Conditions Treated

If your child has been diagnosed with a sports-related condition, please identify your injury in the listing below and you will find information on general risk factors, what symptoms to watch for, your options for treatment and how long recovery might take.

If your condition is not listed below please contact your doctor for more information.

Knee Xray The knee contains the anterior cruciate ligament (ACL), one of four ligaments (tough bands of tissue) that connect the femur (thigh) bone to the tibia (lower leg) bone. In combination with the posterior cruciate ligament (PCL), the ACL makes a diagonal "X" through the center of the knee joint and provides stability to the knee and allows it to twist/rotate and move side-to-side. The ACL is injured or torn when it is stretched beyond its normal range of movement. Research shows approximately 50 percent of ACL injuries also involve other structures in the knee (meniscus, the pad/disc between knee bones, cartilage or other ligaments).

Download Cook Children's guide to ACL injuries (who is at risk, symptoms and treatment options)

Adductor/groin anatomy The adductor/groin muscles are located on the inside of the thigh. Adductor/groin strains can happen during vigorous directional changes, while running, sprinting and jumping. A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a possible pull or tear in the muscle.

Download Cook Children's guide to adductor/groin strains (who is at risk, symptoms and treatment options)

Ankle/ligament anatomy An ankle sprain is the overstretching of the ligaments (structures that connect bone to bone) during a traumatic fall or twisting of the ankle. There are varying types of ankle sprains dependent on location and severity. Lateral (outside of the ankle) sprains are most common.

Download Cook Children's guide to ankle sprains (who is at risk, symptoms and treatment options)

Patella anatomy Anterior knee pain is pain around the front part of the knee and/or under the kneecap (patella). Anterior knee pain can have several causes such as patellofemoral pain syndrome, chondromalacia patella, patellofemoral instability/patella subluxation, fat pad irritation or iliotibial band friction syndrome (I-T Band).

Download Cook Children's guide to anterior knee pain (who is at risk, symptoms and treatment options)

Back muscles Back muscle strains can happen during any physical activity that requires the back to bend or rotate, including lifting, throwing, kicking, swinging and performing stunts. A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a possible pull or tear in the muscle.

Download Cook Children's guide to back muscle strain (who is at risk, symptoms and treatment options)

Chondromalacia patella Xray Chondromalacia patella is the softening of the cartilage on the underneath surface of the patella (kneecap). When this cartilage lining becomes softened it begins to breakdown producing irregularities to the underneath surface of the patella. Chondromalacia patella is caused by excessive and uneven pressure on the cartilage from structural alignment of legs and muscle imbalances that can be caused from rapid growth or poor technique of training skills. Pain is around the patella and can sometimes be behind the knee.

Download Cook Children's guide to chondromalacia patella (who is at risk, symptoms and treatment options)

Fat pad Xray Fat pad impingement occurs when the fat pad becomes irritated and swollen from repetitive tissue pinching by the structures within the knee joint. The fat pad is situated deep within the patellar tendon and assists with providing a cushion to the front part of the knee as well as supplying blood and nutrients to the patellar tendon. If the fat pad is irritated/swollen it can become impinged into the knee joint causing extreme, exact pain.

Download Cook Children's guide to fat pad impingement/irritation (who is at risk, symptoms and treatment options)

Leg and calf anatomy The gastrocnemius/soleus are located on the back of the calf. Gastrocnemius/soleus strains can happen during vigorous running, sprinting, jumping activities or repetitive heel raises (i.e. relevé in dance and gymnastics). A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a pull or tear in the muscle.

Download Cook Children's guide to gastrocnemius/soleus strain (who is at risk, symptoms and treatment options)

Hamstring anatomy The hamstring muscles are located on the back of the thigh. Hamstring strains can happen during vigorous running, sprinting and jumping activities. A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a possible pull or tear in the muscle.

