Ouch! Sports Injuries and Young Athletes

Lisa Leslie Henderson writer

Hayley Blatz caught the basketball her teammate on the Wellesley High School freshman team threw her, but as she pivoted, she could feel and hear something pop in her knee. What she didn't know was that she had just torn her anterior cruciate ligament (ACL). Nine months later, after surgery and many physical therapy sessions in which Hayley built up the muscle in her legs and learned how to jump and pivot more safely, she is back on the court, leg in a sport brace, hearing swishes in the basket, rather than a pop in her knee.

Hayley’s story is, unfortunately, common. The US Consumer Product Safety Agency estimates that 3.5 million young athletes incur sports-related injuries every year—and this number is growing. Pediatric sports specialists suggest that this statistic grossly underestimates the real rate of injury as it only captures acute sports injuries, such as a broken arm, sprained ankle, or torn ligaments, for which an emergency room visit took place. What is not included are the millions of injuries whose symptoms develop over time, primarily from overuse—shin splints, Little League elbow, swimmer’s shoulder, or stress fractures of the spine—injuries that are more likely to be treated by a pediatrician, orthopedist, physical therapist, or trainer.

The root cause of overuse sports injuries is simple: kids doing more than their bodies are capable of doing. “Kids are not just smaller versions of adults,” observes Michael Perry, a strength and conditioning trainer, who trains young athletes as well as pros at Wellesley-based, Train Boston. “The prevailing attitude of ‘more is better’ is not true when it comes to the bodies of children and young adults. A kid may be good at a sport, but it doesn’t mean that their body has the strength or movement patterns to sustain constant competitive play.”

Here is why: young athletes’ bodies are still growing. Their ligaments, growth plates, and bone-tendon-muscle systems mature unevenly, which can adversely affect kids’ strength, stamina, and coordination, setting them up for potential injuries. The risk is highest during peak growth periods, like puberty, when young persons’ bones tend to be soft while their ligaments and tendons are relatively tight—not a winning combination. Higher estrogen levels and anatomical differences may place girls at a greater risk for injury than boys.

But both male and female athletes, who play the same sport year-round, and on multiple teams, are continually at risk for both acute and overuse injuries—not just during peak growth periods. Without adequate time for their bodies to heal, the repetitive stress takes its toll, manifesting itself as chronic muscle or joint pain and other conditions that were formerly associated primarily with professional athletes. The typical treatment for overuse injuries is rest—sometimes for a week or two, and sometimes for the entire season. But this “medicine” can be very hard for kids, parents, and coaches, who often have so much invested in the sport.

“There is a competitiveness in youth sports that works against young athletes taking care of their bodies,” explains Perry. It begins early and it encourages kids to specialize prematurely. To be at the top, the prevailing wisdom prescribes that kids should begin playing a sport as early as possible, play as often as they can, and compete at the highest levels possible.

“If a child does not start a sport, or any other activity for that matter, by early elementary school, they quickly get out of step with the skills needed to join the pack later on,” explains Dr. Gwenn O’Keeffe, a Wayland mother, pediatrician, and pediatric sports injury expert. “And the intensity expected at such young ages is mind-boggling. When our nine-year-old asked us to look into girl’s hockey this year, we were shocked to hear from coaches of youth leagues: ‘You’d better sign her up now – she’s already on the old side to start’.”

(Athletic superstars such as Billy Jean King and Michael Jordan might not have been discovered nowadays; King didn’t pick up a tennis racket until she was eleven and Jordan wasn’t good enough to play varsity basketball at his high school until his senior year.)

Young athletes, many of whom have made sports the center of their lives, are vulnerable to these competitive messages and can even lead the way. It is intoxicating to please your parents or your coach and to win the league, or maybe the championship. It is honorable to emulate professional athletes who play though pain—and have bloody socks to show for it. And then there is the holy grail: sports as a ticket to college—or the pros—never mind that the average NCAA sports scholarship amounts to $2,000 and that only 0.03 percent of high school seniors will ever have a chance to play professionally.

Just how serious are overuse injuries? Dr. Lyle Michaeli, Director and Co-founder of the Sports Medicine Clinic for children at Children’s Hospital in Boston warns, “When these injuries go undetected, the damage to a growing child’s hard and soft tissues can be permanent. Evidence suggests that overuse injuries sustained in childhood may continue to cause problems in later life, like arthritis.”

How much should kids be playing organized sports? The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends that young athletes limit any one sporting activity to a maximum of five days a week, with at least one day off a week from any organized physical activity. In addition, the Council urges young athletes to take at least two to three months off per year from their particular sport—just like the pros. The off-season isn’t a time of inactivity, however, it’s a time for cross training, letting injuries heal, developing strength and balance, and for regaining motivation.

Will taking time off reduce a player’s competitiveness? Brian Grasso, Executive Director of the International Youth Conditioning Association emphatically believes that, “The off-season is important, so much so that true athletic development and the ascension to becoming a better athlete isn't possible without one.” Perry agrees, “The key is moderation, both in sports and other areas of kids’ lives. Most kids have very little moderation in their lives. It is no wonder that many young athletes are injured or burned out before their high school or college athletic careers really begin.”

How can sports injuries be prevented? “Youth sports experts all agree that the system needs to be overhauled,” explains Dr. O’Keeffe. “The American Academy of Pediatrics has long advocated for a child-focused system that emphasizes injury prevention and skill-building.” Momentum for change in children’s sports is building, but is not yet where it needs to be. In the meantime, consider these recommendations:

1. Be in proper condition to play the sport. Kids should have a preseason physical examination to determine whether there are any underlying physical issues of which they should be aware. In anticipation of an upcoming sports season, kids should cross-train, rather than using the sport to get in shape.
2. Check out the coach. Many community coaches are well-meaning parents with a love of the game—but coaches need to understand the unique issues of young athletes and be trained accordingly. Parents, be respectfully aware of how your child’s team is training and how their bodies are feeling afterwards.
3. Wear protective gear. Proper equipment and safety gear can go a long way toward injury prevention. That means helmets, mouth guards, athletic cups and supporters, shoes, padding, and eye gear.
4. Warm up and cool down. This is time well spent—it will improve athletes’ performance and accelerate the recovery process. Gil Cohen at KOR Personal Training in Wellesley recommends “dynamic” stretching, which means that if kids are getting ready to move, they should warm up by moving. He recommends starting with a 10-minute jog, and then moving the body in its natural range of motion with exercises like arm circles, straight kicks, and torso twists. More traditional “static” stretches (holding a stretch without movement) can follow.
5. Maintain proper hydration. Adequate water or other liquids should be readily available for kids to have before, during and after competition and training. Read labels carefully on sports drinks and avoid those that contain large amounts of sugar. Cohen recommends diluting sports drinks with water. Feeling thirsty is not a reliable indicator of hydration.
6. Don’t play through pain. Pain signals that something is wrong.
7. Keep perspective. When it comes to kids and sports, less can be more.