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ACL Injuries in Young Athletes

December 30, 2019

When I was growing up, it was common for kids in my class to play different sports throughout the year. It was unusual to have someone who played year-round or played at multiple levels at once (like the school team plus club-level plus something else). You played your sport for that season, and then moved on to the next one when the time came. I don’t remember any of my friends dealing with things like ACL injuries or hip labral tears, for example.

Things are different now.

Kids, especially teens, are beginning to specialize in a sport at a much younger age and are practicing more intensely than was the norm in the past. Children are expected to choose their sport earlier and practice is no longer just a seasonal thing.

As a result, we are starting to see changes in the types of injuries that young athletes are dealing with. We are even noticing that certain injuries that were mostly seen in adults are now being seen in kids. We are even seeing injuries that used to be seen mostly in professional athletes!

This early specialization and more intense practice means that children are causing more repetitive stress and trauma to their bodies during a time that they are more vulnerable anyways. During puberty, the body is playing a game of catch-up. The bones are rapidly growing and changing, while the muscles, ligaments, and tendons are trying to keep up. At the same time, the brain and nervous system have to figure out how to coordinate and move the body that is ever changing.

One study found that risk patterns for injury differed for girls versus boys. Once the volume of training was accounted for, no one sport stood out as being more risky for girls. Any specialization for girls, however, increased the risk of injury by 30%. This was not true for boys – specialization in general was not problematic, but baseball, gymnastics, and cheerleading significantly increased their risk.

One type of injury that has shown a lot of change is ACL tears.

The ACL (anterior cruciate ligament) serves as one source of stability for the knee joint, connecting the femur (thigh bone) and tibia (shin bone).

Historically, teen girls have always had a higher risk of ACL injuries, but now we see that the rate of injury has been drastically climbing. Girls don’t develop power in the same way as boys during their growth periods. Besides that, differences in bony alignment between males and females also contribute to the risk of injury, as well as hormonal fluctuations.

Young athletes usually get ACL injuries through non-contact scenarios, like pivoting or landing from a jump. Some sports that may see this more often are soccer, tennis, volleyball, football, and skiing.

And these injuries are on the rise…

Here are some crazy statistics:

  • According to an article in the Daily Mail, one clinic in Philadelphia has seen a 400% increase in ACL surgeries in teens over the past 10 years, and one clinic in Australia has seen a 148% increase during the same time frame.
  • A group in Australia analyzed data on 320 children who were hospitalized for ACL injuries between 2005 and 2015.
    • A whopping 96.9% of them were between the ages of 10 and 14 and more than half of them were boys.
    • Sports activities accounted for 57% of the injuries, with 52% of the girls and 35% of the boys that were specifically playing ball sports.
    • In total the rate of injury went from 2.74 injuries per 100,000 kids to 6.79 per 100,000!

Surgery is often the solution after experiencing a tear, especially if the athlete wants to continue playing in the future. Part of the problem with needing surgery after a tear is the risk that comes along with it. Physicians are often recommending to0 hold off on surgery as long as possible, in an attempt to let the bones continue growing and therefore preventing injury to the growth plate. And whether or not surgery is done, some evidence suggests that people may have a higher risk of developing osteoarthritis in that knee in the future.

So what’s the solution?

One thing that many experts agree on is changing up what the child is doing. Play more than one sport. Allow for breaks and changes in activity. Change it up to let muscles work differently. Even unstructured play can be helpful!

Make sure that all equipment is well fit and well maintained. This means ensuring proper fit of your student athlete’s shoes. They may be growing rapidly, but it’s worth getting new shoes when they need them, rather than waiting until they’re done growing, for example. Kids also need to use the proper equipment and make sure that it’s in good shape.

Be aware of the surfaces that the student is playing on. Artificial turf requires different responses from natural grass. A sprung floor provides less stress on the joints than traditional hardwood floors for dancers, but also requires a different technique for safe use.

Girls, in particular, also need more attention to make sure that their muscles are developing to appropriately support the ways they move in their sport of choice. Particularly for those in sports that require landing from jumps or pivoting and cutting need additional guidance.

Well-rounded training is also crucial. Kids’ programs should include prevention training, specifically neuromuscular training. Cross-training is important, as is working on balance and endurance. A fatigued athlete is always at a higher risk of injury.

And, most importantly, good ongoing communication between parents, coaches, trainers, and physical therapists play a large role in both prevention and recovery.

Need more info or have questions?

Contact us at Back in Step Physical Therapy to get scheduled for an evaluation. We want to keep your student athlete in peak condition to decrease their overall risk of injury, and, if they’ve already experienced injury, we want to help them return quickly and safely!

