Common Causes of Adolescent Knee Pain

Common Causes of Adolescent Knee Pain

by | Aug 12, 2021 | Research & Innovation

Content included below was presented at the 2021 Pediatric Orthopedic Education Symposium by pediatric orthopedic surgeon Philip L. Wilson, M.D.
 
You can watch the full lecture and download this summary.
 
Diagnosing common causes of adolescent knee pain can be confusing, but it can be simplified by looking at history and physical findings during the exam systematically. To narrow the list of common causes, symptoms are broken down in three ways:

  1. Acute vs. Chronic presentation
  2. Effusion vs. No Effusion
  3. Primarily a Pain Problem vs. Primarily a Motion Abnormality

Below is a list of common knee conditions:

  • Sprain
  • Contusion
  • Stress Fracture
  • Apophysitis
  • Patellofemoral Dislocation
  • ACL Tear
  • Tibial Spine Fracture
  • Meniscal Pathology
  • Osteochondritis Dissecans

Conditions with an Acute Presentation
If the presentation is acute instead of chronic, the number of potential diagnoses becomes much smaller:

  1. Acute vs. Chronic presentation: Acute
    • Sprain
    • Contusion
    • ACL Tear
    • Tibial Spine Fracture
    • Meniscal Pathology

By determining if there is an effusion, or a collection of fluid within the joint, the list of common diagnoses narrows even further:

  1. Acute vs. Chronic presentation: Acute
  2. Effusion vs. No Effusion: No Effusion
    • Sprain
    • Contusion

Then, the likely diagnosis can be determined by looking at where the patient’s pain is located:

  1. Acute vs. Chronic presentation: Acute
  2. Effusion vs. No Effusion: No Effusion
  3. Primarily a Pain Problem vs. Primarily a Motion Abnormality: Primarily a Pain Problem

If the patient has soft tissue swelling and pain around the joint with nothing focal, no bony tenderness and no effusion, it is most likely a sprain.

  • Treatment
    • Protect, Rest, Ice, Compression, Elevation (PRICE)
      • Sometimes an Ace wrap, a splint or a brace is used to immobilize and protect the joint
    • Early protected range of motion
      • Get the patients up and moving early
    • Restore strength

Patients do not need to be referred to Scottish Rite unless their pain lasts for more than three or four weeks.
 
If the patient has an acute problem with an effusion, different common causes of adolescent knee pain from the list are likely:

  1. Acute vs. Chronic presentation: Acute
  2. Effusion vs. No Effusion: Effusion
    • Patellofemoral Dislocation
    • ACL Tear
    • Tibial Spine Fracture
    • Meniscal Pathology

To determine the cause, consider the motion associated with the injury to further narrow down the list of diagnoses:

  1. Acute vs. Chronic presentation: Acute
  2. Effusion vs. No Effusion: Effusion
  3. Pain vs. Motion Abnormality: Motion Abnormality
  • Patellofemoral Dislocation
    • Twist and valgus
    • “Knee dislocated”
  • ACL Tear
    • Twist and valgus
    • “Gave out” / “shifted”
  • Tibial Spine Fracture
    • Hyperflexion
  • Meniscal Pathology
    • Twisting event

Knee Injury and Effusion
How to tell if the patient has an effusion, not soft tissue swelling:

  • X-ray – side view image of the knee
    • Look at the kneecap as it is related to the thigh bone.
    • Look at the muscle coming off the kneecap
    • Look at the space between the kneecap and the femur
      • If there is a curvilinear density that is not the linear muscle, not the deep muscle or the fat pad, it is most likely an effusion.
  • Physical examination
    • Compare the patient’s knees
      • A knee with an effusion will look bulbous and will not have all the concavities around the patella of a normal knee
    • Push on the tissues around the knee
      • If the fluid can be moved from lateral to medial or if you can see a fluid wave, it is most likely an effusion
        • Soft tissue swelling cannot be moved around
X-ray of a knee

Knee Effusion – Patellar Dislocation
When a patient has a patellar dislocation, they relate an instability event where they knee “popped out of place.” There is also an effusion.

