Sports Rehab for Kids

• All sports have a risk of injury.
• In general, the more contact in a sport, the greater the risk of a traumatic injury. However, most injuries in young athletes are due to overuse.
• The most frequent types of sports injuries are sprains (injuries to ligaments) strains (injuries to muscles), and stress fractures (injuries to bones). Injury occurs when excessive stress is placed on tendons, joints, bones and muscle.
• In a growing child, point tenderness over a bone should be evaluated further by a medical provider even if there is minimal swelling or limitation in motion

• The pressure to win can cause significant emotional stress for a child. 
• Sadly, many coaches and parents consider winning the most important aspect of sports. 
• Young athletes should be judged on effort, sportsmanship and hard work

• Psychological intervention in reducing post-injurypsychological consequences and improving psychological coping during rehabilitation. 
• Specifically, guided imagery/relaxation was shown to be associated with improved psychological coping and reduced re-injury anxiety. 
• Goalsetting however, was not directly associated with reduction ofnegative psychological consequences.

Joint sprains & dislocations – knee, ankle, shoulder and finger injuries

• P R I C E [Protection of the injured joint (plaster cast or posterior splint), Rest, Ice, Compression, and Elevation to control inflammation] principle.
• Muscle strengthening exercises are started as soon as pain allows
• Rehabilitation should be active, and we discourage return to sporting activities before 8–12 weeks. The child should have regained a full range of movement before resuming full sporting activity
• However, one in six patients will develop recurrent dislocation and will require realignment surgery

Stress fracture 

• Stress fractures are difficult to diagnose and are often associated with training errors.
• Endogenous factors such as body size, sex, diet, hormonal status and anatomical factors are also important, but difficult to prove. 
• Primary management consists of immobilization and reduction of activity to a pain-free level, followed by a gradual increase in exercises.

Muscle strains – hamstring, calf, quadriceps

• Quadriceps contusions may produce local muscle bleeds associated with injury.
• As in other muscle injuries, the injury may occur from a direct blow, sudden explosive action or occasionally from a more trivial action. 
• Treatment includes rest, ice, compression, elevation and analgesia. Restriction of sport is essential followed by a graduated return to sport

Tendon injuries – Achilles, patella and gluteal tendon pain

• Achilles tendinopathy can arise due to excessive eccentric weight bearing, and tibialis anterior tendinopathy can result from direct pressure in skates or ski boots. In most patients, partial rest and strapping are sufficient
• Some children will benefit from physiotherapy, especially stretching, and occasionally from peritendinous injections

Ankle sprains:

• Ankle sprains are more common in patients with weak and deconditioned peroneal muscles and pes cavovarus deformity.
• In general, they should be treated conservatively with the use of orthotics, if the hind foot is in varus. 
• The first line management in chronic ankle instability should be strengthening and proprioceptive training

Ligament injuries 

• Anterior cruciate ligament tears were considered rare in children, but they are becoming more frequent and are often associated with MCL tears
• Heat and cold therapy is applied to enhance relaxation and reduces pain. It is important to use ice after exercise and after any activity that causes discomfort. Pulsed electrical stimulation can also be used to relieve the pain.
• Stretching, mobility and strengthening exercises need to be done regularly. Exercises will restore the movement and maintain the adequate strength and stability of the knee joint.
• Perform all exercises 3-4 times daily
• Rehabilitation from surgery – knee, shoulder or ankle arthroscopies or reconstructions

• Take time off. Plan to have at least 1 day off per week and at least one month off per year from training for a particular sport to allow the body to recover.
• Wear the right gear.  
• Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee, shin), helmets, mouthpieces, face guards, protective cups, and eyewear. 
• Young athletes should not assume that protective gear will prevent all injuries while performing more dangerous or risky activities.

• Strengthen muscles. Conditioning exercises during practice strengthens muscles used in play.
• Increase flexibility. Stretching exercises after games or practice can increase flexibility. Stretching should also be incorporated into a daily fitness plan.
• Use the proper technique. This should be reinforced during the playing season.

• Helmets are often mandatory or highly advised in a number of sports to reduce the risk of injury from a blow to the head (e.g. American Football, Ice Hockey, and Cycling). 
• Faceguards are frequently included in many ball games such as hurling or baseball to prevent facial injuries. In cycling specifically, it has been shown that wearing a helmet can reduce the risk of severe injury from an associated blow to the head by approximately 63-88%

• Prehabilitation describes a systematic approach to identifying common injuries within a specific sport and then designing an appropriate series of exercises that work toward minimizing their incidence. (Meir R et al. 2007)
• Prehabilitation programmes usually consist of strength and conditioning training, proprioception exercises, and sport specific drills. Occasionally psychological skills training may be incorporated.

• Strength and conditioning is the most common type of prehabilitation used within young athletes. Studies have found that programmes that include strength, flexibility, balance, and sport‐specific fitness and technique training prevent lower limb injury.
• It is also thought that the benefit is continued when the prehab is performed throughout the playing season. This provides important information regarding physiotherapy practice, as strength and conditioning should be an ongoing “prehab” strategy for young athletes in which the physio should recommend.
• Resistance training can help reduce injury by improving joint integrity, therefore reducing the risk of subluxation, dislocation, and strains. It is within a physiotherapist’s role to ensure that resistance training is kept safe and is in line with the individual's growth. The benefits that can be achieved for adolescents participating in an appropriate resistance training programme are outlined underneath.

• Take breaks. Rest periods during practice and games can reduce injuries and prevent heat illness.
• Play safe. Strict rules against headfirst sliding (baseball and softball), spearing (football), and checking (in hockey) should be enforced.
• Do not play through pain.
• Avoid heat illness by drinking plenty of fluids before, during and after exercise or play; decrease or stop practices or competitions during high heat/humidity periods; wear light clothing.
• If children are jumping on a trampoline, they should be supervised by a responsible adult, and only one child should be on the trampoline at a time; 75% of trampoline injuries occur when more than one person is jumping at a time. 

• 2017 American Academy of Pediatrics
• http://dx.doi.org/10.1016/j.jshs.2012.06.003
• John Miller (2015) ACL injury: What is ACL injury? http://physioworks.com.au/ acl-anterior-cruciate-ligament-injuries