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Mimi Zumwalt, MD

Chapter 13 Prevention and Management of Common Musculoskeletal Injuries in Pre-Adolescent and Adolescent Female Athletes. Mimi Zumwalt, MD. Learning Objectives. Understand the musculoskeletal anatomy and physiology of the athletic female prior to and after pubescence

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Mimi Zumwalt, MD

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  1. Chapter 13Prevention and Management of Common Musculoskeletal Injuries in Pre-Adolescent and Adolescent Female Athletes Mimi Zumwalt, MD

  2. Learning Objectives • Understand the musculoskeletal anatomy and physiology of the athletic female prior to and after pubescence • Recognize the differences between adolescent males and females’ anatomy, physiology, and biomechanics of the musculoskeletal system • Delineate more unique orthopaedic injuries incurred by adolescent female athletes • Comprehend various measures of prevention and management of musculoskeletal trauma sustained by adolescent female athletes

  3. Introduction • Adolescent growth spurt • Growth, development, & maturation • From childhood into adulthood • Alteration of reproductive, physiological, & musculoskeletal systems • Children NOT equate to small adults

  4. Musculoskeletal Anatomy/Physiology of Pubescent Females • Longitudinal skeletal growth • Adolescent growth spurt • Increase in body size/weight • Estrogen • Body shape transformed • Sex specific & SQ fat deposition • Hypertrophy & hyperplasia • Enhancement of motor skills

  5. Musculoskeletal Anatomy, Physiology, & Biomechanics of Adolescent Males vs. Females • Testosterone • Boys stop growing 2 later • Boys gain more muscle mass & strength • Boys deposit less fat • Boys better in motor skills • Speed, power, & endurance • Body structure maintained

  6. Musculoskeletal Injuries In Pre & Adolescent Female Athletes • Title IX in 1972 • Gender equality in scholastic sports • Acute vs. chronic overuse injuries • Growth plate trauma • Bursitis, tendonitis, ligamentous sprains, stress reaction/fatigue fracture • Environmental factors • “Miserable malalignment syndrome” • ACL tears from LE landing attitude

  7. Prevention of Athletic Injuries in Pre & Adolescent Females • Safety equipment/environment • Well-fitting footwear & running stride mechanics • Gradual progression of workout volume • Preseason conditioning program • Strength, endurance, plyometrics/power • Resistance, flexibility; speed/agility, jumping/landing techniques

  8. Management of Musculoskeletal Injuries in Pre & Adolescent Female Athletes • “PRICE” – prevent/Protect, relative Rest, Ice, Compression, Elevation; NSAIDs • Orthopaedic consultation if not improved • Cross training w/alternative activities • Formal physical therapy rehab • Resistance training for muscular strength • No power lifting • Progress to sports-specific drills

  9. Conclusion • Transition from childhood to adolescence • Reproductive, hormonal, nervous, & musculoskeletal changes • Growth, development, & maturation • Acute & chronic orthopaedic trauma • Minimize risks & maximize gains • Strength & conditioning program

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

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