adolescent injury

Did you know we as physios can play a huge role in how adolescent athletes go on to think about injuries?

Adolescence is a period of neuroplasticity and heightened social sensitivity. Many will present to you with their first injury. And like it or not, our job isn’t just to reduce pain and restore function, it’s to shape how that experience is understood.

That first injury can influence beliefs about pain, confidence in their body, and future injury behaviour. So we need to make sure to adapt our clinical approach to this stage of life.

Big responsibility, right?

Luckily, Dr Loretta O’Sullivan-Pippia shows how this can be done in her Case Study on managing a 13-year-old with an ankle sprain. This blog shares a few of the key ideas that stood out.

If you want to see exactly how expert Dr Loretta O’Sullivan-Pippia optimises her management of adolescent injuries, watch her full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

Initial management

The case itself is simple on paper: a first-time lateral ankle sprain, no red flags.

But the context is where things become more complex. There’s an upcoming tournament, coaches reacting on-court, parents asking questions, all of which can make the situation feel a bit chaotic. These environmental and social factors can often lead to unnecessary escalation, such as scans, boots, and restriction, which can shape how the athlete views injuries moving forward.

So a lot of early management is actually about slowing things down. Being clear, calm, and not overcomplicating things.

Loretta uses the Ottawa Ankle Rules as an example; they’re extremely helpful for ruling out fracture, but we also need to consider how applying them in a high-stress environment can amplify the pain experience and push decision-making towards escalation. Part of our role is to actively prevent that.

Creating a calm environment is the first step, small things make a big difference. Take the mechanism of injury in the athlete’s own words, avoid directing communication only to parents, and ensure the situation is explained in a way the athlete can understand.

Initial management here is really about setting the tone: clear, confident communication and reassurance that actually reduces uncertainty, rather than adding to it.

Shared decision-making

Involving adolescents in their injury management early on isn’t just good for this injury, it helps shape how they’ll manage injuries in the future.

Rather than telling them when they’re ready to progress, Loretta uses clear, observable criteria that the athlete can assess herself. This helps her understand how the injury is progressing and builds confidence in her own judgement.

It shifts the locus of control. Instead of relying on the clinician, she starts to develop her own sense of readiness. That’s a really important autonomy shift, especially at this age.

Loretta explains how she did this in the clip below from her Case Study:

For many adolescents, this is the first time they’re learning how to respond to pain, interpret symptoms, and make decisions about their body. Giving them some ownership in that process builds confidence and reduces reliance on external reassurance (which can, at times, be more chaotic than useful).

Education plays a role here too, but it’s less about volume and more about framing: pain is a protective signal, listening to your body is useful, and recognising that the environment can influence how pain feels.

These are simple concepts, but introduced early, they can shape how an athlete approaches injury long-term.

Applying the biopsychosocial model in practice

We talk about the biopsychosocial (BPS) model a lot, but this case shows what it actually looks like in practice.

The social environment around the injury was deliberately addressed.

There were conversations with coaches and team managers to set expectations and clarify roles; for example, having a single first responder rather than multiple people crowding in. Teammates were guided on how to respond in a way that shows support without escalating the situation.

Another key part was involving the athlete in this process. Rather than everything happening around her, she was part of the discussion. That involvement builds autonomy, but also helps her make sense of the experience in a more constructive way.

See Loretta explain real-life BPS model application in this clip from her Case Study:

Wrapping up

Whether it’s an ankle sprain or something more complex, we’ll always need to get the clinical, “bio” side of things right.

But for all patients, and with adolescents particularly, that’s only part of the job.

Early injury experiences can shape confidence, fear, and decision-making around activity and pain. How we communicate, manage the situation, and involve the athlete all contribute to that experience.

Handled well, a first injury can build trust in the body, support self-management, and keep someone engaged in sport long-term.

If you want to learn exactly how an expert does this in a real-life case, watch Dr Loretta O’Sullivan-Pippia’s full Case Study here.