Sport-Specific Injuries In Children

Sports related injuries are of two types. Macrotrauma occurs as an acute, perhaps dramatic event, like a concussion or spinal cord injury, or a fracture or dislocation. Microtrauma occurs as a repeated injury, usually not noticed initially because the injury is microscopic in magnitude, but where the cumulative trauma leads to pain and in some cases, significant disability. Stress fractures and the so-called overuse syndromes are examples of microtrauma.

Any injury can be caused by any sport, but there are injuries that are recognized to be peculiar for a specific sport in a specific age group. The following are some injuries peculiar to certain sports, with suggestions for prevention and treatment.

• Baseball

  Elbow injuries occur frequently in pitchers. The valgus stress placed on the elbow during pitching causes distraction of the medial side of the elbow and compression of the lateral side. In the child, this leads to inflammation of the medial epicondyle with microtears of the flexor tendons (Little League elbow). In the adolescent, with increasing strength, there may be avulsion fractures through the epiphysis or growth plate. On the lateral side, osteochondritis dissecans can occur, where a fragment of bone from the capitellum loses its blood supply, loosens, and becomes a loose body in the joint. Surgery is often needed to correct the problem. The best way to prevent this is to learn proper pitching technique, as well as limiting the number of pitches allowed in Little League baseball. Studies suggest that a young pitcher should not exceed 350 throws a week.

  Pitcher’s shoulder (or Little League shoulder) is from repeated stress on the head of the humerus in young pitchers, causing a stress fracture of the proximal humeral epiphysis. When diagnosed, rest is essential for healing and to prevent further damage. Another form of Little league shoulder is due to impingement syndrome, from overuse of the rotator cuff tendons leading to stretching and proximal migration of the humeral head and impingement against the acromion and coracoacromial ligament.

  Shoulder Separation (or AC separation) can occur with falls, especially head-first slides. Impact on the shoulder causes injury to the acromio-clavicular joint, sometimes with disruption to the ligaments of the joint, hence the term separation.

  Foot and ankle injuries can happen with sliding injuries, when the foot or ankle gets caught while trying to slide into base. This causes a twisting injury, resulting in an ankle sprain or fracture of the foot.

• Basketball

  Hand injuries are common. Mallet finger occurs when the tip of the finger is truck by the ball. Gamekeeper's thumb occurs when the thumb is forced outwards by the ball or a fall. Finger fractures and dislocations are common. The key to prevention is learning proper catching technique that uses the whole hand, rather than the fingers.

  Jumper's knee (or patellar tendonitis) is common with frequent jumping, as is ankle sprain when landing wrong. The best prevention for these injuries is proper conditioning and warmups before sports.

• Bicycling

  Head injury is the main cause of disabling injuries in bicyclists, and is often fatal. Helmets are therefore strongly recommended for all bicyclists.

  Prolonged sitting on the saddle can cause pressure on the nerves and plood supply ot he penis. This may sometimes cause priapism (persistent erection) or impotence, usually temporary.

  Carpal Tunnel Syndrome occurs due to constant pressure of the palm of the hands on the handlebars.

  Quadriceps or patellar tendonitis, and anterior knee pain (chondromalacia patellae) are quite common in cyclists, who put a lot of strain on their knees.

• Boxing

  Head injury is after all, the intent and object of this sport, and it is therefore not surprising that boxing carries a high risk of head and brain injury.

  Boxers who are near sighted are prone to detached retina when the eye is hit. Consult a physician before deciding if it is worth the risk to take up boxing.

• Dancing

  Snapping hip occurs in the young dancer. The hip "snaps" due to the iliotibial band rubbing against the greater trochanter, or less commonly, due to the iliopsoas tendon rubbing against the neck of the femur. In both cases, rest is important as well as physical therapy to stretch and strengthen the trunk muscles, the iliopsoas and external rotators of the hip.

  Stress fractures of the metatarsals of the foot is not infrequent, especially during periods of hard training.

  Ankle sprain occurs when the dancer lands on the outside of her foot.

• Diving

  Spinal cord injury occurs, usually due to diving in shallow water or hitting an object. Prevention includes public education and posting warnings in public places.

  High velocity dives may cause wrist or shoulder injuries from impact when the body hits the water.

  Springboard exercises may cause knee problems like Osgood-Schlatter disease, or Jumper's knee.

• Football

  Head and neck injuries include intracranial hemorrhage, cervical spine fractures and dislocations and quadriplegia. These injuries are now less common due to improve helmet design and the 1976 ban on spearing - using the helmet to deliberately ram an oppponent.

  Lumbar spondylolysis and spondylolisthesis occurs due to pars interarticularis injury occurs. This is often a form of stress fracture.

  Shoulder separation is common with falls on the shoulder.

  Finger fractures and dislocations are common.

• Golf

  Back pain is common with golf. The best way to prevent this is to learn proper swing atechnique and to have proper conditioning and warmup before a game.

  Golf elbow and tennis elbow occur frequently in golfers who have not developed a smooth and balanced swing, grip the club too hard, or hit the ground frequently.

