Biokinetics for sporting injuries: Children

Children and sporting injuries

Injuries in sport:
It is important to note that all sports carry a risk of injury. The severity and frequency of injury varies depending on the sport, position played, amount of preparation building up to competition, level of competition, and the age of the “athlete”.

There are many predisposing factors for injuries in sport. Three major factors which affect the prevalence of injury in younger athletes are: lifestyle, seriousness/level of competition, and amount of preparation.

1) Effect of lifestyle and posture:
Lifestyles and economics have changed the way we raise our children. Kids are more sedentary then previous generations due to pressures at school, increasing technology (gaming consoles) and lack of access to safe play space. In the past children would cycle, run, swim, climb trees, and be outdoors. All of which helped with muscular development, co-ordination and posture. Now children are taking part in exercise and developing over use injuries, that are normally seen in adults. Young children are developing injuries like lower back pain and rotator cuff impingement, due to abnormal biomechanics (movement patterns) and muscle development.

2) Seriousness of sport:
Children don’t play anymore. There are fewer and fewer non-outcome based activities (like climbing trees). There is an increasing agenda of goal driven outcomes. Play to win. School sport, especially at younger age levels, should be about learning (skill driven) not about winning. It should be about learning motor skills in a fun and enjoyable way. Not about crushing the opposition and scoring goals.

Parental pressure and early specialization also have a large role in the incidence of injury. Childrens’ tiny bodies are getting overloaded by increased training demands and an increase in pressure from parents and schools. Kids are becoming sporting “specialists” at far too young an age. Swimming is a case in point where potential swimming “stars” are required to swim longer distances, more frequently (every day twice a day). The problem with this is that there is a direct relationship between rotator cuff impingement and the number of hours/distance swum. Combine this fact with the poor posture sedentary children have and the risk of injury drastically increases.

Parental pressure on the side of the field, and at home, also has an impact on the young athlete. Sport takes on a whole new dimension if a parent tries to take control of the child’s sporting “career”, and it is no longer fun. More and more parents have begun shouting at children, coaches and sporting officials. Parents should let the professionals deal with the child’s sport and conditioning. Children are very impressionable and will push themselves harder and further to win parental approval. Some children will even hide the fact that they are injured to avoid upsetting a parent. Parents shouldn’t try to live their sporting dreams through their children’s lives.

3) Preparation for sport:
Preparation for sport can be a double edge sword as too little may result in an acute (sudden) injury and too much may result in a chronic (overuse) injury. It is a fine balance which is easy to get wrong. Our provincial and national teams will have an entire coaching team to ensure the proper conditioning of the athletes. At lower levels this responsibility falls entirely on the coach. Most coaches will condition their athletes the way they were conditioned, with a no pain no gain approach. The problem is that science and conditioning has evolved. Proper planning is required especially with the change in modern lifestyle. Sedentary children need different conditioning to children of yesteryear who were out roughing it in the garden. Children are not mini-adults. They cannot do the same strength and conditioning as adults. They need special consideration and individualized conditioning. A conditioning coach or biokineticist needs to be consulted to avoid over-training and to prevent injury.

Recommendations:
• Correct conditioning is essential for sedentary children
• Do postural exercises and “prehab”
• Seek medical attention when your child is injured (don’t rely on the coach
to make a diagnosis)
• Don’t specialize too early (most of the top athletes today played a variety
of sports when they were younger)
• Let kids play and have fun (avoid the “wrong” kind of parental pressure.
Encourage sport and physical activity. Not a win at all costs attitude.)

What to do following an injury:
• Follow the PRICE recommendation (P – position, R – rest, I – ice, C –
compression, E – elevation).
• Seek medical advice (Doctor/Sports Physician, Physiotherapist, Biokineticst).
• Treat appropriately
• Do extensive rehabilitation to prevent future injury.
• Do “pre-habilitation” to avoid any other injuries.

Rugby Injuries:
Rugby is a physically demanding full contact sport, which carries a high risk of injury. There is an injury continuum ranging from minor soft tissue injuries to severe fractures. The most common injuries from lower level rugby games are the soft tissue injuries. Where there is blunt force trauma to a muscle or joint (most often the knee). These are relatively simple to recover from, and if not too serious can be treated conservatively. However, if the pain persists then you should seek medical advice from a Doctor or Physiotherapist. More severe injuries like fractures or concussions need to be treated by a medical professional as soon as they occur. These injuries are extremely serious and should not be taken lightly. With adequate preparation and conditioning the risk of injury can be significantly lowered. Basic strengthening exercises (using body eight) should be included over and above normal rugby practice. A Biokineticist should be consulted as to which exercises are the most appropriate for your child.

Soccer:
Soccer carries a lower risk than rugby as there is less contact. However it is still possible to sustain a concussion in soccer, so the sport should not be taken lightly. Medical professionals still need to be on hand to treat the more severe injuries. As in rugby the majority of injuries are soft tissue injuries. However, rather than blunt force trauma these injuries are in the form of muscle strains. The most common being the hamstrings or groin. Ankle injuries are also very common in soccer. The severity of the ankle injury will determine the treatment protocol and the best course of action is not to limp around but rather seek medical attention.

Swimming:
Swimmers can occasionally suffer from back pain, but the most common injuries are to the shoulder. Swimmers will often have poor postures due to abnormal muscular development and tightness. This predisposes them to abnormal biomechanics (or movement patterns), which in turn leads to over use injuries. Rotator cuff impingement syndrome can be caused from abnormal biomechanics and repetitive strain from hours and hours of swimming. A Biokineticist should be consulted for a shoulder assessment and pre-habilitation programme to prevent overloading the shoulder.

Running and Jumping injuries:
In recent years there has been a higher incidence of over use injuries in children across all sports. More and more research is indicating that activities performed in younger developmental years can shape and form the skeleton. This is not always a good thing as it can affect biomechanics later on in life. Adolescent bones are weaker than adult bones, and are often weaker than the tendons that pull on them. This results in over-use traction injuries, where the bone is forced to grow outwards at the site of tendon attachment. This causes bony deformities and in many cases pain. The most common locations for traction injuries are the heel where the Achilles tendon attaches (Sever’s Disease), or just below the knee where the Patella tendon attaches (Osgood-Schlatter’s Disease). These injuries are chronic injuries, in that they develop over time. However, painful acute symptoms usually present after a sudden increase in activity, such as the start of athletics season. The course of treatment is to rest (avoid the aggravating activity such as running or jumping) and do corrective exercises prescribed by a Biokineticist.