COMMON ORTHOPEDIC ADOLESCENT INJURIES

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COMMON ORTHOPEDIC ADOLESCENT INJURIES

By Nathan Snell, PT, CSCS

When I was in school as a teenager, the changing of the season meant beginning a new sport. I would look forward to spring and the crack of the bat as baseball season kicked off. However, in today’s competitive club sports scene, this rotation of sports no longer exists. It is not uncommon for a 10 year old to play one sport all year round, and at an extremely high level. Each year, approximately 30 million children and teenagers participate in organized sports. Sports are the leading cause of injury in adolescents, and it is estimated that one half of all sports injuries are preventable with proper education and use of protective equipment. As a physical therapist, I have seen a growing number of adolescents, playing year-round sports, with injuries related to overuse and repetitive trauma. Adolescents may be particularly at risk for sports-related overuse injuries as a result of improper technique, training errors, and muscle weakness and imbalance. Most of these injuries can be managed conservatively with proper and timely diagnosis by a physical therapist.

Overuse syndromes in adolescents often involve stress to the growth plate region as it is unable to meet the demands placed on it. As overused muscles pull on this attachment site, repetitive microtrauma develops. In severe cases, it can progress to involve a fracture, called an avulsion fracture. Some common apophyseal (growth plate) injuries include little leaguer’s elbow, Osgood-Schlatter disease and Sever’s disease.

Little Leaguer’s Elbow

Little leaguer’s elbow has been described as an apophysitis of the medial epicondyle in athletes between nine and 12 years of age. Most patients experience pain in the medial aspect of the elbow during throwing, and they may have decreased pitch velocity or control. Symptoms may include swelling, loss of motion, and tenderness of the elbow or forearm. Our expertise as physical therapists allow us to identify causative factors related to the condition. A thorough assessment of posture, body mechanics, flexibility and strength can begin the road to recovery and successful return to the sport. Proper education is imperative; little leaguers who make more than 350 forceful throws per week are at a higher risk of trauma.

Treatment consists of complete rest from throwing or pitching for at least four to six weeks; ice packs and analgesic medications may be used for swelling and pain. General conditioning, stretching, and core strengthening should be encouraged. When we make the decision to return the athlete to baseball, a gradual and progressive (interval) throwing program may begin. Most athletes are able to return to competitive pitching and throwing at 12 weeks.

To help prevent little leaguer’s elbow and shoulder, the American Academy of Pediatrics recommends limiting the number of pitches to 200 per week or 90 pitches per outing. However, USA Baseball Medical and Safety Advisory Committee recommends more conservative pitch counts (i.e., 75 to 125 pitches per week or 50 to 75 pitches per outing, depending on age). Other preventive measures we use frequently with the athletes include a preseason conditioning program, instruction on proper pitching mechanics, and allowing time during the early part of the season to gradually increase the amount and intensity of throwing.

Osgood-Schlatter Disease

Osgood-Schlatter disease often is encountered in children 10 to 15 years of age who participate in cutting and jumping sports such as soccer, basketball, gymnastics, and volleyball. The exact cause of this condition is unknown, but histologic studies suggest that as bone growth outpaces soft tissue growth, muscle-tendon tightness across the joint and decreased flexibility develop. Also, the strong pull of the quadriceps musculature, through the patellar tendon, on the tibial tuberosity leads to microtrauma. As the quadriceps contracts, the patellar tendon can begin to pull away from the bone.

Patients often have anterior knee pain and swelling, and occasionally the symptoms involve both extremities. Examination reveals tenderness and swelling at the tibial tubercle, the bony outgrowth below the knee cap, and pain can be produced with contraction of the quadriceps.

Most patients respond to conservative treatment consisting of rest from painful activities, icing, and analgesic medications as needed for pain. Quadriceps stretching as part of a strengthening program encouraged once symptoms are controlled. As a PT, the primary focus of my treatment is to correct any muscular imbalances between muscle groups and work on proper sequencing of muscle firing. Most patients are able to return to full activity within two to three weeks.

Sever’s Disease

Calcaneal apophysitis (Sever’s disease) is the most common cause of heel pain in athletes five to 11 years of age due to repetitive microtrauma or overuse of the heel as the Achilles tendon pulls on its attachment site. In our clinic, we commonly see athletes with this condition who participate in basketball, soccer, track, dance, gymnastics and other running activities.

Patients with Sever’s disease may have activity-related pain in the back of the heel, and commonly patients report pain of both extremities. Our clinical evaluation often reveals tenderness with compression of the sides of the calcaneus and decreased flexibility of the calf musculature. Treatment consists of activity modification, icing, stretching of the gastrocnemius-soleus complex, analgesic medications, and heel lifts or cushions. Most patients are able to return to pain-free activity within three to six weeks.

RUNNING ON AIR

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RUNNING ON AIR

Written by Matt Kraemer PT, DPT, ATC, CSCS

The Alter-G, G-Trainer, has landed at Endurance Rehabilitation in Arcadia.

Gone are the days of long recoveries, runs missed due to injury, and unachieved time splits. With the usage of the G-Trainer, athletes form all backgrounds and levels can train and compete to their full potential. This gravity altering treadmill allows the user to reduce their effective body weight (amount of weight and force they have to absorb while running) and train to their full potential without symptoms.

Designed and produced by Alter G, in Menlo Park California, this futuristic treadmill uses air pressure to lift the user and therefore unweight them allowing for greater ease with walking and running. A surprisingly quiet airflow system continually adds and removes air in the see through bubble that surrounds the user from the waist down. This change in pressure is determined by a force plate in the treadmill platform that is constantly analyzing the forces produced. The Woodway treadmill sports a touch screen interface allowing for speeds up to 18 MPH forwards or backwards, 25% incline, and a reduction in body weight of up to 80%.

