Youth Sports Injuries, Just Growing Pains?

When is it More than Just Growing Pains?

As a physical therapist specializing in sports medicine for 20 years, I have discovered a plethora of misinformation pertaining to the pain our youth are experiencing as a result of their athletic endeavors. In my practice, I have witnessed an increase in the numbers of kids, ages 5-18, who play one sport 4-6 days per week, year-round. Many of these kids have struggled with the same injury on and off for years before they come in for treatment. I frequently encounter upset parents because they were instructed to have their child “rest, it will just go away.” Rest can help to diminish the injury temporarily, but if it isn’t healed properly, that same injury will return to haunt and hinder every sports season.

Another myth I often hear is, “it’s just growing pains; they’re kids, they will just heal.” The problem is it doesn’t always just heal. Remember, pain is a signal to our bodies that something is wrong. Also, when someone has pain, compensatory patterns can develop. Think of a limp, it becomes a habit and even when the pain is gone, the limp may still be there. We have the opportunity to correct these problems BEFORE they become an issue. The beauty of the youth athlete is they are still growing and changing. This is the prime window of opportunity to guide their movement and strength progressions while they are developing, before it becomes a chronic injury.
Next, I want to highlight overuse injuries in the youth athlete. Over 70% of youth injuries are from overuse. Kids have common patterns of overuse that are very different from the adult athlete. Children are not small adults. There are variations we must consider in their athletic training.

1. Growth spurts, the pattern in which they grow, will change how they move. During a growth spurt, the brain does not know yet where the body is in space, therefore the child may be clumsy (think of the puppy with big paws that falls every time it runs). That in and of itself, will predispose the young athlete to injury.
2. Energy expenditure associated with growth may cause fatigue, and thereby increase risk of injury.
3. Year-round training in one sport has been shown to increase overuse injuries significantly in our youth athletes.

The common overuse injuries we’ll address today are fractures, growth plate injuries, soft tissue strains and chronic sprains.
A stress fracture is an overuse injury in a young athlete due to the increased porosity of the immature bone. When the muscles are tired, there is inevitably more impact and stress on the bones. With the increased volume of training sessions, the cells of the bones are unable to repair fast enough to keep up with demand. This often occurs more frequently in the lower legs. Stress on the shins (shin splints) is very common for runners and sports that involve high levels of running like: track, soccer, basketball, volleyball. Vertebral (low back) injuries are high among gymnasts, divers and skiers. It is very common to see the onset of pain early to mid-season, in concert with the increased volume of training because the body is not yet trained to keep up.

Growth Plate injuries are very common in children. The growth plates are the space on the ends of the long bones that have not hardened yet. Because the plate is sandwiched between the hard bone, it is more vulnerable to shear and compressive forces.

“Approximately 15% to 30% of all childhood fractures are growth plate fractures. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires prompt attention. If not treated properly, it could result in a limb that is crooked or unequal in length when compared to its opposite limb. Fortunately, serious problems are rare. With proper treatment, most growth plate fractures heal without complications.”

Common injuries that happen with trauma and overuse are Severs (heel pain), Osgood Schlatter disease (tibia: large painful bump just below the knee cap), little league elbow and gymnast wrist. These injuries can be overlooked and regarded as “just a sprain.” When these injuries are not identified, significant problems can arise that may affect the child well into their adult years.

Soft tissue injuries are something I see very frequently in my athletes. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC2213798/ These are commonly known as Tendonitis and chronic muscle strains. Shoulder pain is frequent throughout the season in our pitchers and swimmers. The ache just below the knee cap for our soccer players and volleyball players. The chronic hip flexor strain for all my track athletes, and don’t forget the “pulled hammy” that just won’t stop hurting with all my sprinting and cutting sports.

The soft-tissue injuries occur when the muscles around a joint are not balanced. The muscles are pulley systems. Image a huge round stone with a bunch of guidewires, we have 10 people pulling these wires to roll the stone in a straight path. If everyone pulls evenly in the right sequence the stone will roll straight. If one side pulls harder or at the wrong time, the stone moves in that direction. If the hamstrings pulls before the gluteus muscle, that muscle gets the brunt of the force. The outcome is an overtaxed and painful hamstring. The same goes for the quadriceps and hip-flexors. These are prime examples of the common compensation patterns I referred to at the beginning of the article.

Rest and ice are imperative to stop the symptoms of the injury. The way to address the root cause is to evaluate the movement patterns. A skilled physical therapist will evaluate the poor patterns and re-train for appropriate balanced muscle. This is needed to abolish the poor pattern that caused the stress. A good physical therapy program will include a strong focus on the neuromuscular education, teaching the nerves and muscles to move in a pain free efficient manner. The gains in strength and speed will be exponential!

