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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.

Pars Interarticularis Stress Fractures

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Following on from my last blog on overuse injuries in young athletes and leading into cricket season, I thought I'd examine one of the higher risk overuse injuries more closely. Let's focus on stress fractures of the pars interarticularis (spondylolysis).

These stress fractures are a fairly common cause of persistent lower back pain in the young athlete population (1). These stress fractures are most commonly located in the lower lumbar spine, most typically occurring at the level of L4/5. They can be unilateral or bilateral fractures.

Young athletes that compete in sports which require their lower back to move into repetitive extension and rotation such as cricket, rowing, diving, dancing, gymnastics, athletic throwing sports and some foot ball positions are at increased risk of developing these fractures (2). Young athletes are especially vulnerable to this stress in growth phases (2).

Compared to the adult population, young athletes are far less likely to experience lower back pain as the result of disc pathology, muscle-tendon strain or osteoarthritis (3). In one study, comparing lower back pain in 100 young athletes with 100 symptomatic adults, 47 out of the 100 young athletes were shown to have pars fractures. Compare this with just 5% of the adults from the sample (3).

So when should you as a parent be suspicious that your child has this condition? Generally speaking, if an active child or adolescent complains of lower back pain for a period of two weeks or more this pain should be investigated, especially if they play one of the above mentioned sports and have experienced a recent growth spurt. Often the pain will start insidiously and the young athlete may complain of an aching back which is worse for back extension, running and sore after sport. Often the pain will improve with rest. They may also complain of pain in their back at nighttime.

If it is suspected by your clinician that your young athlete has a pars fracture they will be sent for imaging to confirm this diagnosis. This usually involves a plain film x-ray first and if necessary will be followed up with an MRI.

Rest from strenuous exercise is the best treatment option for Pars fractures. Most young athletes will have to take time off sport for a minimum of 12 weeks and then commence a graduated return. Each athlete is individual however and the time frame for healing will be variable. Taking time out to rest may reduce the likelihood of non-union of the fracture and may reduce the likelihood of surgical intervention.

Importantly, young athletes shouldn't be complaining about persistent lower back pain! They are not likely to have the same cause of lower back complaints as adults and therefore their lower back pain needs to be promptly investigated. The sooner a pars fracture is identified, the sooner if can be well managed.

(1) DiFioroi, J.P., Benjamin, H.J., Brenner, J., Gergory, A., Jaynthi, N., Landry, G., Luke., A. Over use injuries and burnout in youth sports: a position statement from the American Medical society for sports medicine. British Journal of Sports Medicine 2014; 48:287-288.

(2) Iwamoto, J., Sato, Y., Takeda, T., Matumotomo, H. Return to sports activity by athletes after treatment of spondylolysis. World Journal of Orthopedics, November 18, 2010; 1 (1): 26-30.

(3) Micheli, L., Wood, R. Back pain in young athletes, significant differences from adults in causes and patterns. Archives of pediatric and adolescent medicine, 1995; 149 (1): 15-18.

Overuse Injuries In Young Athletes

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There is a trend in youth sport to push our young athletes hard. At CSSM we often see young athletes who participate in sport between 6-8 times per week. There is an emphasis on sporting competitiveness from a young age, which sometimes comes at the price of overuse injuries.

An overuse injury can be defined as ‘an injury occurring as the result of repetitive submaximal loading of the musculoskeletal system when rest in not adequate to allow for structural adaptation to take place’ (2).

These injuries do not occur as the result of a single acute event, rather they occur more insidiously over a period of time when repeated stress and load is placed on the body. These injuries can affect any part of the musculoskeletal system including joints, muscles, bone and cartilage. Some overuse injuries are lower risk than others (but still sore!). Common low risk examples include Osgood-Schlatter disease and Sever's disease. Others are higher risk including stress fractures to the lower back (pars fractures) and femoral neck stress fractures.

