Sports Injuries & Emergencies

The Middle/High School Athlete
Friday June 27, 2008
Sig Auditorium
Dell Children's Medical Center of Central Texas
$15 before June 24, $25 late registration
Contact Laura Fohn at (512) 324-000, x8684

A recent study published in the American Journal of Sports Medicine found that knee injuries are the most common reason for high school sports-related surgeries. It's one of the concerns that led medical professionals at Dell Children's Medical Center of Central Texas to establish an annual Sports Injuries and Emergencies Conference.

The conference target is coaches, trainers and others who provide initial interventions for pre-college athletes. Orthopedist and sports medicine specialist Nathan Breazeale, MD, is a presenter who focuses diagnosis, treatment and prevention of youth-related knee injuries.

"Most student athlete knee injuries fall into two types," says Dr. Breazeale, "acute injuries and over use injuries. Acute injuries typically are sudden and include such things as torn ligaments or dislocation of the knee. Overuse injuries generally come on gradually and often are associated with repetitive movement that results in painful tendonitis."

Acute Injuries

Acute injuries are really different from other types because there is almost always an identifiable event that precipitates it, such as a fall, twist, collision or sudden change in direction that causes acute pain, often fairly rapid swelling and dysfunction," says Dr. Breazeale.

He shares his knowledge of the characteristics of acute injuries:

• Often these types of injuries are more serious and should have a medical evaluation to assess the severity.
  
  
• Severity varies and can include such examples as cartilage or meniscus tears, anterior cruciate ligament (ACL) tears or acute fractures that may involve the growth plate of the bone. These all affect the way the knee works.
  
  
• It is important to assess the integrity of the growth plate to make sure the injury won't have along term effect on the bone's growth. Most growth plate injuries adapt well and most patterns of growth plate fractures do not significantly affect long term growth. However, certain fracture patterns that cross the growth plate can be of concern because they ca result in premature closure of t he bone in one limb that could cause one leg to be longer than the other in adulthood.
  
  
• An injury that causes a displaced fracture across the growth plate often requires surgical manipulation to reposition and possibly pinning to hold it in place. In the short term, the athlete is held out of practice and the sport until healing is complete. In the younger athlete, disruption in growth and the creation of a leg length discrepancy could affect both the youth's future athletic capabilities and possibly even daily function.
  
  
• Muscle tears, hamstring tears or a quadriceps tendon tear are serious injuries of the muscle and tendon unit that puts young athletes at risk of recurrent injuries and often require medical evaluation and physical therapy.
  
  
• Any sport that involves running, twisting, rapidly shifting direction puts the knee at risk for injury.
  
  
• Diagnosis can involve imaging with X-ray or Magnetic Resonance Imaging (MRI).

Overuse Injuries

"Overuse injuries are the most common and often treated by athletic trainers. If they do not persist, there is no need for medical care," adds Dr. Breazeale.

Like acute injuries, overuse injuries exhibit identifiable characteristics.

• The most common overuse injury is tendonitis caused by repetitive injury to a tendon. Athletes who do a lot of jumping, for example, tend to injure the patellar and quadriceps tendons. Other possibilities are injuries to the lateral tendons of the knee. Overuse produces a strain and results in pain.
  
  
• Most of the time, modification of the activity can stop the injury process. Swelling can be treated with anti-inflammatory medications and a series of stretches and strengthening exercises can help promote recovery. Sometimes these treatments can be readily accomplished by an athletic trainer. Sometimes the help of a trained physical therapist is indicated.
  
  
• Overuse injuries tend to come on gradually. They are treated most rapidly when they are identified early and intervention begun early in the process.
  
  
• Warning signs of overuse injuries include limping after training or exercise, especially if the athlete was not limping before play began. They also can include pain and tenderness around the knee and some swelling.
  
  
• Surgery is not often required. Younger athletes are a big more susceptible to overuse, especially during a rapid growth phase, because their skeletons are immature. This is the age where shoulder and elbow problems also occur.

Preventing Injuries

"Injury prevention strategies are best developed by identifying the risk to an athlete. Certain injury patterns are more prevalent in certain sports and body characteristics sometime create a higher or lower risk," says Dr. Breazeale.

Examples include:

• Non-contact anterior cruciate ligament (ACL) injury in female athletes, often following a rapid cut or turn. Young women who play volleyball, soccer or basketball are at higher risk than female runners.
  
  
• Protective equipment and gear should be used by all athletes participating in any contact sport, especially football. Preventive knee bracing is recommended for football linemen.
  
  
• Certain strengthening routines can be incorporated into team and individual training that can help limit injury.
  
  
• Overall conditioning is important and excessive sports participation at a young age should be discouraged.
  
  
• Cross training with different sports and a healthy variety of athletic participation is beneficial rather than focusing too soon on year-round participation in one sport only. This approach helps reduce the likelihood of repetitive overuse injuries and develop a wider variety of athletic skills.

"I certainly support the idea of kids playing sports," adds Dr. Breazeale, himself a collegiate swimmer. "Although all sports carry some risk of injury, the risks are outweighed by the benefits of exercise, conditioning and skill-development that young athletes experience."