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Bone Heath in the Adolescent Athlete – are you harming your future self?
Bone Health in the Adolescent Athlete – are you harming your future self?
Written by APA titled Sports & Exercise & Musculoskeletal Physio Rick Bain
As an APA Titled Sports and Exercise Physiotherapist, I work with a lot of endurance athletes, both recreational and professional. As a result, I am regularly (way more than I would like to) diagnosing and managing Bone Stress Injuries (BSI’s). I see these injuries in a broad age spectrum, from adolescents to the middle aged. Commonly, once a Bone Stress Injury has been diagnosed, it is also found that the athlete has less than normal Bone Mineral Density (BMD). BMD is often the main marker for bone health, and usually peaks in early adulthood when many athletes are reaching their peak of their athletic potential. Ensuring adolescents reach their sporting goals whilst optimizing bone health can be a tricky balancing act.
The adolescent years are key for the development of bone health, with approximately 90% of peak bone mass being achieved by approximately 18 years of age. Peak bone mass is a major predictor of long-term BSI/fracture risk (osteoporotic fractures). Once athletes pass the adolescent phase, BMD decreases over time, so it is crucial that optimal BMD is reached before the end of adolescents for long-term bone health, and to minimize the incidence of BSI’s into the future.
What Influences Bone Mineral Density?
BMD is influenced by numerous modifiable and non-modifiable risk factors. Engaging in weight bearing sports has been shown to be a protective factor in bone health in the general population, with athletes demonstrating up to 10% higher BMD than their non-athletic counterparts. Adolescents who perform ball sports generally have a higher than average BMD, and adults with a history in ball sports appear to be protected from bone stress fractures in future sporting pursuits. This is thought to be due to ball sports incorporating multi-directional, intermittent, weight bearing bone stimulus that is crucial for developing strong healthy bones.
In contrast, adolescents specialize into running or aesthetic sports (gymnastics, figure skating, diving), are at significantly higher risk of sub-optimal bone health, in part, due to high training loads and under eating/fueling for aesthetics, leading to development of Relative Energy Deficiency in Sport (RED-S). Some of the risk factors for low BMD include; genetics, diet, Relative Energy Deficiency in Sport (RED-S), smoking, inadequate skeletal loading (muscle strengthening), early sports specialization, and certain medications.
Relative Energy Deficiency in Sport (RED-S) presents a significant risk factor for low BMD in an adolescent, and hence an increased risk of Bone Stress Injury and osteoporotic fractures. RED-S is where the body is not taking in enough energy (caloric intake) to meet the demands placed on it by the amount of exercise/training being performed. Also known as “Low energy Availability”, this leads to not only insufficient energy for optimizing sports performance, but also insufficient energy to maintain optimal bone health development, among other wide ranging body functions.
Put simply: Energy Expenditure > Energy Intake = decreased energy availability
How do we investigate bone health in the adolescent athlete?
If investigation into bone health is indicated, an assessment by a Sports Physician is essential. This will include taking a comprehensive history to screen for pertinent risk factors. There are several blood tests indicated to assess for medical contributors to bone health, such as Calcium, Vitamin D, and bone turnover markers, among others. Imaging via Dual Energy X-ray Absorptiometry (DEXA) measures Bone Mineral Density (BMD) and is matched with a healthy person of the same age and sex.
| Level | Definition |
| Normal | BMD within 1 SD (+1 or −1) of the young adult mean. |
| Osteopenia | BMD between 1 and 2.5 SD below the young adult mean (−1 to −2.5 SD). |
| Osteoporosis | BMD 2.5 SD or below the young adult mean (−2.5 SD or lower). |
Conclusion:
- Peak BMD is achieved in in adolescents and these years are key in to achieve long term adequate skeletal heath. Adult athletes are at an increased risk of Bone Stress Injuries if the adolescent years pass without developing sufficient bone mineral density. BMD is difficult to improve in adulthood.
- Low BMD in adolescents often develops due to complex, multi-factorial relationships between medical risk factors, high training loads, and under-fueling.
- Low BMD is an important diagnosis not to miss in the young athlete. In those with risk factors, a DEXA scan should be considered to investigate and potentially treat any immediate and long term fracture risk into adulthood.
Our Physio team is available for consult, for quick and easy booking go online www.mygcphysio.com or call us during business hours on 07 5500 6470
Physio can help before you get injured, not just after.
By Running Physio, Kyle Weise
A common misconception about physio is that we are just here for when an injury and pain gets to the point that it limits your ability to function or participate in your hobbies &/or sporting pursuits. However, there is significantly more that Physio can offer you- whether you are experiencing a current injury or not.
What I tend to find in the clinic is someone will present with an injury, however, the information and planning we put in place even after the initial injury has settled to help improve function and performance in addition to reducing the risk of further injury are things that could be put in place before the initial injury is even present. I find the largest barrier to people realising this is how good we are at forgetting what it was like to be injured. This leaves us thinking we “will be fine” because everything is feeling good right now. Runners, I’m looking at you! Oh how quickly we forget what it was like to not be able to run.
So what can physio offer to someone who is not currently experiencing pain or injury?
Identify actual or potential training errors.
