Time Magazine
Sunday, Sep. 10, 2006
To an Athlete, Aching Young
Specialization and year-round play are putting active kids at increased risk of crippling injury
By CHRISTINE GORMAN
Considering the fact that 1 out of 6 youngsters in the U.S. is overweight, you'd think that any increase in physical activity for kids has got to be a good thing. But that isn't necessarily so. It's true that the earlier in life you make running, jumping, swimming and other physical activities a regular part of your daily routine, the healthier you'll be--provided that you keep it up as an adult. But the enormous boom over the past few years in soccer, gymnastics and other highly competitive sports for children has a dark side as well: an epidemic of sports injuries that go well beyond the bruises, scrapes and occasional broken bones parents might expect.
In some cases, those injuries can lead to crippling arthritis or require extensive surgery to repair. It's no longer unheard of, to name just one example, for a 10-year-old baseball pitcher to need a tendon transplant for an ailing elbow--an operation that used to be restricted almost entirely to major league baseball players. And orthopedic surgeons report they are under increasing pressure to offer ever more experimental surgery for younger athletes.
Although sports injuries are a danger at any age, youngsters in their preteen and early teen years are particularly vulnerable, especially to vigorous, repetitive movement, because of the way their bones grow. Instead of expanding all along their length, as you might assume, young bones generate new tissue at so-called growth plates located near the ends of most bones. "The growth plate is actually at its most vulnerable in the year before it closes," says Dr. Jon Divine, medical director of the Sports Medicine Biodynamics Center at Cincinnati Children's Hospital in Ohio. Reason: a protective band of tissue that supports the growth plate starts to break down at puberty so that bone can completely ossify in preparation for adulthood. Without that protective band, the plate is especially susceptible to being unnaturally compressed or even pulled apart. Parents are often shocked to discover that overuse injuries may require six months or more to heal properly.
Specializing in one sport and playing it year round is an obvious way to court trouble. But young athletes can also be tripped up by playing different sports that put stress on the same parts of their body over and over again. For example, swimming, water polo and volleyball put a great deal of strain on the shoulders, so athletes wouldn't really give themselves a rest by switching among those sports. For the same reason, softball pitchers shouldn't swim competitively in the off-season or play football. They would be better off doing something dissimilar like bicycling, which uses different sets of muscles.
Each sport comes with characteristic dangers. Whereas volleyball players and swimmers are prone to overuse injuries of the shoulder, basketball and soccer players often have trouble in one or both of the knees. Divers, cheerleaders, gymnasts and football linemen, meanwhile, are susceptible to stress fractures of the lower back. Indeed, lower-back pain is normally uncommon in adolescents. If it shows up, parents should schedule an immediate visit to a doctor.
Some injuries seem to distribute themselves differently between the sexes. Boys suffer concussions more often than girls do, no doubt because boys play more contact sports. But researchers are only beginning to understand why girls are more likely to tear their anterior cruciate ligament (ACL), a piece of connective tissue that helps hold the knee together. The difference can be dramatic. A recent study by researchers at the Morgan Stanley Children's Hospital in Manhattan determined that adolescent female athletes were eight times as likely to injure their ACL as their male counterparts.
Part of the problem, investigators believe, may be that girls usually mature more quickly than boys do, girls' knees tend to be a little looser and girls' quadriceps muscles (at the front of the thigh) are often stronger than their hamstrings (at the back of the thigh), destabilizing the knee. Many soccer coaches have learned to address the problem by spending more time drilling girls on how to land properly and encouraging them to build up their hamstrings.
But in many ways, the underlying problem is not merely one of anatomy but of psychology as well. The pressures to compete earlier and earlier in life--because winning an athletic scholarship demands it, for example, or simply because everyone else is doing it--can be immense. And it's not always clear if it's the parents, coaches or kids themselves who are pushing the hardest. "We have a culture that is tremendously out of balance, in which you have nothing but competition," says Brooke de Lench, a onetime squash and lacrosse player who wrote Home Team Advantage, a newly published advice book for moms who want to avoid the pitfalls of overly intense sports for their family. "Children need to be playing and having fun."
But that's a tougher goal than it seems. Just look at the set of new pitching rules that Little League is putting into effect for the 2007 season. After decades of trying to prevent injuries by limiting pitchers to six innings a game--which could result in anywhere from 54 to more than 100 pitches per outing--Little League officials will focus instead on the total number of pitches per game, depending on the pitcher's age. Pitchers 10 and younger will stop after 75 pitches, and those 11 to 12 years of age are limited to 85 pitches a game. The move, designed to minimize the chances of seriously injuring a pitcher's elbow or shoulder, was based on research conducted by the American Sports Medicine Institute (ASMI) of Birmingham, Ala. Its studies actually indicated that an even lower number of pitches--75 for children 11 to 12 years old--was ideal.
But pilot testing by the Little League organization showed that a lower limit would mean changing pitchers more often during the game than coaches and players really wanted. So the investigators looked at their data again and decided that 85 pitches was still within the safety zone--and just as important, made it more likely that a pitcher could complete an entire game.
That wasn't the only compromise. ASMI had also recommended that pitches be limited to 1,000 a season and 3,000 pitches a year. But the sports organization chose not to follow through on those guidelines, at least for now. "There is no way we could enforce or mandate it," says Stephen Keener, president and chief executive of Little League Baseball and Softball. "We understand the reasons for the season-long cap and why they are suggesting the kids do it, but we don't have any way to control it. It's already such a dramatic change in how we legislate pitching."
It's understandable that Little League officials find themselves in a bind. Even before the new limits go into effect, there are plenty of parents and coaches who think the organization is not competitive enough and are choosing to participate in one or more travel teams that often don't restrict pitching. There's no guarantee that anyone will follow Little League's lead in counting pitches. Then the question becomes, Which will your child have longer--a nice, shiny trophy from winning a tournament or the injury he or she sustained getting it?
ELBOW
Kids who play sports like baseball and tennis risk elbow injuries from repeated throwing and hitting. The growth plate at the end of a bone is especially vulnerable: fracturing or tearing away of the bone can cause the plate to become deformed
SPINE
Activities such as cheerleading, gymnastics and football can lead to a fracture of the spine (spondylolysis)--typically at the fourth or fifth lumbar vertebra--or to spondylolisthesis, in which one vertebra slips away from its neighbor. Both cause chronic lower back pain, which is otherwise uncommon in children
KNEE
The pain and swelling of Osgood-Schlatter disease, which is more common in boys, comes from irritation of the growth plate just below the kneecap as well as of the tendon that stretches across the kneecap
With reporting by by Carolyn Sayre/New York
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