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