too much, too soon is causing overuse injuries
ising rates of childhood sluggishness resulting in obesity are an oft-spotlighted cause for concern these days, but doctors are reporting an alarming trend on the other side of the spectrum: growing numbers of kids who are too active. Overuse injuries, once mostly non-existent among adolescents, are fast becoming a leading cause of young athletes’ visits to doctor’s offices and emergency rooms.
But overuse injuries aren’t the only type that has these experts worried. All kinds of youth sports injuries are reportedly on the rise, last year sending approximately 8000 kids to the emergency room every day and accounting for somewhere around five million injuries.
In fact, youth sports injuries have gained enough recent prominence that in 2010 the National Athletic Trainer’s Association gave the U.S. a very mediocre grade on youth sport safety: C-.
“This is a neglected population in terms of focusing on health and safety during sports participation,” NATA President Marjorie J. Albohm told HealthDay News (healthday.com) in December of last year. “The numbers of young people [playing sports] far outweigh the numbers of elite or professional athletes, yet we haven’t given them the attention they deserve in terms of health and safety.”
breaks vs. concussions
Few would deny that injuries are part and parcel of sports, but experts say that the current rate of injuries among youth athletes — particularly overuse injuries — is unnecessarily high.
Safe Kids USA, a nonprofit dedicated to “eliminating preventable childhood injuries,” found recently that among athletes ages five to 14, 15 percent of basketball players, 28 percent of football players, 22 percent of soccer players, 25 percent of baseball players, and 12 percent of softball players have been injured while playing their respective sports.
About half of those injuries are what orthopedic surgeon David Anderson, MD, who practices through the Minnesota Orthopedic Sports Medicine Institute, called “acute” — straightforward trauma damage like broken bones, fractures, concussions, and cuts and bruises.
The other half fit that brand of injury that was once quite uncommon among young athletes: overuse injuries. Complaints like stress fractures, cartilage injuries, and pitcher’s elbow have all become commonplace among a young demographic.
A particularly striking example of the changing nature of youth injuries is the prevalence of Anterior Cruciate Ligament (ACL) tears, which usually requires corrective surgery and rehabilitation lasting anywhere from four to 12 months.
Dr. Mininder S. Kocher, associate director of the Division of Sports Medicine at Children’s Hospital Boston, told the American Orthopedic Society for Sports Medicine that ACL tears were once exceedingly rare among “skeletally immature athletes.” Now, of the 150 ACL reconstruction surgeries Kocher performs each year, nearly two-thirds are on youth patients.
These injuries aren’t the only ones cropping up in young athletes. The news has been dominated in recent years by reports of rising concussion rates among athletes; a study published in the journal Pediatrics found that the rate of concussion-related hospital visits among young athletes increased steadily from 1997 to 2007 and was especially high among those involved in football, hockey, and soccer. In athletes aged 14 to 19, concussion rates increased by over 200 percent. What is especially scary about a childhood concussion is the possible long-term effect: researchers have linked repeated concussions to mental issues such as emotional problems, long-term memory loss, and progressive dementia.
Anderson, who also works with local high schools, says that head injuries are among the scariest that he has seen in youth sports, along with cervical and spine trauma. He recalled a cheerleader who fell on her head during a stunt at a high school football game and ended up spending multiple nights in the hospital for a concussion.
“There are always going to be injuries like broken bones — we can fix those,” Anderson says. “What we really need to try to minimize are those injuries that can cause permanent loss of function.”
a serious business
Many attribute the rise in injuries among young athletes to the changing nature of the games that young athletes play. “Children are playing at higher intensities and at younger ages,” said Kocher. “They are facing the same kind of pressure to perform as professional athletes.”
Anderson says young athletes are not only playing harder, but also specializing sooner. He sees a lot of youth hockey players who play year-round, with little or no time off between seasons. That specialization, he says, is the culprit behind many of the overuse-related injuries, like stress fractures and inflammatory knee pain.
And kids aren’t only playing harder and more often — they’re also getting bigger, thanks to improved nutrition and health care, as well as training and conditioning from younger ages.
“You [have] eight year-olds with 13-year-old bodies but the maturity still of eight year-olds,” says Dr. Lisa Bakhos, lead researcher of the concussion study published in Pediatrics Now. “When you put big kids with a lack of maturity in a game they’re going to get injured.”
minimizing injury
So what is the key to minimizing injury?
According to Anderson, it involves striking a delicate balance between being fit and conditioned before jumping into a sport, and getting one thing that many young athletes don’t see enough of these days: time off. For kids who don’t want downtime, playing a different sport that works different muscles (for example, swimming in the winter; soccer in the summer) is a good alternative.
