Posts tagged adolescents
Risk Factors for Knee Injuries in Adolescents and Teenagers

The knee is one of most commonly injured areas among our Boulder County student athletes.  Injuries range from the traumatic (ligament tears) to overuse (tendonitis) across a variety of indoor and outdoor sports.  Prior research has shown overuse injuries to be the most common knee injury affecting our student athletes but data regarding the risk factors for these two types of injuries has been limited.  

Recently a large study was conducted to document sports participation, injuries, and pain levels of over 1300 8-15 year old children (Junge et al. Med Sci Sp Ex. 2016).  The authors documented the frequency, severity, and type of knee injuries within this group in order to determine the risk factors associated with these injuries.  The authors reported 952 knee injuries (85% overuse) were sustained by the athletes in the study.  Participation in gymnastics was the greatest risk factor for traumatic knee injury.  

Within the overuse injury category female sex, prior knee injury, and a higher frequency of practices and games per week were associated with a higher risk of injury.  The majority of these overuse conditions were self limiting in nature and are successfully managed with conservative care including Physical Therapy.  To learn more on now to reduce your child's risk of knee injury contact your local Physical Therapist. 

Weight Training in Children

A common question we receive from parents is "when can my child start weight training".  This is a difficult question to give a standard answer on because so many variables are at play including the maturity of the athlete (skeletal, neuromuscular, emotional, and mental), the demands of their sport, and their training experience.  Our main concern would be the technique and form the athlete can demonstrate without resistance.  Adding a bar or weight plate onto poor technique, form, or coordination is a recipe for injury.  As in any exercise program, if resistance training is applied properly in the right athlete positive adaptions will take place.  In children, the strength gains noted are more due to improvements in neural communications to other nerves or muscles and not due to changes in muscle size (Faigenbaum et al. 2001 and 2009).  This improved coordination and communication between the nervous and musculoskeletal systems highlights the importance of technique over the amount of weight the athlete can lift.  

A recent study examined the impact of a strength training program of 18 healthy, pre pubescent boys (Tanner Stage I) ranging from 10-12 years old (Cunha et al. Research Quarterly for Exercise and Sport. 2015).  The boys were divided into two groups of 9 and randomized to either a resistance training group or a control group.  The resistance training group lifted weights 3 x per week for 12 weeks under close supervision.  The coach to athlete ratio of 1:4 should be emphasized.  Each athlete went through a warm up, stretching, and weight training program emphasizing major muscle groups for 60 minutes.  Athletes were re tested following this 12 week intervention program.  The resistance training group showed significant improvements in strength measurements and lean body mass by DEXA scanning.  The resistance training group also prevented gains in fat mass compared to the control group.  

In short, choosing a resistance training program for young athletes should be a case by case decision.  A Physical Therapist must evaluate the athlete for variables which would make a program of resistance training appropriate for each athlete.  In our experience, most individuals aged 10-12 should focus on skill and motor development as they move through middle school.  These positive changes in movement and coordination will serve them well as they begin a resistance training program.  

More information can be found here

Early Sports Specialization and Injury Risk

Over the last few years there has been a spike in athletic injuries in our community's youth and adolescent athletes.  Authors believe the spike can be blamed in part on the pressure placed on young athletes by their parents and coaches to specialize in sports early in their childhood.  Specialization is described as intensive year round training in a single sport at the exclusion of other sports (Jayanthi. Sports Health. 2013).  70% of junior tennis athletes specialized at an average of 10 years old while close to all specialized by age 18 (Jayanthi J Med Sci Tennis. 2011).   The American Academy of Pediatrics reports the risks of early specialization include burn out, dropping out of sports, and overuse injuries.  The components that define early sports specialization include

1. Selecting a main sport
2. Participate in 1 sport for >8 months out of the year
3. Stopping all other sports to focus on their main sport

Authors use these variables to place an athlete at low, moderate, or high risk of injury based on their sports specialization.  For example an athlete who meets all 3 criteria would be at a high risk of any injury and serious overuse injury, but a low risk of acute injury.  Conversely, an athlete who meets 0-1 of the criteria above would be at a low risk of overall injury or serious overuse injury, but would be at a moderate risk for an acute injury.  The variables allow us to identify young athletes at greatest risk of injury due to sport specialization.   

