Reducing Injury in the Growing Athlete
In an outpatient physical therapy clinic, we often treat young athletes with muscle or joint injuries that occurred while at practice or in a competition setting for their competitive sport or activity. In most cases, the injury did not happen while trying something new, but while the athlete was performing a well-practiced movement in a sport in which they are highly trained.
So, what changed that led this one instance of a familiar and well-rehearsed move to result in injury? Typically these injuries occur during a time of rapid growth when the body is more prone to injury. The adolescent is usually at the age of puberty and undergoing a growth spurt. Most females will undergo growth spurts between the ages of 11 to 14, while most males experience it between the ages of 12 to 18, but the time period may vary.
Growth spurts leave the young athlete more prone to injury in three critical ways:
1. The center of gravity of the adolescent’s body has become higher from the ground, leading to a greater challenge to maintain balance and control of movement. For a period of time, the athlete is not as balanced and has less control of quick body movements or changes in direction.
2. Flexibility in the arms and legs decreases as the bones often grow faster than the muscle that connects to them. This leads to increased muscle tension (tightness) when the body is moving during quick athletic movements, such as running, jumping, changing direction, tumbling, etc. Tight muscles are more likely to be pulled during quick movements.
3. Muscle strength is reduced, especially in the hips and the core muscles, therefore the athlete may no longer have the strength required to perform all aspects of their sport effectively.
Some injuries may be treated with a few days of rest, along with the use of ice packs and over the counter medicine. For more severe injuries, a doctor may order physical therapy and extended time off from sports. Immediate physical therapy treatments to muscle or joint injuries may involve modality treatments such as heat, ice, ultrasound, laser, or electrical stimulation in order to increase healing rate and reduce pain and inflammation resulting from the injury. Hands on treatments by the therapist and gentle exercise for the injured area are usually performed as well.
Once the injury is showing good signs of healing, the focus of the program will shift to insure that the athlete has the proper strength, flexibility, and movement control to safely return to their competitive sport or activity. One important element to preventing future injuries once the athlete returns to his or her sport, is to reestablish core stability and strength that may have been lost during the growth spurt.
The core includes the abdominals, the muscles that bend and rotate the back, and the muscles that hold the pelvis in place.
The growing athlete should establish core strength and stability by participating in an exercise program that teaches controlled body movement while holding the core in a stable position. Along with core strength training, a stretching routine should also be performed, with a focus on the long muscles of the limbs, to include the hamstrings, quadriceps, calves, biceps, and triceps. The exercises may be taught as part of the physical therapy program in which the therapist teaches the athlete to hold proper body and spine alignment while challenging balance and performing sports specific activities. Or, the exercises may be taught by a credentialed personal trainer, athletic trainer, or other certified fitness instructor.
Two popular and effective methods that may be taught in group or one-on- one classes to address both core strength and flexibility are pilates and yoga.
The best approach for parents or coaches of growing athletes is to encourage a program that includes core strengthening and leg and arm stretching that the adolescent performs 2-3 times weekly. Injuries may still occur, but will likely be less frequent and less severe in nature when they do happen.
Other considerations for parents and coaches of young athletes whose bodies are undergoing rapid growth are as follows:
1. Consider reducing the amount of high impact training.
2. Include training exercises that incorporate balance training in order to help the athlete acclimate to their new center of gravity.
3. Minimize movements that require rapid changes in direction until core stability and balance have been re-established.
4. Encourage parents to invest in a core strengthening program that is tailored to the needs of their child. Be sure that the program is taught by a certified professional who has experience working with young athletes. Check the credentials of the trainer and ask for referrals from other clients.
5. If an injury has occurred, follow the recommendations of the treating doctor and/ or physical therapist carefully. Often athletes return to their sport too quickly following injury, resulting in re-injury of the same area, and sometimes new injuries of other areas. Re-injury is usually the result of muscle weakness that persists from the initial injury.
by, Leigh Anne Nash, PT, OCS