• Gymnastics

  Spondylolysis occurs frequently in female gymnasts, due to the hyperextended position required in gymnastic routines, e.g. back walk-overs. It may represent a form of stress fracture. Prevention includes abdominal and spinal muscle strengthening.

  Elbow injury from excessive weight-bearing with the elbow in an exaggerated valgus position (since this sport is often performed by young females) can lead to problems similar to Little League elbow.

  Wrist pain is frequent in young gymnasts, due to constant stress on the lower radial epiphysis or growth plate at the wrist. If ignored, it can cause premature closure of the growth plate, leading to a Madelung deformity.

  Knee pain is very frequent in young gymnasts, especially Osgood-Schlatter disease, Patellar tendonitis, and Patello-femoral syndrome.

• Hockey

  Head and neck injuries occur with collision against the board or another player. Severe injuries can be caused by a direct blow with the stick (spearing), which is illegal. Prevention includes use of protective equipment and strict enforcement of rules.

• Horseback Riding

  The most serious injuries occur with falls involcing the head or neck. Riding helmets are important.

  Falls on the shoulder can cause shoulder separation, or injuries to the knee including fractures.

• Ice Skating

  Stress fracture of distal fibula occurs with eversion stress to the ankle, exaggerated by the blade of the skate raising the foot off the ice.

  Fractures of the lower radius and scaphoid are common with falls.

  Ill-fitting boots can cause Skater's heel or pump-bump, due to irritation of the back of the heel. There is normally a bursa that protects the heelbone, which gets inflamed and tender. A "bump" occurs that can be quite painful. Treament consists of ice, rest, anti-inflammatory medication, and making adjustments to your boots. Rarely is surgery required.

• Running

  Stress fracture of tibia and metatarsal occurs especially at the beginning of track season, when too much demand was placed on the body too soon. According to the principle of bone conditioning, muscle strength builds up much faster than bone strength. During the third week, when muscle strength has developed much more than bone strength, it would be wise to limit training in the third and fourth week to allow bone strength to catch up, to prevent stress fracture. Another factor concerns the use of proper running shoes and choice of running surface.

  Shin splints and anterior leg pain are common with runners.

  Planter fascitis occurs frequently in runners. Proper shoe wear and running surfaces are important considerations in preventing this problem.

• Soccer

  Head injury may occur with collision. But repeated heading of the ball has been known to cause chronic encelopathy (brain damage). It is recommended that children before high school age should be discouraged from heading.

  Overstretching sideways can cause hip abductor strain, and overstretching forwards with the leg to kick the ball can cause a hamstring strain.

  Shin injuries from idrect kicks can cause a fracture of the tibia. Shin guards are important to prevent this injury.

  Knee sprains and ankle sprains are very common soccer injuries.

• Swimming

  Swimmer’s shoulder occurs when there is chronic overload (microtrauma) of the rotator cuff tendons, leading the weakness and proximal migration of the head of the humerus. This causes impingement syndrome and pain with the upstroke due to the rotator cuff being impinged by the acromion and coraco-acromial ligament. Treatment consists of rest, ice and antiinflammatory medications. Prevention includes learning proper technique, or learning an alternative swimming style.

  Breast-stroker's knee is due to the whipkick that puts excessive strain on the medial collateral ligament of the knee. By reducing the width of the kick, this problem can be avoided.

  Back pain can occur with the butterfly stroke, and is due to strain on the back. Reduction of training and alternating swimming styles while training may help.

• Tennis

  Tennis elbow, or lateral epicondylitis occurs with repeated stress on the lateral aspect of the elbow with backhand shots. Causes include an oversized racket, overtight grip, and not hitting the ball squarely with the racket. Two-hand backhand shots may be preferable for young players to unload some of the stress on the dominant hand.

  Elbow injuries not unlike those of a pitcher's elbow are often seen.

• Trampoline

  Head and spinal cord injury occurs, even in experienced gymnasts. It is discouraged as a form of sports or exercise.

• Weightlifting

  Low back pain occurs with improper lifting techniques, and chronic overuse.

  Osteolysis of the distal clavicle has been reported in weightlifters, where the bone in the distal part of the clavicle gets absorbed, due to an inflammatory response from overuse. There is usually a dull pain over the AC joint, and over time, X-rays will show the distal clavicle being absorbed. Activity modification is recommended, avoiding bench presses, dips, flies, pushups and any lifts that cause pain. It is thought that bench-pressing with the hands held closer together causes less stress to the acromio-clavicular joint, thus preventing this from happening, or allowing the athlete to continue exercising. Rest and nonsteroidal antiinflammatory medications usually reverse the problem, although in the more intractable case, resection of the distal clavicle may be necessary.

  Biceps strain and shoulder separations can occur with bench presses.

• Wrestling

  Spinal cord injury usually occurs when the participant is thrown and lands on his head. When the head is forcibly flexed to one side, the brachial plexus may be stretched, causing tingling and numbness to the arm and hand.

NOTICE: The information presented is for your information only, and not a substitute for the medical advice of a qualified physician. Neither the author nor the publisher will be responsible for any harm or injury resulting from interpretations of the materials in this article.

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