Today is World Children’s Day. Our focus is on an emerging health issue that is closely linked to outdoor activities and the benefits they bring to the old and the young alike . At the same time, we also focus on injuries sustained by children from various sports. While the benefits of exercise is well documented following the invasion of hi technology into classrooms and homes, resulting in the rise of obesity and early onset of non communicable diseases, the fact that no outdoor activity is without some exposure to injury, is not understood well or taken seriously. To ignore such injuries, or delay in getting treatment, could have life long impacts. Due to their fear of the treatment procedure, most kids often delay in seeking help which complicates the injury. But adopting drastic methods such as, surgery is usually the last option, given the long term and much less painful method of physiotherapy.
Chartered physiotherapist, Dr Gopi Kitnasamy, in an interview with the Sunday Observer, draws on his long years of experience to justify this claim.
Excerpts…
Q. The Education Ministry recently decided to give priority attention to school outdoor sports with the idea of promoting fitter students for the future. Is this a good thing?
A. Outdoor activities form an important part of their life and have long term benefits on their health. Adequate outdoor activity increases health and physical development by improving sensory development, reducing obesity and stimulating blood cells. It helps kids stay fit and active which will benefit them in the long run. They can ward off health problems like obesity and heart ailments later in life. Participation in sports activities improves physical fitness, coordination, and self-discipline, and gives children valuable opportunities to learn teamwork.
Q. Many children spend a lot of time out in the sun. Can this adversely affect them?
A. While too much of the sun’s warm rays can be harmful to the skin, the right balance can have lots of benefits. Vitamin D thanks to the sun, plays a big role in bone health.
Low vitamin D levels have been linked to rickets in children and bone-wasting diseases like, osteoporosis and osteomalacia.
Q. Ideally, how long should children be asked to spend time doing outdoor sports activities while in school?
A. While researchers don’t always have an exact measurement for how long you should stay outside to reap these benefits, the ideal time should be 30 minutes to 1 hour.
Q. Games like rugby, cricket, tennis, basketball, football, athletics, running, netball, table tennis, are some of the most popular sports in schools. Which of these outdoor activities will most benefit a child?
A. Always consider age-appropriate activities with children. Your child is likely to show natural preferences for certain sports or activities. Start there, keeping your child’s age, maturity and abilities in mind. For children aged 6 – 9, organized activities like running, gymnastics, swimming and tennis are a good choics. And children above 10, are typically ready to take on complex skill sports, such as football, basketball, hockey and volleyball. Keep in mind, however, that growth spurts caused by puberty can temporarily affect a child’s coordination and balance. Before allowing your child to participate in a contact sport, consider his or her age, maturity, and physical size. Whatever sports your child participates in, ensure that he or she has a foundation of proper technique and movement.
Q. All these sports carry a risk of injuries. Your comments?
A. Yes, although sports participation provides numerous physical and social benefits, it also has a downside, the risk of sports-related injuries. All sports have a risk of injury. In general, the more contact in a sport, the greater the risk of a traumatic injury. Most frequent sports injuries are sprains (injuries to ligaments) strains (injuries to muscles), and stress fractures (injury to bone) caused when an abnormal stress is placed on tendons, joints, bones and muscle.
Q. As an experienced Chartered Physiotherapist tell us how you could avoid such injuries on the playground in 1) general 2) in the specific sports mentioned.
A. The developing bodies of the children are more vulnerable to injuries compared to that of adults. Fortunately, most sports injuries in children can be prevented. Some of the more effective ways to prevent these injuries include age-specific coaching, appropriate physical conditioning, and proper use of equipment. You can also prevent injuries by encouraging children to train for their sport, rather than rely on the sport to whip them into shape. Proper physical conditioning can go a long way towards keeping players off the injured list and on top of their game. The other important strategies to prevent sports injuries are, being in proper physical condition (strength and flexibility), wearing appropriate protective gear, making warm-ups and cool-downs part of the child’s routine before and after sports participation, staying hydrated and stopping the activity when there is pain.
Q. What kind of exercises do you recommend for them?
A. Exercises for children should include the three important elements – endurance, strength and flexibility. Endurance develops when kids regularly get aerobic activity (sports) which if done regularly strengthens the heart and improves the body’s ability to deliver oxygen to all its cells. Improving strength doesn’t have to mean lifting weights, they can do push-ups, crunches, pull-ups, and squats to help tone and strengthen muscles. Stretching exercises help improve flexibility, allowing muscles and joints to bend and move easily through their full range of motion.
Sports specific exercises are training methods used to target those muscles that are particular to a single type of activity. The sport activity is duplicated using various weight training methods.
Muscle strength, endurance, flexibility and range of motion (ROM) are developed specifically to enhance the sport activity by over training individual muscles or groups of muscles so that they perform better at the lighter loads of a specific sport.
Q. How often and for how long do they have to be done?
A. These exercises will take 45 – 60 minutes and can be done on a daily basis but all three elements need to be given equal importance.
Q. Complications through neglecting an injury sustained during sports?
A. If management of sports injury is neglected or delayed, it can lead to an adverse outcome. When muscle is injured and not treated, it can lead to scar tissue formation and the muscle can lose its flexibility and neglected ligament and joint injury can bring about soft tissue (ligament) loosening and joint instability. This may lead to repetitive injury and eventually more serious functional loss and will force you to get out of your sport.
