Recognizing Movement Injuries in Children
Williams, Biff, Marston, Rip, JOPERD--The Journal of Physical Education, Recreation & Dance
Most children seem to have a natural desire to be active and to explore new experiences. Their rapidly developing bodies provide ever-increasing opportunities to challenge the limits of their motor abilities. In addition to their physical education classes, more and more children are participating in extra-scholastic activity programs such as youth sport clubs and community recreation programs. Unfortunately, with the increased opportunity to participate in such activities comes an increased risk of injury. Children in the elementary grades are particularly prone to injury because they are not as coordinated as adults and react more slowly to movement hazards in the environment (e.g., they have trouble getting out of the way of a running teammate or thrown object). They may not be able to assess the risks involved or consequences connected to specific movements (e.g., a dive-forward roll; throwing the bat after hitting the ball). In addition, children of the same age can vary greatly in size and weight. All o f these factors contribute to an environment that may be more conducive to injury than to learning.
Sport injury hazards are drawing increased national attention, and for good reason. According to a national survey, an average of 775,000 children under age 14 are treated in hospital emergency rooms each year for sport-related injuries, and "21 percent of traumatic brain injuries in children are the result of sports or recreational activities" (KidsHealth, 2001). Another two million children per year receive a sport-related injury that does not require a visit to the emergency room (KidsHealth). Such statistics have prompted the National Athletic Trainers' Association Research and Education Foundation to form an alliance with the American College of Sports Medicine in order to study injury patterns in youth sports. As the chair of the foundation's research committee stated, "Youth make up the largest group of participants in organized sports, and yet we know relatively little about how and why they are injured" (National Athletic Trainers' Association, 1998).
Most injuries to children can be classified as either acute injuries or overuse injuries. Acute injuries usually occur suddenly (e.g., bruises, strains, sprains, eye injuries, broken bones), while overuse injuries tend to result from practicing a specific movement too often or from improperly executing a repetitive movement (e.g., Little League elbow, swimmer's shoulder, shin splints) (KidsHealth, 2001). Recent data indicate that 30 to 50 percent of all pediatric sports injuries are due to overuse (DiFiori, 1999).
Although conscientious teachers and scholastic coaches may strive to provide safe, developmentally appropriate activities for their students, many children are engaging in additional movement activities over which qualified professionals have little, if any, control. For example, teacher associates, whose major objective is to maintain a minimum level of social accountability (translated: "no fights"), supervise most school recesses in a chaotic setting wherein little regard is given to factors related to injury. Similarly, many community recreation organizations rely on volunteer personnel for the core of their programs. These volunteers usually have good intentions but may lack the background to create physically or emotionally safe activity environments. Untrained personnel sometimes view children as miniature adults. Yet, children differ physiologically, cognitively, and emotionally from teenagers and adults. They should not be told to "play through" injuries such as tendonitis, stress fractures, and shi n splints (American Academy of Pediatrics, 2000). The "no pain, no gain" philosophy is not appropriate for children's practices or games.
Parents may likewise lack knowledge about appropriate levels of participation for their children or their own role in preventing youth sport injuries. For example, the results of the National SAFE KIDS Campaign survey (2000) indicate that many parents are not very concerned about injuries in youth sports:
More than half of parents...express little concern about the possibility of their child getting hurt, despite the fact that nearly one of every three of their children...is injured playing team sports.... Four out of five parents whose child suffered a sports injury believe, 'It was part of the game and probably would have happened anyway.'
Given these and other factors, physical educators are encountering an increasing number of students who have been injured while participating in activities outside of school. Many of these students will not discuss their injury with their classroom teacher or physical education teacher; because the injury occurred outside of the school day, they may perceive it as being unconnected to their school activities. Yet, elementary school physical educators, whether they be classroom teachers or physical education specialists, are in a unique position to screen students for movement injuries. When students are sitting in a classroom, their injuries may not manifest themselves in observable behavior. During physical education class, however, children who have sustained an injury may attempt to modify movement tasks or avoid them altogether. Unfortunately, such children are sometimes perceived as being defiant (if they refuse to do the movement but don't complain about their injury) or as "whiners" (if they do compla in), when in reality they are simply responding to the signals that their pain receptors are transmitting.
