Femur Bone – Slipped Capital Femoral Epiphysis (SCFE) a Runner’s Guide

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If you notice any aches or pains which seem to suggest femur problems? read this article so that you can take the right responses.

 

The femur bone is a primary support structure in the human body. As a runner, you are probably no stranger to a good workout burn or body ache. Sometimes aches are good: They are little bits of feedback that tell us we’re working parts of our body we haven’t before, or that our muscles and bones are getting stronger. This is commonly referred to as delayed onset muscle soreness or DOMS for short. However, as a runner, you must be aware of what pain is normal and what pain is indicative of something worse.

The topic of this post is an injury that can affect runners as well as other athletes and even some non-athletes. An injury that everyone should be aware of and look out for is Slipped Capital Femoral Epiphysis (SCFE). While SCFE mostly occurs in children, it can also occur in rare instances in adults, with certain practices and habits having the potential to increase the risk of becoming injured in this way. The majority of this information will be most relevant to children, as they are the most common sufferers of this injury, but adults can benefit from this information as well if they feel they are at risk of sustaining this injury.

For runners especially, it is essential to diagnose SCFE as soon as possible given the instability that it can cause and long-term issues it can have on bone health. Athletes, especially experienced ones, are used to working through pain and tend to push their bodies to the absolute limit in order to gain some kind of athletic advantage, such as speed, agility, strength, and so on. They can often overlook a real feedback mechanism indicating real pain associated with a serious injury, confusing it for everyday pain associated with an intense workout, such as DOMS. It is in these moments where it is essential to pay close, special attention to the body in order to identify any abnormal spikes in body function and pain, as failing to do so can result in an extended period of inactivity which would negate all of the hard work leading up to an injury.

This article will provide information in depth about the nature of SCFE: the symptoms, causes, treatment, prevention methods, risks, and false positives. After reading this article, individuals should feel more empowered to identify warning signs associated with Slipped Capital Femoral Epiphysis and will understand the necessary steps to rule out the injury or seek treatment in the event it happens to them or to their children.

     

What is a Slipped Capital Femoral Epiphysis (SCFE)?

A Slipped Capital Femoral Epiphysis is a developmental condition and type of femur fracture usually occurring in pre-teens and teens.  With this injury, the ball of the femur, also known as the epiphysis, slips backward off the neck of the femur bone at the growth plate. Much how like two tectonic plates slide against each other in an earthquake, the femur bone and femur ball slide past each other in a similar fashion. The result of this tectonic shift in the bone is extreme pain and instability in the affected hip.

SCFE is most common in children ages 12-16, occurring more often in boys. However, this condition can also occur in girls commonly between the ages of 10 and 14. A child with SCFE will normally complain of pain, stiffness, or balance instability, and may have indications of swelling and redness in their affected hip. SCFE is the most common hip disorder in pre-teens and teens, with a prevalence of 10.8 cases out of 100,000 children. What is especially startling about this condition is that even with its high commonality, it is one of the highest missed injury diagnoses in the hip.

Based on the stability of the femoral bone, Slipped Capital Femoral Epiphysis is classified as either Stable Slipped Capital Femoral Epiphysis or Unstable Slipped Capital Femoral Epiphysis. More information about the difference between these two classifications is listed below.

Source: Children’s Hospital of Wisconsin
Source: eorthopod.com

Stable Capital Femoral Epiphysis

With Stable SCFE, bearing weight on the affected hip and walking is still possible, although in many cases it will require the help of crutches or some other walking aid. Most documented cases of SCFE are classified as Stable. Patients with Stable Slipped Capital Femoral Epiphysis may experience limping, with the foot of the affected leg pointed at an outward angle. Additional symptoms patients of Stable SCFE will often exhibit are stiffness and/or pain in the knee or lower pelvic area. Lastly, this pain may increase and subside depending on the level of activity; more pain may be experienced with more strenuous activity, and it may lessen with rest.

If you are experiencing pain in the hip area as a runner, you may want to pay close attention to your pain patterns in that area. What may seem like an ache from an intense workout may be a pain signal from a developing fracture in the femur. What is often the case with Stable SCFE is that the injury can develop over a longer period of time. This gradual worsening of symptoms can go undetected, creating no cause for concern, unlike a sharp pain after an isolated trauma would create. Any chronic pain in the area that does not subside or that resurfaces with high activity should be checked by a doctor. Late diagnosis of SCFE can lead to more complex bone disorders like arthritis later in life.

