Adolescent Services

Adolescent Services


Problems specifically (not exclusively) affecting adolescents

Children are structurally and physiologically different from adults – they are not simply a smaller version. This means that their problems need addressing with the implications of immature anatomy and physiology in mind. This has particular relevance for fitness programmes; research has shown that children and adolescents can benefit from strength and fitness training (Blimkie 1993; Lillegard et al 1997; Faigenbaum 2000; Guy 2001), but that they require different regimes to the adult. For example, cross-country running is restricted in distance as immature bodies are less effective at dealing with physiological effects of distance running; in resistance training children use body weight as resistance, not lifting heavier than body weight until the skeleton is mature. For these reasons a child cannot join a gym or enter a marathon until the age of eighteen.

Children also mature at different rates and show enormous physical and therefore physiological variation within the same chronological age group. This is an important consideration for sports involving physical contact, where children need to be equally matched to avoid injury.

Injuries
Avulsion fractures:

In children the ligaments are proportionally stronger than the bone to which they attach (not so in adults) and fast strenuous contraction of a major muscle can result in the ligament boney attachment becoming avulsed, or detached, from the rest of the bone. These injuries are usually seen in sports with sudden violent muscular contraction such as football, sprinting and jumping.

The most common sites for this to occur are:
– Sartorius muscle to the anterior superior iliac spine ( anterior pelvis)
– Rectus femoris (hip flexor) muscle to the anterior inferior iliac spine (anterior pelvis)
– Ilio-psoas muscle (hip flexor) to the lesser trochanter (hip joint).
– Patella tendon to the tibial tuberosity
– Abdominal muscles to iliac crest
– Hamstring muscles to ischial tuberosity

Overuse injuries:

The most common types of overuse injury seen in children are the Osteochondroses – disorders of the growth centers of the bone.

1) Traction/ pulling mechanism of injury:
The traction osteochondroses occur at those sites where the major tendons attach to the immature skeleton and overuse, poor biomechanical alignment and other features cause inflammation, partial avulsion of the secondary center of ossification, healing and subsequent bone growth.
– Osgood-Schlatters : Patella tendon to Tibial Tubercle ( front of shin)
– Sinding-Larsen-Johannson: Quads to inferior pole of patella (kneecap)
– Severs: Achilles tendon to calcaneus (heel)

2) Crushing mechanism of injury:
Areas of greater weight-bearing where the mechanism of injury is sustained crushing.
– Perthes disease- femoral head (hip)
– Kienbocks disease –lunate bone (wrist)
– Friebergs disease-second metatarsal head (foot)
– Kohlers disease-navicular bone (mid foot)

3) Splitting mechanism of injury:
Biomechanical forces include more rotation for splitting injury
– Ostechondritis dessicans- medial knee, capitellum (elbow), Talar dome (foot)

The problems are usually self limiting but general principles of treatment include:
– activity modification
– biomechanical assessment: addressing postural/muscle imbalance/tight tissues.
– local treatment
– progressive exercises.

Stress fractures:

These are caused by a number of factors: sudden increase of intensity in training, poor technique, altered biomechanics (shoes worn out and unsupportive). They usually affect lumber spine or lower limbs and feet.
– Pars interarticularis- vertebrae/ lumber spine
– These usually occur in activities involving hyper-extension (bending back)
and rotation e.g. cricket, gymnastics, horse- riding (saddling up/mucking out).
– Fracture on one side is called Spondylolysis; fracture on both sides can cause
a forward slip of one vertebrae on another and is called Spondylolythesis.
– Tibial stress fracture – (Shin) Often caused by running activities on hard ground/Astroturf.
– Femoral neck-hip
– Navicular bone-mid-foot

Postural muscle imbalance:

Produces pain and muscle spasm but nothing to see on investigation with X-Ray/scan. Poor postural control in adolescence leads to permanent wear and tear changes in later life.

For example:
– Rapid growth spurt >> Tight Hamstrings (as bone grows faster than muscle)
>>Stiff lumber spine (as hamstrings attach to Ischial tuberosity (sitting bone)
and restrict pelvic movement) >>Pain
– If you can’t sit up straight with legs out straight in front of you you’re your
hamstrings are too tight.

For example:
– Poor thoracic posture (rounded shoulders) >> Limited shoulder range of movement
(altered position of shoulder blade which houses socket of ball and socket joint of shoulder)
>> Shoulder impingement of sub-acromial structures >> Pain

References:
Blimkie, C. J. (1993). Resistance training during preadolescence. Issues and controversies. Sports Med. June; 15 (6):389-407.
Lillegard, W.A et al. (1997). Efficacy of strength training in prepubescent males and females: effects of gender and maturity. Paediatric rehabilitation. Jul-Sep; 1 (3):147-57.
Faigenbaum, A.D. (2000). Strength training for children and adolescents. Clinics in Sports Medicine. Oct; 19(4):593-619.
Guy, J. A. (2001). Strength training for children and adolescents. Journal of American Academy of Orthopaedic Surgery.Jan-Feb;9(1):29-36