Thursday, September 5, 2013

Overuse Injuries in Adolescent Elite Basketball Players-not just “Growing Pains”

Below is the most recent edition in a series of articles written by Dr. Kenneth Ransom exclusively for Buckeye Prep Report readers. Enjoy!

Overuse Injuries in Adolescent Elite Basketball Players-not just “Growing Pains”

The Buckeye Prep Elite Showcase this year promises to be the biggest ever.  Only the best youth basketball players will be coming to compete with each other.  In order to achieve this level of performance, most of these kids are committed to playing basketball year-round.  Specialization in one sport has become common in elite youth sports today and often begins in middle school.  The benefits of this dedication will be evident over the weekend of September 21-22 in Columbus, Ohio where the basketball will be nothing short of amazing.

However, there may be potential problems associated with prolonged intense training in a single sport.  Doctors are seeing an increase in overuse injuries in athletes that are focusing on just one sport and are training year-round. Adolescent athletes are especially at risk for injury because their bodies are still growing. The bones grow first, pulling and tightening the muscles and tendons. Growth plates in developing bones are weaker than the ligaments and tendons and are consequently more susceptible to injury from repeated stress and continuous use by the same muscle groups.  Combined with overtraining and inadequate periods of rest, adolescents can be at serious risk for overuse injuries.

Overuse injuries in young basketball players occur most often the lower leg.   In the knee area, growth-related disorders include: Osgood-Schlatter disease (OS) and Sinding-Larsen-Johansson disease (SLJ).  Both of these injuries are caused by stress induced inflammation of the bone at the sites of the patellar tendon attachments.  The patellar tendon goes from the knee cap where SLJ can occur to the top on the tibia (tubercle) where OS occurs. Sever’s disease is a similar problem at the heel where the Achilles tendon (heel cord) attaches. These sites can become very painful with activity and are usually associated with a hard, tender “lump.” The pain may even get better with continued play but ultimately a period of rest is necessary for the pain to resolve.  It is very important to avoid repeated stress on the injured growth plate so as not to cause permanent damage and possible growth disturbances.  Non-steroidal anti-inflammatory medication can be given after activity, but never before.  Masking pain from an injury with anti-inflammatory drugs during activity may worsen the severity of injury to the growth plate.  Stretching exercises and wearing shoes with heel pads and arch support will help reduce recurrences. The player may have to struggle with these injuries with repeated periods of rest but they seldom amount to more than a nuisance if treated properly and these “growing pains” will completely subside after the growth plates have closed.

More serious overuse injuries in the legs can result from actual micro-trauma to the tendons.   “Jumpers Knee” is a tendonitis of the patellar tendon itself.  Also Achilles tendonitis can occur with inflammation and possible injury to this very important structure. These are more serious injuries than the growth plate inflammatory problems (OS, SLJ, and Sever’s) and require a longer healing time. Tendons can become so damaged that reconstructive surgery may be necessary.  It is important to consult a physician experienced in sports injuries if pain does not improve with a sufficient periods of rest.  Professional evaluation should also be obtained if there is an associated joint effusion or instability. There are number of serious soft tissue injuries of the knee and ankle area that generally result from an instantaneous traumatic event but can occasionally be more insidious in their presentation.

Another serious overuse injury seen in basketball players are stress fractures.  Stress fractures occur when muscles become fatigued and transfer the overload of stress to bones.  Especially in adolescents, where growing bones need adequate time to repair otherwise it can eventually fail and a small crack (stress fracture) can develop.  Most stress fractures in basketball players occur along the medial edge of the tibia. These injuries can take up to 8 weeks to heal and if activity is resumed too quickly a larger, harder-to-heal stress fracture can develop. Stress fractures can ultimately develop into a chronic pain problem if not treated properly.  In contrast, the “shin splint,” which is also a common cause of medial tibia pain, but is a result of inflammation of the bone and is not a fracture.  This is much less serious than a stress fracture and, as with other inflammatory problems, subsides in about a week with rest and anti-inflammatory agents. Shoes with good arch support and heal padding may help prevent shin sprints from occurring.

The best way to manage overuse injuries is to prevent them.  The National Athletic Trainers Association reports that more than half of all overuse injuries may be preventable.  They speculate that these injuries are caused by training errors and improper technique, excessive sports training, inadequate rest and early specialization.  Players dedicated to in a single sport should participate in a general fitness or cross-training program during the off season in order to stretch and strengthen their core and other muscles groups.  

Adolescent athletes need plenty of sleep and rest including at least 1 to 2 days off per week from competitive practices, competitions and sport-specific training.  And finally, a reminder that growing bones and soft tissues need a good sports diet with plenty of protein, carbohydrates, calcium and Vitamin D to be strong and healthy.

By Dr. Kenneth Ransom

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