Kids, Sports, and Safety

    Experts Say Balance is Best

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    Sometime during the preschool years and elementary school, many parents and their children enter the world of organized sports. For us, it started with four-year-old soccer, a sport that consists mainly of parents watching several children move in a single clump up and down the field. From there, we moved on to basketball, baseball, football, lacrosse, and field hockey, filling our home with all the gear and equipment that goes with it. In the U.S., there are approximately 35 to 40 million kids participating annually in organized sports, a dramatic increase in recent decades. But along with what most of us consider a positive upward trend in sports participation comes an equally sharp rise in the number of sports injuries.

    Injuries and Awareness

    The National SAFE KIDS Campaign reports that each year 3.5 million children aged 14 and under will receive treatment for a sports injury. These injuries, occurring more often in practice than games, range from scrapes and bruises to something more serious, such as spinal or brain injuries. However, the majority of sports injuries fall somewhere in the middle. Sprains and strains, growth plate injuries, repetitive motion injuries, and heat-related illnesses rank among the most common types of youth sports-related injuries. The good news is these types of injuries are mostly preventable and easily treatable.

    So let’s back up a bit. While the increase in kids’ sports injuries may seem troubling, the benefits of participation in organized sports are immeasurable. Bill Shaw, MD, is medical director of the pediatric group practice for Children’s Hospital of Richmond at VCU. He cites improved cardiovascular, bone, and mental health, as well as skill development, opportunity for fun, and friendship as direct benefits of playing sports. However, based on stages of childhood development, he recommends younger children, around four or five, begin with an instructional league only, moving on to more classic organized sports around the age of six.

    As kids get older, there are increasing opportunities for them to specialize in one sport. The American Academy of Pediatrics (AAP), however, says kids should play multiple sports until age 12. Between the ages of 13 and 15, kids may only play two or three different sports. Specialization, if desired, is not recommended until the age of 16. Dr. Shaw agrees. “The idea is that kids get the opportunity to learn numerous motor skills, perhaps hitting upon several they may be particularly good at, but never would have known had they specialized in a single sport early on,” Shaw says. In addition, early specialization has been linked to a rise in repetitive motion or overuse injuries. In fact, many experts believe that overuse injuries were mostly unheard of in children prior to the recent explosion in organized youth sports.

    Overtraining is also an unwelcome side effect of early specialization. Signs include fatigue, lack of enthusiasm, or a decrease in performance that lasts weeks or months. “Overtraining is due to training stress (including monotonous training), lack of adequate recovery, poor nutrition, and outside stressors at home and school,” says Dr. Shaw. The AAP recommends young athletes should limit organized sports participation, taking a day or two off each week to allow the body to rest. This coalition also suggests taking two to three months off to focus on other activities and cross-training to prevent loss of skill or conditioning. “Well-rounded, multi-sport athletes have the highest potential to achieve the goal of lifelong fitness and enjoyment of physical activity,” according to the AAP. Dr. Shaw adds that multi-dimensional athletes are less likely to suffer from burnout or identity crisis should they reach a ceiling effect, meaning the sport is no longer challenging or fun.

    Medical experts are also concerned about a recent rise in children’s knee injuries. A study by researchers at the Children’s Hospital of Philadelphia discovered a 400 percent increase in the number of anterior cruciate ligament (ACL) and meniscus tears in children. John Mitrovic, PT, SCS, regional director at Tidewater Physical Therapy, adds, “Most of the injuries to the ACL are non-contact in nature – 80 percent or better. This means young athletes are hurting themselves with planting, or cutting when running, decelerating, and/or pivoting,” says Mitrovic. “In all these, there is an inward stress to the knee.” Many believe these injuries are partially due to increased intensity in youth sports and improper technique. Mitrovic says today’s coaches, parents, and players need to be educated on this issue. What makes these injuries more troublesome for children is the lengthy recovery period and the risk of impaired growth.

    Another headliner in the world of sports safety is traumatic brain injury (TBI). A study of nine high school sports and their associated injuries showed TBIs (including concussions) to be 9 percent of the reported total, highest in football and girl’s soccer. Compared to adults, children with TBIs may experience increased severity and prolonged recovery. According to Amanda Davani, MS, education coordinator at VDH, young brains are in the business of maturing until age 25. “Concussions in the early years are damaging to a developing brain,” she says, “and can affect the ability to make decisions or complete simple tasks.” In addition, the damage from concussions can be cumulative. Dr. Shaw agrees, “Some kids are having to retire from various contact sports due to ongoing effects of TBI, even if they have had only two concussions. With each concussion, the next one happens easier and the effects linger longer.”

    It is because of this rising awareness that 37 states (including Virginia) have passed legislation addressing student-athlete concussions. Virginia law requires schools to develop protocol to identify and handle suspected concussions, including removing players from practices or games. Students and their parents are also required to review educational materials about TBIs before athletes are allowed to play.

    In spite of the rise in overall youth related sports injuries, the majority are still diagnosed as acute injuries, commonly defined as an injury caused by a single blow of force such as a fall. Usually quick to heal, acute injuries are typically bruises, ligament strains, muscle pulls, and lacerations. Although most require little to no medical treatment, others such as dislocations and fractures take longer to heal. Unlike overuse injuries, which are often chronic in nature, acute injuries in children have not risen along with the growth in organized youth sports participation. In fact, most doctors believe these types of injuries have simply been transferred from the playground to the playing field.

    Treatment and PreventIon 

    Many acute injuries, such as bruises or muscle pulls, respond to the classic R.I.C.E. treatment: rest, ice, compression, and elevation. If the injury is chronic, however, or parents have questions, medical treatment is recommended. More serious injuries should receive immediate attention. In addition, parents should consider the AAP recommendations and balance sports participation, limiting early specialization and over training.

    While it’s impossible to fully eliminate sports-related injuries, parents and coaches can help to reduce the risks. According to Dr. Shaw, there are three crucial steps to take into account. “Athletes need opportunities to warm up and stretch. Adequate hydration is needed before, during, and after exercise. They should wear proper safety equipment [helmets and shin guards].” He also advocates appropriate field equipment and surface maintenance to reduce injuries like ankle sprains. Furthermore, he stresses that old injuries should be fully rehabilitated before an athlete returns to action.

    Orthopedists and physical therapists stress the importance of learning proper technique to take stress off children’s bones. Sound nutrition is also crucial to help with bone accretion, healing of soft tissues, and reduction of overuse injuries and stress fractures. Finally, Dr. Shaw adds children should be surr

    ounded by a “culture of positive coaching, supportive parenting, and rule adherence.”

    While participation in organized youth sports will always pose some risk of injury, it also provides substantial benefits to a child’s overall mental and physical health, helping them to build a long-lasting love of physical fitness.