One Question, Many Answers (#2)

So after the amazing readership of the first “One Question, Many Answers” I knew I had to keep bringing it. Recently this subject has gained popularity, probably because people are starting to see how serious the problem is. So this month I asked:

In your opinion, why are childhood overuse injuries becoming so prevalent in our society? (Roughly one paragraph limit)

Here is the rundown –

Thomas Lee, MD – The incidence of overuse injuries in children is growing within our orthopedic practice. The incidence of surgery for sports injuries are also growing within our practice.  With a greater emphasis on competition and higher performance on children, the forces exerted onto developing joints, ligaments, and growth plates frequently exceed their structural tolerance. In addition, todays protective equipment allows for greater exertion with a false sense of security and invulnerability against injury.
Finally, there has been less emphasis on recovery and nutrition for our younger population.  Whereas we caution our older patients to get plenty of rest and proper protein intake, we assume that our children with their high metabolism and intuitive sense of sleep would naturally eat and rest.  Which they would if we adults wouldn’t interfere with their natural cycle of play.
twitter:  thomasleemd

Chris Melton – “Today’s young athletes are deciding at a very young age what sport they’d like to master.  This has led to playing the same sport “year-round”, the acquisition of “sport-specific” coaches, attending multiple, high-level training camps and parents seem to be encouraging these activities.  This continual emphasis on excelling in a particular sport is leading to many “over-use” injuries.  One example:  young baseball pitchers are throwing year-round damaging shoulders and elbows and resulting in surgeries that used to be seen at a later stage of life.  Little League baseball has sought to remedy this by imposing new and stricter pitching/rest rules (a good idea in my opinion).”

Patrick Ward, MS, CSCS, LMT – “The issue of overuse injuries in young athletes stems from several potential causes.  One critical factor is early specialization.  Parents want the best for their kids and they mean well; however, they often don’t understand athletic development.  It is not uncommon to find kids playing/specializing in the same sport year round without any breaks.  A lot of times these kids are playing on several teams at the same time!  I have spoken to parents who have their kids on 3-different baseball teams and they also go to a hitting or pitching coach – at the age of 14!  Aside from the risk of overuse injuries, this type of schedule can often lead to burnout and loss of interest on the part of the athlete.  I try and encourage parents to let their children play as many different sports as possible through out the year, and also be sensitive to the fact that they should have an offseason, where they can back off from playing sports and do something else.  The other issue is that parents are putting a lot of stress on sports preparation (various leagues, practices, specialized sports coaching) and not taking their athletes to a qualified strength coach.  The offseason is a great time to work on weaknesses and basic, fundamental movements.  Parents are often concerned about their athletes lifting weights, but in reality, the forces that are placed upon them in a game situation are typically far greater than those they will encounter in the weight room.  Training in the gym is a great time to slow down the pace of things and really dissect fundamental movement and enhance learning.  Practicing a sport or playing in a competition is always a 100% effort.  Time in the  weight room should be spent really breaking down basic movements and developing quality technique and understanding of these movements in a safe and controlled environment.  In doing so, the athletes will be better prepared to handle the intensity and forces during game situations, as the movements are now “familiar” to them.”

Mike T. Nelson,  MS, PhD(c), CSCS, RKC – “While there are many reason, I think the biggest one is lack of UNstructured play in our society.   This is not to be confused with signing up junior for fast pitch baseball at 6 years old where adults control all the rules.   Kids need to be kids and conduct non structured games with kid made-up rules on the spot play.   Let them grab your broom out of the garage and play “baseball” ( kid ball perhaps?) with it and a volleyball.  If they do this, PLEASE don’t interrupt them and explain that brooms are for sweeping only and volleyball is a different sport all together.  Let me them play!

Kids need to learn as many different motor skills as possible from both a developmental and an over use stand point.  They need to move in ALL directions and eventually at high speeds.  They need to learn how to fall (I teach adults how to fall since falling is a huge source of fear) and yes they may get skinned up a bit or gasp, even break a bone at times.   We send kids out to play now with more pads than an NFL lineman as we dictate how they should play and yell at them for breaking the rules of the game.   Relax, tell them to go play and have fun.   I used to ride my bad a$$ banana seat Huffy bike off an old half of a ping pong table that my sister and I made into a launch ramp as my sister and I played “bike tag.”   I still turned out normal. Well, normal depending on who you ask.”

