Treating Stress Failure Injuries In Young Athletes

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By Patrick Agnew, DPM

Is the term “overuse injuries” really appropriate? After all, many so-called “overuse” injuries of the lower extremity are unilateral. In most cases, the right foot is used just as much as the left foot so the term becomes illogical. Perhaps stress failure phenomena would be a more accurate description of these injuries. Some examples of mechanisms leading to stress failure problems include repetitive motion, repetitive loading and repetitive impact.
Your patients might encounter repetitive motion injuries in endurance sports like swimming or sports such as cross-country running or basketball. Athletic injuries are often blamed on training, technique or equipment errors. I would add biological errors to the mix.
Training errors occur when a child goes too far, too fast, too heavy or too soon. Technique errors often occur in the absence of good coaching. An example might be when an athlete’s improper kicking in swimming breaststroke leads to knee derangement. Equipment errors, such as worn out shoes, can lead to repetitive impact injuries.
Unfortunately, biological errors are all too often discovered after the fact. For example, a child who sustains a repetitive loading injury to the second metatarsal head may later be recognized as one who overpronates. If a practitioner had recognized the injury early on, he or she could have used an orthotic to stop the overpronation from destabilizing the first ray and allowing overloading of the second ray.
However, stress failure injuries are tough to detect as they often have an insidious onset. This is because the repetitive nature of the damage builds gradually to the point that the “straw that breaks the camel’s back” may occur. Prodromal signs and symptoms of an impending stress failure might include vague or mild discomfort, similarly mild edema, erythema, ecchymosis and eventually a loss of use of the involved anatomy. These are the same signs and symptoms associated with acute trauma but they are more gradually developing with stress failure injuries.
Some examples of stress failure in children might be categorized by tissue type. These certainly could include failure of bone, soft tissues or skin.

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