Why adult-like overuse issues are the new norm with youth sports injuries

Why adult-like injuries are becoming the norm for  youth, and why the most common youth sports injuries are often a result of …

If you’ve noticed an uptick in young, injured athletes seeking medical treatment, your perception is correct. Roughly three million youth sports injuries fill hospital rooms each year, with another five million seeing their primary care doctor or a sports medicine clinic for treatment.

While these numbers are substantial, they account for only those injuries ever reported, and exclude the innumerable injuries never treated. With 35 million kids now playing sports, it’s no wonder youth sports injuries have climbed to the second leading cause for emergency room visits for children.

Youth sports injuries: competition is driving kids harder

Why are we seeing so many adult-like injuries on such young bodies still developing? A few things are happening in the world of youth sports, and unfortunately, they appear to be the road forward.

Sports have become incredibly more competitive and more demanding just to stay in the game. Many athletes now focus on just one sport beyond its regular season, or else play multiple sports, year-round.

Athletes are also getting younger and are training harder for longer periods of time. They’re starting much earlier with intensive, adult-like training regimes, often with private coaching, and we’re seeing that with each new birth year the competition fiercely intensifies. According to the latest statistics, 70% of kids playing sports are throwing in the towel by 8^th grade.

Overuse injuries

With so much training due to intense competition, there’s an influx of injuries caused by overuse. While occasional accidental injuries expectedly occur, it’s estimated 50% of today’s youth sports injuries are a result of too much, too often.

Overuse injuries are chronic and caused by high levels of physical stress without proper time allocated for the body to recover. To prevent overuse injuries, it’s important to consider factors impacting potential injury, such as an athlete’s level of physical maturity, age, body mass index (BMI) and anatomic variations. Equally important are external factors causing stress to the body, such as intense and repetitive training regimes, improper footwear, faulty equipment and environmental factors.

Common injuries that were once uncommon

Not long ago, the most common youth sports injuries were wrist injuries, twisted ankles, and fractures from mostly baseball, basketball and football. Today’s youth sports injuries, however, more closely resemble those once reserved for professional athletes and adults participating in recreational activities: stress fractures, apophysitis, tendinitis, bursitis, and osteochondral injuries of the joint.

We are seeing more ACL tears in kids — rarely seen 20 years ago — followed by injuries of the knee (Osgood-Schlatter disease), shin, heel (Sever’s disease), ankle, Achilles tendon, elbow (Little League Elbow), hand, wrist, calf, head and neck. Strains and contusions show up frequently in the examination room, and likewise do ligament injuries, sprains and fractures.

Many of these injuries are not the kind of injuries once held by kids engaging in free recreational play. They are chronic and can become worse over time.

Highest injury occurrences by youth sport

Sports and physical activities across the board have all seen an increase in athletic intensity. Gymnastics and cheerleading are two great examples.

Children start gymnastics as early as age 2, later increasing their conditioning to 2- to 3-hour daily practices for junior competitions. Cheerleading has also evolved from cheering and chanting to full-on, gravity-defying aerobic stunts and tumbles requiring intensive athleticism, conditioning and training.

Some sports bring a higher propensity for injury and are known for specific types of youth sports injuries. Below are five top sports notorious for the highest number of emergency room visits.

1. Basketball — According to the National Safety Council (NSC) 2020 statistics, basketball ranks highest in youth injuries among all other team sports. There is little to no protective gear, resulting in fractures, ankle sprains, ligament tears, muscle contusions, muscle strains, concussions and tissue damage in ankles, knees, thighs and faces. Overuse injuries such as Patellofemoral Pain Syndrome (PFPS), jumper’s knee/patellar tendinitis, shin splints and stress fractures often surface throughout the season. In younger players still physically developing, apophyseal injuries appear, such as Sever’s disease in the heel and Osgood-Schlatter disease in the shin.
2. Swimming — In 2020 alone, swimming injuries accounted for 130,000 visits to emergency rooms, half of which were suffered by children aged 14 years or younger. Common injuries include swimmer’s shoulder or shoulder impingement syndrome, rotator cuff tendonitis or tears, biceps tendonitis, lower back pain, neck pain and bicep pain. It’s important to train within the body’s physical limits. Swimmers experiencing pain for more than 48 hours should seek out medical attention.

3. Football — America loves football, but with it comes risk of player injury. The majority of youth football injuries occur in the lower leg, ankle and foot in the form of contusions, ligament sprains, strains and fractures. As players age, risk increases. Players in grades 7-8 are twice as likely to be injured than their 4^th– to 6^th-grade counterparts. On average, kids age 14 years or younger account for 50% of those treated in the emergency room for football-related injuries.

