Scott Webb (Host): This is Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Scott Webb. And today, I'm joined by Robbie Williams, physical therapist at Children's Health Andrews Institute for Orthopedics and Sports Medicine, to discuss athlete safety and more.

Robbie, it's nice to have you here today. We're going to talk athlete safety, and you and I were just kind of talking off the air before we got started here, and daughter's going to play Division I basketball next year in Michigan, and I'm excited about that. But it's been a concern of mine over all of these years. You know, holding my breath every time she took off in the air, you know, driving down the lane. And I'm sure a lot of folks, a lot of parents have those same concerns.

So, let's start with maybe the big one here. Like, what are the most common injuries that you see in young athletes?

Robbie Williams Jr.: The spectrum of injuries has almost mirrored the sport at which the athlete's doing anymore. But the big thing with it is sports have kind of evolved over the last 20 years. They're not seasonal like they used to be. Example being a young boy would play soccer or football in the fall. They'd play basketball in the winter. And then, in the spring, they would run track or play baseball.

Host: Right.

Robbie Williams Jr.: Sports specialization has become a real thing. And now, a sport, if you will, say basketball, is almost become a year-round activity, whether through training camps, club teams, your school team. And so unfortunately, because of the mass increase in volume that the athletes are participating in one specific sport, we're starting to see just a lot of these overuse injuries. And it's purely just based on the volume of activity that the sport's asking from said individual.

Host: Yeah, that's so right and that's so true in my experience with our daughter, is just, you know, basketball used to be a thing that I played, like when I was a kid, I played it in the winter, and then I did something else in the spring. Whereas she plays basketball and practices basketball like 11 months out of the year. So, you really do see how just those overuse injuries, you know, the miles that add up on young bodies, you know, how they can lead to injuries, right?

Robbie Williams Jr.: Yes, sir. Absolutely. That's the thing. And so, different sports require different movement patterns and things like that. And that's essentially what helped kind of build the foundation of what makes an athlete an athlete. They're multidimensional. They understand and they're capable of doing things like speed, agility, power, multidirectional positioning, things like that. And sometimes with these sport-specific activities of just doing the one sport, you're not necessarily always getting that variation and stimulus or requirement of like just different movement patterns.

Host: Yeah, it makes me wonder then, you know, we've, over the years, tried to sort of look into our crystal ball and think about the injuries that our daughter—and I'm sure a lot of parents go through this—like what might they experience? What injuries might happen to them in this sport? So, do you have some recommendations, like how we might be able to prevent sports injuries before they happen? Like, is that a thing?

Robbie Williams Jr.: Obviously, that's where I feel like a lot of research has headed or the direction it's gone. But obviously, you've seen a large increase in amplitude of just sports performance facilities and things like that, and they're very data-driven and things like that. And being able to pick up metrics of where somebody may be weak where they may lack power or they may lack mobility and things like that. And so, as a clinician, I can't ever just sit here and say like, "Hey, if you do this program, I'm going to guarantee that you're not going—"

Host: Sure.

Robbie Williams Jr.: it's just incredibly foolish of me to try to convince somebody that. But if we can reduce the likelihood and things like that, and that's where I think injury screenings have become really important, whether through a physician, athletic trainer, physical therapist, of just making sure an individual's able to move in certain patterns that is going to be able to withstand kind of the forces that are expected or required or asked of that sport.

And so, that's where, again, trying to help cut back, reduce sport injuries. Again, it's multifaceted. But the big thing is just, first, I always like to look at when I'm doing an evaluation on a patient that's coming in, is what is our volume of activity? We'll talk soccer for example. If somebody comes in and it's like, "Okay, I'm playing for my school team from the months of March through June, and then I play for a club team from June through August. And then, maybe I work some just with a coach during the fall months, and I go to like different facilities or studios and stuff like that." That's just screaming to me overload of just constantly doing a sport. It actually gotten to the point where I really encourage getting in with a strength and conditioning coach during your true off-season and just, one, kind of peeling back the layers of the onion of seeing like where you may have deficits, limitations, areas of prior injuries, and just working on building a robust system of speed, power, agility, strengthening.

A lot of times , with the injuries I'm seeing in clinic, a lot of these kids just need to get on just a broad spectrum, just strength and conditioning program working in different types of movement patterns and stuff like that, that they're just not familiar with.

