strategies for pediatric sports rehabilitation · excessive anterior pelvic tilt? • too often we...

Strategies for Pediatric Sports Rehabilitation

Marc Sherry PT, LAT, CSCS, PES11-14-08

4 Pediatric Rehab Goals1. Create athlete centered / parent

supported treatment and education2. Understand differential diagnosis for

pediatric athletes3. Rehabilitation program to return athletes

to pain-free function and sport4. Focus on LTAD

– Minimize chance of re-injury or compensatory problems

1. Create athlete centered / parent supported treatment and education

• “Our goal is to pitch on the varsity team as a freshman.”

• “We have been doing the exercises.”• “The team needs her back as fast as

possible”• “They won’t have a chance without him”

Advantages of the patient centered / parent supported approach:

• Empowers the patient• Makes the patient feel that they are the

primary concern• Establishes ownership of the rehabilitation

program and guidelines• Avoids parent-child conflicts

How…………….• Talk to the kids as patients and parents as

parents• Direct your eye contact to the patient• Don’t ask parents what/how the athlete is feeling• Involve parents in treatment to assist not to

supervise• If needed ask parents to wait in the waiting room

(summary report)• Watch out for the over-invested, overprotecting,

and over-programming parent

2. Understand differential diagnosis for pediatric athletes

• Knowledge – communication (MD & PT)• Response to treatment can be an effective

diagnostic tool• Accurate differential diagnosis will

determine your tolerance for continued play

3. Rehabilitation Approach and Progression

• Treat the cause not the symptoms– car analogy

• Dynamic and static posture and alignment– Fundamental movements

• Force reduction before force production– Injury mechanisms

• Develop Athleticism• Sport biomechanics

Treat the cause not the symptoms

• 15 yo male bball player with patellar tendonitis– modalities and anti-

inflammatory treatments for the tendon, direct stretching and strengthening of the quad

Treat the cause not the symptoms• Cause =

– valgus and anterior knee alignment during squats and landings

– Tight calf musculature doesn’t allow for normal dorsiflexion during triple flexion

– Lateral hip weakness allows femoral IR

RX = proximal hip strengthening, calf stretching, neuromuscular and proprioceptive drills

Dynamic and Static Posture

• Tension vs. Tightness

• Does the athlete have tight hamstrings or an excessive anterior pelvic tilt?

• Too often we stretch tension

• More often we should strengthen antagonists

Dynamic and Static Posture• lower limb pronation

– plantar fascitis, achilles tendonitis, medial tibial stress syndrome

• knee valgus– ACL injuries, medial hamstring problems, ITB

• excessive ant. pelvic tilt– spondys, hamstring injuries, hip impingement

• scapular winging– shoulder impingement, TOS, bicep tendonitis

Fundamental Movements• Squat: single and double

leg– triple flexion, stable spine– ankle-knee-hip

Fundamental Movements• Lunge – forward and lateral

Force Reduction – Eccentric Control

• “Triple Flexion” + alignment• Bending while landing vs. Bent landing

Force reduction – or lack thereof

The Seven Elements of Athleticism

• Strength• Core Balance• Dynamic

Mobility/Flexibility• Agility• Coordination• Speed• Power

Sports Biomechanics

• Assess biomechanics to assess for abnormal and compensatory stress

4. Focus on LTAD Don’t let short term sport success affect long

term athletic development

• Develop objective criteria based on evidence and stick to it.– 11 year old strikeout king is often the HS 2nd baseman

• The next game will always be the biggest game.• Perfect practice makes perfect• Healthy kids make healthy adults

Kubler-Ross's five stages of Injury

1. Denial - education2. Anger - focus on the future, not

the past, let them know you care

3. Bargaining - have strict criteria, one game make-break theory

4. Depression - try to involve athlete in team activities, screen

5. Acceptance - provide means for success and progressive goals

Gambetta Sport Age - Training Sequence

Questions

Marc Sherry PT, DPT, LAT, CSCS, PES

MSherry@UWHealth.org

www.uwsportsmedicine.org