Physical activity and sport are fundamental for child development. Unfortunately, engaging in sports is also the number one cause of injury in children. Research has shown that the majority of sports injuries in youth are in the 10-14 year-old age group, and males are more often at a higher risk. Soccer and hockey are the most popular sports across Canada, which may explain why they have consistently been shown to have the most injuries. It is estimated that 30% of school aged children will suffer a sports related injury each year, which will lead to a loss of time in sport, school and the unfortunate cost of treating the injury. As such, research efforts have focused on prevention programs targeted towards young athletes.
Why do Children get Injured?
They are not fully developed and generally have muscle imbalances;
Growing bodies are more vulnerable to stresses;
Younger children are less coordinated and have slower reaction times;
Many children do not have the complex motor skills required for certain sports;
Children develop at different rates and there may be a drastic size difference in athletes playing at the same level;
Higher demand for specialization in one sport early on.
Play multiple sports in order to develop a broad range of fundamental motor skills;
Proper technique: a little league pitcher consistently pitching with poor technique will eventually lead to injury. Ensure that coaches and trainers are properly trained and teaching children proper form and technique;
Proper equipment: Protective equipment and sporting gear needs to fit properly to do its job;
Exercise Based Injury Prevention Programs: Current research on injury prevention in young athletes has focused on exercise based programs. The majority of injuries in sport occurs during cutting, landing, and quick changes in direction. Therefore, plyometric and proprioceptive exercises are the most beneficial in preventing injuries, since they train the body to perform these movements with perfect form. A systematic review of exercise-based injury prevention programs showed the following findings:
Girls benefited significantly more that boys;
Lower skilled athletes benefited significantly more than higher trained athletes;
They are beneficial if completed pre-season or in-season;
Resulted in an injury reduction of 46% across sports.
Take Home Message:
The most beneficial injury prevention strategy is exercise-based programs focusing on proprioception and plyometric drills. These exercise programs should be implemented across all youth sports in order to improve overall fitness, performance and prevention of injury.
Fridman et al., (2013). Epidemiology of sports related injuries in children and youth presenting to Canadian emergency departments from 2007-2010. BMC Sports Science, Medicine, and Rehabilitation.
Rossler et al., (2014). Exercise-Based Iinjury Prevention in Child and Adolescent Sport: A systematic review and meta-analysis. Sports Medicine. 1733-1748.
Kinesio tape, that colourful elastic athletic tape, has been used for over a decade in the treatment of musculoskeletal injuries. It probably became most popular after the 2008 Olympics, where it was donated to team therapists, which resulted in almost every athlete using it. The majority of the people who have used this tape LOVE it! However, the research on the effectiveness of the tape isn’t so wonderful. There have been hundreds of research studies done on kinesio tape, so we’ll examine some of the more recent systematic reviews that outline what exactly the tape has been proven to achieve.
How the tape works
Kinesio tape is different from regular white athletic tape because it is flexible and allows for full range of motion, (and it looks a lot cooler). Below are the main functions of kinesio tape:
Improve range of motion;
Correct joint alignment;
Improve swelling and lymphatic drainage;
Facilitate or inhibit muscles
In order to achieve any of the desired effects above, the tape MUST be properly applied, including the direction of pull of the tape and the amount of tension applied.
What does the research say?
Overall, most studies show that kinesio taping for pain reduction, function and proprioception is better than no treatment, yet it is no better or worse than other traditional treatment options (Choon Wyn Lim et al., 2015)
Good support for reduction of pain in individuals with musculoskeletal injuries, (Montalvo et al., 2014)
Some support that it may improve painfree range of motion (Taylor et al., 2014).
Some support that it may help correct alignment i.e., patellar tracking (Barton et al., 2013).
Inconclusive support for improved swelling and lymphatic drainage (Kalron et al., 2013).
No support for the facilitation of muscle strength. A review of 19 studies that examined if kinesio tape increases muscle strength or facilitates muscle contraction showed no difference compared to a control group (Csapo et al., 2015).
A lot of the research discusses a potential placebo effect to help explain the benefits of kinesio tape
Take home message:
Kinesio tape is inexpensive, noninvasive, and has little to no side effects (there is a potential for skin irritation). Therefore, it is a safe and effective treatment option for pain relief, improvement in range of motion and correction of joint alignment. Future research may show beneficial effects on swelling, lymphatic drainage and facilitation of muscles.
Choon Wyn Lim et al. (2015). Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: Is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. British Journal of Sports Medicine.
Montalvo, E. Cara and G. Myer. Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: Systematic Review and Meta-analysis. Physician and Sports Medicine. 2014. Vol 42. Issue 2. P. 48-52.
Taylor et al. (2014). A Scoping Review of the use of Elastic Therapeutic Tape for Neck and Upper Extremity Conditions. Journal of Hand Therapy.
