Physical Activity and the Developing Athlete

unoccupied play

the child is relatively stationary and appears to be performing random movements using their arms and legs with no apparent purpose. A relatively infrequent style of play.

solitary play

a child plays alone, unaware of any other children playing nearby

spectator/onlooker play

when a child watches and observes other children playing but will not play with them

parallel play

When a child plays side by side but not directly with another child

associative play

Children interact, observing each other and sharing material, but their play is not yet mutual and reciprocal.

cooperative play

children play together, creating and elaborating a joint activity or taking turns

0-3 months

at what age is unoccupied play observed in children

0-2 years

at what age is solitary play observed in children

2 years

at what age is spectator/onlooker play observed in children

2+ years

at what age is parallel play observed in children

3-4 years

at what age is associative play observed in children

4+ years

at what age is cooperative play observed in children

- physical activity everyday throughout the day

- active play through a variety of enjoyable physical activities

what are the activity recommendations for preschool aged children (3-5 years)

- >60 minutes of moderate to vigorous intensity physical activity daily

- a variety of enjoyable physical activities

- as part of the 60 min, on at least 3 days a week, children and adolescents need: vigorous activity, muscle strengthening, and bone strengthening.

what are the activity recommendations for children and adolescents aged 6-17 years

- at least 150 minutes a week of moderate intensity activities

- at least 2 days a week of activities that strengthen muscles

what are the activity recommendations for adults ages 18-64 years

- at least 150 minutes a week of moderate intensity activities

- at least 2 days a week of activities that strengthen muscles

- activities to improve balance

what are the activity recommendations for older adults ages 65+

Physical Activity

"Any bodily movement produced by skeletal muscles that results in energy expenditure"

Physical Fitness

a set of attributes that are either health- or skill-related. The degree to which people have these attributes can be measured with specific tests.

- Females have more overuse, LE and spine injuries

- Males have more traumatic and UE injuries

what are the primary differences between the mechanism of injury in young male vs young female athletes

what are recommendations for overuse injury prevention in pediatric athletes

- Diversify early, specialize late in adolescence!

- Take 3 months off each year

- 1-2 days off/week can limit injuries

- Monitor training programs

- Good nutrition is significant support for injury prevention

What are common Causes of Overuse Injuries in pediatric athletes

- Training Errors: Too much, too soon, too fast!

- Problem with equipment

- Growth spurt- Tighter muscles causes decrease flexibility

- Prior injury

- Muscle imbalance

- Deconditioning/ out of shape

- Environmental Conditions

what is the number 1 cause of overuse injuries in pediatric athletes

#1 Cause is Training Errors: Too much, too soon, too fast!

What is the Apophysis

Cartilaginous prominence at a muscular, tendon or ligamentous attachment that is a secondary growth center

What is Apophysitis

Inflammation/stress injury to apophysis.

what are the clinical presentations of Apophysitis

- Characterized by pain with gradual onset

- Symptomatic until growth plate closes and requires REST

- Children 8-15 (up to 18) years

- Seen in repetitive overuse activities

- Direct chronic traction of tendon at origin/ insertion

what is the general cause of apophysitis

- Seen in repetitive overuse activities

- Direct chronic traction of tendon at origin/ insertion

what aged children are most susceptible to apophysitis

Children 8-15 (up to 18) years

Common sites of Apophysitis

- Knee: Osgood Schlatter’s disease

- Lower part of patella: Sinding Larsen Johansson disease

- Heel: Sever’s disease

- Elbow: Little league elbow

- Hip

What is Osgood Schlatter Disease

Inflammation of bone, cartilage, and or tendon at tibial tuberosity

what are the characteristics of Osgood Schlatter Disease

- Pain worse with exercise, relief with rest

- Swelling or tenderness at tibial tuberosity

- Limping after exercise

what are the typical palpation findings in patients with Osgood Schlatter Disease

- Pain on tibial tubercle

- thickening of patellar tendon

- localized swelling

- enlargement of tibial tuberosity (chronic)

what are the possible differential diagnoses for Osgood Schlatter Disease

- Stress Fracture

- Sinding-Larsen-Johansson Syndrome

- Plica Syndrome

- Tibial Tubercle Fracture

what disease is characterized by Inflammation of bone, cartilage, and or tendon at tibial tuberosity

Osgood Schlatter Disease

What are the Associated impairments/characteristics of Osgood Schlatter Disease

Tight hamstrings and/or quadriceps, may have extensor lag

what does acute phase treatment for Osgood Schlatter Disease entail

Ice, analgesics and nonsteroidal anti-inflammatory drugs NSAIDS

what does sub-acute phase treatment for Osgood Schlatter Disease entail

Quadriceps and hamstring stretching and strengthening, core strengthening, patellar tendon strap

