Are You "Over-Playing"?

By Lyz Pfister, Stop Sports Injuries.org

Matthew Ryden was on the court dribbling a basketball, when he suddenly collapsed. It was late January, and he’d been suffering from a tender knee for about 18 months so that knee pain was nothing new to him. Matt would rest and ice it, ease up for a few days—and then hop back in the game. But this was pain unlike anything he’d experienced so far. At the hospital, a series of x-rays and a subsequent MRI diagnosed him with a case of osteochondritis dissecans, a condition where cartilage in the joint, along with a thin layer of the bone beneath it, detaches from the rest of the bone. Matthew was just 13.

“It’s become an epidemic that we’re all very concerned about in our field,” said Dr. William Levine, Director of Sports Medicine at Columbia Orthopaedics, concerning the increasing frequency with which seriously injured young athletes, nationwide, are sent to specialists and the operating room. Over the past few years, “overuse” injuries have increased 400% among youth sports teams, yet according to the U.S. Center for Disease Control, more than half of these injuries are preventable.

What are overuse injuries? Generally, they stem from playing one sport nearly year round, and a majority of the time they are serious. Because of the frightening rise of overuse injuries, a nationwide campaign is underway to educate coaches and adults about their dangers, and to encourage kids to keep playing—but to do so by playing a multitude of sports, not just one.

“I can’t tell you who it is who drives these programs, who drives baseball to be run from February to July,” said Theresa Ryden, Matt’s mother, “or who basically tells you your kid won’t be able to play if they don’t do club.” The Rydens live in Boise, Idaho, but by no means are these type of overuse injuries more likely to occur in that part of the country, or one region more than another. According to the CDC, nearly 30 million children nationwide participate in youth sports, and geography plays an insignificant role in the overuse-injury dilemma. Whether you live in warm-weather states like Florida or California, or New York City neighborhoods like Flatiron or Forest Hills, if you’re playing one sport nearly year round, you could very well be at risk of a serious injury.

Are coaches and parents, in general, really to blame for pushing kids to play too intensely, or stretching out a single sport’s season too long? Findings by medical experts indicate that they probably are. The good news, however, is that usually the pushing is not malicious. According to many orthopedic surgeons, the incidence of both traumatic and overuse injuries is rising at an alarming rate mostly because coaches and parents just don’t know that it’s an issue.

Enter Dr. Jim Andrews, president of the American Orthopedic Society for Sports Medicine (AOSSM) and founder of STOP Sports Injuries, whose commitment to the cause includes leveraging his star status in the world of professional sports to spread the word about the dangers of serious injuries suffered by kids and adolescents.

“Everything’s upside down,” said Dr. Andrews, who treats dozens of superstar professional athletes and is widely considered to be the leading orthopaedic surgeon in the United States. “We’re now seeing more adult-type sports injuries on high school and younger kids than we’re seeing on college and professional athletes.”

In conjunction with the American Academy of Orthopedic Surgeons, the National Athletic Trainers’ Association, and SAFE Kids USA, STOP is trying to increase awareness as to how, and why, kids are injured playing sports and how they can stay safe. In other words, it’s an effort on how to keep kids on the playing field—and out of the operating room.

Although one of STOP’s long-term goals is to prevent athletes from overextending themselves physically, STOP— which stands for Sports Trauma and Overuse Protection and was launched on April 1—is by no means trying to keep kids from playing sports.

“It’s positive for your mental health, your physical health, and your cardiovascular health,” said Dr. Jo Hannafin, an orthopedic surgeon at the Hospital for Special Surgery in New York City. “ It builds confidence, it builds teamwork— there are huge positive benefits to sports. What you don’t want to do is break people down and burn them out because of over-training.”

Dr. Hannafin believes that some of the intensity usually reserved for college and professional level athleticism has trickled into youth leagues and school teams. That’s may be why many parents and coaches push too hard without understanding the negative consequences.

“One of the things we’re trying to get people to stop, both athletes, parents, and coaches, is that training through pain is not the way to get better,” said Dr. Hannafin. “The way to get better at your sport is to recognize when you’re overtrained, to recognize when you begin to develop pain.

“If you’re a parent, and your child is having pain,” she continued, “take them to someone who can evaluate them, who can find the right solution, perhaps to modify their training program or get them on appropriate strengthening, so you enable that child or young adult to continue to train.” Increasingly, in lower-level athletics, kids are encouraged to excel in a single sport rather than participating in multiple sports over a few seasons. This tunnel-like focus has dangerous consequences for young athletes, since so many overuse injuries occur due to repetitive motions for which young bodies are not equipped.

“Kids are being pushed like they’re professional athletes at a young age and their bodies are just not ready for that kind of a specialization,” says Dr. Andrews, describing why young athletes are at a higher risk than older athletes. Dr. Andrews, who is based in Birmingham, Alabama, added that over 60% of these overuse injuries are preventable with a little common sense. That would include making sure coaches (1) utilize proper training techniques; (2) use equipment that fits; (3) watch out for early signs of injury, and most importantly; (4) not put as much pressure on children to perform at such high levels.

Part of the problem with single-sport specialization, STOP believes, is that athletes don’t just play one season, but they also join a club team; a traveling team; play indoors during the off-season; and if they’re talented, play in showcases to impress scouts on various levels. Playing a single sport for such an extended period of time stresses the same muscle and joint groups over and over again, and athletes often don’t do the appropriate strength training.

