Chapter 27: Sports Medicine

INTRODUCTION

Sports medicine as a separate discipline has grown since the 1980s in response to an expanding body of knowledge in the areas of exercise physiology, biomechanics, and musculoskeletal medicine. As more children participate in recreational and competitive activities, pediatric health care providers are encountering more young athletes in their practice. Familiarity with the common medical and orthopedic issues faced by athletically active children and knowledge of which injuries necessitate referral to a sports medicine specialist are essential.

BASIC PRINCIPLES

Pediatric Injury Patterns

Although young athletes have injuries and issues similar to those of adults, there are many injuries that are unique to the pediatric and adolescent athlete. An understanding of the differences between adult and pediatric injury patterns is important to foster an appropriate index of suspicion for situations unique to pediatrics.

Components of a long bone include the diaphysis, metaphysis, and epiphysis. In the pediatric bone architecture, the presence of cartilaginous growth plates and apophyses predispose children to unique injury patterns that are different from their adult counterparts. Open growth plates or physes and their various stages of development are important factors to consider when treating young athletes. The physes are located at the ends of the long bones and are the primary ossification centers where length is added to the immature skeleton. The physis is a weak link in the musculoskeletal complex and has a high risk of fracture during periods of rapid growth. The surrounding soft tissues, including ligaments and tendons, are relatively stronger than the physis. The epiphyses are secondary centers of ossification that also contribute to long bone formation and, like the adjacent articular cartilages, are vulnerable to trauma. Injuries that involve the epiphysis can lead to joint deformity. The apophyses are secondary centers of ossification that add contour but not length to the bone. The apophysis is the attachment site of the muscle-tendon unit and is vulnerable to both acute and chronic overuse traction injury during times of rapid growth. Unlike injuries to the physis and epiphysis, however, apophyseal injuries do not result in long-term growth disturbance. Recognizing injuries to growth centers is important because of the risk for partial or complete physeal arrest. Complications of growth plate injury can lead to limb length discrepancy or angular deformity.

FITNESS & CONDITIONING

Compared to children who are sedentary, physically active youth tend to develop greater agility and skills and maintain better fitness throughout their lifetime. Young children and adolescents should participate in physical activity for 60 minutes or more each day. To improve overall fitness and reduce the risk of injury, children and adolescents should focus on three different components of exercise:

1. Integrative training (curriculum of diverse skills, increasing fitness, and appropriate rest periods). Examples include developing fundamental skills and technique, learning proper movement mechanics, and aerobic and anaerobic ...