After completion of this chapter, the physical therapist should be able to do the following:
Describe common macrotraumatic and microtraumatic musculoskeletal injuries occurring in the skeletally immature patient.
Describe selected congenital, acquired, and musculoskeletal pathologies seen in active skeletally immature patients.
Apply basic rehabilitation principles governing the care and prevention of macrotraumatic and microtraumatic musculoskeletal injuries in the skeletally immature patient.
Differentiate between categories of growth plate fractures.
Describe physiologic considerations unique to the active skeletally immature patient.
Describe special psychological considerations for the skeletally immature athlete.
Describe participation guidelines for the skeletally immature athlete.
Growing musculoskeletal tissue is innately predisposed to specific injuries that vary greatly from the injuries sustained by their skeletally mature counterparts, yet more and more youngsters are sustaining injuries that years ago primarily occurred in the skeletally mature athlete.1,19,39 Many injuries that occur in youth sports today can be attributed to the increased volume of participation by youngsters in a variety of competitions that are scheduled by adults.18
This chapter briefly describes common macrotraumatic and microtraumatic injuries sustained by the young patient, along with basic principles that govern the treatment of these injuries. Macrotraumatic injuries occur as a result of a single, supramaximal loading of bone, ligament, muscle, or tendon. Common youth macrotraumatic injuries that are discussed include epiphyseal and avulsion fractures. Microtraumatic injuries, on the other hand, result from submaximal loading that occurs in a cyclic and repetitive fashion. Common microtraumatic injuries that occur in the immature musculoskeletal system that are presented include osteochondroses and traction apophysites. Special concerns unique to the immature musculoskeletal system that do not fall neatly into the macrotraumatic or microtraumatic categories also are presented. Finally, physiologic and psychological issues unique to the youth patient also are presented.
Macrotraumatic Musculoskeletal Injuries
Growing bone is the weak musculoskeletal link in the young athlete. Physical demands resulting in muscle strain or ligament sprain in the skeletally mature patient may result in epiphyseal plate injury in the young patient. The epiphyseal plate or growth plate is divided into zones differentiated from one another by their structure and function. Beginning at the growth area of long bone and progressing in the direction of mature long bone, the 4 regions of the growth plate are the reserve zone, proliferative zone, hypertrophic zone, and bony metaphysis. The reserve zone produces and stores matrix; the proliferative zone also produces matrix and is the site for longitudinal bone cell growth. The hypertrophic zone is subdivided into the maturation zone, degenerative zone, and zone of provisional calcification. It is within the hypertrophic zone that matrix is prepared for calcification, and it is here that the matrix is ultimately calcified.48
Injury to the growth plate can occur when stress or tensile loads placed upon bone exceed mechanical strength of the ...