Unstable Capital Femoral Epiphysis

An Unstable Slipped Capital Femoral Epiphysis is much more severe. In this type of SCFE, the affected leg cannot bear weight, which usually means that the patient is not able to walk at all. Unstable SCFE usually occurs suddenly after an isolated impact or trauma to the leg and is extremely painful. Treatment is urgently required and will often require immediate surgery. Unstable SCFE can present more serious complications such as restricted blood flow to the hip joint, which can cause tissue death (necrosis) in the affected area.

If you have this type of SCFE, you will know it. The pain will be excruciating and it will come after a large impact to your legs, such as a collision with a vehicle. In this instance, you should seek treatment right away: either with a same-day visit to your doctor or to the emergency room for immediate care. Make sure that you allow yourself to be mobile without bearing any weight as you go to the hospital. To accomplish this you may need to use the aid of a crutch or wheelchair, or arrange for transport via ambulance if none are available at the time of injury.

Bilateral Slipped Capital Femoral Epiphysis

There have been situations where an individual suffers from SCFE in both legs simultaneously. This condition is known as bilateral SCFE, and it is surprisingly common in children who are susceptible to this injury. One study into the epidemiology of bilateral SCFE determined that roughly 40% of children who suffered from this condition had it in both legs. With bilateral femur injury, walking is extremely difficult if not impossible. The affected individual may also appear bow-legged, with both their feet and knees facing outward at an awkward angle.

Symptoms

The most common symptom of SCFE will be a pain in the affected hip which will often result in difficulty walking. It’s important that you consider the possibility of SCFE with any persistent pain and consult a doctor right away if you suspect that this is the cause of your discomfort. Remember that chronic pain in the same area could be a sign of something more serious, and shouldn’t always be written off as DOMS. Pain may develop over time and/or become worse with increasing physical activity and subside during times of rest. However, if the pain you are feeling doesn’t subside with rest and recovery, or if it immediately flares back up the next time you engage in physical activity, see your doctor to identify and treat any serious developed or developing conditions.

Along with hip pain, other symptoms include:

  • Knee pain
  • Difficulty walking due to pain or limp
  • Hip pain
  • Hip stiffness
  • Outward-facing leg or foot
  • Restricted hip movement

More serious symptoms include:

  • Swelling in the side hip of the affected area
  • Redness around the hip, upper thigh, or groin
  • Warmth to the touch in the hip, upper thigh, or groin area
  • Inflammation in the hip, upper thigh, or groin area

If you or your child experience any of these symptoms in the pelvic area seek treatment from a doctor right away.

Causes

While the exact cause of SCFE is still unknown, doctors have discovered many potential causes. What they do know is that femur injury can happen after trauma from a small fall or can develop gradually over time with no history of an injury. In more technical terms, SCFE occurs when substantial force is placed on the epiphysis, which is the ball of the femur bone, or when the growth plate called a physis experience a decrease in resistance to shearing. No one cause contributes to SCFE but there are several risk factors associated with the injury such as obesity and hormonal imbalances like hypothyroidism.

Many active adolescents, especially those who play school or league sports, will notice pain develop on one side of their pelvic area if they begin to experience SCFE. This pain can increase with time or come and go. It’s important to pay special attention to the pain to determine if its persistence is abnormal; if it continues to linger for weeks on end, visiting a doctor is critical to prevent further injury to the femur bone.

    

Risk Factors

While Slipped Capital Femoral Epiphysis affects both boys and girls, it is more common in adolescent boys. Prevalence in adults is very uncommon, although this form of femur injury should not be ruled out when attempting to identify the cause or source of leg pain. Some of the most common risk factors are:

