Assessing Injuries in Youth Sports

by Christopher Annunziata, M.D.

Assessing Injuries in Youth Sports

When children are young, their bones and muscles are still developing. It can be hard to tell which injuries just needs ice and rest and which ones requires evaluation by a specialist.

The symptoms mentioned by the youth athletes give parents and physicians the best insight into whether an injury needs intensive medical attention. Low levels of pain are not concerning, but severe pain can be a sign of a more significant injury. Another symptom that should be taken seriously is a feeling of numbness or even a complete lack of sensation. As the parent, you know your child well and can determine the significance of the complaint.

You may also see physical changes at the site of the injury. Deformity of a joint or limb is a serious concern. Significant swelling, especially right after the incident, is a strong indicator of a more intense injury. If there is a significant cut or bleeding with any injury, that needs attention right away. Another major sign is the inability to bear weight or to walk on the injured extremity.

This broad topic can be broken down by discussing specific injury patterns, categorizing them into four groups: sprains, strains, fractures, and instability events.

Sprains

Sprains are injuries to the ligaments, the connective tissue that stabilizes the joints. We have major ligaments in all our major joints, and some injuries to certain ligaments can be significant.

The ACL is the anterior cruciate ligament. It’s one of the major stabilizing ligaments of the knee, femur, and tibia. Unfortunately, this ligament commonly gets injured in many of the popular sports, especially stop-and-start sports such as basketball, soccer, and volleyball.

The classic sprain story is one in which there’s a sudden stop and twist or a sudden change in direction accompanied by a pop or tearing sensation and significant pain. Sometimes, however, the injury is a little bit more subtle. Sometimes the athlete just feels something happen, and they’re not sure what it was. There might not be severe pain or a popping sensation, but they know something is wrong.

If it’s a severe injury where the athlete can’t bear weight on the limb, you may want to seek attention that evening or go to a walk-in clinic such as Ortho On Call. If it’s not severe, it still should be evaluated by a physician, but you can make an appointment.

Strains

Strains are injuries that occur to the muscle-tendon complex, the structures that move limbs. The muscle-tendon complex starts at the bone, then goes to the tendon, the muscle, back to the tendon, and then back to the bone. You can have an injury anywhere in that complex.

Strains are also very common. The best example to give involves the quadriceps, the big muscle group along the front of the thigh.

An injury to this muscle can occur from sudden deceleration, slowing down or stopping abruptly. For example, an athlete goes to strike a soccer ball and is abruptly hit in the ankle, which is a sudden force to an engaged muscle. Often the athlete will feel a tearing sensation and a pop. There may be immediate swelling at the point of injury but usually there is not a significant deformity. There may be some limitation in their ability to bear weight.

Strains typically do not require immediate attention. Some of these symptoms can be a bit worrisome, especially if the injury involves the tendon pulling off a piece of bone rather than an injury to the muscle itself.

Fractures

Fractures are injuries to bones. It could be an injury to a distinct aspect of the bone or around growth plates, depending on which bone is injured.

The most common fracture we see in younger athletes is an ankle fracture. These typically occur from a sudden twist, or even more commonly, a fall. The athlete will feel pain and maybe a popping sensation. They may have difficulty bearing weight on the specific ankle.

It can be tough to tell whether an ankle has a sprain or a fracture. Some ways to distinguish between the two injuries include:

The sprain typically is more minor and just on the outside of the ankle. The athlete may have little bit of difficulty bearing weight, but usually they know it’s not a serious injury.
A fracture is more serious and more painful, with pain on both sides of the ankle. The athlete will have a difficult time bearing weight.

The fracture usually doesn’t require immediate attention, just the basic tenets of care which are rest, ice, compression, and elevation. If it is a more significant break, then you may want to seek some medical attention that evening.

Instability events

Instability events consist of dislocations and partial dislocations, called subluxations. These can occur at almost all major joints.

The best example of an instability event involves the shoulder. The most common situation that causes a shoulder dislocation is a fall with an outstretched arm, but it can also occur when someone is throwing a ball and that movement is suddenly interrupted by a tackle.

Instability events are extremely painful. The athlete will let you know right away that they feel seriously injured, and there will be a significant deformity (the joint will not look normal). This injury needs attention immediately whether it be on the sideline by an athletic trainer or by a physician at a hospital or walk-in clinic.

There are more subtle dislocations called subluxations. The athlete may feel that something isn’t quite right, and they may notice a shift in the joint. Subluxations aren’t typically severe, but they can be problematic and may lead to future issues. They need to be evaluated by a physician to help prevent any further injury or damage to the joint.

Frequently asked questions

My child has Sever’s disease (a.k.a. calcaneal apophysitis). Is an orthopedic physician the best provider to see for management of this condition?

Sever’s disease is a very common problem with younger athletes. Adolescents and adults tend to get stress fractures, while younger athletes get stress injuries at the growth plates.

Sever’s disease is inflammation of growth plates of the calcaneus (the heel bone). It does not lead to any growth disturbances. It just can be problematic, and it may take a year to go away.

This condition is one of the few where I’ll tell parents to not stress and to just manage it the best you can. The best ways of managing it include limiting how much time the athlete participates in their sport and understanding when the athlete starts to feel discomfort. Cushion inserts for shoes can also be helpful.

Over-the-counter anti-inflammatories and acetaminophen combined with icing after activity can aid at keeping symptoms manageable. Additionally, before playing a sport, a good dynamic warm up can loosen up the joints.

When do you use ice vs. heat?

There’s not a good scientific answer to this question.

Inflammation will be present at acute injuries. After an acute injury, using ice immediately for at least 24 hours is the best treatment.

Heat comes later, especially with the strain recovery patterns. After that first inflammation, a strained muscle and muscle tendon will start to feel tight. Heat is more helpful at that point.

Why do youth athletes only have preseason physicals compared to professional athletes who have pre- and postseason physicals?

For younger athletes, the preseason physical is to see if there are thing that are modifiable. So, if the physical find that there are significant imbalances around certain joints, the athlete can address those concerns with a good strengthening program prior to the season.

Another example could be a youth soccer player who has a very tight muscles in their quads and hamstrings. It will be important for that player to focus on a good dynamic stretch routine before they begin to play during the season. Or maybe a youth athlete is returning from injury during the offseason, and they might not have fully recovered yet. During the preseason physical, we may see some weak places that still need to be worked on to prevent further injury.

The purpose of a preseason physical is the same for professional athletes. Professionals have a postseason evaluation due to the high amount of stress put on their bodies. At the end of the year, we want to see what they’ve really been struggling with and if there are things that we need to address surgically.