It is important to seek attention from a Physical Therapist immediately following an injury so that you may understand the severity of your injury and make the best decisions on return to sport. For example, recovery time from an ankle sprain can range from 1-8 weeks depending on the amount of damage and level of treatment received. If an athlete returns to sport too early, they risk the chance of receiving a repeat injury. A physical therapist will help guide the athlete through the rehabilitation process to full recovery.

Physical Therapists are trained to evaluate and diagnose injury, determine and apply appropriate treatment, and help with injury prevention after recovery. A Physical Therapist is also highly skilled at assessing impairments in athletes, ranging from weakness to stiffness and poor mechanics that impact return to sport. Your Physical Therapist can also determine if your injury requires the attention of a Physician and direct you accordingly.

Each patient’s treatment begins with a focused evaluation, including health history and physical examination. Specific treatment goals are established to align with patient expectations and time lines. Patients are encouraged to take an active role in their recovery. Hands on manual therapy, modalities, functional exercises, and home programs are designed to enhance recovery. Patient education and participation is essential to achieve goals as quickly and safely as possible. Open communication is essential for optimal success. Throughout treatment, patients gain valuable knowledge and tools that help them return to function, prevent future injury, resume an active lifestyle, and maintain wellness. When considering whether to seek medical care, remember that state law allows you to seek medical treatment for your musculoskeletal issues directly from a Physical Therapist of your choosing, without a Physician referral. This places Physical Therapists as a first-line provider for your musculoskeletal health and for sports-related injuries.

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Differences Between Child and Adult Athletes

Because young athletes are still growing, they are at greater risk for injury than adults. The consequences of overdoing a sport can include injuries that impair growth and may lead to long-term health problems. When injuries do occur, it is important to understand the healing process and your treatment options for a fast and full recovery.

Children Are Still Growing

Children’s bones, muscles, tendons, and ligaments are still growing, making them more susceptible to injury.

Children Vary in Size and Maturity

Young athletes of the same age can differ greatly in size and physical maturity and thus deliver varying amounts of force in contact sports.

Children Can Injure Growth Plates

Growth plates are weaker than the nearby ligaments and tendons. Injuries to these regions have the potential to disrupt the normal growth of bone.

Youth Athletics

Acute Injuries vs. Overuse Injuries

Acute injuries typically happen in an instant and have a clear onset of injury, whereas overuse injuries occur gradually over time due to a repetitive action or stress. The prevalence of overuse injuries varies by sport, but overall there is a 50/50 split between Acute and Overuse injuries in youth athletics. Both injuries must be properly diagnosed and treated prior to return to sport, but it is much easier to identify and take action for an acute injury than one that comes on gradually over time.

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Identification:

Acute injuries are caused by sudden trauma, such as a twist, fall or collision. If you were not a witness to the injury, encourage your athlete and coaches to record and report all acute injuries no matter how severe.

Common acute injuries include broken bones, sprains (ligament injuries), strains (muscle and tendon injuries), and cuts or bruises.

Common Symptoms:

Symptoms to look for include the following: injured area being red, swollen, and hot; extreme pain to affected or surrounding areas; extreme pain with palpation around affected or surrounding areas; not able to bear weight or functionally use affected area.

Medical Triage:

If an injury occurs, the first and most important step is to determine if immediate medical care is needed. Medical red flags and a healthy amount of common sense are required, so if you are in doubt, please seek medical intervention immediately. It is often times difficult to assess the severity of an injury immediately, and our recommendation is to err on the side of caution when in doubt. During this time, if there is severe pain with palpation to the injured or surrounding areas or severe pain with weight bearing, you would most likely benefit from an x-ray to rule out a break or fracture.

Immediately following injury:

Prompt first aid treatment should be provided by coaches and parents when injury occurs. This usually consists of the PRICER method: Protection, Rest, Ice, Compression (wrapping with elastic bandages), and Elevation (above heart). This usually limits discomfort and reduces healing time. Immediate first aid treatment will minimize swelling and help your doctor and/or physical therapist establish an accurate diagnosis.

Within 24-48 hours of injury:

Research shows the sooner you are treated for an injury the faster your recovery time. Medical attention from a physician or physical therapist is recommended within 24-48 hours to ensure no fractures or other serious injuries have occurred, and to begin the process of recovery.

Identification:

Overuse injuries occur gradually over time and are caused by repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. When an athletic activity is repeated often, parts of the body do not have enough time to heal. This can lead to micro trauma that, left untreated, can lead to overuse injuries. Exercise applies stress to the body, which adapts by thickening and strengthening various tissues involved. This results in improved muscle strength, firmer and sometimes larger tendons, and increased bone density. If exercise is applied in such a way that adaption cannot occur, the excessive and repetitive overload causes microscopic injuries that lead to inflammation, which is the body’s response to injury.

Overuse injuries typically involve the muscle-tendon unit, bone, articular cartilage, bursa, neurovascular structures, and ligaments. Examples of overuse injuries include throwing injuries in the elbow, Achilles tendinitis, and shin splints.

