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Youth and Adolescent Injuries in Sport​​

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An Introduction to Common Injuries in Youth and Adolescent Football

Discussion on injuries in youth football often centres on whether youth and adolescents suffer with different injuries to their adult counterparts. 

It’s a fact that the developing skeleton is more vulnerable to certain types of injuries and conditions; and several of these will be discussed in future articles.

With youth and adolescent players in particular, overuse injuries and injuries caused by actions of a repetitive nature can be an enormous problem.

These can arise from a sudden unexpected change in training routines or workload intensity; and that can lead to an increased number of injuries. 

When turning professional, for example, teenagers who have previously been used to only having a couple of evening training sessions a week in addition to a weekend game are affected by the change in routine.


They suddenly have to adapt to a sudden switch from part-time hours to the full-time training routine of a professional player.

This is in addition to having an increased amount of game time which can result in an increased number of injuries. 


It’s not always a straightforward comparison of injuries either.  The incidence and nature of injuries in youth and adolescent football can vary from those in open-age football.

Price et al (2004) compared the injuries at academy level to those in the adult professional game and found that in 90% of injuries recorded in the academy study were to the lower extremity. 


They also noted that just over half the injuries recorded were sustained during competition (50.4%), and that most injuries were sustained on the dominant side of the body.

Leininger et al., (2007) audited 1,597,528 football soccer injuries sustained over a thirteen-year period in the USA and found that sprains and strains accounted for 35.9% of the injuries detailed; followed by contusions and abrasions (24.1%) and fractures (23.2%).

Fridman et al (2013) showed that football soccer injuries presenting to Accident and Emergency departments accounted for 11,941 out of 56,691 injuries recorded across 13 different sports in Canada over a three-year period.  

Research addressing injuries in youth and adolescent football has increased during the last few years and this has helped with our overall injury management. 

Earlier studies such as that by Price et al., (2004); Le Gall et al., 2006); and Deehan et al., (2007) which were conducted in the professional academies have since been complemented by extensive hospital-based research.

Not surprisingly, much of this research has shown that areas of the body which are affected most by growth and physical change will be the first to react.

Several common adolescent football injuries falling into this category are Osgood Schlatter’s Disease (OSD), Medial Tibial Stress Syndrome (MTSS), and stress fractures of the tibia or metatarsal bones of the feet.  

Additionally, Sever’s Disease, which affects the area of the insertion of the Achilles tendon on the heel bone (but can also present as pure bilateral heel pain) can be a problem for adolescents.


So too can Sinden-Larsen-Johanssen’s Syndrome; which affects the origin of the patella tendon at the lower aspect of the kneecap.  Like Sever's Disease, both of these conditions are common in players of youth and adolescent ages. 

Gender differences are also thought to play a part in the aetiology of injury, with several studies into the incidence and nature of injuries in women’s football also including players of youth and upper adolescent age groups in those surveyed.

Dick et al, (2007) for example, reviewed 15 years of injury data collected by the National Collegiate Athletic Association and highlighted several injury patterns prevalent in women’s football across the age groups.

Concussions, ankle injuries, and internal derangements of the knee were the three most prevalent game-sustained injuries that resulted in an absence from training and playing for longer than 10 days. 

But as in the adult game, recurrent or repeated injuries are always a risk if players return to play soon; which often leads to a longer spell on the side-lines.

On that topical note, Price et al (2004) found that recurrences of injuries were significantly lower in the youth academies (3%) than in adult footballers (9%).

Perhaps this could be attributed to the fact that there may be less pressure applied to youth team players to return to competition as opposed to their senior counterparts? 

Either way, there is a real need to acknowledge that physical development during the adolescent years can have a major effect on the nature of injuries sustained and that treatment strategies need to be adapted accordingly.

The danger is that not every injury will be seen by a medical professional. 


Anecdotal evidence suggests that many players at local level will opt purely for self-management alone if their injuries are considered to be routine in nature and are thought to be self-limiting.

This is despite the fact that getting the correct diagnosis is essential in managing any injury correctly; and even more so when age factors are known to influence the recovery period.

As with any injury, the golden rule is to seek appropriate advice right away to exclude any underlying pathology or undiagnosed complication of what may seem at first to be a perfectly straightforward injury.


Injuries seen in the early stages nearly always do better than those left unseen until they reach the stage where medical advice becomes essential.

At the other end of the spectrum, return to play strategies should be based on how well an injury responds to treatment as opposed to the length of time since the injury was sustained.


Advances in the treatment and management of injuries have led to a deeper understanding of the mechanics of injury, together with improvements in our diagnostic and treatment methods.


One clear benefit of research in the football academies has been the increase in knowledge of sports-specific injuries and related conditions applicable to  youth and adolescent players. 


But the emphasis still needs to be on early diagnosis and the exclusion of potential complications to recovery; making early examination by a medical professional essential.  


References:

Deehan DJ, Bell K, McCaskie AW (2007).  Adolescent musculoskeletal injuries in a football academy.  The Journal of Bone and Joint Surgery, British Volume.  Vol. 89 (1); 5 – 8.

Dick R, Putukian M, Agel J, Evans TA, Marshall SW (2007).  Descriptive epidemiology of Collegiate women’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988 – 1989 through 2002 – 2003.  Journal of Athletic Training.  Vol. 42 (2); 278 – 285.

Fridman LR, Fraser-Thomas JL, McFaull SR, McPherson AK (2013).  Epidemiology of sports-related injuries in children and youth presenting to Canadian emergency departments from 2007 – 2010.  BMC, Sports Science, Medicine and Rehabilitation.  Vol. 5 (30).   Available at: http://www.biomedcentral.com/2052-1847/5/30   accessed 2nd July, 2015.

Hawkins RD, Hulse MA, Wilkinson C, Hodson A, Gibson M (2001).  The association football medical research programme: an audit of injuries in professional football.  British Journal of Sports Medicine.  Vol. 35; 43 – 47.

Le Gall F, Carling C, Reilly T, Vandewalle H, Church J, Rochcongar P (2006).  Incidence of injuries in elite French youth soccer players: a 10-season study.  American Journal of Sports Medicine.  Vol. 34 (6); 928 – 938.

Leininger RE, Knox KL, Comstock RD (2007).  Epidemiology of 1.6 million paediatric soccer-related injuries presenting to US emergency departments from 1990 – 2003.  American Journal of Sports Medicine.  Vol. 35 (2); 288 – 293.

Price RJ, Hawkins RD, Hulse MA, Hodson A (2004).  An audit of injuries in Academy youth football.  British Journal of Sports Medicine.  Vol. 38; 466.



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