What is Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis

Pull at inferior pole of patella (with running, jumping, climbing kneeling)

what are the characteristics of Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis

- Pain worse with exercise, relief with rest

- Limping after exercise

- X-rays may show irregular calcification at inferior pole

what would you expect to find when palpating the patella in patients with Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis

Boney tenderness with or without localized swelling

what are possible differential diagnoses for Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis

Sleeve Fracture: inferior pole can avulse, along with cartilage and retinaculum with a rapid, forceful muscle contraction, unable to weight bear, swelling, unable to extend knee and requires surgical fixation

What are the Associated impairments/Characteristics of Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis

Tight hamstring and/or quadriceps, may have extensor lag

what does the acute phase of treatment for Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis look like

Ice, analgesics and nonsteroidal anti-inflammatory drugs NSAIDS

what does the sub-acute phase of treatment for Sinding-Larsen-Johansson Disease (SLJD)/ "Jumper's Knee": Patellar Apophysitis look like

- Quadriceps and hamstring stretching and strengthening, core strengthening, patellar tendon strap

- May continue sport as tolerated

What is the Calcaneal apophysis

attachment site for Achilles tendon, Plantar fascia

TRUE or FALSE: Sever’s Disease: Calcaneal Apophysitis is the most common overuse injury in pediatric and adolescent population

True

What are the symptomatic characteristics of Sever's Disease: Calcaneal Apophysitis

- Pain at insertion of Achilles tendon and plantar fascia with focal pain that increases with running & jumping

- Walking on toes alleviates pain, may limp

what are the expected palpation exam findings in patients with Sever's Disease: Calcaneal Apophysitis

tenderness at heel

What are the characteristics associated with the development of Sever's Disease: Calcaneal Apophysitis

- Common in running and high impact activities-tennis, ballet, gymnastics, football

- Flat feet in cleats (common with new cleats)

- Recent growth spurt

- Overuse or start of the season

- Obesity

- Weak dorsiflexors and tight heel cords

what does the acute phase of treatment for Sever's Disease: Calcaneal Apophysitis entail

- Ice, analgesics and nonsteroidal anti-inflammatory drugs NSAIDS

- Avoid barefoot walking

- Possible heel pads, heel lifts, or orthotics

- Taping, cast immobilization

- Severe cases may require crutches or walking boot

what does the sub-acute phase of treatment for Sever's Disease: Calcaneal Apophysitis entail

- Heel cord stretching

- Ankle strengthening

- Restore normal gait pattern

what is the general recovery timeline for Sever's Disease: Calcaneal Apophysitis

Symptoms resolution ~2 to 8 weeks

What is Little League Elbow: Medial Condyle Apophysitis

Inflammation of medial condyle due to valgus stress on elbow from overhead throwing

Inflammation of medial condyle due to valgus stress on elbow from overhead throwing is known as

Little League Elbow: Medial Condyle Apophysitis

what are the characteristics associated with Little League Elbow: Medial Condyle Apophysitis

- Aching, sharp pain on inside of elbow

- weak & ineffective throws

- Pain with resisted wrist flexion & forearm pronation

- Elbow X-ray(B/L): widening of physis

what are the primary diagnostic characteristics of Little League Elbow: Medial Condyle Apophysitis for differential diagnosis

- weak & ineffective throws

- Elbow X-ray(B/L): widening of physis

what would you expect to find when palpating a patient with suspected Little League Elbow: Medial Condyle Apophysitis

- swelling on inside of elbow

- Tenderness over medial epicondyle

what are risk factors associated with the development of Little League Elbow: Medial Condyle Apophysitis

- Most common in pitchers but can also be catchers, infielders or outfielders

- Overuse!

what does the acute phase of treatment for Little League Elbow: Medial Condyle Apophysitis entail

Ice, analgesics and nonsteroidal anti-inflammatory drugs NSAIDS

what does the sub-acute phase of treatment for Little League Elbow: Medial Condyle Apophysitis entail

- Focus on Elbow ROM and strengthening forearm, upper arm, shoulder, back, core

- Return to pitching when pain free and full ROM and strength

- Progress gradually (nonthrowing position ->less throwing ->full throwing)

what are preventative measures that pediatric athletes can take to prevent the development of Little League Elbow: Medial Condyle Apophysitis

- Year-round fitness

- Active rest

- Follow pitching guidelines

- Warm up

What is Hip Apophysitis

Gradual onset of pain in the pelvis/hip without specific trauma due to chronic traction at growth plate where tendon inserts

The gradual onset of pain in the pelvis/hip without specific trauma due to chronic traction at growth plate where tendon inserts is known as