Q. What kind of injuries need surgery? Fractures?
A. Surgery is often considered a last resort, it is most commonly used following a serious injury or as a result of persistent symptoms. Common surgical procedures in sport include repair to damaged cartilage and ligaments in the knee (especially, cruciate ligament tears), shoulder injuries, dislocations and tendonitis. Surgery can usually be used to repair damaged soft tissue, align bones and re-position joints.
Q. What injuries can be treated with physiotherapy and what are the latest treatment options available?
A. Sports injuries may be hard to avoid with active children, and can range from minor cuts and bruises, to more serious sprains, fractures and broken bones. Most of the sports injuries are musculoskeletal and soft tissue related which can be treated with Physiotherapy. Managing and preventing injury in children requires a different approach to adults. Children’s bones are still growing and the presence of the growth plate or apophysis creates a group of conditions unique to children.
Laser therapy is now a popular, safe and effective method of accelerating recovery and is particularly effective for acute soft tissue related sports injuries.
Q. What are the benefits of swimming?
A. Swimming is a fantastic sport that combines all body strength, flexibility and endurance. Swimmers are unfortunately prone to overuse injuries affecting the shoulder, neck, lower back and knees. Training errors such as over training, overloading, or poor technique may also contribute to this condition.
Q. Can such injuries be treated with physiotherapy?
A. Treatment involves corrective exercises and electrotherapy, but more importantly, finding the root cause of the injury and modifying stroke technique to prevent the issue from reoccurring. Avoid overtraining in one particular style of swimming. Core strengthening, rotator cuff strengthening (very important – to prevent shoulder injuries) and land based exercises done pre, post and during swimming season.
Q. Are home remedies an option for sports injuries?
A. Yes, you can treat some of the minor sports injuries at home. Follow the acronym R.I.C.E. as a first aid. Rest the area, apply Ice, Compress it with an elastic wrap, and Elevate it.
Ice therapy
Cold therapy also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. Apply only for 10 minutes but you can repeat it every 3-4 hourly. The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage by:
1. Decreasing the amount of bleeding by closing down the blood vessels
2. Reducing pain
3. Reducing muscle spasm
4. Reducing the risk of cell death by decreasing the rate of metabolism
Q. Is leading an active life a pre-requisite to doing well in sports? Why?
A. Yes definitely, staying active and healthy, reduces the chance of future injuries from occurring, and improve overall performance. A well balanced diet, healthy eating habits, adequate fluid intake and good sleeping routines are also important to improve sports performance.
Q. Obesity in children is an emerging problem in Sri Lanka as it leads to early diabetes and other non communicable diseases. Is this due to lack of exercise? Diet?
A. Childhood obesity is a complex health issue. Lack of physical exercise in children is the main culprit in the startling rise of childhood obesity, heart disease, diabetes, and all other types of preventable medical conditions. Other behaviours that influence excess weight gain include eating high-calorie, low-nutrient foods and beverages, sedentary activities such as watching television or other screen devices and sleep routines.
Q. Can obesity adversely impact on children who wish to excel in the sports field? How?
A. Obesity can cause limitations of the cardiopulmonary and the metabolic systems, resulting in exertional dyspnea (shortness of breath or difficulty in breathing), contribute to the limitations in the functional capacity. In addition, the sedentary lifestyle often adopted by these children contributes to impaired exercise tolerance and poor sports performance.
Q. What exercise do you recommend for obese children to get down their excess fat?
A. Obesity in children often is the result of a sedentary lifestyle. Exercising to reduce weight is very important but need to be carefully monitored. Asking children to elevate their heart rates to a heightened aerobic exercise rate for 30 minutes or longer may be dangerous.
Start with an exercise pace that resembles a brisk walk, rather than a jog. Warm up slowly for the first few minutes, let children take breaks as needed and make sure they drink water whenever they become thirsty. Obese children may develop joint or back pain if they perform repetitive, high-impact exercises like running, aerobic dancing, jumping or skipping. Low impact exercises like cycling and water jogging and aerobics are very good choices.
Children are more likely to continue exercise if it’s fun, for example playing sports together. Set goals and keep records so children can see improvement to have a positive impact.
Q. Any new advances with regard to detection, treating and preventing sports injuries?
A. Technology is being increasingly used in the form of proactive health monitoring and diagnostic tools to prevent injuries or detect them early. Diagnostic and rehabilitation solutions are becoming more sophisticated, allowing for more targeted assessment of injuries and controlled strength-training and faster recovery. Better understanding of the player’s biomechanics, digital modelling, appropriate and advanced protective gears, latest monitoring and diagnosis, accurate diagnosis and advanced treatment and rehabilitation methods are helping in early detection and quicker recovery.
Q.Your advice to students?
A. Don’t ignore an injury sustained during sports. When you are injured, your body is giving you a signal. Don’t ignore it; do the right things so that you can fully heal and continue to enjoy sports. If not, it can worsen the issue over time.
Avoid focusing on just one sport to become ultra-competitive. This results, in pushing oneself beyond acceptable thresholds in your formative years, leading to injuries that are typically seen in professional players..
Q. Your advice to parents?
A. Active parent equals active child. For healthier, happier, and smarter children, parents must start at home encourage their children to go outside and play.