Injuries in Adolescent Footballers

Injuries in Adolescent Footballers:

Young athletes are susceptible to many of the same injuries as their adult counterparts. However there are some significant differences in the types of injuries sustained by children and adolescents because of differences in the structure of growing bones compared to adult bone.

The main differences between adult and growing bone are:
  • The articular cartilage is a thicker layer than in adult bone and can remodel.
  • The junction between the epiphyseal plate and metaphysis is vulnerable to disruption, especially from shearing forces.
  • Tendon attachment sites (apophyses) are cartilaginous plates that provide a relatively weak cartilaginous attatchment, predisposing to avulsion injuries.
  • The metaphysis of long bones in children is more resilient and elastic, withstanding greater deflection without fracture.
  • During rapid growth phases, bone lengthens before muscles and tendons are able to stretch correspondingly this can lead to muscle and tendon injuries, and can also be responsible for a growing athlete losing coordination and therefore reducing their performance.

One more slow 6 minute jog- during this jog, add in the following exercises. Side to side, skipping, bum kicks, backwards jog

Acute Injuries:
  • Contusions
  • Sprains
  • Strains
  • Dislocations
  • Fractures
Overuse Injuries:
  • Contusions
  • Overuse injuries are chronic injuries related to repetitive stress on the musculoskeletal system without sufficient recovery time.
  • Often seen with a rapid increase in training and in athletes training at consistently high levels.
Predisposing factors:
  • Hard training surfaces
  • Inappropriate equipment
  • Coaching
  • BMI
  • Age
  • Decreased flexibility and extremity malalignment
  • Foot hyper pronation
  • Excessive ligament laxity
  • Muscle weakness or imbalance
Typical presentation:
  • Insidious onset no acute injury.
Important considerations:
  • location of the pain
  • Surface training on
  • Type of sport being played
  • Intensity, duration and frequency of participation.
  • Recent increase in the training
Treatment
  • Relative rest ↓ intensity or frequency of play
  • Reduce inflammation
  • Regain strength
  • Restore range of motion

Overuse injuries commonly seen in youth footballers include; stress fractures, chronic groin pain, apohysitis such as Osgood Schlatters and Severs disease, tensonoses and patellofemoral pain syndrome.

Stress Fractures:
  • They result from repetitive, excessive loading of bone. Bone normally undergoes remodelling in response to stress. A stress fracture occurs when there is an imbalance between bone resorption and formation leading to microfractures that may progress into stress fractures.
  • Gradual onset of pain during or immediately after exercise, and over time progresses to having pain with non-sport activities.
  • Often following a change in the training program
Examination/Diagnosis/Imaging:
  • Localised tenderness over the involved bone
  • Clinical diagnosis confirmed radiologically.
  • Plain radiographs have a high specificity but low sensitivity for picking up stress fractures.
  • Stress fractures usually appear normal for the first 2 to 3 weeks of symptoms
  • Radionuclide bone scan used to diagnose stress fractures, with a high sensitivity for showing focal uptake at the fracture site.

Calcaneal stress fractures. (A) Sagittal proton density image through the calcaneus shows a faint fracture line with adjacent low- signal marrow edema.

Treatment:
  • Avoidance of painful activities until healing occurs.
  • Tibial and metatarsal stress fractures this includes complete rest for 1 month, #cross training with deep water running in the pool or stationary bike is allowed.
  • Gradual return to sport, ↑ impact activities by 10% per week over an 8 week period.
  • No hard surface running
  • More cushioned running shoe
Chronic Groin Pain:
  • Common injuries in footballers; due to the forces they endure with kicking activities.
  • Important as physiotherapists that we accurately assess and treat these injuries before they develop into longstanding debilitating injuries.
A number of potential sites that can be causing groin pain., these include:
  • adductor tendons
  • hip flexors
  • pubic symphysis
  • lumbar spine + SIJ stiffness
  • Inguinal wall weakness.
Typical Presentation:
  • Insidious onset of groin pain in adductor tendons.
  • Over time can spread to other regions and become bilateral.
  • Pain is aggravated by exercise with running, twisting/turning and kicking the most challenging activities.
  • Often notice a ↓ in sporting performance.
  • Pain following activity and is often accompanied by stiffness, particularly the next morning.
  • Progressive deterioration until symptoms prevent sports participation.