Sports injuries are on a sharp upward curve in Sri Lanka.. Not a day passes when we hear of some student being called off the field due to an injury he/she has sustained. Some of these injuries require drastic interventions like surgery. But in the majority, simple physiotherapy exercises can help to correct their problem.
Chartered Physiotherapist Dr. Gopi Kitnasamy tells the Sunday Observer what these exercises are and why outdoor activity helps to keep children stay fitter, improve their learning skills, and ward off early onset of non communicable diseases.
Excerpts;
Q. The Education Ministry recently decided to give priority attention to school outdoor sports with the idea of promoting fitter students for the future. Is this a good thing?
A. Yes. Outdoor activities have long term benefits on their health. Adequate outdoor activity increases health and physical development by improving sensory development, reducing obesity and stimulating blood cells. It helps kids stay fit and active which will benefit them in the long run. They can ward off health problems like obesity and heart ailments, later in life. Participation in sports activities improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork.
Q. Ideally, how long should children spend time doing outdoor sports activities while in school? One hour? Two hours?
A. While researchers don’t always have an exact measurement for how long you should stay outside to reap these benefits, the ideal time should be 30 minute to 1 hour.
Q. Games like rugby, cricket, tennis, basketball, football, athletics, running, netball, table tennis, are some of the popular sports in schools. Which of these outdoor activities should they focus on to help them make maximum use of time spent outside the classroom?
A. I would say, always consider age-appropriate activities with children. Your child is likely to show natural preferences for certain sports or activities. Start there, keeping your child’s age, maturity and abilities in mind. For children of ages 6 – 9, organized activities like running, gymnastics, swimming and tennis are good choices. Children above 10 are ready to take on complex skill sports, such as football, basketball, hockey and volleyball. Keep in mind, however, that growth spurts caused by puberty can temporarily affect a child’s coordination and balance. Before allowing your child to participate in a contact sport, consider his or her age, maturity, and physical size. Whatever sports your child participates in, ensure that he or she has a foundation of proper technique and movement.
Q. All these sports carry a risk of injuries. Your comments?
A. Yes, although sports participation provides numerous physical and social benefits, it also has a downside- the risk of sports-related injuries. In general, the more contact in a sport, the greater the risk of a traumatic injury. Most frequent sports injuries are sprains (injuries to ligaments) strains (injuries to muscles), and stress fractures (injury to bone) caused when an abnormal stress is placed on tendons, joints, bones and muscle.
Q. As an experienced Chartered Physiotherapist, tell us how you could avoid such injuries on the playground in 1) general 2) in the specific sports mentioned earlier like cricket, tennis, badminton, basketball, rugby etc.
A. The developing bodies of the children are more vulnerable to injuries compared to that of adults. Fortunately, most sports injuries in children can be prevented. Some of the more effective ways to prevent these injuries include age-specific coaching, appropriate physical conditioning, and proper use of equipment. You can also prevent injuries by encouraging children to train for their sport, rather than rely on the sport to whip them into shape. Proper physical conditioning can go a long way toward keeping players off the injured list and on top of their game.
The other important strategies to prevent sports injuries are, being in proper physical condition (strength & flexibility), wearing appropriate protective gear, making warm-ups and cool-downs part of the child’s routine before and after sports participation, staying hydrated and stopping the activity when there is pain.
Q. Are there specific exercises for each sport?
A. Sports specific exercises are training methods used to target those muscles that are particular to a single type of activity. The sport activity is duplicated using various weight training methods. Muscle strength, endurance, flexibility and range of motion (ROM) are developed specifically to enhance the sport activity by over training individual muscles or groups of muscles, so that they perform better at the lighter loads of a specific sport.
Q. What kind of exercises do you recommend for children?
A. Exercises for children should include the three important elements – endurance, strength and flexibility. Endurance develops when kids regularly get aerobic activity (sports) which if done regularly strengthens the heart and improves the body’s ability to deliver oxygen to all its cells. Improving strength doesn’t have to mean lifting weights. They can do push-ups, crunches, pull-ups, and squats to help tone and strengthen muscles. Stretching exercises help improve flexibility, allowing muscles and joints to bend and move easily through their full range of motion. These exercises can be done for 45 to 60 minutes daily provided all three elements mentioned are given equal importance.
Q. Complications of delayed treatment in sports injuries?
A. If management of sports injury is neglected or delayed; it can lead to an adverse outcome. When muscle is injured and not treated, it can lead to scar tissue formation and the muscle can lose its flexibility and neglected ligament and joint injury can bring about soft tissue (ligament) loosening and joint instability. This may lead to the repetitive injury and eventually more serious functional loss and will force you to get out of your sport.
