Common Adolescent Conditions – Part One: Ankle
This topic seems somewhat timely given these particular injuries are normally load related.
As discussed in my previous blog about Load Management, the last 6 months have played havoc with people’s Acute Chronic Workload Ratio and children/adolescents are no exception.
The conditions I will be discussing are usually related to a big spike in activity which has been the case this year with most sporting organisations eager to recommence their seasons. These spikes will be somewhat amplified in young athletes who participate in multiple sports or who are already specialising in their chosen sport which can mean numerous training sessions/games per week.
This topic seems somewhat timely given these particular injuries are normally load related.
As discussed in my previous blog about Load Management, the last 6 months have played havoc with people’s Acute Chronic Workload Ratio and children/adolescents are no exception.
The conditions I will be discussing are usually related to a big spike in activity which has been the case this year with most sporting organisations eager to recommence their seasons. These spikes will be somewhat amplified in young athletes who participate in multiple sports or who are already specialising in their chosen sport which can mean numerous training sessions/games per week.
Sever’s Disease
What?
An irritation of the insertion of the Achilles into the calcaneus. This differs from adult Achilles tendinopathy due to the immaturity of the adolescent skeleton which means it affects the actively remodelling trabecular metaphyseal bone.
How?
As mentioned previously, it is usually due to the area’s inability to deal with an increase in activity (particularly activity that uses that area eg running or jumping sports).
When?
More common in boys and usually between the ages of 10-15 compared with girls which is usually between the ages of 8-13.
How does it resolve?
Usually self resolves with time (6-24 months) however the reason it’s best to seek treatment/advice is due to the pain that accompanies the condition which can affect sports performance and most importantly day to day activities.
What is the treatment?
The main focus of treatment is to reduce pain levels. This can be done in a few different ways including:
- Manual therapy (eg muscle massage)
- Heel raises for footwear to offload the tendon
- Taping to offload the tendon
- Exercises to strengthen key areas
- Implementation of load management strategies (eg RPE scale)
- Advice regarding recovery (eg icing)
The main takeaways about the condition are:
- The adolescent will grow out of it
- It can still be quite painful however so there should be a focus on pain relief
- Load management with guidance from a physiotherapist can allow the continued participation in sport without compromising day to day function
If you would like your injury reviewed by one of our physiotherapists, then don’t hesitate to book an appointment. All of our physiotherapists specialise in sport and have had extensive experience with adolescent athletes.
Achilles Tendinopathy - What you need to know
With running season well upon us, here are some hints and tips about a common running injury achilles tendinopathy.
What is a tendinopathy?
Tendinopathy simply means that the tendon has failed to adapt to loading, doing “too much, too soon”.
Whether you have increased your load by volume, intensity or frequency… this amount was greater than the tendons capacity to cope and recover.
Load > Capacity
How did I get an Achilles Tendinopathy?
You may be more prone to a tendinopathy if you are a…
o Running / jumping / landing athlete i.e. distance running, basketball, AFL and netball.
o Weekend warrior who over exercises on weekends and under trains during the week.
o Older person with a history of poorly rehabilitated and/or grumbly tendon.
Where does it hurt?
Do you pinch your heel and feel your pain?
People tend to have a very specific site that is the source of their symptoms and can put their finger right on it.
Do I need a scan of my Achilles?
No.
In 90% of cases this should be easily diagnosed by your physiotherapist or sports physician. If you aren’t getting results with your treatment and rehab then you may be referred for a scan.
What should I avoid doing?
- Don’t rest
Staying off it completely will only increase the time it takes to rehabilitate the tendon.
- Don’t stretch/massage the tendon
Stretching and massaging the tendon won’t get it stronger. Muscle massage however, is ok. Stretch may feel good temporarily, however can make the tendon more irritable.
- Don’t train through high levels of pain
Low or mild discomfort can be ok during activity, but if you are still sore 24-72 hours later then you have done too much, too quickly.
I’ve been having physio and not getting better, what should I do?
Ask yourself;
- ‘Do I have the correct loading amount in my work out?’
… not too much or too little.
- ‘Am I sticking to the program?’
… over committing/loading or too many days between rehab sessions won’t help the tendon to strengthen and repair.
If you’re doing all these things right then discuss with your health practitioner where to go to next.
What’s the best treatment for Achilles Tendinopathy?
Best practice for tendon health is a combination of…
- Regular progressive loading, and
- Pain monitoring
- A short period of staying off the grumpy tendon may also be necessary.
- Your GP or health professional will be able to advise regarding anti-inflammatory use.
Speak to your physiotherapist who will assess and prescribe the optimum amount and intensity of exercises for you.
Author: Peter Gangemi - Master of Physiotherapy