Additional risk factors in the literature include 

> 16 hours of total sports participation (regardless of sport)
Athletes who play at higher level of competition

An recent article by Jayanthi et al. (Am J Sports Md. 2015) examined close to 1200 young athletes ages 7-18 years old.  The authors attempted to document the impact of early sports specialization in athletes compared to their peers who change sports each season.  The authors found a highly specialized athlete was twice as likely to sustain an injury than their matched peers even when the hours per week of activity were the similar.  It appears early specialization has its' own inherent risks of injury for young athletes.  

Authors believe early specialization is more risky than season sports participation in the young athlete because of 3 reasons.  First, early specialization increases the exposure to injury over a longer duration than a shorter season.  Prior research has shown a direct correlation between number of exposure hours and injury risk (Rose Med Sci Sport Ex. 2008).   In addition, authors noted athletes who did not take one season off during the year where also at risk for future injury.  A balanced sports year may allow athletes to reduce their sport exposure and allow for their bodies to recover from the demands of their sports.  

A second reason for concern is the lack of variety in training or mechanics involved in a single sport.  Playing multiple sports in the same year allows an athlete to develop many aspects of their fitness including strength, speed, agility, coordination, and balance over a variety of movements.  Conversely, playing the same sport year round at an early age does not let an athlete "cross train" and maintains a constant, consistent level of stress on the body.  In addition, athletes who specialize early may be pressured to attempt mechanics (ex. curveball in baseball, top spin serve in tennis) that their bodies cannot handle at an early age.  

Finally, early sports specialization leads an athlete to greater numbers of competitions per year which are associated with greater injuries.  In addition, athletes who compete more often have greater mental, emotional, and physical demands placed on their bodies than their peers.  These athletes often forgo necessary rest periods between training sessions or competitions placing their bodies at risk for overuse or traumatic injuries.  

Authors recommend the following to reduce the injury risk among our youth athletes (Myer et al. Sports Health. 2015)

1. Youth should be given opportunities for free, unstructured play to improve motor skill development and parents and educators should encourage child self-regulation to help limit the risk of overuse injuries. 
2.  Parents and educators should help provide opportunities for free, instructed play to improve motor skill development during the growing years, which can reduce injury risk during adolescence
3.  Youth should be encouraged to participate in a variety of sports during their growing years to influence the development of diverse motor skills and identify a sport, or sports, which the child enjoys.




Overuse Injuries in Adolescent Athletes

High school fall sports are around the corner. Recently sports medicine professional have noticed an increase in the rates of overuse injuries among adolescent (13-17 y.o.) males and females. Growth factors; lack of cross training and increased volume of training may contribute to this increase in injuries. In particular, these last two factors may allow clinicians to identify individuals most at risk for overuse injury and loss of practice and competition time. A recent article in the Journal of Pediatrics (Schroeder et al. 2015) analyzed athletes in 20 sports over a 7 year period and found females were found to be a greater risk of injury than males and in particular female track and field hockey athletes were at the greatest risk of overuse injury. Half of these injuries resulted in greater than 1 week off of training and competition. For more information on how to prevent adolescent overuse injuries contact the experts at MEND.

Hip Pain associated with Femoral Acetabular Impingement and Labral Tears
hip pain, sports injury, impingement, and labral tears

Hip Pain associated with Impingement and Labral Tears

hip pain, femoral acetabular impingement
femoral acetabular impingement, bone morphology, pain, injury

Femoral Acetabular Impingement (FAI) is defined as the mechanical abutment of the femoral head against the acetabulum1. This contact is either structural (cam or pincer lesion), functional or a combination of both and results in pain, loss of motion, and disability.