The common ages that children experience growing pains are 3-5 and 8-12. To help ease that pain, I recommend a massage or gentle rubbing, Epsom salt baths, and gentle movement.
What can we do to help our kids?

1. Listen to them. If they hurt let them rest. They may still desire to play in the pool or goof-off in the backyard. This can be active recovery from a tough week of drills at practice.
2. There is a growing body of evidence that shows sports specialization before high school can lead to greater risks of overuse injury and burnout. They may do better with an entire season off. Let them play a recreational sport, one that is different from what they are doing competitively. The majority of professional athletes played more than one sport allowing the body to actively recover between seasons.
3. Find a physical therapist or trainer who will work with your child to teach effective patterned movements. Regardless of the injury or the cause, there will be imbalances in the injured region, in addition to, the joint above and below. The time of healing is the perfect time for a professional movement specialist to retrain the muscles and joints to move with the best efficient pattern. You will see huge gains when your child can move effectively without pain!

The list of potential injuries and treatments could fill a text book. Should you desire more information on specific injuries, I provided links to a few helpful articles. Remember, pain is a message to our bodies that something is wrong. Finding a trained practitioner to help your athlete move through their childhood with less pain will reap the rewards twenty fold.

 

 

http://www.espn.com/espnw/voices/article/17831948/5-reasons-want-your-kid-multi-sport-athlete

https://www.nfhs.org/articles/study-indicates-higher-injury-rates-for-athletes-who-specialize-in-one-sport/

https://www.babycenter.com/0_growing-pains_1388141.bc

http://orthoinfo.aaos.org/topic.cfm?topic=A00613

http://www.coloradoan.com/story/sports/2016/03/04/playing-multiple-sports-pays-off-high-school-athletes/81131570/

Julie Granger Young Female Athlete, Prism Wellness 2016.

Lake Tahoe Ski

5 Ways to Recover from Ski Injuries this Season

How to know if it’s a tweak or something more serious:

The Reno-Tahoe area is buzzing with excitement over the recent record snowfall in January that has coated the Sierra Nevada in pure white powder.  I’m hoping everyone has had a chance to get out and enjoy the beautiful winter in their own way. Whether you’re a snowshoer or a downhill shredder, the snow and terrain challenges our bodies in ways we don’t normally encounter most days. Occasionally, this leads to falls, tweaks, twists and discomfort that leaves you wondering if the injury is serious or will just work its way out with time.

Our knees and spine are particularly vulnerable to injury during outdoor adventures, especially in deep snow, which can be unpredictable.  Aside from pain, be on the lookout for swelling, redness, warmth and decreased range of motion in the affected area. Obviously, these suggestions apply to injuries that aren’t immediately thought to be serious (i.e. broken bones, head injury) but if you twisted your knee funny on a turn, or have aching in your back after a fall, then these 5 tips can help you recover as quickly as possible, and get back to enjoying the snow:

Tahoe Ski Photo

1. Know the warning signs and when to consult a professional 

Some symptoms are considered more significant than others and should lead you to a professional immediately. These include: suspected head injury, dizziness, loss of consciousness, bleeding, suspected dislocation of a joint, pronounced numbness or tingling in a limb or changes in bowel or bladder control. These signs indicate a more severe type of injury and are worthy of immediate medical attention. If you made it off the mountain and back home and haven’t exhibited any of the above symptoms, then try the following tips. Keep in mind that every situation is different and when in doubt, contact a physician or urgent care.

2. Rest a full 24 hours 

This one seems like a no-brainer but sometimes it’s tough to know when to stay off an injury or keep it moving. Give yourself a full 24 hours of rest including keeping the part elevated above the level of the heart, icing it for 20 minutes at a time every hour and avoiding activities that increase pain. Also, protect the area using a gently wrapped compression bandage

3. Move in non-painful ways

Muscles will begin atrophy (decline in strength) in only a matter of days when they go unused, so to prevent atrophy and additional loss of motion, find exercises or activities that don’t increase pain. This could include taking an easy walk, pedaling a stationary bike with light resistance, rising up on your toes while holding on to a counter for safety. Also, maintaining the range of motion in the other joints surrounding the injury (i.e. if the knee is hurt, make sure you continue to move the hip and ankle) helps minimize the impact of the injury on the rest of the body. These are just a few ideas and other options will depend on your personal situation, however the key is to only do movements that do not increase the pain or create new symptoms.

4. Get a good night’s sleep

Sleep is crucial for healing so find a position where the injury is supported and can rest. Try sleeping on your side with a large body pillow or king pillow between the knees and hug a pillow to your chest. This position helps maintain the proper alignment of the spine decreasing strain. The second position is on your back with a large pillow under your knees and thighs, this position takes the strain off the lower back and hamstrings. When the body can rest with support often times the inflammatory process is mitigated and you can heal quicker.

