Fall Sports Injuries in Young Athletes

It’s Fall Sports time!! The time of year where school sports start for young athletes. School and team spirt are at their peak during the fall, however injuries are inevitable in young athletes participating in fall sports. There are a multitude of injuries which can occur for our young athletes playing fall sports such as soccer, football, and cross country.  Some examples to discuss:

1. Ankle Sprain
2. Pediatric Ankle Fracture
3. Shin Splints
4. Peroneal Tendinitis

ANKLE SPRAINS

It is estimated that there are 26,000 ankle sprains per day in the United States. Ankle sprains of the most common sports medicine injury to the foot or ankle. Running and jumping sports have the highest risk for ankle sprains. 75-95% of ankle sprains are to the outside or lateral aspect of the ankle. The injury most often occurs when the foot is in a downward position in the foot “rolls underneath” the leg.

Besides treating the initial injury, the most significant concern of ankle sprains is the risk of re-injury or chronic symptoms secondary to inadequate initial treatment. Upwards of 20% of patients have residual symptoms after ankle sprains due to suboptimal initial management. Therefore, an ankle sprain rehabilitation protocol is paramount for full recovery of an ankle sprain and prevention of ankle sprains in the future. I recommend an aggressive treatment protocol for ankle sprains.  I believe we should never use the phrase “it’s just an ankle sprain”. These injuries require special attention and a thorough treatment protocol.

Ankle sprains are classified by the severity of the injury into Grade 1, 2, or 3.

• Grade I
  • Stretch of the ligament without tearing
  • Mild swelling or tenderness
  • Ability to walk
• Grade II
  • Partial tear of the ligament(s)
  • Moderate pain, swelling, tenderness
  • Difficulty walking
• Grade III
  • Complete rupture of the ligament(s)
  • Severe pain, bruising, swelling, tenderness
  • Inability to walk

Treatment and rehabilitation are based on the grade of injury.

• Grade I
  • Brace for 3 weeks
  • RICE [Rest, Ice, Compression, Elevation]
  • Oral anti-inflammatory medication
  • Early active range of motion exercises
• Grade II
  • Brace for 3 weeks
  • RICE [Rest, Ice, Compression, Elevation]
  • Oral anti-inflammatory medication
  • Early active range of motion exercises
  • Physical therapy 3-4 weeks
• Grade III
  • Soft Cast for 1 week for significant swelling
  • Walking boot for 3 weeks then brace for 3 weeks
  • RICE [Rest, Ice, Compression, Elevation]
  • Physical therapy 4-6 weeks

A majority of medical research on ankle sprains reveal improved outcomes with early functional treatment methods.  The concept of early movement with a proper physical therapy rehabilitation protocol improves patient outcomes.  In these studies, aggressive treatment allows symptoms to subside quicker, provides earlier return to work and physical activity, and creates less chance for re-injury.   Incomplete rehabilitation has been shown to be a common cause of persistent symptoms, therefore completing therapy in full provides optimum results.

Ankle sprains happen often and will continue to occur in our athletic population.  It is important not to treat an ankle sprain as a minor injury and not seek specialty treatment for the condition.  With early aggressive treatment your ankle sprain will cause you less issues immediately and less potential issues in the future.

PEDIATRIC ANKLE FRACTURE

With the involvement of more children & adolescents playing high end athletics, there has been increased numbers of pediatric ankle injuries. This is true especially in sports involving lateral motion and jumping such as soccer. Pediatric ankle injuries typically occur during sports or vigorous play when a child’s lower leg or foot twists unexpectedly. While youth athletes have the ability to suffer an ankle sprain, their growing bones create risk of injury to the growth plates, the areas of developing cartilage tissue that regulate bone growth and help determine the length and shape of the adult bone. If an athlete has open growth plates of the ankle [indication their leg is still growing], they are at a higher risk of injuring the growth plate then spraining their ankle under the same mechanism of “rolling their ankle” as the growth plate is the weaker of the structures.  Growth plate injuries of the ankle require immediate attention and treatment.

