Lecture #6 Conditions in Specific Populations PDF

**Lecture \#6: Conditions in Specific Populations** **Youth Athletes** **Injury Risk Factors to Young Athletes?** **Growth & Development:** - Maturation (emotional and physical) differs between sex despite same chronological age. **Bone Growth** - Primary ossification centre at diaphys...

**Lecture \#6: Conditions in Specific Populations** **Youth Athletes** **Injury Risk Factors to Young Athletes?** **Growth & Development:** - Maturation (emotional and physical) differs between sex despite same chronological age. **Bone Growth** - Primary ossification centre at diaphysis - Secondary ossification centre at epiphyses (end of bone) - Early childhood = epiphysis ossification, followed by diaphyseal and metaphyseal (giving length) - Bone growth is adapting faster than muscle; can make them prone to certain injuries **Anatomy of Growth Plate** - Growth Plate "Epiphyseal Plate" - Made of cartilage - Strength of plate is 1/5 of joint capsule and surrounding ligaments - Making them prone to injuries, can impact ability of bone to grow properly - Can stunt growth if growth plate is injured - Growth Plate Zones - Reserve Zone - Proliferation Zone - Maturation Zone - Calcification Zone - If Metaphyseal area is injured, can impact blood flow to area which in turn can affect growth. **Growth Related Problems** - **Mismatched Growth** - Muscle-tendon tightness due to longitudinal bone growth out pacing soft tissue growth - Creates susceptibility to overuse injuries - Bone can grow 2-3inches in a couple of months - For muscle to catch up to bone may take a year; increased tension until it catches up - **Ligaments and Tendons** - Insertions into fibrous and fibrocartilaginous periosteal perichondral regions of metaphysis - Typically stronger than physis or apophysis - Evulsion Fractures can occur Common Problems - Epiphyseal Fractures (growth plate) - Apophyseal Injuries (Evulsion) - Various Osteochondroses (degenerative changes to bone) - Stress Fractures (Spondylolysis, Spondylolisthesis) - PAtello femoral pain syndrome **Epiphyseal Injuries** **Classifications** Type I: Separation of the Physis Type II: Fracture - Separation of growth plate and small part of Metaphysis Type III: Fracture - Part of Physis - usually ankle Type IV: Physis and Metaphysis - combination of 2 & 3, usually knee, - don't recover well due to displacement Type V - Crushing of physis with no displacement - may cause premature closure. - can potential stunt growth due to blood flow stoppage. **Apophyseal Injuries** - Young physically active individuals are susceptible: - Apophyses are traction epiphyses in contrast to pressure epiphyses - Serve as sites of origin and insertion for muscles **Osgood-Schlatter's Lesion** - Growth spurt - Femur growth causing Quadmuscles to tighten - Causes Patella Tendon pulling on tibial tubercle and patella - Results in inflammation, pain **Osteochondrosis** - Degenerative changes to cartilage portion of epiphyses of bone during rapid child growth or trauma - Running based sports, lots of pivoting or turning - Possible cause includes - Can lead to Aseptic Necrosis (disrupted circulation to epiphysis) - Cartilage fractures cause fissures to subchondral bone - Trauma to a joint that results in cartilage fragmentation - Resulting in swelling, pain, and locking **Types of Osteochrondroses** - Articular - Perheses Disease = Femoral Head - Kienbocks Lession = Lunate - Kohler's Lession = - Freiberg's Lesion = Second Metatarsal - Osteochondritis Dissecans = Medial Femoral Condyle, Capitulum, Talar Dome - **NON-ARTICULAR:** - Osgood-Schlatter's Lesion = Tibial Tubercle - Sinding-Larsen Johansson = Inferior Pole of Patella - **PHYSEAL:** - Sever's Lesion = Calcaneus - Sheuermann's Lesion = Thoracic Spine - Blount's Lesion = Proximal Tibia **Stress Fractures** **Pars Interarticularis** - region between two facets, tends to be weakest portions - Could be congenital or from mechanical stress from axial load (top down) - flexion, hyperextension, rotational movements, repetitive causes shearing force to vertebrae. - **SPONDYLOLYSIS** = a stress fracture of the pars interarticularis. - occurs typically before age of 8, symptoms show 10-15 years old. - **SPONDYLOLISTHESIS** = a bilateral fracture of the pars interarticularis accompanied by anterior slippage of the involved vertebra. - common at L5-S1 - more common in males, more severe cases with women. **Other Considerations** - Consent - injury history - pain scales **Female Athletes** **General Information** - Females and males equal rates of injury incidence - Female likely structural - ACL - PFS & Patella Subluxation - Spondylolysis & Spondylolythesis - due to hormonal and menstruation factors - Stress Fractures - Knee vulnerable injuries due to pelvic differences (Q-Angle) **Biomechanical Predisposition** Knee Injuries - Increase femoral obliquity (Q-Angle) - More Valgus force can cause more stress on medial structures (MCL, Meniscus,) and ACL - Small intercondylar notch - Cause instability and hypermobility - Quad to Hamstring strength ratio - lack of hamstring recruitment/reliance - Hormonal Effects - Extreme cyclical hormone level changes effect ***collagen*** tissue and remodeling stages; causing tissue degradation. - Progesterone and Estrogen lower during menstruation. **Skeletal Differences** **Q-Angle** **Male** - 13% Q-Angle - Increased medial tibiofemoral contact - Genu Valgum = More medial knee pressure **Female** - 18% Q-Angle - Increased lateral patellofemoral contact **Anterior Cruciate Ligament** - more common in females - 2-6x more common Mechanisms of INjury - valgus force - hyperextension - IR (internal rotation) of femur and deceleration **PFS & Patella Subluxation** - smaller patella **Stress Fractures** Predisposition - Overuse - Poor mechanics - Low bone density - nutrition - Hormonal Societal - Thin body - Working mom (can't take