Home Blog All Young Athletes are “Injured” – even if they don’t know it

All Young Athletes are “Injured” – even if they don’t know it

Written on January 7, 2011 at 7:27 am, by Eric Cressey

I’ve written quite a bit in the past about how one should always interpret the results of diagnostic imaging (MRI, x-ray, etc.) very cautiously and alongside movement assessments and the symptoms one has.  In case you missed them, here are some quick reads along these lines:

Preventing Lower Back Pain: Assuming is Okay
Who Kneeds “Normal” Knees?
Healthy Shoulders with Terrible MRIs?

While some of these studies stratified subjects into athletes and non-athlete controls, not surprisingly, all these studies utilized adult subjects exclusively.  In other words, we’re left wondering if we see the same kind of imaging abnormalities in asymptomatic teenage athletes, which is without a doubt our most “at-risk” population nowadays.

That is, of course, until this study came out: MRI of the knee joint in asymptomatic adolescent soccer players: a controlled study.

Researchers found that 64% of 14-15 year-old athletes had one or more knee MRI “abnormalities”, whereas those in the control group (non-athletes), 32% had at least one “abnormality.”  Bone marrow edema presence was markedly higher in the soccer players (50%) than in the control group (3%).

Once again, we realize that just about everyone is “abnormal” – and that we really don’t even know what “healthy” really is.  So, we can’t hang our hat exclusively on what a MRI or x-ray says (especially since we don’t have the luxury of knowing with every client/athlete we train).  What to do, then?

Hang your hat on movement first and foremost in an asymptomatic population.  Do thorough assessments and nip inefficiencies in the bud before they become structural abnormalities that reach a painful threshold.

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One Response to “All Young Athletes are “Injured” – even if they don’t know it”

  1. Jason Hodges Says:

    Oh boy. Tell me about it.

    I live this every day as a radiologist. Over half the people over 50 that I do upper GI studies on have hiatal hernias. Obviously, I am studying symptomatic patients so there is a selection bias. But how many folks have to have something before it’s not “abnormal”. It may not even be related to their symptoms. It may be an ‘incidentaloma’ as we like to say.

    Who is to say the bone edema is any more abnormal than delayed onset muscle soreness? It may just be a normal reaction to progressive stress on a tissue.

    As imaging improves and evolves, ‘new’ anatomy crops up. Glenohumeral ligaments didn’t really ‘exist’ before MRI because we could never see them on CT or arthrograms. I’m sure the orthopods could see them at arthroscopy, but for us radiologists, they existed in the realm of fairies and unicorns.

    Imaging is a piece of the puzzle, not the magical all-seeing eye. It is also subject to interpretive errors in addition to the technical limitations of the imaging modality itself. That is why my reports end with an “Impression”, not a “Statement of Metaphysical Certitude”

    Jason the metalheaddoc

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