Children Can Easily Tear the ACL
Young people are in a constant state of growing, for girls this can go on until around 18; for boys this is around 22. “Around” is the right word because growth is as individual to growing adults as eye color or height. Longer growing time means greater height which is the real explanation as to why men are relatively taller than women.
An unfortunate truth is that the highest number of ACL injuries in young people are found in girls playing soccer. The combination of the rigors of the sport and the constant twisting, torquing, and running creates an environment for a torn ACL.
While bodies are growing they are in a constant state of pulling and stretching ligaments and muscles. This leaves all ligaments and muscles vulnerable to damage, even more than when they reach adulthood. The most compelling reason that we must be the parent to our children when it comes to physical performance is that an activity that was “safe” to do one week may be damaging the next week because that is the moment that the body is growing. We have to take the perspective that every moment is a potential growing moment and assume that safety to joints is our prerogative.
It is important, however, to be fully conversant with your child’s injury. Ask for copies of any scans and for accompanying radiologist’s reports, which might not otherwise be included. Ask to have terminology explained in excruciating detail. If your child is a teenager, he or she should be in attendance during these explanations, I think, although that decision is yours. Bear in mind that a teenager may soon be in college and needing to explain his or her medical history to doctors and coaches there.
I have always held the perspective that if your patient does not understand you, then you (the doctor) are at fault. It is your job to explain medical information is a way that the patient understand, not the role of the patient to rise to your deeper understanding.
The above advice applies to any injury, of course. But dealing with A.C.L. tears, which, by some estimates, occur at the rate of about 40 per hour in the United States, requires certain unique considerations from parents.
For the first few weeks after an A.C.L tear, the most widely accepted treatment involves icing the joint, performing range-of-motion exercises, and bracing, if needed, to allow your child to walk. Visit a pediatric sports medicine specialist for the brace fitting; if your child is small or lanky, adult-sized braces, we discovered, tend to slip down the leg.
Use these weeks to consult orthopedic surgeons about why you might not need an orthopedic surgeon. Reconstructing a torn A.C.L. is common, but requires fashioning a new ligament from other parts of your child’s leg or from a cadaver. The surgery is invasive and may not improve long-term knee function when compared to physical therapy alone. In a study published earlier this year,active adults who had opted for physical therapy after an A.C.L. tear had knees that were basically the same after five years as those of adults who had undergone surgery, based on clinical measures of stability and function.
Yes, I wrote “physical therapy” and not chiropractic. A chiropractor should be brought into the part of the therapy that is rehabilitative but not on the part that is reconstructive.
Anecdotally, athletes perform better with a surgically rebuilt knee. So discuss at length with your surgeon whether reconstruction is necessary or desirable for your son or daughter. And talk, too, with your child about the future. One A.C.L. tear can contribute to an increased risk of another tear later, especially if he or she returns to competitive sports.
“Sometimes you need to consider whether just maybe your child should do something else,” said Dr. Andrew Veitch, a professor of orthopedic surgery at the University of New Mexico and the head team physician for the university’s sports teams. A young athlete with a wounded knee might, for example, want to think about taking up low-impact swimming or bicycling instead of returning to soccer or football, in which case he or she could probably skip the surgery.
“Be wary,” however, of cadaver ligaments for a young athlete, Dr. Martha Murray, an orthopedic surgeon and researcher at Harvard Medical School, told me. A number of studies have shown that these tissues, which are frozen and sterilized to kill any infections, tend to be too fragile to withstand the forces applied to them during sports like football, basketball and soccer. Too frequently, they rip.
Meanwhile, whether you decide to proceed with surgery or not, gather recommendations from physicians and friends about local physical therapists with lengthy experience dealing with A.C.L. rehabilitation. A well-designed physical therapy program should help to restore not just your child’s joint range of motion, but his or her balance and proprioception, or sense of body positioning, as well. Researchers, Dr. Murray said, suspect that tearing an A.C.L. severs the ligament’s intricate connections to the nervous system, making the knee and adjoining muscles a millisecond less responsive during movement, which could contribute to injury later. With proper supervision, hopping, lunging and catching a ball while perching on one leg could help your child regain fuller control of his or her lower body.
Whether you encourage your child to maintain close ties with his or her sports team during this time is up to you. It may seem as if showing up for games and practices should buck up an injured athlete. But for many, such vicarious involvement “is frustrating and depressing,” said Dr. Murray, who recommends that her young patients volunteer at an animal shelter or find other means to productively use their after-school time and avoid the playing field.
The same advice applies to parents.Parents often mourn their child’s absence from the playing field more than the child. Be with them while they strengthen their leg and body for surgery, talking about next season, and remodeling themselves adults. If we are all lucky, you will be that grown up, someday.
via Blogger http://chiropractic-lane.blogspot.com/2013/09/children-can-easily-tear-acl.html
Recent Comments