In part 1, we discussed the inability of the body to learn its limits of range of motion and strength. Let’s begin now with Pediatric Sports Injuries in Kids – Part 2 with ankle sprains. The rates of sprains in children are high and climbing. The only known predictor of an ankle sprain is a previous sprain, which means the earlier in life one has a sprain the better chance of a sprain later in life.
We see all ages of athletes and non-athletes in our office with sprains, most patients recall a similar event but in teenagers we don’t get this history. Research has shown that this group probably had a sprain during early years that went undetected or incorrectly treated. Part of the problem is that parents, coaches and doctors may not be aware that this will result in chronic ankle instability.
The most common sports producing ankle sprains are basketball and soccer. The feet and legs are continually moving without rest and the muscles begin to weaken. This allows excess mobility to take place and under the right stresses and angle a ligament will rupture. By definition this is a sprain.
Because of the research we tend to treat these injuries more seriously than in the past. Children need to be treated as adults when they have an injury. Their treatment time may be less, but the actual treatment should be the same. This includes taping casting or bracing and in some cases non weight bearing with crutches. Once a patient has been successfully treated, which may include physical therapy, it may be necessary to wear an ankle brace while competing to deter another sprain.
We as clinicians use R.I.C.E. (rest, ice, compression, elevation) as our initial treatment. The amount of each of these varies greatly amongst patients. Of these compression is the most important. Icing should be limited to a few days and only for 10 minutes during any hour. We need the blood to flow to the area for healing. Typically after a week we can start stretching the muscles above the ankle and begin to restore up and down motion of the ankle.
The final treatment includes the return of proprioception. Nice word. Right.. I’ll explain. Every motion we perform with or without thinking is done through the brain. For instance, as we walk our heel hits the ground but doesn’t go through the ground, nor do we break our heel or leg, because as we step our brain signals all our lower leg muscle to pull the tendons so are heel lands with the correct pressure. This happens all throughout are bodies every second. We get sprains because our brain didn’t respond fast enough or the amount of stress to the body was more than our muscles could control. An example would be “missing a step” Our brains learned that walking up and down steps requires certain strength and distance. When we miss a step and go up or down a different amount we all get a jolt because we changed the variables that our brain has learned over the years. All of this is called proprioception. It means your brain knows what your arms and legs are doing.
Following an injury and while you’re rehabilitating your brain has to get back in synchronization with that injured part. This takes time and exercise. After an ankle sprain, one of the best and easiest exercises is standing on one foot for a few minutes. Anyone who has done this exercise knows how difficult it was at first compared to the good leg.
Children should be immobilized initially and their return to sports gradual and protected. Because there are so many degrees of injury each individual needs to have a customized treatment plan. The most important thing to remember is that children won’t grow out of chronic ankle instability. It will follow them into adulthood. If you are going to allow them to play sports, whether one or five different sports, then you must be knowledgeable of abilities. Pushing them may be hurting them.
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