Parents and coaches may have difficulty spotting less severe problems, however, because the pain is low grade and the athlete often ignores it. Repeat injuries may turn into overuse conditions. The most common cause of overuse injuries are training errors, and the most common training error is “too much, too often, and too soon.” The body needs time to adapt to continuous stress, and youth athletes are no different.

Common Symptoms:

Parents and coaches should be aware of the more common signs of overuse injury. These include:

  • Decline in performance (speed or quality)
  • Lack of motivation
  • Swelling (which may be noticeable)
  • Athlete is irritable/uncooperative
  • Favoring one side of the body or impaired function of the affected part
  • Affected area may be red or warm to the touch
  • Gradual onset of pain or increased periods of time for pain to resolve
  • Difficulty sleeping
  • Headaches
  • Muscle or joint stiffness

All of these signs may be present but not noticeable in the beginning stages. Often the first stage may be stiffness or soreness (especially in the morning), which may disappear with warm-up. Continued use may cause continued damage, and the pain will last through warm-up and even worsen after activity finishes. It may be difficult to assess the severity of these symptoms, but they should not be ignored as “growing pains” as they are early signs of overuse injuries.

The Four Stages of Overuse Injuries:

  1. Discomfort that disappears during warm-up
  2. Discomfort that may disappear during warm-up but reappears at the end of activity
  3. Discomfort that gets worse during the activity
  4. Pain or discomfort all the time

Medical Triage & Treatment:

When an overuse injury is present, seeking care from a physical therapist as soon as possible is important. Physical therapists are uniquely trained and experienced in the evaluation and treatment of overuse injuries, making them your best first choice.

Don’t wait. Identification and treatment during stage 1 allows continued activity as long as the injury does not worsen. At stage 2, activity may be continued at a modified pain-free level during treatment until complete healing occurs. If the injury progresses to stage 3, activity must be stopped immediately until returned to sport by treating clinician. In stage 4 it would be highly unlikely that the athlete would want to compete, and obviously should not be allowed until treatment and recovery are complete.

Treatment of an overuse injury will be specific to the athlete. It may include techniques to decrease pain and inflammation and address any faulty movement patterns or imbalances in strength and flexibility that lead to the overuse injury.

Physical Therapy & Injury Phases

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With fractures or other serious injuries ruled out, the athlete is ready for physical therapy. During the acute phase, 4-6 days following the injury, a physical therapist can assist in the management of pain and swelling of the injured area. Once weight bearing is possible, light and pain-free movement will be introduced.

This phase lasts approximately 6 weeks after the injury, but it may take longer to return to sport. During these six weeks, the soft tissue that was injured is working to repair itself and heal. Allowing an injured athlete to return to play too soon and without the proper rehabilitation is setting them up for repeat injury and possibly a worse injury than the original. During the sub-acute phase, a physical therapist will instruct the athlete on exercises and stretches to ensure that proper strength, stability, and flexibility is being returned to the injured area. The sooner an athlete begins treatment with a physical therapist, the faster and more complete their recovery.

Range of Motion

Normal joint movement is vital to recovery, and this will be a focus for physical therapy intervention. Physical therapists have experience in gaining full range of motion for patients as quickly and safely as possible. This includes remodeling of affected soft tissue, stabilization of surrounding areas, and strengthening of supportive structures.

Stabilization

Your physical therapist will perform a full body assessment to determine areas of weakness that put the athlete at risk of injury. Unstable joints at any point in the body increase the risk of injury throughout the Kinetic Chain and must be fixed in order to prevent future injury and support injured area in recovery. If the athlete is in need of bracing for support or protection, the physical therapist can also assist in finding and fitting the proper device.

Strengthening

Our muscles weaken after injury, so adding a specific strength component is required for recovery. Your physical therapist will prescribe and monitor safe and effective strengthening exercises throughout the sub-acute phase with the goal of return to sport.

Functional Movement

Athletic activities involve many complex movement patterns that all support the explosive movements of athletes. These are defined as neuromuscular pathways which physical therapists are training to evaluate and treat. Your exercise prescription will progress to functional, whole body exercises that include agility, speed, plyometric, etc. This training will help to improve performance and prevent re-injury.

The final stage in the injury process is the remodeling phase. At this time, the injured area no longer needs protection, but the underlying structures that are weak will continue to strengthen and repair themselves. A physical therapist can increase the athletes exercise program during this phase to mimic more of the functional movements the athlete performs during sport. Once the athlete reaches full recovery of strength and flexibility, they are able to return to sport.

Allowing an injured athlete to return to play too soon and without the proper rehabilitation is setting them up for repeat injury and possibly a worse injury than the original.

Direct Access

When considering whether to seek medical care, remember that state law in most states allows you to seek medical treatment for your musculoskeletal issues directly from a Physical Therapist of your choosing without a Physician referral. This places Physical Therapists as a first-line provider for your musculoskeletal health and for sports-related injuries.

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