Protecting Young Athletes From Sports Injuries

By Jan Howard

Sports injuries to children and adolescents were among health issues addressed at the 16th annual Pediatrics Update Conference for medical personnel at Danbury Hospital.

Dr Michael E. Joyce, assistant clinical professor of the Department of Orthopedic Surgery, University of Connecticut School of Medicine, and athletic team physician, spoke about the prevention, diagnosis, and management of sports injuries on November 1 in the John C. Creasy Center for Health Education.

Before a young athlete plays any sport, he or she should be examined by a physician to determine the athlete’s state of health, identify any life-threatening conditions, identify conditions that may worsen with sports participation, assess physical maturation and fitness level, and satisfy legal and insurance requirements, Dr Joyce said.

“A systematic approach will take note of children with asthma and diabetes, or other chronic diseases,” he said.

A preseason physical would also call attention to overuse injury problems, which are seen most in freshmen.

“You don’t get strength from overtraining,” Dr Joyce said. To develop endurance, athletes with overuse syndrome need to condition in other ways.

The physical can also identify acute athletic injuries, and the need for rehabilitation of sports-related injuries.

“Preexisting problems need to be identified,” he said, emphasizing that the history of any injury is critical. “Do they have pain with activity or all the time?”

Once pain control is instituted following an injury, a rehabilitation plan should be undertaken. This is comprised of steps, Dr Joyce said, such as starting with a tossing program for a pitcher and progressing.

“Recovery is part of the step program, conquering each step as they go and assessing if they have pain. Get them better, then put a maintenance program in place,” he said. “Growing bones are at risk for overuse injury.” Common overuse syndromes include tendonitis and stress fractures.

The health care staff should know what injuries plague their athletes and work with school coaches to put an emergency plan in place.

“A formal, written emergency plan should exist for every organized practice and competition,” Dr Joyce said. Emergency personnel should be present and emergency equipment, such as backboards, collars, and splints should be available. “Hoping things don’t happen doesn’t work,” he said.

Health care personnel should have regular meetings with coaches at the high school and middle school levels to discuss injury issues and review injury data, he said, and athletes at risk should be identified. The role of sports equipment should be stressed, such as the proper distribution of shoulder pads to protect against injury.

“I’ve had to rein in coaches a bit,” Dr Joyce said, adding that some coaches believe they are able to diagnose, manage, and release athletes to play following an injury. Coaches need to understand the need for referral and follow-up so athletes quickly get diagnosed and treated.

“The athletic trainer should follow up so the athlete is seen right away,” he said. “The better you know your coaches, the better this will work.

“Minor injuries can put athletes at risk for bigger problems,” he added.

For acute injuries, Dr Joyce recommended that the athlete knows the prognosis and that the return to sports be part of the diagnosis. A decision should be made as to whether rehabilitation will require a therapist. “For a simple injury it may not be needed,” he noted.

For a stress fracture, get a bone scan, he said. “Do things for an athlete that are more aggressive in diagnosis and optimize the healing process if the season is starting.” Protect the injury as much as possible. Occasionally, a stress fracture in a foot will need to be immobilized through a cast or walking boot.

Ankle sprains have an excellent potential to heal once swelling is under control, Dr Joyce said.

To distinguish an ankle fracture from a sprain, symptoms include pain to palpation directly over the bone. Treatment would include evaluation, x-rays, surgery or cast immobilization.

Ice, stretching exercises several times a day, and activity modification are recommended in the treatment of bone and heel spurs, injuries that can occur because of overuse or sports participation, he said.

Dr Joyce also discussed treatment of medial collateral ligament (MCL) sprains and anterior cruciate ligament (ACL) tears of the knee. If pain in the MCL continues after a few weeks, it is indicative that there is a complete tear and surgery may be occasionally necessary. For ACL tears, surgery is required.

 His presentation to the hospital personnel also contained information on other sports injuries, such as a tear to the meniscus of the knee, hip and pelvic strains, back strain or sprain, herniated intervertebral disk, spondylolysis and spondylolisthesis. It also addressed fracture of the collar bone, shoulder dislocation or separation (AC joint), rotator cuff injuries, elbow and wrist fractures, and finger injuries.