Adolescent Services

We owe it to our children to equip them with all the capabilities they’ll need to thrive in the limitless world beyond the classroom. – Naveen Jain

Problems specifically (not exclusively) affecting adolescents

Children are structurally and physiologically different from adults – they are not simply a smaller version. This means that their problems need addressing with the implications of immature anatomy and physiology in mind. This has particular relevance for fitness programmes; research has shown that children and adolescents can benefit from strength and fitness training (Blimkie 1993; Lillegard et al 1997; Faigenbaum 2000; Guy 2001), but that they require different regimes to the adult. For example, cross-country running is restricted in distance as immature bodies are less effective at dealing with physiological effects of distance running; in resistance training children use body weight as resistance, not lifting heavier than body weight until the skeleton is mature. For these reasons a child cannot join a gym or enter a marathon until the age of eighteen.

Children also mature at different rates and show enormous physical and therefore physiological variation within the same chronological age group. This is an important consideration for sports involving physical contact, where children need to be equally matched to avoid injury.

Injuries

Avulsion fractures

In children the ligaments are proportionally stronger than the bone to which they attach (not so in adults) and fast strenuous contraction of a major muscle can result in the ligament boney attachment becoming avulsed, or detached, from the rest of the bone. These injuries are usually seen in sports with sudden violent muscular contraction such as football, sprinting and jumping.

The most common sites for this to occur are:

Sartorius muscle to the anterior superior iliac spine ( anterior pelvis)

Rectus femoris (hip flexor) muscle to the anterior inferior iliac spine (anterior pelvis)

Ilio-psoas muscle (hip flexor) to the lesser trochanter (hip joint).

Patella tendon to the tibial tuberosity

Abdominal muscles to iliac crest

Hamstring muscles to ischial tuberosity

Overuse injuries

The most common types of overuse injury seen in children are the Osteochondroses – disorders of the growth centers of the bone.

Traction/ pulling mechanism of injury:
The traction osteochondroses occur at those sites where the major tendons attach to the immature skeleton and overuse, poor biomechanical alignment and other features cause inflammation, partial avulsion of the secondary center of ossification, healing and subsequent bone growth.

Osgood-Schlatters : Patella tendon to Tibial Tubercle ( front of shin)

Sinding-Larsen-Johannson: Quads to inferior pole of patella (kneecap)

Severs: Achilles tendon to calcaneus (heel)

Crushing mechanism of injury:
Areas of greater weight-bearing where the mechanism of injury is sustained crushing.

Perthes disease- femoral head (hip)

Kienbocks disease –lunate bone (wrist)

Friebergs disease-second metatarsal head (foot)

Kohlers disease-navicular bone (mid foot)

Splitting mechanism of injury:
Biomechanical forces include more rotation for splitting injury

Ostechondritis dessicans- medial knee, capitellum (elbow), Talar dome (foot)

The problems are usually self limiting but general principles of treatment include:
activity modification
biomechanical assessment: addressing postural/muscle imbalance/tight tissues.
local treatment
progressive exercises.

Stress fractures

These are caused by a number of factors: sudden increase of intensity in training, poor technique, altered biomechanics (shoes worn out and unsupportive). They usually affect lumber spine or lower limbs and feet.

Pars interarticularis- vertebrae/ lumber spine

These usually occur in activities involving hyper-extension (bending back)
and rotation e.g. cricket, gymnastics, horse- riding (saddling up/mucking out).

Fracture on one side is called Spondylolysis; fracture on both sides can cause
a forward slip of one vertebrae on another and is called Spondylolythesis.

Tibial stress fracture – (Shin) Often caused by running activities on hard ground/Astroturf.

Femoral neck-hip

Navicular bone-mid-foot

Injuries

Avulsion fractures

In children the ligaments are proportionally stronger than the bone to which they attach (not so in adults) and fast strenuous contraction of a major muscle can result in the ligament boney attachment becoming avulsed, or detached, from the rest of the bone. These injuries are usually seen in sports with sudden violent muscular contraction such as football, sprinting and jumping.

