Transcript Common Overuse Injuries - Palmyra Riverton Soccer Club

Common Overuse Adolescent
Injuries
David B. Gealt, D.O.
Assistant Professor UMDNJ-SOM
Assistant Professor UMDNJ-RWJ
Cooper Bone and Joint Institute
Cooper University Hospital
August 24, 2011
Understanding Normalcy
Inverted
Bow-legged
Normal
Normal
Everted
Knock-kneed
Understanding Normalcy,
cont.
These are abnormal foot types…a normal or neutral foot
type is a happy medium between these two.
Pes planus = Flatfoot
Pes cavus = High arch foot
Best Foot Forward
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A person who runs
properly:
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Lands on heel
Foot rolls to ball of toe
while turning inward
(pronates)
A person who runs flat
footed:
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Lands on heel AND ball of
foot
Foot rolls inward
excessively, which also
causes the lower leg to turn
inward
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A person who runs with a
high arch:
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Lands hard on heel
Doesn’t pronate enough to
allow the impact of running
to be absorbed through the
body
The feet and outer part of
knee and hip bear the brunt
of each step
The Right Shoe:
Basic Qualities
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How often do you need
new shoes?
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It depends on how much
running you do per week…
Ex: Jog 60-70 mi/wk,
replace shoes every 3-4 mos
Worn-out shoes (esp if
soles are worn down
unevenly) can be
dangerous

They don’t provide proper
support/stability anymore
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Be aware of your foot type
before purchasing new
shoes
With all the new shoes
available, choosing a shoe is
no easy task…this is where
running shoe store experts
come in!
Shoe Inserts
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Some flat-footed runners
may turn their feet inward
to such a degree that good
running shoes alone aren’t
good enough
Prescription orthotics are
custom-designed from a
mold of the foot
Sport orthotics should be
made of soft, but firm
materials
Stress Fractures
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Caused by repeated
loading stresses
Most commonly in
metatarsals (esp 2-4)
Other common sites
are tibia and
sesamoids
First symptom is pain,
often vague but
localized

History is extremely
important
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Usually 2-3 weeks into
season
Often after radical
increases in training
Stress Fractures, cont.
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X-rays may not be
positive for 3-4 weeks!
If the clinician has a
high degree of
suspicion, an early
diagnosis can be made
by bone scans and MRI
Stress Fractures:
Treatment
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Usually
accommodative
Pneumatic CAM
walker (pictured)
Cast boot
Below knee cast
Orthotic with aperture
cut-outs for involved
metatarsal to
redistribute forces
around it
Achilles Tendonitis

