Strickland, Jennifer (2018) The development of a new comprehensive management model for Apophysitis Syndromes in adolescents, based on the assessment and management of passive muscular tension. PhD thesis, University of Greenwich.

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Abstract

Introduction: To date there appears to be no consensus to the accepted management of Apophysitis syndromes (AS) and no coherent research towards one. Despite these conditions being amongst the most common injuries to affect adolescents, and in particular young athletes, most recommended approaches are based on opinions and experience only. This thesis presents a new comprehensive approach to the management of AS in the lower limb, based on an assessment of local passive muscular tension as demonstrated by reduced flexibility.

Method: A new theoretical model of passive and active tension underlying AS is proposed and used to demonstrate the new approach. Four main studies are presented. The first study examined a novel treatment of the most common AS in adolescents – Osgood-Schlatter’s disease (OSD). The same approach was applied to a different AS – Sever’s disease, in the second study. The third examined the role of growth and flexibility during adolescence in a longitudinal study to ascertain the influence of passive tension in the development of AS, and finally an experimental stretching intervention study addressing reduced flexibility in young footballers, was performed as a preventative strategy for AS, and compared to current incidence rates from 3 football academies. Together they present a coherent strategy for the treatment, aetiology and ultimately prevention of AS.

Results: Findings from the OSD study found that reducing passive tension in the quadriceps muscle enabled the recovery of patients in a median of 17 days (6- 40). Similar results of 13 days (5-42) occurred in the second study on Sever’s disease treatment. Monitoring growth and flexibility during adolescence in academy football players found that flexibility significantly reduced in academy footballers prior to developing AS, and there was a strong negative correlation between growth rate and muscle flexibility (-0.96 and -0.97) for the quadriceps and calf muscles respectively. Introducing a stretching programme as an intervention to those whose flexibility exceeded set thresholds, showed none of these players went on to develop an AS. Incidence of AS was shown to have declined in the intervention club by 69% compared with control clubs 7% and 15%.

Conclusion: Increased passive tension during adolescent growth appears to be associated with the development of AS. Addressing this during treatment improves the outcomes for patients and can be part of a preventative strategy for potential at- risk players. Everyone involved in encouraging youth sports should be aware of the problem of AS and recognize the need for a proactive flexibility approach during the peak adolescent growth spurt. This study presents the arguments and creates the opportunity to promote widespread changes for the good of adolescent well-being and health.

Item Type:	Thesis (PhD)
Uncontrolled Keywords:	Apophysitis Syndromes, musculoskeletal care, sports medicine, adolescents
Subjects:	Q Science > QM Human anatomy R Medicine > RC Internal medicine > RC1200 Sports Medicine
Faculty / School / Research Centre / Research Group:	Faculty of Engineering & Science Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	09 Oct 2021 04:45
URI:	http://gala.gre.ac.uk/id/eprint/31341

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