscles; tears
to soft tissues such as ligaments; broken bones; internal injures (bruised or
damaged organs); concussions; back injuries; sunburn. Knees and ankles are the
most common injury sites.
• Safest playing with helmet; mouth guard; shoulder pads; athletic supporters for
males; chest/rib pads; forearm, elbow, and thigh pads; shin guards; proper shoes;
sunscreen; water.
• injury prevention: proper use of safety equipment, warm-up exercises, proper
coaching techniques and conditioning.

Baseball and Softball

• Common injuries: soft tissue strains; impact injuries that include fractures
caused by sliding and being hit by a ball; sunburn.
• Safest playing with batting helmet; shin guards; elbow guards; athletic
supporters for males; mouth guard; sunscreen; cleats; hat; detachable,
“breakaway bases” rather than traditional, stationary ones.
• Injury prevention: proper conditioning and warm-ups.

Basketball

• ”High ankle sprain”

• Syndesmosis injury
• * ligament between tibia and fibula tears
• * Mechanism is outward twisting of ankle

Soccer
• Common injuries: bruises, cuts and scrapes, headaches, sunburn.
• Safest playing with shin guards, athletic supporters for males, cleats, sunscreen,
water.
• Injury prevention:
aerobic conditioning and warmups, and proper training in “heading” (that is, using
the head to strike or make a play with the ball).
Gymnastics
• Common injuries: sprains and strains of soft tissues.
• Safest playing with athletic supporters for males, safety harness, joint supports
(such as neoprene wraps), water.
• Injury prevention: proper conditioning and warm ups