Researchers have questioned if the findings noted on x-ray are a normal morphological changes based on anatomy and biomechanics or a structural pathology(3).

These structural changes are apparent in asymptom- atic individuals and there are currently no randomized controlled trials showing they lead to early OA or hip surgery(2).

In a study of over 2000 asymptomatic hips authors noted labral and FAI bone changes in 68% and 67%, respectively. The prevalence of pathology consistent with FAI was higher in asymptomatic athletes(5). Pathology in asymptomatic hips also appears to increase with age(6).

Authors note an 18 fold increase in surgeries from 1999 to 2009 and a 365% increase in surgery between 2004 and 2009 among 20-39 year olds alone(4). This rapid increase in surgery is thought to be due in part to an increase in MRI being performed in this population.

Physical Therapy Solutions for Hip Pain

Conservative treatments are the first line of treatment for patients with anterior hip and groin pain resulting from labral tears or FAI. Interventions include activity modification, education, manual therapy (joint mobilization/ manipulation, soft tissue mobilization, and dry needling), self hip mobilizations, and exercise (stretching, strengthening, balance, and motor control) interventions.

Experts suggest a 8-12 week course of conservative care may improve decision making for possible surgical referral(3).

Ayeri et al. demonstrated a negative response to an injection predicts a negative outcome following surgery more than a positive response for a positive outcome after surgery(8). 

hip manual physical therapy, hip pain, sports injury

Physical Therapy Evidence for Treating Hip Pain and Injuries

Evidence for the conservative treatment of FAI lesions is currently at a case series level of research for both conservative and surgical treatments. To date no randomized controlled trials or long term data exist on surgical outcomes.

Kemp et al. documented poor outcomes for patients undergoing FAI surgery with greater chondral damage and those over age 40(9).

Hunt et al. found a multimodal treatment approach consisting of manual therapy, exercise, and education reduced lower quar- ter impairments and improved function at both short and long term outcomes(7).

In our experience at Mend, athletes and patients with a diagnosis of labral tears or FAI are able to return to sport following a treatment plan involving manual therapy, exercise, biome- chanics evaluation and modifications (ie gait analysis), and education. 

hip pain and injury strengthening exercises

When to seek Physical Therapy for Hip Pain and Injury

Athletes and patients with anterior hip and groin pain, loss of hip range of motion, and disability should be referred to Physical Therapy for conservative management.

Pain mainly in the groin (sensitivity .96-1.0) and a subjective report of hip/groin pain with clicking, locking, and giving way (sensitivity 1.0, specificity .85) may assist in the diagnosis of an acetabular labral tear(10,11). 


1. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003(417):112–20.

2. Collins JA, Ward JP, Youm T. Is prophylactic surgery for femoroacetabular impingement indicated? A systematic review. Am J Sports Med 2014;42:3009–15.

3. Reiman, M. Femoracetabular Impingement Surgery: Are we moving too fast and too far beyond the evidence? Br J Sp Med. 2015. 0:1-6.

4. Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013;29:661–5.

5. Frank, J. et al. Prevalence of FAI imaging findings in asymptomatic volunteers. A systematic review. Arthroscopy. 2015:1-6.

6. Nardo, L. et al. FAI: Prevalent and Often Asymptomatic in Older Men: The Osteoporotic in Men Study. Clin Orthop Relat Res. 2015

7. Hunt D, Prather H, Harris Hayes M, et al. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. Pm R 2012;4:479–87.

8. Ayeni OR, Farrokhyar F, Crouch S, et al. Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2014;22:801–5.

9. Kemp JL, Collins NJ, Makdissi M, et al. Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty. Br J Sports Med 2012;46:632–43.

10. Keeney JA, Peelle MW, Jackson J, et al. Magnetic resonance arthrography versusarthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res 58 2004;429:163–9.

11. Burnett RS, Della Rocca GJ, Prather H, et al. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 2006;88:1448–57.