Young athletes are at high risk of overuse injuries for a number of reasons:

  • Prior injury to the area is a strong predictor of future overuse injury
  • They have a higher rate of sports participation compared with an adult population (1)
  • They are more likely to have high training volumes and high training workloads
  • They are vulnerable during adolescent growth spurts
  • Their immature bones are less resistant to compressive and tensile forces
  • They may be over-scheduled in regards to training load
  • They are more likely to out grow sports and training equipment
  • They often have a lack of lean tissue mass

What can parents, coaches and young athletes do to reduce the risk of overuse injury?

A position statement by from the American Medical Society for Sports Medicine regarding overuse injuries in sport recommends:

  • Placing time limits on participation in sports. This relates to weekly and yearly participation.
  • Ensuring that young athletes get enough down time between sporting sessions for their body to recover.
  • Scheduled rest periods from high intensity sports should be encouraged.
  • Monitoring and if necessary reducing high intensity sport specific repetitive movement.
  • Modifying each young athletes training load taking into account their injury history, age and growth rate.
  • Closely monitoring young athletes training regimes at times of rapid growth.
  • Ensure equipment is well fitted.
  • Monitored strength and conditioning training including pre-season conditioning programs can be a good way of preparing young athletes for the season ahead.
  • Sport diversification should be encouraged rather than sports specialisation from an early age.

It is important for persistent ‘niggles’ in young athletes to be assessed by an appropriate clinician. These niggles can sometimes be serious underlying overuse injuries that may hinder long-term sports involvement. If these injuries are assessed, diagnosed and appropriately managed early on, the young athlete has far better prospects of a pain free return to sport.

References:

(1)http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Jun+2011

(2) DiFioroi, J.P., Benjamin, H.J., Brenner, J., Gergory, A., Jaynthi, N., Landry, G., Luke., A. Over use injuries and burnout in youth sports: a position statement from the American Medical society for sports medicine. British Journal of Sports Medicine 2014; 48:287-288.

Make Your Move

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With Mother's Day just around the corner we thought it timely to discuss the Australian Governments Girls make your move campaign. Whilst this campaign is targeted at girls aged between 15-18 years, the significance of improving levels of physical activity for all women is highlighted. Promoting well-being and health for our next generation of mums.

Women face a unique set of barriers to participating in physical activity when compared to men. These barriers are particularly highlighted in young women who can feel they're not fit enough to participate, they may be anxious about not looking the part, they may perceive themselves as not 'attractive enough' to exercise and they often exhibit anxiety about being ridiculed when exercising.

There are a multitude of mental-health benefits related to regular exercise including improving mood and self-esteem, reducing levels of stress and anxiety, socialisation and then of course there are the physical benefits and the long term health benefits such as reducing the risk of some chronic diseases.

The stats in Australia suggest that 9 in ten young people just don't move enough. Younger women are generally less active than their male counterparts, exercise less intensely and are more likely to be sedentary than young males. With the Australian guidelines for young adults set at 1hour of moderate to vigorous exercise per day, what can mums do to get their young daughters moving?

Research suggests that finding an activity that a young women enjoys is one of the key factors to keeping her active. Not into netball? Why not try an 80's dance class! Exercise should be fun and exercising with peers has been identified as an important factor for regular participation. Why not start a sports team with friends? Or take a group of friends to the gym. Family role modelling can have also have a really positive effect on young women. Setting a good example and participating in physical activity will likely have a positive effect on your children's attitude towards physical activity.

So this May in honour of mother's day, women everywhere set yourself a goal to get out, have fun and get moving.

Australia's Physical Activity and Sedentary Behaviour Guidelines for Young People (13-17 years), Commonwealth of Australia 2014 Bauman A, Bellow B, Vita P, Brown W, Owen N 2002. Getting Australia Active: towards better practice for the promotion of physical activity, National Public Health Partnership, Melbourne, Australia in ABS Australian Health Survey; Physical Activity, 2011-12 Van Bueren D, Elliott S, Farnam C 2016. 2016 Physical activity and sport participation campaign insight's report. Department of Health, Commonwealth of Australia.