  • Diagnosis
    • Apprehension sign
      • While pushing down on the medial kneecap, the patient becomes apprehensive and will sometimes try to stop the exam because they think that their kneecap will become dislocated.
    • “J” sign
      • As the knee is flexed, the kneecap visibly jumps from out of the groove to back into place.
  • Treatment
    • PRICE
    • Physical therapy (PT)
    • Surgery

Refer patients to Scottish Rite for continued effusion or recurrent instability.

Knee Effusion – ACL Tear
When a patient describes twisting their knee and it giving out on them or shifting and they have an effusion, they most likely have an ACL tear. Their knee is unstable. There are four ligaments in the knee: the medial knee ligament and the lateral collateral ligament on each side, with the anterior cruciate ligament (ACL) on the front and the posterior cruciate ligament on the back. When the ACL is torn, the knee has more motion, so patients say that their knee slipped or gave out. The best way to check for a torn ACL is the Lachman test.

  1. The patient lies on their back with their legs out straight and their muscles relaxed, especially their hips and hamstring muscles.
  2. Bend the patient’s knee slowly and gently to about a 20-degree angle. Physicians may also rotate the patient’s leg so their knee points outward.
  3. Stabilize the patient’s thigh with one hand and gently move the tibia forward with the other hand.
    • If there is a great deal of of motion and instability, it is likely because the ACL is torn

Treatment

  • Surgery may be necessary to repair instability or an associated meniscal injury.

Refer any patients with a suspected ACL tear to Scottish Rite.

Knee Effusion – Tibial Spine Fracture
With a tibial spine fracture, the patent usually has a large effusion called a hemarthrosis, or blood in the joint, because of the fracture. These are usually caused by a flexion event like a fall from a bike or skiing or a twist in sport. This fracture will leave a fragment within the “notch” between the thigh bone and the shin bone. This is because instead of the ACL tearing in the middle of the rope, it pulls that piece of bone.
Treatment

  • Surgery
    • Put the piece of bone back in place
  • Casting
    • Moving the leg and putting it in a cast may work if it can be placed in a good position

Refer patients to Scottish Rite for immobilization or surgery.
Knee Effusion – Meniscal Tear

It the patient’s reports a twist or pop event and their effusion appears small while experiencing pain on the side of their joint, it is most likely a meniscal tear. Other things to look for to make the diagnosis are focal joint line pain, a loss of extension, a negative Lachman exam, no patellar apprehension, and nothing positive on their X-rays. An MRI may be needed to confirm the diagnosis. The effusion usually means that there is an internal derangement that needs to be treated with surgery.

Conditions with a Chronic Presentation
If the athlete’s injury is a chronic injury, a different set of diagnoses becomes likely:

  1. Acute vs. Chronic presentation: Chronic
  • Stress Fracture
    • Has been sore for a while
  • Apophysitis
    • Pain at the growth plate
  • Patellofemoral Dislocation
    • Pain around the kneecap
    • Not a specific injury
  • Osteochondritis Dissecans
    • An idiopathic osteonecrosis below the cartilage surface during development

These conditions generally do not have an effusion, and are all activity-related knee diagnoses.

  1. Acute vs. Chronic presentation: Chronic
  2. Effusion vs. No Effusion: No Effusion
  3. Pain vs. Motion Abnormality: Pain

To determine which condition it is, find out where the pain is located.

  • Stress Fracture
    • Focal distal femur or proximal tibia
    • Tender over a small area around a bone
  • Apophysitis
    • Focal distal patella or tibial tubercle
    • Focally tender
  • Patellofemoral Dislocation
    • Poorly localized / Not focally tender
    • “Horseshoe” sign
  • Osteochondritis Dissecans
    • Cannot localize
    • Deep within

Slipped Capital Femoral Epiphysis (SCFE)

ALWAYS CHECK THE HIP IN ADOLESCENTS WITH KNEE COMPLAINTS

When adolescents have activity related knee pain, often with no inciting event, and display symptoms including a limp, walking with their foot externally rotated and a limited range of motion (especially with internal rotation), it may be SCFE. SCFE is checked with a hip rotational exam. If the patient has equal symmetric range of motion, physicians can rule out SCFE and move on to other diagnoses.