5. Know who to consult

If you have a physical therapist that you trust, contact them to discuss the symptoms and determine the next step. If you don’t already have one, read our article on finding the right Physical Therapist. A Physical Therapist can help guide you on the path of efficient recovery and can help address other issues that may have arisen because of the injury such as changes in the way you walk or move.

If you have made it through a week of recovery time, and are feeling stronger and less sore, then continue moving in non-painful ways and gradually add more challenging activities. Check out the Battle Born Health YouTube channel for exercise basics and progressions to get you feeling stronger and moving again.

Here are a few recommended videos that focus on the core, hips and legs which will keep you safe in the snow: 

How to do a proper lunge:

How to do a proper squat: 

The basics of core stabilization: 

About the author: Jessica DeVore holds a Doctorate of Physical Therapy from UT Southwestern Medical Center. She lives in the Tahoe area, where she enjoys rock-climbing, backpacking, skiing, and mountain biking. As a Physical Therapist at Battle Born Health, she loves helping people restore their bodies in order to live a full and active life.

Battle Born Health

Freedom from Muscle Pain: It’s Not a Christmas Miracle, It’s Mechanics

Patients often come into the clinic because they are in pain, let’s say their shoulder hurts. When we ask what happened, we often hear answers like “I don’t know, I just woke up with this.” Left untreated, the muscle pain won’t go away and may worsen over time.    

First, the physical therapist will perform an evaluation to determine the issue. We ask a lot of questions, ask you to move in various directions, and build a 3D picture of what is happening inside your body.    

The Mechanics of Muscle Pain in the Body

To understand what we’re looking for, picture the construction of a skyscraper. Cranes move huge beams at all different heights and angles to construct the structure, or skeletal system of the building. This is accomplished by strong cables and pulleys manipulating the beams and structure, similar to the way muscles and tendons act on bones and joints. 

Now, picture one of the beams getting snagged or hung up on something as it’s being moved – the cables will continue to lift and pull, but the stuck area will prevent movement, placing extra strain on the pulleys and cables. In the body, when the tendons or muscles are strained, an inflammatory process begins. This process rushes cell-rich blood to the area resulting in a warm, red and sore joint. Rest is beneficial so that the biological response can perform its functions, but it can’t fix the root cause of the irritation – the mechanical hang-up within the body’s bone and joint structure.    

Physical Therapy Can Restore Joint Mobility

A physical therapist is able to perform manual techniques to get the joints moving, which may feel like an aggressive massage. These techniques allow the physical therapist to unstick the metaphorical beam and restore normal mobility of the joint. After treatment, or a series of treatments, the patient discovers that they’re finally able to move their shoulder without muscle pain, they’ll patient exclaim “it’s a miracle!”  NOPE it’s mechanics! Now the beams and cables are moving freely, no strain and no pain.   

That’s just part one of the solution.   

Part two involves re-educating muscles to move in the correct patterns so the joints don’t get stuck again.  When the joint has improper mobility for an extended period of time, the muscles will find a way to compensate, producing bad habits. Without correcting those bad habits, the hang-ups are likely to just recur, which is why your PT will work with you to help train your muscles to activate and move in the correct sequence to keep the joints healthy and moving properly. 

Neuromuscular Reeducation Creates Lasting Improvements

Physical therapists are specifically trained in neuromuscular re-education. Neuromuscular reeducation is the process of identifying bad movement habits, then training and the appropriate, coordinated patterns of movement.  Exercise with good form will promote strength, speed and pain free range of movement. This is not a quick fix, and requires dedicated work on the part of both the physical therapist and from the patient, but it is the best and only way to create real and lasting improvement toward the goal of becoming pain free. 

If you have a recurring injury, or aches and pains that refuse to go away despite plenty of resting and careful exercise, your body mechanics are likely off.  The physical therapists at Battle Born Health are ready and excited to offer you the one-on-one time and attention that’s needed to properly identify the problem and its root causes, create a personalized plan for recovery and prevention, and get you through your injury with a full and lasting recovery.  Every session puts you in their capable hands, one-on-one, with the goal of reducing your overall muscle pain. 

With Battle Born Health, there’s no techs, no time in another room with another patient while you do exercise. It’s just you and a Doctor of Physical Therapy.   

Call today to schedule a complimentary consultation, and let us show you how we can help you meet your goals.

Personal Stories: Why I Love Being a Physical Therapist in Reno

Becoming a physical therapist was the best decision I’ve ever made. I love working with people who want to improve themselves and their lives, and physical therapy affords a rewarding way to do that. 

I’m also a die-hard muscle geek! Muscles are truly fascinating. They have personality, and can develop bad habits, like being over-achievers, which gets them in to trouble when other muscles slack off and don’t do their jobs. The over-achievers step in and work hard to do both jobs, which—you guessed it—can result in overuse injuries. 

