Both adults and children alike find that their level and intensity of exercise peaks and troughs throughout the year. The body has the most amazing capacity to adapt to any stress or load placed on it providing that it has time to do so. If we ask more of the body both bone and muscles can get stronger. The problems start when we have a sudden spike in a new activity or we do more sport at a greater intensity following a period of rest such as following the summer holidays and Christmas. When we then resume our sport with renewed vigor in a determination to regain any lost fitness the sudden spike in activity results in tissue overload and pain. Transitions between the sporting seasons such as the end of the football season and beginning of the cricket season pose problems with double the demand on the body.
In growing athletes, there are two common types of overuse injuries, those affecting the bone and those affecting the insertion of the tendon on to the bone. Excessive, repetitive and sudden loading of young bones can cause bone bruising which often causes pain. With adequate rest, this will settle but if the symptoms are ignored, the child becomes at risk of a hairline fracture in the bone known as a stress fracture. These types of injuries tend to affect cricketers, swimmers and gymnasts who repeatedly arch their lower back stressing the bones in the lower back. They also are prevalent in the shin and foot bones especially in young runners. Recent thinking is that, in addition to excessive load there may also be a link to low levels of Vitamin D and it is worth considering supplementing the diet of children who live in northern England and those involved in indoor sports such as swimming and gymnastics.
In adults, we see many overuse injuries in tendons such as the rotator cuff tendon in the shoulder caused by a sudden spike in activities such as hedge cutting and is known as a tendinopathy. However, in children the area of bone where the tendon attaches to the bone is weaker than the tendon itself and loading the tendon in the same way results in a growth plate injury to the bone. These injuries are commonly found in the heel where the Achilles’ tendon attaches (Sever’s disease), the quadriceps attachment at the knee (Osgood Schlatters disease) and can occur in any area where muscles attach to young immature bones.
Traditionally the advice for overload injuries was rest. With careful management compete rest may not be necessary if the young athlete is given the correct early advice. There are guidelines within certain sports such as in cricket to limit the number of balls that young crickets can bowl in any one session and accumulated over the week. Many experts have used graphs such as this one to help us understand what is too much or too little (the “Goldilocks principle”) and it varies from child to child. The important factor is giving the growing body time to adapt and become stronger. The England Cricket Board adopt a recipe of no more than 2 consecutive days of fast bowling with no more than 4 days of play in every 7-day period.
This is a sensible approach to most sports giving the body a day to recover allowing minor stresses to be heal and repair and more tissue can be laid down in case the load recurs. Many young athletes can pack an enormous amount in to a week with some children doing several sports a day and no days off to repair. It is not only the muscles and bones in these very active children that are at risk. These children are often exhausted and susceptible to a condition called overtraining syndrome with recurrent sore throats and fatigue. Ensuring children get adequate sleep is paramount as this is when the body can repair.
The better conditioned a young athlete becomes, the stronger level of protection against injury. Learning to move correctly is critical to a child’s development and just like they must become literate in Maths and English, it is essential that they learn correct movement patterns and become physically literate. Movements such as lunging, crawling, squatting and deadlifts form the basis of many sports and should be taught at an early age but are often missing from the current physical education curriculum.
Physiofit specialises in the development of young athletes and can provide guidance on how to create strong and robust athletes who learn to monitor their workload and safely learn how to do age appropriate strength and conditioning in a 1:1 or class environment in our rehabilitation centre in Wilmslow.
Angela Jackson MCSP AACP ACPSM – www.physiofit.co.uk
Angela established Physiofit in 1992. She has been involved in treating people in sports at all levels both in the UK and Canada for the last 28 years. She has worked with the England Volleyball team, Cheshire Hockey, National league hockey clubs and is the Consultant Physio to all the Cheshire Cricket teams. Her major interest is in prevention of injuries especially in children. She now lectures on courses to share her expertise on developing athletes and gives regular talks in schools and clubs on injury prevention.
She launched the Physiofit screening programme 20 years ago to identify how to prevent injuries and enhance performance and has helped many young athletes realise their sporting dreams in representing their country including her own two children. Her areas of expertise are in knee injuries, the sporty child, hockey, golf, running, cricket and nordic walking.
In the last few years she has become a dedicated running physio training with The Running School and with Blaise DuBois from the Running Clinic in Canada. She has extensive knowledge in golf strength and conditioning and screening having trained with TPI, Ramsay McMaster and Golf Biodynamics.