  • Obesity: There are many negative effects obesity can play in an individual’s health, such as type 2 diabetes or higher blood pressure that leads to an increased risk of heart disease. Another effect that obesity has on the body is that it can weaken one’s bone structure. This is an especially significant risk factor for children, as childhood obesity can affect their natural skeletal development, potentially causing deformities later in life. With a weaker or malformed femur, the likelihood of epiphysis slippage is high.
  • Heredity: Scientific studies have found that many individuals who suffer from SCFE have family members who have also suffered the same injury. This means that hereditary factors can potentially contribute to the development of this condition, possibly due to genetic mutations in an individual’s family history. If you know a relative who has suffered from this condition, you are also potentially at risk.
  • Hormone Imbalances: Pre-teens and teens with an endocrine system disease are prone to epiphysis slippage. These types of diseases produce a hormonal imbalance that can lead to SCFE. Some examples of diseases that cause endocrine imbalances are diabetes, Cushing syndrome, hypothyroidism, and hypopituitarism. If you are diagnosed with one of these conditions by an endocrinologist you are at risk of femur injury. Other endocrine imbalances that can lead to bone injuries like these are growth hormone imbalances, which can be caused by steroid abuse.
  • Thyroid Disorders: Issues with an individual’s thyroid gland can cause a host of bone-related problems and diseases. In the event of hyperthyroidism, excessive amounts of thyroxine are produced in the body. Smaller amounts of this thyroid hormone are necessary for regulating bone health and structure, but if too much is produced it can weaken the bones, increasing the likelihood of SCFE as well as stress fractures and osteoporosis.
  • Kidney Failure: The kidneys are primarily responsible for maintaining a proper level of minerals and hormones in the body. These include calcium, which is directly linked to bone health, and phosphorous, which must be kept at a reasonable level in order to maintain bone strength. If the kidneys are damaged due to chronic kidney disease or diabetes then the body is unable to maintain proper bone health, leading to many different bone problems and the likelihood of femur injury.
  • Coxa Profunda: In coxa profunda, the ball of the femur sits too far into the hip socket, causing restricted mobility in the hip. A normal femur sits slightly outside of the socket exposing some of the head of the femur, which allows for a greater range of motion. Patients with coxa profunda are unable to rotate their hip or move their leg in a large circle like those with a normal ball and socket anatomy.
  • Retroversion: A femoral retroversion is caused by tightening the external rotator muscles on the hip. This contraction, whether involuntary or due to outside factors, can force the femur to rotate outwards and present the appearance of ‘out-toe’. Patients with this abnormality tend to walk with their feet pointed outwards as a result. Acetabular retroversion, another form of retroversion that can cause SCFE, is similar to coxa profunda in that the acetabulum or hip socket is rotated a bit more to the back than a normal hip.

False Positives

A false positive is a test result indicating that the suspected disease or injury is present when in reality it is not. For example, if you wake up one day with a runny nose, congestion, and fever, you may come to the conclusion that you’ve caught a cold or the flu. However, upon closer observation, you may notice that your eyes are also itchy and there is a thick film of pollen on your car. In this hypothetical scenario, what you really have are seasonal allergies or hay fever. Similarly, SCFE can be falsely identified if symptoms of another ailment mimic those of SFCE.

The injuries listed below are often confused with Slipped Capital Femoral Epiphysis due to similar symptoms or causes but will require different means of treatment. In order to rule out these false positives, be sure to receive a thorough diagnosis from a doctor or medical professional as soon as you suspect an injury. Failing to properly identify your injury can cause you to waste time and money treating an injury incorrectly, and can even cause permanent damage in some extreme cases.