The most common sites for this to occur are:

Sartorius muscle to the anterior superior iliac spine ( anterior pelvis)

Rectus femoris (hip flexor) muscle to the anterior inferior iliac spine (anterior pelvis)

Ilio-psoas muscle (hip flexor) to the lesser trochanter (hip joint).

Patella tendon to the tibial tuberosity

Abdominal muscles to iliac crest

Hamstring muscles to ischial tuberosity

Overuse injuries

The most common types of overuse injury seen in children are the Osteochondroses – disorders of the growth centers of the bone.

Traction/ pulling mechanism of injury:
The traction osteochondroses occur at those sites where the major tendons attach to the immature skeleton and overuse, poor biomechanical alignment and other features cause inflammation, partial avulsion of the secondary center of ossification, healing and subsequent bone growth.

Osgood-Schlatters : Patella tendon to Tibial Tubercle ( front of shin)

Sinding-Larsen-Johannson: Quads to inferior pole of patella (kneecap)

Severs: Achilles tendon to calcaneus (heel)

Crushing mechanism of injury:
Areas of greater weight-bearing where the mechanism of injury is sustained crushing.

Perthes disease- femoral head (hip)

Kienbocks disease –lunate bone (wrist)

Friebergs disease-second metatarsal head (foot)

Kohlers disease-navicular bone (mid foot)

Splitting mechanism of injury:
Biomechanical forces include more rotation for splitting injury

Ostechondritis dessicans- medial knee, capitellum (elbow), Talar dome (foot)

The problems are usually self limiting but general principles of treatment include:
activity modification
biomechanical assessment: addressing postural/muscle imbalance/tight tissues.
local treatment
progressive exercises.

Stress fractures

These are caused by a number of factors: sudden increase of intensity in training, poor technique, altered biomechanics (shoes worn out and unsupportive). They usually affect lumber spine or lower limbs and feet.

Pars interarticularis- vertebrae/ lumber spine

These usually occur in activities involving hyper-extension (bending back)
and rotation e.g. cricket, gymnastics, horse- riding (saddling up/mucking out).

Fracture on one side is called Spondylolysis; fracture on both sides can cause
a forward slip of one vertebrae on another and is called Spondylolythesis.

Tibial stress fracture – (Shin) Often caused by running activities on hard ground/Astroturf.

Femoral neck-hip

Navicular bone-mid-foot

Postural muscle imbalance

Postural muscle imbalance produces pain and muscle spasms but often doesn’t show up in X-rays or scans. Poor postural control in adolescence can cause pain and joint strain.

Example 1: Rapid growth spurts

Rapid growth spurts lead to tight hamstrings as bone grows faster than muscle.
Tight hamstrings lead to a stiff lumber spine — as hamstrings attach to Ischial tuberosity (sitting bone), which restricts pelvic movement.
A stiff lumber spine and restricted pelvic movement cause movement issues and pain.

If you can’t sit up straight with legs out straight in front of you, your hamstrings are too tight.

Example 2: Poor thoracic posture

Poor thoracic posture can cause issues such as rounded shoulders, which limits the range of shoulder movement. This is because of the altered position of the shoulder blade, which houses the socket for the ball and socket joint of the shoulder.
Having a limited range of shoulder movement can cause the impingement of sub-acromial structures such as irritation and inflammation of the tendons.
Irritated or inflamed tendons can be painful, can limit your movement range further, and can cause weakness.

Our Adolescent Services practitioners

Nevzat Yuksel

MSK (FCP) Physiotherapist - BSc (Hons). MCSP.

Musculoskeletal
Rehabilitation post-op/injury
Biomechanical Assessments
Sports injuries
Functional rehabilitation

Paula Stephen

MSK (FCP) (Paediatric) Physiotherapist - BSc (Hons). MCSP.

Paediatric Orthopaedics
Paediatric Neurology

To book or for more information please call Paula on 07870 294677 or go to physio4children.com

Jo Hartshorn

Director/Owner - MSc. MMACP. MCSP. Grad Dip Sp Inj.
MSK (FCP) Physiotherapist

Musculoskeletal
Rehabilitation post-op/injury
Headaches and migraines
TMJ and face pain
Adolescent problems

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