Muscles are also great cooperators. They work well in groups, each doing their part to achieve a coordinated movement (like reaching for a glass in an overhead cabinet). The coordinated effort of a movement pattern from a group of muscles is like a beautiful ballet dance—the choreography and timing must be perfect to pull off the desired effect. One small slip-up can result in disaster. The same is true for the body. Things can go wrong quickly when even one muscle isn’t working properly or firing on time. Even issues that seem small, like a sleeping pattern that slowly tweaks a shoulder muscle over time, can result in behavioral changes that may be subtle at first, even subconscious, like holding the steering wheel differently to avoid discomfort in a certain position. But even these small changes in posture and movement can result in overcompensation habits that compound muscle problems, increase pain, and end in injury. 

Sometimes we ignore these issues for so long that we layer compensation over compensation until the original problem is obscured. I never get tired of playing detective to sleuth out an underlying problem, and developing custom, client-focused mobility techniques and therapies to retrain those muscles and return their bodies to that natural, beautiful, strong, well-orchestrated function. Who couldn’t love a job like that?

Battle Born Health’s team of certified physical therapists in Reno are ready to help you get back into life—pain free. Give us a call today at 775-747-2278 to schedule your appointment.

Pro Tip: Don’t Sacrifice True Health for a Fast Fix

Microwaves, remote controls, TiVo, cell phones, email and instantaneous Internet —the Millennial generation and even the generation before it have never had to think much about waiting. We have so many tools at our disposal to rush just about any process along, that we forget there can be a value to giving things time.  We’re so anxious about saving time, we’ll readily develop technology to help us do it.

Thankfully there’s not an app (yet) for fast-forwarding a sunset, a relaxing glass of wine, or a perfect fall day!

But even those of us who grew up without cell phones and Internet have our hurry-up crutches. Medications like pain-relievers and antibiotics are among them. These treatments can be helpful and sometimes even critical, but as a culture, we’ve gotten ourselves into a habit of popping a pill at the first sign of even minor issues. This can come at a price to our overall health. Antibiotics make us feel better quickly, and we all want to feel better quickly when we’re sick. But antibiotics can also change our gut ecosystems, compromising our immune systems and making us less able to fight off viruses and infection next time. These things can also mask pain and dysfunction, making it difficult to pinpoint the true problem and its behavior.

Our bodies have built-in tools that, paired with help from us, are finely-tuned to help us succeed. When we interrupt those natural processes with medicated shortcuts, we undermine our bodies’ ability to be self-sufficient in healing, and to build up our natural defenses.

At Battle Born Health’s physical therapy center in Reno, our role in healing is working with the body’s natural tools to identify the true source of an injury, learn how it’s affecting the body, and to re-train muscles to perform the way they’re supposed to. In other words, taking time to do things the right way. At Battle Born, you always work directly with a certified physical therapist—no technicians here—on your self-designated goals for getting back on track with sports, work, and other activities you’ve been missing out on. 

Give us a call at775-747-2278 to find out more information about how physical therapy can help you.  

Physical Therapy Lingo: "Aggs and Eases"

In PT-speak, “aggs and eases” refer to the activities and circumstances that aggravate or ease pain. For instance, an “agg” for some patients might be running a mile. An “ease” might be lying down on the couch with an ice pack. In some patients, that might be reversed—a short, easy run might help stretch out tense fascia, or lying down in certain positions might actually increase pain in specific areas.

Part of effective physical therapy is learning what each patient’s own unique aggs and eases are. Paying attention to these factors and their patterns will help your physical therapist learn more about your injury.  

Health care professionals get excited when a patient comes in with textbook symptoms—these are easy cases to solve. Unfortunately they’re also very rare. Most patients exhibit an array of symptoms and issues that we have to work at piecing together in order to start working on solutions. That’s why articles and social media video clips that promote one-size-fits-all cures aren’t helpful, and can sometimes even be dangerous. They don’t take into account the millions of unique sets of “aggs and eases” in a diverse population.  

Fiber is a terrific example. Most studies suggest that everyone should consume 25-30 grams of fiber daily. While many people do just fine and improve their health with higher fiber diets, some people experience painful and debilitating gas and diarrhea when consuming that much fiber, which can then lead to dehydration and other issues.

Exercise is another good example. We all know exercise is a key factor in overall health, but not all exercises are created equal, and not all exercises work for all people. If a 30-minute run sends you straight to the couch with an aching back and a swollen knee, it’s safe to say that running isn’t good for you at this point in time. And a good physical therapist will help to determine why, and based on your unique circumstances, recommend other exercises that can serve as “eases” instead of “aggs.” In essence, a skilled physical therapist can help you investigate the root of your problem and take back control over your own comfort and function—which in turn puts you back in control of your life—through careful consideration of your own set of aggravating triggers and easing activities.