  • Muscle Strain: Hip and groin pain is a common symptom of many injuries to the lower body, especially in children. Before concluding that a child may have SCFE it is important to rule out any other possibilities that may exhibit similar symptoms. Other causes of hip pain could include a strain in the muscles near the hip, groin, thigh or calf. A severe enough case of a muscle strain in these areas of the leg can exhibit similar symptoms to femur injuries, such as stiffness, limited mobility, and pain that varies during the day and during different levels of physical activity.
  • Stress Fracture: Bone damage can come in many forms, with different causes and methods of treatment. Although SCFE affects the femur bone exclusively, it is not the exclusive bone injury that can affect this part of the skeleton. Microscopic cracks can appear in any bone, causing pain and swelling as well as excessive stiffness and limited mobility. These are known as stress fractures and won’t usually require surgery unless the fracture is particularly severe. Due to their rarity, a femoral neck stress fracture in children can easily be misdiagnosed in this way. In some cases, secondary issues such as anorexia nervosa or other bone strength compromising disease can lead to a femur bone fracture like a femoral neck stress fracture.
  • Synovitis: If pain, swelling, stiffness, and deformities in the leg are observed near the knee, the cause of these symptoms can be synovitis rather than a direct injury to the femur. With synovitis, the protective lubricating fluid found in an individual’s knee begins to build up, causing the joint to swell and hurt with movement or weight bearing. This injury can be caused by trauma and can affect children, but the cause of pain is different and the condition often resolves itself after a few weeks of rest.
  • Hip Dislocation: If a child or adult suffers from severe trauma, such as a collision with a vehicle or hard impact during a contact sport, the possibility of hip dislocation is present. This injury can be confused with femur injury because pain can be felt in a similar area of the body during a hip dislocation. Another common symptom both ailments share is a change in gait, with the possibility of one foot pointing inwardly or outwardly at an unnatural angle. Dislocation can be less severe than a full break like SCFE, but the pain is still severe and the recovery process is still time-consuming.
  • Septic Arthritis of the Hip: Also known as infectious arthritis, septic arthritis is caused by a bacteria or fungus that induces inflammation in the area or joint where the infection is localized. Usually, the infection is centered around a large joint such as the hip or hip socket and rarely affects multiple joints. The bacteria usually enters the bloodstream from an opening in the skin like a wound or surgical procedure. The most common bacteria attributing to septic arthritis are Haemophilus Influenzae, staphylococcus, and streptococcus. Septic arthritis has similar symptoms to SCFE like pain and inflammation in the joint area and can contribute to a false positive diagnosis of SCFE. This can usually be ruled out by a doctor that conducts a thorough interview with the patient about their medical history, as well as by analyzing blood work.
  • Leukemia: Leukemia is a type of blood cancer that affects blood-making tissues like bone marrow and the lymphatic system. Cancer affects white blood cells and can inflict children and adults alike. White blood cells are essential in fighting infection; with leukemia, white blood cells abnormally develop in the bone marrow and compromise the body’s ability to fight infection. While symptoms of leukemia vary, common signs are bone pain or tenderness which are coincidentally also symptoms of SCFE. Leukemia is the most common cancer afflicting children. What this means is if your child or a child you know complains of pain or tenderness near a bone or bone joint, it is imperative to seek medical attention immediately to identify any potential long-term complications and to address health concerns quickly.

Complications

In the event that cases of Slipped Capital Femoral Epiphysis is not treated properly in time, more serious injuries can develop as a result. These are known as complications as they are more complicated injuries that are harder to treat and can cause much more severe damage to the body. There are only two recorded complications from SCFE but they are particularly nasty. Because of this, it is extremely important to identify and treat cases of femur injury in a timely manner, or you run the risk of developing one of these conditions:

  • Avascular Necrosis: When the epiphysis becomes detached from the femur, blood flow is restricted to the leg bone entirely. This can result in further degradation of the bone and cartilage in a condition called avascular necrosis or osteonecrosis. This condition can eventually lead to bones rubbing against each other, which will cause extreme pain as well as the possibility of developing osteoarthritis. Osteonecrosis is most common in cases of unstable SCFE, but it has occurred with cases of stable SCFE as well, so the threat of this complication is present in any case of SCFE.
  • Chrondolysis: This is a painful condition potentially caused by SCFE where cartilage surrounding the hip joint begins to degrade. The effect this has on the lower body is that it will cause excessive pain and stiffness in the hip as well as the possibility of deformity and limited movement. In some cases, chrondolysis can occur as a result of surgical treatment of SCFE. Fortunately, advanced in medical treatment methods and technology have made this condition much rarer to occur. However, the possibility is still present of this injury occurring as a complication of femur damage, albeit at a probability of 1 to 2 percent.

How Do You Treat a Slipped Capital Femoral Epiphysis?

With knowledge of this debilitating injury and what kind of harm it can have on the body, it should be clear that SCFE is a condition that needs to be treated if an individual becomes afflicted with it. The first and most important step in the treatment process is obtaining a diagnosis from a medical professional. Do not attempt to treat your injury without first being diagnosed by a doctor. If you aren’t properly diagnosed before attempting to treat your injury, you run the risk of worsening your condition in the event that it is actually one of the false positives listed above.

Diagnosis

It cannot be repeated enough: being examined by a doctor at the time of hip pain is the only way to receive a valid diagnosis and treatment. It is essential that children experiencing any prolonged pain in their hip visit a doctor as soon as possible to identify treatment options and to understand if surgery might be needed. Here are some methods a doctor will use in the diagnosis process:

Interview/Physical Examination

This is the first course of action for most diagnoses from a doctor and is used for a preliminary examination before attempting more thorough methods. The doctor will ask the patient a series of questions about their daily habits, medical history, family history, and what level of physical activity they engage in regularly. At the same time, the doctor will perform a cursory physical examination. This examination involves touching various parts of the affected body part (in this case, the leg) in order to check for any abnormalities and gauge the patient’s pain level.