Overuse Conditions – Stress Fracture
Stress fractures are an activity-related pain that often happens after periods of inactivity, like summer. They are associated with high activities like running. Patients are focally tender on their bone, but their knee joints are fine. An X-ray usually shows a stress fracture on their distal femur. The treatment for a stress fracture is forced rest until the patient is pain-free and a gradual return to sports.

Overuse Conditions – Apophysitis
Apophysitis is an activity-related condition with pain focal to only one place. The growth plate is going through a transition with a great deal of stress applied in that area with activities. The two main apophysitis to consider are Osgood-Schlatter Disease in which the patient’s pain is on the tibial tubercle, and Sinding-Larsen Johansson (SLJ) Syndrome in which the pain is on the inferior pole of the patella. The treatments for apophysitis are rest, anti-inflamitories, and quad stretching.

Patellofemoral Pain Syndrome
Unlike Osgood-Schlatter Disease and Sinding-Larsen Johansson (SLJ) Syndrome, the patient cannot pinpoint their pain with Patellofemoral pain syndrome. Patients motion all around the knee in what is called the “Horseshoe” sign. They do not have instability in their knee, but they do have pain around their kneecap. The cause of Patellofemoral pain syndrome is unknown, but it is believed to be related to an abnormal balance of the homeostasis of the muscle strength around the front of the knee. During the exam, physicians determine the “Q” angle, or the quadriceps angle. This is the angle between the quadriceps tendon and the patellar tendon. This angle provides useful information regarding the alignment of the knee joint. “Q” angles greater than 14° are vulnerable to patellar conditions. Physicians also look for poorly developed vastus medialis oblique muscle (VMO), a “J” sign, and pain with patellofemoral compression.

Treatment

  • Physical therapy
    • Quadriceps strengthening
    • Knee balance
    • Knee proprioceptive strengthening
  • 70% improved with physical therapy, regardless of associated interventions.

Osteochondritis Dissecans (OCD)
OCD is an idiopathic osteonecrosis below the cartilage surface during development. This can lead to cartilage surface cracks, instability and lesion on the joint. OCD can happen with or without trauma. In an X-ray, a radiolucent lesion is visible.

  • 2:1 Male to female
  • 33% Bilateral

The younger the patient is and the smaller they are, the more likely they are to heal. The location of lesion and the status of articular surface also play a factor in the patient’s healing potential.

Treatment

  • Forced rest
  • Unloader brace
  • Surgery if the patient is older or if the MRI reveals instability.

Meniscal Pathology
A meniscal pathology has a chronic presentation with no effusion, but a motion abnormality instead of pain.

  1. Acute vs. Chronic presentation: Chronic
  2. Effusion vs. No Effusion: No Effusion
  3. Pain vs. Motion Abnormality: Motion Abnormality

The patient says that their knee pops or snaps. They may also have a loss of extension and a limp. These are signs of a discoid meniscus.

Discoid Meniscus

  • Discoid meniscus is a congenital malformation of the meniscus
    • Affects approximately 1:100 children
  • Mechanical symptoms in childhood with no trauma history
    • Snapping in the knee usually occurs between the ages of 2 to 6.
  • Palpable / audible “snap” at lateral joint line during exam
  • Visible bulge at lateral joint line

As children get older, the discoid meniscus presents like a regular meniscal tear. The treatment for this condition is arthroscopic surgery if the patient is symptomatic.

Refer patients to Scottish Rite for mechanical symptoms or loss of motion.

