Minimizing the Risks of Organized Youth Sports

While participation in organized sports is generally beneficial to children and adolescents, parents and young athletes alike need to be increasingly mindful of the risk for injury posed by longer seasons and the ever growing intensity of adult-directed competition.

That's the advice of Roger M. Lyon, MD, Medical College of Wisconsin Associate Professor of Orthopedic Surgery and Pediatric Orthopedics, who practices at Children's Hospital of Wisconsin. Dr. Lyon agrees with the body of statistical evidence that shows more and more youth are having surgeries and other treatments for injuries and conditions that in the past were mainly common in adult athletes at the college and professional levels.

"There are two broad categories of injury with kids in sports, and that hold true with adults as well but it's just different types of specific problems that occur," said Dr. Lyon. "There's acute injury, something like an ankle sprain or knee sprain or muscle pull, which are reasonably obvious when they occur. And then there's the other type, which are problems of overuse. In these it's more difficult to figure out exactly when the problem started. These injuries can be just as devastating. The diagnosis is also usually less obvious (to parents, physicians and surgeons).

"It's sometimes easier to miss the initial signs of an overuse problem, so it can fly under the radar for a long period of time. Because there often is not a specific event, the assumption is made that the child is fine: "It's just a muscle pull," or "It will resolve on its own." A stress fracture is one of the things that can result from overuse. Kids' bodies are constantly changing and their bones tend to be weaker and they're not able to endure as much stress. So, a seemingly reasonable amount of activity can cause an overuse injury in a child.

"If you're thinking that it takes the same amount of intensity to cause an injury in a child as it does in an adult, that's your first mistake."

"Contact" Not the Only Culprit
Some sports are obviously riskier than others for certain injuries, Dr. Lyon said, but he added that pressure on children to gain skills quickly and advance upward in age-level league play has led to longer seasons and therefore more injuries in sports such as soccer.

Even in cheerleading, the number of injuries resulting in hospital visits went form 4,954 in 1980 to 22,603 in 2001, according to the US Consumer Product Safety Commission. That dramatic increase came as the style of cheerleading became more gymnastics-driven and adult-directed local and national competitions gained popularity and turned cheerleading into a year-round activity.

"Traditionally, the sports that cause the more familiar injuries, like the acute blown out knee or dislocated shoulder, are pretty much the same as they used to be," said Dr. Lyon. "That's contact sports, like football and hockey. Now soccer is getting a little bit more that way as well."

Football season lasts three months of the year. There's a start and there's an end and it's reasonably definite. In contrast, you have soccer being played all year 'round. Instead of having a season that's three months long, you extend it out to twelve months, and the number of injuries can be multiplied by three or four.

"As you increase the number of hours a sport is played the numbers of injuries are going to increase as well," noted Dr. Lyon. "Also, the long seasons bring in a whole new category of problems. You've got stress fractures and other overuse injuries."

Free Play Presents Less Risk
"Free play" among children on the playground and in the neighborhood usually presents less risk than in organized sports activity, said Dr. Lyon. "I don't think that there's any question that there is higher risk in adult-directed organized youth sports than in free play," he said. The variety of activities that children engage in on their own is important for musculoskeletal development and children seem to know when to stop before overuse becomes a problem, he added.

As Dr. Lyon told the American Medical Association publication American Medical News in 2004 article, children are not simply downsized adults when it comes to sports, "We are totally pushing the envelope. It's not uncommon for me to see a 15 year old who has had three surgeries for sports-related problems. Can someone see that this is not a good picture? How is this child going to be doing at age 45?"

Adults looking to keep fit often use "cross-training" techniques to be sure that no single activity overextends the body's ability to cope with stress and to provide the most healthful overall workout. This cross training technique should also apply when dealing with children and adolescents, Dr. Lyon said.

"The old 'three-season' athletic year was pretty good for cross training" said Dr. Lyon. "It started with football, went into basketball and then into baseball. Whatever the sports a child is involved in, regular breaks from them are beneficial. Children younger than age 14 should not play any sport on a daily basis, especially at an adult-directed level. Each week should be broken up with two or three days of rest or free play. And it's probably much better not to do any one sport for the entire year.

"No doubt the increase in participation in all sports has led to an increase in injuries, but treatment options are also better and it's easier to make decisions about pursuing treatment because we're better at correcting a lot of these problems. Still, with age, what are these kids going to experience as adults? You only have a certain amount of mileage on your 'tires,' so if you blow it all by age 16 you've lost a lot earlier than need be.

"Don't get me wrong. I think sports are really good for young people, for a lot of reasons. By and large, the risks are pretty low, but multiple injuries and surgeries cannot be beneficial in any way."

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.