Download Cook Children's guide to hamstring strain (who is at risk, symptoms and treatment options)

Hip flexor anatomy The hip flexor muscles are located on the front of the hip. Hip flexor strains can happen during vigorous sprinting and kicking activities. A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a possible pull or tear in the muscle.

Download Cook Children's guide to hip flexor strain (who is at risk, symptoms and treatment options)

Doctor examining patient's back alignment Scoliosis is a curve of the spine measuring more than 10 degrees. Idiopathic means the cause is unknown. While there are different types of scoliosis, idiopathic scoliosis is the most common form affecting children and adolescents. Scoliosis is not caused by bad posture, diet or backpacks.

Download Cook Children's guide to idiopathic scoliosis (who is at risk, symptoms and treatment options)

Femur anatomy Iliotibial band friction syndrome is an overuse injury that occurs as a result of the rubbing between the iliotibial band (a non-elastic collagen cord stretching from the outside of the hip to below the outside of the knee) and the lateral epicondyle on the femur (the outside of the knee). It is often the result of iliotibial band and tensor fascia lata muscle (outside of thigh) tightness.

Download Cook Children's guide to iliotibial band friction syndrome (who is at risk, symptoms and treatment options)

Ligament diagram The knee contains the lateral collateral ligament (LCL), one of four ligaments (tough band of tissue) connecting the femur (thigh) bone to the tibia (lower leg) bone. In combination with the medial collateral ligament (MCL), the ligament on the inside of the knee, the LCL lies on the lateral (outside) of the knee joint and provides stability to the knee for side-to-side movement. When the ligament is stretched beyond its normal range of movement, it can become sprained or torn. LCL injuries may involve other knee structures, such as the medial or lateral meniscus, which can present as pain on the opposite side (inside) of the knee. Other ligament tears can also occur, such as the posterior cruciate ligament (PCL), when the LCL is injured.

Download Cook Children's guide to lateral collateral ligament injury (who is at risk, symptoms and treatment options)

Lateral epicondyle anatomy Lateral epicondylitis is caused by repetitive stresses on the outside of the elbow that causes inflammation (swelling) and microfractures (small breaks) in the apophyseal cartilage (growth plate on the bone) and the surrounding structures.

Download Cook Children's guide to lateral epicondylitis (who is at risk, symptoms and treatment options)

Medial ligament diagram The knee contains the medial collateral ligament (MCL), one of four ligaments (tough band of tissue) connecting the femur (thigh) bone to the tibia (lower leg) bone. In combination with the lateral collateral ligament (LCL), the ligament on the outside of knee, the MCL lies on the medial (inside) of the knee joint and provides stability to the knee for side-to-side movement. The ligament becomes injured or torn when it is stretched beyond its normal range of movement.

Download Cook Children's guide to medial collateral ligament injury (who is at risk, symptoms and treatment options)

Medial epicondyle diagram Medial epicondylitis is caused by repetitive stresses on the inside of the elbow. It can cause inflammation (swelling) and microfractures (small breaks) in the apophyseal cartilage (growth plate on the bone) and the surrounding structures.

Download Cook Children's guide to medial epicondylitis (who is at risk, symptoms and treatment options)

Mensical tear diagram The menisci are two C-shaped fibrocartilage structures that serve as padding and separate the two bones of the knee joint, the femur (thigh bone) and tibia (lower leg/shin bone). The menisci disperse 30-55 percent of the forces that impact the knee joint. The menisci also provide stability, cushioning and aid in joint lubrication. The medial (inside) meniscus is injured four times as often as the lateral (outside) meniscus.

Download Cook Children's guide to meniscal tear (who is at risk, symptoms and treatment options)

Kneecap anatomy Osgood-Schlatter is an overuse condition found in child/adolescent athletes. It is characterized by inflammation and pain around a growth plate where the patellar tendon (this tendon straightens your knee) attaches to the front of the shinbone (tibia). This is just below the kneecap at an area called the tibial tubercle. The pull of the tendon creates tension on the area of the growth plate. In some child/adolescent athletes, this may lead to inflammation, local swelling and then pain with activities. Some patients may also develop a limp. This discomfort may last over a period of months.