“In the young kids, inherent muscle imbalances makes them more vulnerable for injury,” says Dr. Andrews. “So they’re the ones that need the best protection and they’re the ones that are getting the least attention and the least protection.”

Tears in the anterior cruciate ligament (ACL), for instance, are twice as common in girls as in boys. Yet often, those who coach lacrosse and soccer, sports that involve cutting and pivoting, don’t incorporate strengthening exercises into practices—many because they don’t know they need to.

“Those are the things I struggle with,” says Dr. Hannafin. “The traumatic injuries often happening because kids are not trained well enough, they’re not trained in preventive strategy, or they’re playing to fatigue.”

Though the end result is often the same—too many kids with preventable sports injuries – the causes for these injuries are numerous and often sport specific. Young baseball players for instance, should only pitch the appropriate number of pitches for their age group and not on consecutive days. Soccer players should begin a routine of aerobic conditioning, strength training, and agility training before embarking on a full-blown soccer season. Swimmers should do core strengthening and cross-training exercises as part of pre- and early-season routines.

This is the sort of information STOP hopes to spread among the athletic community through conferences, Power Point presentations, and grassroots efforts through word of mouth. It has also set up a comprehensive website (www. stopsportsinjuries.org), where each sport has its own list of injuries and a tip sheet, compiled by sports injury specialists, on how to prevent them.

In addition, STOP aims to facilitate conversations between parents, coaches, and athletes, to keep kids healthy, safe, and above all, to give them the greatest chance to have fun. Part of this dialogue is openly addressing parents’ desires for their children to be good enough at their sport to garner a college scholarship or even to play at the professional level.

“We see a lot of parents pushing, pushing, pushing their kids and having their kids not only do practices, but have a private coach,” said Ms. Ryden. “And if they didn’t make the team, then they’re coached again so they can make the team next year.”

The reality, however, is that playing a sport to the point of serious injury is detrimental to pursuing an athletic career— which is precisely the opposite result hard-driving parents and coaches are shooting for.

“Once you have surgery, and you’re under the age of eighteen, the likelihood that you’re going to be a professional athlete, as low as it was prior to that, has probably gone as close to zero as it can be,” says Dr. Levine at Columbia Orthopaedics.

And possibly even more sobering is this statistic from the STOP website, citing CDC research: “By age 13, 70 percent of kids drop out of youth sports.” Factoring this in, it can be argued that all things being equal, with a large majority of kids giving up sports entirely, all the extra pressure being exerted on them to thrive and improve not only will be wasted, but it may saddle kids with serious injuries for life.

Dr. Levine also mentioned that in some circles there’s the alarming misconception that having elbow surgery is a good thing— that the elbow is stronger after surgery than it ever was before.

“There can be nothing further from the truth,” said Dr. Levine.

Having an overuse injury or surgery at such a young age is something that could adversely affect the rest of their lives.

“That to me is heartbreaking, because if you tear your ACL at 14, and you get back to sports, you may be perfectly fine,” said Dr. Hannafin. “But if you tear your ACL at 14 and you also injure the cartilage in your knee, that’s the beginning of the development an arthritic process in the knee that may go on over many years.”

Since finding out about his injury about four months ago, Matt Ryden has traded in his lacrosse stick and gloves, skateboard and a pair of basketball shoes, for a guitar. He’s taken up cycling and is thinking about switching from snowboarding to skiing in about a year, which is when doctors expect him once again to be able to play any sport he chooses. He’s making the best of a bad situation. But what about his athletic career?

“It’s just basically one big question mark,” said Matt’s mother, who wonders whether it might take a generation, growing up in a hyper-competitive athletic environment, to revolutionize the system. “Maybe there will be a change just through attrition or through the kids that are living it—or else they’ll all be really smart and they’ll become orthopaedic surgeons. Because there’s going to be a huge need for them.”

WARNING SIGNS OF OVERPLAYING
Led by Dr. James Andrews, one of the country’s leading orthopedic surgeons, STOP’s awareness campaign is providing concerned parents and coaches important information that can help prevent young athletes from developing serious injuries.

To determine whether your child is overplaying, here are some warning signs STOP says you should to watch for:
Playing through fatigue Complaining of pain in an overused area Changes in a child’s attitude about a sport Not countering sport specific practices with appropriate strengthening exercises You not knowing what your child is doing in practice.

Indications that an injury may have already occurred:
Avoiding putting weight on a certain body part, favoring one side or the other Appearing to be in pain Inability to sleep Shortness of breath during activity Headaches during or after activity Appearing to exhibit stiffness in joints or muscles Dizziness or lightheadedness Difficulty sitting and/or climbing stairs Inability to feel fingers or toes. Experiencing unusual weakness Irritated skin or blisters.

Tips on how to cut down on overuse:
Cut back on intensity, duration, and frequency of an activity Adopt an alternating hard/easy workout schedule, and cross-training with other activities Learn about proper training and technique from a coach or trainer Perform proper warm-up activities before and after playing Use ice after an activity for minor aches and pains Use anti-inflammatory medication as necessary Keep lines of communication open /know what your kids are doing in practice.