Hip Apophysitis

what are the common clinical presentations of Hip apophysitis

- AIIS, ASIS and iliac crest > ischial tuberosity

- Site is somewhat sport specific

- Tenderness on palpation at the site of tendon insertion

what does treatment for hip apophysitis entail

Rest x 4 weeks, PT, return to play

What is Humeral Apophysitis: Little League Shoulder

Inflammation of the proximal humerus epiphysis due to repeated torsional stress common in pitchers and throwers ages 11-16 years

Inflammation of the proximal humerus epiphysis due to repeated torsional stress common in pitchers and throwers ages 11-16 years is known as

Humeral Apophysitis: Little League Shoulder

what are the clinical presentations of Humeral Apophysitis: Little League Shoulder

- Gradual onset of pain

- Weakened throw

- Positive impingement signs

- Widening of proximal humeral epiphysis on x-ray

- Tenderness to palpation over proximal humerus

what are the key exam findings for the differential diagnosis of Humeral Apophysitis: Little League Shoulder

- Positive impingement signs

- Widening of proximal humeral epiphysis on x-ray

what does treatment for Humeral Apophysitis: Little League Shoulder entail

- Rest and rehab 3+ months

- Gradual return to throwing

What is Osteochondritis Dissecans

Separation of cartilage from subchondral bone due to lack of blood flow seen in children 10-20 years

what are the clinical presentations of Osteochondritis Dissecans

- Can occur at knee (lat. aspect of medial femoral condyle), elbow, and ankle

- pain, swelling, jt. popping/ locking, jt. weakness, decreased ROM

what is the primary cause or etiology of Osteochondritis Dissecans

high impact activities such as jumping or running

what does the treatment of Osteochondritis Dissecans entail

- Pain management, non-weight bearing

- Surgical management

- Gradual return to sports after 4-5 months

What are key points about Epiphyseal Fractures

- Account for 20% of all pediatric fractures

- Most common in boys during early adolescence

- Depending on severity (Grades III, VI, V) can result in changes in bone growth

- More common in UE > LE

- Most common in distal radius > distal humerus > proximal tibia/fibula

Salter Harris Classification of Growth Plate Injuries: grade 1

straight across the growth plate (physis)

Salter Harris Classification of Growth Plate Injuries: grade 2

above the growth plate

Salter Harris Classification of Growth Plate Injuries: grade 3

Lower or below the growth plate

Salter Harris Classification of Growth Plate Injuries: grade 4

through the growth plate

Salter Harris Classification of Growth Plate Injuries: grade 5

ruined or crushed growth plate

what is the most common type of growth plate injury

grade 2

what does the treatment of grade 1 and 2 growth plate injuries entail

closed reduction

what does the treatment of grade 3 growth plate injuries entail

Most require ORIF

what does the treatment of grade 4 growth plate injuries entail

ORIF

what does the treatment of grade 5 growth plate injuries entail

surgical correction

what is the general prognosis for grade 3 growth plate injuries

Good if vascular intact

what is the general prognosis for grade 4 growth plate injuries

Possible growth disturbance

what is the general prognosis for grade 5 growth plate injuries

Possible joint incongruity

what are key points about Greenstick Fractures

- Specific to pediatrics

- Often in long bones when a force is applied to one side of the bone and results in angular deformity of the bone

- Typically managed with closed reduction cast

- UE>LE

What are key points about the Anterior Cruciate Ligament (ACL)

- Most commonly treated knee ligament in athletes

- Important for stability in cutting and deceleration

What are key points about Anterior Cruciate Ligament (ACL) Injuries

- Often hear a "pop", severe pain, reduced ROM, rapid swelling and "giving way"

- Can be the result of contact or non-contact

- Test with Lachman's or Anterior Drawer Test

what is the incidence of Anterior Cruciate Ligament (ACL) Injuries in adolescents

- Occurs in prepubertal males > females

- Occurs in post pubertal females > males

what are the primary causes of patellar dislocation

- Twisting injury to the knee joint causes patellar dislocation

- Causes: cutting motion, change of direction, force against another athlete, trauma

what does treatment of patellar dislocation entail

- RICE

- Closed Reduction

- Immobilization 2-4 weeks

- Knee rehabilitation

Within what population are patellar dislocations most common

teens

What is a Hip Avulsion Fracture

Occurs when a tendon or ligament pulls bone from the hip

what are common sites of Hip avulsion fractures

AIIS, ASIS and ischial tuberosity

Within what population are Hip Avulsion Fractures most common

12–18-year-olds

what are the causes of Hip Avulsion Fractures

- Sports and activities with speed and sudden stops

- Sudden and forceful contraction of the hip muscles

what are the symptoms associated with Hip Avulsion fractures

- swelling

- pain in hip/groin

- limited ROM

What does surgical treatment for Hip Avulsion Fractures entail

ORIF, skeletal traction