Download Cook Children's guide to Osgood-Schlatter disease (who is at risk, symptoms and treatment options)

Upper elbow Xray Panner's disease is abnormal ossification (formation of bone) of the capitellum (base of the upper arm bone, the humerus, forms the top part of the elbow joint). This abnormal ossification is believed to be caused by an interference in blood supply to the growth plate of the bone blockage.

Download Cook Children's guide to Panner's disease (who is at risk, symptoms and treatment options)

Patella and tibia anatomy Patellofemoral instability is when there is excessive movement of the patella (kneecap) and/or weakness in the surrounding structures. The patella connects the muscles of the thigh to the tibia (shinbone). The patella moves through a groove on the femur (thigh bone) when the leg is flexed (bent) and extended (straightened). If this groove is too shallow or uneven in addition with muscle weakness, it could result in a subluxation (comes out of the groove, but comes back into position) or a complete dislocation (remains outside of the groove). Patellofemoral subluxations/dislocation can also be a result of muscle imbalances or a direct traumatic fall on the knee.

Download Cook Children's guide to patellofemoral instability/subluxation/dislocation (who is at risk, symptoms and treatment options)

Tibia and patella anatomy Patellofemoral pain syndrome is a dull, achy pain with minimal swelling around the patella (kneecap) due to malalignment of the femur (thigh bone), tibia (shinbone), patella and/or feet. Individuals with genu varum (bowed legs), genu valgus (knocked knees), femoral anteversion (thigh bone turning in), tibial torsion (shinbone turning in or out), patella alta (high-riding knee cap), patella baja (low-riding knee cap), leg length discrepancies, muscle imbalances and/or soft tissue tightness are more prone to have patellofemoral pain syndrome.

Download Cook Children's guide to patellofemoral pain syndrome (who is at risk, symptoms and treatment options)

Posterior ligament Xray The knee contains the posterior cruciate ligament (PCL), which is one of four ligaments (tough bands of tissue) that connect the femur (thigh) bone to the tibia (shin) bone. In combination with the anterior cruciate (ACL), the PCL makes a diagonal "X" through the center of the knee joint and allows the knee to twist/rotate and move side-to-side. The PCL becomes injured or torn when it is stretched beyond its normal range of movement. Research shows that up to 60 percent of PCL injuries may also involve other structures in the knee (meniscus, the pad/disc between the knee bones, cartilage or other ligaments) creating increased instability.

Download Cook Children's guide to posterior cruciate ligament injury (who is at risk, symptoms and treatment options)

Quadricep anatomy Quadriceps muscle is located on the front of the thigh. Quadricep strains can happen during vigorous running, sprinting, jumping and kicking activities. A strain typically occurs when a muscle is placed in a stretched position and then contracted forcefully in the opposite direction, resulting in a pull or tear in the muscle.

Download Cook Children's guide to quadricep strain (who is at risk, symptoms and treatment options)

Shoulder anatomy The shoulder joint is a ball and socket-type joint formed by the scapula bone (shoulder blade), which acts as the socket, and the head of the humerus (upper arm bone), which acts as the ball. The rotator cuff includes four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) located on the upper back portion of the shoulder. The rotator cuff muscles provide stability to the shoulder joint and perform specific movements at the joint. Injuries can occur as a result of traumatic injury, overuse, incorrect movement patterns involving the arm. A rotator cuff injury can be a muscle strain, a partial tear or a complete rupture of the muscle.

Download Cook Children's guide to rotator cuff injury of the shoulder (who is at risk, symptoms and treatment options)

Heel anatomy Sever's disease is an overuse syndrome found in child/adolescent athletes and is characterized by inflammation and pain around a growth plate on the back of the heel bone (calcaneus). This area is where the heel cord (Achilles tendon) attaches to the heel bone. The pull of the tendon on the bone and growth plate creates inflammation in some children and adolescents. This may lead to pain with activities and occasionally a limp. The discomfort may last over a period of months.

