Active Care

Overuse Injuries Are Not Just For Adults

Overuse injuries are not just for adults.  With 30 million kids participating in organized youth sports every year, athletics have become the number one cause of injury among adolescents.  Those that participate in organized sports frequently play in a year-round format that allows little time for recovery and may encourage the development of overuse or repetitive stress injuries.

During periods of rapid growth, the areas in which tendons connect to bones are vulnerable sites of injury as these growth centers are subjected to the high demands of athletic activity.  Two common injuries of this type are Osgood-Schlatter’s Disease of the knee and Sever’s Disease of the heel.  As both are caused by the repetitive stress of athletics, a pause in sports activity may play a role in recovery from these conditions.  However, with the increasing seriousness and organization of youth sports, the traditional approach of extended rest and activity modification may not sit well with eager young athletes anxious to return to a favorite sport.

Those children with Sever’s Disease are typically between the ages of 7-10 and are usually very active.  Pain or soreness is usually located at the back of the heel where the Achilles’ tendon meets the bone with many experiencing symptoms on both sides.  Like overuse injuries in adults, early diagnosis and treatment are important in a quick resolution of the problem.  Not surprisingly, weakness and a lack of flexibility of the calf and lower leg are associated with the condition and should be addressed as part of any treatment program.  Physical therapy aimed at strengthening and stretching of the calf and leg is recommended by nearly all sports medicine clinicians and researchers.  Although relative rest from sport may be important, young athletes can still remain active through cross-training on a stationary bike or in the pool.

Osgood-Schlatter’s is usually found in 11-15 year old adolescents, especially in those playing basketball, volleyball and soccer.  Pain is present below the kneecap at the bony bump at the top of the lower leg bone.  This bump, called the tibial tubercle, usually swells and remains more prominent, even after the condition resolves.  Like Sever’s, many experience the condition on both sides.  For Osgood-Schlatter’s, strengthening the quad, hamstring and hip is of primary importance in treating the condition.

As kids increasingly begin to suffer from sports-related overuse injuries it is important to take an active, exercise focused approach to treatment.  As many young athletes are dedicated to a year-long sport, rehabilitation can no longer consist of long periods of complete rest and a recovery based on “just go play.”

Quite Simply a Pain in the Rear

It’s quite simply a pain in the rear.  While it goes by the technical name, high hamstring tendinopathy, the condition can strike runners and triathletes with a vengeance.  With a training program that features miles of running combined with the uncountable hills that litter the Bay Area landscape, the hamstring muscles and their tendons can become overworked and overloaded.  The first inkling of this is usually soreness after a run in the upper portion of the back of the leg and may progress to pain during exercise and difficulty with simple daily tasks like sitting and walking.  Despite the fact that high hamstring pain is common in those that exercise it is underreported in the medical literature and can often be misdiagnosed.

Trying to ignore the soreness and “run through” high hamstring tendinopathy frequently leads to a worsening of the condition and possible prolonging of the recovery.  Making matters worse, high hamstring tendon pain is frequently associated with back conditions as the hamstring muscles can be weakened with back-related nerve irritation.  If this is the case, treatment of the high hamstring tendinitis must first begin by addressing the lower back condition.

In the early phases of recovery running should be halted and cross training on a stationary bike used to maintain cardiovascular fitness.  Safe yet vigorous reconditioning of the hamstring and leg are the focus of the initial exercise program.  After the hamstring tendon irritation has subsided and leg strength improved, more advanced cardiovascular training can be combined with functional pre-running exercises.


Preventing Winter Sports Injuries

For Bay Area skiers and snowboarders, the recent stormy weather means one thing-snow is on the way.  Soon the roads up to Tahoe will be clogged with anxious snow lovers on their way to ski favorite runs at Squaw, Heavenly and Sugar Bowl.  While it is extremely popular, Alpine skiing and snowboarding are sports that come with a risk of knee injury.  However no injury is inevitable and several techniques can be taken to minimize the risk and stay on the slopes.

The most important step in a pre-season skiing program is a comprehensive leg strengthening program.  The sports medicine literature is full of research validating the effectiveness of leg strengthening and coordination training in minimizing the risk of injury with sports, especially in women.  As researchers also point to a lack of core stability and coordination as an independent risk for injury, core stability training should also be included in a comprehensive program.

Another related cause is stopping skiing before fatigue becomes a limiting factor as an all too common refrain is the “last run of the day” injury.  Interestingly a study in the Journal of Sports Science and Medicine found that recreational skiers, when fatigued, changed their technique to a more “uncontrolled” style rather than properly using tired muscles.  Unfortunately uncontrolled skiing frequently means injury-prone skiing.

Other important factors include using a multi-directional release binding as well as a proper binding setup.  Not surprisingly, first time skiers and snowboarders are at increased risk of injury for a variety of factors.  In addition to improper equipment and setup, the authors of this study also implicate insufficient conditioning as a reason for the greater threat.

So use the rain as an excuse to hit the gym before you hit the mountain.  The following exercises will get your legs tuned up so you can ski or snowboard longer and hopefully avoid injury.


Side Plank

Pseudo-hop 1

Pseudo-hop 2

Hamstring Bridge 1

Hamstring Bridge 2