Transcript SPORTS MEDICINE OVERUSE INJURIES

OVERUSE INJURIES
IN ADOLESCENTS
IRVING RAPHAEL MD
Syracuse Orthopedic Specialists
Former S.U. Head Team Physician
June 5, 2015
June 5, 2015
OLYMPIC MOTTO
CITIUS
ALTIUS
FORTIUS
OLYMPIC MOTTO
CITIUS - FASTER
ALTIUS - HIGHER
FORTIUS - STRONGER
OUTLINE
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WHY ARE WE CONCERNED??
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SPECIFIC INJURIES
• WHAT DO WE DO ABOUT IT??
Who’s At Risk?
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Soccer
Basketball
Football
Lacrosse
Volleyball
Skiers
Gymnasts
Cheerleaders
YOUTH SPORTS INJURY
STATISTICS
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30 million youth participating in US
HS athletes – 2 million injuries per year
3.5 mill under age 14 get medical Rx
Age 5-14, account for 40% of sports injuries
treated in hospitals
• Overuse - half of sports injuries, mid & HS
• By 13, 70% drop out of youth sports
• Since 2000 – 5 X increase in serious
shoulder and elbow injuries - throwing
Overuse Injury - Definition
• “Micro-traumatic damage to a bone,
muscle, or tendon that has been subjected
to repetitive stress without sufficient time
to heal or undergo the natural reparative
process.”
Stages
• 1. Pain after physical activity
• 2. Pain during activity without restricting
performance
• 3. Pain during activity restricting performance
• 4. Chronic unrelenting pain even at rest
RISK FACTORS
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PRESENCE OF GROWTH AREAS
MUSCLE DEVELOPMENT – IMBALANCE
PRESSURE TO COMPETE
IMMATURITY – PHYSICAL AND
EMOTIONAL
• PLAYER AGE / SIZE DIFFERENTIAL
• YEAR – ROUND PARTICIPATION
• MULTIPLE TEAMS
BURNOUT
OVERTRAINING SYNDROME
“A series of psychological, physiological
and hormonal changes that result in
decreased sports performance.”
-- chronic muscle or joint pain
-- personality changes
-- elevated resting heart rate
-- chronic poor athletic performance
-- fatigue, lack of enthusiasm
COMMON TYPES
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PATELLO – FEMORAL PAIN
JUMPER’S KNEE - OSGOOD SCHLATTER
SOCCER HEEL – CALCANEAL APOPHYSITIS
LITTLE LEAGUER ELBOW
SWIMMER’S SHOULDER
GYMNASTS BACK - SPONDYLOLYSIS
RUNNER’S “SHIN SPLINTS”
OSGOOD SCHLATTER’S
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Painful bump over tibial tubercle
Tender patellar tendon
Aggravated by activity
Sports – running, jumping, twisting
Diagnosis – clinical, radiographic
Worse during growth spurts
Boys more than girls - changing
OSGOOD SCHLATTER
ECTOPIC BONE – TIBIAL TUBERCLE
O.S.G. - TREATMENT
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REST, REST, REST
Immobilization, knee brace
NSAID
Symptomatic – Ice vs. Heat
Self limiting
REST, REST, REST
SEVER’S DISEASE
CALCANEAL APOPHYSITIS
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Growth area back of heel bone
Pain with activity – running, jumping
P.E. – normal appearance, Squeeze test
Radiographs – normal
Both heels – more than half patients
SEVER’S TREATMENT
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REST, REST, elevate
Medication
Orthotics
Physical Therapy
Icing
Open back shoe
Stretching hamstring & calf muscles
LITTLE LEAGUE ELBOW
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Lateral apophysitis of elbow – avulsion?
Overuse with throwing
Repetitive valgus stress on elbow
Year round single sport
Longer competitive seasons
Training and conditioning errors
Diagnosis – clinical, ?Xray
TREATMENT – L.L. ELBOW
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REST, REST, REST
Icing
Medication
Physical Therapy
Recovery over months
Gradual return to pitching
Throwing – number, distance, velocity
SPONDYLOLYSIS
Female Gymnast Back
Stress fracture of Pars
Interarticularis
Repetitive flexion,
extension, rotation
Pain, Tight Hamstrings
Radiographs, MRI, Scan
Sports at Risk
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Gymnasts
Offensive linemen, football
Weight lifters
Wrestlers
Dancers
Pole Vaulter, High Jumper
Treatment - Spondylolysis
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Restrict Activity - ?Bed Rest
Medication
Brace ?
Surgery rare
Exercise – Abdominal, Hamstring
Pain-free activity – swim, bike
SWIMMER’S SHOULDER
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Overuse, Over-training
Impingement, rotator cuff tendonitis,
biceps tendonitis
• Related to stroke
• Muscle imbalance
• Instability, laxity
Shoulder Treatment
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Rest, “out of the pool”
Medication
Ice, Heat
Physical Therapy
Shoulder muscle girdle strengthening
Scapular Stabilization
Graduated return to swim program
KNEE CAP PAIN
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Patello-femoral pain syndrome
Retro-patellar pain syndrome
Chondromalacia patella
Patellar malalignment Syndrome
Anterior knee pain aggravated by sports,
stairs, walking, jumping, sitting for long
periods- “Theater sign”
Treatment – Knee Cap Pain
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R.I.C.E
Exercise – Quadriceps Strength
Physical Therapy
Medication
Bracing, Taping
Orthotics – shoe inserts
Surgery ??
SHIN SPLINTS
• Medial Tibial
Stress Syndrome
(MTSS)
• Tibial Periostitis
SHIN SPLINTS
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Throb, ache during or after run
“Ramping up” work out
Change in surface, distance, speed
Clinical diagnosis
Excess pronation feet
R/O Stress Fracture, Compartment Syndr
Xray, MRI, Bone Scan, Pressure Measure
Shin Splint - Treatment
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Rest
Ice
NSAID
Physical Therapy
Arch Supports – Orthotics
Slow return to running
What do we do about overuse
injuries in adolescents ??
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Athletes
Coaches
Parents
EMPHASIS
* INJURY REDUCTION *
PROPER EDUCATION
SUPERVISION
TRAINING
PARENTAL GUIDANCE
EARLY RECOGNITION
INTERVENTION / TREATMENT
Questions?
Thank You
RAPHAELMD.COM