Part 1: LESSONS LEARNED FROM WORLD CONGRESS OF SPORTS PHYSICAL THERAPISTS 2022

This year the World Congress of Sports Physical Therapists was held in Nyborg in Denmark. With a fantastic lineup of speakers from around the world, the days were packed with great learning opportunities and nuggets to improve treatment outcomes.

This blog covers the 1st Symposium:

The adolescent athlete

Early Sports specialization and injury risk – DR. AMANDA JOHNSON (UK)
Overuse knee injuries in adolescents – DR. MICHAEL RATHLEFF (DK)
ACL re-injuries in adolescents – DR. MARK PATERNO (US)
The hyperflexible young athlete – DR. SUSAN MAYES (AUS)

Early Sports specialization and injury risk – DR. AMANDA JOHNSON (UK)

Early sports specialisation involves participating in a single sport, with a deliberate focus on training and development in one sport only for greater than 8 months per-year at the exclusion of other sports. Definitions and the age at which this is defined varies across the research from 12-15.

In sports where a low body mass may assist in some of the rotational based movements such as gymnastics, rhythmic gymnastics, figure skating, and diving there may be benefits from early sport specialisation but this may be at the risk of burnout.

The evidence is mixed around whether a single sport specialisation increases injury risk but there is a relationship between exceeding recommended training load and injury. Training load may be guided by the age of the child e.g. 10 years olds may participate in 10 hours of structured training per week. However, the maturation stage of each child is different from their chronological age (DOB), and the skeletal maturity differences within one age group may be as great as a 5-6 year span.

Despite restrictions being implemented in sports to protect against overuse such as limiting throwing volume in baseball, bowling in cricket, and reducing pitch size and ball size in soccer, there has been little change to injury rates, potentially due to only 80% of coaches and parents being unaware of these restrictions.

Biobanding based on biological age has been introduced and successfully used in both training and competition in soccer to ensure children who may be later developers are not subjected to training loads prescribed for kids who are biologically more mature.

Recommendations:

1. Mix in another activity session a week to develop more diverse movement skills e.g. combat sports in soccer to teach them how to fall
2. Do not exceed training hours per week > than chronological age e.g. 8 hours for an 8-year-old
3. Maintain a ratio of no greater than 2:1 structured to unstructured sport per week
4. No single sport for greater than 8 months a year
5. Delay sports specialisation until after puberty – 15-16 years of age for greater sporting success
6. Introduce biobanding in addition to chronological age banding
7. Screen athletes for training load, growth and maturation, fitness and wellness

 

Overuse Knee Injuries in Adolescents – Michael Rathleff (Denmark) and Ben Smith (UK)

Communication is key – Empower, explain and understand what they understand and what is important to them

Understand the socio-cognitive process to allow them to develop competencies

Patient education is essential to enable rehabilitation and self-management of longstanding knee pain in adolescents.

Recommendations:

1. Include the athlete & parent

2. 

   Functional theories of pain govern behaviours – we need to listen

3. Reassure and validate what they are experiencing
4. Seek to understand what they believe and need – poke the bear
5. Give them credible explanations based on credible examination to set them up to learn and take in new information
6. Give their symptoms a name they can use with vocab they can repeat
7. Design activities that allow them to take ownership of their learning through experiential learning
8. Give them actionable advice
9. Address beliefs and fears
10. Give them appropriate tools and give them confidence & competence that they can self-manage and a feeling of control
11. Use an activity ladder to return them back to play
12. Activity may be painful up to a level of no > 2/10 VAS

 

ACL reinjuries in adolescents – Mark Paterno (USA)

Athletes with a prior ACL injury are at risk of future ACL injury in either limb. Adolescents as high as 33% reinjury level, especially in females and those who return to a higher level of sport, with low BMI.

The percentage of patients who achieve recognised return to sport criteria is as low as 26% when the threshold is 90% limb symmetry indices and 9% when this is raised to 95%. However, failure to meet one criterion did not predict a 2^nd re-injury rate and those who met the criteria in one study were at greater risk of a 2^nd injury than those who did not meet the criteria.

Lack of confidence has been reported as a risk factor for a 2^nd ACL injury. However, in a study of young athletes (mean age 17.2 ± 2.6 years old at the time of RTS post-ACLR), those who reported higher self-reported confidence scores had 5 x higher limb symmetry scores at RTS versus those Lacking Confidence. What was surprising was the group who displayed greater self-confidence and met the RTS criteria had a 10 x higher risk of 2^nd injury potentially due to returning at a greater intensity than those who lacked confidence.

 

The hyperflexible young athlete – PROF. SUSAN MAYES (AUS) and DR. BEHNAM LIAGHAT (DK)

Generalised joint hypermobility – GJH – collagen phenotype that impacts the whole body – can be asymptomatic or symptomatic with multiple presentations.

Diagnosis:

1. Beighton’s score: Different thresholds for males (4/9) and females (5/9) needed and adolescents (6 or 7 out of 9) and in dance population where all can out hands to the floor and 95% prevalence
2. Beighton score alone is not comprehensive enough as excludes shoulders, hips and ankles, and cervical spine, therefore add the Upper & Lower Limb Assessment Score
3. Potential to add: 5-part questionnaire (5PQ)
4. Check skin extensibility – can you lift the skin on the back of the hand over 3^rd MC > 2cm = hyperextensibility

Injury:

The relation between GJH and injury is still not clear especially in elite athletes although in non-elite > risk of shoulder injuries. GJH does not increase the risk of cartilage injury in the hip over 5 years.

Dancers have larger hip musculature but Iliopsoas is smaller in those with hip pain (sartorius, TFL, and rec fem did not differ). Overall muscle strength and endurance are higher in GJH and have a higher capacity to generate force than in non-GJH.

Management:

1. Progressive, supervised high load strength training is effective in shoulder instability and may have crossover in to GJH but dancers may fear bulking up, losing mobility and previous beliefs. Avoid pain provoking movements. Once easy – change the load and keep reps low
2. Strengthen don’t stretch – in the Australian ballet increased ROM DF in the ankle following planter flexion heel raises with bias for inversion and eversion. Don’t talk about increasing tendon stiffness in ballet dancers – they fear losing range with word “stiff”.
3. Educate and reassure
4. Balance training
5. Add step running programme for strength and cardio

Anxiety has been observed in 52.3 % of dancers – there is a link to those with GJH having a greater incidence of anxiety – reassure, reduce fears. Important to screen for anxiety.

 

 

References on request – email info@angelajacksonphysio.com

If you would like to learn about how to implement return to sport protocols and develop confidence in knowing when an athlete is ready to return to sport, then email me for more details on my practical day course From Assessment to Return to Play in the Junior Athlete or learn online with Active Kids Are Not Mini Adults