Adolescent Hip Dysplasia and Other Causes of Hip Pain

Adolescent Hip Dysplasia and Other Causes of Hip Pain

by | Aug 6, 2021 | Hip Disorders

Content included below was presented at the 2021 Pediatric Orthopedic Education Symposium by pediatric orthopedic surgeon William Z. Morris, M.D.

You can watch the full lecture and download this summary.

In hip dysplasia, the acetabulum (or hip socket) is shallow and doesn’t adequately cover the femoral head. Developmental dysplasia of the hip (DDH) occurs in approximately 1% of newborn children, and it is associated with four risk factors:

  • Female
  • Firstborn
  • Feet first (breech)
  • Family history

Hip dysplasia is relatively more commonly diagnosed in skeletally mature adolescents, affecting around 3% to 5% of the asymptomatic population. Cross-sectional studies have shown that female sex and a family history of dysplasia remain risk factors in adolescents.

There has been growing attention to the treatment of hip dysplasia as there is an association between hip dysplasia and the development of early osteoarthritis. In 1939, Gunnar Wiberg first described hip dysplasia and objectively measured it using what is now called the lateral center edge angle, to describe how well the socket (acetabulum) covers the ball (femoral head). On an AP (anterior posterior) pelvis X-ray, the angle is created by a vertical line through the center of the femoral head and a line from the center of the femoral head to the lateral border of the acetabular fossa. A larger angle reflects greater hip coverage, and a smaller angle reflects less coverage, commonly seen in a dysplastic hip.

Wiberg followed patients with dysplasia for up to 30 years and found that all of the patients with hip dysplasia eventually developed osteoarthritis. The smaller their center edge angle was (reflecting greater hip dysplasia), the faster they developed osteoarthritis.

Development of Osteoarthritis in Dysplastic Hips
The development of early osteoarthritis is suspected to occur due to a couple mechanical reasons. The most important factor is that:

Pressure = Force / Unit Area
In the hip, pressure on the joint surfaces depends on the total surface area of the femoral head in contact with the socket. A well-covered femoral head distributes weight-bearing forces across a larger surface area, reducing the pressure on each unit of cartilage. In contrast, a dysplastic acetabulum offers less surface area which increases the pressure on the cartilage contributing to earlier hip degeneration. In addition to the smaller weightbearing surface, the acetabulum is also more obliquely oriented. Therefore, compressive forces are less and shearing forces are greatly increased. This increased shear force may also contribute to cartilage degeneration.

Symptoms of Adolescent Hip Dysplasia
There are many different causes of hip pain in an adolescent patient and combining clues from the history and physical exam is essential to determine the underlying problem. The location of a patient’s pain can help determine the underlying etiology. Intra-articular pain of the hip usually presents as anterior groin pain, often due to a cartilage injury, a tear in the labrum (the ring of cartilage at the periphery of the socket) or inflammation of one of the hip flexors called the Iliopsoas tendon. Lateral hip pain that locates over the greater trochanter (the bony prominence on the lateral aspect of the thigh) probably reflects trochanteric bursitis or inflammation of the bursa overlying that region. Pain or soreness after activity above the greater trochanter where hip abductors like the gluteus medius are located may signal hip abductor fatigue, which is common with hip dysplasia. Pain over the iliac crest where the abdominal musculature attaches could reflect some inflammation of that apophysis, of the anterior superior iliac spine (ASIS) where the sartorius attaches, or of the anterior inferior iliac spine (AIIS) where the rectus tendon attaches.

Additional Factors to Consider when Discussing Hip Joint Symptoms

  • Pain
    • Duration
    • Aggravating factors
      • Squatting, stairs, low chairs
    • Alleviating factors
  • Mechanical symptoms
    • Locking, popping, catching, snapping
  • Neurological symptoms (which may suggest spinal pathology)
    • Radiating pain, paresthesias

Physical Exam

  • Pain Assessment
    • Palpation can reproduce symptoms and help to localize the pain.
  • Strength Testing
  • Range of Motion
    • Limited internal rotation (IR) can indicate hip impingement or a more acute concern, slipped capital femoral epiphysis (SCFE)

Special Tests

Straight Leg Raise Test
A straight leg raise is a passive test that helps to distinguish between hip and spine pathology and is performed by flexing the hip with an extended knee in a supine position. If this maneuver reproduces the patient’s pain that radiates distally, the problem may be related to nerve compression in the spine rather than a problem in the hip.

