Early year-round sports specialization contributes to rise of overuse injuries

Bobby Boyle engages in serious year-round sports training and has had his share of minor muscle injuries. When the 12-year-old athlete felt tightness in the back of his thigh while sprinting at track practice, he and his parents thought he pulled a hamstring and assumed it would heal with limited exercise time.

"We asked Bobby to take it easy for the week and not to go to his track practice. We wrote him a note to skip that but we wanted him to go to soccer practice and just take it easy," says John Boyle, Bobby's father. "So for the first week, he was icing it, he was in the hot tub, he was stretching; but he wasn't getting any better."

After two weeks of pain, frustration and no improvement, Bobby's parents took him to the University of Michigan MedSport clinic, which is one of the only pediatric sports injury programs in the United States. There, he was examined by Laurie Donaldson, M.D., who diagnosed him with a potentially serious growth plate injury to his pelvis and prescribed him six weeks of complete rest.

"That diagnosis was pretty shocking," says Olabisi Boyle, Bobby's mother. "He works out and tries to stay in shape all year long. It was pretty devastating hearing that, mostly because I know how hard he had worked for this season in particular and now he was basically being told the entire season was shot."

Younger age, multiple sports involvement increases risk

Bobby participates in soccer, tennis, track and field, basketball and cross country—often times playing on more than one team in one season. Similarly, 45 million children participate in organized sports each year in the U.S. Many of these children, like Bobby, are engaging in serious sports training and specialization at younger ages, which makes them more susceptible to potentially serious injuries.

Earlier year-round sports specialization is likely contributing to the rise of overuse injuries.

"We're seeing more serious sports injuries at a younger age," says Donaldson, sports medicine specialist at U-M's MedSport. "The concern is they are still skeletally immature with open growth plates that are prone to injury."

The growth plate is the area of developing tissue near the end of a child's bones and is the weakest area of a growing skeleton. Once growth is complete around adolescence, the growth plates become solid bone. An injury that would cause a sprain to a ligament or muscular strain in an adult could cause a serious growth plate injury that could effect physical development in a child.

Donaldson says growth plate injuries are commonly seen at MedSport.

"Growth plate injuries can be very serious, particularly if it's a fracture in one of the long bones because that can affect the growth of the bone," says Donaldson, who is also team physician for the USA Hockey National Team Development Program. "If treated improperly, it can either grow too long or not long enough."

Donaldson says there isn't one sport that causes more injuries in kids. Each sport is unique to the type of injury it can produce, depending on the body part most often used. Half of pediatric sports injuries are related to overuse while the other half constitutes ligament sprains, muscle strains and bruises.

Young females are eight times more likely to suffer an anterior cruciate ligament tear in the knee and are susceptible to the female athlete triad, where females have disordered eating, causing menstruation to become irregular or stop altogether and stress fractures from weakened bones.

On the mend

After completing six weeks of rest, Bobby says he's doing a lot better.

"Once I got off my restriction, I started jogging a little, I had some lessons with my soccer coach, I did rehab, I've been doing some exercises and lifting weights," he says. "I'm feeling a lot better and there's no pain so that's good."

Bobby's parents say they've learned a lot about how to continue to encourage his sports participation and protect him from potential injuries in the future.

"While it's great these kids are getting all this activity and getting all the fun and enjoyment and success that they get out of doing well, there's a potential downside if you don't really keep on them to make sure they're training properly," says John Boyle. "I didn't remember anything like this when I was their age and it's quite serious."

Advice for parents

Donaldson says she encourages kids to be active but provides advice for parents in order to protect their children from potentially serious sports injuries:

•Encourage play and fun rather than competition under the age of six.

•Discourage year round sport specialization until after puberty, but rather encourage the "well rounded" athlete. "We know that young athletes who participate in a variety of sports play sports longer and have fewer injuries than those who specialize in a single sport before puberty."

•Have children rest two or three months out of the year from a specific sport to participate in cross training.

•Recommend a day or two of rest a week from organized sports and training.

•Make sure they stretch and warm up appropriately to prevent growth plate injuries from lack of flexibility.

•Condition ahead of seasons and follow the 10 percent rule—increase distance or participation by 10 percent a week, particularly if coming back from an injury.

•Teach children not to work through the pain of an injury because it could be a more serious injury than originally assumed.

"With guidance from parents, coaches, trainers, physicians and the sporting community, we can promote safe sports for kids. I believe kids' activity in sports is great for life-long health reasons because it encourages them to be active for the rest of their lives," says Donaldson. "It's good for teaching socialization, teamwork and healthy competition that can lead to success later in life."