In this blog, we will look at some of the most common injuries we see in children and the parts of the body that where they occur, ankles, knees, elbows, and heels. We will also list our tops tips on how to prevent injury.
Ankles
Ankle injuries are most often acute sprains. Sometimes ankle pain can be caused by going back training too much too soon but in the main, they are ligament sprains on the outside of the ankle. The ligaments on the inside of your ankle (deltoid ligaments) are much stronger. This is part of the reason they get injured less.
Another reason the deltoid ligaments are injured less often is the mechanism of injury involved. To injured the deltoid ligaments generally, a lot of force is needed to hit the inside of the foot. This then overextending the foot outwards and causes the sprain.
This usually happens to block a ball in football that has been kicked with a great degree of force. In comparison to this, the ligaments on the outside of your ankle are the ones that get injured when you ‘roll’ or ‘twist’ your ankle.
The ligaments on the outside of your ankle get injured a lot from twisting and turning in field sports. There’s also an element of luck to ‘rolling’ your ankle. Ankle sprains often happen through bad luck situations such as grass going from under your foot, standing on an opponent’s foot or the worst I’ve seen is standing on a sliotar by accident.
Why is it ankles are injured often in adolescents?
Part of the reason for high levels of ankle sprains in adolescents is not due to some inherent risk in this age group. The levels of initial sprains mirror older age groups. The difference though is that once you have sprained your ankle there is a risk it will happen again. Usually what happens with children is they do the usual “rest, ice, compression, and elevate.” This is enough to remove the symptoms but if adequate rehab isn’t done then it is likely to happen again.
The reason the appropriate rehab is missed more so with children than adults is that often it’s the symptom of pain and/or swelling that drives the decision to go to the physio. After the rest, ice, compression, and elevation often the pain is gone. But, the re-injury risk has not gone with it.
After an ankle sprain, you need to improve strength around the ankle joint. Pain at the ankle can inhibit the calf muscle and it can weaken during the period spent resting. You also need to work on proprioception and balance. If the balance has decreased as a result of an ankle sprain it needs to be worked on directly. Balance won’t come back fully by just working on strength. The balance needs direct training.
What is proprioception?
Proprioception is your sense of where your body is in space. After an injury, we can lose some proprioception. But, this does not mean it is gone forever. Like strength, it can be trained.
Why is this important after an ankle injury?
Having good proprioception in your lower limbs means having a better understanding of your foot position and makes you less likely to roll your ankle again. If your proprioception is poor it may mean you spend a lot of time looking at your feet instead of looking at the pitch.
When you go back to playing this will not only be a risk of re-injury but it means you can’t play as well. If your son or daughter is playing for foot maybe performance isn’t the be-all and end-all for them. But, at the end of the day being able to do your best makes the sport more enjoyable. And re-injuring an ankle again means missing more sports.
How can I reduce the chances of my daughter/son getting a second ankle injury after their first?
The first answer is making sure they stick to their rehab. A good physiotherapist will give you the best possible advice for rehabbing the injury but sometimes adolescents need to be reminded to do their rehab and be thorough with it. A bit like homework, not every kid does all their homework without prompting rehab can be the same.
Secondly, use ankle strapping. Ankle supports/taping is advisable after first injuring an ankle. Ankle taping/supports have been shown to reduce the chances of re-injury. If your child has never hurt their ankle before there is no need to wear ankle strapping. If they have though, they should wear a support/tape their ankles before games and training for 6-12 months after injury. It is not something they have to do forever but as a precaution, it is useful for the first 6-12 months.
Taping can be expensive and time-consuming before every session. It also requires some learning on your behalf or access to a physiotherapist which isn’t always possible. For this reason, the supports are often a good investment. The ankle supports we recommend are the DeRoyal Pro supports available on www.physioneeds.biz
Finally, your physiotherapist should make the rehab as specific to your child as possible. The rehab should build towards what your child wants to get back to. If your child wants to Irish dance or if they want to play a field sport the rehab should look a bit different when it comes to their ankles. That’s not on you, that’s on the physiotherapist.
Unsure if the rehab given is the right thing for your child’s ankle?
Then ask the physio to explain why they chose each exercise for your child. They should be able to give you a satisfactory answer. We don’t pick exercises for no reason. Ask for our reasons if you think there’s something off. Physios are a bit like mechanics. It’s good to have one you trust.
Knees
Knees are a common site of injury and pain in adolescents. There are a number of reasons for this. Firstly, overuse issues. Often with teenagers, they play more than one sport and they go to as many training sessions as possible. I know myself as a teenager I think I had training daily if not twice a day with different teams and sports. Sometimes this is too much and gives knee pain as a result. This doesn’t mean the knees are damaged and doesn’t mean that your teenager can only train/exercise 3 times a week for the rest of their childhood.
