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growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

What are teenagers Growing Pains?

Growing Pains

Osgood Schlatters (OS), Larsen-Johansson (LJ) and Severs disease are common adolescent conditions that affect young rapidly growing athletes. These injuries occur where the muscle tendons attach to the bone. During a growth spurt the bones, muscles and tendons are all growing at different rates. If the muscles are tight they put extra stress on the bone resulting in inflammation and pain. In the case of OS and LJ the pain is felt at the knee, where Severs affects the heel. Many athletes are specializing in sport earlier and are engaging in year round training, how can you make sure your young athletes can continue to train during this stage of development without suffering from growing pains?

Injury Prevention Strategies

Risk Factor #1

The bones are growing faster than the muscles can adapt in terms of flexibility. Which puts a lot of stress on the muscle-tendon junctions, bone-tendon junctions, ligaments and growth cartilage.

Prevention strategy: Implement a regular stretching program focusing on the hamstrings, quadriceps, and calves, which have all been shown to be excessively tight during the adolescent growth spurt. Stretching should take place when the body is warm, i.e., at the end of your workout. Stretches need to be held for at least 30 seconds to be effective x 3 sets.

Hamstrings: Raise one foot onto a bench, lean forward bending from the hips and keeping your back straight. You should feel a stretch at the back of your leg.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

Quadriceps: Stand on one leg (holding onto to something for support if needed). Bend your opposite knee and bring your heel towards your buttock as you hold your foot with your hand. You should feel a stretch in the front of the leg.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

Calves:

1. Gastrocs: Stand in front of a wall/bench and bring one leg back ensuring your toes are facing forward. Keep your heels on the ground and lean forward keeping the back leg straight. You should feel a stretch in the back leg.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

2. Soleus: From the same position as above bring your back foot forward. Make sure both heels stay on the ground and bend through your knees. You should feel a stretch in the back leg.growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

 

Risk Factor #2

“Adolescent Awkardness:” the athlete is growing at different rates and there is now an imbalance in strength and coordination.

Prevention strategy: Exercises focusing on glute strengthening, core stability and neuromuscular control. Stability and strength of the pelvis and spine help with proper mechanics and loading of the lower extremity in running, kicking, and changing directions. Perform the exercises below 2x/week for 10 repetitions and 3 sets.

GLUTE STRENGTHENING:
Start position for exercises below. Start in an athletic stance, both knees/hips slightly bent with your chest and head up. A band is wrapped around your knees or ankles. Your knees should be in line with your 2nd toe. Make sure your knees are not caving in (see bad/good form below).

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

1. Mini walks with a band: Start in an athletic stance. From this position take a step outwards and then feet back together again. Repeat 5-8 steps in one direction and then back in the other direction.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

Single leg balance (with or without a band): Start in an athletic stance with a band around your knees for added difficulty. Keep one leg bent and raise the other leg out in a 45 degree angle. Hold for 5 seconds and return to start position and repeat on the other side.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

CORE STRENGTH:
Plank (with/without a ball pass): Start in a plank position from your elbows or hands, making sure your back stays flat and core stays tight. Hold for 30 seconds. For added difficulty hold the position while rolling the ball to a partner or wall.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

Side plank: Place one hand on the ground, extend your legs out so you are in one straight line. The only thing touching the ground is your hand and the outside of one foot. Make sure your hips don’t sag towards the ground. Lift the top leg up for added difficulty. Hold for 20-30 sec and switch to the other side.

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

POSTURAL CONTROL:

Y balance exercise: You can use tape to draw a Y on the floor (or imagine a Y on the floor) while you are doing this exercise. Stand on 1 leg with the support knee slightly bent, while reaching out in three different directions with the opposite leg. Position 1 is in front, position 2 is out to the side and back, and position 3 is back and across to the opposite side. Perform each position once and repeat the cycle for 3-5 sets. Ensure your form is good, and your stance knee is staying in line with your 2nd toe (not caving in).

growing pain for teenagers Sheddon Physio Sports Clinic Oakville Mississauga

 

Risk Factor #3

Congested training schedule with very little rest

Prevention strategy: Modify your exercises and training if you are suffering from an injury. I.e., Single leg landing, jumping and sharp cutting drills puts a lot of stress on the knee and heel and will aggravate these injuries. Modify or eliminate these exercises as needed.

If you are the parent, coach, or trainer of a young growing athlete be proactive and chat with one of the therapists at Sheddon on injury prevention strategies.

For more info, contact Sheddon Physiotherapy and Sports Clinic at 905-849-4576.

We are located only 6 min East of Oakville Place and 4 min from Oakville & Milton Humane Society

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SLEEP: The Key to a Quick Recovery

Do you want to boost your athletic performance? Reduce your risk for injury? Improve your reaction time, accuracy and speed? The secret is easier than you think, and doesn’t cost a single cent. Yet, most young athletes often neglect this essential component of their training: SLEEP! Sleep is a vital component of the recovery process following intense training and competition. It provides both psychological and physiologically benefits. However, sleep deprivation is very common in young athletes due to extensive training schedules, anxiety, lack of awareness of the importance of sleep and poor sleep hygiene. Why is catching enough z’s so important and what can you do to ensure a better quality sleep?

