Pediatric injuries are not the same as adults and should not be treated the same. Pediatric and adolescents need to be approached with an understanding of their unique stage in development. Children and teenagers are not just small adults. They have not fully developed and their growth plates are still open. This must be considered when identifying injuries, administering rehabilitation techniques, as well as, for strength and conditioning.
Children do not typically get tendonitis. The area where the tendon of a muscle attaches to the bone in an immature skeleton is a growth plate. Typically children get inflammation at the growth plate, apophysitis, not in the tendon because the tendon or ligament is stronger than the growth plate. Osgood Schlatter’s disease is a type of apophysitis. These may seem similar but the traditional treatment programs for adults may cause further damage to a maturing child or adolescent.
The cause of all musculoskeletal problems is movement related. Physical therapy can address the movement related issues and use modalities such as electrical stimulation to decrease pain and inflammation. If their symptoms are very acute and painful, Rest and activity modification may be required to alleviate symptoms and decrease further progression of the injury.
Common types of apophysitis and pediatric conditions:
Sever’s Disease – Achilles Tendon - The child usually experiences pain at the posterior or back of the ankle where the Achilles tendon attaches to the calcaneus or heel bone.
Sinding Larson Johansen Syndrome –Jumper’s Knee -Patella tendon and inferior or bottom pole of the patella. The child usually experiences pain in the anterior or front of the knee with jumping and squatting.
Little league shoulder – humeral head and rotator cuff attachments Panner’s disease is a compression injury, repetitive or acute, of the growth plate of the Radial head. Valgus forces from activities such as throwing cause compressive forces on the lateral elbow.
Slipped Capital Femoral Epiphysis – a disruption at the femoral head growth plate inside the hip joint causes a slippage of the head of the femur at the growth plate resulting in hip pain.
Legg Calve Perthes - Blood supply to the femoral head growth plate inside the hip joint ceases temporarily resulting in hip pain.
Spondylolysis or Spndylolisthesis - Lumbar spine pathologies that cause a stress fracture or fracture to the lumbar vertebra secondary to excessive stress in lumbar extension. This is a common weight lifting injury in adolescents secondary to poor supervision, technique and too much weight. In the American Journal of Sports Medicine 2007, Walsh examined 3D spine kinematics during free squat. Free squatting with a barbell on the back increased lumbar extension at 60-80% 1RM compared to 40%, with or without a weight belt. Lumbar extension is compensatory for inability to stabilize the trunk with the weight moving anterior to the lifter’s center of gravity. This is of greater implication to adolescent athletes secondary to the nature of the spinal growth plate injuries seen. Numerous studies have shown the vulnerability of the lumbar spine in adolescents with radiographic abnormalities identified.
The greatest mistake we see today occurs with the 8th or 9th grader who enters a strength and conditioning program at their high school. They end up being grouped with and doing the same exercises with similar loads as a 17 or 18 year old junior or senior with a more mature and developed musculoskeletal system. They need to be on a program that takes their age, maturity and competence into consideration.
Children and adolescents need to focus on creating muscular balance, coordination, force absorption, flexibility, speed, balance and proprioception. Their rehabilitation and training programs should be comprehensive, focusing on motor learning and sports specific movements.