What is usually an issue with overuse injuries is that the muscles are the knee is not strong enough to support the joint. The knee than can feel sore and achy after training. They can absolutely get to the point where they can play multiple sports for different teams. But there needs to be a time where activity is modified and proper strengthening is introduced. This strengthening needs to be individualised to the child. No two kids are the same, their injuries are no different.
The second issue that causes knee pain and even other pains/injuries in teenagers is the myth that weight training is bad for teenagers. Weight training does not stunt your growth. Weight training in children and teenagers in fact reduced the chances of injury. Obviously done incorrectly you can get injured in the gym. But, like anything the right amounts in moderation can be good for you. Going from never running to running the marathon will likely get you injured, the same applies to the gym. Never lifting weights and then trying to break Olympic records in your second session will lead to injury. Don’t be afraid to let your kids lift weights.
The third reason knees are a common site of injury for children and teenagers is because of the prevalence of the dreaded ACL. Knees can be prone to overuse issues but are also a major site of acute injuries. Acute injuries are more likely to cause damage such a ligament sprains/tears. Ligaments in and around the knee can be sprained much like the ankle is sprained. They are not always ruptured or torn like an ACL might be.
The reason ligament sprains are common in the knee is because they are injuries that occur with twisting, landing and/or contact. These are all things that occur in most field sports that children and teenagers take part in. Even without contact in sports just as tennis and basketball there can still be ligament sprains occurring in the knees.
How can I reduce the chances of my daughter/son getting a knee injury?
First of all, a big help is to have coaches at training who have their coaching badges. The ‘Rugby 7’ or ‘FIFA 11’ or ‘GAA 15’ are all injury prevention programs that are worked into training as part of the warm-ups in various sports. Most sports have an equivalent and proper coaching of these warm-ups at all ages has been shown to reduce injury rates on teams that use them. Gone are the days of a few laps and a static stretch in a circle. Evidence-based injury prevention programs as part of the team warm-up are a must.
On top of the injury prevention program implementation of strength training with teenagers will help to reduce the chances of injuries, knee injuries included.
Apophyses
What are Apophyses?
They are the growth plates in the bones of children. They are very common sites of injury in children and adolescents. The main places that children will get “growing pains” are the elbow, knee, and heel.
In the knee, you may have heard of Os-good Schlatter’s disease and in the heel Sever’s disease. The elbow is less common in Ireland but in America, it is commonly known as “little league elbow” as it is usually seen in throwing sports such as baseball. These issues are generally seen in the ages of 11 to 14 years old. By 14 your child should have grown out of these issues. There is no cure for Os-good Schlatters or Sever’s disease. They are conditions that need to be managed.
The good news is that if your child has one of these issues it does not mean it will cause lasting damage to the area. If you want to read more about Os-Good Schlatter’s click here Sever’s disease then click here.
Ways to reduce the chances of your child getting injured?
- As mentioned above using proper coaching and an injury prevention programme such as the GAA 15 for warm up at training can reduce injury rates.
- Adequate hydration has been shown to reduce chances of injury. Especially in cold conditions. When it’s warm out the drive to drink water is much more frequent and in fact on warm days players are less likely to be dehydrated because they keep sipping on water regularly. On colder days they are less likely to drink water. So, even though they sweat less they take on less fluids and therefore may become dehydrated as a result. A quick way to know if you have fully hydrated after training is to weigh yourself before training and again afterwards. IF you are 1kg lighter than when you left you need to drink 1 litre of water.
- Where possible have medical coverage at games. Having a physio at a game makes it more likely that a serious injury won’t happen. It may not change what happens on the day but often niggles are reported after a game that if missed may lead to an injury within a week. If these niggles go ignored an injury is more likely.
- Proper equipment is vital to reducing injuries. Helmets that fit in hurling, boots that have all there studs. Wearing a gum shield. All these things help to reduce preventable injuries.
- Proper officiating was also shown to be linked to reduced injury rates. Possibly the biggest issues when organising team is finding enough refs for each game. Refs are constantly put off doing their job because of abuse from parents and players. I refereed myself when I was younger and in fact the parents were often the bigger issue. Kids generally want to just play on. If refs aren’t put off doing games by players and parents giving them abuse then they are more likely to keep refereeing for longer periods of time. They are then more likely to get better at refereeing. Better referees means less injuries.
- Pre-season testing. A physical exam to show weaknesses in players is recommended if possible. Logistically this may not be possible but it is definitely worth doing if you can. Spotting weaknesses and addressing them before they become injuries can help to reduce injuries during the season.
