Transcription:
Preventing Kids’ Overuse Sports Injuries

Melanie Cole (Host):  Does your child play a competitive sport?  Maybe something that they play all year long?  Well, they could be risking an overuse injury. My guest today is Dr. Michael Freehill. He’s an orthopedic surgeon specializing in sports medicine at Allina Health. Welcome to the show, Dr. Freehill. Let’s talk about children and sports specific training. Do you think that parents today are putting too much emphasis on one sport when they find that their child has really got some talent for one sport?

Dr. Michael Freehill (Guest):  Absolutely. We’re seeing that more and more where kids are specializing early on in their careers and specific sports and oftentimes when they get into their young teen years, experiencing injuries that we typically wouldn’t see except maybe in the adult population in the past. So, I do think we are seeing young kids having injuries based on doing one sport over and over for an extended period of time at a young age.

Melanie:  Because this is a fine line, if a child does show a gift towards a specific sport and they want to excel in that, it’s hard to get them to try other things. Not only is it the parent but it’s the athlete themselves.

Dr. Freehill:  That’s true. Trying to convince not only the parents but the athlete that playing an additional sport is beneficial can be challenging. What I oftentimes tell the patient--the child--and the family, is that other sports can actually improve the performance in their primary sport because we’re using other muscles, other muscle groups and we’re using other skills that can be further developed by playing other sports other than their primary sport.

Melanie:  What are some of the risks of that sport specific training if it’s tennis or pitching or anything that they do repetitively?  Tell us some of the risks of complications.

Dr. Freehill:  For example, in the overhead athlete, you mentioned tennis. We see a number of tennis players, volleyball players, swimmers, baseball players--they all come in with very similar injuries. We’re seeing young kids who are having rotator cuff issues. They’re having fractures or stress fractures around the shoulder and elbow areas. We’re seeing an increase in the popular Tommy John injury where the ligament on the inside part of the elbow is damaged. We’re seeing this in younger and younger kids. In fact, Jimmy Andrews who is one of the more preeminent orthopedic surgeons in the country who does UCL reconstruction, is seeing about five times the number of injuries in young kids that he used to see. So, I think there’s an indicator that, again, over-training is causing these injuries to occur earlier and earlier in young athletes’ careers.

Melanie:  What do you want to tell parents about cross-training and maybe it’s not even training another sport but doing something else?  Swimming in the off season or taking up cardiovascular training or something else to get them to strengthen other muscles and even their cardiovascular system.

Dr. Freehill:  That’s a great question. In terms of a multi-sport athlete or a well-rounded athlete, what we know is that the major emphasis is oftentimes on the same body part. As we discussed in swimmers and volleyball players, it’s the shoulder. If you’re going to participate in another sport, we typically recommend you take at least two to three months off your primary sport so that you give those body parts a chance to rest and then, participate in a sport that uses other muscle groups. For example, if you are swimmer, you may want to participate in soccer or track and field where you’re not using your upper extremities as much but you’re training the lower body and the core which can oftentimes parallel the muscle groups that you use in swimming. So, it can be beneficial in that way also. It’s picking a sport that doesn’t stress the same body parts over and over again. Golf is another fine, kind of fun sport to play. It doesn’t stress the body too much. So, making sure that if you’re a swimmer you’re not going out and playing volleyball. If you’re a baseball player, you’re not playing tennis where you can continue to overuse the shoulder and elbow areas.

Melanie:  Certain sports go together.  I mean, certain sports might lend themselves, as you say, to doing them on alternate seasons. Basketball is during one time of year and soccer is during another. So, do you help parents figure that out so that they don’t injure something that could possibly hinder the sport they really want to play?

Dr. Freehill:  Yes. We really have to make sure that when they are playing the other sport, if they do become a multi-sport athlete, that they’re not over stressing as you said. Basketball and soccer are played at different times of the year where there’s a lot of running. We know that runners actually have the highest rate of overuse injuries. About 68% of runners will develop an overuse type injury. If you’re participating in a sport that requires a lot of extensive running, basketball and soccer being great examples, probably those are not the best crossover sports to do back to back because they could lend themselves to overuse. So, if you are a basketball player, you might be better off playing tennis or baseball where you’re using different muscle groups to participate. We do have to break that down with the parents and the athlete, again, that you’re doing this sport nine months out of the year and try something different working different muscle groups during that timeframe.

