Adolescent Athletes

This session included presentations on: Risks with adolescence; Spinal stress injuries in adolescents; Imaging and follow-up of common stress injuries in adolescents; Axial malalignment in the adolescent; Adolescent hip pain; Heel pain in adolescents – managing apophysitis; Strength and conditioning in adolescents; Rehabilitation of the young athlete.

One of the main themes from this session is that adolescents are not young adults. They have different anatomy, physiology and pathology. For example, their body segments are of different proportions, which can result in different biomechanics. The bones of adolescents have different properties compared to adults, which can make them the weaker structure in the chain. The specifics of the age group should be understood. Education of all the stakeholders in junior sport of these differences, as well as appropriate training loads and injury avoidance is key for planning exercise and rehabilitation programmes. Spondylosis is the second most common cause of LBP in the sporting adolescent population and is due to repeated submaximal force and requires rest and the prevention of overtraining. It is crucial not to forget the red flags for serious spinal pathology. Adolescents are also susceptible to stress fractures as a result of increased stress. Diagnosis/management of these injuries is aided by imaging, the choice of which has to be balanced against radiation dose. Start with X-ray and MRI. Bone torsion in the femur is normal to a certain extent in children and can cause patellofemoral joint dysfunction. Torsion is caused by excessive femoral anteversion [compensated for by turning toes in (pigeon-toed)] and tibial external rotation [(compensation for by turning toes out (increased foot progression angle)]. However, torsion can significantly impact PFJ loading and muscle mechanics, leading to progression of pain to dislocation and arthritis. It needs directed and specific physiotherapy. De-rotation surgery has a role in a selected, severe population, which has good outcomes. Hip pain in adolescents is rare but not normal and imaging is essential for good diagnosis and management. Tears in the acetabular labrum are usually due to dysplasia or impingement, and arthroscopic surgery to correct bony abnormalities provides good pain relief but can also delay or prevent arthritis; delaying surgery only results in more damage. Hip replacements can be necessary in children and there is no reason not to do them as modern ceramic on ceramic prosthesis are very durable. Heel pain (calcaneal apophysitis or Sever’s disease) is usually self-limiting with appropriate conservative management and patient education. There is no role for injections, but consider imaging in refractory or severe cases. Strength training and in particular high intensity resistance training can have anti-inflammatory action in the body. It can also improve the physical and psychological health in the adolescent ballet dancer. Ballet is a discipline-driven sport that has a higher than usual percentage of overuse injuries. Youth sport literature suggests that 50% of these injuries could be avoided.