– When someone presents with an injury, I will also go through the person’s history and what they have been doing over recent times. The vast majority of the time, we will be able to find likely contributing factors to the current injury presentation. One of the most useful things we do as physios is help you understand why an injury has happened and help give you the knowledge as to why so that you will be able to identify things that will contribute to future injuries.
Identify physical weaknesses/imbalances
– Even though most people work quite hard on these areas, there are generally always things we can improve on. Identifying these areas before they potentially contribute to a future injury can be very useful at reducing your risk of future injury.
Identify other contributing factors
– There are numerous factors outside of just a particular activity which can increase your risk of suffering an injury or pain. Identifying these other factors can be very useful in reducing your risk of injury as they are often things you will not realise increase your risk of injury.
I want to make a note here that we cannot prevent injuries (and if anyone tells you this, ask them for the research to back this concept as we really have none!), however, we CAN reduce your risk of experiencing injury and we can certainly help your performance of activities of daily living, exercise or sports performance.
One of the common phrases that someone will say after we discuss all of the things they could have done better before they suffered their injury is, “I wish I knew this information earlier”.
The main reason I wanted to write this article is to you know that you CAN have access to this information and help NOW- BEFORE an injury stops you from doing the things you love.
Book an appointment now online www.mygcphysio.com.au or phone us on 07 55006470
Can we prevent shoulder injuries in Surf Life Saving?
Injuries are always going to occur in sport and unfortunately the research doesn’t suggest we can completely prevent injuries – so what should we consider instead?.
In surf life saving injuries can be either traumatic such as falling in a pothole when running on the sand, or getting dumped by a wave, or overuse from the high training volumes across the multiple disciplines of swimming, board, ski and running plus gym- across all disciplines, “Clubbies” can be training up to 14 sessions per week! And within this there is a lot of repetitive use and stress, in particular through the upper back and shoulders if you are a water athlete. This may be a cause for the higher number of injuries seen in these body area’s in these athletes.
So how can you reduce overuse shoulder injuries from occurring?
There are a few risk factors present that may put you at a higher risk of developing shoulder pain. Identifying these risk factors is the key to preventing shoulder injuries from occurring. Some of these factors cannot be changed, such as a past history of shoulder pain or the shape of your shoulder joint. Other factors can be changed, and this is where physiotherapy can help.
The first area to identify and address is your range of motion through your shoulder and upper back. It is important to assess how each area moves in isolation, but also with each other. If there is any loss of movement, joint stiffness, or muscle tightness present then these can be addressed.
The next area is to check for strength around the shoulder and the shoulder blade. Your rotator cuff muscles from your shoulder to your shoulder blade play an important role in keeping your shoulder stable and strong during movement, and weakness in any of these may increase your risk of shoulder pain. Measuring the strength of your rotator cuff tells us a few things. We can simply check for side-to-side differences, but this often isn’t enough. We can calculate the balance of strength, or ratio, between the muscles in the front and back of your shoulder and make sure this is where we need it to be. We can also calculate how strong your shoulder should be based on your body weight. All of these different areas can potentially contribute to you developing shoulder pain and can be addressed to reduce that risk.
If you want to get started on some management of your shoulder then check out these foam rolling exercises, here https://www.gcphysio.robicoweb.com.au/…/foam-roller-exercises/
or this upper back mobility exercise here
extensions/
Or if you need help then get in contact with the team here at Gold Coast Physio & Sports Health for an assessment and individual prevention plan today, phone 07 55006470 or Book an Appointment Online www.mygcphysio.com.au
I’m stuck in COVID isolation part 2
I’m in COVID isolation part 2- Self-massage, stretches and foam roller
By Katie Harders- Senior Remedial Massage Therapist and Pilates instructor
Many of us will be stuck in isolation unable to regular remedial massage or physio appointments and from experience the body has stiffened up from watching copious amounts of Netflix or you may have been feeling rubbish but when you feel fit we have put together a few handy self-massage, foam roller stretches and other stretches that will help you at home until you can get back into the clinic for your regular appointments. We have provided a short video of trigger ball and foam roller releases plus some images of other stretches talked about through this article.
- Your trigger ball is your friend– RAD roller, tennis ball or golf ball will do! Put this ball between you and the wall and find some of those sore spots especially around the shoulder blades and mid back, when you find a sore spot hold some pressure on it till it eases off then continue to search for other parts that may be tight (see video)
- Trigger ball rolling release– This is best done with a RAD roller or 2 tennis balls/balls taped together! Place trigger ball either side of the spine up against the wall like above and gently roll up and down with some pressure this will help release those tight back muscles (see video)
- Foam roller back release– start by doing this on the wall and you can progress to the floor as you feel fit. Place the foam roller horizontally between you and the wall and roll up and down your back- move the roller down and continue. You can also do this on the floor, roller under mid back and roll back and forth (see picture)
- Chest and back stretch– place roller vertically along spine make sure head and lower back are supported, best down with long roller (see picture)
- Foam roller hip release– lay face down and place foam roller under hips and gently roll back and forth (see picture)
- Basic lower back and hip stretches– see pictures
We hope these few easy self-massage techniques and stretches get you through isolation and we look forward to seeing you back in clinic when you’re feeling well. We offer online booking so you can book your appointments ahead so you don’t miss out!