Melanie:  Let’s talk about some not only prevention but treatment. If kids are playing a specific sport, they’re training pretty hard, they’ve got, maybe, tennis elbow, a forearm injury. They’ve got shoulder pain, knee pain. Do you recommend first that a parent help with wrapping, RICE--ice, compression and elevation--or do you tell them to give it a rest from the sport for a bit?

Dr. Freehill:  Ultimately, it does come down to some early treatment is always the best prevention for hoping to stop the injury before it becomes significant. Having the athlete, if they have access to an athletic trainer or their pediatrician or a physician who can actually assess the injury to see if it’s something more severe that can be handled with the typical rest, ice, compression, elevation routine that we frequently recommend. If the pain is something that is inhibiting their ability to play, for example, I would highly recommend they seek professional help at that point in time. If it’s a minor injury--a bruise or a little bit of overuse that just started a few days ago, I think that the ice and compression and rest is oftentimes helpful. We typically recommend that they take at least one to two days per week off from organized or structured sports so that they can give their body a chance to recover during the season.  So, not playing six or seven days a week can help prevent these overuse symptoms.

Melanie:  What about anti-inflammatories and such? We hate to give those to our kids to get them through the season.

Dr. Freehill:  Personally, I’m not a huge fan of the anti-inflammatories for a couple reasons. Number one, yes, they can help in some circumstances with the symptoms of pain and discomfort but oftentimes, depending on whether the injury is acute or chronic, an anti-inflammatory may actually inhibit the ability for the body to heal itself. I am typically more of a fan of Tylenol or Tylenol derivatives where they can actually help with the pain. They have what we call an analgesic effect. So, they do help with the pain symptoms but they don’t interfere with the body’s ability to heal itself. Ice is actually quite favorable in that circumstance, if you want to avoid anti-inflammatories like the ibuprofen and things. Ice has been shown to change the way the body reacts to pain signals.  So, it can help reduce swelling and actually help reduce the sensation of pain that you’re having in the affected area. I’m much more a fan of icing and rest and, if you need something for pain, taking a Tylenol-based medication, I think, can be more effective in those circumstances.

Melanie:  When should parents make an appointment with a specialist such as yourself?  When does it come down to them saying, “Come on we have to go see somebody now?”

Dr. Freehill:  I think if the child continues to complain of the same symptoms, if it’s a very localized area of discomfort, they’re having a hard time performing their day-to-day activities, they can’t put their backpack on anymore, they’re having a hard time doing their hair in the morning before they go to school. So, when the basic activities of life start to get affected and they really are having a hard time participating effectively in their sport, I think that’s when you seek professional care to make sure that it’s treated appropriately and that there can be a safe and timely recovery.

Melanie:  In just the last few minutes, Dr. Freehill, give your best advice for parents and their young athletes on avoiding these overuse injuries and sports specific training and what you tell people every single day.

Dr. Freehill:  Number one, you have to keep it fun and interesting for the athlete. We want to avoid the burnout syndromes that we see. So, making sure the athlete is still having fun in their sport. That’s primarily number one. Number two, as I mentioned earlier, is making sure you have adequate time during the season to rest. So, taking one to two days off per week, allowing the body to rest and participate in other outside activities that aren’t using the same body parts over and over again. Routinely, particularly in my baseball players where we often times see this more frequently, I recommend not participating in the sport more than nine months out of the year.  Multiple studies have shown that if you play a sport more than nine months, you’re risk of overuse or overtraining goes up significantly. The final thing is making sure you have adequate rest so you’re sleeping well. Nutrition and hydration is vitally important, getting good proteins, making sure you’re drinking plenty of water or recovery drinks, if necessary, depending on the intensity of your sport. They can help maintain the body’s general, overall condition to help you recover from the stresses that we place on it.

Melanie:  Thank you so much, Dr. Freehill. What great information. You’re listening to The Wellcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.