care of themselves) - Fashion (Heels - shortened achilles - Hallux valgus (toe inward Prevention - Strengthen - Legs musculature - Test Quads and Hamstring - Posture and Biomechanics - Education **Hormonal Effects** Amenorrhea: Females does not menstruate - Primary: No period by 16. - Stress Fractures common. - Secondary: Has stopped. - Can be pregnancy related Oligomenorrhea: Irregular Menstrual cycle. Anovulation: Not ovulating - low levels of estrogten Short Luteal Phase: Phase reponsible for progesterone after ovulation. - Can decrease progesterone Dysmenorrhea: Pain during mensturation - Cramps, naussea, emotional variability \*All of these to lead to loss of progesterone and estrogen causing bone degredation **Female Athlete Triad (old)** - Osteroporosis - Low bone density - Not eating enough - Eating disorder - Irregular Periods - Amenorrhea **RED-S: Relative Energy Deficieny in Sport (new)** - cause of syndrome is energy deficiency between diertary enegry and energy expenditure - now involves males - Weight based sports it has a larger importance **RED-S CAT** - Concussion evaluation **The Pregnant Athlete** - competition up until 7th month - Females usually dont continue after 3rd month Biomechanical Changes - INcreased lordosis and upper spine extension - 50% experience low back / pelvic girdle pain - 25% continue to feel after 1 year Contraindications of Exercises - a Menopause - 40-60 (avg. 52) - Ovaries start produce smaller hormone amounts Bone Health - Causes Bone health degradation - Increase stress factors and osteroporosis **Male Athlete** **Testosterone** - Development of fetal development - development of primary and secondary sex characteristics - Creates anabolic effects - Promote spermatogenesis and maturation and sperm **Spermatogenesis** - Generation or spermatozoa - Begins 13 - Occurs in seminiferous tubules - Testosterone required **Penile Trauma** - Superficial wounds, contusions, lacerations, avulsions, frost brite, penetrating wounds - Fracture of penis - Prudenal nerve irritations - paresthesia and priapism - Priapsim: overstimulation - Primary: Trauma and infection, abnormal growth (cancer) - Secondary: Different neurological conditions **Testicle Trauma** - Hematocele: Swelling caused by blood collecting in body cavity - cavity of tunica vaginalis - 50% will have testicular rupture; surgical repair or aspiration (needle to drain) - Hydrocele: type of swelling in scrotum that occurs when fluid collects in thin sheath surround a testicle - common in newborn (goes away on their own) - adults, older boys due to inflammation or injury - unilateral - Varicocele: an enlargement of veins within scrotum - similar to varicose vein - due to low sperm or decreased sperm quality - Spermatocele: Cystic swelling either of the epididymis or testes that contains spermatozoa. - Lives above and behind testes - No treatment required **Testicular Torsion** - an emergency condition - spermatic cord rotates and becomes twisted - cuts off blood supply and cause swelling - swelling - nausea - abdominal pain - one testical appears to be higher - 6-8 hours treated in hospital, if need surgery to cut testes **Hernia** - congenital or acquired Umbilical / Direct - common over 40 - weakness in fascia bounded by RA, inguinal ligament and epigastric vessels Inguinal - common 70% - Weakness in peritineum around inguinal ring Femoral - common in women - protusion in femoral ring into femoral canal Detection - visual assessment - bulge - valsalva - test - herniography (radiopaque dye) - test - unusual pulling feeling - Synonym: Tenoperiostitis of adductors, iliopectineal bursa, abdominal strain **Testicular Cancer** - most common in young men in Canada - curable when recognized early - cancer cells developed in tests - direct cause unknown Risk Factors - 15-40 - cryptochidism (undescended testicle) - family history - personal history - race, ethnicity (higher in Caucasians - hiv infection Symptoms - Lump - enlargement of testicles - scrotum heaviness - dull ache in groin or abdomen - sudden scrotum fluid collection - pain, discomfort scrotum or testicles - enlargement or tenderness of breast **Mature Athletes** **Results of Inactivity** - decreased cardiovascular fitness, strength, flexibility **Potential problems** - hypetension, osteo, obesity, coronary heart disease **Cardiovascular Effects of Aging** - Cardiovascular disease is leading cause of mortality - 40% adults have hypertension - 1-2% decrease in max VO2 per tear - lung function is well preserved in absence of disease **Respiratory Effects of Aging** - Decline in maximal consumption - Loss of elastic recoil - Calcification of soft chest wall tissues **Integumentary System** - skin becomes wrinkled and dry - sebum decrease - Thickness of dermis 20% - Vascular fragility occurs, Purpura (red or purple discoloration) and slow healing - skin disorders common **Musculoskeletal System** - from 47% \@21-30 to 27% \@70 - increased cross linkage collagen fibers - strength decreases from 40-50 - Strength training can produce similar gains in younger adults - most from increased motor units not hypertrophy **Neurological Effects of Aging** - Decrease weight in brain - loss of neurons in brain and spinal cord - Loss of balance, propioceptive feedback **Arthritis** - chronic inflammation of joint, initially painless and no swelling - Hip, Knee, spine, weight bearing joints; can also be fingers - Gradual breakdown of articular cartilage **Osteoarthritis** - most common - bone on bone contact - knees, hip, hands, spine - occurs due to aging or injury, obesity, genetics **Inflammatory Arthritis** - joint damage from inflammation not wear and tear - Immune system attack the body - Pain, stiffness **Gout** - caused by small crystals of uric acid that form in joints - body immune system attacks crystal, causing pain redness, swelling in joint and surround tissue - Commonly found in big toe