No parent or coach wants to hear that a player cannot play during his/her season due to an injury. Worst, is hearing that they are unable to play because of an injury that happened at practice, or even in the backyard. Here are the most frequent mistakes that I have seen over the past 20 years when working with young athletes.
1. PUSHING through PAIN.
We all know that working out can be tough. Muscle pain and soreness are sometimes expected. Unfortunately, by allowing your young athlete to play with an injury or extreme pain in muscles, joints, and bones, their body may compensate with movements that can even cause injury. In 2011, a study in the Medicine & Science in Sports & Exercise showed a significant change of mechanics (adaptations) in runners if they had knee pain. Furthermore, their race times were compromised due to adaptations at the knee and hip. Adaptations are also seen frequently in swimmers with painful shoulders. Studies show that swimmers with shoulder pain exhibit a wider entry into the water, forcing their body to have increased trunk rotation. Both of these athletic compensations can cause excessive force on areas on the young athletes body that are not capable of taking on new loads, causing stress fractures, sprains, and tendonitis. The safest way to gauge your athlete’s ability to continue through an activity when they are experiencing pain, and want to keep playing, is by keeping a close eye on their technique. If they are limping, avoiding use of the arm, leg, ankle, or changing their mechanics, enough for you to see at the sidelines, it is time to give it a rest. You may not need to take the child completely out of practice, just have them work on something that won't compromise the area.
When do you call your doctor for pain?
The American Academy of Pediatricians suggests you call your doctor if you child exhibits any of the following…
Swelling that doesn’t decrease or grows worse after 24 hours despite attempting the RICE treatment (REST, ICE, COMPRESSION, ELEVATION),
A persistent lump in a muscle,
Reddening or increased warmth of the skin overlying the muscle,
Dark urine, especially after exercise (may need emergency support).
2. OVERUSE. (OVERPLAY)
What if I told you that 50% of the overuse injuries that I treated last year were preventable? I know that you may have heard this term "overuse" before, but what is overuse? Overuse is defined by the American Academy of Pediatrics as “a micro traumatic injury to a bone, muscle or tendon that has been subjected to repetitive stress without sufficient time to heal or undergo the natural healing process”. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. In a 10-year study of 481 youth pitchers aged 9-14, they found that if you pitch more than 100 pitches per game, you were 3.5 times more likely to be injured. If the athlete played catcher, the injuries were even more likely. Another study in the 2005 by the American Journal of Sports Medicine, looked at fatigue and landing mechanics during stop-jump tasks (which is seen in many sports such as basketball, tennis, and volleyball). As the athlete fatigued, they found that more stress was put on the knee because of the altering mechanics. Having adequate rest is an essential part of elite athlete programs. This includes rest from activity and even promoting good sleep routines.
The American Academy of Pediatrics recommendations for avoiding overuse in the young athletes:
Rest 1 day of the week away from organized athletes.
Limit 1 sporting activity to a maximum of 5 days per week.
Take at least 2 to 3 months off per year from their particular sport to rest the principal muscle groups involved.
3. UNDERSTRETCH/ OVERSTRETCH
Having a proper warm-ups and cool downs in athletics is crucial. Why? Just think about the youth athlete that comes to practice after school. How long have they sat during the day in a flexed posture in their desk? Add to that the travel time athletes have to get to events/ tournaments/ games sitting in buses or cars which promote this shortened posture. Warm-ups should consist of sport specific dynamic stretching (stretches that are performed with movement) that are age appropriate. Practices should end with static stretching (stretches that hold the muscle with tension). Having your athletes run around the court then start playing may not prepare and protect their young joints. When it comes to stretching with young athletes you may be surprised to find out that many of them are hyper-mobile (loose jointed)…even the athletes that ones that can’t seem to touch their toes! You must consider that even the slightest gains in bone growth will tighten up muscles until your young athlete's body adapts and the muscles naturally stretches to meet the new needs. I had one patient who grew 3 inches over a summer! Her range of motion kept changing monthly! Tears (also called strains) to the muscle, growth plate disorders such as Severe’s Disease to the ankle (see my previous blog) and Osgood-Schlatters disease (tibial tubercle apophysitis) to the knee, are common to athletes and may be averted, or at least reduced, with a proper warm-up and stretching programs. By making stretching a priority in all workouts, the growth changes are not as dramatic. Conversely, overstretching a pitcher, swimmer, cheerleader or gymnast, can have detrimental effects on joints especially with the shoulder. In the Journal of Applied Physiology, D.L. Morgan and colleagues noted that overstretched muscles deactivate and lose their ability to contract normally, therefore decreasing joint stability. Overstretched ligaments, which attach to and stabilize bones of the shoulder, also create joint instability. With decreases in the ability to use arm muscles and or get stability in the ligaments, we increased the risks of shoulder injuries. Once the stabilizing elements of the shoulder, elbow, hip, and knee, and ankle are compromised, it is very difficulty to regain control of the joint. An athlete may sprain, or dislocate more easily. This too can end your early athletic career.
No one wants to injure a young athlete. By monitoring their pain, not over playing, and practicing with proper warm-ups and appropriate stretching techniques, your athletes will stay healthy and in the game!