Rehabilitation After Pediatric and Adolescent Knee Injuries.

According to epidemiology studies, the majority of youth sports injuries presenting to primary care, athletic trainers, and emergency departments impact the musculoskeletal system. Both acute and overuse knee injuries can contribute to sports attrition before high school. Effective rehabilitation of knee injuries ensures a timely return to sports participation and minimizes the negative physical, psychological, and social consequences of becoming injured. The following article provides rehabilitation and returns to play strategies for postsurgical and nonsurgical injuries of the young athlete's knee.

Youth sport: positive and negative impact on young athletes.

Organized youth sports are highly popular for youth and their families, with approximately 45 million children and adolescent participants in the US. Seventy five percent of American families with school-aged children have at least one child participating in organized sports. On the surface, it appears that US children are healthy and happy as they engage in this traditional pastime, and families report higher levels of satisfaction if their children participate. However, statistics demonstrate a childhood obesity epidemic, with one of three children now being overweight, with an increasingly sedentary lifestyle for most children and teenagers. Increasing sports-related injuries, with 2.6 million emergency room visits a year for those aged 5-24 years, a 70%-80% attrition rate by the time a child is 15 years of age, and programs overemphasizing winning are problems encountered in youth sport. The challenges faced by adults who are involved in youth sports, from parents, to coaches, to sports medicine providers, are multiple, complex, and varied across ethnic cultures, gender, communities, and socioeconomic levels. It appears that an emphasis on fun while establishing a balance between physical fitness, psychologic well-being, and lifelong lessons for a healthy and active lifestyle are paramount for success.

Recognition and management of traumatic sports injuries in the skeletally immature athlete.

Over the last decade, participation in organized youth sports has risen to include over 35 million contestants.(1) The rise in participation has brought about an associated increase in both traumatic and overuse injuries in the youth athlete, which refers to both children and adolescents within a general age range of seven to 17. Exposure rates alone do not account for the increase in injuries. Societal pressures to perform at high levels affect both coaches and athletes and lead to inappropriate levels of training intensity, frequency, and duration. In this environment high physiologic stresses are applied to the immature skeleton of the youth athlete causing injury. Typically, since bone is the weakest link in the incomplete ossified skeleton, the majority of traumatic injuries result in fractures that occur both at mid-shaft and at the growth centers of bone. The following clinical commentary describes the common traumatic sports injuries that occur in youth athletes, as well as those which require rapid identification and care in order to prevent long term sequelae.

Medical sports injuries in the youth athlete: emergency management.

As the number of youth sports participants continues to rise over the past decade, so too have sports related injuries and emergency department visits. With low levels of oversight and regulation observed in youth sports, the responsibility for safety education of coaches, parents, law makers, organizations and institutions falls largely on the sports medicine practitioner. The highly publicized catastrophic events of concussion, sudden cardiac death, and heat related illness have moved these topics to the forefront of sports medicine discussions. Updated guidelines for concussion in youth athletes call for a more conservative approach to management in both the acute and return to sport phases. Athletes younger than eighteen suspected of having a concussion are no longer allowed to return to play on the same day. Reducing the risk of sudden cardiac death in the young athlete is a multi-factorial process encompassing pre-participation screenings, proper use of safety equipment, proper rules and regulations, and immediate access to Automated External Defibrillators (AED) as corner stones. Susceptibility to heat related illness for youth athletes is no longer viewed as rooted in physiologic variations from adults, but instead, as the result of various situations and conditions in which participation takes place. Hydration before, during and after strenuous exercise in a high heat stress environment is of significant importance. Knowledge of identification, management and risk reduction in emergency medical conditions of the young athlete positions the sports physical therapist as an effective provider, advocate and resource for safety in youth sports participation. This manuscript provides the basis for management of 3 major youth emergency sports medicine conditions.