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EDITORIAL Table of Contents  
Ahead of print publication
Perpetuating chronic injuries in the young sports’ person?


 Amar Jyoti Institute of Physiotherapy, University of Delhi, Delhi, India

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Date of Submission31-Mar-2022
Date of Acceptance01-Apr-2022
Date of Web Publication25-May-2022
 


How to cite this URL:
Parasher RK. Perpetuating chronic injuries in the young sports’ person?. J Soc Indian Physiother [Epub ahead of print] [cited 2022 Dec 7]. Available from: http://www.jsip.ac.in/preprintarticle.asp?id=345921




The participation of children in sports is promoted from a very young age as it leads to overall fitness and comprehensive development of the child—cardiovascular, cognitive, psychological, emotional, etc. Traditionally, it was considered important enough for parents to urge their kids to “go out and play” for obvious health benefits and, additionally, to promote the development of life skills. The life of children was relaxed and playful.

However, things have changed—sports have now become highly competitive and aggressive—leading to children as young as 6 years being propelled toward a journey of physical as well as psychological injuries and reinjuries. About 90% of young athletes report physical injury during play, and more than half of them continue to play while injured—most often with the knowledge of the team physician/physiotherapist and or coach/parent.

The young athlete is clearly ignorant of the long-term ramifications of repeated injuries and the masking and more damaging effects of pain killers that consequently lead to even more severe injuries. They are high on testosterone and will do anything to get back on the field, so as to not lose their “spot” on the team!

It is not surprising that the abuse of pain killers and/or narcotics starts young, soon becoming a chronic problem. Interestingly, everybody involved: the coach, the field medical personnel, and parent, and most of all the athlete add to problem by reducing the gravity of the injury—and refusing to stop play or practice. He or she is asked to “shake” it off! Little does one realize that injuries, regardless of severity, need time (at best 3–6 weeks) to heal, and rehabilitated in preparation for return to play. The biology of the developing tissue further impacts the type, severity, and healing of the injury—for example, the bone growth plates are more prone to injury and require extra time and care to heal.

The immediate or acute response to injury is to “shut down” all activity in the injured part—as a protective response. Consequently, there is an overuse of the uninjured body parts as the body weight and the activity will shift to the uninjured side. This leads to an automatic cortical reorganization of the sensory motor areas responsible for the control of the injured and uninjured limbs. Accordingly, comprehensive rehabilitation should include interventions that address deficits that are directly and indirectly as a result of the damaged tissues but also interventions that will address the reorganization of the neural system—to preinjury status. Unfortunately, we stop once the localized pain and discomfort have been alleviated!

Pain secondary to injury serves as a signal that initiates the body’s healing mechanisms. Rest and/or immobilization allows the healing processes to occur at a tissue and or the molecular level. Tissue is repaired essentially by the laying down of collagen fibers—a process critical to the long-term integrity of the healed tissue. Hence, suppressing pain or stressing the injured tissue too early, as in the immediate return to sport by taking painkillers, results in poor or weak tissue healing—leaving it vulnerable to reinjury and sometimes a complete tear. Thus, the suppression of pain should be graded and done with caution. It is important to administer pain-suppressing modalities in order to make the injured athlete comfortable—to reduce his/her suffering—but should not be used as a strategy or tactic to return them to play.

It is imperative to realize that there are no shortcuts when it comes to the rehabilitation of the injured athlete, and more importantly, there should be a consensus between stakeholders in deciding the plan of care and their return to sports. Furthermore, it is vital that we set a goal of ZERO tolerance, as a vicious cycle of injuries and reinjuries has significant ramifications to the long-term participation of the athlete in sports and to their quality of life as they grow older—with the early onset of degenerative changes in tendons, joints, etc., reducing their playing life span.

Another sports injury that plagues young children involved in recreational play as well as organized leagues is the incidence of repetitive minor head injuries or subconcussions in soccer players, boxers, and/or other contact sports. Soccer is a popular team sport played by both boys and girls across all ages. It involves the repetitive heading of a ball—both during practice as well as during a game. Similarly, boxing, another contact sport played by youngsters, involves the repetitive hitting of the opponent on the chin and or head. In both cases, the young athlete experiences a large number of repetitive submaximal concussions during a game as well as over a period of time. Imagine a firm gel-like mass, a young developing brain, being repeatedly bashed against an unrelenting hard surface (our skull). These repetitive hits lead to microscopic bleeds and widespread, intermittent, cellular damage—in the short and long term—resulting in a broad spectrum of neurological deficits. The general approach to the effects of such head injuries (yes, head injuries), albeit several minor ones, is to “shake it off” and continue with the game or match. It is important to understand that these brains are still maturing. Several studies have reported deficits related to cortical damage, such as reduced reaction times, attention deficits, anger issues, and problems with decision-making following such injuries. Needless to say, sending these athletes back on to the field makes them exponentially more vulnerable to more severe injuries over the long term or as they grow older.

The solution is not a complete cessation of all sports, but rather to implement policies and procedures that will increase safety standards and prevent or reduce unwanted injuries and reinjuries. This responsibility lies with all stakeholders—clinicians, coaches, school management, club management, etc. Additionally, the all-around physical infrastructure of the playing field/arena/equipment needs to be drastically improved. Finally, and more importantly, we need to be able to take tough decisions of benching an injured player. Trained personnel on and off the field should be given the freedom to make independent decisions, without external pressure. Rehabilitation should be comprehensive, and adequate time should be given to allow the tissue/body to heal. We/clinicians should at best facilitate the process not “short change it.”

In schools and sport clubs where organized sport is serious occupation—we need to mandate regulatory policies that will protect the young athlete. National and state sport authorities need to formulate and implement regulatory policies that safeguard the athlete, as well as ensure that only certified and/or licensed medical personnel and coaches are employed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



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Correspondence Address:
Raju K Parasher,
Amar Jyoti Institute of Physiotherapy, University of Delhi, Vikas Marg, Karkardooma, Delhi 110092
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jsip.jsip_3_22





 

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