More Than Grazed Knees: Why Injuries in Children and Teens Need to be Treated Differently
While most of the people we see at WLP are adults, proper treatment and rehabilitation of an injury is just as important in children and adolescents, as they’re still learning how to use their body. Any stiffness or malalignment left over from an injury could have severe knock on effects, such as reducing their enjoyment of physical activity or the development of faulty movement patterns. At the extreme end, a mistreated injury could even affect how they grow.
Here are a few of the reasons why children and adolescents can’t be treated the same way we treat adults.
Young Bones are Delicate
It’s rare for children to get ligament or tendon injuries, but they’re much more likely to get bony injuries. This is because their still-growing bones lack the density of adult bone, a weakness that continues or can increase in adolescence, as their sudden growth spurts spreads bone matter over a larger area, making bones thinner and more susceptible to breakage.
If I was to twist my ankle running this weekend, the cause of the injury would almost certainly be a torn or sprained ligament between my ankle bones because the ligament is less capable of handling the excess force than my bone. But in children and adolescents, the reverse could be true, resulting in the ligament pulling off a piece of bone.
This is known as an avulsion fracture, and while the amount of pull-off from the bone is usually quite minor, the diagnosis of twisted ankles or similar injuries should include an x-ray in children and adolescents to rule out bone damage. The treatment itself isn’t all that different: tape up the area, put compression on, gradually reintroduce movement and work on the strength and balance of the joint – though the younger the patient, the more fun we have to try and make the treatment.
Adolescent Girls Are More Susceptible to Knee Injuries
It’s normal for both boys and girls to go through rapid growth spurts in their teens, creating periods of reduced bone density and wonky coordination. For boys, this coincides with an increase of testosterone which promotes muscle growth. This muscle growth and strength therefore counteracts the above.
However, girls do not get an increase in testosterone and as a result they have less muscle to support the increased force going through their joints. This is why adolescent females are more susceptible to ACL and MCL tears, damage to knee cartilage and are the segment of the population most likely to experience anterior knee pain or patellofemoral pain syndrome.
The problem is, this is also the age where girls are likely to first become seriously engaged with team sports such as football, basketball, lacrosse and hockey, which all involve the sort of twisty-turny movements that can put dangerous pressure through their knees.
Studies have shown injury prevention programmes that teach safe jumping and landing techniques massively reduces knee injury risk in adolescent girls, so it’s essential that such programmes are incorporated into the training and coaching of female sports teams that are of this vulnerable age. In addition, as with everyone else, exercises that improve the strength of leg muscles and correct the inward drift of the knee joint (common in females of all ages) will further reduce risk of injury.
If you’re a parent of a teenage girl and they report knee pain, you must significantly reduce their activity until the pain has resolved, and if it recurs, they should see a specialist. This can be difficult, as they may be under great pressure to keep up with their team, but their health always comes first.
If Your Boy Has Back Pain, Take it Seriously
Back pain may be the quintessential malady of middle-age, but it can arise much earlier for boys that experience a sudden growth spurt. Again, the decrease in bone density and muscle strength relative to their size is to blame, but in adolescent boys, their reduced bone density also puts them at significantly increased risk of stress fracture of the vertebrae, known as a pars defect or spondylolysis.
Pars defects account for 50% of lower back pain in young athletic populations, so any sign of such pain should be taken seriously with immediate medical attention. If it’s not picked up early, a pars defect can require six months or more of rehabilitation and definitely no sport, which is always distressing for a budding athlete.
We Treat Children and Adolescents Too
All kids are going to have a few scrapes and bruises, but if there’s any reason to suspect more serious damage, don’t hesitate to bring them to see us so that we can get them back to enjoying their youth.
David Wynne BSc (Physio) MSc (Sports and Exercise Medicine) MCSP MHCP
Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy
For any other questions regarding this topic please do not hesitate to contact West London Physio on 0207 937 1628 or email David at david.wynne@westlondonphysio.
