Prevention and Treatment of Youth Running Injuries:Prevention and Treatment of Youth Running Injuries:Are they just little adults?Are they just little adults?

Andrew Cannon, PT, MHS, SCS, CSCSAndrew Cannon, PT, MHS, SCS, CSCSDirector of Sports Medicine, NRHNDirector of Sports Medicine, NRHN

Team Physical Therapist, Merrimack CollegeTeam Physical Therapist, Merrimack CollegeBoard Certified in Sports Physical TherapyBoard Certified in Sports Physical Therapy

TIMES HAVE CHANGED!TIMES HAVE CHANGED!

% Of Young People Overweight% Of Young People Overweight

0

2

4

6

8

10

12

14

16

1963-70 1971-74 1976-80 1988-94 1996-00

Overweight isOverweight isdefined as being indefined as being inthe 95%for bodythe 95%for bodymass indexmass index

Blue age 6-11Blue age 6-11 Green age 12-17Green age 12-17

Do they need to be active?Do they need to be active?

0

2

4

6

8

10

12

14

1963-70 1971-74 1976-80 1988-94

age 6-11

age 12-17

% of young people who are% of young people who areoverweightoverweight

inactivity and poor diet causesinactivity and poor diet causes300,000 preventable deaths every300,000 preventable deaths everyyear in the USAyear in the USA

Only tobacco causes moreOnly tobacco causes morepreventable deathspreventable deaths

Evidence suggests that someEvidence suggests that somechronic adult diseases may begin tochronic adult diseases may begin todevelop in childhooddevelop in childhood

Government guidelines and clinicalGovernment guidelines and clinicalrecommendations emphasize therecommendations emphasize theimportance of children beingimportance of children beingphysically activephysically activeFulton, JE. Assessment of Physical Activity, Fulton, JE. Assessment of Physical Activity, PedPed Ex Ex SciSci13:113124,200113:113124,2001

Do they need to play sports?Do they need to play sports?Whatever happened to gym class?Whatever happened to gym class?

Daily participation inDaily participation inphysical education byphysical education by% of high school% of high schoolstudentsstudents

SammannSammann, P., P. Active Youth. Human Kinetics, 1998Active Youth. Human Kinetics, 1998

0

5

10

15

20

25

30

35

40

45

50

1991 1993 1995

girls

boys

Does academic performanceDoes academic performancerelate to physical activity?relate to physical activity?

7,961 school kids7,961 school kids Age 7-15Age 7-15 Consistently acrossConsistently across

age groups andage groups andgender academicgender academicperformance wasperformance wascorrelated withcorrelated withphysical activity andphysical activity andfitness measurementsfitness measurements

Dwyer T, Relation of academic performance to physicalDwyer T, Relation of academic performance to physicalactivity and fitness in activity and fitness in childrenchildren.Ped.Ped ExSciExSci 13:225-23713:225-23720012001

Is my 13 year old a kid?Is my 13 year old a kid?

Children are not small adultsChildren are not small adults Anatomy and physiology isAnatomy and physiology is

developing and not maturedeveloping and not mature Despite these concepts whichDespite these concepts which

are intuitively understood inare intuitively understood inthe broadest sense, inthe broadest sense, inpractice, especially in athleticpractice, especially in athleticpursuits, these distinctions arepursuits, these distinctions areforgotten or worse, ignoredforgotten or worse, ignored

How come the other kid is faster,How come the other kid is faster,stronger, more coordinated?stronger, more coordinated?

Should anybody but parentsShould anybody but parentscare?care?

50% of all children, age 5-18, participate in50% of all children, age 5-18, participate inorganized sport programsorganized sport programs

18 million will incur sports related injury this18 million will incur sports related injury thisyear.year.

50% of these are overuse type injuries50% of these are overuse type injuries Annual cost to treat these preventableAnnual cost to treat these preventable

injuries is $1.2 billioninjuries is $1.2 billionHawkins, D:Overuse Injuries in Youth Sport. Hawkins, D:Overuse Injuries in Youth Sport. Med Med SciSci SprtSprt ExerExer. . 33:1701-1707, 200133:1701-1707, 2001

Why should kids not run?Why should kids not run?

1. Not medically cleared1. Not medically cleared2. Parents want them to2. Parents want them to3. Parents want them to3. Parents want them to4. Parents want them to4. Parents want them to5. Parents want them to5. Parents want them to

Are boys and girls equally injured?Are boys and girls equally injured?What will they injure?What will they injure?

