Sports Injuries in Children

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Young athletes are often treated as ‘small adults’ when it comes to treating sports-related injuries. However, the fact remains that children are both anatomically and physiologically different from adults. Furthermore, the pathogenesis (course of development) of most of these injuries varies dramatically from that of adults.

To treat these injuries, orthopods tend to follow treatment protocols extrapolated from adults. Such practices should be discouraged and management protocols specific for treating these injuries should be followed.

Preventing injuries in the first place can reduce the alarming rate of incidence of these injuries. Improving the athlete’s technique, biomechanics, promoting use of protective gear, changing rules to protect athletes and preventing abuse by an overzealous coach/parent can go a long way in achieving this.

Incidence of Sports Injuries in Children

Contrary to popular belief, sports injuries in children are not a rare occurrence by any stretch of imagination1.

• Belechri et. al., studying the incidence of sports injuries in children from 6 European Union countries, reported an annual total of quarter of a million outpatient visits in 2 of the countries2

• a similar study conducted in Holland reported a prevalence rate of 10.6 per 100 participants3

• across the Atlantic, a study conducted in the late 1990s reported 7 million Americans receiving medical attention for sports related injuries; children between the ages of 5-14 (59.3 per 1000 persons) had the highest incidence of injuries4

Age and Gender Bias

Research suggests that sports injuries tend to occur:

• more often in boys (2-3 times) as compared to girls4;5; this may suggest more competitiveness in youth male sports

• incidence is highest between the age of 5 to 15 years for both boys and girls4;6

• peak incidence for girls is 12 years

• peak incidence for boys is 5 years4. Boyce et. al., however, report a peak incidence at 14 years for boys5

In contact sports, injuries are more common in post-pubertal than in pre-pubertal children signifying increased levels of intensity in older children4.

High Risk Sports for the Young Athlete

Young athletes involved in the following categories of sports are more likely to get injured3;7-9:

• team contact sports

• combat sports

• high jumping sports

• indoor sports

Sports that causes most injuries:

In young male athlete2-4:

• Football

• Soccer

• Basketball

• Field Hockey

Young female athlete2;4;10:

• Gymnastics

• Softball

• Volleyball

Other sports identified as dangerous are cycling, horse riding and rugby8. Another interesting fact is that winter sports have more potentiality to cause injuries in children than summer sports.

Severity of Sports Injuries in Children

Sports injuries in children tend to be mild in nature and self limiting. Maffulli et. al. have gone to the extent of calling youth sports ‘totally safe’11. Also, allegedly, most of these can be effectively treated by first aid given at the venue by a coach, teacher, or a parent5.

However, some researchers have reported the increasing incidence of severe injuries (fractures) requiring hospitalisation2. In a paper published in the American Journal of Sports Medicine, Backx et. al. reported that of all the sports related injuries in school children, a whopping one-third were serious enough to require medical attention3.

3-4% of all cases of sports related injuries require hospitalization2;5.

Profile of Sports Injuries in Children

Soft tissue injuries like sprains, strains and contusion are more common compared to bony injuries3;7.

Lower extremity injuries3 and upper limb injuries5 have been found to occur more frequently.

Fractures mostly affect the ankle (40%), knee (25%) and lower leg (29%)7-9. Involvement of wrist in fractures as well as soft tissue injuries due to fall on an outstretched hand is another common occurence5.

Mechanism of Sports Injuries in Children

Common mechanisms of sports injury in children are4:

• bumping into someone or someone bumping into you

• fall

• overexertion

Some interesting facts about young athletes’ injuries are:

• immature musculoskeletal system is more often to blame

• tend to differ vastly from those in the adult skeleton

• muscle tendons and ligaments are stronger than bones

• sheering, overload and avulsion forces acting at the points of connection of these strong structures with non-fused bones lead to undue buckling or bowing of bones and thus injuries11;12

• can be detrimental to the normal growth process, esp. of long bones leading to life-long side effects11;13;14

• repeated microtrauma is another factor identified as being responsible8;15;16

Prevention of Sports Injuries in Children

Preventive strategies designed by reputed researchers in the field of sports medicine are given below.

• pre-season conditioning for the young athletes with gradual increase in skill training suggested by Dollard et. al.17

• injury prevention programs be taught and implemented in school curriculum7

• use of protective gear including helmets, mouth guards, and shin guards in addition to specific training recommended by Flynn et. al.8;18

• improving technique, adequate rest for recovery and avoiding overtraining recommended by Franklin and Weiss19

• identifying the risk of life-long disability; designing methods to prevent and reduce these risks20

• physical, physiological and psychological immaturity be taken into account when dealing with the young athlete11

• sharing of responsibility to promote young athletes’ safety: schools, instructors/coaches, parents and physicians should be held accountable21

Discussion

More and more children these days are participating in competitive sports. With so much pride and money at stake, there has been a drastic improvement in the level of athletic training, coaching and equipment involved.

Vast improvements have also been made in the area of sports medicine related to young athletes. Researchers have designed and recommended protocols to prevent and cure sports related injuries in young athletes1;22-25.

Despite all this, the fact remains that children still keep getting injured at an alarming rate. What’s more worrying is that some of these injuries lead to long term alteration of bone anatomy and hence life-long deformities.

Conclusion

The sheer frequency, severity and differences in pathogenesis (course of development) of sports injuries in children compared to adults, has made in-depth study of these injuries necessary. Specialist doctors who can deal with these injuries are the need of the hour; prevention, rehab and treatment protocols specific to young athletes’ injuries should be designed and implemented.

