September Brings
Child Injury Prevention Week
Learn how to avoid and treat tween and teen
sports injuries.
Dieter M. Lindskog, M.D., and David Magit,
M.D.
TWEENS & TEENS News September 2006
About 35 million children ages 5 to 18 years
participate in organized sports in the United
States. The benefits of playing sports are
far-reaching: Sports foster self-esteem, teamwork,
lifelong friendships and physical fitness—
all vital elements to a well-balanced and
empowering early development. In addition,
the increased attention on girls in sports
has produced opportunities for many young
athletes that until recently ceased to exist.
However, increased participation and opportunity
has also lead to an elevated level of competition
among athletes, coaches and parents. The resulting
intense level of training and preparation
often puts excess demands on young athletes’
minds and bodies.
Physically, these greater demands have spurred
an increase in acute and chronic injuries.
It’s estimated that 2.6 million young
people ages 5-24 years visit emergency rooms
in the country annually for sports-related
injuries, with the highest percentage occurring
in 5-14 year old boys. Basketball, cycling,
football and soccer comprise the sports associated
with the highest number of visits.
While many of these injuries result from falling,
colliding or twisting during competition,
an increasing number of injuries are chronic
in nature. Such “overuse injuries”
represent chronic injuries to the bone, growth
plates or surrounding soft tissues from repetitive
use. Under normal circumstances, athletes
can avoid chronic injury as the body adapts
to repetitive stresses by allowing sufficient
recovery time. Without adequate recovery,
local inflammation from repetitive injuries
damages local tissues. The cumulative effects
of this damage result in a clinical injury.
Therefore, be mindful not to encourage (or
allow children’s teammates or coaches
to encourage) “playing through pain,”
as this pressure may result in long term physical
injuries.
In general, overuse injuries can be categorized
into three common groups. The first group
includes athletes who rapidly increase their
level of activity, such as the athlete who
enters preseason camp unprepared and unable
to adapt to the increased training intensity,
or the runner who decides to abruptly increase
his mileage without allowing for proper recovery
time. The second group includes athletes who
were either inadequately trained or lack proper
skills in a specific sport, such as a team
substitute with poor throwing mechanics filling
in for the quarterback. The third group includes
young athletes who participate in high intensity
sports on a daily basis. These athletes maintain
an activity level that is so high they are
at risk for overuse injury.
Of the many factors that contribute to overuse
injuries, common factors that concern young
athletes are prior injuries, malalignment
of a joint (especially around the knee-cap),
hormonal and menstrual dysfunction, psychological
issues, inappropriate equipment or poorly
fitting footwear, and uneven or hard training
surfaces.
The mechanical structure and relative strength
of adolescents’ muscles, tendons and
bones can lead to different types of injuries
than which occur in adults. Children’s
bones are able to grow because of a physis
(or growth plate) composed of growing cartilage
that is slightly weaker than the surrounding
bone. Growing teens’ tendons are also
relatively stronger when compared to bones,
and injury tends to occur where the tendons
meet the bones.
Overuse injuries can occur in many places
throughout the body. The most common complaint
is feeling pain while participating in sports.
Other more subtle signs may signal that kids
have an overuse injury, especially in children
who don’t want to complain about pain
for fear they will have to stop participating.
Changes in an athlete’s mechanics, such
as throwing motions or running style, can
signal a possible overuse syndrome. Increasing
need for pain medication or taking pain medication
prior to activity may also indicate an injury.
Other social and emotional clues may be present
as well. Losing interest in participating
or changes in sleep or play habits may all
signal an underlying injury.
Treatment
The five key tenants to treating overuse injuries
include identifying the overuse factors, changing
the offending factors with rest and activity
modification, controlling pain, properly progressing
functional activity, and adopting and maintaining
a program used to prevent recurrence.
Prevention
Education by coaches, teachers and parents
is crucial to avoiding overuse injuries in
young athletes. Here are a few tips to help
your young athlete steer clear of such injuries.
Tip #1: Start the season with a pre-screening
physical.
Doctors can often identify children at risk
for injury during preseason screening physicals.
Screening allows doctors to pick up subtle
physical abnormalities in muscle strength
or limb and spine alignment that can potentially
contribute to causing injuries. Plus, a thorough
history and physical exam aid in detection
of the rare cardiac or pulmonary abnormalities
in an otherwise healthy, asymptomatic child.
Ultimately, the pre-screening session allows
parents and athletes to ask questions and
express concerns regarding the upcoming season.
Tip #2: Optimize the conditions.
Prevention requires the use of age-appropriate
sports equipment, including adequate footwear
and proper fitting gloves, racquets, bats
and other equipment. In addition, coaches
are encouraged to further their knowledge
of injury prevention and update newly available
equipment, taping and training protocols by
participating in annual educational courses
and meetings. The PREPARE course developed
by the National Center for Sports Safety (www.sportssafety.org)
is an online sports safety course designed
for coaches on how to prevent common injuries,
how to recognize potentially dangerous conditions
and how to respond in emergency situations.
Tip #3: Learn good training habits and sport-specific
techniques.
Proper nutrition and a diet that replaces
the calories lost during high intensity exercise
are crucial components to injury prevention,
as is proper physical training habits. Maintaining
a healthy balance of strengthening, conditioning
and flexibility exercise schedules allows
athletes to become better prepared for competition
and avoid injuries related to repetitive motions.
Coaches are responsible for teaching correct
positioning and sport-specific mechanics,
as well as recognizing the potential for injury
when athletes use poor technique.
Tip #4: Set goals and limitations.
Overuse injuries frequently occur when training
intensity reaches a point where the athlete’s
bone, growth plate or soft tissue structure
cannot meet or maintain the demand. One simple
guide is the ten percent rule. Total training,
including intensity, frequency, duration or
any combination of these should not increase
by more than ten percent at a time. For example,
an athlete running 30 miles per week should
not increase his or her mileage by more than
three miles (ten percent of 30) the following
week. For overhead throwers, pitch counts
and innings thrown should be recorded by coaches
and limited based on the age of the athlete.
Sound throwing mechanics and control should
be emphasized over distance and velocity.
Tip #5: Listen to your body when injury starts
to set in.
Young athletes often have difficulty admitting
to injury given surrounding pressures. Coaches
and parents should be aware not only of the
physical signs of injury but also the more
subtle indicators, such as a sudden avoidance
or loss of interest in the sport. Young athletes
need guidance that when injuries occur, rest
is required.
Tip #6: Remember to have fun.
Keep sports in perspective. Remember that
at the end of the day, games on and off the
playing field should be fun. Setting records,
scoring goals and striking players out are
only so important; whereas playing among friends
yields joyous memories that last a lifetime.
Dieter M. Lindskog, M.D., is an assistant
professor of orthopedic surgery at Yale University
School of Medicine and David Magit, M.D.,
is chief resident in the Department of Orthopedics.