Host: Yeah, that's what my daughter, our daughter does is she mixes in the speed, conditioning training with basketball. She's also playing softball and just trying to use all the muscles and do different things in different ways and get as ready as she can, not only for college basketball, but to prevent injuries. It makes me wonder, Robbie, like, how do we tell the difference, right? Between, let's say, normal soreness, which, you know, we adults have, kids have from sports and otherwise, and then the potential injury type things we hear from them?

Robbie Williams Jr.: Yeah. And so, everyone's a little different on that, especially you'll usually see some of those early signs at like the start of a season, especially if the athlete really hadn't been doing much prior to that. Some of that is just soreness of their bodies getting used to and adapting to the loads of the sport, the workload, things like that.

Usually, that soreness, that kind of works itself out over 48, 72 hours and things like that. Obviously, it becomes concerning for possible injury risk when you start to see things like pain, swelling, losses or decreases in motion, mobility. But also, you'll start to see deficits in strength and the illicit, like power force behind a certain movement. And obviously, at the highest level, I think of almost like a F1 race team. you've a pool of sports specialists, who are constantly analyzing the athletes, looking at all these variables, for lack of a better word, making sure that engine's firing the way it needs to.

 And so, obviously quick, easy signs to notice that with a youth high school athlete is just making sure that they're not limping, say, if it's a lower body injury, or they're not losing motion, or you're able to see signs of swelling, and stuff like that. Usually, general soreness itself should kind of work itself out over a span of two or three days. But if it's not getting better after that, that's certainly when you want to talk and let your athletic trainers know that are working with them. And they usually keep a really good close eye on that. And if they need to intervene just by adding in some corrective exercises to work on that. But also too, your athletic trainers are going to be speaking with physicians around there and then determining, okay, if it's not getting better with these adjustments, maybe then it is time to get in and see a specialist that's a little more advanced, whether a physician, PA, nurse practitioner.

Host: You know, I haven't had much luck over the years with either of my kids, convincing them to do really good thorough warmups and stretching and, you know, all of that.

Maybe from you, from an expert, for parents and passing it down to their kids and maybe they're listening too, like, what is the role, like warm up, stretching, strength training, all of that, how do all those things contribute to keeping our kids safe and on the fields and on the courts and all of that?

Robbie Williams Jr.: it's everything. And obviously, I feel like the younger you are, youth is a huge factor and a huge benefit to where they can just roll out of bed and run out to the field or court and just fire it up. But being a man from the Midwest, all too familiar with those winter mornings and going outside and preheating the car and starting that up on a brisk winter morning, just to let the engine get rolling.

And I kind of explain that same anomaly with the athletes of, like, you need to get your nervous system primed and fired. You need to get blood flow going. You need to get your body temperature up to essentially be able to withstand the forces and the stimulus that's going to be required of you for activity. And working with athletes across the spectrum, I always like to use it, like you should theoretically be sweating by the time a contest starts. That tells me that your body temperature is where it needs to be. Muscles are moving, they're fired up. And so, they're everything. And again, warmups are going to vary based on what's available, time of the year, resources, things like that. But it certainly is always important that they're spending anywhere from 15 minutes to a half hour getting their body loose and primed before an activity.

Host: So, that's kind of the before. How about the after? You know, I'm sure a lot of parents have difficulty holding these thoroughbreds back, right? And slowing them down a little bit. I haven't had much luck with my kid. She's up at 6:00 in the morning, she's working out, she's shooting baskets, going to school, all this stuff. I'm sure parents are nodding their heads. So, like, how important is rest, and maybe what are some of the risks we're discussing here, playing year-round and specializing maybe in sports, you know, too early?

Robbie Williams Jr.: Yeah, absolutely. And so, you're just constantly putting a stimulus on your body, and like your central nervous system's in that like fight or flight mode constantly. And your body just doesn't know when to calm down, shut things down, go into that recovery mode if you're constantly just hitting the rev limiter or pushing the expectations of what the body's capable of.

And so the rest is really important, not only from a physical perspective and recovery, but also from just a psychological standpoint as well. Burnout is certainly a real thing, and the expectations across various levels of youth all the way up to high school, collegiate, pro sports, it certainly is a rising thing of burnout and stuff like that, lack of desire to continue playing, especially if they're not able to escape, focus on themselves, do different things. And so, that certainly has become a rising thing.

And a lot of that has been correlated with some of these sports specialization activities. So yes, being able to kind of like just shut the body down, that's essentially when your body knows like, "Okay, I'm not in that fight or flight mode. I can start to recover. I can work on things like mobility, strength and conditioning, do a different sport, do a different activity," and just letting their body naturally recover. I feel like there's been a huge push over the last 10 years of various different recovery treatments, modalities, things like that, that you can buy at local sporting goods stores or online, things like that.

