Injury prevention in young athletes

iNJURY pROVENTION

Photo Credit: Patrick Price.

Most of us are aware of the explosion of triathlon across Ireland over the last 10 years.

This increase in participation is not restricted to age groupers and weekend warriors alike, the growth of youth participation in triathlon is following a similar trajectory. With the underage elites, academy and recreational athletes training and racing more, injury prevention and management within these individuals should be a top priority for all youth coaches and support teams. With coach education improving massively over the last few years we are more than aware that coaching youth athletes as ‘little adults’ isn’t the way forward, with most coaches having a good idea of the ‘pitfalls’ involved in keeping our young athletes healthy. This will hopefully serve as an update and provide a bit of clarity surrounding specific conditions.

Young athletes are more susceptible to injury/burnout for a variety of reasons. Namely growing bones/joints and tendons are less resilient to stress and ‘sharp’ or ‘extreme’ changes to training or racing loads. This is much more of a factor during a growth ‘spurt’ i.e. increase in miles, weights, speed work combined with increasing ‘tension’ or load on muscle/tendon brought about by increasing tissue length. In addition to not being aware of the consequences of not reporting symptoms, young athletes can also be inconsistent with these reports i.e. fatigue, pain or reporting extra training/exercise done in curricular activities e.g. P.E. Coaching children/young adults can be a lot more coach driven with less discussion regarding training and goals which again can exacerbate the issues outlined above.

In young endurance athletes the main concern is overuse injuries and burnout. An overuse injury is a repetitive micro trauma or ‘reactive change’ within tendons and bones most commonly. They can be loosely characterised within four stages. Stage one – pain in the affected area after physical activity. Stage 2 – pain during the physical activity with no restriction of performance. Stage 3 – Pain during activity, restricting performance, and finally stage 4 – chronic, persistent pains during activity and at rest. Common overuse injuries in young endurance athletes include:

Osgood Schlatters Syndrome

‘Stress reaction’ of patellar (knee) ligament on tibia (shin bone). This is characterised by a painful lump just below the knee and is most common in young males undergoing a growth spurt (growth spurt not always involved however). This has also been known to be present in both knees in 20-30% of cases (Carlo 2010).

Sever’s

This is a ‘stress reaction’ of the Achilles tendon pulling on the calcaneus (heel). Severs presents with pain in the heel and aggravated by physical activity or prolonged physical activity i.e. start of running or 5-10 minutes into session. Most commonly between 9-11 year olds (Schorfbillig 2008).

Apophyseal injuries

These injuries are similar to Osgood’s and Sever’s. They are again caused by a ‘stress reaction’ of the tendon attaching to the bone. These most commonly occur around the front of the pelvis (groin), hips and top of hamstrings i.e. buttock crease (Moeller 2003). If these above symptoms are ignored it could lead to long term pain, reduced training and/or stress fracture (in more extreme cases).

Stress fracture

Stress fractures can be a common problem in endurance athletes of any age. Common stress fractures in young endurance athletes include metatarsal (foot), tibia/fibula (shin) and pars defect (low back) with lower numbers of femur (thigh) stress fractures when compared to adults. It’s important for coaches to be aware of these symptoms and know when to rest, modify training and to consult a health professional. Prevention and management of these injuries is similar to that of older athletes i.e. rest (or activity modification – this will be more significant with stress fractures), offloading the joint or tendon, this can be achieved again with activity modification, cross training (variation of training) and/or therapeutic methods such as preventative taping, shoe inserts etc..

Burnout

We have all encountered this to some degree be it psychological ‘burnout’ or physical fatigue, burnout can have a huge cost to training and racing days. ‘Burnout’ is characterised as a series of psychological, physiological and hormonal changes that result in reduced sporting performance. The symptoms of burnout include chronic joint/muscle pain, personality changes, elevated resting/effort heart rate, reduced performance, fatigue, lack of enthusiasm and subsequent difficulty completing sessions (Gustafsson 2007). Preventing burnout should be paramount in training program/session design, with certain ‘fail safes’ built in i.e. 1-2 days’ rest weekly, 2-3 months off or cross training, keeping training interesting and reacting to symptoms by altering training/rest.

Keeping our young athletes interested and committed enough to realise their potential is a challenge that we can have varied influence over, but keeping our athletes healthy when they are interested and committed if key to them fulfilling this potential.

If you have any questions then please feel free to give me an email.

Martin Dunlop - Peak Physiotherapy Clinic - rm_dunlop@live.com