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Sports Injuries in Children

Why should children play sport?

There are many benefits associated with children participating in sport.

These include reduced levels of obesity and diabetes and improved cardiovascular (heart) and bone health. As well as the medical side there are also psychosocial advantages with playing sport including improved self esteem, reducing drug use as well as improved academic performance and career success. It improves bone strength for later life.

Undertaking sport allows children to have fun, improve their motor skills, experience excitement, be with friends and part of a team, learn to win and loose and improve their fitness.

What sports injuries are suffered?

The number of sports injuries seen in children is difficult to quantify. It depends on the sport and position they play. It varies depending on age and gender. There is no exact definition of what represents “an injury”.

Everyone risks injury simply by participating in sport.

40% of all sports injuries presenting to Casualty departments occur in children aged between 5-14. 3-11% are injured whilst playing sport, the remainder occurring during training. 70-80% are minor (sprains and bruises) with less than a week of activity being missed. 44% of injuries occur in the legs, 35% in the arms and the rest involve the head.

Boys are twice as likely to be injured compared to girls (peak age 14 compared to 12 for girls), with jumping and contact sports having the highest injury rates. Elite athletes have a lower risk of injury than non elite athletes.

Children are not simple “small adults”. They are less coordinated, have slower reaction times and are less accurate in their performance of tasks. They are unable to accurately assess risk. Children are still developing motor and cognitive skills.

Their bodies have different thermoregulation, nutrition and hydration compared to adults.

The bones of children are different from those of adult in shape, physiology and biomechanics. They have the ability to grow and remodel. The growth plate (growing area in the bone) is injured in up to a third of injuries. Children are not prone to stiffness even if they have been in a plaster.

Why is there an epidemic of sports injuries?

There are two epidemics currently face by children, obesity and sports injuries.

There is an increasing recognition of injuries. There is less free play time and less down time during training. Training and matches are played at a higher intensity for a longer period of time. Rather than playing a number of different sports, children are increasingly playing only one or a limited number of sports – often year round. Parents, scouts and coaches are more focused, some being driven by money.

There is an increasing participation in children’s sports especially amongst female athletes. There are more non traditional sports being played and more participation from disabled athletes.

How do children get injured?

Under the age of 10, injury usual occurs during the first few weeks of individual activities such as bike riding or roller skating.

After this age, injuries tend to occur during organised team events such as rugby and football. With increasing age and weight, the force and severity of the collisions increase.

How are injuries classified?

Direct and indirect.

Direct

This occurs when one athlete directly hits or is hit by an object or person.

These injuries will always occur due to the nature of the sport. Efforts are constantly being made to reduce these types of injuries by rule changes and their enforcement, teaching appropriate techniques, proper preparation of the athlete, appropriate safety equipment, playing children by weight not age and education of parents, coaches and scouts.

Indirect (no contact)

Acute

This occurs when a structure such as muscle or bone is overloaded by a force. Resulting in injuries such as torn muscle or twisted ankles.

Chronic (repetitive overloading)

This occurs when the athlete’s body or part of their body is subjected to repetitive force. One exposure to the force does not cause significant damage, but repeated exposure to the force does.

This is commonly seen in the growing areas of children, especially where tendons join the bone – the apophysis.

Examples of this condition are Severs’ disease, Osgood- Schlatter’s disease and Sinding Larsen Johansson syndrome.

Osteochondritis dissecans is a condition in which the surface lining of the end of the bone is subjected to repetitive micro (small) trauma causing problems with the blood supply. This causes fragmentation of the bone and surface lining.

How should injuries be prevented?

Different strategies are used to prevent direct and indirect injuries

Direct Injuries

Correct safety equipment, rule changes and enforcement, teaching appropriate technique, adult supervision, play children by size/weight and not age, adult education (parents, coaches and scouts).

Indirect injuries

Warm up and down, stretching, avoid single sport focus, game time versus practice, free play, never play through pain, seek early medical input.

Ironically, there are child labour laws in many countries that forbid stereotype work movements and excessive loading. These same restrictions do not apply to children’s sports.