Yes, they are helpful, certainly in season. But to me, some of these too, they're just band-aids. I usually will tell parents and athletes that, look, if you're not getting the appropriate rest, nutrition, hydration, psychological just recovery, all these other great tools, like, meaningless if you're still not taking care of those foundational things of rest, repair, nutrition, hydration, things like that.

Host: When do you recommend, you know, that a child stop playing and be evaluated by a medical professional? We're talking about so many sports across so many different kinds of kids, you know, it's not a one-size-fits-all. But generally, like, how do we know, like, okay, it's time they see an expert?

Robbie Williams Jr.: Yeah, and that's where our on-the-field staff, coaches, athletic trainers, strength coaches, things like that, parents as well, that are able to keep an eye on the child. And the body's going to tell you if something's wrong. And obviously, the athlete himself, they want to do everything possible to stay out on the field. And so, you were spot on. They're rarely the first ones to tell you that something's off.

And so, just noticing signs, like I'd mentioned before, if you notice that, like, their speed's going down, or they're taking a little bit longer to get to one end of the court. Like I said, I've done a lot in baseball over the past 10 years. And especially in the pitching population itself, you'll start to notice, like, ball velocity is going down, trouble locating the pitch, the time between pitches is taking longer. And so, that's where keeping a track on different metrics, pitch counts, things like that, have been really helpful in having standards of, like, "I don't care how you really feel, you've met your ceiling for this respected game, you're going to be done." And so, some of those certainly since those have been put into play have been really helpful with reducing injuries and helping kids stay out on the field longer.

Host: Well, I really appreciate your time today. As I told you before we got started, I'm a vested party here as a dad with an athlete, and I'm sure this benefits, lots of folks, parents, kiddos, everybody. I'll just to give you a chance here at the end, like, maybe best advice for helping kids to stay active, of course, be competitive, but also safe at the same time.

Robbie Williams Jr.: Yeah, that's where completelyit's having enjoyment in the sport. When it starts to feel, especially in the youth athlete, like a full-time job, and you're not able to enjoy the little things that you used to really have fun with during the sport and you're showing signs of burnout, you want to stay active, try a different sport, try a different position. Be multifaceted in terms of being involved in different sports organizations or even school organizations as well. And so, just kind of broadening almost your spectrum of just involvement in different activities. And so, that's the big thing I've realized throughout my career is just trying not to essentially grow up too fast too soon. And enjoy the moment, enjoy the sport. When that time comes and those decisions need to be made, it's usually not until the latter phases of high school if this is a possibility of taking it to the next level.

Host: Yeah, maybe playing in college. Yeah, one day, my daughter's softball team, they showed up at, you know, 6:00 AM for a practice one morning, and the coach had arranged to have them just go play pickleball. And she had breakfast for them, and they just went and played pickleball, and it had nothing to do with softball. It was just fun and team building, and that made me so happy. Because to your point, you know, when we start talking about just overuse and burnout and all these types of things that parents might be dealing with with their kiddos, you know, sometimes you just go play pickleball and have fun and be a kid, you know? Remember that they are still kids, and don't force them to grow up too early, right?

Robbie Williams Jr.: Exactly that. Exactly that. And there's too much stress in our lives and being able to just go out and be a kid.

Host: Yeah

Robbie Williams Jr.: The best thing for them. And that was certainly kind of like one of the big messages with Dr. Andrews, who's founded, who founded multiple orthopedic facilities and obviously has partnered with Children's Health here in Plano. And it's essentially the focus of young players should be to develop physical fitness, athleticism, and general knowledge of the game, all right? And those are the big things, and just making sure we're educating different safety rules, stuff like that for the kids, and it's really important.

Host: Important. Yeah, for sure. And let them be kids when they want to be kids, because you're only a kid once, and all of us adults out here, we wish we had, you know, the youthful energy and exuberance and all of that that our kids have. So, I appreciate your time today, Robbie. Thanks so much.

Robbie Williams Jr.: Yeah, absolutely. I really enjoyed it. Thank you again.

Host: Children's Health Andrews Institute for Orthopedics and Sports Medicine provides comprehensive care for young athletes, including sports medicine, orthopedics, concussion care, rehabilitation, spine care, and sports performance services. Same- and next-day appointments are available at locations in Plano, Frisco, Prosper, and Fairview. Call 469-303-3000 or visit childrens.com/andrews to learn more or to schedule an appointment.

Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share this episode, and please follow Children's Health on your social channels.