Sports injuries in children require different approach | Sunday Observer

Sports injuries in children require different approach

Early detection, diagnosis, appropriate treatment will quicken recovery

Recent news of children fainting or developing chest pains while running a marathon or doing their normal outdoor physical exercises in the morning, has raised concerns among health officials. It has also led to the Health Minister calling on all school Principals to ensure that their students have started out their day with a healthy breakfast.

With the re opening of schools and preparations for school sports meets, children are bound to become increasingly pressurized by their parents, coaches and school authorities to perform beyond their abilities, putting them under tremendous mental and physical strain. Worse still, many are unaware that delay in treating injuries sustained on a playing field could lead to drastic consequences, e.g. head injuries if treated lightly could end up with even fatal results, while a minor sprain could become a complicated injury if proper treatment is not given in time.

“Children’s injuries during sports are different from those of an adult as the former are still growing. We need to take a different approach to managing them”, says a leading Chartered Physiotherapist who has been treating children with sports injuries for over thirty years, mostly with muscle strengthening exercises.

Following are excerpts of an interview the Sunday Observer had with Dr Gopi Kitnasamy:

Q. With the reopening of schools and preparations for school sports meets and regular school sports activities, it is likely that there could be a surge in injuries among schoolchildren. What kind of injuries do you foresee to spike in a) young children b) in teenagers?

A. Physical activity plays a significant role in the well-being of a child. At a young age, sport is for enjoyment and also for health and personal development, but during sports meets, over training and exposure to excessive levels of physical activity can increase the risk of injuries. Incidence and distribution of sport-related injuries vary based on sport affiliation, participation level, (e.g. grade level, age and skill level), gender and player position. Certain intrinsic factors may predispose a young athlete to overuse injuries. Anatomic mal alignments lead to abnormal stresses, motor strength imbalance can result in muscular strains and skeletal growth leads to tight musculo- tendinous units, which are, in turn, associated with muscle strains.

Muscle strains are the most common type of sports injuries in children followed by joint sprains (ligaments) and contusions due to contact sports.

Q. In some countries sports injuries are the second leading cause for emergency room visits for children and adolescents, and 2nd cause of injuries in schools. How does Sri Lanka compare to this?

A. Yes, sports injuries are very common among children all over the world. Children and adolescents are at a special risk of injuries because most sports are not adapted to the motor skills of their specific age group. Thus, adolescents play according to the rules of adults and the apparatus used are not adjusted to their sizes. For example, the basketball baskets are just available at one height and almost all sports have only one ball size, the one used for adults. However, particularly, adolescents may sustain injuries, which can impair their growth with potential lifelong effect.

Q. In what kind of sports do you incur the most amount of injuries? Name them according to the sport.

A. Unsurprisingly, contact sports like football and rugby lead the list but other sports like cricket, basket ball, volley ball, hockey are also common sports to cause injuries to children. Individual sports like badminton, tennis, swimming, and athletics are also common sports which are related to injuries in children. The incidence of sports injuries seems to increase with age and injuries to the upper extremity are more common than the lower extremity and the head.

Q. Are there any statistics on injuries during sports at school in Sri Lanka?

A. As far as I know, there aren’t many studies on statistics of sports injuries among children in Sri Lanka. But, we see many children with sports related injuries in our Physiotherapy Department. The number is always high during sports meet and other events.

Q. How do they get injured? Genderwise, do boys get more injuries than girls ? Why?

A. In children, bones and muscles show increased elasticity and heal faster. Around the period of peak linear growth, adolescents are vulnerable to injuries because of imbalance in strength and flexibility and changes in the biomechanical properties of bone. Sudden overload, excessive strains, high-intensity training and overuse can cause injuries to the growing musculoskeletal system.

Training in improper environments or with incorrect footwear equipment can also result in injury. Players should ideally be matched for body size, athletic ability and biological maturity with appropriate body protection and supervision. Balanced nutrition is also important.

Yes, boys get more injuries than girls and get more severe ones, like head injuries, fractures and dislocations. The type of injuries may vary depending on the age and types of sports. Ankle and knee injuries are common among the girls; and shoulder, elbow, spine and head injuries are more common among the boys.

Q. It has been charged that injuries of the young athlete are often trivialized, and that they are usually encouraged to toughen up and play through pain . Do you think this is a good approach and in the best interest of the young athlete? What are the positive and negative outcomes of such an approach?

A. When it comes to sports injuries, the olden days of “just suck it up” or “play through the pain” are over. Now, we all know that playing through a sports injury can cause damage that keeps you out of the sports longer or may even end your sports career entirely. In addition to worsening an existing injury, playing when you’re already injured means you also can get hurt someplace else, because your body protects the injured area but puts other areas at risk.

Q. In this respect how can your profession as a Physiotherapist help ?

A. Sports injuries may be hard to avoid with active children, and most of the sports injuries are musculoskeletal and soft tissue related which can be treated with Physiotherapy. 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.

Children have a lot of enjoyable sporting years ahead of them. It would be a shame to see this enjoyment ended too soon. Never force them too much, allow them to play at their own intensity and pace.

Encourage them to start getting in shape and conditioning at least a month before any sports events. Emphasize stretching and flexibility exercises on a daily basis and make sure they wear adequate protective equipment.

Early detection, accurate diagnosis, appropriate treatment, supervised conditioning and training will quicken recovery, improve performance and also prevent reoccurrence.

Q. Your advice to children, relating to sports injuries?

A. When you are injured, your body is giving you a signal. Always, stop playing as soon as you notice an injury or pain and talk to your coach or Physiotherapist. Don’t ignore it so that you can fully heal and continue to enjoy your sports.

Q. Can neglect of a treatable injury result in permanent injury that prevents sports participation in the future?

A. If management of sports injury is neglected or delayed, it can lead to an adverse outcome. When the 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. What kind of exercises do you recommend for a sports injury? Are there specific custom tailored exercises for different injuries, such as, to the wrist, ankle, knee, etc?

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.

Q. What are sports specific exercises?

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. These exercises will take 45 – 60 mins and can be done on a daily basis but all three elements need to be given equal importance.

Q. One of the promises of the government of good governance is to make physical exercises a compulsory outdoor extra curricular activity for children from primary grades on . Do you think this is a good idea? Ideally, at what time should children engage in these outdoor activities?

A. The answer is Ýes’ to the first question and to the second, when the sun is not too hot outside, preferably before noon.

Q. Your message to parents and students on sports injuries?

A. Parents should check whether all sporting equipment such as, the helmet, pads, boots and elbow pads fit the child properly. Give them a balanced healthy diet, plenty of fluids, preferably water, while playing, to ensure that they stay hydrated. Tell them to avoid playing through pain and take adequate rest.