UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Musculoskeletal injury in children and skeletally immature adolescents: Overview of treatment principles for nonoperative injuries

Authors
Gabriel P Brooks, PT, DPT, SCS, MTC
Dana M Fitzgerald, MD
Albert C Hergenroeder, MD
Section Editor
Joseph Chorley, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic provides an overview of the basic principles of and modalities used in the treatment of nonoperative musculoskeletal injuries in young athletes. Rehabilitation of musculoskeletal injuries, with an emphasis on the physical therapy program, is discussed separately. (See "Musculoskeletal injury in children and skeletally immature adolescents: Overview of rehabilitation for nonoperative injuries".)

The discussion that follows assumes that fractures and joint instability have been excluded. The evaluation of musculoskeletal trauma and the management of fractures and unstable joints are discussed separately.

EPIDEMIOLOGY

Formal physical activity in the form of high school sports participation has grown from an estimated 4 million participants during the 1971-72 school year to an estimated 7.5 million in 2008-09 [1]. For the first time in 2007, the number of girls competing in high school sports exceeded 3 million. The health benefits of increased physical activity (eg, bone health, weight management, improved self-esteem, increased strength, endurance, and flexibility) are well documented. However, those who participate in athletics are at risk for sports-related injuries [2].

High school athletes account for an estimated 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations annually [2]. Most injuries among high school athletes are lower-extremity sprains and strains. (See "Ankle sprain".)

Among younger children (aged 3 to 15 years) who present to their primary care provider with complaints of musculoskeletal pain, more than 80 percent of cases are caused by trauma, overuse, or osteochondroses (eg, Osgood-Schlatter, Sever disease, Kienböck disease, Freiberg infraction) [3,4].

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Apr 11 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. National Federation of State High School Associations. 2008-2009 High School Athletics Participation Survey. Indianapolis 2009. www.nfhs.org/content.aspx?id=3505 (Accessed on October 09, 2009).
  2. Centers for Disease Control and Prevention (CDC). Sports-related injuries among high school athletes--United States, 2005-06 school year. MMWR Morb Mortal Wkly Rep 2006; 55:1037.
  3. de Inocencio J. Musculoskeletal pain in primary pediatric care: analysis of 1000 consecutive general pediatric clinic visits. Pediatrics 1998; 102:E63.
  4. De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child 2004; 89:431.
  5. Stirling JM, Landry GL. Sports medicine training during pediatric residency. Arch Pediatr Adolesc Med 1996; 150:211.
  6. Taras HL, Nader PR. Ten years of graduates evaluate a pediatric residency program. Am J Dis Child 1990; 144:1102.
  7. Anderson JM, Felsenthal G. Residency training in physical medicine and rehabilitation. I: Clinical and didactic experience. Arch Phys Med Rehabil 1990; 71:372.
  8. Glazier RH, Dalby DM, Badley EM, et al. Determinants of physician confidence in the primary care management of musculoskeletal disorders. J Rheumatol 1996; 23:351.
  9. Glazier RH, Dalby DM, Badley EM, et al. Management of common musculoskeletal problems: a survey of Ontario primary care physicians. CMAJ 1998; 158:1037.
  10. Reid DC. Sports Injury Assessment and Rehabilitation, Churchill Livingstone, New York 1992.
  11. Magee DL, Quillen WS, Zachazewski JE. Athletic Injuries and Rehabilitation, 1st ed, WB Saunders Company, Philadelphia 1996.
  12. Anderson SJ. Principles of Rehabilitation. In: Care of the Young Athlete, 2nd edition, Anderson SJ, Harris SS (Eds), American Academy of Orthopaedic Surgeons: American Academy of Pediatrics, Elk Grove Park, IL 2010. p.263.
  13. Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage 1994; 9:56.
  14. Hergenroeder A. Acute shoulder, knee, and ankle injuries part 2: Rehabilitation. Adolescent Health Update 1996; 8.
  15. Mac Auley DC. Ice therapy: how good is the evidence? Int J Sports Med 2001; 22:379.
  16. Lievens P, Leduc A. Cryotherapy and sports. Int J Sports Med 1984; 5(Suppl):37.
  17. Janwantanakul P. The effect of quantity of ice and size of contact area on ice pack/skin interface temperature. Physiotherapy 2009; 95:120.
  18. Tomchuk D, Rubley MD, Holcomb WR, et al. The magnitude of tissue cooling during cryotherapy with varied types of compression. J Athl Train 2010; 45:230.
  19. Hocutt JE Jr, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. Am J Sports Med 1982; 10:316.
  20. Hobbs KT. Results of intramuscular temperature changes at various levels after the application of ice. Sport Health 1983; 1:15.
  21. Myrer JW, Measom G, Durrant E, Fellingham GW. Cold- and hot-pack contrast therapy: subcutaneous and intramuscular temperature change. J Athl Train 1997; 32:238.
  22. Zemke JE, Andersen JC, Guion WK, et al. Intramuscular temperature responses in the human leg to two forms of cryotherapy: ice massage and ice bag. J Orthop Sports Phys Ther 1998; 27:301.
  23. Merrick MA, Knight KL, Ingersoll CD, Potteiger JA. The effects of ice and compression wraps on intramuscular temperatures at various depths. J Athl Train 1993; 28:236.
  24. Sloan JP, Gidding P, Hain R. Effects of cold and compression on edema. The Physician and Sports Medicine 1988; 16:116.
  25. Quillen WS, Rouillier LH. Initial management of acute ankle sprains with rapid pulsed pneumatic compression and cold. J Orthop Sports Phys Ther 1982; 4:39.
  26. Bugaj R. The cooling, analgesic, and rewarming effects of ice massage on localized skin. Phys Ther 1975; 55:11.
  27. Waylonis GW. The physiologic effects of ice massage. Arch Phys Med Rehabil 1967; 48:37.
  28. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther 2010; 90:581.
  29. Drez D, Faust DC, Evans JP. Cryotherapy and nerve palsy. Am J Sports Med 1981; 9:256.
  30. Cross KM, Wilson RW, Perrin DH. Functional performance following an ice immersion to the lower extremity. J Athl Train 1996; 31:113.
  31. Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med 1986; 3:398.
  32. Uchio Y, Ochi M, Fujihara A, et al. Cryotherapy influences joint laxity and position sense of the healthy knee joint. Arch Phys Med Rehabil 2003; 84:131.
  33. LaRiviere J. The effect of ice immersion on joint position sense. J Sport Rehabil 1994; 3:58.
  34. Hopper D, Whittington D, Davies J. Does ice immersion influence ankle joint position sense? Physiother Res Int 1997; 2:223.
  35. Dover G, Powers ME. Cryotherapy does not impair shoulder joint position sense. Arch Phys Med Rehabil 2004; 85:1241.
  36. Costello JT, Donnelly AE. Effects of cold water immersion on knee joint position sense in healthy volunteers. J Sports Sci 2011; 29:449.
  37. Oliveira R, Ribeiro F, Oliveira J. Cryotherapy impairs knee joint position sense. Int J Sports Med 2010; 31:198.
  38. Grassi Dde O, de Souza MZ, Ferrareto SB, et al. Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint. Man Ther 2011; 16:495.
  39. Cleland JA, Mintken PE, Carpenter K, et al. Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial. Phys Ther 2010; 90:1239.
  40. Tate AR, McClure PW, Young IA, et al. Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series. J Orthop Sports Phys Ther 2010; 40:474.
  41. Jennings J, Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. J Orthop Sports Phys Ther 2005; 35:409.