 

Daily Mail

Reuters

UCLA Health

Science Daily

10TV

 

Steroid Injections: What You Should Know

December 2, 2019

Steroid injections have become a common recommendation in the case of pain or injury. They are most often used to treat inflammation, especially when it has become chronic. Just like so many other things in medicine, these injections have potential benefits, as well as potential side-effects. And, recently, there has been new research that may change how often these injections are even recommended in the first place for use in joints.

We thought it would be important to talk a little bit more about it, since this treatment has become so commonplace and new research has come out.

About Steroid Injections – General Info

This treatment is used for pain and inflammation. It is injected to treat the joint, bursa, tendons or ligaments.

The procedure is most often done in a physician’s office and takes just a few minutes. The area is first cleaned and is often numbed with a topical anesthetic (spray or cream). Depending upon what area is being treated, the physician uses ultrasound to determine placement of the needle. The injection itself will either be the corticosteroid alone, or it may be a mixture that also contains a local anesthetic to help numb the treated area for a few hours. It is typical to have some aching in the treated area for 1-3 days.

Most physicians recommend getting an injection no more than 3-4 times per year, if indicated. It’s typically recommended to wait at least 4-6 weeks if another injection is warranted.

Results can vary person to person, and even between body regions for the same person. Some sources state that pain can be reduced for 6 weeks to 6 months. According to what we’ve heard from our own patients over the years, they’ve experienced relief anywhere between 1 week and 1 year.

Injections may not be recommended if you:

  • are on blood thinners, as it can cause additional bleeding at the injection site;
  • have diabetes, as the medication injected can affect blood sugars;
  • are dealing with an active infection, as it can make recovery from the infection more difficult;
  • have a joint that is already severely damaged, injections likely won’t be helpful.

After treatment, it is recommended to slowly increase activity. If you’ve gotten good relief, it can be tempting to jump right back into normal activities. However, this can be too much, too fast – so pace yourself!

Potential Side-Effects

In the past, many sources have reported that steroid injections have few side effects and none of them are very common, especially in response to a single injection. Worst-case scenario is that nothing changes and the patient gets no benefit.

Side effects include infection, allergic reactions, allergic reaction, skin discoloration, and tendon rupture. Some people may also experience something called post-injection flare. This flare occurs when the inflamed area is aggravated by a reaction to the injection.

Repeated use in one area can increase the likelihood of side effects. One concern is particular to treatments of tendon or ligament. Over time, repeated treatment can contribute to tissue damage. It can even contribute to tendon rupture. There is also a theory that repeated treatments can result in decreased benefit.

New Research

One research group did a meta-analysis in 2015 regarding knee arthritis, reviewing 27 different research articles on the topic. They determined that the benefits of steroid injections for knee arthritis are inconclusive and unclear.

In 2017, an article published in the Journal of the American Medical Association (JAMA) showed some interesting findings. Researchers worked with patients with knee arthritis. One group received the typical steroid injection and another group received an injection of saline. People reported the same result, regardless if they received the steroid or the saline. In addition, they found that more of those that received the steroid injection saw more erosion of the cartilage in the joint after treatment.

A new study published in October of 0291, by the Boston University School of Medicine, suggests that steroid injections can actually speed up destruction of a joint, leading to things like earlier total knee and total hip replacements. They’ve found an increase in problems like stress fractures, joint collapse, and progression of osteoarthritis.

So What Does This Mean?

First of all, research doesn’t quite know what to make of the injections. They may or may not actually help. They potentially have more significant side effects than originally thought.

In either case, one of the most important things to consider if you are thinking about getting steroid injections is that they are meant to treat the symptoms of pain and inflammation. Steroid injections do not “cure” the problem. If the symptoms were caused by injury or overuse, for example, other things will need to be addressed to have long-term results.

A steroid injection should be just one part of a larger treatment plan. Physicians may recommend NSAIDs (non-steroidal anti-inflammatory medications) or use of a brace. Hopefully, they also recommend physical and/or occupational therapy. The best recommendations, especially in the case of early osteoarthritis, include exercise, weight loss, and lifestyle changes.

Do your research. Ask your physician questions. Ask what your options are. Talk to a physical therapist to learn what can be done. Try exercise and changing your lifestyle.

Physical Therapy as an Option

So how does physical therapy play into all of this?

Your physical therapist will do an evaluation to see what all needs attention. Quite often, those with arthritis benefit from working on strength, balance, and stretches. PTs will also show you different ways to do things that will decrease stress on your body and joints. We have so many options to help, so give us a call! If you have more questions, contact us at Back in Step Physical Therapy.

Check Out These Articles

News Articles:

  • The Telegraph
  • The Atlantic
  • CNN

Research Articles:

  • Radiology
  • JAMA 2015
  • JAMA 2017

 

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6551 S Revere Pkwy, Ste 215
Centennial, CO 80111

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