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Systematic Structured Development

Professional Football Development

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Common Injuries and
Medical Conditions

Having a good knowledge and understanding of common sports injuries and medical conditions is not just for physiotherapists:

Youth Coaches
Are you familiar with common sports injuries, growth injuries, and cardiomyopathy? Do you know how to diagnose them in the early stages? Do you know how to administer emergency first aid? Do you know how to programme youth training hours based on injury records?

Players
Do you know your own body and can you regulate the stresses and strains that you put yourself under during football playing / practice? Do you need strapping, supports, medical check-ups or periodic rest?

The following are only a few examples of some of the main youth injuries / conditions to look out for - make sure that you further your knowledge on all aspects of this topic:

- - - - - - - - -

KNEE INJURIES
Osgood Schlatter Disease

Torn Cartilage (Meniscus Tear)


MEDICAL CONDITIONS
HCM-Cardiomyopathy

OSGOOD SCHLATTER DISEASE

Technical Definition
This condition is caused by traction on the tibial tubercle at the point of insertion of the patellar ligament. This traction causes microfractures.

Risk Area
Osgood-Schlatter disease is often encountered by children 10 to 16 years of age who regularly participate in sports such as football, basketball, gymnastics, volleyball, etc.

Basic Symptoms & Diagnosis
A tender painful lump at the top of the shin bone just under the knee joint.





General Treatment
Most youngsters fully recover from the disease after a period of 12 - 18 months without the need for any surgery. As this injury is predominantly caused by 'over use' it goes without saying that complete rest is the initial course of action. In the case of high level young athletes (Academy players, etc), then continuous monitoring of the situation is required by the club physio and a 'minimum' of 1 to 2 days rest is given between training sessions and matches.

DO NOT
Massage the affected area - this only weakens the ligament joint;
or
Use heat treatments (use ice packs on a regular basis);
or
Undergo any weight training exercises until a qualified physio feels that the situation is under sufficient control - and then use progressive 'quad' strengthening exercises

ALWAYS
(Training, Play, and Rest)
Wear a knee sock bandage to prevent any excessive twisting of the knee joint and a single support brace around the lower part of the knee (the join between the shin bone and the patella ligament) as this helps to transfer the load to the upper part of the leg and away from the affected area.

Surgical Treatment
Surgery is rarely required, but if a scan indicates an ossicle under the patellar tendon, then Arthroscopy provides excellent results.

MENISCUS TEAR (Torn Cartilage)

What happens with a meniscus tear (torn cartilage)?
The two most common causes of a meniscus tear are due to traumatic injury (often seen in athletes) and degenerative processes (seen in older patients who have more brittle cartilage). The most common mechanism of a traumatic meniscus tear occurs when the knee joint is bent and the knee is then twisted.
It is not uncommon for the meniscus tear to occur along with injuries to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) - these three problems occurring together are known as the "unhappy triad," which is seen in sports such as football when the player is hit on the outside of the knee.





Symptoms of a Meniscus Tear
Individuals who experience a meniscus tear usually encounter pain and swelling as their primary symptoms. Another common complaint is joint locking, or the inability to completely straighten the joint. This is due to a piece of the torn cartilage physically impinging the joint mechanism of the knee.
The most common symptoms of a meniscus tear are:

**  Knee pain
**  Swelling of the knee
**  Tenderness when pressing on the meniscus
**  Popping or clicking within the knee
**  Limited motion of the knee joint

Continued on Next Page.

Continuation - Osgood Schlatter Disease

Swelling
Swelling is one of the most common symptoms of a torn meniscus and can vary quite a bit among different injuries, and in some cases, there can be very little or no swelling whatsoever. Your knee will feel very tight and look visibly larger than your uninjured knee - when put side by side you will be able to tell if it is swollen. Many people describe it as looking like a grapefruit (large and puffy) and the outline of your knee cap may even disappear. This type of swelling is called an effusion because it is contained within the joint.
A meniscus tear will usually swell very slowly, usually over the first 24-48 hours. This is important to know when you talk to your physician, because it helps to differentiate your injury from other types of knee injuries during evaluation.

Pain
Another meniscus tear symptom is pain. Pain is usually rated as mild to moderate, 2 - 7 on a 10 point scale. It is usually sharp at first, and then may become throbbing or achey as your knee begins to swell.
Trying to straighten or bend your knee often increases pain, and this is especially true after your knee swells up. Although pain is common, you can have a meniscus tear without experiencing pain. But the chances are if you don't have pain you probably won't notice the tear very quickly.

