Young Hockey Player

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Young Hockey Player

• Common overuse injuries
• Injury Prevention
• Strength training

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COMMON OVERUSE INJURIES IN ADOLESCENTS

• Patella-Femoral Malalignment
• Osgood Schlatters
• Severs Disease (Calcaneal Apophysitis)
• Shin Splints (Medial Tibial Stress Syndrome)
• Compartment Syndrome

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Osgood Schlatters

• Excessive pulling of patella tendon at its
  insertion on the tibia which in adolescents is
  still too soft for this excessive load.
• Pain inferior to patella.
• Swelling and tenderness.
• Worse start of activity and post.
• Pain on resisted quad contraction.

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Treatment

• Relative rest
• RICE
• Address biomechanics
• Strapping can help
• Doing too much, pain will continue

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Severs Disease (Calcalneal apophysitis)

• Due to mismatch in growth of bone and muscles
  causing increased traction of Achilles on its
  calcaneum insertion.
• Bone is still soft in pre-puberty (compounds the
  increased load). Girls 9-11 years.
• Posterior heel pain during and post activity.
• Tender to touch, bulge or swelling
• Calf tight
• May limp or tip toe walk.

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Treatment

• Relative rest especially jumping activities
• Ice
• Heel raise
• Address biomechanics
• Soft tissue releases
• Primarily a self-limiting problem

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Patella femoral malalignment

• Maltracking of the patella as it slides in
  femoral groove
• Due to musculoskeletal imbalance genetic vs
  activity components
• Pain around knee cap with activity or prolonged
  sitting
• Severe cases dislocate patella
• Seen in children and adults

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Treatment

• Address musculoskeletal imbalance (tight lateral
  structures vs weak medial structures)
• Soft tissue releases
• Exercise
• Bony alignment
• Shoe wear

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Shin Splints (Medical Tibial Stress Syndrome)

• Inflammation of the tibial periosteum caused by
  excessive traction forces by the attaching
  muscles.
• Pain medial tibia, worse start and often post
  exercise.
• Tender to touch, may be bumpy.
• Seen in adolescents and active adults.
• Confused with Compartment syndrome

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Treatment

• Rest, ice, anti-inflammatories.
• Address biomechanics.
• Address exercise load.
• Shoe wear and activity surfaces (road running).

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Compartment Syndrome

• Normally later teens and 20s.
• Swelling within one or more compartment of the
  shin causing compression of nerves, blood vessels
  and muscles.
• Pain, pins/needles, decreased power, firm to
  palpate.

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Treatment

• Rest, ice.
• Address biomechanics.
• Anti-imflammatories.
• Address activity load.
• Shoe wear and activity surface.
• Surgery.

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Overview of Injury Prevention

• Monitor load (rest week/cycle), no true off
  season.
• Manage load during growth spurts
• -Awkwardness/period of decreased co-ordination.
• -Change to body shape.
• Recognise signs/symptoms and seek advice (aim
  address underlying problem).
• Shoe wear
• Recovery post game/training
• Start basic strength/balance training (address
  biomechanics)

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Questions???????????