Children's sports injuries

Exercise is healthy and everyone knows the benefits of an active lifestyle by now. This applies to adults, but perhaps certainly to children.

The fact that sports can also lead to injuries seems generally accepted, despite the fact that, according to the RIVM, there are around 5.5 million sports-related injuries in the Netherlands every year. The RIVM describes a sports injury as follows:

“A sports injury is an injury that occurred during or as a result of a sporting activity and as a result of which this activity had to be stopped or could not be participated in the next activity”.

In recent years, we have seen more and more injuries in children (< 17 years) caused by a sports activity in our physiotherapy practice. Figures from the RIVM also show that around 12.5% of children under 17 years old have to deal with a sports injury every year. That percentage is almost the same as the age group 35 to 54 years, and that seems remarkable at first glance. For me, this is a reason why I would like to share my thoughts about this with you and, above all, try to prevent these injuries.

In the case of injuries, we can distinguish between overuse injuries and acute injuries. In field football, one third are overuse injuries and two thirds are acute injuries. But these acute injuries are also related to overload because local fatigue makes it less or too slow to respond to unexpected contact moments. An example of this is the ankle spraining while landing a jump after a child in the air received a push at the end of a workout.

But how is it that children become overburdened when performing their sport? Shouldn't children be able to move endlessly, unlimitedly, all day long?

On the one hand, there is generally less exercise there. There is less playing outside, there is less and less gym classes at school, and in addition, the arrival of Playstation, Nintendo Switch, Xbox and other gaming consoles has led to less exercise and poorer overall physical development. Sport, if any sport is being done at all, is often the only real exercise moment in their week and this is often a unilateral burden.

In addition, at an increasingly younger age, the sporting child is required to specialize in sports. Because of this early specialization, a child has a narrower motor basis and therefore little variability in movement. This variability is necessary to perform a motor task in different ways, such as the different techniques for throwing a ball from A to B. The more options the nervous system can come up with to perform the same task, the higher the variability. When a child can only throw a ball in one specific way, we speak of low variability. When a child specializes at an early age, they develop fewer choices for the nervous system to perform a motor task. Due to a reduction in choices (low variability), the same movements are often made and overload occurs earlier. In addition, with a low variability, acute injuries also occur earlier, as the body cannot adapt properly to situations outside its own motor base.

A high variability of exercise is therefore important for sports clubs to apply, for parents to monitor this, but also especially in physiotherapy during the recovery and prevention of children's injuries.

Variation in physical therapy

If a child with an injury comes to a physiotherapist, there is currently still too often a focus on the five basic motor properties. For example, the muscle strength of the leg is trained on a leg press, a leg extension or a leg curl. Aside from the discussion whether strength training on machines is suitable for children, it is also simply a very boring thing for them to do. A variety of different forms of exercise are a well-known principle in physical education (gym classes), but in sports training and rehabilitation with a physiotherapist, you still see these basic principles not being applied enough.

Variation in exercise and “task-oriented training” in a playful way is more effective and fun to do. As an example, I am currently supervising a 12-year-old football player after a knee ligament injury. Here, I try to make each rehabilitation training different from the others in order to train strength and stability from different positions of the body. This includes the standard lunge exercises (lunge), which you can vary endlessly. The lunge can be done at different heights, on/without a bosu ball, with/without duo tasks from football, with/without the torso at different angles, with/without external resistance, with/without command, or with/without visual input. This increases the child's motivation and attention and trains the body to be able to react and anticipate from different situations outside its own motor base, two birds with one stone, I would say.

Why should we simply train on a device when the task is complex and multi-faceted? And why should we train one prescribed exercise pattern such as the lunge endlessly with increasing weight instead of training this dropout (the task) with endless variations?

I would like to end with the advice to parents and associations to make exercise more varied. At the moment, for example, Ajax's youngest youth only spends 55% of the time playing football and they also do judo, gym, etc. Let's all follow this example.

First move, then exercise and then specialize.

Best regards, Guylian Kick

Physical therapist

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