With more than 30 million children participating in organized youth sports and many more active in unorganized sports, the potential for injury is large. Sports injuries have increased considerably over the past 15 years, with a minimal change in population. This is due mainly to an increase in participation.1 Of the data that has been collected among high-schoolers, it has been estimated that organized sports account for 25 percent to 30 percent of the total injuries in that age group, while unorganized sports account for 40 percent.2 There is an increased likelihood of injury during the first month of participation in organized recreational sports.3
Rates and Stats
The injury rates for high-school boys and girls are similar. Boys are most likely to be injured in football, while soccer accounts for the most injuries in girls. Soft-tissue injuries (sprains, strains and contusions) are the most common types of injury. More acute injuries occur during a practice session than during a game. Of adolescent injuries, 30 percent to 50 percent are due to overuse, and more time is lost from sports due to overuse injuries than acute trauma. National data including adolescents 17 years of age and younger shows that sports and recreational injuries account for 59 percent of sprains, 48 percent of fractures and dislocations, and 25 percent of lacerations. When looking at all athletic injuries, 50 percent occur to the lower extremity, 30 percent to the upper extremity and 20 percent to the axial skeleton.2
Most of the skeleton's bone mineral density is acquired during adolescence, making nutrition very important during these years. For that reason, bone mass may fail to accrue optimally if the child is dieting or trying to lose weight. Ligament and tendon strength normally develop faster than bone strength. That is why there is a greater risk for avulsions at the insertion sites of bones than for muscle and ligament tears.
One of the most common sites for this type of injury is the insertion of the patellar tendon over the tibial tuberosity. The condition, commonly called Osgood-Schlatter disease, is far more common in athletes involved in jumping activities such as basketball. The patient may complain of anterior knee pain aggravated by jumping, squatting or kneeling. X-rays may show fragmentation of the tibial tubercle and possibly an ossicle in the patellar tendon. Treatment should include ice, flexibility exercises for the quadriceps and hamstrings, and the use of a stabilizing strap. A break from sports activities for several months usually will allow the injury to heal, and in many cases, after it has healed, it will not recur.
In the adolescent, growth cartilage is present at the epiphyseal plate, joint surface and epiphysis. The growth cartilage is the weakest link and is more prone to injury than the ligaments. The risk of growth-plate injuries is high in contact sports, especially when adolescents are going through a rapid growth spurt. Acute growth- plate injuries are twice as common in the upper extremity as the lower extremity.2 Stress injuries can occur to the growth plate also due to chronic repetitive microtrauma associated with intense training, which occurs with pitchers, runners and gymnasts.
Heavy weight training in adolescents before the growth plate closes is not advisable, as it may cause growth-plate injuries. When there is localized tenderness on palpation over the growth plate, injury to the adjacent ligaments, or displacement or deformity in more severe injuries, the athlete should be referred to an orthopedic surgeon for consultation. With these injuries, there is potential for serious complications, such as limb-length inequality or deformity.
The most common injuries seen in adolescent athletes are musculoskeletal overuse injuries. For example, the articular cartilage is very susceptible to repetitive microtrauma, and overuse could potentially be a contributing factor in osteochondritis dessicans-type lesions. Contributing factors in overuse injuries can include subluxation, poor equipment, adverse environmental conditions, and training errors.
It is important to have the spine and extremities of athletes checked for misalignments that could put greater stress on a joint, which may then lead to injury. Equipment and training machines should be adjusted to the size of the athlete. The shoes should be appropriate for the environment in which athletes are competing and should have proper shock absorption. Custom-made, flexible stabilizing orthotics that support the arches, absorb shock and enhance performance are recommended. During training, young athletes should not increase intensity, duration or frequency of activities faster than their bodies' ability to adapt. A good coach or trainer will help them make the most of workouts and correct subtle errors in technique to protect athletes from injury, allowing them to perform to their maximum potential.
Conservative and Knowledgeable Care
There are many other injuries to be aware of in young athletes. Shoulder impingement syndrome, or rotator cuff syndrome, is a common cause of shoulder pain in overhead throwing sports such as tennis and swimming. If not properly cared for, repetitive overuse of the rotator cuff muscles leads to swelling and inflammation, which can progress to scarring; and tendonitis, which can lead to rotator cuff tears. Conservative treatment should include modifying activity, decreasing inflammation and rehabilitating the injured or weakened muscles. One of the most effective ways to rehab these muscles is with a low-tech rehab system (such as one that utilizes stretching exercises with surgical tubing).
Other upper extremity syndromes include "Little Leaguer's shoulder," which is an injury of the proximal humeral physis; and "gymnast's wrist," which covers a host of injuries involving the wrist, from carpal tunnel syndrome to ganglion cysts. And don't forget medial and lateral epicondylitis, which affects young athletes to a lesser degree than adult athletes.4
As with most preventable injuries, the best plan involves educating participants in ways to avoid injuries. That starts with making observations of their posture and gait. Look for abnormal wearing of their shoes, and look at their spine from the front, back and side. If imbalances are found, make the proper chiropractic adjustments or recommend rehab to aid in correcting any imbalances. Do some muscle tests and look for a weak muscle that could potentially be the cause of an injury in the future. Check ranges of motion of the spine and extremities. If deficits are found, work to correct them through adjustments, rehab, and muscle work.
When treating the young athlete, it is important to understand the unique characteristics of adolescent growth and development. The doctor also needs to have a good understanding of the sport, the body mechanics that are needed to play the sport, and knowledge of common injuries encountered in that sport. By understanding this and then performing a thorough examination, the doctor will have a better grasp of the causes of many of the common injuries affecting young people, and will do a better job of treating those injuries.
- Jones SJ, Lyons RA, Sibert J, Evans R, Palmer SR. Changes in sports injuries to children between 1983 and 1998: comparison of case series. J Public Health Med, 2001;23(4):268-271.
- Patel DR, Nelson TL. Sports injuries in adolescents. Med Clin North Am, 2000;84(4):983-1007.
- Stevenson MR, Hamer P, Finch CF, Elliot B, Kresnow M. Sport, age and sex specific incidence of sports injuries in Western Australia. Br J Sports Med, 2000;34(3):188-194.
- Bylak J, Hutchinson MR. Common sports injuries in young tennis players. Sports Med, 1998;26(2):119-132.
Click here for previous articles by Kim Christensen, DC, DACRB, CCSP, CSCS.