The Unique Differences Between Pediatric and Adult Sports Injuries

By Stan Schooler, M.D.

Pediatric and adult sports injuries vary in diagnosis, symptoms and rehabilitation.  The shoulder, knee, back, foot and ankle are the most common injuries that require distinct differentiation.

SHOULDER INJURIES

Shoulder injuries in the adult are often secondary to a rotator cuff tear, arthritis or traumatic dislocation.  However, in the pediatric patient, this is often due to muscle imbalances in the rotator cuff, which result in the instability of the shoulder muscle group.  Swimming, tennis, baseball and volleyball are sports in which there is a risk for this muscle weakness and/or imbalance. The good news is that surgical treatment or injections are rarely needed for the pediatric athlete (with the exception of shoulder dislocation).  A rehabilitation program of muscle strengthening and physical therapy is usually the most effective and beneficial course to take.

KNEE INJURIES

Knee injuries in the adult patient can often be due to arthritic conditions or cartilage issues.  In the pediatric population, pain in the front of the knee (which occurs most often) seldom requires surgery and responds well to proper rehabilitation. 

However, a common sports enigma is the fact that adolescent girls are prone to ACL tears.  Current research has determined that this can be prevented by neuromuscular education of the muscles and ligaments.  Proper techniques of landing after a jump in soccer, baseball, volleyball and/or basketball are paramount in the prevention of ACL injuries.  In addition, "jumper's knee" and Osgood-Schlatter, common injuries due to overuse, affect the kneecap and adjoining structures.  These entities are treatable with physical therapy, ice and elastic strapping; again, surgery is not necessary.  Iliotibial Band Syndrome is another common knee condition (on the outside part of the knee) that does not require surgery and can be rehabilitated with ice and stretching.

BACK PAIN

Back pain is a common complaint of the adult population.  It is often related to deconditioning of the back and abdominal core muscles, but arthritis, osteoporosis, and disk rupture can also be the cause.

Children and adolescents seldom complain of back pain, but when they do, a search for the cause should be initiated.   Stress fractures of the pars interarticularis can result in spondylolysis or spondylolisthesis, which demand an experienced physician to evaluate and determine proper treatment and rehabilitation. These stress fractures of the spine are more common in cheerleaders, gymnasts or offensive linemen.  Tumors of the spine need to be considered in any pediatric patient who is having night pain or pain not associated with activity. A physician should evaluate pain of this nature as soon as possible.  On the other hand, scoliosis (or curvature of the spine) seldom causes back pain and should not deter the athlete from participating in a chosen sports program or activity. 

FOOT AND ANKLE INJURIES

Foot and ankle problems in adults are usually related to ankle sprains.  In the pediatric population, it is important that growth plate fractures be excluded since they commonly present as ankle "sprains." 

Heel pain in adults is usually secondary to plantar fasciitis (inflammatory condition around the bottom of the heel), but heel spurs and plantar fasciitis are seldom seen in children or adolescents.  If there is heel pain in the pediatric patient, he or she usually presents with Severs Disease, which is easily treated with stretching and strengthening and by placing a heel cup in the shoe. 

Parents need to be on the alert for other pediatric concerns, such as the "female athlete triad," which is characterized by menstrual abnormalities, disordered eating and osteoporosis. A knowledgeable sports medicine physician is able to determine the unique growth and development stages of the pediatric and adult athlete, as well as the proper rehabilitation required for the normal or abnormal musculoskeletal anatomy. The sports medicine physician can offer a unique perspective in diagnosis, treatment and rehabilitation of common or unusual athletic injuries in order to return the athlete to play.

Stan Schooler, M.D. is a former college football player, board-certified pediatrician at Wilford Hall Medical Center USAF, board-certified emergency medicine physician at Floyd Memorial Hospital in New Albany and board-certified sports medicine physician at Active Athlete Sports Medicine in New Albany.