Managing Sports Injuries in Adolescents

The CDC reports that more than 2.6 million pediatric patients are treated in emergency departments for sports-related injuries each year.¹ Acute and overuse musculoskeletal injuries are prevalent among adolescent athletes, with overuse injuries accounting for more than 50% of all sports-related injuries in adolescents and young adults.²

Several oral and topical OTC analgesic products are available for treating mild to moderate sports-related injuries, such as tendonitis, sprains and strains. Pharmacists can be a valuable resource for parents and caregivers seeking advice regarding OTC analgesics for managing sports injuries in adolescents. Pharmacists can also recommend nonpharmacologic therapies for these injuries. In addition, pharmacists can emphasize the critical nature of using OTC analgesics responsibly and safely because these medications can be associated with adverse effects, such as hepatotoxicity and gastrointestinal issues, and potential drug—drug interactions.

According to the results of a 2016 study, high use of OTC analgesics among adolescents was associated with frequent pain, lower self-esteem, reduced sleep, and lower educational ambition, and may be a warning sign of other potential issues.³ Pharmacists can encourage parents and caregivers to have an open dialogue with adolescents about medication safety because many adolescents self-medicate with OTC analgesics.³ Pharmacists can also ascertain when self-treatment is not appropriate and direct patients to see their primary health care provider when warranted.

Typically, the goals of therapy are to alleviate pain, restore patient function, and allow resumption of sports activity.^1,2 Currently, oral OTC analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (ie, ibuprofen, naproxen), and salicylates (ie, aspirin, magnesium salicylate, sodium salicylate).¹ Topical analgesics include menthol, camphor, capsaicin, and trolamine salicylate. Most topical analgesics list a minimum age of 12 years for use; some products, such as those containing capsicum, list the age of use as 18 years and older.¹

Prior to recommending the use of any analgesic, pharmacists should evaluate patients for potential drug—drug interactions and contraindications. Patients with preexisting medical conditions and those taking prescription medications should always be reminded to consult their primary health care provider before using any analgesic. Patients should be advised on the proper use of the selected product and on nonpharmacologic measures, such as RICE (rest, ice, compression, and elevation), which may reduce swelling and inflammation, and localized heat therapy, which may be useful for noninflammatory pain.¹ Patients with severe or recurring pain should seek medical care from their primary health care provider, especially if pain worsens or there are no signs of improvement after self-treatment.

The National Institutes of Health and the American Academy of Pediatrics report that most common sports injuries are due to accidents and poor training practices. Although not all injuries can be prevented, measures can be taken to reduce their incidence (Table^1,4,6).^4,5 In addition to sharing the tips in the Table, pharmacists should take every opportunity to remind parents, caregivers and adolescents about educational resources on drug safety, such as the National Council on Patient Information and Education website (talkaboutrx.org/acetaminophen/drug-facts-label.jsp).

Table: Tips for Preventing and Managing Sports Injuries in Adolescents

• To prevent sports injuries, do warm-up and stretching exercises, wear appropriate footwear and protective gear, and maintain adequate hydration.
• Limit use of systemic analgesics to 10 days, unless otherwise directed by a primary health care provider.
• The National Reye’s Syndrome Foundation states that aspirin or other salicylates should not be administered to patientsyounger than 19 years who are recovering from chickenpox, influenza, or during episodes of fever causing or viral illnesses.
• Do not use naproxen in patients younger than 12 years.
• Always read labels and adhere to recommendations for use based on age, dosage, and duration.

^{Adapted from references 1, 4, 6, and 7.}

Ms. Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.

References​

• Preventing musculoskeletal sports injuries in youth: a guide for parents. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. https://www.niams.nih.gov/Health_Info//Sports_Injuries/child_sports_injuries.asp. Published September 2016. Accessed February 14, 2017.
• Feucht CL, Patel DR. Analgesics and anti-inflammatory medications in sports: use and abuse. Pediatr Clin North Am. 2010;57(3):751-774. doi: 10.1016/j.pcl.2010.02.004.
• Skarstein S, Lagerløv P, Kvarme LG, Helseth S. High use of over-the-counter analgesic; possible warning signs of reduced quality of life in adolescents: a qualitative study. BMC Nurs. 2016;15:16. doi 10.1186/s12912-016-0135-9.
• What are sports injuries?. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. niams.nih.gov/health_info/sports_injuries/sports_Injuries_ff.pdf . Published November 2014. Accessed February 14, 2017.
• Paddock C. Young athletes: injuries and prevention. Medical News Today website. medicalnewstoday.com/articles/248796.php. Published August 9, 2012. Accessed February 14, 2017.
• What is the role of aspirin in triggering Reye’s? National Reye’s Syndrome Foundation website. reyessyndrome.org/aspirin.html. Accessed February 22, 2017.
• Olenak J. Musculoskeletal injuries and disorders. In Krinsky D. Berardi R, Ferreri S. et al, eds. Handbook of Nonprescription Drugs 18th ed. Washington, DC: American Pharmacists Association; 2015.