Most athletes are well aware of the benefits of proper nutrition, skill training and conditioning to improve athletic performance. So what exactly happens while you’re sleeping that is so important? The body regenerates and repairs cells, and allows restoration of several systems such as the immune, nervous and endocrine system. It also releases hormones that help with recovery. Certain hormones such as growth hormone and androgens are only released during the deep sleep cycle and they are vital for muscle repair, muscle building and bone growth. Therefore, the quality of sleep you’re getting is just as important as the quantity.

Sleep deprivation can lead to a number of detrimental effects on your athletic performance (decreased reaction time, speed and strength), cognitive function (poor attention, concentration and motivation) and risk for injury (compromised immune function, impaired muscle damage repair). Studies have shown, even a single night of sleep deprivation can impair your cognitive and motor performance equivalent to alcohol intoxication.

Current guidelines recommend that 7-9 hours of sleep is essential for psychological (ability to learn, motivation, and memory) and physiological recovery (metabolism and inflammation). Moreover, athletes require an even greater quantity of sleep to recover from injury and intense training. If you’ve struggled with getting enough sleep, read the strategies below for some tips on how you can change your sleep habits:

  • Avoid stimulating activities prior to sleep and limit electronic device use at least 1 hour prior to bedtime;
  • The optimal sleeping environment should be cool, comfortable, noise-free and dark (to achieve these conditions you may need to use a fan, eye mask, ear plugs, light blocking blinds, white noise machine or app);
  • Keep daytime napping to a maximum of 30 minutes;
  • Limit exposure to bright lights in the late evening, as they can have an alerting effect and decrease the release of melatonin. (i.e., dim the lights, and limit LED screen use several hours before bed);
  • Avoid caffeine and alcohol in the evening;
  • Stick with a consistent time for going to sleep and waking up.

Marshall et al., (2016). The importance of Sleep for Athletic Performance. Strength and Conditioning Journal. 38,1,61-68.

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Predicting the Stormy Weather Through our Pain

We probably all know at least one person who is considered to be a human barometer as they can predict upcoming weather changes due to headaches or achy joints. How and why is pain/stiffness weather sensitive? Is it actually backed by scientific findings, or is it purely psychological?

Unfortunately, the majority of studies have found no significant relationship between different weather conditions and pain. Furthermore, findings were strictly subjective pain ratings without objective medical findings. Does this mean it is purely psychological? It is highly unlikely that so many people are wrong. As you can imagine, it is hard to control for weather in a study, as so many weather variables would have to be taken into consideration, that it makes it very difficult to find relationships between any one specific variable. For example, at least 50% of headache sufferers believe that weather changes trigger their migraines/headaches. However, wind speed, temperature, humidity, barometric pressure and sunlight have all been reported as triggers. In addition, some individuals have headaches triggered by falling barometric pressure, while others report headaches with rising barometric pressure. These individual differences make it hard to see specific correlations with any one weather variable.

Overall, the studies that showed specific relationships between pain and weather generally found that cold and damp weather conditions influenced reports of pain in subjects with arthritis, headache, fibromyalgia, gout, low back pain and chronic pain.

Interestingly, one study that took place over a two-year period, examining the effects of weather on active individuals with osteoarthritis, found no relationship between weather and joint pain or stiffness. The authors concluded that exercising regularly, may have diminished the effects of weather on pain (Wilder et al., 2003).

How does weather affect symptoms?

Some studies have tried to explain the physiological effects that weather has on the body, but there haven’t been any conclusive results.

  • Some studies have shown that low vitamin D (less sunshine and less light) may play a role in increasing arthritis symptoms;
  • Some researchers suggest that mood may play a role. Damp and cold conditons are associated with a more negative mood, which in turn has been associated with higher pain levels. One study found that individuals reported the least number of symptoms on warm sunny days, due to more exercise, better sleep and a more positive mood;
  • Colder temperatures may increase joint stiffness and pain, due to an increase in viscosity of synovial fluid;
  • A decrease in barometric pressure will allow tissue to expand, therefore putting more strain on joints;
  • Increased humidity can cause increased joint swelling/stiffness.

Take home message:

There’s not much you can do to change the weather, studies have looked at different climates around the world, and they have yet to find the ideal location. As such, you need to focus on what you can control to help keep your headaches and achy joints happy.

  • Regular exercise may help prevent flare-ups of pain during poor weather conditions;
  • Add layers over your achy joints in order to keep them warm during cold and damp days;
  • Try to remain positive even if the weather is gloomy.

 

Aikman (1997). The association between arthritis and the weather. International Journal of biometeorology.

