Hey PS+R Crew!
PS+R is excited to launch our new website with full explanations of services, testimonials, and evolution over the past 3-years. Be sure to check it out!
Share the love! 2024 finally brought us a google business page- we’d love for you to leave a review: https://g.page/r/CXZ2JA04uELUEAE/review
Keeping kids healthy in sport
Repeat after me: kids are not little adults!
Keeping our kids healthy in sport during their growth and development should be a primary concern for parents, coaches and medical teams managing and growing our youth athletes. We all want the best for our kids and when they show an aptitude for sport, we are often presented with opportunities to develop that athletic talent with the promise of a bright future in collegiate or even professional sport. But more training does not always lead to better results for kids and can often lead to pediatric specific overuse injuries.
As children approach adolescence and the onset of puberty, the loads imparted on their musculoskeletal system play a part in determining their long term health and wellness.
We are all familiar with the idea that children have growth plates. These centers of bone growth are typically at the end of the long bones are called physes. This area of bone is the origin of the growth center as children mature to reach their eventual adult height. These areas of bone are sensitive to mechanical loads imparted on them. That means that the way kids move, or don’t move, have an impact on the growth and development of their skeleton and joint structures. In the case of the hip, we know that in adolescence, athletes who engage in sports with a lot of flexion and internal rotation such as soccer, hockey and football develop extra bony formation at the junction between the head and neck of the femur called a cam lesion which is a type of hip impingement. Thankfully, most athletes who develop this bony adaptation will not go on to develop pain or dysfunction related to this extra bone formation, but unfortunately some will — and we aren’t sure how to predict which kids are at risk or how to modify training factors during adolescence to minimize that risk.
In addition to the growth plates at the end of long bones, the cortical bone structure around the edge of long bones also develops in response to loading throughout the lifespan but the bone laid down in youth tends to create long term trends as children become adults. For instance, track athletes have been found to have greater bone density in the front and back of the tibia compared to the sides as their sport loads the bone primarily in this plane. This is one of many reasons why doing multiple sports throughout youth and adolescence is so important in keeping kids healthy and strong for a lifetime.
Researchers are working to better understand risk factors for injury in youth sport, and much of this work narrows its focus to the period of rapid growth during adolescence. During this period, there is increased deformation of articular cartilage during repetitive loading in addition to asynchronous changes in muscle, ligaments, tendons and concurrent changes in neurocognitive processing. Taken together, this transitional period is a time where there may be temporary disruptions in mobility and coordination which increases injury risk. Rapid gains in height are associated with a higher overall incidence of bone and growth plate injuries in soccer and track and field athletes but the relationship is not linear and there appears to be a peak growth rate at which injuries are more likely to occur. Athletes who mature later may be more at risk of injury as increased training loads in sport academies may progress beyond the athlete’s maturity and capabilities. As with much research in sport, our knowledge extends more to adolescent males than females and more work is needed in larger cohorts of girls to understand sex based differences in these trends.
Movement diversity and variable athletic exposure are keys to long term health for young athletes. When athletes do chose sport specialization (defined as chosing one main sport, quitting all other sports and training/competing >8 months per year in that sport), training should include strength and conditioning work with sport-specific skills. Movement quality and neuromuscular training is key, especially for kids in their maximum growth acceleration phase. Athletes should be encouraged to play other sports in their off season and should know that this may actually improve their performance in their primary sport by building more adaptable movement patterns, improved perceptual abilities, and protection against burnout.
Monitoring load response in adolescence should be at the center of any healthy coaching program, particularly in elite programs where training volume is high. The schematic below gives an idea of how load should be appropriately managed between coaching and medical staff in the youth athlete. Movement quality can be assessed by coaching staff, however, partnering with a performance physical therapist to understand vulnerabilities in movement patterns as they relate to current training loads will help athletes stay healthy for a lifetime of sport.
Jayanthi N, Schley S, Cumming SP, et al. Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation. Sports Health. 2022;14(1):142-153. doi:10.1177/19417381211056088
PS+R In The News | February 2025
Libby’s Research
Libby presented with her colleagues and research team at the American Physical Therapy Association’s national conference in Houston, Texas this month alongside Dr. Ed Mulligan (Tufts University), Dr. Joel Wells (hip preservation surgeon at Baylor, Scott and White), and Dr. Jenny LaCrosse (Post-Doctoral Researcher at the University of Michigan). Their educational session was about navigating hip pain and dysfunction throughout the lifespan in patients presenting with pelvic health complaints. The interdependence between the hip and pelvic floor is one of Dr. Bergman’s long term research interests!
Where in the world is Steve and the USMNT?
Steve and the USMNT travel to Los Angeles March 15-23rd to take on Panama (March 20th) in the Semi-final match of the Nations League with hopes of moving on to a 4th consecutive final in the tournament (March 23rd). Be sure to tune into TNT or Peacock.
PS+R Client Spotlight | Becky Thompson
This month’s client spotlight is Becky Thompson! Becky is 110% dedicated to her health and wellness and as a physical therapist herself, she knows the importance of consistency in recovering from injuries. Becky progressed from a long standing lateral elbow tendinopathy that limited her ability to grip, strength train and pop up to catch waves. After a procedure to improve blood flow to the tendon, we worked on progressively reloading the lateral elbow tendon and progression of surfing specific strengthening to improve her upper back, shoulder and core movement patterns and coordination. Becky never misses a day and it paid off with returning to surfing pain free this past month in Hawaii- go Becky! 🤙
Thanks for staying connected with us! See you around!!
