Saturday, July 21, 2012

Sports Medicine Trends and Your Kids

I wanted to share with you some of the news and trends that came out last week after an annual meeting of top sports medicine professionals.  These topics should be of great interest because they provide clues and warnings of conditions that are affecting developing young athletes nation wide.

Researchers presenting their work at the American Orthopaedic Society for Sports Medicine highlighted a common, painful hip condition in elite athletes.

Labral tears in the hip are often associated with a traumatic injury, such as dislocation, but researchers say they are increasingly seeing hip issues due to repetitive motions and underlying structural abnormalities.

“The proper function of the labrum in the hip is a critical component of mobility for any athlete. When this area gets hurt, repair can be difficult,” said research author, Marc J. Philippon, MD, of the Steadman Philippon Research Institute in Vail, Colorado.

The above study ties in nicely to the topic of sports hernias that were also covered at the AOSSM meeting.

A sports hernia is a common cause of groin pain in athletes, however until lately little has been known as to why they occur.

Researchers presenting their study today at the AOSSM Annual Meeting suggest that a type of hip condition, Femoral Acetabular Impingement (FAI) might be a contributing cause.

“Our study illustrated that those patients with FAI tend to have a change in hip biomechanics which in turn leads to increased stress across the groin. With these stresses a sports hernia (tear to the oblique abdominal muscles), is more likely to occur,” said lead author, Kostas Economopoulos, MD from the University of Virginia Department of Orthopaedics.

“We hope that our study encourages physicians who see sports hernia and chronic groin pain in athletes to further investigate the possibility of FAI and in turn can recommend better treatment options for this puzzling condition,” said Economopoulos.

It’s widely debated whether those with FAI are born with it, or whether it becomes part of normal development in some kids.  Well, I guess it would depend on whether you consider playing one sport to excess year-round “normal.”

Based upon anecdotal evidence (my experience and others in my circle of influence) I would estimate that over 90% of the FAI cases have come in hockey, soccer, and baseball players.  What do these sports have in common?  The demands of each of these sports force athletes to adopt poor pelvic alignment.  Not a big deal if they played sports seasonally and gave their bodies a break but the incidence of FAI and associated hip issues has increased dramatically since the AAU generation rolled in and kids played the same sport 10-12 months of the year!

It is likely that if you screened these athletes early in the season and assigned them a quality-training program to address the demands of their sport (restoring neutrality to the pelvis) these problems could be prevented.

Conversely, a “dead lift-squat-bench” program (standard protocol at most high schools) is a recipe for feeding the pelvic dysfunction that contributes to FAI in the first place and will likely bring about pain and injury more rapidly.

And along with this perspective is the realization that an entire generation of young athletes have been so mismanaged that we’ve actually created a new classification of developmental problems and pathologies: FAI, labral tears, and sports hernias that have the sports medicine community “puzzled.”

Also making news at the AOSSM meeting last week; U.S. Army researchers made a surprising discovery while examining the impact of an anterior cruciate ligament (ACL) tear (a common knee injury), on four indicators associated with cartilage health. The researchers found that pre-injury concentrations for all but one of the four indicators studied were associated with the subsequent likelihood of ACL injury.  U.S. Army Lt. Col. Steven Svoboda, M.D., during his presentation, stated, “ff we can identify people predisposed to ACL tears, one day we may be able to prevent injuries before they occur.”

ACL tears are endemic, with 150,000 ACL injuries in the U.S. each year among military personnel, athletes and others with physically demanding careers or pursuits. Several recent studies have shown that high-risk biomechanical movement patterns, specifically excessive knee valgus angle during landing – or landing knock-kneed – causes increased pressure on the joint. “Our study adds to existing knowledge by raising the possibility of a link between risky movement patterns and biochemical processes associated with cartilage metabolism,” added Dr. Svoboda. “Coaches and athletic trainers of the future may help athletes with high biomarker levels reduce their risk of ACL injury by improving their balance and motor control or correcting how they jump and land.”

The study also has implications for the study of post-traumatic osteoarthritis (PTOA) because a high percentage of those who experience ACL tears go on to develop PTOA.

Patients who undergo repeated anterior cruciate ligament (ACL) reconstructions, or repeat vision surgery, are unlikely to return to prior activity levels despite showing basic functional improvement according to research being presented at the American Orthopedic Society for Sports Medicine’s (AOSSM) Annual Meeting.

One of the 3 Pillars of my youth fitness/athletic development practice is injury –prevention screenings or assessments and the above studies are evidence of why it’s a point of emphasis for me.  Most youth sport injuries are preventable in nature, some health care providers believe that approximately 50% of overuse injuries sustained by young athletes could be prevented if children were better prepared to play the game. [1]

The best way to safeguard children from injury is following a progressive and multi-faceted fitness “education” that is focused on long-term wellness over short-term results.  Absent that, and I am afraid this is just as essential now based upon the fact that basic levels of fitness in children have declined significantly, are injury prevention screenings and a conditioning program that provides what children aren’t getting in school and from sport specific participation. [2]

Injury prevention is a point of emphasis for me because a damaged body never runs as efficiently as the original with all of it’s own parts intact.  Not to mention that surgeries can be quite expensive and as indicated by the ACL research above often lead to degenerative conditions such as osteoarthritis.

To summarize children play to train instead of training to play.  Because children don’t play or rotate sports seasonally their basic movement foundation is lacking and they aren’t equipped to handle the demands of excessive sport participation.  As evidenced by the topics at the AOSSM meeting the current youth sport culture is a major contributor to new classifications of injuries and pathologies.

The answer is diversity of experience particularly for young athletes under the age of 15.  For more advanced athletes in the mid-to-late teen years, injury prevention screenings and training programs that counteract the demands of excessive sport participation have become a necessity.


Dr. William Levine, chairman of the STOP Sport Injuries campaign, summarizes the above information very well in this short video:

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