High profile events like the Olympics bring the hope that witnessing and celebrating dedicated athletes at the top of their game, will inspire young people to take up sport and physical activities that help them develop confidence, lead more satisfying lives, and not least, secure long-term health by reducing their risk for developing chronic illness like diabetes, obesity, cancer and cardiovascular diseases.
But unfortunately, if they don’t take appropriate measures, young athletes can instead, end up in pain, on a different path to poor health, due to avoidable sport injury.
James R. Andrews, a former president of the American Society for Sports Medicine (AOSSM), said in May this year, the US has experienced a tremendous rise in the number of young people taking up sport. Estimates show 3.5 million children aged 14 and under receive medical treatment for sport-related injuries, while high-school athletes account for another 2 million a year.
“This makes sports the leading cause of adolescent injury. Along with time away from school and work, these injuries can have far-reaching effects,” said Andrews.
This article looks at some of the common and less common injuries in young athletes. It then reviews a new project that is tracking injuries in Olympic athletes, introduces some ideas about avoiding and minimizing injury, and finishes with a list of tips for preventing sport injury in children.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is part of the National Institutes of Health in the US, the most common sport injuries are due to accidents, poor training practices or using the wrong gear or equipment. People can also hurt themselves because they are not in shape, or because they don’t warm up or stretch enough.
Some injury experts in the US have said they are also seeing more and more young athletes injured because of overuse and doing too much, and this may partially explain the growing numbers that drop out of sport by the eighth grade. The most common sports injuries are:
- Knee injuries,
- Sprains and strains,
- Swollen muscles,
- Achilles tendon injuries,
- Pain along the shin bone, and
- Fractures and dislocations.
While injuries in young athletes are similar to the ones that affect adults, they can’t always be treated in the same way because their bodies are not fully developed.
Take for example knee injury.
One type of knee injury is damage to the anterior cruciate ligament (ACL). This is a severe injury that occurs most often in athletes who play football and other contact sports.
Twenty years ago, doctors were seeing few children or adolescents with ACL injuries. Today, these injuries are more common because youngsters are taking up sports earlier, and pushing themselves more competitively.
Another reason for the rise in young people with ACL injury, say researchers from the Hospital for Special Surgery (HSS) in New York City, is that more and more young athletes are specializing in one sport, putting them at risk of injuries normally only seen in professional athletes.
But this type of knee injury in young people is a particular concern because it is not easy to repair in growing bodies, for instance ACL reconstructive surgery that works well in adults can potentially cause uneven limb length or other deformities in growing bodies. That is why often the best course has been “benign neglect”. However, clinicians are beginning to realize that not operating can also lead to problems, such as early arthritis.
There are alternatives to conventional ACL reconstructive surgery, that have lower risk of damage in growing bodies, such as the All-Inside, All-Epiphyseal ACL Reconstruction (AE), but this is not commonly available.
Clinicians are calling for more research to be done into sports injuries in younger people.
Back and neck injuries are much less common in young athletes, but when they occur, they can cause enormous frustration. The athlete must complete a comprehensive and demanding rehabilitation program before returning to competitive sport: in some cases, they may never return to their given sport.
Most back and neck injuries in athletes are sprains of ligaments or strains of muscles. Aside from trauma, these are usually due to athletic overuse, improper body mechanics and technique, being out of condition, or not stretching enough. The athlete will complain of back pain when active and performing, and will feel relief when resting.
But, occasionally, a more serious condition can have similar symptoms. Because of this, proper treatment of back and neck injuries in young athletes should always include a good evaluation by a doctor, using imaging studies when necessary.
According to the North American Spine Society, the more serious back and neck injuries include:
- Spondylolysis and spondylolisthesis: a particular type of defect in the vertebra of the spine (spondylolysis), and where one vertebra slips relative to another (spondylolisthesis). A common cause of back pain in young athletes, particularly gymnasts because they have to twist and hyperextend their spines.
- Stinger (also called “burner” or “nerve pinch”): where forcing the head back and to the side compresses a nerve of the spinal cord in the neck, or where forcing the head sideways away from the shoulder over-stretches the nerves in the neck and shoulder. Most common in football and wrestling, the injury often goes unreported because symptoms can resolve suddenly and quickly. Can recur and lead to persistent pain or arm weakness if not treated.
- Disc injury: a common cause of back pain in adult athletes, much less so among young athletes, it may or may not be associated with sciatica (shooting pain down the leg). Careful diagnosis, including MRI scans, can help to rule out other possible causes that can mimic disc injury in young bodies that are still growing.
- Scheuermann’s Disease or juvenile kyphosis: another common cause of back pain in young athletes during puberty that occurs in the mid- as opposed to the lower-back, and leads to a roundness of the back that worsens to a dome shape on bending forwards. Exercises are often not enough to correct this disease, and if wearing a brace does not relieve the pain, surgery may be required, after which it is unlikely the athlete will be able to resume their given sport.
Although you can’t completely eliminate injury and illness, you can look at ways to reduce the risks. This is the purpose of an ambitious and comprehensive national multisport study called the Injury and Illness Performance Project (IIPP).
Beijing 2008 was the first time the International Olympic Committee gathered data on multisport injury, and the Great Britain (GB) squad showed itself to be the best prepared, recording the lowest average injury rate.
Shortly after Beijing, the UK Sport Research & Innovation Team and the English Institute of Sport (EIS) set up the country’s first national multisport injury and illness epidemiological study of its kind.
The project started collecting and examining data in 2009 and is still ongoing. Medical and coaching staff from sports national governing bodies send in detailed information about the occurrence of injury and illness in athletes, and their exposure to risk in training and competition.
Rod Jaques, Director of Medical Services at EIS, says it is important to understand the nature of illness and injury incidence before putting in place new treatments.