Patients and non-athletes agree, the G Trainer is a remarkable machine. By unloading a post-operative knee patient, they are able to begin gait training at a much earlier time, and therefore reduce the amount of compensation and strength loss. This allows for faster progressions in their rehab, and a quicker return to their sport. “The G-Trainer allowed me to walk normal without pain or crutches 4 weeks following ACL reconstruction”, said Jerame Powell.

Athletes are also benefiting from the lack of gravity in their training with or without injuries. “Before the G Trainer I could not run past 9 miles without pain, but since using the G Trainer, I was able to increase my training mileage to 14 miles without any symptoms, in addition to reducing my pace from 9:00 min/mile to an 8:00 min/mile,” said Darlene McClellan-Brosamer, recreational marathoner.

Other athletes from all walks of light are taking advantage of the unweighting properties to continue to train through injuries without symptoms and to improve their speed. By decreasing the amount of force the body has to absorb, the user is able to recruit his or her muscles faster and more rapidly, allowing for greater foot and step turnover. When utilizing this learned response by the body with normal outdoor running, speed is increased.

So whether you are recovering from an injury, trying to avoid one, or just trying to become a better athlete, the G Trainer may be your ticket to the next level.

ASTYM – GOOD FOR WHAT AILS YOU

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ASTYM – GOOD FOR WHAT AILS YOU

Written by Nathan Koch

In my work as a physical therapist, I encounter athletes of all stripes who are limited by soft-tissue injuries. Plantar fasciitis, hamstring strain, patellar tendinosis – these are just a few diagnoses of injuries that can stop an athlete cold, or at least limit their effectiveness in and enjoyment of their activity. Triathletes are particularly susceptible to overuse injuries dealing as they do with the high volume hours of training necessitated by their sport.

While I use many therapies in my practice to heal patients, there is one treatment system I have found to be excellent and effective in healing soft-tissue injuries. ASTYM treatment is a cutting-edge therapy system that really does work. It is evidence-based, with proven and reliable outcomes I trust.

I work with many coaches, personal trainers and doctors who also believe in the ASTYM system. Joe Friel, who has coached many elite-level athletes to personal records, often sends injured athletes in to receive ASYTM therapy. He says: “My injured athletes have responded very well to ASTYM treatment. I like how it gets them back into training more quickly than other methods I’ve seen used in the past.”

Soft-tissue injury typically goes something like this: An athlete increases her running miles and starts to notice that a hamstring becomes irritated. She stretches, maybe uses ice or ibuprofen, but the discomfort continues. Being an athlete, she continues to train through her discomfort. Some days are better than others, some days are worse, but the hamstring never really feels wonderful. After a while, the hamstring becomes the limiting factor in her training and her success as an athlete. In worst-case scenarios, the athlete tells herself that she is too old, or too injured to continue running, and gives up the sport she loves.

One age-grouper triathlete I worked with was in this exact painful physical and emotional state. Carlos Mendoza, 42, was considering retiring from the sport of triathlon because of his discomfort with IT band and hamstring issues. After receiving ASTYM treatment, he went on to a PR at the SOMA Half Ironman, placing second in his age group. He says, “ASTYM works. I recommend it to any athlete who is dealing with endurance training injuries.”

Physiologically, what happens when injury occurs is this: The athlete increases her training, and her hamstring – for one reason or another – gets irritated. The body first causes inflammation to happen around the muscle and, as she continues running, it starts to lay down scar tissue, trying to heal itself.

Scar tissue, if you look at it under a microscope, is disorganized and crazy – it looks like steel wool. Healthy tissue looks like dried spaghetti – it lines up together in tidy, parallel lines. Scar tissue is by nature contractile: it contracts down upon itself over time. In our hypothetical runner’s case, this would mean that her injured hamstring would get shorter and less flexible the longer she ran with her untreated injury.

Restricted motion is another by-product of soft-tissue scarring. The layers of skin, fascia and muscle adhere to one another, and develop a grainy, gritty texture easily felt by patients. These adhesions have poor blood flow, restrict movement, and can be precursors to injury.

What ASTYM therapy does is jump-start the healing process of the body. The system is a three-tiered process. After evaluating the patient, a certified ASTYM clinician performs a hands-on treatment of the injured area. We spread a heavy cream over the skin, and use specially-designed tools in firm strokes, working not just the injury, but also surrounding areas. The patient can feel the adhesions being mobilized underneath the skin, often identified as a “crunching” sound.

What happens on a cellular level is that the tools are causing microtrauma in the tissue. The body’s response to the microtrauma is to start the healing cascade: it sends in collagen and starts to lay down fresh tissue. The old scar tissue is resorbed into the body as part of this healing process.

A critical part of the ASTYM system rests in the hands of the patients themselves. The second and third parts of the treatment system are specific stretches and strengthening exercises that tell the body to lay down new tissue in an organized fashion. Also – and this is crucial to the athletes I treat – ASTYM therapy asks patients to do the activity that led to their injury. This may sound counter-intuitive, but staying active in their sport actually strengthens the body specifically for the activity.

I truly believe in ASTYM therapy and have used it with great effect in my clinics. I use it on over 75 percent of the patients I see. It works. It’s fast. It allows people to keep doing the sports they love. And finally – ASYTM makes a lot of sense.

Nathan Koch, PT, ATC, is a physical therapist and Director of Rehabilitation for Endurance Rehabilitation in Arizona, with offices in Phoenix and Scottsdale.