Clicking, Catching, Popping
Following a meniscus tear you may experience popping or clicking in your knee when you bend and straighten it. The meniscus sits directly between the femur and the tibia and if there is a tear, this disrupts the normal movement of the bones. Depending on the tear, and its placement within the joint, it may pop or click when you bend the knee, or you may feel like your knee catches and needs to pop. This is a very common meniscus tear symptom.

Loss of Motion Range
Because a meniscus tear may cause swelling you will most likely lose range of motion in your knee - trouble bending it and unable to bend to 90 degrees, plus difficulty in completely straightening the leg.

Loss of Strength
Because of the swelling and injury to the knee your quadriceps muscles may be inhibited by the body in order to try to protect the injury. This means that you will have trouble lifting your leg, or straightening it out, both because of pain, and a feeling of weakness.

Diagnosis of a Meniscus Tear
Any patient who has knee pain will be evaluated for a possible meniscus tear. A careful history and physical examination can help differentiate patients who have a meniscus tear from patients with knee pain from other conditions. Specific tests can be performed by your doctor to detect meniscus tears, X-rays and MRIs being the two most common - an x-ray can be used to determine if there is evidence of degenerative or arthritic changes to the knee joint and MRI is helpful at actually visualising the meniscus. However, simply 'seeing' a torn meniscus on MRI does not mean a specific treatment is needed. Treatment of meniscus tears depends on several factors and not all meniscus tears require surgery.

Simple Stair Test
If you have pain walking up the stairs - then it is more than likely a torn cartilage!
If you have pain walking down the stairs - then it is more than likely a patella injury!
Note: this is only a very basic initial self-test which will be useful information for your doctor, but a full medical 'knee movement' diagnosis will still have to be undertaken by your family doctor.

Treatment of a Meniscus Tear
Treatment of a meniscus tear depends on several factors including the type of tear, the activity level of the patient, and the response to simple treatment measures. When surgical treatment of a meniscus tear is required, the usual treatment is to trim the torn portion of meniscus, a procedure called a meniscectomy. Meniscus repair and meniscal transplantation are also surgical treatment options. Determining the most appropriate meniscus tear treatment is something you can discuss with your doctor.

* REMEMBER *
Knee joints are extremely complex areas of the body and you may have more than one damaged part - for instance, a young highly active teenage footballer may be encountering Osgood Schlatter disease at the same time as having a Torn Meniscus - so, if feeling any sort of knee discomfort A FULL MEDICAL 'KNEE MOVEMENT' diagnosis is required.

HCM - CARDIOMYOPATHY

A lot has been written about this disease ever since the tragic deaths of Terry Yorath's son (Leeds United youth player) and John Marshall (Everton youth player), but several conflicting so called medical expert opinions have confused many people as to the actual underlying root cause of this disease and its medical remedies.
SSD has sought the very best medical opinion:

What exactly is Cardiomyopathy?
It is a disorder that affects the heart muscle - where the muscle gradually thickens and eventually interferes with the heart valve action (doctor's use the term 'the heart's electrical wiring system').

Who does it affect?
Many young people - one child dies every week from it in the UK.

How common is it?
One in every 500 children has it.

Is it hereditary?
Yes - so check your family history!

What are the symptoms?
In most cases there are no obvious symptoms and the person concerned often has no knowledge of it. Outwardly, the individual appears perfectly healthy, although in some cases, they may show signs of regular breathlessness.

Do doctors normally check for this disease as part of a routine check up?
No - a special medical screening technique is required which is beyond the scope of most local medical practices.
Ultrasound screening and echocardiogram IS THE ONLY WAY to detect the condition in its early stages.

Why do so many active children die from it?
Vigorous physical exercise can bring about a sudden deterioration in the normal functioning of the heart leading to an abnormal heartbeat and congestion of the lungs. Fainting, collapse, or sudden death may occur as a direct result.

What treatment is available?
Early treatment with medication and surgery can save lives, but as the victim is generally unaware of the underlying condition, in most cases, discovery and treatment sadly comes too late!

* SSD RECOMMENDATION'S *
All youth players from age 14 upwards SHOULD be scanned for possible signs of Cardiomyopathy.

Note: Most young players attending professional club football academies in England are now generally checked for this disease through the wearing of heart rate monitors - but not all, so if your child is at an academy then check what procedures they have in place!


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