14 Olympic sports are involved in the study, each with their own set of data on injury incidence, illness prevalence, and associated risk factors. And each sport has a specific set of recommendations for reducing the risk of injury or illness.
Injury-related results from the project show that since 2009:
- 67% of interruptions to training for British athletes from Olympic sports have been because of injury.
- 43% of athletes will get at least one injury per season, some will have several.
- On average, each injury results in a loss of 17 days of training, and 1 missed competition.
- The rate and severity of injury during training is lower than during competition.
- Overall, injuries to the knee, shoulder, hip and lumbar spine present the greatest risk, and the greatest number of total days lost.
EIS Sports Physician Kate Strachan says that the project is a powerful tool because you can turn to an athlete and say, “you have lost X days due to injury last season”. This is just as important to take notice of as making sure you have the best kit and training environment and coach.
Paul Jackson, another EIS Sports Physician, works with pentathletes. He says the information on the link between some lower limb injuries and training load has helped them change injury prevention drills. For some pentathletes, “this means not running and fencing on the same day,” he adds.
Debbie Palmer-Green, a Research Scientist at the EIS, says the project signifies a new approach that views injury and illness as “performance threats”.
Prehab, short for prehabilitation, is a relatively new idea in sports medicine and therapy. It is a personalized exercise program that is individually designed for athletes to help them prevent injury in their given sport.
(There is also another use of the term prehab that refers to improving patients’ fitness before undergoing surgery so they make a quicker recovery and can withstand the inactivity that often follows the procedure).
A prehab programme is becoming a regular part of an athlete’s training routineThe aim of prehab is to avoid injury by compensating for the repetitive movements and stresses of regular, often daily, training. In some respects, you can view athletic training for peak performance in a sport as a form of repetitive strain, with the potential to result in injury in much the same way as computer operators can get occupational injuries like carpal tunnel syndrome and shoulder problems.
With repetitive use, muscles become tight, the body develops imbalances in strength and muscle coordination. These happen naturally during activity, but because training is repetitive, they become repeatedly reinforced with each workout, unless that workout also incorporates some compensating activity, such as in a prehab routine.
A common problem in athlete training is that many athletes and coaches follow the traditional methods of upper and lower body lifting, or basic sprinting and lifting exercises, as a way to develop strength outside of the specific sport drills. But this can leave the core weak in comparison. A prehab program in this case would start with core stability, perhaps focusing on hips, stomach and back core.
Once the basic core program is in place and working, the prehab is updated to include more subtle and focused movements that increase dynamic stability and improve skills in the given sport.
To ensure the best chance of success with prehab, the athlete should start practising it before injury occurs. But unfortunately the usual route to prehab is via injury. A typical scenario is the athlete injures him or herself, goes to a sport therapist or specialist trainer for rehabilitation (rehab), and the therapist then persuades them to sign up for prehab to stop it happening again.
Another way to keep prehab useful and working for the athlete, is to ensure it continually evolves with the needs and changing fitness and ability of the individual. The exercises should be progressive and re-evaluated regularly. There is also the important need to challenge and motivate the athlete, and stop them becoming bored, or habituated to the program.
A successful prehab program is one that forms a regular part of an athlete’s training routine. The therapist needs to have a detailed knowledge of the athlete’s sport, their strengths and weaknesses, and be able to have frank, open conversations with the individual.
Stew Smith, graduate of the US Naval Academy, former Navy SEAL, and author of several fitness and self defense books, advocates prehab as a way to prevent common injuries of daily life and sport.
He says, to be specific, a prehab program must focus on a person’s body imbalances. There are many natural imbalances in the body:
“Basically, for any movement your body makes,” says Smith, “there are two or more groups of muscles or joints that are stretching (or flexing) to make (or oppose) that motion.”
Most imbalances, says Smith, occur in the following regions of the body:
- Abdomen/lower back: too many people when working out, focus on stomach muscles and neglect lower back.
- Chest and upper back/rear shoulder: many young athletes try to “bench press a truck” but neglect their upper backs and rear deltoids. This can result in shoulder injury and a sloping upper back.
- Thighs and hamstrings: you need a very delicate combination of exercises so the backs of the legs don’t get underworked. Hamstring injuries usually occur when sprinting or jumping, and usually the upper side of the hamstring gets injured. A smart rehab program would include stretching that incorporates the top and bottom of the hamstring connections.
The American Academy of Pediatrics recommends the following:
- Time off: take at least 1 day off a week to give your body time to recover.
- Take breaks: during practice sessions and games to reduce risk of injury and prevent heat illness.
- Use the correct gear: this should be right for the sport and fit properly, for instance pads for neck, shoulders, elbows, chest, knees, and shins, as well as helmets, mouthpieces, face guards, protective cups, and/or eyewear. And don’t assume because you are wearing protective gear you can perform more dangerous and risky things.
- Drink plenty of fluids: before, during and after exercise or play to avoid heat illness; wearing light clothing also helps. Coaches and trainers should reduce or stop practices or competitions when heat or humidity is high.
- Build muscle strength: do your conditioning exercises before games and during practice to strengthen the muscles you use during play.
- Increase flexibility: by stretching before and after games and practice.
- Use the proper technique: coaches and trainers should reinforce this during the playing season.
- Play safe: coaches and leaders should enforce strict rules against headfirst sliding (eg in baseball), spearing (football), and body checking (ice hockey), and stop the activity if there is any pain.
They also advise coaches and parents to consider the emotional stress that the pressure to win can cause for a young athlete, and recommend they adopt these principles:
“Young athletes should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for improving their skills rather than punished or criticized for losing a game or competition. The main goal should be to have fun and learn lifelong physical activity skills.”
Written by Catharine Paddock PhD