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
