The culture of athletics in the United States has changed significantly over last 25 years. Athletes often participate in one sport year round and competitive seasons last longer. The multisport athlete is almost becoming a thing of the past, as athletes are pressured to dedicate themselves to one sport. Children and adolescents often train year-round in one sport with the hope of earning a college scholarship in that sport or becoming a professional athlete. However, less than 1 percent of high school athletes ever make it to the professional level. The American Academy of Pediatrics (AAP) has taken the position that the goal of youth participation in sports should be to promote lifelong physical activity, recreation and skills of healthy competition and not focused on the hopes of obtaining a college scholarship, or making an Olympic or professional team.
It is estimated that up to 50% of all pediatric sports medicine injuries are related to overuse. Doctor Lyle Micheli, a specialist in Adolescent Sports Medicine, estimates 75% of the patients he sees at his clinic at Children's Hospital Boston are due to overuse injuries. He describes a long line of; “soccer players with tender knees, swimmers whose shoulders hang like limp spaghetti and the never-ending line of baseball pitchers accompanied by their aching elbows.” What troubles Dr. Micheli is that most of these injuries could be easily prevented by introducing variety, moderation and rest into an everyday sports routine.
The AAP describes an overuse injury as microtraumatic (general term given to small injuries to the body) damage to a bone, muscle, or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural reparative process. Overuse injuries can be classified into 4 stages:
· Pain in the affected area after physical activity
· Pain during the activity, without restricting performance
· Pain during the activity that restricts performance
· Chronic, unremitting pain even at rest.
The risks of overuse are more serious in the pediatric/adolescent athlete because the growing bones of the young athlete cannot handle as much stress as the mature bones of adults. A young athlete’s bones, muscles, tendons, and ligaments are still developing making them more susceptible to injury, especially to the growth plates. There are technically two types of growth centers that are responsible for the growth of the bone, the epiphysis and apophysis. The epiphyses are located at the ends of bones. In children, the shaft of the bone and the epiphysis are separated by an epiphyseal cartilage or plate. This plate provides the means for the bone to increase in length. Since these epiphyses are mostly cartilage, the epiphyseal plates are vulnerable to the stresses and strains placed on them by repetitive activities. Once adulthood is reached and growth is completed, the epiphyseal plates fuse and are replaced by bone. It is prior to this fusing that damage can be done as the growth plates are weaker than the nearby ligaments and tendons. What is often a bruise or sprain in an adult can be a potentially serious growth plate injury in a young athlete.
Other common injuries are Osgood-Schlatter disease, a painful inflammation just below the knee and injuries to the heel’s growth plate known as Sever’s disease. Nagging elbow or shoulder injuries are frequently reported by young baseball pitchers and swimmers Young athletes are also more vulnerable to stress fractures especially in sports where the body takes a pounding like gymnastics.
Proper supervision is critical to a young athlete’s well-being. Unfortunately, many coaches of youth and school sports clubs are parent volunteers who have not had any formal training in first aid. Athletes, parents and coaches should all be familiar with the symptoms of an overuse injury. Knowledgeable supervision by coaches, enforcement of sport rules and medical supervision at competitions and practices should help decrease the risk of overuse injuries in young athletes
Some signs to look for:
· A gradual onset of pain, or pain presenting as an ache.
· No history of direct injury.
· Stiffness or aching after or during training or competition.
· Increasing periods of time for pain to resolve or missed training session because of pain.
· Point tenderness, redness, warmth, or visible swelling at the location of pain.
The best way to deal with any injury is with prevention. Here are some basic guidelines that will help protect young athletes from overuse injuries:
· Young athletes limit training in one sport to no more than five days a week, with at least one day off from any organized physical activity.
· Join only one team per season.
· Be aware of risks associated with weekend tournaments (soccer, baseball, tennis), such as heat-related illness, nutritional deficiencies, overuse injuries and burnout.
· Focus of sports should be on fun, skill acquisition, safety and sportsmanship
· Multi-sport athletes who use the same body parts for different sports need to take a break between seasons to avoid overuse injuries.
· Athletes should take time off from one sport for two to three months each year. Taking a break from a sport allows injuries to heal and the opportunity to work on strength training and conditioning to reduce the risk of future injuries. It also helps kids take a psychological break, which is necessary to avoid burnout, or overtraining syndrome.
· Overuse injuries usually happen when there is a sudden increase in training intensity, frequency, or duration. An athlete should always increase their training demands slowly and if one of these variables is increased, then one or both of the others should be reduced accordingly.
Learning your personal limit of training level is as important in preventing injury as the strength, flexibility and stability exercises you do. Rest and recovery are extremely important for preventing injury. Also remember to warm up and cool down properly before and after activity. When beginning an exercise program or sport seek the advice of a sports medicine specialist or athletic trainer to prevent chronic or recurrent problems. If you have suffered an injury you should return to play only when clearance is granted by a health care professional.
Something that often is not mentioned with young athletes is the impact of injuries are having on their self esteem and mood. An athlete who has had to take time off from their activity not only experiences physical pain, but also the emotional pain related to stopping their sport. Many of these youngsters have such passion for their sport and also gain a great deal of self worth from their participation. To take that away from them is emotionally devastating, and their young minds are not cognitively developed enough to deal with the loss of their athletic activities, even for a short time. Paying attention to a young athlete’s emotional well-being is just as important as caring for their physical injuries.
If you would like to read more on this topic, Sports Illustrated did an excellent feature article titled; America's Obsession with Youth Sports and How It Harms Our Kids