One way that a doctor will check for SCFE during a physical examination is to rotate and observe both of the patient’s hips. Usually, a leg affected by this femur injury will rotate externally when the hip is flexed at an angle of 90 degrees. The purpose of rotating both hips is to compare a healthy leg to the injured one; however, this won’t be effective in the rare case that a patient is suffering from SCFE in both legs. If a doctor notices activity that could be caused by Slipped Capital Femoral Epiphysis, they will often move on to imaging scans.

Imaging Technology

The only way SCFE can be confirmed with absolute accuracy is with an X-ray of the front and back of the hip, as well as an X-ray with the patient’s legs bent with their feet together resembling frog’s legs. While performing these scans, your doctor will be looking for any of the injuries described above that are associated with Slipped Capital Femoral Epiphysis as well as any other femur fractures in the affected hip. Additionally, they will be looking for any other developmental or mechanical abnormalities that are known to be key risk factors for SCFE.

In some cases, radiographs taken from an X-ray won’t be sufficient for obtaining a proper diagnosis. In order to rule out any other false positives and confirm that a patient is definitely suffering from SCFE, a doctor may schedule an MRI scan. MRI scans, short for magnetic resonance imaging scans, provide a greater level of detail in their scans. This is accomplished by taking 360-degree images of the targeted limb and can capture detail in both bone and tissue. MRI scans are very effective at diagnosing bone injuries such as a slipped epiphysis and can identify any complications from this injury such as avascular necrosis in the surrounding tissue.

After a thorough examination and study, your doctor will advise you on the best course of action to heal the fractured femur bone (if there is, in fact, a fracture or SCFE) and provide further recommendations for correction, prevention, and/or long-term care such as physical therapy.

Source: American Family Physician
Source: Medscape

Treatment

Once SCFE is confirmed, the doctor will place the patient on weight-bearing crutches or a wheelchair and refer the patient to an orthopedic surgeon familiar with SCFE injuries for a treatment course of action. Surgery is the best course of action that can completely treat this injury. In very rare and minor cases, nonsurgical treatment can be used to treat SCFE. This form of treatment involves an extended period of rest and applying a cast to the affected leg. However, the vast majority of SCFE cases will require invasive surgical procedures in order to facilitate a full recovery. Treatment goals with these procedures are to set the femoral fracture back into place, prevent further slippage, and prevent any complications from developing.

Surgery

The type of surgical treatment recommended by the doctor will depend on the nature and severity of the injury and femur fracture. If your injury is a stable SCFE, the surgeon will most likely correct the fracture with an in situ screw fixation. This is a surgical procedure that involves making a small incision in the hip and inserting a screw through the top of the femur bone. This screw is placed through the growth plate and into the femoral head in order to prevent any more slippage. Any further slippage stops once the growth plate is sealed, which will occur over time in children and will be fully sealed by the time they reach adulthood.

For an unstable SCFE, the surgeon may need to perform an open reduction. This procedure begins by making an open incision into the hip and coaxing the femur bone back into place before inserting a stabilizing screw. One or two screws may be necessary to hold the femur bone into place until the growth plate seals. This procedure is more complex and requires more postoperative recovery time. After performing one of these surgical procedures, patients will need to be observed for a short period of time in order to determine that the hip joint has been secured adequately. After this short period of observation, patients can expect to leave the hospital within one or two days after surgery.

How the treatment will work depends on how fast the injury is diagnosed and treated. Delaying treatment can lead to early degenerative hip arthritis or avascular necrosis, both of which may require further hip surgery down the road. However, if this condition is identified and treated in due time, patients can expect to make a full recovery and resume a normal level of activity.

Source: Rijnland Orthopaedie

How do you Prevent a Slipped Capital Femoral Epiphysis?

Due to the fact that the primary cause of this condition is genetic, most cases of SCFE are unfortunately not preventable. However, steps can be made to ensure that individuals that aren’t genetically predisposed to this form of femur injury can prevent it from occurring. These are mostly lifestyle changes, focused on improving an individual’s overall health. The benefits of proper nutrition, adequate exercise, and proper hydration will not only prevent femur injury but will also work to prevent a great deal of potential running injuries. Whether you are a parent concerned about your child developing this condition, or an adult who wants to avoid any debilitating injury, these prevention methods can benefit you greatly.

