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Concussions & Young Athletes

Your Child

Sports Variety Recommended to Avoid Overuse Injuries

1:45

Kids who participate in a variety of sports are more likely to benefit from lifelong physical activity according to a clinical report from the American Academy of Pediatrics (AAP).

Researchers also noted that children, who specialize in a single sport at a younger age, are at a higher risk for overuse injuries from training as well as increased stress and burnout.

In its report, “Sports Specialization and Intensive Training in Young Athletes, “the AAP reviewed patterns of youth sports and found the culture has changed dramatically over the past 40 years.

"More kids are participating in adult-led organized sports today, and sometimes the goals of the parents and coaches may be different than the young athletes," said lead author Joel S. Brenner, MD, FAAP, past chairperson of the AAP Council on Sports Medicine and Fitness.

"Some are aiming for college scholarships or a professional athletic career, but those opportunities are rare," Dr. Brenner said. "Children who play multiple sports, who diversify their play, are more likely to enjoy physical activity throughout their lives and more successful in achieving their athletic goals."

The AAP suggests that kids participate in several sports and delay specializing in one particular sport until late adolescence.  The academy also advocates banning the practice of ranking athletes nationally and recruiting for college before they reach their late high school years.

About 60 million children age 6-18 participate in organized sports annually, according to the 2008 National Council of Youth Sports. Of those, about 27 percent participated in only one sport, the council found. Increasingly, children specialize in one sport early and play year-round, often on multiple teams. By age 7, some participate in select or travel leagues that are independent of school-sponsored programs.

About 70 percent of children drop out of organized sports by age 13, research shows.

While there are a variety of reasons why kids may choose to drop out of sports, Brenner believes stress may play a role.

"One reason could be pressure to perform better and lack of enjoyment due to a variety of reasons, including a lack of playing time," Dr. Brenner said.

During the recent Olympic games in Rio, sports such as figure skating, rhythmic gymnastics and diving gained international attention and praise. There is no doubt that these remarkable athletes have been training diligently since they were children. While few will achieve the kinds of success these athletes have, it hasn’t stopped them from trying.

Youth athletes often begin their competitive sports careers as early as age seven, with some youth participating in organized sports activities as early as age four, if not sooner. With an estimated 25 million scholastic, and another 20 million organized community-based youth programs in the United States, the opportunity for injury is enormous.

That is not to say that children should avoid sports, in fact, physical activity is necessary for normal growth and good health. However, when young children specialize in one particular sport and the activity level becomes too intense or too excessive in a short time period, tissue breakdown and injury can occur.

These overuse injuries used to be seen frequently in adult recreational athletes, but are now being seen in children. The single biggest factor contributing to the dramatic increase in overuse injuries in young athletes is the focus on more intense, repetitive and specialized training at much younger ages.

The AAP has these recommendations for young athletes and their parents:

•       Delay sports specialization until at least age 15-16 to minimize risks of overuse injury.

•       Encourage participation in multiple sports.

•       If a young athlete has decided to specialize in a single sport, a pediatrician should discuss the child's goals to determine whether they are appropriate and realistic.

•       Parents are encouraged to monitor the training and coaching environment of "elite" youth sports programs.

•       Encourage a young athlete to take off at least three months during the year, in increments of one month, from their particular sport. They can still remain active in other activities during this time.

•       Young athletes should take one to two days off per week to decrease chances of injury.

"The ultimate goal of sports is for kids to have fun and learn lifelong physical activity skills," Dr. Brenner said. "We want kids to have more time for deliberate play, where they can just go out and play with their friends and have fun."

The AAP report was published online in the journal Pediatrics.

Story sources: https://www.healthychildren.org/English/news/Pages/AAP-Clinical-Report-Young-Children-Risk-Injury-in-Single-Sport-Specialization.aspx

http://www.nationwidechildrens.org/kids-sports-injuries-numbers-are-impressive

 

Daily Dose

Busy Sports Schedules

1:30 to read

I can’t get over how many of my young patients who play sports tell me that they are up late at night during the school week due to their soccer schedule, or who miss church on Sunday due to a soccer or baseball game. Not only are kids starting organized sports at younger and younger ages (soccer for 3 year olds, flag football at 5?), the commitment to practice or play at what I would term “inappropriate” times seems to be more prevalent and absurd to me.

The mother of a 10 year old boy called me recently to discuss how upset and tearful her son had been since school has started.  Upon further questioning it seems that he had joined a fall baseball team and some of their games are scheduled on school nights at 8 pm....which means they don’t even get home until 10:30 or 11:00 pm?  When my own sons were playing high school sports I was not thrilled about Thursday evening JV games and how late we got home....but elementary school?  Of course, her son was exhausted and then he would get anxious about getting his homework done before hand and getting to bed so late and then being able to get up in the morning etc. etc.  She said that he now wanted to “quit playing baseball”, and cried every time he had to practice.

She was trying to explain to him that he had made a commitment to his team and needed to finish out the season, which I agree is an important life lesson about following through.  At the same I totally understand how upset he is that he has to stay up past his usual school night bedtime. It is not uncommon for some children to get very tearful when they are just exhausted...same for adults.

So how do you rationalize teaching your child about loyalty to their team and commitment when adults make up crazy schedules requiring young kids to stay up past an appropriate bedtime, or forgoing Sunday school if that is what they typically do on Sunday morning rather than going to a scheduled soccer game?

