1. OVERUSE INJURIES IN ADOLESCENTS IRVING RAPHAEL MD Syracuse Orthopedic Specialists Former S.U. Head Team Physician June 5, 2015

3. OLYMPIC MOTTO CITIUS ALTIUS FORTIUS

4. OLYMPIC MOTTO CITIUS - FASTER ALTIUS - HIGHER FORTIUS - STRONGER

6. OUTLINE WHY ARE WE CONCERNED?? SPECIFIC INJURIES WHAT DO WE DO ABOUT IT??

7. Who’s At Risk? Soccer Basketball Football Lacrosse Volleyball Skiers Gymnasts Cheerleaders

8. YOUTH SPORTS INJURY STATISTICS 30 million youth participating in US HS athletes – 2 million injuries per year 3.5 mill under age 14 get medical Rx Age 5-14, account for 40% of sports injuries treated in hospitals Overuse - half of sports injuries, mid & HS By 13, 70% drop out of youth sports Since 2000 – 5 X increase in serious shoulder and elbow injuries - throwing

9. Overuse Injury - Definition “Micro-traumatic damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process.”

10. Stages 1. Pain after physical activity 2. Pain during activity without restricting performance 3. Pain during activity restricting performance 4. Chronic unrelenting pain even at rest

11. RISK FACTORS PRESENCE OF GROWTH AREAS MUSCLE DEVELOPMENT – IMBALANCE PRESSURE TO COMPETE IMMATURITY – PHYSICAL AND EMOTIONAL PLAYER AGE / SIZE DIFFERENTIAL YEAR – ROUND PARTICIPATION MULTIPLE TEAMS

13. BURNOUT OVERTRAINING SYNDROME “A series of psychological, physiological and hormonal changes that result in decreased sports performance.” -- chronic muscle or joint pain -- personality changes -- elevated resting heart rate -- chronic poor athletic performance -- fatigue, lack of enthusiasm

14. COMMON TYPES PATELLO – FEMORAL PAIN JUMPER’S KNEE - OSGOOD SCHLATTER SOCCER HEEL – CALCANEAL APOPHYSITIS LITTLE LEAGUER ELBOW SWIMMER’S SHOULDER GYMNASTS BACK - SPONDYLOLYSIS RUNNER’S “SHIN SPLINTS”

16. OSGOOD SCHLATTER’S Painful bump over tibial tubercle Tender patellar tendon Aggravated by activity Sports – running, jumping, twisting Diagnosis – clinical, radiographic Worse during growth spurts Boys more than girls - changing

17. OSGOOD SCHLATTER ECTOPIC BONE – TIBIAL TUBERCLE

18. O.S.G. - TREATMENT REST, REST, REST Immobilization, knee brace NSAID Symptomatic – Ice vs. Heat Self limiting REST, REST, REST

19. SEVER’S DISEASE CALCANEAL APOPHYSITIS Growth area back of heel bone Pain with activity – running, jumping P.E. – normal appearance, Squeeze test Radiographs – normal Both heels – more than half patients

21. SEVER’S TREATMENT REST, REST, elevate Medication Orthotics Physical Therapy Icing Open back shoe Stretching hamstring & calf muscles

22. LITTLE LEAGUE ELBOW Lateral apophysitis of elbow – avulsion? Overuse with throwing Repetitive valgus stress on elbow Year round single sport Longer competitive seasons Training and conditioning errors Diagnosis – clinical, ?Xray

25. TREATMENT – L.L. ELBOW REST, REST, REST Icing Medication Physical Therapy Recovery over months Gradual return to pitching Throwing – number, distance, velocity

27. SPONDYLOLYSIS Female Gymnast Back Stress fracture of Pars Interarticularis Repetitive flexion, extension, rotation Pain, Tight Hamstrings Radiographs, MRI, Scan

29. Sports at Risk Gymnasts Offensive linemen, football Weight lifters Wrestlers Dancers Pole Vaulter, High Jumper

30. Treatment - Spondylolysis Restrict Activity - ?Bed Rest Medication Brace ? Surgery rare Exercise – Abdominal, Hamstring Pain-free activity – swim, bike

31. SWIMMER’S SHOULDER Overuse, Over-training Impingement, rotator cuff tendonitis, biceps tendonitis Related to stroke Muscle imbalance Instability, laxity

33. Shoulder Treatment Rest, “out of the pool” Medication Ice, Heat Physical Therapy Shoulder muscle girdle strengthening Scapular Stabilization Graduated return to swim program

34. KNEE CAP PAIN Patello-femoral pain syndrome Retro-patellar pain syndrome Chondromalacia patella Patellar malalignment Syndrome Anterior knee pain aggravated by sports, stairs, walking, jumping, sitting for long periods- “Theater sign”

35. Treatment – Knee Cap Pain R.I.C.E Exercise – Quadriceps Strength Physical Therapy Medication Bracing, Taping Orthotics – shoe inserts Surgery ??

36. SHIN SPLINTS Medial Tibial Stress Syndrome (MTSS) Tibial Periostitis

37. SHIN SPLINTS Throb, ache during or after run “Ramping up” work out Change in surface, distance, speed Clinical diagnosis Excess pronation feet R/O Stress Fracture, Compartment Syndr Xray, MRI, Bone Scan, Pressure Measure

38. Shin Splint - Treatment Rest Ice NSAID Physical Therapy Arch Supports – Orthotics Slow return to running

39. What do we do about overuse injuries in adolescents ?? Athletes Coaches Parents

40. EMPHASIS * INJURY REDUCTION * PROPER EDUCATION SUPERVISION TRAINING PARENTAL GUIDANCE EARLY RECOGNITION INTERVENTION / TREATMENT

41. Questions?

42. Thank You RAPHAELMD.COM