Physical therapists are seeing an influx of youth athletes in their practices for a simple reason: too much activity, too soon, for too long. As more children in the United States participate in year-round organized sports, some of the smallest players are treated for sports overuse injuries. Between 25-30% of many physical therapists' caseloads are pediatric patients in an unspecialized setting, but is far from a new phenomenon.
The Root of the Problem
Overuse injuries have always been most prevalent in the pediatric population.
Sports overuse injuries are more common because more kids in sports are playing more organized sports, more hours per week and more weeks per year.
Kevin McHorse, PT, SCS, Cert. MDT, former chair of the Youth Athlete Special Interest Group (SIG) of the Sports Physical Therapy Section of the American Physical Therapy Association, sees many pediatric clients per day. Half of the athletes he treats at Central Texas Pediatric Orthopedics in Austin, Texas, are there for sports overuse injuries. McHorse says that this is due to how kids are training and the amount of training they do has changed dramatically within the last 10-15 years.
Though it's important that players and coaches understand proper training techniques, it takes more than on-the-field knowledge to keep a child-athlete healthy. Tim Cummings, DPT, of Elite Physical Therapy and Integrative Health in Kansas City, Mo., claims that inactivity throughout the day and an increased workload in short periods of time do not help prevent injury.
"Kids in general are completely offsetting physical activity with a sedentary lifestyle, playing video games, playing on their phone or sitting down doing homework," Cummings said. "If you're in a sedentary position for too long, your exercise or sports participation is going to be completely offset by that amount of sedentary behavior."
Cummings suggests taking a look at how physical activity can be incorporated throughout the day - not just in hour-long practices. A sedentary lifestyle not only affects an athlete's chances of getting injured in a game, but can affect their chances of developing cancer, stroke and other diseases.
Any sport is capable of causing an overuse injury, but some are more likely to cause strain on players. For the lower body, physical therapists tend to treat athletes who play running and jumping sports (soccer, lacrosse, basketball, etc.) For the upper body, sports such as tennis and baseball cause the highest amount of strain on a child's body. According to McHorse, injuries sustained to the upper body, specifically the shoulder and elbow, are easiest to prevent as they are related to training, strengthening and the volume of pitches thrown.
Adult vs. Youth Overuse
The most common youth injuries treated by physical therapists are Sever's Disease, affecting the heel; Osgood-Schlatter Disease, affecting the knee and tibia; Little League elbow and shoulder; and patellofemoral knee pain. Injuries vary depending on the movement of the sport and they need to be approached differently than adult overuse injuries.
"The main difference is the existence of the growth plate. Pediatric and adolescent athletes are usually not finished growing until 13-15 for girls and 16-18 for boys," says Gary Shiffman, PT, ATC, CSCS, clinical director of Professional Physical Therapy, Mahwah, N.J. "Until their growth plates are closed, which determines their ultimate height, the existence of the growth plate is the main difference in sports medicine. It's softer, and you can get injuries to that area that you wouldn't see in adults."
McHorse says the distinction in treating these injuries is due to physiology as well. "Most adult overuse injuries are to muscles or tendons. Many youth athlete overuse injuries are to the growth plate," McHorse said. "These tissues respond to different treatment methods and heal in different ways."
Avoiding Injury
There is some good news for athletes and coaches alike: Overuse injuries can, to some extent, be prevented. Unlike acute traumatic injuries, such as ankle sprains, many overuse injuries can be deterred with correct strengthening and conditioning, proper warm-ups and cool-downs, communication and a bit of common sense. Parents and kids should look for signs that athletes are playing in pain.
Kids play sports because they enjoy them, they're fun and they get to be with their friends. If they're in pain when they play, it's no longer fun. If [coaches] notice something's wrong, chances are that there is something wrong. Be aware of your players. If they've been playing a lot of minutes and they're starting to look sluggish, they're probably tired. If they're limping, get them off the court; if they're wincing when they're throwing the ball, get them out of the game. Coaches need to know their players and look for signs of fatigue and playing in discomfort.
A proper cool-down that goes beyond the traditional 10-minute stretch after practices and games is essential to a player's health, according to Cummings.
What do players do after practice and games? You don't see improvement until you're done with practice and take time to rest. You need to address any muscle soreness and stiffness [at this time]. Players need to make sure that they're getting adequate nutrition, getting enough sleep, and addressing soft-tissue work to maintain tissue and joint integrity. That's how you reap the benefits of your training.
McHorse believes that age-appropriate conditioning is the key to healthy players. "For years, the thought was that younger players shouldn't train with weights before puberty. Research has shown that once they hit 11 or 12, they can start lifting weights safely."
However, there are conditions to this statement: For pre-adolescent athletes, there must be adult supervision, and proper form must be used at all times. Athletes should also make sure that they are not over-lifting by opting for higher repetitions at a lower weight.
How PT Can Help
Physical therapists can provide a range of treatments for youth sports overuse injuries, including assessing weakness, tightness or muscle imbalances prior to injury, and providing focused work on these areas as part of an overall training program. It's necessary to address physiological differences between adult and pediatric patients, though.
"[With a kid] you might need to start with stretching and then go into other conditioning for something like Sever's or Osgood-Schlatter. The growth plate needs time to recover first before starting the strengthening phase of rehab," McHorse said. "With an adult, you may jump right into strengthening for many overuse injuries. The biggest mistake I see with injuries like Osgood-Schlatter and Sever's is that people try to go right into over-strengthening, and the patient's pain increases. You need to grade the load that you apply appropriately so that the tissue has time to recover."
Physical therapists can also assist players in preventing injuries through teaching proper stretching and strengthening techniques, which should be used both in the clinical setting and at home.
You wouldn't wait until your car engine exploded to check the oil. Why would you do the same with your body? People don't necessarily understand what therapists do to contribute to preventative measures. A physical therapist can help with being an extra set of eyes to see those red flags essential to preventing injury and keep the athlete on the right track.
Overuse injuries can, in fact, be preventable. Through proper training, techniques and a little knowledge on the part of those involved in youth sports, child-athletes have a higher chance of staying healthy and happy on the field.
Please let us know if you have any questions or concerns related to youth sports and injury prevention.
Reference: Katherine Bortz at ADVANCE.