Q. If that happens is surgery the option?
A. Surgery is often considered a last resort. It is most commonly used following a serious injury or as a result of persistent symptoms. Common surgical procedures in sport include repair to damaged cartilage and ligaments in the knee (especially, cruciate ligament tears), AC shoulder injuries, dislocations and tendonitis. Surgery can usually be used to repair damaged soft tissue, align bones and re-position joints.
Q. What about physiotherapy?
A. Managing and preventing injury in children requires a different approach to adults. Children’s bones are still growing and the presence of the growth plate or apophysis creates a group of conditions unique to children. Most of the sports injuries are musculoskeletal and soft tissue related, which can be treated with Physiotherapy. Laser therapy is now a popular, safe and effective method of accelerating recovery and is particularly effective for acute soft tissue related sports injuries.
Q. Injuries from swimming? What are they?
A. Swimming is a fantastic sport that combines all body strength, flexibility and endurance. Swimmers are unfortunately prone to overuse injuries affecting the shoulder, neck, lower back and knees. Training errors such as over training, overloading, or poor technique may also contribute to this condition. Another issue is, most swimmers develop muscle imbalances where the adductors and internal rotators of the arm over develop (due to the nature of swimming). Unfortunately, this leaves a relative weakness of the external rotators and scapular (shoulder blade) stabilizers - simply because they don’t get used as much. This can lead to shoulder instability and injuries.
Q. How can physiotherapy help them?
A. Treatment involves corrective exercises and electro therapy. However, it is important to find the root cause of the injury and modifying stroke technique to prevent the issue from reoccurring. Avoid over training in one particular style of swimming. Core strengthening, rotator cuff strengthening (very important – to prevent shoulder injuries) and land based exercises done pre, post and during your swimming session.
Q. Any home remedies?
A. Follow the acronym R.I.C.E. as a first aid. Rest the area, apply Ice, Compress it with an elastic wrap, and Elevate it.
Ice therapy, cold therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. Apply only for 10 minutes, but you can repeat it every 3-4 hourly. The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage by 1) Decreasing the amount of bleeding by closing down the blood vessels.2) Reducing pain 3) Reducing muscle spasm 4) Reducing the risk of cell death by decreasing the rate of metabolism.
Q. Is leading an active life a pre-requisite to doing well in sports? Why?
A. Yes definitely, staying active and healthy, reduces the chance of future injuries, and improve overall performance. A well balanced diet, healthy eating habits, adequate fluid intake and good sleeping routines are also important to improve sports performance.
Q. Obesity in children is an emerging problem in Sri Lanka.. Is this due to lack of exercise?
A. Childhood obesity is a complex health issue. Lack of physical exercise in children is the main culprit in starting the rise of childhood obesity.
Q. Can obesity adversely impact on children who wish to excel in the sports field?
A. Obesity can cause limitations of the cardiopulmonary and the metabolic systems, resulting in exertional dyspnea (shortness of breath or difficulty in breathing), contribute to the limitations in the functional capacity. In addition, the sedentary lifestyle often adopted by these children contributes to impaired exercise tolerance and poor sports performance.
Q. Exercises for obese children?
A. Exercising to reduce weight is very important but need to be carefully monitored. Asking children to elevate their heart rates to a heightened aerobic exercise rate for 30 minutes or longer may be dangerous. Start with an exercise pace that resembles a brisk walk, rather than a jog. Warm up slowly for the first few minutes, let children take breaks as needed and make sure they drink water whenever they become thirsty. Obese children may develop joint or back pain if they perform repetitive, high-impact exercises like running, aerobic dancing, jumping or skipping. Low impact exercises like cycling and Water jogging and aerobics are good choices. Children are more likely to continue exercise if it’s fun, for example, playing sports together. Set goals and keep records so children can see improvement to have a positive impact.
Q. Your advice to students?
A. Sports injuries in children are on the rise. The growing concern is that many of these children ignore their injuries, and such inattention can worsen the issue over time. Another trend is that kids are focusing harder on just one sport to become ultra-competitive. As a result, many of them are pushing themselves beyond acceptable thresholds in their formative years, leading to injuries that are typically seen in professional players. When you are injured, your body is giving you a signal. Don’t ignore it; do the right thing so that you can fully heal and continue to enjoy sports.
Q. Your advice to parents?
A. Exercise alongside your children. To make physical activity a lifetime commitment which will result in healthier, happier, and smarter children, parents must start at home and make a concerted effort to encourage their children to go outside and play.
Football
Common injuries and locations: Bruises, sprains, strains, pulled muscles, tears to soft tissues such as ligaments, broken bones, internal injures (bruised or damaged organs), concussions, back injuries, sunburn.
Knees and ankles are the most common injury sites. Safest playing with: Helmet, mouth guard, shoulder pads, athletic supporters for males, chest/rib pads, forearm, elbow, and thigh pads, shin guards, proper shoes, sunscreen, water.
Injury prevention: Proper use of safety equipment, warm-up exercises, proper coaching techniques and conditioning.