There are potential long-term consequences to an injury of the growth plate of the ankle include abnormal growth of leg and unequal length of legs. The growth plates are last portion of bones to harden making them vulnerable to fracture. Ligaments within the ankle are generally stronger than the growth plates. Rolling the ankle that would result in a sprain in an adult is more likely to cause a growth plate fracture in a child.  The growth plates of the ankle close between the ages of 12-14 in girls and 14-16 in boys. Pediatric ankle fractures account for 9% to 18% of all growth plate fractures. A strong sign of a pediatric ankle fracture is when a child cannot put weight on the injured ankle. When the pediatric ankle fracture is isolated to the distal fibula growth plate, the fracture generally heals well when treated with a walking cast or boot for 4-6 weeks.  When the pediatric ankle fracture involves the tibia growth plate, the injury may require manipulation of the fracture and casting. If the tibia growth plate fracture is unable to be placed back into position with manipulation and casting, then surgery is performed. 

So do not assume a child who has rolled their ankle has an ankle sprain. These injuries need to be evaluated by a foot and ankle specialist to rule out these specific injuries to the growth plates to prevent potential long-term complications of growing bone.

SHIN SPLINTS

Overuse running injuries are common in young athletes, especially when returning to sport after a summer break. Pre-season training sessions encompass a lot of cardiovascular training for all fall sports, especially for cross country athletes. The lower extremity gets taxed at a high level with cardiovascular training making the athlete susceptible to shin splints.

The most common form of shin splints is medial tibial stress syndrome, so much so that the terms are often used interchangeably. The condition is an overload on the shinbone and the connective tissues that attach your muscles to the bone. The overload is often caused by specific athletic activities:

• Running downhill
• Running on a slanted or tilted surface
• Running in worn-out footwear

Shin Splint treatment is aimed at decreasing the burden on the lower extremity. Treatment includes activity modification, ice massage, oral anti-inflammatory medication, topical anti-inflammatory medication, use of over-the-counter inserts or custom orthotics, taping, and an emphasis on addressing inflexibility.  Calf/Achilles stretching is of foremost importance with shin splints.  This can be accomplished through a home exercise program or through a referral to formal physical therapy. The emphasis for addressing calf/Achilles issues is through an eccentric exercise/stretching/strengthening program. Eccentric exercise is working an active muscle when it is lengthened under load. This increased load helps to strengthen and improve tendon structure. In addition, core strengthening is an important additional adjunct to assist in addressing shin splints as well. Core Strengthening builds abdominal and other core muscles around your back and pelvis. Strong core muscles make it easier to do most physical activities, therefore it is of utmost importance to maintain a strong core.

PERONEAL TENDINITIS

Peroneal Tendinitis is another common overuse running injury. It is referred to as classic runner’s lateral foot pain. It is pain to the outside of the foot and comes on without a specific history of a traumatic event or injury. While seen most often in runners, the condition is not limited to sports such as cross country. Any sport with repetitive overuse of the foot is susceptible, especially sports such as soccer where the cleats provide little support. There are two tendons to the outside of the foot that compose the peroneal tendon complex, the peroneus brevis tendon and the peroneus longus tendon. The pain and discomfort from the injury occurs when overuse of the tendon or tendons creates tendon enlargement, thickening, and swelling. This is secondary to repetitive activity irritating and inflaming the tendon or tendons over long periods of time.​ New exercise or markedly increased activities initiate the condition, therefore it will often during the pre-season portion of fall sports. The initial treatment protocol for peroneal tendinitis, like with shin splints, includes activity modification, ice massage, oral anti-inflammatory medication, topical anti-inflammatory medication, use of over-the-counter inserts or custom orthotics, taping, and an emphasis on addressing inflexibility. In addition, the use of a foot/ankle brace is helpful for athletes with peroneal tendinitis participating in sports such as football and soccer. Should the athlete develop continued pain and discomfort, a formal physical therapy or rehabilitation protocol is initiated.  Patients with chronic non-responsive peroneal tendinitis should obtain an MRI to determine the exact nature, cause, and extent of their injury and to rule out a potential chronic partial tear of either of the peroneal tendons.  Should an MRI reveal a tear, then immobilization in a walking boot and discontinuation of sport is necessary for 4- weeks.