Z Health Master Trainer

Mike Young, PhD –  “Childhood overuse injuries are rampant now because of two somewhat opposite scenarios that are becoming increasingly common. In the first, the loss of physical and motor education at young ages combined with later training that is inappropriate for the athlete’s work capacity and training age leaves athletes more susceptible to overuse injuries. In the second scenario, early sport specialization due to overzealous parents and coaches leave athletes likely to have a variety of problems later in their life.”

Owner- Human Performance Consulting; Director of Sports Performance – Athletic Lab
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twitter: @mikeyoung

Ken Zelez – I work in a high school where I am the Athletic Director and also look over our huge Sports Medicine program.  In the past 3 years, I have seen a significant rise in overuse injuries.  The chiro’s and physio’s that I am in constant contact with are saying the same thing.  When we speak about overuse injuries, we often speak about conditions such as shin splints, stress fractures, tendonitis or tendonosis.  While these injuries show physical signs and symptoms, we often miss one of the most obvious signs of overuse – Burnout!
Almost every student athlete I treat or talk too about their overuse injuries makes reference to the fact that they are “tired” of playing their sport.  This is a direct result of training too hard at a young age and not getting the appropriate rest and recovery time.  Specifically, I am speaking of one sport athletes who specialize in a single sport.  For these athletes, there is no such thing as an “off-season”.  They go from league to club to some variation of training that replicates the sport they play.  As a result, they are only working specific muscles and joints over an over again producing overuse injuries!  Kids need to take part in a wide variety of sports and not specialize at an early age.
Ken Zelez
Zealous Vitality Inc.

Selena Horner – Childhood overuse injury is a multidimensional topic.  It could be guesstimated that 30-45 million kids from the age of 8-18 are involved in some level of sport participation from recreational to school sponsored to competitive traveling teams.  With sport participation it is probably not uncommon for the following scenarios:  overtraining, burnout, endurance events allowing youth participation (i.e. triathlons, marathons, half-marathons), year round playing on multiple teams and multiple sport participation.  Add on top of the physical factors involved in sport participation, the parental factor (i.e. dreams, hopes, wishes for scholarships).  Also, over the years, there has been an influx of popularity from a societal perspective for youth to be participating in sports at higher and higher levels.  Research has not kept up with the rate of more and more kids playing sports competitively.  Without sound research to guide decisions about training and participation in sports, the inherent risk will be increasing rate of injury.  To my knowledge, The American Academy of Pediatrics, Committee on Sports Medicine and Fitness, provides one of the few reviews with regard to Intensive Training and Sports Specialization in Young Athletes.  You can find it here:  Even though there is little research in the area of youth and sport participation, it is questionable whether those involved with the youth are even aware of what has been advocated for youth sport participation.

Mark Young (who is a new father!) – “I think the biggest cause of repetitive strain injuries in youth athletics probably has to do with early specialization.  In the hopes of creating superstars parents and coaches expect kids to focus almost exclusively on one sport year round.  Obviously, repeated movements specific to a single sport are more likely to create repetitive strain injuries at this age.  Add to that the fact that children’s bodies are not yet fully developed so repetitive stresses placed on their bones and tissues can cause adaptations that wouldn’t be nearly as harmful to an adult.  The solution, of course, would be to allow children to experience a greater variety of sports much like I did when I was kid.  Granted, I’m no Wayne Gretzky or Michael Jordan, but I think the athletically gifted will always rise to the top regardless.”

Jeff Cubos, BPHE, MSc, DC, ICSSD, CSCS – There are several reasons for the recent increase in childhood overuse injuries. A 2007 report in pediatrics by Brenner highlighted this topic quite well. He stated that overtraining is one cause, especially during peak growth years. One of his recommendations was to take 2 to 3 months off from their primary sport each year to allow injuries to heal and refresh the mind. Early specialization is another risk factor for overuse injuries. It is known that those who participate in multiple sports actually have a decreased risk. However, multi sport athletes who do not get enough rest between daily activities or workout sessions, especially if both sports emphasize a particular area of the body (such as those participating in both swimming and baseball) have a higher risk than those who participate in multiple sports of different emphasis, (i.e. Track and Golf).”