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Most important cause is
inadequate heel cord
flexibility
Other causes
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Instability of foot and
heel strike
Running on unyielding
surfaces
Inadequate shoes
Shin Splints
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The most common running
injury
Symptoms include tightness
and aching in the front or
back of the leg muscles
during and after running
X-rays or MRIs must be
taken to be sure of diagnosis
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Other possible
diagnoses with similar
symptoms:
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Stress fracture
Chronic compartment
syndromes
Periostitis
Myositis
Tendonitis
Anterior Shin Splints
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Often caused by change in
running surfaces (from
soft to hard), change in
running pattern or change
in shoes
Treatment
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Shoe inserts or orthotics
Ice massage
Strengthening exercises
Change in running surface
(hard to soft)
Wearing shoes with thick,
shock-absorbing soles
Posterior Shin Splints
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Mostly caused by
abnormal foot function in
which the posterior
muscles are overworked
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Posterior muscles fatigue
and fibers can tear loose
from attachment to leg bone
Treatment
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Custom molded orthotics
Stretching exercises
Ice massage
Runner’s Knee
a.k.a. Chondromalacia Patella
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Knee pain may appear
during or after running
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Frequently worse with
running uphill or climbing
stairs
Patellofemoral pain is in and
around kneecap, often
associated with swelling and
a sense that the knee cap is
“off track”
Chrondromalacia
(Patellofemoral
Syndrome)
Seen in young active persons, either
gender, female predominance
 Subactue onset of patellar pain, worse
walking, stairs, little pain at rest, theater
sign
 Running Hills
 Joint shows reproduction of pain on
pressing patella against femoral
condyles—pushing down on kneecap
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Runner’s Knee, cont.
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Therapy is planned
after assessing patellar
mechanics and leg
alignment
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Treatment
quadriceps isometric
strengthening
exercises,
NSAIDs,
bracing,
orthotics
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Ankle Sprains
The ankle sprain is most common single
injury seen by sports medicine physicians.
 This injury is often viewed as minor, but
can be associated with prolonged disability
and recurrent instability in 25-30% of
patients.
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Returning to Ambulation
1.non-wgt bearing (crutches)
 2.Touch Down- Partial wgt bearing w/
crutches
 3.Full 4 point gait- Full wgt bearing w/
crutches
 4.Once crutch on opposite side
 5.Cane
 6.Nml gait
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Treatment “PRICES”
P - Protection
 R - Rest
 I - Ice
 C - Compression
 E - Elevation
 S - Support
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Treatment Support
Prevents re-injury during rehab and on
return to activity
 Use taping and/or bracing, air-stirrups,
laced Swed-O/McDavid, Kalassy velcro
wrap, or Active ankle
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The Traction
Apophysitises:
Introduction
Categorized as overuse injuries
 Once thought to be found only in elite,
highly trained athletes
 With the growth of organized sports for
children and adolescents, have seen a
large increase in these types of injuries
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The Traction
Apophysitises:
Anatomy
Associated with the growth cartilage
 Located at three sites:
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Epiphyseal plate
 Joint Surface
 Apophyseal insertions of major muscletendon units
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The Traction
Apophysitises:
Anatomy
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Sites of active growth
in a child
Consists of columns
of growth cartilage
uniting tendon with a
bone
The Traction
Apophysitises:
Common Locations
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Foot
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Calcaneal apophysis
Knee
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Tibial tuberosity
Inferior pole of the
patella
The Traction
Apophysitises:
Osgood-Schlatter Disease
First recorded in 1903 simultaneously by
both R.B. Osgood and C. Schlatter
 Osgood believed this was caused by
microavulsions of the tibial tubercle from
the insertion of the quadriceps mechanism
 Age range is 10 – 15 years old
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Girls 11 – 13 years old
 Goys 12 – 14 years old
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The Traction
Apophysitises:
Osgood-Schlatter Disease
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At risk sports –
repetitive impact
sports
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Football
Hockey
Soccer
Basketball
Running
Gymnastics
Osgood-Schlatter
Syndrome
Affects young adolescents
 Pain at the inferior aspect of the patella,
subacute to chronic onset
 Joint is tender to palpation, occasionally
swelling in region of tibial tubercle
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The Traction
Apophysitises:
Osgood-Schlatter Disease
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Clinical manifestations
Pain and swelling over the tibial tubercle
especially after athletic activities
 Pain with running, jumping, squatting,
kneeling
 May have permanent “bump” under knee
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Osgood-Schlatter
Syndrome
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Tx is via reassurance and analgesics
The Traction
Apophysitises:
Osgood-Schlatter Disease
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Treatment
RICE
 Bracing
 Education of disease process to parents and
athlete (self-limiting)
 Modification of sports activity/avoidance of
exacerbating activities
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The Traction
Apophysitises:
Osgood-Schlatter Disease
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Treatment
Stretching and strengthening of the hamstring
and quadriceps muscle groups as well as the
gastrocnemius-soleus muscle complex
 Bracing may be needed for restraint or severe
cases that dissipate the force of the
quadriceps contraction
(chopat strap)
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The Traction
Apophysitises:
Sinding-Larsen-Johansson
Syndrome
Similar to Osgood-Schlatter disease
 Pain is over the distal pole of the patella
 Like OSD, debate over whether pain is
from avulsion fractures vs. patellar
tendonitis
 Analogous to “jumper’s knee” in the
skeletally mature athlete (patellar
tendonitis)
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Sever’s Disease
Calcaneal Apophysitis
 Heel pain is the presenting symptom
located over the oscalcis apophysis
 Most common cause of heel pain in
adolescents
 At risk sports include soccer, running, and
gymnastics
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Sever’s Disease
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+ Squeeze Test
Treatment
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Self Limiting
Rest from activity; NSAIDS
Silicone Heel Cups
Stretching of the gastrocnemius-soleus muscle
complex and strengthening of the dorsiflexors of
the ankle
Cam Walker Boot
Orthotics if necessary
The Traction
Apophysitises:
Sever’s Disease
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Physical Exam
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Pain over posterior heel
The Traction
Apophysitises:
Sever’s Disease
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Treatment
Stretching of the gastrocnemius-soleus
muscle complex and strengthening of the
dorsiflexors of the ankle
 Orthotics if necessary
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 Heel
cups or other OTC orthotics
 Custom orthotics
Conclusion
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Keep in mind that there are
many alternate training
techniques, an athlete does
not have to give up all
training when injured
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Cycling
Swimming
Water running in waist-high
water
Rowing
Upper body ergometer
Etc.
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ALSO remember the
concept behind the
original injury so you
can help to prevent it in
the future