Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child’s first introduction to programmed exercise.
In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.
To understand pediatric injuries that can occur during sports performance, it’s important to be aware of the peculiarities of the growing musculoskeletal system. Children’s tendons and ligaments are relatively stronger than the epiphyseal plate; therefore, with severe trauma the epiphyseal plate will give way before the ligament. However, children’s bones and muscles are more elastic and heal faster. At the peak period of adolescent linear growth, the musculoskeletal system is most vulnerable because of imbalances in strength and flexibility and changes in the biomechanical properties of bone.
Physiological loading is beneficial for bones, but excessive strains may produce serious injuries to joints. Low-intensity training can stimulate bone growth, but high-intensity training can inhibit it. Growth plate disturbances resulting from sports injuries can result in limb-length discrepancy, angular deformity or altered joint mechanics, possibly causing permanent disabilities. Sports involving contact and jumping have the highest injury levels.
Primary Patterns of Injury
The patterns of injuries to growing bone are different than mature bone because of their unique biomechanical characteristics. Two main types of injuries occur, one caused by acute, violent forces applied one time; the other caused by chronic, recurring stress applied over a prolonged period of time. Acute violent injuries can be classified as follows: plastic deformation, torus fractures, green-stick fractures, epiphyseal plate injuries (Salter-Harris classification), and apophyseal avulsions. Chronic recurring stresses include the overuse syndromes, stress fractures and apophyseal injuries involving the patella (Sinding-Larson), tibial tubercle (Osgood-Schlatter’s) and the Achilles, as in Seiver’s; all with a similar mechanism.
The Pediatric Cervical Spine
Cervical spine injuries in children usually occur in the upper cervical spine from the occiput to C3. The fulcrum of motion in the cervical spine in children is at the C2-C3 level; in the adult cervical spine, the fulcrum is at the C5-C6 level. The immature spine is hypermobile because of ligamentous laxity, shallow and angled facet joints, underdeveloped spinous processes, and physiologic anterior wedging of vertebral bodies, all of which contribute to high torque and shear forces acting on the C1-C2 region. Incomplete ossification of the odontoid process, a relatively large head, and weak neck muscles are other factors that predispose to instability of the pediatric cervical spine.
The neurological manifestations of atlantoaxial instability include neck pain, gait disturbances, decreased cervical mobility, torticollis, in coordination, spasticity, hyperreflexia, and clonus. If any of these symptoms is present, the patient should be further worked up with an MRI prior to participation in any sports.
The ability of the cervical spine to absorb and dissipate loads is clearly diminished with long fusion masses. A type I lesion constitutes an absolute contraindication to participation in contact sports because of the marked alteration in spinal mechanics potentially predisposing the athlete to injury or degenerative changes. However, a type II lesion, involving fusion of one or two interspaces at C3 and below, should present no contraindication to sports for an individual with full cervical ROM and an absence of occipital cervical anomalies, instability, disc disease or degenerative changes.
Encourage and steer your children into an active sports lifestyle and watch them have fun. Remember to also have them getting preventive chiropractic care before any injuries crop up and definitely when musculoskeletal injuries occur.