The following sections describe five of the most common youth sport injuries--Little League elbow, swimmer's shoulder, shin splints, Osgood's Schlatter's disease, and jumper's knee--along with their corresponding causes, behavioral symptoms, treatment techniques, and prevention strategies. It is hoped that this information will help teachers identify sports injuries more readily and initiate or reinforce proper treatment by qualified individuals. This approach may prevent a child's sport injury from being prolonged or worsening.
Little League Elbow
Little League elbow is most often found in children who participate in throwing sports (e.g., football, softball, and baseball) (O'Conner, 1998) but may also affect those who play golf or tennis. This condition is caused by repetitive stress to the inside of the elbow from throwing a curve ball, serving a tennis ball, or swinging a bat or golf club. Young athletes who have Little League elbow will complain of pain and stiffness over the inside of their elbow, particularly with any movement of that area (Gallaspy & May, 1996). The teacher will notice that the child does not want to use the injured arm and that the elbow is swollen, red, and very tender when touched.
One way to verify that a child has Little League elbow is to have the child try to extend the wrist while you resist the motion. Another method is to shake hands with the child and ask him or her to try turning the hand palm up while you resist the motion. If either of these motions causes pain, it is highly probable that the child has Little League elbow (Gallaspy & May, 1996).
Once the injury has been detected, the recommended treatment is to ice the elbow initially, then place a compressive wrap over it. The child should be advised to rest the injured arm until pain is completely gone and full movement is restored. Anti-inflammatory drugs can also be taken as recommended by a doctor, and a stretching and strengthening program for the arm should be started (Arnheim & Prentice, 2000). Once recovered from Little League elbow, the child should be encouraged to intensify the strengthening and stretching program during preseason periods in order to prevent the injury from returning. Those who continue to be plagued by the condition should have an expert analyze their sport-specific movements in order to identify any poor skill techniques that may be causing the recurrence (Kids-Health, 2001).
Swimmer's shoulder, also called "thrower's shoulder," is a painful pinching of the shoulder's rotator-cuff muscles (Gallaspy & May, 1996). As the name implies, this injury occurs primarily to swimmers, but it is also very common in baseball players, volleyball players, javelin throwers, and gymnasts (Anderson & Hall, 1995). Swimmer's shoulder is caused by repetitive overhead movements such as those found in the aforementioned sports. This repetition can produce small tears in the rotator cuff that cause athletes to feel extreme pain while moving their arms.
Children with this injury would likely tell their teacher that they feel a snapping sensation when they throw and that the pain increases the more they use their shoulder. The teacher will notice that the children wince in pain with most movements and try to refrain from using the affected arm. One way to test whether children have swimmer's shoulder is to have them extend their arms out in front of their body (thumbs down) and resist while you gently press downward. If this motion elicits pain, there is a high probability that they have a pinching of the shoulder's rotator cuff (Gallaspy & May, 1996).
Once the pinching has been detected, the child should refrain from any physical activity and be referred to an orthopedic physician. Depending on the severity of the injury, the child will need either surgery or treatment by an athletic trainer or physical therapist. The treatment will consist of strengthening and stretching exercises and, possibly, applications of electrical stimulation and ultrasound (Arnheim & Prentice, 2000). In order to prevent swimmer s shoulder, young athletes should be shown proper ways of stretching the muscles surrounding the shoulder on a regular basis. If pain recurs, they should stop the strengthening exercises and ice the affected area immediately.
Shin splints can affect athletes participating in virtually all running sports, including track, cross-country, basketball, and gymnastics (Arnheim & Prentice, 2000). Shin splints are defined as painful micro-tears to muscles in the front of the lower leg (Thomas & Craven, 1993). Factors that contribute to this condition include muscular weakness, fatigue, poorly cushioned shoes, overtraining, running on hard surfaces, and faulty posture (Arnheim & Prentice; Gallaspy & May, 1996).
Children suffering from shin splints will complain of pain in the area that becomes very severe over a period of time. Initially, the child will be able to tolerate the pain, but as the shin splints continue, the child will not be able to participate. The teacher may notice that the child is limping or has an altered gait. The area may be swollen and very tender to the touch, particularly when the child moves the ankle or lower leg (Gallaspy & May, 1996). In order to test for shin splints, the teacher need only ask the child to run in place. If shin splints are present, this running will produce pain in the affected region.