Good Nutrition

When planning out a child’s diet, take care in ensuring meals are high in nutrient-dense foods and low in sugar and trans fats. A balanced and nutritious diet prevents injury by ensuring the body has the proper building blocks to construct bone and muscle. A good diet is also important for maintaining a strong immune system in order to help the body fight off infections. Pathogens (bacteria and viruses that make us sick) are always present in our bodies in small quantities. Our immune system is constantly patrolling and destroying these pathogens so they don’t multiply and cause illness.

Nutrient-dense foods include:

  • ProteinProtein is the building block of the body. It is responsible for building and maintaining muscles, and an inadequate amount of protein in an individual’s diet can lead to issues with muscle growth and recovery. Good sources of protein include lean meat and poultry, seafood, eggs, unsalted nuts and seeds, peas, beans, and soy products.
  • Fruit: Different types of fruits contain high amounts of vitamins that are necessary for proper bodily functions. Vitamin C can be found in citrus-based fruits such as oranges and tangerines, which is essential for proper bone health. It is also responsible for the processing of calcium in the body, which is what helps strengthen bones. What protein is to muscles, Vitamin C and calcium are to bones. try to include as much fresh and dried fruit as opposed to fruit that comes in a can, as fresher fruit contains higher amounts of vitamins and fewer preservatives. It is important to wash fresh fruit before serving or eating especially apples, as they can carry dirt and pesticides.
  • Vegetables: In addition to being a great source of protein, vegetables can provide high amounts of fiber and important vitamins that can’t be found in meat or fruit. Vitamin K is necessary for proper blood flow and coagulation, which will provide oxygen to the body and help to heal injuries. High concentrations of this vitamin can be found in leafy green vegetables such as kale and spinach, as well as herbs such as basil. Try to include as much fresh and dried vegetables as possible into you or your child’s diet. If your child is stubborn and doesn’t like eating their veggies, you can mix it into a smoothie with some fruit and yogurt so that it tastes better.
  • Whole grains: Whole wheat bread, oatmeal, quinoa, brown rice and wild rice contain high amounts of fiber, which is important for maintaining a healthy digestive system. Inadequate fiber can cause problems in the bathroom, so be sure you or your child has a decent amount of it in their diet. In addition, fiber is very filling, so eating fiber-rich foods will help you to feel full throughout the day and prevent excessive snacking in between meals.
  • Dairy: Dairy products include high amounts of calcium, which is important for maintaining strong bones. Some types of milk available at the grocery store are also enriched with Vitamin D, which is an extremely important dietary supplement that promotes general well-being. Healthy sources of dairy include fat-free or low-fat milk, yogurt, cheese, and fortified soy drinks.

In addition to adding nutrient-dense foods to you or your child’s diet, make sure you are limiting the amount of sugar and saturated and trans fats as much as possible. Some other substances to avoid in a proper diet include:

  • Saturated Fats: While some forms of fats are healthy and required for a balanced diet, having too much of the wrong kind of fats can cause health issues. Saturated fats are a form of fat that is saturated with hydrogen molecules.  They have been linked to excess production of LDL cholesterol in the body, which can cause heart problems and contribute to obesity. Excess weight from obesity can lead to bone injury and impede natural bone growth in younger children, so it is recommended to cut down on saturated fats in the body. They are commonly found in fatty meats such as beef and pork, as well as animal fat products such as lard.
  • Trans Fats: Although trans fats are unsaturated, they can still contribute to the excessive production of bad cholesterol while inhibiting the body’s production of good cholesterol. The result of this is an increase in the risk of obesity and heart disease, much like saturated fats, and it can also lead to excessive inflammation which makes recovering from many different injuries more difficult. Trans fats are commonly used to preserve foods and can be found in ingredients like hydrogenated oil.
  • Sugar: Sugar is an important staple of any diet, as it allows the body to generate energy by processing it into glucose. Some healthy forms of sugar can be found in fruits and dairy products. However, many products contain additional sugar, even if they don’t taste sweeter. Excessive amounts of sugar can lead to fat buildup, which contributes to obesity, and can cause other problems with the body such as diabetes and tooth decay. To remove excess sugar from your diet or your child’s diet, look for unsweetened or reduced sugar products, and avoid products with too much high fructose corn syrup or sucrose.
  • Cholesterol: Much like with fats, cholesterol comes in good and bad forms and is required for a balanced diet. However, many forms of cholesterol derived from a regular diet are LDL or bad cholesterol. As previously mentioned, too much LDL cholesterol will contribute to health problems relating to weight and cardiovascular functionality, so limiting your consumption is recommended. Consider eating egg whites instead of entire eggs, and use lean cuts of meat such as turkey and skinless chicken over beef and pork.

