By: Nicole Lloyd, PT, DPT, ATC

A recent national publication devoted their cover story to why young athletes need to be cared for differently than adults. The reason CHKD started a sports medicine program nearly 13 years ago is because they agree.

Kids are still growing and developing, both mentally and physically, up to the age of 18 or older, and that sets them up for a variety of injuries that adults do not experience. These injuries include physeal and apophyseal injuries.^2,3 Physeal injuries are injuries to open growth plates. Growth plates are areas of the bone where growth occurs, most often at the ends of the bone. Because of the immature bony and soft tissue, the growth plate (physis) is the weakest part of the bone.² While pain in an area such as the shoulder may mean a rotator cuff strain in an adult, in a child it could be an overuse injury to the growth plate in the upper arm. Similarly, what may be an ankle sprain in an adult, can be a growth plate fracture in a child.¹ The adult may be referred to physical therapy immediately. However, the child may experience more harm if physical therapy is started too quickly, and instead will need a period of rest before they can start physical therapy to give the growth plate time to heal.²

Apophyseal injuries occur where a tendon connects to a bone. These include such ailments as Osgood-Schlatter’s disease, Sever’s disease, Sinding-Larsen-Johannsson syndrome, and Little Leaguer’s Elbow. Apophyseal injuries occur most commonly in early adolescence.³ Overuse injuries, such as these, are believed to be caused by repetitive loading without adequate rest.⁴ These are injuries that could be misdiagnosed or mistreated by a medical provider who is not accustomed to working with children daily.

Dr. Joel Brenner is the medical director of CHKD’s adolescent medicine and sports medicine programs, and was the past chairman of the American Academy of Pediatrics’ Council on Sports Medicine and Fitness. He has authored several of their documents on overuse injuries in youth athletes and early Sports Specialization.^4,5 Overuse injuries are believed to account for about 50% of all athletic injuries, if not more.^3-5 Besides physeal and apophyseal injuries, other overuse injuries include stress fractures, tendinitis, and other bony and soft tissue injuries.³ CHKD’s sports medicine program specializes in caring for these types of overuse injuries in youth athletes.

Beyond injuries, as kids grow they can appear to lose their coordination and previously developed skills.³ Every time a body part grows, the brain has to relearn how to move that body part. After a growth spurt, a star player on a soccer team may look like they are tripping over their feet and struggling to shoot like they used to. Their body needs to relearn how to do these coordinated movements with their new size.³ However, during this time period, due to faulty mechanics and strength deficits, youth athletes may be at a slightly higher risk of injury. As body awareness is decreased, sometimes visual feedback can be helpful in teaching kids how to correct their movements. For example, video recordings and analysis by a physical therapist or experienced strength coach of them performing a given movement can help supplement verbal corrections so they can understand what they are doing wrong and make the proper corrections.¹ At CHKD, we have these video analysis tools available (even for the pool) and are able to help youth athletes learn or relearn proper movement patterns to decrease their risk of injury, and we are able to do it at an age appropriate level.

CHKD’s sports medicine program has experts in sports rehabilitation. Our team will work with your athlete to design a rehab program not just for a young athlete but for your young athlete. Football, gymnastics, soccer, and basketball all have different demands on the body. We will design a rehab program that will not only address the demands of the sports that your child plays, but will address the other areas of the body that their sport may neglect that may have contributed to your child’s injury. In a football player, we may focus more on short bursts of intense power. In a basketball player, we may focus more on jumping, landing, and change of direction. Both athletes, however, will probably need some work on their flexibility in order to balance out their strength and power and reduce the risk of further injury. Additionally, when an athlete’s sport is incorporated into their rehab, it makes it a lot more fun. It’s fairly common to see soccer players doing footwork drills with a soccer ball, baseball players throwing, and gymnasts flipping when you walk into one of our sports medicine therapy centers.

Young athletes have vastly different needs than their adult counterparts, and it is imperative that their care team understand and appreciate these differences. CHKD’s sports medicine program includes a care team consisting of fellowship-trained pediatric orthopedic surgeons and primary care sports medicine physicians, athletic trainers, physical therapists, physical therapist assistants, exercise specialists, and a sports nutritionist. CHKD’s mental health program is also available to help support the youth athlete’s mental health needs when there is an injury that may take them away from their sport for a period of time. Our program services the Hampton Roads region and beyond with 10 locations and over 150 team members. CHKD’s sports medicine physical therapy program has several specialized programs to help meet the needs of a diverse youth athletic population. Programs specialize in the care of baseball, dance, running, soccer, swimming, volleyball, and gymnastics athletes, as well as concussions and vestibular injuries. Program coordinators help set up training classes specifically geared to the needs of these athletes, offer assessments of specific skills, utilize video technology to analyze mechanics, and keep all of our physical therapists up to date on the current research in treatment of these athletes. Our exercise specialists help kids of all abilities improve their overall health and prepare them for the rigors of athletic participation. Whether a child needs a sound strength and conditioning program to prepare for an upcoming season, or just help getting more active while learning proper movement patterns, our exercise specialists can tailor a program to each individual.

CHKD’s sports medicine program has made it their mission to meet the needs of our area’s youth population and provide them the best possible care. For further information on any of the above programs or services or to schedule an appointment please visit CHKD.org/SportsMed or call 668-PLAY (7529) today!

1. Wojciechowski M. Not ‘Small Adults’. PT in Motion. 2018;10(10):28-34.
2. Arnold A, Thigpen CA, Beattie PF, Kissenberth MJ, Shanley E. Overuse Physeal Injuries in Youth Athletes: Risk Factors, Prevention, and Treatment Strategies. Sports Health: A Multidisciplinary Approach. 2017;9(2):139-147. doi:10.1177/1941738117690847
3. DiFiori, JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014; 48:287-88. doi:10.1136/bjsports-2013-093299
4. Brenner JS and AAP COUNCIL ON SPORTS MEDICINE AND FITNESS. Overuse Injuries, Overtraining, and Burnout in Child and Adolescent Athletes. Pediatrics. 2007;119(6):1242-1245.
5. Brenner JS and AAP COUNCIL ON SPORTS MEDICINE AND FITNESS. Sports Specialization and Intensive Training in Young Athletes. Pediatrics. 2016;138(3):e20162148. doi:10.1542/peds.2016-2148

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About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.