If you have been around high school sports for more than 10 years or more, you have seen the effects of youth sports on the athletes who play. I have seen first hand “super star” youth players that don’t live up to the hype in high school. I have seen baseball players who can’t throw a baseball across the infield due to poor training and overuse in the younger levels. I have seen soccer players who’s legs are “done” by the time they are in high school due to year round demands on them. I have seen several middle school athletes tear their ACLs. I have worked on 9th grade baseball pitcher who had 3 rotator cuff tears (revealed by MRI).
On 11/26/2011, Christopher Smith wrote an article for the Eagle Tribune that documents the injuries that young baseball players are having at a younger age. The injury is a tear of the ulnar colateral ligament in the throwing elbow resulting in “Tommy John” surgery reconstructing the ligament. Most athletes can pitch again after the surgery, but then experience shoulder trouble. The reason why this is such a hot button topic for sports medicine professionals is that this injury is almost 100% preventable, especially at the youth levels. Smith tells the story of Connor Nolan.
Connor Nolan pitched almost year round as a teen.
“I threw high school, Legion, fall ball,” Nolan said. “You just want to get noticed. It’s hard, especially coming from the northeast.”
Nolan, a graduate of Salem, N.H., High and a 2007 Eagle-Tribune All-Star, was determined to win a college baseball scholarship.
He finally achieved his dream, winning a baseball scholarship to Florida State.
But in the process, he ruined his pitching arm and his hopes of making the big leagues.
Nolan is just one example of a trend affecting young pitchers, one that should trouble their parents and coaches.
Tommy John surgery is named for a former Dodgers and Yankees pitcher, and it is usually associated with professional players. Red Sox pitchers Daisuke Matsuzaka, John Lackey and Rich Hill have all undergone the surgery since June.
But increasingly, Tommy John surgery is being performed on amateur pitchers in college, high school and even youth leagues.
Young pitchers are throwing year-round, even in snowbelt states, thanks to indoor practice facilities. Under pressure to impress coaches and scouts, pitchers are throwing with elbow pain as early as Little League and throwing too many pitches during games. Some coaches are also using young pitchers to play other positions, like catcher and shortstop. They’re throwing hard and often on what are supposed to be their days of rest.
“Probably the most common cause is overuse in our young population,” said Dr. Luke Oh, a sports medicine orthopedic surgeon at Massachusetts General Hospital and a Boston Red Sox team physician.
Again, the epidemic of these elbow injuries is due to pushing young athletes to train like the pros.
This epidemic isn’t unique to baseball, it is a problem for an increasing percentage of participants in organized youth sports. Organized sports is not the problem, a lack of variety is the problem. In an article from The Province, Dr. Sue Hubbard writes the need for children to be involved in a variety of sports. I couldn’t agree more Dr. Hubbard!
More and more kids seem to be participating in organized sports at ever younger ages. I know many three-year-olds already playing on soccer teams, and kindergartners involved in football and lacrosse. Also, children are “specializing” in specific sports at younger ages, increasing the risk of overuse injuries.
This specialization seems to be more common among children who participate in dance, soccer, gymnastics and tennis.
While I’ve been noticing more and more overuse injuries in young children, a recent sports medicine study supports this. A preliminary report from the sports medicine department at Loyola University School of Medicine (Chicago, IL) found that “kids are twice as likely to get hurt if they play just one sport than those who play multiple sports.”
It seems those children who participate in multiple sports are actually “cross-training” and are using different muscle groups and different movements.
Dr. Hubbard has hit the nail on the head. Youth sports should focus on fundamental movements, skill development and games fundamentals. But, youth sports are about competition. Ideally, there should probably be a 6:1 or greater practice:game ratio, but my experience ratio is that is rare. And the varsity level coaches I work with also agree.
Added to this repetition is the stress that’s incurred to a growing body. Children ages eight to 16 are still in the throes of major developmental changes and growth spurts and are more vulnerable to injury. Their bodies are just not ready to perform at this level every day, year round. They have so little down time that their bodies just “tire out” and overuse injuries occur. This is often manifested in stress fractures in the back, feet and lower legs, as well as tennis elbow and knee problems, just to name a few. I’ve seen stress injuries in almost every area of the body!
The mainstay of treatment for overuse injuries is rest. But there are children as young as nine to 10 in my practice who become anxious and guilt ridden when told that they may not participate (in whatever sport that got them to this place) for four to six weeks so the body can heal itself.
You can’t rush rest, and the “body is a temple” that needs time to repair, especially in pre-pubertal children.
So where does this epidemic fit into the AT’s domain and expertise? What can be done?
Prevention of overuse or “too much, too soon”, lack of training variety, fundamental movement skill development and recognition of poor mechanics are needs that should be addressed by youth leagues. These needs can be met by consultation with AT. ATs are well educated in all of these issues facing young athletes, but our services are rarely available to these athletes.
I know I am not stating reality here, but ideally wouldn’t parents want better health care for their younger athletes than the older athletes? Doesn’t a bad ankle sprain in 2nd grade have a much more pronounced effect on long term health of an athlete compared to the same degree sprain in 12th grade? The obvious answer is yes! The 2nd grade athlete is still developing and an injury of this type could alter movement skills leading to a multitude of injuries down the road. It could even lead to the athlete dropping sports in a few years. But (in my Utopian world) access to the same AT services provided to collegiate athletes by the youth sport athlete could have very positive outcomes on the long term health of these young athletes.
It is therefore important that every AT understand the value of the service we provide to our communities and our athletes. It is equally important for ATs to look for ways to grow our profession into settings that need our services. Youth sports is one of those settings.