Download Cook Children's guide to Sever's disease (who is at risk, symptoms and treatment options)

Tibia anatomy Shin splints can be defined as a pain response between the knee and ankle on the inside of the tibia (shinbone). The pain is a result of a stress overload on the tibia and the connective tissue that attach your muscles to the bone during repetitive activities.

Download Cook Children's guide to shin splints (who is at risk, symptoms and treatment options)

Shoulder Xray The shoulder joint is a ball and socket-type joint formed by the scapula bone (shoulder blade), which acts as the socket, and the head of the humerus (upper arm bone), which acts as the ball. A dislocation injury occurs when the ball (the head of the humerus) is forced out of the socket, usually resulting from a traumatic event such as falling on an outstretched arm, a direct blow to the shoulder or an overstretch injury associated with overhead hanging (i.e., on monkey bars, basketball rim, etc.). The head of the humerus (the ball) typically dislocates in a forward or downward direction.

Download Cook Children's guide to shoulder dislocation (who is at risk, symptoms and treatment options)

Shoulder joint Xray The shoulder joint is a ball and socket-type joint formed by the scapula bone (shoulder blade), which acts as the socket, and the head of the humerus (upper arm bone), which acts as the ball. Shoulder instability/subluxation occurs when the head of the humerus (the ball) does not move properly against the surface of the scapula called the glenoid fossa (socket). Shoulder instability/subluxation can have several causes, including genetic factors, falling on an outstretched arm, poor throwing technique, excessive overhead activities (throwing, tennis, swimming) and previous shoulder injuries.

Download Cook Children's guide to shoulder instability/subluxation (who is at risk, symptoms and treatment options)

Kneecap pain anatomy Sinding-Larsen-Johanson is an overuse condition found in child/adolescent athletes. It is characterized by inflammation and pain at the bottom of the patella (kneecap) and the attachment of the patellar tendon. The pull of the tendon creates tension on the area of the growth plate. This may lead to inflammation, local swelling which leads to pain with activities. Some patients may also develop a limp. This discomfort may last for months.

Download Cook Children's guide to Sinding-Larsen-Johanson disease (who is at risk, symptoms and treatment options)

Spine pain anatomy Spondylolysis in athletes is typically an overuse stress reaction on the bone. This leads to a crack in the back (posterior elements) of the spine called the pars interarticularis. It can be on one side of the spine or both sides and is usually in the lower back (lumbar spine). If both sides have complete breaks, it can cause a condition known as spondylolisthesis. Spondylolisthesis occurs when the pars defect has allowed a forward slippage of one of the vertebral body on another vertebral body. Spondylolysis and spondylolisthesis are often seen in athletes who participate in sports that require forceful hyperextension (excessive bending backwards) of the lower back.

Download Cook Children's guide to spondylolysis/spondylolisthesis (who is at risk, symptoms and treatment options)

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Conditions Treated

ACL injuries

Adductor/groin strain

Ankle sprain

Anterior knee pain

Back muscle strain

Chondromalacia patella

Fat pad impingement/irritation

Gastrocnemius/soleus strain

Hamstring strain

Hip flexor strain

Idiopathic scoliosis

Iliotibial band friction syndrome

Lateral collateral ligament injury

Lateral epicondylitis

Medial collateral ligament injury

Medial epicondylitis

Meniscal tear

Osgood-Schlatter disease

Panner's disease

Patellofemoral instability

Patellofemoral pain syndrome

Posterior cruciate ligament injury

Quadricep strain

Rotator cuff injury of the shoulder

Sever's disease

Shin splints

Shoulder dislocation

Shoulder instability/subluxation

Sinding-Larsen-Johanson disease

Spondylolysis/spondylolisthesis

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