Trendelenburg Test
The hip abductors (e.g. gluteus medius) are typically weaker when patients come in with pain, so it can be targeted in physical therapy. The Trendelenburg sign is a quick physical examination used to assess for hip abductor weakness.
The patient stands on one leg (stance leg) and bends the other knee about 90°. Observe for evidence of hip abductor (i.e. gluteus medius) weakness which includes:

  • Pelvis drop contralateral to the stance leg.
  • Trunk lean/shift toward the stance leg.

Apprehension Test
Another test to further evaluate for dysplasia is the apprehension test:

  1. The patient lays in a lateral position
  2. Abduct the patient’s leg 30° away from midline
  3. Flex the patient’s knee 90°
  4. Gradually extend the hip

Patients who have an anterior uncovering of the socket from dysplasia will feel pain or a sensation of apprehension, which suggests that there may be some instability or dysplasia.

Femoroacetabular Impingement Test
Hip impingement should also be tested:

  1. Flex the hip to 90°
  2. Abduct the hip, bringing it towards midline
  3. Internally rotate the hip

This test attempts to reproduce hip impingement where the femoral head or neck collides against the socket. If this causes pain, there may be a cartilage injury such as a labral tear. An MRI is recommended to evaluate intra-articular soft tissues.

Slipped Capital Femoral Epiphysis – A condition not to be missed
Slipped capital femoral epiphysis (SCFE) is an adolescent disorder in which the growth plate is damaged and the femoral head epiphysis moves, or slips, with respect to the rest of the femur. Diagnosis in a timely manner is essential to prevent further injury to the hip.

Consider SCFE if these signs are present:

  • limp
  • walk with their foot externally rotated
  • have limited range of motion, especially with internal rotation

Obligate external rotation is nearly pathognomonic for slipped capital femoral epiphysis, so if the patient can’t flex their hip straight up without turning their leg into an externally rotated position to accommodate further flexion, an anterior-posterior and frog pelvis film is recommended to ensure slipped capital femoral epiphysis hasn’t been missed. Immediate non-weight bearing with a wheelchair and urgent referral to pediatric orthopedics or an emergency room is recommended for this condition.

Radiographic Evaluation
A radiographic evaluation is important for a definitive dysplasia diagnosis. The AP pelvis film is a workhorse tool for the evaluation of hip coverage. It is taken standing to allow assessment of the patient’s hip coverage in their functional position using the lateral center edge angle (LCEA). A hip with an LCEA less than 25° is considered dysplastic.
Imaging also allows an assessment of the inclination of the socket. By drawing a line between the medial and lateral edges of the roof of the socket and measuring the angle between that line and a horizontal line, physicians can determine the acetabular inclination. The more inclined the socket is, the more dysplastic.

Treatments
Treatment for dysplasia begins with nonoperative options, which include:

  • Physical therapy
  • Activity modifications
  • Non-steroidal anti-inflammatory drugs (NSAID)

When nonoperative treatments don’t work, and patients continue to have radiographic dysplasia and pain, including abductor fatigue pain above the greater trochanter or anterior intra-articular groin pain, they are treated surgically with a periacetabular osteotomy (PAO). This specialized procedure is done in patients who are approaching skeletal maturity or are already skeletally mature. Several cuts are made around the socket of the acetabulum to mobilize the socket. The socket is then reoriented to better cover the femoral head.

Outcomes
For patients with symptomatic hip dysplasia, the PAO has been shown to be successful in improving patients’ function, getting them back to their activities/sports, and preventing early hip replacement. In patients with hip pain and clinical or radiographic evidence of acetabular dysplasia, please consider a referral to Scottish Rite for Children for discussion of the condition and shared decision-making in the plan for management.

