Download Lecture 13 The Adolescent & The Aging Athlete 2016

The Adolescent and
the Aging Athlete
Stages of Life and Activity
Levels
 Birth to death continually changing , some good ,
some for maintenance some bad – happen to all as
we grow and develop
 Natural progression  youth – growth and development
 Young adult – maturation and adaptation
 Final stages of regression in abilities and function
As we age some activities not so simple any more , we are
slower in reaction time , we fall more
So how does age influence a rehab program
Trends in work and Leisure
 People now have more leisure time than work time
 Increase in the number of leisure activities and
number of people participating
 Different levels of skill and devotion to the activity
 Economic background – sex
 People are living longer and want to be active longer
Pediatric Considerations
 Patients developmental stage and structure injured
 Kids are not small adults
 Can not be treated like adults with rehab programs ,
adjustments must be made with consideration of their
physical and physiological maturity level
 Growth and Development
 Girls begin growth pattern earlier and end earlier (
approx. 2 years)
 Puberty - girls 9 boys 11
 Epiphyses close at 18 girls boys 20
Growth and Development
 Bone factors
 Damage to physis ( forms new bones ) can limit bone growth
 Young bones more resilient and elastic than adult bones
 Green stick fractures
 Articular Cartage Factors
 Subject to same stress as adults , but evidence suggests may
heal better than adults
 Active children may develop thicker cartilage than non
active , leading to active children less lightly to develop OA
 Muscle Factors
 Girls and boys have same muscle proportions and strength
prior to puberty
 Post puberty muscle size and strength greater in boys
 Strength training for preadolescents AAP 2001 guidelines
and recommendations
Growth and development
 Tendon Factors
 Tendon applies increased tension on the apophyseal
attachments
 Repetitive stress injuries
 Growth spurts
 Osgood schlatters
 Neurological Factors
 Repetition of specific activity
 Neural changes and neuromuscular recruitment
improvements are responsible for strength gains in children
prior to puberty
 Thermoregulatory Factors
 Children release heat differently ( do not sweat as well )
 Heat released by convection ( red faced)
Adolescent Sport
Participation
 In USA ½ boys and ¼
girls engage in
organized sports
 Increased sport
participation
numbers = higher
injury rates
 Swimming
 Jogging
 Basketball
 Volleyball
 Weight training
 Intrinsic/ extrinsic
factors
 Non-modifiable
 Modifiable
 Prevention
Common Injuries/ Conditions
seen in Adolescent Athletes
 Epiphyseal plate
injury
 Apophysitis
 Fractures
 Avulsion Fractures
 OsgoodSchlatter’s
 Tendon, sprains
strains
 Swimmer’s
shoulder
 Jumper’s knee
 Gymnast’s back
 Little League
elbow
 tendinitis
Bone & articular cartilage
Rehab
Bone prevent additional injury
Bone heals quickly
Watch out for damage to growth
plates – usually casted
Rehab gradual and progressive ,
generally looking to increase ROM,
usually active are sufficient
Muscle and Tendon Rehab
 High reps low weights
 20 – 30 reps before increasing weight
 Proper form crucial - supervision
 incorporate rest
Neurological and Thermo
Rehab
 Pre pubescent - Will not increase muscle bulk but will
make strength gains
 Repetitions improves accuracy
 Children look red faced after activity – this is normal
 However extra care must be taken on hot /humid
days – more breaks and water
Geriatric Considerations
 Peak physical conditioning 20 – 30 years old
 Reversal is slow process – so many years later we
notice the decline in our abilities
 Normal aging process –
 As therapists we can not have the same expectations
of our patients as we do with young patients
 Remember many may be older than you.. The
therapists .. but they may still feel young and energetic
 They desire as much care and attention as our
younger population
Physiological Considerations
 Bodies Changes with Age
 Peak at 20 – 1% loss a year 40 % loss by time 75 ( 40
– 50 years)
 Some systems decline slower that others
 Generally connective tissue becomes stiffer ,
affecting muscles , tendons and joints
 Risk of injury is increased
 Muscular Factors
 Scaropenia – decreased muscle mass secondary to
aging ( both size and number of muscle fibers )
 15 % decrease each decade after age of 70 30 %
decrease
 Speed and muscle endurance decrease as well
 However size , speed and coordination will increase
with exercises
Physiological Considerations
 Skeletal Factors
 Bones and joints – as we age less water in the cartilage ,
leading to increased joint stress
 Thickness of cartilage decreases with age
 Menopause – bone density decreases slowly at first and
then more rapidly ( post menopausal ) – men bone
density decreases as well
 However bone strength can improve with weight bearing
activities
 Neural Factors
 Balance , speed of movement decrease with age
 Loss of hearing or sight , can effect balance but also
hearing and reading instructions
Rehab considerations
 Exercise a positive influence on the aging
process
 Older athletes may show less decline
 For the aging population , cardio, muscle
strength , balance, coordination, flexibility and
endurance all can increase with regular exercises
 Cardiovascular –
 monitor heart rate – 220 – age 50 % a good start
point , can work up to 80 % of max
 Neuromuscular
 Strength and endurance gains can be made , but
slower
 Agility much slower , caution advised
 balance – single leg young 30 sec single leg , 6585 19 sec
Who is the Aging Athlete?
 Middle Aged 4564yrs old
 Elderly 65-84
 Populations 85
years plus are
considered very
old
 Explosive
population for the
next several
decades
Common Injuries for this
Age Group
 Subacromial
bursitis
 Adhesive
capsulitis
 Subacromial
impingement
syndrome
 Trochanteric
bursitis
 Back pathology
 Degenerative
meniscal tears
 Partial tears of the
triceps surae
 Post traumatic
ankle instability
 Plantar fasciitis
Other Concerns
Strength,
flexibility,
balance
Osteoporosis/
osteoarthritis
Rehabilitation
Considerations
 Initially more time may be needed for
assessments
 Hearing , comprehension
 Larger font handouts
 Similar rehabilitation can be given to aging
athletes
 Older pts compromised vascular supply – healing
will take longer
 Caution and slower progressions should be used
 Warm-ups – cool downs
 Weights – light
 Stretching – avoid overstretching –slow and
controlled
 Balance – watch risk of falling withal exercises