Sports Medicine: The Price of Winning

Youth athletes are injuring themselves more often and more seriously than ever before. Here’s how to keep your child from becoming a statistic.

A few weeks ago, Dr. Brooke Pengel met with a soccer player who had come to her for a second opinion. The young athlete had a lot of pain in his knee and previous doctors had diagnosed him with a fracture, which would require six months of rest as well as possibly surgery.

Pengel had seen exactly this sort of injury many times before and correctly diagnosed him with Osgood-Schlatter disease, a common and relatively minor disorder that causes pain and swelling of the knee in 12-year-olds going through a growth spurt. As the medical director of sports medicine at The Children’s Hospital in Denver and Broomfield, she often sees these sorts of misdiagnoses from physicians who, while excellent at treating adult sports injuries, are trying to treat their young patients the same way.

“Kids aren’t just mini-adults,” Pengel said. “Some adolescents get very specific growth-related problems that can be exacerbated by their sports.”

Sports medicine for young athletes as a field has exploded as more and more children and teens not only participate in sports but also increasingly compete at a more competitive level at a younger age. According to the Centers for Disease Control and Safe Kids USA, 7.2 million high school students participate in school-sanctioned sports each year, and those athletes account for around 2 million injuries per year. At younger ages, the numbers are even higher, with 3.5 million children under the age of 14 injured playing sports each year.

More alarming than the raw numbers, however, are the types of injuries being sustained. Sports medicine specialists are seeing a significant increase in the number of overuse injuries—the types of injuries that occur when an athlete isn’t getting enough rest.

“Overuse injuries are more than 50 percent of my practice,” Pengel said, “and we’re seeing these types of injuries at a very young age. Children as young as 3 and 4 are participating in competitive sports.”

Playing sports at any age is not the problem, but the intensity and volume of activity is; both have seen a marked increase in recent years.

Specific seasons for a given sport have all but vanished. High school athletes routinely participate in the high school season for their sport and then move into a club season. Many children now play a single sport year-round, and that lack of rest is the real culprit when it comes to the jump in overuse injuries.

“It’s hard to know who’s pushing whom,” Pengel said. “There’s a cultural emphasis on elitism and winning in sports. Kids are starting in competitive sports at a much younger age, which gives them less time for free play.”

Dr. Lawrence Lemack, a world-renowned orthopedic surgeon and founding partner of the National Center for Sports Safety (NCSS), shares the sentiment.

“They like the sport so they play more; they see a future in the sport, so they want to play as much as they can and get as good as they can,” he said. “We have to try to educate people to temper the amount of time playing sports, and to play different sports.”

Truly, parents may find themselves conflicted, worrying that their children will be at a disadvantage later in life if they don’t have years and years of experience.

“But there’s a price for winning,” Pengel said.

Other problems can occur when there is a knowledge gap between the medical professionals and the coaches and athletic trainers on the field.

“There are still instances when children are being told to ‘push through the pain,’” Pengel said. “I tell my patients that pain is there for a reason. Pain is your friend: It keeps you out of trouble.”
Pengel and her team at The Children’s Hospital have taken a strong stand against this knowledge gap by making community education an integral part of their mission, as has Lemack in his work with the National Center for Sports Safety; throughout the summer, NCSS will offer a course that educates coaches and volunteers about sports-related emergencies, for free online.

Rather than feeling overwhelmed and paranoid about the possibility of sports injuries, however, parents should use common sense and ask the right questions. Know what your resources are. High schools usually have an athletic trainer in addition to sport-specific coaches. These trainers are required by law to work under a physician. In addition, some high schools have student athletic trainer programs, which provide more eyes watching out for injuries. Club sports and sports for younger children are much less regulated; therefore, parents need to be more diligent.

“You would never drop your child off at a pool without a lifeguard,” Lemack said, noting that parents should also be aware of the training coaches and trainers have received.
Find out if your child’s team has an emergency plan and what it is.

“Know what type of environment it is,” Pengel said. “Are the coaches and trainers taking time to make sure equipment is fitting properly? Are they following the rules, like keeping pitch counts in baseball and softball? How much and what kinds of activities are they doing on a regular basis?”

Finally, Pengel says one of the most important questions to ask is what happens when a kid is in pain.

“It’s not OK to let athletes play through pain,” she said.