Adolescent – A High-Risk Period for Injury
Children are often involved in numerous sporting and recreational activities.
As children begin to develop into adults, injuries can be common due to:
- trauma during the sport or activity
- imbalances between bone growth and muscle strength
It is important to note that the nature of injuries to adolescents is often different from adults, and hence, must be treated differently.
Common sites of pain and dysfunction include:
- Heel pain (Sever’s disease)
- Knee pain (Patello-femoral pain/knee cap pain)
- Shoulder pain or instability
- Posture-related pain and symptoms
Heel Pain – Sever’s disease
Sever’s disease is a common condition in youths.
Pain occurs at the Achilles tendon insertion into the back of the heel.
It is common in children who participate in sports with lots of jumping and running. Adolescents may report an increasing pain in their heel that may progressively worsen with activity.
This condition often coincides with a growth spurt in which the leg bones and calf muscles/achilles tendon develop at different rates.
The change in structure and an increase in load is often the cause of the condition.
Sever’s disease can be successfully managed with physiotherapy, including footwear modification, exercise, taping and manual therapy.
Activity modification may be necessary depending on the individual’s load.
Knee Pain – Patello-Femoral Joint Pain (PFJP)
Knee pain at the front and inside of the knee is frequently reported amongst growing children.
Adolescents may present with pain that worsens with activity (including squatting and jumping), sitting for a prolonged period of time, and using stairs.
The imbalance in the growth of the bones of the pelvis/thigh and lower leg and the strength of the muscles around the hip and knee is the likely cause.
PFJ pain is often a combination of tight and overactive lateral quadriceps, and weak and underactive gluteal, inside quadriceps and calf muscles.
- This imbalance/lack of control leads to poor tracking of your kneecap on the end of your thigh irritating the joint surface or surrounding structures.
PFJP can be treated with a combination of manual therapy, home-based strengthening and stretching program, and taping.
Shoulder Pain / Instability
The risk of shoulder injury is increased for those who participate in throwing sports, contact sports, swimming and sports involving complex upper body supporting manoeuvres (gymnastics, aerobics).
Dislocation or subluxation of the shoulder is common in the adolescent population, however uncommon in the younger child.
Falling onto an outstretched arm, or a blow to an arm that is reaching upwards and backwards can cause a shoulder dislocation.
Management of this requires comprehensive discussion with both your physiotherapist and an orthopaedic specialist.
Impingement pain in the shoulder when lifting your arms overhead or to the side is also common. Impingement often arises from repetitive movements of the shoulder that may not be controlled by weak muscles around the shoulder and shoulder blade (scapula) and can cause damage to the shoulder joint. This can occur in throwing sports, and in swimmers.
Shoulder pain and instability is most successfully managed by a home or gym-based exercise program supervised by your physiotherapist, focusing on strengthening the muscles of the shoulder blade and shoulder to provide as much muscular support and control as possible.
Posture Related Pain
Children spend a great deal of time sitting, either in front of the computer or desk, at home or at school. This can lead to neck and back pain especially if they have poor posture which is quite common in adolescents.
Common causes of pain will be :
- Poor core strength and postural control
- Monitor too low
- Keyboard too far away
- Seat to low or high
- Desk too high or low
Treatment involves addressing these sustained sitting positions and making practical adjustments to help improve your posture and ergonomics e.g. using a desk instead of a table, adjusting the chair or moving mouse/keyboard and re positioning the monitor.
Physiotherapy may involve manual therapy to treat symptoms, as well as an exercise and stretching program.
The focus of exercises will be on :
- Stretches for the chest to minimise the shoulder forward position
- Strengthening of the upper back/scapula muscles to keep the shoulders back
- Activity modification