Too far, too fast for young athletes
A committed sports enthusiast, Ben Foreman has suffered shin splints, chronic heel pain, back problems and broken bones. Such injuries are relatively common for hard-core fitness buffs but somewhat surprising considering Ben’s age: 14.
Basketball, which he’s been playing since he was 5, has been the source of most of Ben’s injuries. “He’s played seven days a week, no less than two hours a day, since starting,” says his mother, Caroline Aaron, of Los Angeles.
Recently he made his high school’s varsity team, and his workouts intensified. “He was playing from 6:30 to 8:30 in the morning and then required to play again from 5 to 7 after school,” she says.
For years, pediatricians have been warning parents about the dangers of childhood inactivity. A sedentary lifestyle during the early years increases the risks of obesity, diabetes, heart attacks, stroke and perhaps cancer later in life. But children can get too much of a good thing -- even exercise -- as demonstrated by the large number of injuries in children participating in competitive sports.
Inspired by the superstars they see on television, and often pushed by their parents and coaches, young athletes are motivated to train harder and play more intensely than ever before.
Many children are electing to concentrate on a single sport at a very young age, exposing the same muscles, bones and joints to physical stress all year long. Children who specialize in track may run as many as 10 to 15 miles every day; gymnasts and tennis players might spend hours each day tumbling or swinging at balls.
But children suffer the same types of injuries, such as tendinitis and stress fractures, that adults develop when they overdo exercise. Repetitive pitching or throwing, for example, can cause inflammation of the tendons of the elbow (a condition referred to as Little Leaguers elbow); inflammation of the tendons of the knee can be triggered by repetitive jumping.
Stress fractures also are increasingly a young person’s problem. They typically occur in the lower legs of runners and basketball players, in the hands of tennis players and in the wrists of volleyball players. In 2001, a stress fracture involving the spine forced junior tennis player Sam Wagner off the court at a national tournament. “He bent over to pick up a ball and was in so much pain he couldn’t stand up,” recalls his mother, Diane Wagner.
Young athletes are particularly vulnerable to the effects of overtraining. Their immature muscles, bones and joints simply cannot stand up to the physical stresses to which they’re being exposed.
One overuse injury unique to children is damage to the growth plate, the area of developing tissue at the end of long bones in the arm or leg. It is particularly susceptible to injury because the growing tissue is much softer than adult bone. Although growth plate injuries generally heal with adequate rest, permanent damage to bone growth is possible.
“Children aren’t emotionally mature enough to know when to back off before becoming injured,” says Jennifer Weiss, a pediatric orthopedist at Childrens Hospital of Los Angeles who specializes in sports medicine.
She offers her patients some simple advice. “I ask my patients to be in touch with their bodies -- to admit when they’re in pain and to back off,” Weiss says.
She adds that counseling is also important for parents, many of whom have difficulty determining how much exercise is too much. “They’re often making these decisions together and working in concert,” Weiss says.
Parents worried about sports injuries must take control of the training process and assume responsibility for decisions. This starts with setting goals and priorities that are realistic for the child’s capabilities. Rarely does a child have such extraordinary athletic ability and potential that the possible benefits of high-intensity training justify the increased risks. The truth is, only a few children fall into that category, and the sooner most parents recognize that fact, the safer their children will be.
It’s important, however, to include the children in the decision-making process. Children are more likely to keep their efforts within safe levels if they have a realistic vision of their athletic potential, reasonable goals for their athletic performance, and good information about the risks of overtraining.
Finally, if signs of an injury appear, parents need to intervene -- stopping or cutting back the child’s activity and seeking medical therapy when appropriate, no matter what the child or the coach wants to do.
But the message to lighten up and diversify a child’s sports activities could be a hard sell.
Until recently, Ben played baseball, flag football and volleyball in addition to basketball, but he has now given up most of those other sports.
“These kids don’t want to get hurt from a sport that’s just fun,” explains his mother. “If they’re going to get injured, they’re going to do it in their sport of choice.”
*
Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. She can be reached at themd@att.net. The M.D. appears the first Monday of the month.