Jay Hargrove – More and more there has been a trend of younger and younger athletes coming into my clinic with elbow and shoulder pain.
I believe that the high incidence of overuse injuries in today’s youth come down to a couple of reasons.  There are no longer delineated seasons for these kids. For instance, baseball has become a 9 month season. They go from the regular season to allstars to pitching camps to showcases. This is too much stress on skeletally immature elbows and shoulders.  Combine these stresses with the fact that these growing kids’ strength has yet to catch up to these new longer lever arms that they are propelling through space and you have a recipe from injury.
I saw a sign once that read “Are you special?  If so, you are at risk.”. I think this bodes true. It seems that these are the kids that are being driven to injury by coaches and parents that see the next MLB allstar.
Education and early intervention is the key to saving these kids from longterm injury.

Matt Johnson, M.S, CPT, PES, USA W SPC & Club Coach (Level 1) – Two answers, impractical coaching and overcompensation.  I’m sure you are familiar with the documentaries on ESPN or the videos on YouTube of youth athletes performing barbell squats, throwing curve balls and playing on teams “above their age group”.  In short, overtraining is stressing the body in an excessive manner. When an athlete reaches an over trained state, it is due to overcompensation or overreaching.  It is important to document every activity (games, practices, training, extracurricular activities, school, parties, etc.) in your athlete’s calendar to identify if you are doing too much. When it comes to overreaching and overtraining, think of your body as a computer.  If you load to many songs, videos and documents on the hard drive what will most likely occur?  At first, it slows down (overreaching) then if left untouched, it crashes (overtraining).

Some signs that your athletes may be overreaching are:

– Complaints about feeling slow or sluggish (Neuro System is the 1st to respond)
– Trouble sleeping
– Extreme fatigue
– Delayed reaction time
– Decreased interest in enjoyable activities
– Decline in the classroom
– Trouble focusing

It is important for our youth to play multiple sports in order to develop coordination, balance, strength and flexibility.  To decrease the incidence of childhood related injuries in the future, a focus needs to be placed on movement based exercises and functional strength at a young age.  Agility training will help activate muscle groups in
the correct order, which will help prevent against ACL trauma in the future.  Before even thinking about touching a barbell or dumbbell, body weight squats, lunges, step-ups, push-ups and core stabilization must be implemented.

The primary training goal for youth athletes should be “prevention through proper implementation”.  To prevent childhood related injuries in the future, implement smart strength and conditioning principles to our youth today.

Joe Bonyai, M.Ed., CSCS – As a strength and conditioning professional, I’d like to believe that young athletes are suffering more overuse injuries nowadays because they are committing more hours to fewer sports, with less rest and without proper physical preparation. Surely, that is part of the answer. However, we have better knowledge, better equipment, and most importantly, more qualified training professionals than ever. So what’s the catch? High fructose corn syrup and cell phones. Get rid of these two weapons of athletic destruction and you’ll have a more attentive athlete with better posture, denser bones, and more energy to boot.

Brooks Tiller, DPT – Kids today are suffering more than ever.  I believe one of the main causes is a lack of play.  Most children can be divided into two different extremes – inactive and specialized.  Inactive children do not receive enough play while those who specialize in a sport do not receive enough variety of play.  Children that are inactive are more prone to injury when they are required to move due to their lack of fitness.  While those that become sport specific and compete year round from an early age increase their risk of injury through repetitive movements, a decrease in variety of movement patterns and a lack of recovery time.  Improving fitness levels and decreasing injury in today’s youth starts with us.  We should encourage kids to increase their activity levels and to be involved in a variety of activities.
Strength and Conditioning Coach