    

Adequate Exercise

The Center for Disease Control (CDC) recommends children and adolescents participate in one hour or more of combined daily physical activity in the following three areas: aerobic activity, muscle strengthening, and bone strengthening. The health benefits gained from following this routine will prevent plenty of injuries, and when coupled with a proper diet, it can allow for a faster recovery from injuries such as bone damage.

Aerobic Activity

Aerobic activity is any activity that gets your child’s heart rate up and makes them sweat. This type of exercise is the best way to burn calories that would otherwise be stored as fat in the body, contributing to obesity. It can also strengthen their cardiovascular functionality, allowing them to perform better in physical activity because their heart can provide more oxygen to their body. Aerobic activity is characterized as an activity of moderate to high intensity. Moderate intensity aerobic exercise includes brisk walking, hiking, or kicking a ball around a field. Examples of high-intensity aerobic exercise are running, dancing, swimming and organized sports such as soccer. The CDC suggests children participate in high-intensity exercise at least 3 times a week.

Muscle Strengthening

Cardio exercise alone, as is aerobic activity, is not enough to maintain good physical health. It is equally important to ensure that muscle strength and tone are maintained in children so that they may be physically fit to carry out strength-dependent activities later in life and to prevent injury. Therefore, include muscle-strengthening exercises at least 3 times a week. Some ideal strengthening exercises include push-ups, squats, resistance band training, incline walking, hiking, and dancing. For children, it’s important to ensure that muscle-strengthening activities are age appropriate, as overtraining can impede their natural growing process. This can be seen in some teenagers involved in wrestling: if they are coached to lose excessive amounts of weight in order to meet a certain weight class, or are encouraged to gain excessive amounts of muscle, their height can become stunted. To avoid this, limit young children to bodyweight exercises such as push-ups and pull-ups.

Bone Strengthening

Similarly to cardiovascular and muscular strength, bone strength is also important to include in your child’s exercise regimen. As the growth plate in the femur bone is developing and fusing in adolescence, total bone health is crucial to reduce susceptibility to femur fractures like Slipped Capital Femoral Epiphysis. To build bone strength, include activities such as running or jumping rope at least 3 times per week. If your child is already a runner, make sure that they are equipped with adequate running shoes to absorb shock from the impact of their legs and feet to the ground. Proper shoes can reduce impact to bones and combined with age-appropriate bone strengthening exercises, will help prevent injuries from developing over time. It is also important to provide adequate time in between exercises to allow for the body to recover. Failing to properly rest in between workouts can lead to injuries, including bone damage.

     

Exercises for Muscle and Bone Strengthening

Burpees (10 repetitions)

  1. Start standing straight up with arms at sides
  2. Squat with hands on the ground and jump back into a plant position
  3. Jump back into a squat position and jump up with hands stretched to the sky
  4. Repeat 9 times

Jump Lunges (20 repetitions)

  1. Start standing straight up with hands on hips (center position)
  2. Step forward with right leg and bring left knee an inch off the ground
  3. Return to a standing position by bringing the right leg back to center position and jump with feet together
  4. Repeat with left leg
  5. Complete 19 repetitions

Walking Lunges (24 steps)

  1. Start standing straight up with hands on hips (or holding weights)
  2. Step forward with right leg and bring left knee an inch off the ground
  3. Return to a standing position by bringing the left leg to the right leg
  4. Repeat 23 times alternating legs

Knee Ups (24 steps)

  1. Start standing straight up with hands at side
  2. Step on a stable stool, chair, or bench with your right leg and raise your left knee
  3. Step back down to a standing position on the floor
  4. Repeat 23 times alternating legs

Sumo Squats (15 repetitions)

  1. Standing upright with feet apart, a little wider than shoulder width with hands at sides
  2. Squat down so that thighs are parallel to the floor and raise arms so that they are parallel to the floor
  3. Return to an upright position
  4. Repeat 14 times

Jump Squats (15 repetitions)

  1. Standing upright with feet apart, a little wider than shoulder width with hands at sides
  2. Squat down so that thighs are parallel to the floor and raise arms so that they are parallel to the floor
  3. Jump up and return to an upright position
  4. Repeat 14 times

Mountain Climbers and One Push Up (15 repetitions)

  1. Start in a plank position
  2. Bring left knee to chest and return
  3. Repeat with right leg
  4. Do one pushup
  5. Repeat 14 times

