I have recently had people ask me some questions regarding injury prevention, especially for youth and adolescent athletes. Coincidentally, the National Athletic Trainers' Association hosted the 4th annual Youth Sports Safety Summit in Washington, D.C. in early February. The major focus of this summit was on concussions which is related to but different than what I want to discuss today. More specifically, Cleveland.com recently
published an article about youth injuries with commentary by famous orthopaedic surgeon, Dr. James Andrews.
The safety and well-being of the youth has always been a hot topic in American politics and media outlets. However, it wasn't until recently that a long-running and beneficial activity for the younger populations, sport and exercise, has been looked at with scrutiny. I would attribute this to the changing culture and philosophies related to sport and exercise.
Dr. Andrews notes…"I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000,"…"I started tracking and researching, and what we've seen is a five- to sevenfold increase in injury rates in youth sports across the board.”
More specifically, a lot of kids/parents/coaches are treating or training youth athletes as if they are currently a professional or collegiate athlete and they expect that doing this will turn them into the next all-star or elite level athlete. Instead of kids playing a fall sport and then changing it up with a season off or another sport all together we are seeing a rise of off-season and club sport leagues. It is also not uncommon for a 15 year old boy playing soccer in the fall at school, then move to directly to indoor club soccer and then move right into outdoor club soccer in the spring and summer. Rinse and Repeat. Sometimes these athletes will do this at the same time as other sports which equals out to them playing multiple sports at the same time.
I am happy to see these kids being active but that is exactly what they are…kids. Some of these youth athletes have a busier schedule than the collegiate athletes that I treat. There are some major issues that I see with this.
1) Lack of Rest & Overtraining
This is pretty self-explanatory but if you have such a hectic and busy schedule how can you expect to have any rest to recover? It seems like 2/3rds of the population is having an inactivity issue while another part of the population struggles with the other extreme of being over-active.
2) No “cross-training”
Ch-Ch-Changes…Cueing my David Bowie here but adolescence is the second biggest time for growth next to infancy. As muscles, bones, and connective tissue are lengthened and changed therefore our motor control (brain-muscle control) behavior need to change. The human body learns from input. If you stick to just one sport you are only getting one set of movement patterns as an input to learn from. If you are a football player that wrestles and runs track you are getting a much more dynamic and varied input movement patterns.
The human body is a dynamic piece of equipment. I have seen basketball players with a poor ability to use their own body for leverage while playing in the post or boxing out but what is baffling is that they have played basketball all of their life. However, I often find out that these athletes only focused on basketball and didn’t participate in other sports.
Cross-training in different sports also exposes your body to different movements and forces that act upon your body. You are more likely to injure your shoulder if you throw a ball all year round versus taking a few months off after a throwing season. Even professional baseball players take several months off after their season is over.
3) Increased exposure to injury
Increased in-season playing time equates to an increased risk of being injured by pure chance. More hours on the field or court is going to increase the chance you will roll your ankle on somebody else's foot, sustain a concussion or any other sort of contact injury. This might not apply if you play a sport like golf but it will still definitely increase your chance at suffering a chronic injury if you have inappropriate mobility, stability or motor control behaviors that are left untreated.
Additionally, one of the biggest predictors for injury is a history of previous injuries. This means suffering additional injuries in out of season club sports may potentially put an athlete at risk for suffering injuries during in-season sports. I’m not saying spraining your ankle in club sports will cause you tear your ACL in-season because nobody knows that. I can say that spraining your ankle may cause muscle imbalances, compensatory movement patterns, and altered sensory input that could affect your risk for an ACL injury.
4) Training like a pro doesn’t make you a pro
If I want to work on becoming an Olympic marathon runner like Ryan Hall I should just copy his training program right? Wrong. Ryan has spent decades of his life devoted to training for the marathon and has progressed his training plans as he has advanced as an athlete. Most of us would probably break down after a week or two on his program if we could even finish one of his workouts. The same thing goes for anyone wanting to be the next NFL quarterback or NBA all-star.
Dr. Andrews labels these phenomenon into two categories, Specialization and Professionalism.
“Specialization leads to playing the sport year-round. That means not only an increase in risk factors for traumatic injuries but a sky-high increase in overuse injuries. Almost half of sports injuries in adolescents stem from overuse.
Professionalism is taking these kids at a young age and trying to work them as if they are pro athletes, in terms of training and year-round activity. Some can do it, like Tiger Woods. He was treated like a professional golfer when he was 4, 5, 6 years old. But you've got to realize that Tiger Woods is a special case. A lot of these kids don't have the ability to withstand that type of training and that type of parental/coach pressure.
Now parents are hiring ex-pro baseball players as hitting and pitching instructors when their kid is 12. They're thinking, 'What's more is better,' and they're ending up getting the kids hurt.”
He also gives this advice to the parents of young athletes…
“The first thing I would tell them is, their kid needs at least two months off each year to recover from a specific sport. Preferably, three to four months. Example: youth baseball. For at least two months, preferably three to four months, they don't need to do any kind of overhead throwing, any kind of overhead sport, and let the body recover in order to avoid overuse situations. That's why we're seeing so many Tommy John procedures, which is an adult operation designed for professionals. In my practice now, 30 to 40 percent of the ones I'm doing are on high-schoolers, even down to ages 12 or 13. They're already coming in with torn ligaments.
Give them time off to recover. Please. Give them time to recover.
I said in the book, I want parents and coaches to realize the implications of putting a 12- or 13-year-old through the type of athletic work done by a 25-year-old. Parents and coaches, though they mean well, need to understand what the long-term effects of overuse can be.”
In part 2 of this topic I will discuss a few items that I think can be used to help prevent injuries in not just youth athletes but active people of all ages. The number one thing that we may need to look at though is our current sport culture and questioning if you are advocating Specialization and Professionalism to your athletes(if you are a coach) or your own children.
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