Chapter 13Prevention and Management of

Common Musculoskeletal Injuries in Pre-Adolescent and Adolescent

Female Athletes

Mimi Zumwalt, MDMimi Zumwalt, MD

Learning Objectives• Understand the musculoskeletal anatomy and Understand the musculoskeletal anatomy and

physiology of the athletic female prior to and after physiology of the athletic female prior to and after pubescencepubescence

• Recognize the differences between adolescent Recognize the differences between adolescent males and females’ anatomy, physiology, and males and females’ anatomy, physiology, and biomechanics of the musculoskeletal systembiomechanics of the musculoskeletal system

• Delineate more unique orthopaedic injuries Delineate more unique orthopaedic injuries incurred by adolescent female athletesincurred by adolescent female athletes

• Comprehend various measures of prevention and Comprehend various measures of prevention and management of musculoskeletal trauma sustained management of musculoskeletal trauma sustained by adolescent female athletes by adolescent female athletes

Introduction

• Adolescent growth spurtAdolescent growth spurt• Growth, development, & maturationGrowth, development, & maturation• From childhood into adulthoodFrom childhood into adulthood• Alteration of reproductive, physiological, Alteration of reproductive, physiological,

& musculoskeletal systems& musculoskeletal systems• Children NOT equate to small adultsChildren NOT equate to small adults

Musculoskeletal Anatomy/Physiology of Pubescent Females

• Longitudinal skeletal growthLongitudinal skeletal growth• Adolescent growth spurtAdolescent growth spurt

• Increase in body size/weightIncrease in body size/weight• EstrogenEstrogen

• Body shape transformedBody shape transformed• Sex specific & SQ fat depositionSex specific & SQ fat deposition

• Hypertrophy & hyperplasiaHypertrophy & hyperplasia• Enhancement of motor skills Enhancement of motor skills

Musculoskeletal Anatomy, Physiology, & Biomechanics of Adolescent Males vs. Females

• TestosteroneTestosterone• Boys stop growing 2 laterBoys stop growing 2 later• Boys gain more muscle mass & strengthBoys gain more muscle mass & strength• Boys deposit less fatBoys deposit less fat• Boys better in motor skillsBoys better in motor skills

• Speed, power, & enduranceSpeed, power, & endurance• Body structure maintainedBody structure maintained

Musculoskeletal Injuries In Pre & Adolescent Female Athletes

• Title IX in 1972Title IX in 1972• Gender equality in scholastic sportsGender equality in scholastic sports

• Acute vs. chronic overuse injuriesAcute vs. chronic overuse injuries• Growth plate traumaGrowth plate trauma• Bursitis, tendonitis, ligamentous sprains, Bursitis, tendonitis, ligamentous sprains,

stress reaction/fatigue fracturestress reaction/fatigue fracture• Environmental factorsEnvironmental factors• ““Miserable malalignment syndrome”Miserable malalignment syndrome”

• ACL tears from LE landing attitudeACL tears from LE landing attitude

Prevention of Athletic Injuries in Pre & Adolescent Females

• Safety equipment/environment Safety equipment/environment • Well-fitting footwear & running stride Well-fitting footwear & running stride

mechanicsmechanics• Gradual progression of workout volumeGradual progression of workout volume• Preseason conditioning programPreseason conditioning program

• Strength, endurance, plyometrics/powerStrength, endurance, plyometrics/power• Resistance, flexibility; speed/agility, Resistance, flexibility; speed/agility,

jumping/landing techniquesjumping/landing techniques

Management of Musculoskeletal Injuries in Pre & Adolescent Female

Athletes• ““PRICE” – prevent/Protect, relative Rest, PRICE” – prevent/Protect, relative Rest,

Ice, Compression, Elevation; NSAIDsIce, Compression, Elevation; NSAIDs• Orthopaedic consultation if not improvedOrthopaedic consultation if not improved• Cross training w/alternative activitiesCross training w/alternative activities• Formal physical therapy rehabFormal physical therapy rehab• Resistance training for muscular strengthResistance training for muscular strength

• No power liftingNo power lifting• Progress to sports-specific drillsProgress to sports-specific drills

Conclusion

• Transition from childhood to adolescenceTransition from childhood to adolescence• Reproductive, hormonal, nervous, & Reproductive, hormonal, nervous, &

musculoskeletal changesmusculoskeletal changes• Growth, development, & maturationGrowth, development, & maturation• Acute & chronic orthopaedic traumaAcute & chronic orthopaedic trauma

• Minimize risks & maximize gainsMinimize risks & maximize gains• Strength & conditioning program Strength & conditioning program

Case Study• You are a pediatrician who has just recently completed a primary care You are a pediatrician who has just recently completed a primary care

sports medicine fellowship and decided to join a multi-specialty group sports medicine fellowship and decided to join a multi-specialty group practice in a suburban town. One of your partners’ physicians practice in a suburban town. One of your partners’ physicians assistant (PA), has been involved with taking care of a local youth assistant (PA), has been involved with taking care of a local youth girls’ soccer team. These young female athletes are under tremendous girls’ soccer team. These young female athletes are under tremendous pressure to win since their team will disband if they do not make the pressure to win since their team will disband if they do not make the playoffs this season; as a result, these female soccer players have been playoffs this season; as a result, these female soccer players have been required to “train” extra hard every weekday before AND after required to “train” extra hard every weekday before AND after practice. Their training program consists of running for a couple of practice. Their training program consists of running for a couple of miles around the track, then lifting weights for strength and power, miles around the track, then lifting weights for strength and power, then run again for another mile or so. Evidently their coach used to then run again for another mile or so. Evidently their coach used to work with male football players, and he is incorporating the majority work with male football players, and he is incorporating the majority of football drills into the regular sports workout during the competitive of football drills into the regular sports workout during the competitive season for these young female athletes. As far as he is concerned, the season for these young female athletes. As far as he is concerned, the heavier weight moved the better. “Work through the pain!” echoes his heavier weight moved the better. “Work through the pain!” echoes his motto. As much as these teenage girls want a good chance at the motto. As much as these teenage girls want a good chance at the championship trophy, they are beginning to get discouraged, mainly championship trophy, they are beginning to get discouraged, mainly because they cannot seem to get rid of their muscle aches and pains because they cannot seem to get rid of their muscle aches and pains despite resting on the weekends and taking over-the-counter despite resting on the weekends and taking over-the-counter medications. In fact, their performances during the games have also medications. In fact, their performances during the games have also started to deteriorate a bit, which makes their coach exercise them started to deteriorate a bit, which makes their coach exercise them even harder. The PA is coming to you for advice concerning this even harder. The PA is coming to you for advice concerning this group of adolescent females.group of adolescent females.