Treatment of sports injuries is unique because these injuries are sometimes predictable and often preventable. Management is complicated by pressures to return the child to sports before healing is complete. Being the child’s advocate and protector is important and sometimes difficult.
Manage the acute injury by using the RICE sequence. Ice in a plastic bag or plastic cup works well. The ice minimizes pain. Advise the family to discontinue the cold if the skin becomes numb. This initial management is designed to minimize swelling and is continued for the first 24 hours, then tapered.
Nonsteroidal antiinflammatory drugs (NSAIDs) are useful in reducing pain and inflammation. Tolmetin, naproxen, and ibuprofen are acceptable drugs for children and adolescents. Ibuprofen is widely used because it is inexpensive and available without a–prescription.
Establish a Diagnosis
Be certain the diagnosis is accurate. Make radiographs of sites of tenderness over bones or joints. Follow with additional imaging studies or seek consultation. Be very careful in managing injuries around joints such as the elbow and knee.
Preparing Family and Coach
Patients, family, and coaches need to be advised in advance about the predicted healing time.
Establish a Management Plan
Develop a plan to manage the acute problem and the rehabilitation. The child should not return until the acute effects of the trauma and the secondary effects on muscle strength, endurance, and joint stiffness have resolved.
Identify causative factors that may have contributed to the current problem.
Training regimens are the most common cause of overuse syndrome. These regimens should not add more than about 10% per week of additional load. Avoid overhead lifting and full squats. Discourage excessive pressure from the trainer or family.
Anatomic features may predispose the child to injury. Such problems include rotational malalignment (femoral and tibial torsion), ligamentous joint laxity, tarsal coalitions, and tight heel cords.
Environmental problems contributing to the injury should be–identified. These factors include surfaces, equipment size, and condition.
Modify causative factors while the child is recovering to prevent recurrence of the problem. Emphasize proper sports techniques.
Provide adequate time for healing of the bone, collagen, or muscle tissue because time, not treatment, is the principal factor in healing. The secondary effect of muscle atrophy and joint stiffness can be prevented by an exercise program. Do not underestimate the seriousness of soft tissue injuries, as they also require considerable time for recovery.
Prevent muscle atrophy during convalescence. Rest the injured part but plan an exercise program to maintain strength in nonaffected muscle groups. Isometric exercises may be used around an injured part. Avoid exercises that cause pain.
Reintroduce activities progressively after healing is complete. Healing requires a minimum of 6 weeks (and sometimes longer) for bone, cartilage, ligaments, and tendons. Reintroduce activities by using the step model. Break down sports into components and add progressively to the repetitions. If the new level of activity is performed without pain, then progress to the next level. If pain recurs, then move to the next lower level of activity.
Return to sports participation gradually Add sport-specific tasks with progressively increasing speeds prior to returning the patient to sports. Then start with practice sessions.
Return to competition Allow only after healing and rehabilitation are complete. Make certain the initial causative factors are corrected, to avoid repeating this cycle.
Exercise programs for children and adolescents can increase strength and should be undertaken to overcome muscle weakness that may contribute to further injuries. Make the programs fun and varied. Children become bored quickly. Avoid many repetitions. Strictly adhere to the 10% rule and decrease the load promptly if symptoms develop. Tailor strength to fit the specific condition and site. The options for exercises fall into several types:
- Closed chain exercises are performed with the hand or foot stabilized.
- Open chain exercises are performed with the hand or foot free.
- Range of motion exercises fall into three types: passive, active, and active assistive.
- Isotonic allows free motion.
- Isometric restricts motion.
- Isokinetic controls speed of contraction utilizing exercise machines.
Usually 20 to 30 repetitions are prescribed, which may be closed or open chain. Isokinetic exercises are most effective but require special equipment.
Exercises for Rehabilitation
Exercises should be tailored to the child. Exercises help in maintaining or restoring strength following injury and in preparing the individual for the demands of certain sports.
Braces and Splints
Providing immobilization and protection is useful following sprains and fractures. A splint is often used in place of a cast when only protection is required. Commercial splints can be more expensive than casts but less expensive than custom braces from an orthotist.
Female Sports Triad
This triad includes delayed menarche, eating disorders, and early osteopenia. This problem is commonly seen in sports that emphasize a low percentage of body fat such as gymnastics, ballet, and endurance running.