Children and Sports
Physical activity has marked physical and psychological benefits for children and adolescents. Sports is one of the best ways to encourage physical activity in the growing child. As children develop, their physiological make up changes and Coaches as well as parents must be cognizant of the changes that occur in children.
In growing children, injuries and medical problems involving the bones and joints as well as muscles and ligaments are usually quite different from conditions that are seen in adults.
These differences come about as a result of the differing structural properties of tissues in children, adolescents as adults. Growing bone is more resilient and elastic withstanding greater deformity without fracture. Thus children tend to sustain incomplete or “greenstick” fractures rather than the badly displaced and complex ones that adults tend to have. Children also tend to heal faster and have greater ability to “remodel” which means they are better able to recover even when the bone is severely angulated.
Foot pain is one of the more common conditions in the younger athlete. Most cases are due to overusage and will resolve spontaneously with activity modification. There are some other common conditions however that need to be considered. Most of the time the diagnosis can be made by carefully examining the foot and localizing the area of maximal tenderness.
Severs disease presents with Heel pain. It occurs during the growth spurt in early puberty. During this time the bones grow faster than the muscles and tendons which literally get stretched. The Achilles tendon which attaches to the back of the heel is similarly affected and puts too much pressure on the back of the heel thus causing the pain.
The mainstay of treatment is activity modification and occasionally anti- inflammatory medication to control pain acutely. Stretching exercises and insoles may also be helpful. Most patients improve in 2 months but it may take longer to settle down in some cases.
Sometimes the bones in the foot do not separate properly at birth and this can lead to a condition called tarsal coalition. It is often not noticed until the child starts running. There is often a family history and the pain is usually in the middle of the foot. Sometimes the child complains of recurrent ankle sprains. The diagnosis is confirmed with Xrays and treatment is again with activity modification and foot orthotics.
Sometimes pain on the “medial” or inside of the foot (the side where the big toe is) can be due to irritation of the navicular bone. This irritation occurs where the tibialis tendon inserts into the navicular and is sometimes associated with an accessory navicular bone ( this is like an “extra” bone)
Knee pain is common at all ages and the young athlete is no exception. Just like in the adult, careful history taking and clinical examination is needed to make a diagnosis but care must also be taken to examine the hip in children and adolescents as pain can be referred to the knee from the hip.
Osgood Schlatter disease
This is one of the most common causes of knee pain in adolescents at the time of the growth spurt. It is characterized by pain at the front of the knee just below the knee cap and is associated with running and jumping sports. This area is called the tibial tuberosity and it is a weak point until the bones fuse.
Osgood Schlatters always settles down by itself as the body matures but it may take up to 2 years. There is NO need to stop sports but some degree of activity modification is required.