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Building Muscle in Young Athletes: Making Nutrition Count

Building Muscle in Young Athletes: Making Nutrition Count

by | Jul 30, 2021 | Sports Medicine

Young athletes in strength-based and power sports may desire to increase muscle mass for better performance or to help them as they start a new position on their team. “While there are many nutrition supplements available, it’s important to understand that these may not be safe for children and teens,” says Taylor Morrison, MS, RD, CSSD, LD. “A young athlete at the appropriate developmental stage should be able to achieve his or her goals with with food and beverages alone.”

 

Before setting any goals, it is also important to understand that young pre-pubertal athletes will not gain muscle mass like an adult because they do not yet have the level of hormones needed to support these gains. While he/she can still build muscle, the level of hormones required to support larger gains in muscle, like those often desired by young male athletes, are not present until after puberty.

When ready, here are important facts to know about how the young athlete’s nutrition can help build muscle for sport.

What builds muscle?

With the appropriate hormones present, these are necessary components for building muscle:

  1. Adequate calories: Getting enough calories or increasing daily calorie intake is essential to building muscle.
  2. Protein: Protein is the key nutrient for building muscle and should be included in all meals and some snacks.
  3. Carbohydrates: Carbohydrates are the main source of energy for working muscles and the brain. They should be present in all meals and snacks to provide energy and allow protein to build desired muscle mass.
  4. Resistance training: Exercises like lifting, pushing and pulling an outside force create necessary changes within the muscle that result in longer, stronger and bigger muscles.

Easy ways to increase calories

  • Increase the number of meals or snacks eaten per day. Most young athletes need a minimum of 3 meals and 2 snacks per day.
  • Add spreads to sandwiches and wraps such as avocado, hummus, pesto and mayonnaise.
  • Choose heartier or thicker slices of bread.
  • Include oatmeal or fresh smoothies with breakfast or snacks and add items such as milk, yogurt, peanut butter, almond butter, honey, fruit, flax or chia seeds.
  • Choose nutrient-dense cereals such as: granola, Raisin Bran®, shredded wheats and Grape-Nuts®.

Ideas for increasing protein at meals and snacks

  • Add an egg or Greek yogurt to breakfast.
  • Choose granola bars with whole grains, nuts or seeds.
  • Include a string cheese with a snack.
  • Add a glass of milk or chocolate milk to meals or snacks.
  • Include beans, nuts and seeds in salads.

Carbs to include with meals & snacks

  • Whole-grain bagels or English muffins.
  • Fresh or dried fruits.
  • Starchy vegetables like white potatoes, sweet potatoes, peas, corn, winter squash.
  • Rice, pasta, quinoa, couscous, etc.
  • Milk or yogurt (also great sources of protein and calcium).
  • Whole-grain crackers, cereals, granola bars.

Keys to Success:

  • Be realistic: Young, pre-pubertal athletes will not gain muscle mass like an adult.
  • Work on body composition changes during the off-season. Trying to make big changes during the season could lead to decreased performance or injury.
  • Plan for gradual muscle gain. Include a well-balanced diet and a developmentally appropriate strengthening program.
  • Remember, the overall goal is optimal performance. Measure improvements in performance (jumping height, running distance, etc.), not a number on the scale.
  • Focus on real food: Rely on healthy, high-calorie and nutrient-rich foods instead of supplements and protein powders.
  • Get enough sleep and manage stress. This is often forgotten for achieving body composition or weight goals, but it is very important.

If unsure where to start, it’s always a good idea to work with a certified sports dietitian who can help you create a plan, recommend products and support you as you work towards your goals.

Not sure if your athlete is ready to build muscle? Read “Building Muscle in Young Athletes: Getting Started”

Visit our sports nutrition page to learn more about nutrition and fueling the young athlete.

What Does a Day of Muscle Building Meals & Snacks Look Like?
Specific foods and portion sizes will vary based on an athlete’s size, age, sport and training demands.