High school X-C, 13.1/1000 athletic exposuresHigh school X-C, 13.1/1000 athletic exposures Girls, 16.7/1000, Boys 10.9/1000Girls, 16.7/1000, Boys 10.9/1000 Girls higher initial injury rate for shin, hip, footGirls higher initial injury rate for shin, hip, foot Girls higher reinjury rate knee, calf, footGirls higher reinjury rate knee, calf, foot

0

10

20

30

40

50

60

70

LE UE BACK

Will my child get injured?Will my child get injured? 18 million will incur sports18 million will incur sports

related injury this year.related injury this year. 24% of injuries from stumbling,24% of injuries from stumbling,

fallingfalling 22% of injuries from twist or22% of injuries from twist or

misstepmisstep 18% from push, kick from18% from push, kick from

opponentopponent Higher rate of injury inHigher rate of injury in

competition than trainingcompetition than training

What type of injury is it?What type of injury is it?

OveruseOveruse TraumaticTraumatic

Overuse Injury PreventionOveruse Injury Prevention

Pre-participationPre-participationscreeningscreening

Athlete/parent/patientAthlete/parent/patienteducationeducation

No pain = no gain??No pain = no gain??

Pain may be the result of a sport injuryPain may be the result of a sport injury Pain is a natural response to something beingPain is a natural response to something being

wrongwrong Pain is the barometer for activity continue or stopPain is the barometer for activity continue or stop Adults have prior experience to qualify painAdults have prior experience to qualify pain Trends can clarify the level of pain and injuryTrends can clarify the level of pain and injury

Overuse Injury Contributing FactorsOveruse Injury Contributing Factors

Muscle tendon imbalance (tight, weak)Muscle tendon imbalance (tight, weak) Inadequate/inappropriate rehab from priorInadequate/inappropriate rehab from prior

injuryinjury Anatomic malalignmentAnatomic malalignment Training errorsTraining errors Poor conditioningPoor conditioning Increased psychological stress, (adult/peer)Increased psychological stress, (adult/peer)

Youth specific risksYouth specific risks

A child with a shorter stride length subjects themselves toA child with a shorter stride length subjects themselves tomore repetition of heel strike to cover the same distance asmore repetition of heel strike to cover the same distance asan adultan adult

Immature cartilage is more susceptible to shear forces thanImmature cartilage is more susceptible to shear forces thanadult cartilageadult cartilage

Asynchrony of bone growth and muscle tendon elongation.Asynchrony of bone growth and muscle tendon elongation.Bone grows first which is the stimulus for muscle tendonBone grows first which is the stimulus for muscle tendonelongation, the delay may be 3-6 months, during whichelongation, the delay may be 3-6 months, during whichtime flexibility is significantly decreasedtime flexibility is significantly decreased

Overuse injury progressionOveruse injury progression

Pain only during high levels of activityPain only during high levels of activity Activity stops, then pain stopsActivity stops, then pain stops Pain will then persist after the activityPain will then persist after the activity

stopsstops Pain worsens with performance alteredPain worsens with performance altered Progresses to pain with ADL and withProgresses to pain with ADL and with

sleepsleep

What are the variables??What are the variables?? Pain present after activity for greaterPain present after activity for greater

than 2 hours must significantlythan 2 hours must significantlydecreases activitydecreases activity

LocationLocation FrequencyFrequency DurationDuration IntensityIntensity Training/competitionTraining/competition Surface, equipmentSurface, equipment

There is always an expert with aThere is always an expert with anew way, techniquenew way, technique

SAIDSAIDSPECIFIC

ADAPTATIONS

IMPOSED

DEMANDS

Overuse Growth Plate InjuriesOveruse Growth Plate Injuries

Good ResourcesGood Resources National Youth Sports Safety Foundation,National Youth Sports Safety Foundation,

nyssf.orgnyssf.org American College of Sports Medicine,American College of Sports Medicine,

acsm.org.acsm.org. National Strength and Conditioning Ass.National Strength and Conditioning Ass.

Nsca-lift.orgNsca-lift.org www.northeastrehab.comwww.northeastrehab.com MomMom’’s teams team Aap.orgAap.org

Should your child lift weights??Should your child lift weights??

Stretch and perform light exercise for 10 minutesStretch and perform light exercise for 10 minutes 6-8 exercises of 10-15 reps, they could do 2-36-8 exercises of 10-15 reps, they could do 2-3

moremore 1-3 sets, minimum of 1-2 minutes between sets1-3 sets, minimum of 1-2 minutes between sets If doing 2 sets, when almost 3, 2x, increaseIf doing 2 sets, when almost 3, 2x, increase

resistanceresistance Focus on better, smoother, not heavier, fasterFocus on better, smoother, not heavier, faster They must succeed!!They must succeed!!

Is the psychological partIs the psychological partoverrated ?overrated ?

Pressed by peers, coaches andPressed by peers, coaches andparents they are more likely toparents they are more likely to

ignore injury when it first begins orignore injury when it first begins orto use it as an escape techniqueto use it as an escape technique

THANKSTHANKS