Avoiding paediatric sports injuries

Thirty million American children and adolescents play organised sports and 10 percent of them suffer injuries each year. About 75 percent of children who come to the Childrenís Hospital Boston Division of Sports Medicine are treated for overuse injuries, up from only 20 percent in the 1990s.

Part of the explanation for the increase is that children start playing sports younger and train longer and harder compared to a decade ago. The repetitive stress causes microtrauma damage, leading to overuse injuries. Children are especially vulnerable because their growing bones can't handle the same level of stress that adults can.

Many of these injuries are unnecessary, says Lyle Micheli, MD, director and co-founder of Sports Medicine. He says at least half of them can be prevented.

Individualised training plans and patient education

Individualised exams and training plans for young athletes are critical in preventing injuries, according to Dr Micheli. When performing an exam and educating patients, clinicians should take into account the athlete's sport, history of injuries, age, gender and biomechanical factors, such as muscle strength and where in their growth development they are, says Pierre d'Hemecourt, MD, director of Primary Care Sports Medicine. "When adolescent athletes go through growth spurts, they're subject to injury to whatever part of the body they are stressing," he says. "For soccer players it's their knees, for pitchers it's their elbows and for gymnasts it's their backs.

Educating athletes, coaches and parents should be a key component of injury prevention. Doctors Micheli and d'Hemecourt hold workshops and seminars at local high schools and colleges for coaches and athletic professionals on proper training and injury prevention techniques. Dr Micheli also does 20–30 lectures per year in local, national and international meetings for physicians, while Dr d'Hemecourt works with the American College of Sports Medicine helping to teach their team physician course.

ACL injury prevention techniques

Since the passage of Title IX in 1972 (the US federal legislation that granted girls and women equal opportunities to play sports), the number of female athletes has soared, but so has the number of anterior cruciate ligament (ACL) injuries.

Studies show that females suffer ACL damage six to seven times more often than males largely due to muscular-skeletal reasons, including weaker hamstrings and differences in jumping patterns. Using injury prevention techniques has been proven to reduce ACL injury levels in females down to levels of their male counterparts. "Basically it comes down to good strengthening of the entire pelvic area and lower extremities, hamstrings, and hip extenders and flexors," says Dr d'Hemecourt. "Learning how to land with the knees bent also takes some pressure off the ACL."

The Division of Sports Medicine holds workshops to teach female athletes effective ways to reduce ACL problems, including plyometrics and agility drills, as well as balance and flexibility training. They also recommend that doctors and coaches encourage every athlete to incorporate weight training into their exercise program.

Controversial cardiac screening

Sudden cardiac death (SCD) takes the lives of almost 75 athletes every year in the United States, yet many of these victims had pre-existing, undiagnosed conditions that cardiac screening might have diagnosed. Screening every adolescent athlete may not be logistically or financially feasible, but populations deemed high-risk should be screened, according to doctors Micheli and d'Hemecourt. This includes athletes with sickle cell anaemia and athletes with a family history of cardiac disease. Young, black males may also be at risk, though more research is needed in this area.

In the meantime, the American Heart Association has developed a 12-point screening system, which includes a questionnaire about personal and family medical history and a physical exam designed to identify underlying cardiovascular problems in athletes.

(Source: Children's Hospital Boston: November 2009)