Here is a great example. 

Paralympian Tanner Wright Is Tokyo-Bound

Paralympian Tanner Wright Is Tokyo-Bound

by | Jul 23, 2021 | Spotlight

Years of hard work and determination have Tanner’s lifelong dream in his sight – the 2020 Tokyo Olympics. Born to stand out, Tanner has with a condition that caused his left arm to never fully develop. He first came to Scottish Rite for Children as a baby and has received world-class care from our team of hand experts.

Never letting anything hold him back, he is now a member of the U.S. Paralympic Men’s Track and Field Team and will represent Team USA as he competes in Tokyo.

Through the years, he has left his mark at Scottish Rite. Originally a camper at Hands Down Camp, he then chose to give back and became a top-notch hand camp counselor. “Tanner is a great role model at camp and encourages the kids to exceed their own expectations of themselves, strive to get out of their comfort zone and accomplish things they never thought possible,” says Occupational Hand Therapist Amy Lake, O.T.R., C.H.T.

 

“We are so proud of Tanner we are excited to cheer him on as he chases his track and field dreams!”

Recovery Strategies for Young Gymnasts

Recovery Strategies for Young Gymnasts

by | Jul 22, 2021 | Sports Medicine

Gymnasts have training needs that differ from many other athletes.

The demands on gymnasts typically involve many hours of high-intensity skills training. Not addressing recovery with the same commitment can leave them less prepared for another workout and at an increased risk for injury. Gymnasts and other athletes have to balance training sufficiently with appropriate rest and recovery techniques. Investing valuable time and money into recovery strategies requires thoughtful consideration.

Recovery principles include reducing edema (swelling), improving blood flow, restoring damaged muscle cells, reducing soreness and returning the athlete to a state for optimal training. These are achieved using a combination of these modalities:

  • Compression
  • Massage
  • Cold

Common strategies include:

  • Massage sessions or tools – Generalized massage can be beneficial to circulate the blood and prevent stiffness post-workout. Localized massage, foam rollers or manual therapy can address specific areas of pain or release tense muscles to reduce postural malalignment.
  • Contrast hot/cold pools – Water offers a dual approach to recovery. The immersion provides compression and alternating between warm and cold environments adds the benefits offered by cold therapy. At Scottish Rite, we have HydroWorx® hot and cold plunge pools for our patients.

  • Epsom salt baths – Easy to implement at home, adding Epsom salt (a naturally occurring mineral compound) to a bath offers a combination of the benefits of compression from immersion as well as possible benefits from the absorption of magnesium, which may help to reduce muscle soreness.
  • Combination cold and compression – After an injury or training, RICE (Rest Ice Compress Elevate) is a traditional approach to reduce swelling. Our team uses a GameReady® device which provides both cold and compression.  The device circulates very cold water around the joint or limb while simultaneously mimicking the muscle pumping actions that circulate blood and prevent swelling.
  • Dynamic compression device – Improving on a therapeutic concept of sequential compression to improve blood flow in the legs, companies like Normatec offer a sleeve that applies a wave of pressure to mimic muscle action.
  • Active recovery – Lower intensity exercise after higher intensity exercise may help reduce stiffness, optimize gains made during training and use muscle activation to create the compressive forces to improve blood flow. Examples include:
    • Dynamic (active) or static stretching
    • Swimming
    • Yoga
    • Pilates
    • Cycling

  • Nutrition – Properly timed and pre- and post-workout fueling help optimize the athlete’s recovery:
    • Anti-inflammatory foods that have shown promise in treating muscle soreness: watermelon, cherry juice, pineapple and ginger.
    • Recovery snacks need these three key components:
      • Carbohydrates
      • Protein
      • Fluid

Professional athletes, world-class gymnasts and exercise enthusiasts have appreciated the value of recovery. Young athletes should learn recovery principles and learn to “listen” to how their bodies respond to exercise and modalities to optimize recovery and prepare for the next workout.

Learn more about pediatric sports medicine.