Flexible Fitness: Support a path of injury-free fun for your athletic child

A National Council on Youth Sports survey found that more than 60 million children participate in some form of organized sport and over 44 million play more than one sport. Children who play sports derive many benefits from doing so, such as the development of a healthy lifestyle, social skills, greater self-esteem and leadership skills. Although playing sports has many benefits, the demands of training and pressure on young children can become too great as the level of competitiveness and competition rise. Unfortunately, the excessive focus on intensity in training and competition compared to developing skills is potentially contributing to overuse injuries at younger ages.

The American College of Sports Medicine estimates that 50% of overuse injuries are preventable. Children experience overuse injuries due to repeated submaximal loading of their body without enough rest to allow their bodies to recover and adapt to the stresses of training. “Submaximal” is defined as, “not at the greatest or highest level.” Though the term implies less loading, without adequate recovery, small damage to tissue occurs and starts the body’s inflammatory response. When this process occurs without training modifications or rest, the body eventually experiences injury. Chronic and repeated exposure to these injuries can lead to weakness, loss of flexibility and in some cases long-lasting pain. Unfortunately, at times, children miss practicing and playing their sport because of overuse injuries developed from playing too frequently.

The most common risk factor for the development of an overuse injury is a history of previous injury to that body part. Other risk factors include growth spurts, imbalance between skeletal growth and strength, increased frequency and intensity in training and loose joints. A risk factor for adolescent girls is the absence or irregularity in the cycle of their period during the expected development age. Overuse injuries can occur from participation in any sport and can affect muscles, ligaments, bones, and growth plates. These injuries appear most frequently in the knee and foot, and boys and girls are equally at risk.

Children that participate in preseason conditioning programs or prescreening programs can reduce their risk of injury. Prescreening programs, frequently offered through schools or sport organizations, are intended to identify poor movement patterns or weaknesses that place a child at risk for an injury. Early identification of risk factors allows participants to correct strength imbalances, strengthen the appropriate muscles and improve movement patterns. These corrections can help reduce the risk for injury and time away from their sport. Often, simple adjustments to, or the addition of, sport-specific equipment with a proper fit can help prevent injuries.

Controlling the overall volume of weekly training can help minimize overuse injuries and training workloads should be monitored even more closely during growth spurts. During a growth spurt, the bones grow faster than the muscles and tendons leading to weakness, inflexibility or imbalances that place a child at increased risk for injury.

There is growing concern that sport specialization (i.e. playing only one sport all year) can lead to overuse injuries from repeated exposure to similar movement patterns. Interestingly, playing a variety of different sports throughout the year during early and middle adolescence may be more effective in developing high-level skills in the child’s main sport of interest. Evidence suggests that children who wait to specialize in a sport are more successful than those who specialize earlier.

Youth sport organizations are recognizing the importance of practicing and playing in a way that minimizes overuse injuries. For example, Little League has adopted pitch count limitations in response to the increase in frequency of elbow injuries occurring in pitchers. Soccer has placed an age limit on when athletes can start heading a ball. Both these changes have led to less injuries.

Ultimately, children will have more fun and stay active in sports longer when they grow up in environments that encourage training and playing at levels their bodies and brains are mature enough to handle. Coaches, parents and players need to work together as a team to keep athletes healthy and sports fun.

Laura Lapolla, PT, MPT, OCS, FAAOMPT, CSCS is a board-certified clinical specialist in orthopedics (OCS) and a certified strength and conditioning specialist (CSCS) at Spaulding Outpatient Center Framingham. She completed a two-year fellowship in orthopedic manual physical therapy. She is a physical therapist who specializes in the treatment of a variety of orthopedic diagnoses including sport-related injuries, post-surgical rehabilitation, spinal disorders and pregnancy-related musculoskeletal disorders or pain.