Reference List

(1) Micheli LJ, Glassman R, Klein M. The prevention of sports injuries in children. Clin Sports Med 2000; 19(4):821-34, ix.

(2) Belechri M, Petridou E, Kedikoglou S, Trichopoulos D. Sports injuries among children in six European union countries. Eur J Epidemiol 2001; 17(11):1005-1012.

(3) Backx FJ, Erich WB, Kemper AB, Verbeek AL. Sports injuries in school-aged children. An epidemiologic study. Am J Sports Med 1989; 17(2):234-240.

(4) Conn JM, Annest JL, Gilchrist J. Sports and recreation related injury episodes in the US population, 1997-99. Inj Prev 2003; 9(2):117-123.

(5) Boyce SH, Quigley MA. An audit of sports injuries in children attending an Accident & Emergency department. Scott Med J 2003; 48(3):88-90.

(6) Watson AW. Sports injuries during one academic year in 6799 Irish school children. Am J Sports Med 1984; 12(1):65-71.

(7) Backx FJG, Beijer HJM, Bol E, Erich WBM. Injuries in high-risk persons and high-risk sports. The American Journal of Sports Medicine 1991; 19(2):124-130.

(8) Du Boullay CT, Bardier M, Cheneau J, Bortolasso J, Gaubert J. [Sports injuries in children. Epidemiologic study]. Chir Pediatr 1984; 25(3):125-135.

(9) Ergen E. [Sports injuries in children and adolescents: etiology, epidemiology, and risk factors]. Acta Orthop Traumatol Turc 2004; 38 Suppl 1:27-31.

(10) Fernandez WG, Yard EE, Comstock RD. Epidemiology of Lower Extremity Injuries among U.S. High School Athletes. Academic Emergency Medicine 2007; 14(7):641-645.

(11) Maffulli N, Bruns W. Injuries in young athletes. European Journal of Pediatrics 2000; 159(1):59-63.

(12) Shanmugam C, Maffulli N. Sports injuries in children. Br Med Bull 2008; 86:33-57.

(13) Buckley SL. Sports injuries in children. Curr Opin Pediatr 1994; 6(1):80-84.

(14) Dankner R, Barel V. [Sports injuries among children]. Harefuah 2002; 141(1):89-92,123.

(15) Emery KH. Imaging of sports injuries of the upper extremity in children. Clin Sports Med 2006; 25(3):543-68, viii.

(16) Demirhan M, Gunesli T. [Elbow problems associated with sports injuries in children]. Acta Orthop Traumatol Turc 2004; 38 Suppl 1:74-80.

(17) Dollard MD, Pontell D, Hallivis R. Preconditioning principles for preventing sports injuries in adolescents and children. Clin Podiatr Med Surg 2006; 23(1):191-19x.

(18) Flynn JM, Lou JE, Ganley TJ. Prevention of sports injuries in children. Curr Opin Pediatr 2002; 14(6):719-722.

(19) Franklin CC, Weiss JM. Stopping sports injuries in kids: an overview of the last year in publications. Curr Opin Pediatr 2012; 24(1):64-67.

(20) Ackery AD, Detsky AS. Reducing lifelong disability from sports injuries in children. CMAJ 2011; 183(11):1235.

(21) MacDonald GL. Sports injuries in children. Necessary consequence of competition? Postgrad Med 1985; 78(1):279-5,289.

(22) Latinis B. Frequent sports injuries of children: etiology, treatment, and prevention. Issues Compr Pediatr Nurs 1983; 6(3):167-178.

(23) Stanitski CL. Management of sports injuries in children and adolescents. Orthop Clin North Am 1988; 19(4):689-698.

(24) Williams S, Whatman C, Hume PA, Sheerin K. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med 2012; 42(2):153-164.

(25) Collard DC, Verhagen EA, Chin APM, van MW. Acute physical activity and sports injuries in children. Appl Physiol Nutr Metab 2008; 33(2):393-401.

About the author

Dr. Deepak S Hiwale
Dr. Deepak S Hiwale

Dr. Deepak S Hiwale, a.k.a "The Fitness Doc" specializes in sports medicine in addition to being an elite personal trainer. He currently runs an elite personal training company in West London. As a sports injury and fitness writer-presenter, he tries to disseminate as much knowledge as possible for the benefit of all. MBBS (University of Pune); MSC, Sports and Exercise Medicine (University of Glasgow); Diploma in Personal Training (YMCA Dip. PT, London).

Follow "The Fitness Doc" on LinkedIn: drdeepakhiwale, Facebook: conditioning.clinic and Instagram: dr.dee.hiwale

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Dr. Deepak S Hiwale

Dr. Deepak S Hiwale

Dr. Deepak S Hiwale, a.k.a "The Fitness Doc" specializes in sports medicine in addition to being an elite personal trainer. He currently runs an elite personal training company in West London. As a sports injury and fitness writer-presenter, he tries to disseminate as much knowledge as possible for the benefit of all. MBBS (University of Pune); MSC, Sports and Exercise Medicine (University of Glasgow); Diploma in Personal Training (YMCA Dip. PT, London).

Follow "The Fitness Doc" on LinkedIn: drdeepakhiwale, Facebook: conditioning.clinic and Instagram: dr.dee.hiwale