Hard for me to figure out how to “fix” this situation until enough parents say..”we will not let our children participate on the team unless the schedule is appropriate for their age”.  

Have you had any similar experiences? What do you think?

 

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Sports Injuries

Daily Dose

Athletes & Injuries

1.30 to read

I see a lot of athletic teens, and while many of them participate in several sports more and more tweens and teens are “specializing” in one sport. In other words, they may only play soccer or basketball, or be a gymnast or a dancer.  In some cases they practice or compete almost 365 days a year. (I think they often are only off on the 6 holidays/year that our office is closed!).  They too work really hard.

I have recently had more than a handful of elite athletes, especially girls who are gymnasts, cheerleaders and dancers, who have come to me complaining of back pain.  In most cases lower back pain is musculoskeletal in nature and will resolve with some anti-inflammatories (like ibuprofen), alternating ice and heat to the back and a few days of rest. But in some cases the back pain worsens, especially with activity and further work up is required.

In several cases the ongoing back pain is due to a spondylolysis, which is a fracture of the pars interarticularis of the vertebrae. It is akin to a stress fracture in other areas.  It is most commonly found in the pediatric population and is thought to be due to mechanical stress of the trunk with repetitive flexion, hyperextension and trunk rotation.  All of those maneuvers are the “usual” for a cheerleader doing back flips or a gymnast doing exercises with hyperextension.  Athletes who are into weight lifting (seems they all do this now) and even children who carry heavy backpacks may be at risk for a “spondy”.

The spondylolysis may show up on a plain X-ray of the back or may require a CT scan to see the fracture.  

In our community there is some difference of opinion on how best to treat the condition.  Unfortunately, it seems that the best treatment is rest which may be for weeks-months.  This is NOT what they competitive gymnast or star football player wants to hear.  

Once the pain has resolved a structured physical therapy program seems to be of benefit as well.  If conservative management for over a year does not help some orthopedists would recommend surgery. Again, there are several different views as to the benefits of surgery in this age group.

But if your child has persistent lower back pain that worsens with activity and hyperextension you should think about this condition and talk to your doctor. It is becoming more prevalent as our kids compete at higher and higher levels.  

Your Child

Kids: Mouthguards For All Contact Sports

1:45

Youth sports participation has grown steadily over the years and so have injuries. The National Youth Sports Foundation for Safety reports dental injuries as the most common type of face and mouth injury kids experience in sports related accidents.

A new report issued by dental experts at the University of Alabama at Birmingham, says that mouthguards should be included in safety gear for all contact sports.  

Sports-related dental injuries send more than 600,000 people to the emergency room every year, the U.S. Centers for Disease Control and Prevention reports.

Most of these injuries involve the front teeth, but the tongue and cheeks can also be hurt while playing sports, the UAB team said.

The best way to protect the mouth and teeth during sports is to wear a mouthguard, says Dr. Ken Tilashalski, associate dean for academic affairs at the UAB School of Dentistry. Mouthguards have been shown to reduce the risk of sports-related dental injury by 60 times, he said.

"Wearing a mouthguard reduces the chances of tooth fractures, tooth dislocations and soft tissue cuts," Tilashalski said in a university news release. "The guards also protect against jaw fractures and concussions by absorbing the energy of a traumatic blow to the chin."

The American Dental Association (ADA) recommends wearing custom mouthguards for the following sports: acrobats, basketball, boxing, field hockey, football, gymnastics, handball, ice hockey, lacrosse, martial arts, racquetball, roller hockey, rugby, shot putting, skateboarding, skiing, skydiving, soccer, squash, surfing, volleyball, water polo, weightlifting, and wrestling. Other experts include baseball and softball infielders on that list. They further recommend the mouthguard to be worn during all practices and competition.

There are basically three types of mouthguards to choose from:

·      Stock: These are preformed and ready to wear, but they may not fit well inside the mouth.

·      Boil and bite: These may be customized and molded to the mouth by softening in boiling water before biting down.

·      Custom-made: A dentist tailor-makes these mouthguards to fit an individual's mouth. These mouthguards provide the best fit and the highest level of protection.

"For my kids, I have chosen to use custom mouthguards as they fit and feel better, do not interfere with speech, and are essentially invisible," Tilashalski said. "Mouthguards need to be replaced as they wear down, and athletes in the tooth-forming years will have to have these replaced more often as the mouth grows and the teeth change."

These mouthguards vary in price and comfort, yet all provide some protection. According to the ADA, the most effective mouthguard should be comfortable, resistant to tearing, and resilient. A mouthguard should fit properly, be durable, easily cleaned, and not restrict speech or breathing.

After each use, rinse your mouthguard and store it in a hard container to prevent the buildup of germs, Tilashalski said. Players should also avoid chewing on their mouthguard to extend its life.

It is important to remember damaged teeth do not grow back. Protect your child’s teeth by making sure he or she wears a mouthguard during practice, competition or just out having fun in a sport where falls are common such as biking, skating and skateboarding.

Story sources: Mary Elizabeth Dallas, https://consumer.healthday.com/dental-and-oral-information-9/misc-dental-problem-news-174/mouthguards-key-defense-against-sports-related-injuries-716284.html

http://www.nationwidechildrens.org

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