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Clinical Management of Musculoskeletal Injuries in Active Children and Youth

Mazer, Barbara PhD*†‡; Shrier, Ian MD, PhD§; Feldman, Debbie Ehrmann PhD†¶; Swaine, Bonnie PhD†¶; Majnemer, Annette PhD*†‖; Kennedy, Eileen MSc; Chilingaryan, Gevorg DMD, MPH†‡

Clinical Journal of Sport Medicine: July 2010 - Volume 20 - Issue 4 - p 249-255
doi: 10.1097/JSM.0b013e3181e0b913
Original Research

Objective: To describe how different health care specialists manage musculoskeletal injury in children and examine factors influencing return to play decisions.

Design: National survey.

Setting: Secure Web site hosting online questionnaire.

Participants: Medical doctors, physical therapists, and athletic therapists who were members of their respective sport medicine specialty organizations.

Independent Variables: Professional affiliation and the effect of the following factors were examined: pushy parent, cautious parent, protective equipment, previous injury, musculoskeletal maturity, game importance, position played, team versus individual sport, and time since injury.

Main Outcome Measures: Recommendation of return to activity after common injuries seen in children and adolescents as described in 5 vignettes; consistency of responses across vignettes.

Results: The survey was completed by 464 respondents (34%). There were several differences between the professional groups in their recommendations to return to activity. Most factors studied did not tend to influence the decision to return to activity, although protective equipment often increased the response to return sooner. The number of participants who would return a child to activity sooner or later for each factor varied greatly across the 5 vignettes, except for pushy parent or cautious parent.

Conclusions: Management practices of sport medicine clinicians vary according to profession, child, clinical factors, and sport-related factors. Decisions regarding return to play vary according to 5 specific characteristics of each clinical case. These findings help establish areas of consensus and disagreement in the management of children with injuries and safe return to physical activity.

From the *McGill University, School of Physical and Occupational Therapy, Montreal, Quebec, Canada; †Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Québec, Canada; ‡Jewish Rehabilitation Hospital, Laval, Quebec, Canada; §Centre for Clinical Epidemiology and Community Studies, Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, Quebec, Canada; ¶Ecole de réadaptation, Université de Montréal, Montreal, Quebec, Canada; and ∥Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada.

Submitted for publication April 23, 2009; accepted March 30, 2010.

This study was funded by the Réseau provincial de recherche en adaptation-réadaptation (REPAR). Dr. Shrier is funded by a Senior Clinical Investigator Award from the Fonds de la Recherche en Santé du Québec. Dr. Swaine holds a Senior Research Award from the Fonds de la Recherche en Santé du Québec. Dr. Feldman is funded by a New Investigator Award from The Arthritis Society of Canada.

B. Mazer and G. Chilingaryan had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Reprints: Barbara Mazer, PhD, Jewish Rehabilitation Hospital, 3205 Place Alton Goldbloom, Laval, QC H7V 1R2, Canada (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.