During the winter, a teenage girl visited my office. For the third time in a few years, she had injured her right wrist. Each of these injuries was due to the hours of practice and competition the gymnast logs weekly. She rarely takes days off.
This girl is hardly alone. Thousands of kids nationally are diagnosed with overuse injuries every year, as young body parts and minds succumb to sport specialization and year-round play. Overuse has afflicted young athletes throughout my 18 years of practicing pediatric medicine, but it has become especially prevalent over the last decade.
New evidence, however, shows a direct link between sport specialization and overuse injuries, and other new research diminishes specialization’s role in breeding elite athletes. In short, we now know that specializing not only does not help preadolescents become elite athletes, it also harms them physically and emotionally.
While advocates work on changing the pressurized amateur sports culture, parents and coaches can address overuse more immediately. Research has illuminated preventative methods and treatments are simple to follow — if not what some parents and athletes want to hear.
The Ramifications of Specializing
Injuries such as stress fractures, jumper’s knee and Osgood-Schlatter’s disease occur when muscles, bones and ligaments are worked beyond their capacity. Young athletes also suffer from emotional overuse, or burnout.
Kids are more susceptible to overuse than adults because their bodies and minds are not as developed. Their ligaments are not as flexible, leading to more stretching and tearing injuries. Adolescents are especially susceptible because they are growing rapidly: An adolescent’s knee is more prone to inflammation, for example, due to repetitive stress on the joint from running and jumping sports. Unrefined techniques — such as incorrect form on tennis serves or swim strokes — also lead to injury when combined with overuse, as does poorly fitting athletic equipment. Psychologically, kids are more likely to grow tired of doing the same thing, such as free throw shooting or fielding drills, or even playing in competitive games.
Combine this internal makeup with pressure to earn a starting spot on a team or a college scholarship, or to be there for the team — pressure that drives kids (and their parents) to ignore pain and medical advice.
Then it’s no wonder that overuse injuries have accelerated. They accounted for about half of visits by patients ages 5 to 17 to a sports clinic over a 10-year study, and two-thirds of the 846 injuries sustained by kids ages 7 to 18 who were studied over three years at two other sports clinics. These figures are probably lower than real trends because kids often don’t report overuse injuries.
Where and when do overuse injuries occur? They strike in the lower leg, knee and shoulder most often, although boys also sustain many in their lower back and feet. They are most likely to occur in girls’ and boys’ track and field, plus girls’ field hockey, lacrosse and gymnastics. Girls are more susceptible because they typically enter adolescence earlier, and their wider hips put more stress on their knees.
Both girls and boys are hurt by playing only one sport and doing it year-round, which are the chief catalysts for the dozen overuse injuries I see almost every week. But we may soon reach a turning point. Research published within the last two years disproves a theory held by many sports parents and coaches: (More) practice makes perfect.
Researchers have found that sport specialization:
— Leads directly to overuse injuries, with risk increasing in proportion with degree of specialization.
— Does not help preadolescents become elite athletes because overuse or burnout often trips them up.
— Stifles motor skill development in preadolescents, increasing future injury risk.
Researchers have also found that unstructured activities and playing multiple sports before adolescence best predict long-term athletic success and psychological maturity. The American Academy of Pediatrics and American Medical Society for Sports Medicine now recommend against early sport specialization for preadolescents and early adolescents.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Preventing Overuse Injuries
Armed with this new evidence, parents, coaches and trainers can help prevent overuse injuries. First, encourage younger kids to sample different sports and activities, and don’t allow them to play any sport year-round. Second, make sure they get rest from structured activities at least once a week, and at least two months’ rest between seasons. They should also get plenty of calcium in their diet to stimulate bone growth, and do stretching exercises to make their ligaments and tendons more flexible.
Adolescents, and younger athletes in “early entry” sports such as swimming and tennis, may specialize if they want to, but watch for signs of burnout and see their regular doctor if they complain of pain. Also ask a qualified trainer to direct integrative training for them, to develop more diverse motor skills and reduce injury risk.
All kids should listen to their bodies. If they feel pain, they should take time off.
[See: What to Say and Do If Your Daughter Thinks She’s Fat.]
Treatment and Recovery
If kids suffer overuse injuries, most recommended treatments are fast-acting and low-risk over the long term. More than 8 in 10 adolescents treated for spondylolysis in one study had a successful outcome after at least one year, for example, and four-fifths of the 3,147 high school athletes who sustained overuse injuries in another study returned to action within three weeks.
When young athletes complain of pain, they should see their regular doctor. Most kids will only need a simple exam, not X-rays or a consultation with a specialist.
If the doctor diagnoses an overuse injury, treat it by applying ice for 24 hours, followed by heat. Administer anti-inflammatories, consider braces for ankles or knees, and ask a trainer to recommend proper stretching and muscle-strengthening exercises. Most importantly, make sure kids rest for at least 7 to 10 days. That means no games, no practice, no training. Just rest. If it still hurts when kids return to action, rest some more.
I know it’s not easy for parents and kids to take that advice. When I diagnosed an elbow injury in a teenage boy last spring, his father told me resting “is not an option.” The boy was pitching on two baseball teams and did not want to miss any of the season. But if he returned to action too soon, he risked suffering a much more debilitating injury that could have sidelined him for several months. The same risk goes for any overuse victim who does not get proper rest.
I understand parents don’t want to hear that warning either. They fear alienating their kid from teammates and coaches by holding the kid out. But it’s the parents’ responsibility to say, “This is enough.” You have to stick up for your kid, who is still a minor no matter how physically gifted or dedicated.
[See: 8 Must-Know First Aid Tips.]
A Call to Action
The gymnast I saw is very gifted and dedicated, practicing six days each week and competing once each month. Her mother knew she could not keep up that pace. “But the coach won’t let me quit,” the girl said. She was too emotionally invested and feared letting her coach and teammates down. When I asked her to rest for 10 days, she sat for two.
I expect to see her again. But you can avoid extra trips to the doctor — or worse. Take overuse seriously. Now that we know how much it harms kids, it’s tough to justify pushing them so hard in sports — even if they want to be pushed.
More from U.S. News
8 Lesser-Known Ways to Ruin Your Joints
Osteoarthritis and Activity: Walking It Out
Pharmacist Recommended Vitamins and Supplements
Overuse Injuries: New Evidence, Prevention and Treatment originally appeared on usnews.com
