October 2006

More intensive teen training means more injuries

Grand Forks Herald

By Kendra Marr, San Jose (Calif.) Mercury News

Mon 21 Aug 2006

Injury hasn’t – and probably will never – stop Heather Fisher from playing softball.

Last season, the 17-year-old centerfielder’s right shoulder started hurting. 

“It sucked,” she said. “It was so painful. There were days I couldn’t lift my arm high enough to throw anything.” 

Her doctor told her to take the year off. Fisher refused. Two cortisone shots and a number of physical therapy sessions later, the pain only got worse. Another doctor told her that overusing her arm had torn her rotator cuff and labrum. 

For many teen athletes, like Fisher, summer is no vacation. It’s the time they step up their training with traveling teams, overnight sports camps and practice twice a day.  

No wonder, doctors say, they are seeing a substantial growth in overuse injuries, raising questions about how hard parents, coaches and young athletes themselves are pushing bodies that aren’t ready for such stress. Muscle, bones, tendons and ligaments in teens are being stressed beyond their physical limits. 

“It’s an epidemic to me,” said Dr. Sally Harris of Palo Alto Medical Foundation’s sports medicine department. “The training for kids is more and more intense.” 

This summer she has seen nearly twice as many overuse injuries in teenagers than last summer – or even the recent school year, she said. 

Overuse injuries account for nearly half of all sports injuries in teens, according to Safe Kids Worldwide, an organization dedicated to preventing accidental childhood injury. 

These young athletes are not sleeping till noon, watching daytime television and gorging on junk food. 

“The concept is seen as utter weakness,” said Dr. Scott Hoffinger, an orthopedic surgeon at Children’s Hospital and Research Center in Oakland, Calif. “It’s like the Marines. But you’re not storming beaches of Normandy. You don’t need to be bloody and dragging along.” 

A decade ago, overuse injuries were an adults-only problem, Harris said. Now damage and inflammation caused by repetitious motion – such as a swimming stroke – are now common among younger athletes.

Girls going through puberty are especially at risk, as their legs and hips begin to change, Harris said.

And some injuries are unique to teens. 

Harris said she treats stress fractures of the spine – an uncommon injury she had previously seen only once a month – at least twice a week this summer. High-impact sports twist and hyperextend the spine.

Damage can usually heal in a month or two. But untreated, like other high-impact injuries, Harris said, such stress fractures can lead to a slipped disc or damaged nerves.

Who’s to blame? Parents, coaches and athletes all play a part.

Hoffinger recalled a mother who broke down crying when she was told her baseball-playing son wouldn’t be able to pitch for a year.

“Sports are everything to us – that’s the pronoun she used,” Hoffinger said.

Some coaches believe young athletes can play in pain like professional athletes do, doctors said. But while it’s OK for adults to push through discomfort, like tennis elbow, it’s detrimental to growing teens.

“It’s hard to tell people to cut back,” Harris said. “It’s not what they want to hear. They want the problem fixed quickly without affecting participation.”

Harris said she has a hard time convincing families to skip summer sports camps before a minor injury turns into something more permanent.  

“It seems like common sense, but athletes and parents lose perspective when they’re wrapped up in it and put money out for it,” Harris said. “It’s hard to sit back and say it doesn’t matter if my kid can’t do a camp for one week.”

And athletes push themselves.

Fisher got surgery to fix her rotator cuff and labrum tear. Despite the pleas of her doctor and physical therapist, she still plays summer league and intends to play this high school season.

“I don’t think I ever could take a break,” she said. “I’m so used to going hard, playing my best. In games I’ll play as hard as I can, then go, “ow, that hurt.”

Lindsay Dowd, 15, aspires to play volleyball in college like her older sister. Her freshman year on the Leigh High School varsity team, she got shin splints. Now during summer conditioning, just as she’s begun her career as a setter, she began to develop tendonitis in her hands.

“Advil has been a big help in my life so far,” said Dowd.

Mark Milioto, 15, of San Jose, Calif., has been attending summer baseball camps since he was 8.

“You kind of have to keep going all year,” he said, “so you can hit that 80 mph fast ball.”

San Jose 12-year-old Alli Rao is attending 18 volleyball camps this summer. Ann Pardon, 13, is going to six.

Young athletes don’t know their limits, unlike adults who, with more experience, can self regulate their exercise, said Dr. Michael Henehan, director of the San Jose-O’Connor Hospital Stanford Affiliated Sports Medicine Fellowship Program.

“If the coach says run 100 miles in the sun, they’re going to do it because that’s what coach told them to do,” he said.

Rest and moderation are the only ways to curb injuries among competitive teens.

Teens are breaking down bone faster than their bodies can repair, Harris said.

Fabian Garza, a coach for USA Seventeen Youth Soccer Academy in Santa Clara, Calif., said teens need to beat the system. Often club season overlaps high school season, leaving athletes without a break.

“For society here, more is better and someone is always working harder or doing more” than you, he said.

So a number of Garza’s boys have opted out of playing high school sports to recover and work on personal skills.

Ellyn Crawford of Sunnyvale, Calif., said she worries about her 12-year-old daughter Shayna, especially after she developed a spinal stress fracture following a winter volleyball camp.

“It is pressure,” said Crawford, watching Shayna play at a Santa Clara University summer camp. “You can’t do high school unless you do this. We don’t do the power teams, we just do the local thing. I don’t want her to burn out. I could be wrong. I just don’t want to push her.”  

**40 percent of all sports injuries treated in emergency rooms happen to children ages 5 to 14.

**30 percent of parents report that their child has been injured while playing a team sport.

**21 percent of traumatic brain injuries to children are sports and recreation injuries.

Kid’s injuries by sport 

Number of children ages 5 to 14 treated in emergency rooms for injuries in 2004, by sport

**Basketball 198,200

**Football 193,600

**Baseball 10,500

**Soccer 74,600

**Gymnastics 23,500

Source: Safe Kids Worldwide