Barton, et al. (2014). Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms. British Journal of Sports Medicine, 48(6), 417-424.
Kalron and S. Bar-Sela. A Systematic Review of the Effectiveness of Kinesio Taping-Fact or Fasion? European Journal of Physical and Rehabilitation Medicine. 2013. Vol. 49. Issue 5. P. 699-709.
Csapo et al. (2015). Effects of Kinesio taping on skeletal muscle strength – a meta-analysis of current evidence. Journal of Science and Medicine in Sport, 18(4), 450-456.
Whether you’re a veteran marathon runner or newbie at jogging, we’ve all experienced the daunting task of trying to find the perfect running shoe. The criteria are usually pretty standard: comfort, affordability and look. This seems pretty basic until you approach the running shoe display and have dozens of shoes staring back at you. In this blog we’re going to discuss some of the recent research on running shoe design and injury prevention.
What are the different types of shoes?
These are running shoes that mimic a barefoot running style. They are flexible, lightweight and have a low heel to toe drop. A low heel–toe drop simply means that there is less “shoe” between your heel and the ground (see picture below, the shoe on the left has a low heel-toe drop vs the shoe on the right). It has been shown that a low heel-toe drop encourages a mid-forefoot strike pattern, as opposed to a big chunky heel that encourages heel striking.Some common brands include Vibram Fivefingers, New Balance Minimus and Nike Free.
These are meant for the average foot that doesn’t over-pronate or supinate. They are cushioned and have support, but have very little correction for any biomechanical issues.
These are meant for people who have low arches and mildly pronate during walking. There is medial and lateral support built into the shoe to help control the amount of pronation.
These are meant for people who have really flat feet and severely over-pronate. They provide a lot of biomechanical support to prevent the foot from falling in. You would not wear an orthotic with this type of shoe since it already is meant to correct foot alignment.
For years running shoe selection has been based on your foot shape and arches. For example, if you had flat feet and over-pronated, you would be given a motion-control shoe. Unfortunately, there is little to no research to support this method of shoe selection (Knapik et al., 2014). Furthermore, research has shown that motion-control and stability shoes don’t always control foot pronation or lower leg biomechanics, nor do they prevent injuries or lead to increased comfort.
So why do salespeople and Runners World magazine still advocate their running shoe selection based on your arch type and biomechanics? Perhaps because running shoes are a billion dollar industry and they don’t want you to know about the conflicting research.
If running shoes aren’t doing what they’re meant to do, is barefoot the way to go?
With the increased popularity in barefoot and minimalist running, a plethora of research has emerged around the topic. So what does the research show in terms of traditional running shoes vs barefoot/minimalist shoes? Research has shown that traditional running shoes will change your natural biomechanics, causing heel striking, pronation, and improper knee alignment. As a result, they also lead to a decreased cadence and increased vertical loading; all of which have been shown to lead to injuries. On the other hand, running barefoot, or in minimal shoes, has been linked to mid- and forefoot striking, lighter strides, and proper alignment of the lower body, which has in turn resulted in a higher cadence and decreased ground reaction force. Although no long-term studies have been completed to date, the current research suggests that barefoot/minimalist running MAY actually prevent running related injuries.
Based on the promising research around barefoot/minimalist running, should you throw away the motion control shoes that you’ve worn for the past 20 years and buy a pair of minimalist shoes, and try to run your regular 10 km loop? NO!!! You will get injured and jump on the Vibram class-action lawsuit requesting your money back. Transferring to a barefoot or minimal running shoe has been linked to an increase in injury, IF the transition is done too quickly. The rule of thumb for transitioning to a minimal shoe is one extra minute per day starting with one minute. It’s a very slow progression and you must listen to your body. If your Achilles or the bottom of your foot starts to hurt, you’re transitioning too fast. Barefoot/minimalist running isn’t for everyone, and people with certain health conditions (i.e., diabetes with decreased sensation in the foot), foot deformities or current injuries should not be transitioning to a minimal shoe.
If you want to learn more about running shoe selection, I strongly recommend that you check out Blaise Dubois’s website. A couple years ago I had the pleasure of taking a course with Blaise, a physiotherapist and international leader in the prevention and treatment of running injuries. A lot of the research in this blog is based on his work around running shoe design and injury prevention. Through research he has developed a number of great tools for runners to help guide and educate them on proper shoe selection. Check out his site therunningclinic.com for more great information.
If you want to learn more about the prevention and treatment of running injures, chat with one of the therapists at Sheddon.
Knapik et al. Injury-reduction effectiveness of prescribing running shoes on the basis of foot arch height: summary of military investigations. Journal of Orthopaedic Sports Physical Therapy. 2014; 44:805–12.