Straight Leg Jackknife (20 repetitions)

  1. Start by lying flat on your back with your arms stretched above
  2. Raise arms and legs up until they touch and return to starting position
  3. Repeat 19 times

Lay Down Push Ups (15 repetitions)

  1. Starting on your stomach with legs stretched out and the palms of your hands on the floor at your chest
  2. Stretch arms out forward
  3. Return arms to the side and do one pushup
  4. Return to starting position
  5. Repeat 14 times

Conclusion

After reading this article, you should be a bit more knowledgeable about the presentation, causes, risks, treatment, and prevention steps for Slipped Capital Femoral Epiphysis. As a runner or a parent of a young runner, injuries are common and will require you to look out for them. However, with some awareness and education, you will be more empowered to take steps towards preventing injury and seeking help if symptoms present for you or your child.

Also worth repeating is the importance of proper nutrition as a preventative and long-term health behavior measure. Inside our bodies, billions of reactions and processes are taking place that keeps us alive. These processes include the generation of new cells, the deployment of infection-fighting cells, tissue repair after a cut or wound, and even creating the energy molecules to fuel our muscles to keep running. Therefore, providing our bodies with the right tools that it needs to do those processes is critical. When your diet is poor, such as when you consume fast food or foods high in trans-fat, you are depriving your body of those tools and effectively shutting down those very important processes that keep you breathing and functioning normally. The nutritional guidelines outlined above are essentially a checklist of the necessary tools to keep you healthy.

As it relates to Slipped Capital Femoral Epiphysis, nutrition may be the single most effective action an individual can take to prevent the injury from occurring. Obesity in children in the U.S. is at the highest it has ever been, and the health of future generations depends on how we think about the care of our bodies now. Given that running can be an excellent method of exercise, it can also be the most taxing on the body, which provides even more incentive to also maintain good nutritional habits.

Remember, upon experiencing any pain or abnormal activity with your body, it is always essential to seek out the recommendation of a licensed clinician. For non-life threatening issues, make an appointment with your doctor as soon as possible. For more urgent but non-life threatening issues, seek out an urgent care center near you. And lastly, for urgent and life-threatening matters, go to your nearest emergency room or call 911.

      

Sources

Below is a list of sources that were used to support the information in this post. While the content of these sources originates from research institutions, hospital systems, peer-reviewed journals, and medical associations, the information in this post was written to be purely informational. The information contained in this article is not intended to be used as medical advice. Please seek guidance from a medical professional for any of your health needs.

Sources

  1. American Family Physician, Slipped Capital Femoral Epiphysis: Diagnosis and Management., Informational Website,
  2. Charles J. Odgers IV, M.D., The Alfred I. Dupont Institute. Bilateral Slipped Capital Femoral Epiphysis., Journal Publication,
  3. Stanford Children's Hospital, Slipped Capital Femoral Epiphysis., Informational Website,
  4. American Academy of Orthopaedic Surgeons, Slipped Capital Femoral Epiphysis, Informational Website,
  5. Kevin D. Walter, MD, FAAP, Slipped Capital Femoral Epiphysis., Informational Website,
  6. Medline Plus, Slipped Capital Femoral Epiphysis., Informational Website,
  7. Marc Swiontkowski, M.D., Slipped Capital Femoral Epiphysis: Preventing and Managing Complications., Journal Publication,
  8. Johns Hopkins Medicine, Slipped Capital Femoral Epiphysis, Informational Website,
  9. Seattle Children's Hospital, Slipped Capital Femoral Epiphysis: Symptoms and Diagnosis., Informational Website,
  10. Melvin C. Makhni, Slipped Capital Femoral Epiphysis., Journal Publication,
  11. Farr JN, Dimitri P., The Impact of Fat and Obesity on Bone Microarchitecture and Strength in Children., Journal, Dec 04, 2016
  12. Gunnar Hägglund, Lars Ingvar Hansson, Staffan Sandström, Familial slipped capital femoral epiphysis, Journal, Jan 01, 1987
  13. Sharon Moe, M.D., Mineral & Bone Disorder in Chronic Kidney Disease, Article, Nov 01, 2015
  14. DAVID PECK, MD, Slipped Capital Femoral Epiphysis: Diagnosis and Management, Article, Aug 01, 2010
  15. Northwell Health, Slipped capital femoral epiphysis treatment, Article,
  16. Loder RT; Aronson DD; Greenfield ML, The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan., Journal, Jan 01, 1993