Wilder et al., (2003). Osteoarthritis pain and weather. Rheumatology. 955-95

How to Keep your Hamstrings Injury Free

Hamstring injuries have been reported as one of the most common sporting injuries across a variety of sports that involve repetitive kicking and high speed running,  such as soccer, track and field, football, and rugby. Re-injury rates are also an issue affecting many athletes long term, with roughly 30% of athletes suffering a re-injury to the hamstring within the first year. As such, risk factors, injury mechanisms and prevention strategies are essential for coaches and athletes participating in these high-risk sports.

Injury Background

The hamstrings are a group of 3 muscles whose main purpose is to bring the hip back and bend the knee. They play a major role in many daily activities involving walking, running, and jumping. The majority of injuries to the hamstrings are grade 1-2 strains that occur during sprinting, especially as the muscles contract eccentrically to decelerate the leg. Injuries that occur during running usually take an average of 16 weeks to return to pre-injury level. Injury can also occur during activities like dancing and kicking where the muscle is overly stretched. Research has shown that an injury due to over stretching of the muscle will take much longer to heal, with an average of 50 wks to return to pre-injury level (Heiderscheit et al., 2010).

Due to the high prevalence of hamstring injuries, combined with a devastatingly long recovery and high probability of re-injury, research has focused greatly on risk factors and rehabilitation strategies to help prevent hamstring injuries altogether.

Risk Factors:

Age

Unfortunately, the older you get, the higher your chance for hamstring injury. The age when the risk starts to significantly increase is 25 years old, with research suggesting a 30% increase in risk annually thereafter.

Decreased Flexibility

Although a lot of prevention programs focus on only stretching the hamstrings, research has shown that tight hamstrings are not a significant risk factor for injury, interestingly, tight hip flexors and/or quads have been associated with increased hamstring injury.

Demographics

Although research is conflicting, there are some studies showing that an increased BMI (Body Mass Index) is a risk factor for hamstring injury. Furthermore, research consistently shows that race plays a role, with an increased incidence of hamstring injuries in aboriginal, African and Caribbean populations vs. caucasians.

Time of injury

Research suggests that most hamstring injuries occur later in games/practices and are related to fatigue.

Decreased Strength

Hamstring strength alone is not an important risk factor for injury, but rather the balance between the quads and the hamstrings strength plays an important role in injury prevention. More specifically, athletes with significantly stronger quads vs. hamstrings (as commonly seen with athletes in kicking sports) were at a significantly higher risk of hamstring injury.

Previous Injury

Previous injury to the hamstring, groin and/or knee is one of the most commonly reported risk factors for a hamstring injury. Studies show that even a mild hamstring strain will put you at risk for further injury to the hamstring within the following 2 years.

What can you do right now to keep your hamstrings healthy?

Rehab your Injuries

Whether it’s your knee, groin, lower back or actual hamstring, you need to address the injury sooner than later in order to prevent long-term problems and re-injury. The high rate of re-injury can be related to decreased eccentric strength in the hamstring, tightness related to scar tissue and altered biomechanics.

Eccentric Strengthening Programs

Eccentric strengthening programs have been demonstrated in numerous studies to significantly reduce the prevelance of hamstring injuries. Some common eccentric hamstring exercises widely researched are the Nordic Hamstring exercise, the Glider, and the Diver. Click here to learn more about these exercises.

Work on your core

One main problem with most rehab programs is that they only isolate the hamstrings. Research has shown that the hip flexors, core and pelvic musculature play a major role in injury prevention. A recent study compared a core stability program focusing on trunk stabilization and agility vs. a traditional program of hamstring stretching and strengthening following an injury. Results showed that the core stability group returned to sport sooner and had a reoccurrence rate of only 7% during the year, compared to the traditional rehab group, which took longer to return to sport and had a reoccurence rate of 70% during the year (Sherry and Best 2004). Click here to see the core stability program.

Running Program

Most hamstring injuries occur later in the game when fatigue sets in. Therefore, you must ensure that your conditioning program focuses on interval speed training and endurance training to improve overall conditioning.

Proper Warm-up

As with all injury prevention programs, warming up is key! Studies have shown that the FIFA 11 warm-up program has been successful in the prevention of many different injuries. Click here to learn more about the FIFA 11 program.

Thermal shorts

Some studies have shown a reduced risk in players who wear thermal shorts, which help keep muscles warm during training.

Take home message:

Many risk factors for hamstring injuries are not preventable, so work on what you can control:

  • Core stability, flexibility and strength

If you still have questions about your injury, or want more guidance on injury prevention, book an appointment with one of the Sheddon Therapists.

Heiderscheit et al., (2010). Hamstring strain injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. Journal of Sports Physical Therapy. 67-81.

Liu et al., (2012). Injury rate, mechanism, and risk factors of hamstring strain injuries in sports. A review of the literature. Journal of Sport and Health Science. 92-101.

Prior et al., (2009). An evidence based approach to hamstring strain injury. A systematic review of the literature. Sports Health. 154-164.

The Sticky Truth Behind Kinesio Tape

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 20160217_141404allows for full range of motion, (and it looks a lot cooler). Below are the main functions of kinesio tape:

  • Decrease pain;
  • Improve range of motion;
  • Increase proprioception;
  • 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.

References:

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.