Jan 29, 2015
Growing Pains

Dr. Andrew Gregory’s “Physeal Injuries in High School Athletes” was the first-ever NATA presentation for the American Academy of Pediatrics’ Council on Sports Medicine and Fitness–and its message was loud and clear: Youth athletes are not adult athletes, so don’t treat their injuries the same way, either.

Over the past five years, Gregory noted, the level of intensity in youth sports has become more competitive, resulting in a skyrocket increase in the number of acute and repetitive injuries sustained by middle and high schoolers. While these formerly adult-only injuries have created debate over which treatment programs effectively meet the needs of the young athlete as much as a growing child’s needs, there is a serious concern about misdiagnosing youth injuries and understanding the damage done to the athlete’s bone structure and growth plates once an injury is incurred.

For instance, compared to an adult’s bone structure, the skeletal system of adolescents tends to be more elastic and rubbery in texture, with relatively stronger ligaments. Therefore, a youth athlete will rarely suffer a dislocation or ligament injury. What will be affected, though, is the physis–the weakest and lightest part of the bone–as well as the child’s growth plates, which surround the body’s joints and are responsible for lengthening bone and strengthening muscle.

Because of a youth’s relatively flexible skeletal system, it’s often hard to diagnose an injury by external observation alone, said Gregory. One reason, he noted, is that unlike adults, when bone is broken in children, there may be no significant swelling around the afflicted area. So what is generally the first physical sign hinting that an injury occurred is instead absent, and the young player returns to activity damaged. This not only increases the chances of a young athlete incurring repetitive or acute injuries but the odds of stunting growth plates or causing the plates to set improperly, potentially weakening the bone structure as the athlete matures into adulthood.

To ensure a proper diagnosis, Gregory recommended having an X-ray performed on the presumed afflicted area. If a break is diagnosed, it will be based on the Salter-Harris Scale, from one to five. A “1” is the least complicated but most difficult break to diagnose because the fracture appears in the light-colored physis, which can be easily overlooked on an X-ray. A “5”, or a “crunch” injury, is the worst. The growth plates have been squashed, and surgery followed by a comprehensive rehab program are necessary for a full recovery. A “2” – a.k.a. stress fracture – is the most common break suffered by youth athletes, with the break tearing through the first and second layers of the bone. The remedy is usually resetting via a cast and, as the cliché goes, letting time heal all wounds (with a little bit of weight training to help strengthening the bone and increase one’s range of motion).

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