Most sports experts agree. Brian Grasso, executive director of the International Youth Conditioning Association, told Pediatrics Now that the off-season is so important that “true athletic development and the ascension to becoming a better athlete isn’t possible without one.”
As for preventing muscle injuries like strains or tears, there’s nothing quite like a good warm-up, which raises body and muscle temperatures, preparing the body’s systems for more strenuous exercise. Warm-ups often involve a combination of jogging and stretching.
Many coaches have switched to “dynamic warm up” routines, which use continuous active motion like lunging and skipping to increase body temperature, excite the heart rate, and elongate muscles — exactly the preparation the body needs to play without getting hurt.
There are many other small ways that parents and athletes can minimize risk of injury. Things as simple as nutrition can play an important and often forgotten role in athletes’ performance; young athletes require good sources of energy and fiber, a variety of vitamins, as well as healthy doses of calcium and protein to aid bone and muscle development.
Sports trainer Rachel Harris, who often coordinates with the National Center for Sports Safety (NCSS), says hydration is a similarly crucial factor in preventing athlete injury or illness. “Dehydration happens really fast,” Harris says. “Just losing two percent of a kid’s body weight can negatively affect their performance, and they can easily lose that just by running outside.”
dealing with injuries
Being conscientious about preventing injuries can’t always stop them from occurring. Accidents happen, especially in sports. When they do, Anderson says, the most important thing is to take “the safe approach”: have injuries evaluated.
Many kids want to play through the pain — and many coaches and parents encourage such “toughness,” Anderson says. But that can often turn what started out as a minor injury into a problem that can sideline an athlete for a long time.
“Kids try to make up for lost time after an injury and then they push themselves too hard,” Michael Prybicien, president of the Athletic Trainers Society of New Jersey, told a New Jersey news site. “They need to learn to listen to their bodies and not play through the pain.”
Playing through injuries like concussions is especially dangerous, because sustaining a second blow to the head can dramatically worsen symptoms and lengthen recovery time.
Anderson acknowledges that taking time off for an injury can be very challenging for devoted young athletes. He knows, because he’s been there; when he was 16 he tore up his knee, which put him out of football and ski racing for good. He says the experience helped point him toward a career in sports medicine.
“[An injury] is a big event in a young athlete’s life,” Anderson says. “They come to realize they’re not invincible. They have to commit to a rehabilitation program that takes a lot of time and patience. We see a lot of kids mature through that process.”
Beth Kates, another athletic trainer with the NCSS, says emotional effects are an important part of any injury. “We tend to look at the mental side of an injury too,” Kates says. “An injury is more than just a broken leg. Many injured athletes are worried about coming back to their sport, and we help them address that.”
addressing the problem at every level
The responsibility for preventing injuries in youth sports belongs to everyone involved — not only to athletes, but also parents and coaches, medical professionals, and club administrators.
It’s up to young athletes to heed the signals that their bodies give them, and play the game in a safe and sportsmanlike way.
But it’s up to the adults involved to teach them to do so, to schedule time off, and to emphasize fun over competition to keep kids loving what they do. The National Alliance for Sports reports that 70 percent of kids quit league sports by the age of 13, which points many kids toward the opposite end of the problem spectrum: inactivity.
The resources to help parents and coaches prevent injuries are growing. Groups like Sports Trauma and Overuse Prevention, the National Alliance for Youth Sports and the NCSS are working to protect young athletes by providing education programs and online videos. Both the American Academy of Pediatrics and the American Academy of Neurology have issued new guidelines for dealing with sports concussions.
“There is not one parent that would drop their child off at a local community pool if there were not a certified lifeguard on duty,” says NCSS founder Lawrence J. Lemak, M.D. on the organization’s website. “That same standard of care should be available for every sports facility in this country. If we can prevent just one fatality or injury, it will be worth the effort.”
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Treating basic injuries
For most minor sports injuries, like muscle contusions (bruises) and minor muscle strains, use the RICE formula:
Rest: stop exercising
Ice: apply on and off for 20 minutes at a time
Compression: lightly wrap the injury in a soft bandage
Elevation: raise the injury to a level above the heart
Diagnosing a concussion
According to the Mayo Clinic, the signs of a concussion can be subtle and might not be immediately apparent.
They may include:confusion, amnesia, headache, dizziness, ear-ringing, nausea or vomiting, slurred speech, fatigue
Hours or days later: Memory or concentration problems, sensitivity to light and noise, sleep disturbances, irritability or depression
The American Academy of Pediatrics recommends that you call your child’s doctor for advice if your child receives anything more than a light bump on the head.
Injury prevention education resources
stopsportsinjuries.org
sportssafety.org
safekids.org
nays.org
