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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
www.uwsportsmedicine.org
