Is Pre-season Training Harming Your Child?

The new school year is upon us and winter pre-season training is ramping up. This time of year, Bathurst Physio is busy with younger clients suffering overuse injuries which can be quite painful and distressing for your young athlete. Many parents who bring their children in for treatment are worried their child may have permanent damage, due to their pain and suffering.

To understand what is happening we need to unpack the relationship between training and children a bit more.

Training

Load is the term we use for the amount of activity performed, training load is the product of volume x intensity. Too much volume e.g. increasing the number of training sessions or too much intensity in those sessions can contribute to the development of an injury. Risk of injury increases with quite small changes in load. A recent high-quality review paper (Windt, J & Gabbett, T, 2017) reinforced the traditional view that when weekly load changes by 10-15% (either more or less) there is a significant increase in injury risk.

Children

Children typically have two growth spurts. When this occurs their bones grow rapidly, the soft tissues around those bones adapt and lengthen over the next couple of months. While the soft tissues are catching up, they are under slightly more stress.

The perfect storm for injuries in children is to start preseason training after a summer of inactivity whilst undergoing a growth spurt. The two most common injuries in this situation are:

• Osgood Schlatter’s disease - occurring just below the knee where the quadricep tendon inserts onto the tibia (shin bone).
• Sever’s disease – occurring where the Achilles tendon inserts into the heel.

Both these conditions are the same problem occurring in different locations. Despite the scary name, they are definitely not diseases. The technical name is a traction apophysitis, which just means there is tension where the tendon attaches onto the bone. In response to this tension, the area becomes inflamed and painful. If this persists the body attempts to stabilise the area by laying down more bone, resulting in a small lump in the area.

In the vast majority of these cases the condition is self-limiting, which means it will settle over time without having to do anything. Additionally, pain is not a measure of damage. Pain does however affect performance and more importantly enjoyment of the activity.

What can be done?

Although the condition is regarded as self-limiting, it can take weeks or months to settle. It can also return every time activity increases. There are many things that can be done to settle the pain and speed up recovery. These include:

• Ice the area for ~10 minutes every 3 - 4 hours
• Avoid activities that aggravate the pain
• Modify the volume/ intensity equation
   

Should my child see a physio?

There are many conditions that cause knee and heel pain, some are more serious than others. An accurate diagnosis is best done by a physiotherapist.

Every young body is different. There is no recipe for treatment. Your physiotherapist will assess all the contributing factors such as:

• Muscle length
• Muscle strength, coordination and muscle imbalances
• Biomechanics
• Kinetic chain dysfunction
• Footwear
• Training load

Addressing all these factors will minimise the pain and, in many cases, completely relieve it.

The goal is to teach you and your child how to manage the condition and minimise the impact of pain on your child’s enjoyment.

So, pre-season is not harming your child, it can however make exercise and sport painful and unenjoyable. There is no need for your little athlete to suffer. The staff at Bathurst Physiotherapy will get them back “living a better life.”