4. Soccer — Over the past decade, youth soccer participation has exploded in popularity in the U.S. and is equally popular by gender. With three million youth soccer players in the country, 52% are boys and 48% are girls. Common injuries in the field include ankle and knee sprains; calf strains; clavicle, foot, wrist fractures; kneecap bursitis; meniscal tear; and concussions. As with any sport, it’s important to refrain from playing if you are extremely tired to avoid injury. Staying hydrated and well-nourished are of equal importance in preventing fatigue. Roughly 45% of patients treated in the emergency room for soccer-related injuries are age 14 years or younger.

5. Baseball/Softball — For baseball and softball players, springtime brings with it daily ball practices, weekend tournaments and frequent double headers — all of which can take a toll on young, developing bodies. Common baseball and softball injuries to watch out for are Little League Elbow, Little League Shoulder, rotator cuff injuries, ankle sprains, concussions, muscle strains and overuse injuries.

Treating injuries in young athletes

Children’s bodies are still in the process of development, and their skeletal systems can be affected long-term by damaged growing bones and soft tissue injuries. During these growth years, there are significant changes in the biomechanical properties of the bone.

As bone stiffness increases, resistance to impact diminishes and can result in stress overload, causing bones to bow or buckle. Shearing and compression can cause epiphyseal injuries at the epiphyseal growth plates. Thankfully, our youngsters are gifted with remarkable healing powers, and often fully recover to appear normal in later life.

To prevent risk of significant chronic injuries, it’s imperative to promote a safe, age-appropriate training regime designed according to the physical development level of the young athlete. To help your patients, their families and their coaches be prepared for injuries should they occur, share with them the easy-to-remember treatment plan: R.I.C.E:

Rest

• Stay off the injured area and see a physician
• Use crutches, if necessary

Ice

• Ice the injured area immediately and for the next 48-72 hours to reduce swelling
• Apply crushed ice or frozen peas for 15-20 minutes at a time while awake

Compression

• Wrap the injured area with an elastic wrap or compression sock to reduce swelling
• Leave toes/fingers exposed, and watch for numbness, discoloration or temperature changes
• Do not sleep with compression wrap

Elevation

• Elevate the injury higher than the heart to prevent swelling

Preventing injuries before they occur

Most sports injuries can be prevented through advanced preparation and by implementing safety precautions. When players are not in shape or neglect to properly stretch and warm up before play, injuries can occur.

Likewise, the most common youth sports injuries are often a result of poor training practices or improper use of gear or equipment. It’s important to encourage young athletes to visit their doctors for a pre-season physical examination. Pre-season concussion tests are just one way of providing a solid benchmark for potential future injuries.

Here are a few ways you can help guide your patients, their parents and their coaches to pave the way to a safer athletic experience (provided by the American Academy of Pediatrics):

• Take at least one day off of training a week so the body has time to recover;
• Take breaks during practices and games to prevent injury and heat illness;
• Use the correct, properly-fitted protective gear including pads for neck, shoulders, elbows, chest, knees and shins, as well as helmets, face guards, mouthguards, protective cups and/or eyewear;
• Stay hydrated by drinking plenty of fluids before, during and after play;
• Wear weather-appropriate clothing to stay warm and prevent overheating. Coaches and trainers should reduce or stop practices or competitions when heat or humidity is high;
• Strengthen muscles before competing so the body is well-conditioned during play;
• Stretch and warm up before and after games and practices to prevent stress injuries;
• Implement safe, proper athletic techniques throughout the season.

There’s no question that participation in youth sports yields endless long-term physical, social and psychological benefits. It can build character, boost self-esteem and help develop teamwork skills. As medical practitioners, we generally feel compelled to help keep our patients healthy, so it’s important we share information that can help provide the safest possible athletic experience.

Connect with your local youth athletes

One way to make a difference in helping protect young athletes is to connect with them directly by sponsoring a local team.

Beyond the thrill of seeing your logo embossed on their team uniforms — or on the side of the Zamboni during a drive-by between periods — is the gratification of supporting your community on its most local level. Additionally, your financial support may qualify for a tax deduction, and your medical knowledge can be shared to help promote wellness and reduce the risk of injury.

It’s truly a wonderful way to give back and build a strong relationship with the families, players and athletic leaders in your community. Not to mention, your business’ brand name will stay top of mind, and you may just score a season’s worth of free event tickets. Just make sure you get a team photo to frame and proudly display on your office wall.

RUSSELL GREENSEID, DC, is a chiropractor, major shareholder and chief of staff at Metro Healthcare Partners in Brooklyn, N.Y. He is a trusted advocate and respected voice in the chiropractic field with a doctor of chiropractic degree from New York Chiropractic College in Seneca Falls, N.Y. He resides in Short Hills, N.J., with his wife and two sons. Visit metrohealthnyc.com for more information on Greenseid and his multidisciplinary team of professionals.