Injuries to the Achilles tendon is one of the most common injuries experienced among athletes, especially runners and soccer players. Statistics show that roughly 24% of athletes develop pain in the Achilles. It’s also an injury that can linger for long periods of time, if left untreated. One recent study found that 63% of soccer players with Achilles tendinopathy still had symptoms 2 years after onset. With the high prevalence of injury to the Achilles tendon and potential for long-term recovery, prevention is key. Below we will discuss its common causes, symptoms, treatment and most importantly, prevention.
What is the Achilles Tendon?
The Achilles tendon connects the calf muscles (the gastrocnemius and soleus) to the heel bone. It is one of the strongest tendons in the body, but it is also highly vulnerable to injury, given the high amounts of tension put on it. Injury to the tendon can include a strain, partial tear, or full rupture.
Some common factors that can cause an injury to the Achilles tendon are:
Repetitive overuse, especially in sports that require running and or jumping;
An injury to the Achilles can be acute i.e., due to a kick to the back of the leg, or chronic as a result of repetitive irritation over time. It usually has a gradual onset starting with stiffness after activity; although, as the injury progresses, the stiffness becomes painful either during or after activity. It will become tender to touch with possible redness and swelling around the tendon. You may also notice thickening of the tendon or a nodule around the painful area. It will usually hurt when you go up onto your toes or stretch the muscles. As the injury worsens, daily activities such as walking and climbing stairs will also be limited and painful.
What does treatment entail?
Initially one of the main focuses of treatment is decreasing the pain, which can be achieved through manual therapy, taping and heel lifts. The other focus is promoting healing with modalities such as laser, which has excellent research support that it speeds up recovery time. Exercise is also one of the best ways to promote tissue repair. Research has shown that eccentric calf muscle training can decrease pain, as well as improve function and a quick return to sport following an Achilles injury. Finally, in order to get rid of the injury and prevent it from re-occurring, the cause of the injury must be addressed. Training errors, poor biomechanics and equipment issues such as footwear may need to be changed.
What can you do right now to prevent an Achilles injury?
Examine what you’re putting on your feet. Are your shoes/cleats too tight, too loose or held together by a thread? Shoes that don’t fit well or support your feet can alter your biomechanics, which puts more stress on the Achilles.
Look at yourself in the mirror barefoot. Are your feet flat on the ground, do you look bowlegged, do you have super-high arches? If you can’t tell what you’re looking for, have your biomechanics checked out by a Sheddon therapist. Abnormal biomechanics and deformities in the foot (even something that seems minor), can put the foot at an angle that creates extra stress on the Achilles tendon. Therapists at Sheddon Physio are trained in gait assessment and will watch what your feet and lower leg are doing while you stand, walk and run. Findings may indicate specific exercises and manual therapy to correct the abnormalities.
Are your calves super tight and/or weak? Muscle imbalances in the lower body can put strain on the Achilles, leading to a higher chance of injury. An exercise program that specifically addresses your imbalances may help prevent future injuries.
Do you rush to your game and run onto the field without properly warming up? An improper or lack of warm-up is one of the easiest ways to injure the Achilles. Take 5-10 minutes before games to warm up properly. Check out the FIFA11 warm-up program here.
Have you recently increased your intensity, frequency, distance or speed in training? Too rapid an increase in any of the above without adequate rest days could put extra strain on the body and lead to overuse injuries in the Achilles. Working with a coach, trainer or therapist could help prevent over-training.
Have you started doing more training that involves stairs, hills and/or jumping? All of the above activities put an extra load on the Achilles tendon and should be introduced into a training program with adequate rest and proper scheduling.
So, you now know how to keep your Achilles healthy and injury free, but what about the rest of your body? During this time of year, soccer players usually aren’t training as much, so take advantage of the extra time you have now to address any nagging injuries. Research has shown that injuries to muscles and tendons roughly take 6-10 weeks for full recovery, if treated at the initial onset of symptoms. However, if you do what most people do and wait until the symptoms get really bad (in hopes that it will go away on its own), recovery could take 3-6 months. Getting your injuries fixed now may ensure that you’re healthy and pain-free for outdoor season.
Are you injury-free but out of shape? Aside from their technical skills, soccer players require speed, agility, endurance and strength. Spending the winter months hibernating indoors on the couch could set you up for injury by the time warm weather and the outdoor season come around. Research has shown that preseason conditioning significantly decreases overall soccer injuries. Preseason conditioning should focus on any muscle imbalances and weaknesses, as well as general and functional strengthening, speed, agility, interval training, and plyometrics. Not sure where to start? Talk to one of the therapists at Sheddon Physio and they can get you started on a program.
SHEDDON IS OPEN
Read here about latest updates regarding COVID-19 protocol.