Once shin splints have been detected, the child should be referred to a physician to rule Out the possibility of a stress fracture. Treatment for shin splints consists of icing the area, rest, and stretching the muscles of the lower leg and foot (Arnheim & Prentice, 2000; Duff, 1992). In order to prevent the recurrence of shin splints, the child should continue a stretching and strengthening program for the musculature of the lower leg and be very cautious when buying shoes (Duff).
Osgood's Schlatters Disease
Osgood's Schlatters disease is one of the most common conditions that occur to physically active children. It "is characterized by pain at the attachment of the patellar tendon to the tibial tubercle" (Arnheim & Prentice, 2000, p. 551). Most adults who were physically active when they were younger can feel a bump just below their knees. This bump is the tibial tubercle, which increases in size as young athletes participate in regular physical activity. The increased size of the tubercle is caused by a fracture that occurs to the area due to the stretching of the patellar tendon. As the fractured area heals, the tubercle gets larger. The disease is the most common cause of knee pain in 10-to-15-year-old boys and 8-to-13-year-old girls (O'Conner, 1998), and it usually disappears by its own resolve.
Young athletes who have Osgood's Schlatters disease will complain of anterior knee pain during movements of the quadriceps muscles, including squatting motions. They will also have a large, observable bump just below their knee, with a smaller quadriceps muscle on the affected leg and knees that are swollen and very tender to the touch (Gallaspy & May, 1996). If a teacher suspects that a student has this condition, a recommendation should be made that the child see an orthopedic physician.
Once the condition has been identified, the treatment is usually very conservative. The child's physical activities should be reduced significantly for 6 to 12 months. If the child continues to participate in some activities, the affected knee should be iced after each session and a strengthening program for the quadriceps and hamstring muscles should be started (Arnheim & Prentice, 2000). In severe cases, the child may be placed in a cylindrical cast. In order to prevent Osgood's Schlatters disease, children who begin having anterior knee pain should start icing the area after strenuous activities and begin a comprehensive stretching and strengthening program for the quadriceps and hamstrings.
Jumper's knee affects young athletes who jump and run. The condition is very common in basketball but can affect athletes of any sport. Jumper's knee is a form of tendonitis just below the kneecap. The repetitive jumping and running causes a microtruama and degenerative changes to the patellar tendon (Gallaspy & May, 1996).
A child who has jumper's knee (patellar tendonitis) will complain of pain after active movement. In some cases, the child will complain at the beginning of exercise but will explain that the pain goes away as the movement continues. The child will also have pain in the area after sitting for a long period of time and after waking up. In chronic cases, the child may have pain all of the time (Arnheim & Prentice, 2000). The teacher will notice that the child may have altered running and walking patterns that might even progress to a limp. The teacher may also notice that the area is red, swollen, and very tender to the touch.
Once a child has been diagnosed with jumper's knee, the treatment consists of icing, stretching, ultrasound, and strengthening exercises (Anderson & Hall, 1995). In order to prevent jumper's knee, children should stretch properly before physical activity and make sure that the surrounding musculature is properly strengthened.
Athletic injuries can affect children in a number of negative ways. Children who are injured might feel ashamed or embarrassed of their injuries and therefore avoid telling their physical education teacher that they should not participate. Continued participation may hinder the healing process or lead to additional injuries. Other children may seek different ways of avoiding activity in order to hide their injury from their teacher or peers. This strategy may lead to teasing from other children that could eventually affect the child's attitude towards physical activity. Armed with the above information on the causation, identification, and treatment of common injuries, teachers and youth sport coaches can help children prevent such injuries and maintain their excitement for physical activity.
Biff Williams is an assistant professor, and Rip Marston is an associate professor, in the School of Health, Physical Education, and Leisure Services at the University of Northern Iowa, Cedar Falls, IA 50614.
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Publication information: Article title: Recognizing Movement Injuries in Children. Contributors: Williams, Biff - Author, Marston, Rip - Author. Journal title: JOPERD--The Journal of Physical Education, Recreation & Dance. Volume: 72. Issue: 6 Publication date: August 2001. Page number: 29. © 2009 American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD). COPYRIGHT 2001 Gale Group.