John DeLucci, SPT, CSCS – Why do I think overuse injuries are so prevalent in our society, simple, too much too early at a very vulnerable developmental stage and not enough training education/knowledge in youth sports. Children’s skeletal structures are going through a tremendous amount of growth and development at this time. Their epiphyseal plates (growth plates) are wide open so they are subject to injury. Children’s bodies are also trying to normalize to adult angles especially at the hip, knee and ankle, so when excessive stress and overuse is introduced this can cause detrimental rotational and angular abnormalities. If these improper motor patterns are not tended to then they will carry over and progress to injuries, such as postural weakness and tightness, stress fractures, cartilaginous injuries, patellar misalignment and ACL injuries. The same thing can evolve in the upper-body, much like the shoulder and elbow in youth pitchers. 
When the majority of kids are playing in multiple leagues with no off-season training then their bodies are just not prepared for the stress they will see in-season. Children should be involved in strength and conditioning program in the off-season to help progress off-season, for instance biweekly 5-10%.I believe at this stage focus should be on the nervous system in a low impact and low resistance environment focusing on motor patterns and FUN. Certified strength and conditioning specialists (CSCS) and Physical Therapists are the perfect individuals to seek for program development. What I think needs to happen; PREVENTION, PROGRESSION, RESEARCH and FUN. Regulations and guidelines need to be formed much like current research is evolving with youth pitching protocols. Professionals should be sought after for program development in this population to prevent and progress the athlete in a correct manner. Credentials and/or courses should be implemented for youth coaches to increase their knowledge base with training this specific population. Most importantly FUN should be reintroduced as the primary goal and whole purpose of youth sports not “my child will be a professional.” 
Springfield College Graduate Student ’11
Doctorate of Physical Therapy Program
“Whatever the mind can conceive and believe, the mind can achieve.”

Carson Boddicker – “Childhood overuse injuries are so prevalent in our society due to the sorry misconception that the only chance kids have to be successful in the long run is to play a single sport for years on end.  Unfortunately, what parents fail to recognize is that the nervous system at young ages is prepared and requires input of multiple patterns for optimal development. The nervous system is like a sponge for movement patterns and skill at this time, and if we fail to train certain patterns (that typically occur during unstructured play) then we fail to optimize their effectiveness in the long run.  Likewise, the musculoskeletal system of young athletes is
less prepared to handle loading as much as an older athlete.  If we want
to develop the best athletes in the world, we need to be sure to stress
tissues frequently, but do so in many different patterns of movement.”

Jesse Dimick, LATC, PTA – “Overuse injuries in todays youth is mainly attributed to specialization at such a young age.  I see so many kids in middle school that are focused solely on one sport.   On any given weekend they could have a school, town, and club game in the same day.  There is no cross training and too many hours a week spent doing one sport.”

Twitter –

Considering this post is possibly the longest in the history of the internet I will spare you some time and forego my opinion. I think everything that I would say was already said above. Keep reading everyone and remember, always evolve.


13 responses to “One Question, Many Answers (#2)

  1. So, Mike Scott… do I dare suggest you create a synopsis of say the 5 most valid points? Like basically do another post sharing the most valid points and then linking it to this post. SO not right to be asking for more…

    Nice idea bringing in a variety of views.

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  3. It seems to me that the increase of overuse injuries is a result of parents believing that if their child plays a sport year round they will be more skilled at that sport.the problem is at what price. Most kids just want to go play in the backyard around the neighborhood kids.they can learn movement so much better by jumping fences, crawling on grass, playing tag, etc…
    the best advice I have for parents is give your child a break from their sports to rest their bodies, teach them
    proper nutrition, and explain the importance of recovery. Also, I feel that so many parents are forcing their children to
    play sports because they are athletic or they played that sport when they were younger. This is your child’s live not yours, so
    let them discover what they like to play.

    Jimmy Lamour

    • Jimmy,
      I could not agree more, and I think that the overwhelming message from this post is that kids need to just move and be kids. I treated two sisters recently, both of which have full college scholarships for sports (track and squash) and their mom came in to talk to me one day. As she was leaving she said, and I quote, “Thank you for taking care of my invenstments, these girls have saved me and their father a lot of money.” I took her aside and lost it. Parents think that because their 10 year old can throw a ball 60 mph they are the next Pedro, or Randy Johnson. Kids should never be looked at as in “investment”. This pressure to compete at elite levels, or please their parents is playing a part in the rise in youth injuries today as well.

      Thanks again Jimmy, and keep on reading.

  4. You article definitely was one of the highest points of my Saturday. I was on MSN searching for something totally unrelated when the post caught my attention. I’m glad I took the time to read your article! Feel free to comment on my blog at Singorama Review!

  5. Just want to say your article is striking. The clarity in your post is simply striking and i can take for granted you are an expert on this subject. Well with your permission allow me to grab your rss feed to keep up to date with forthcoming post. Thanks a million and please keep up the ac complished work. Excuse my poor English. English is not my mother tongue.

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