Youth Sports - how much is too much?

When I start working with an athlete I want to know their history - history of exercise and history of injuries.  I test them for muscular imbalances.  I look at core strength.  I look at overall health and daily nutrition.  How often do we do this with our own kids as they start new sports programs.  Have you ever had a youth coach test your child for muscular imbalances?  Have they asked about what your kids eat before or after a game?  Do you know how many practices/games a week your child should be attending/playing at their age?

Too often we get caught up in the ‘keeping up with the Jones” mentality of all the other kids are doings 2 clinics a week and practicing 3 days with a game on a 4th, so my child needs to do the same or they will get left behind.  We are lead to believe that if our kids don’t commit to a sport when they are 10, they will not develop skills and not have an opportunity to play later on.  High School coaches sometimes start grooming athletes in certain programs in middle school.  I bet if you polled Dads there would be many in one of two camps:

• I want my child to have the sports career I never had
• I want my child to play in college, so I am getting them started early

On April 5, 2011 the New York Times ran an article, ‘A Warning on Overuse Injuries for Youths’.  It starts off by talking about overuse injuries in youth like Osgood-Schlatter disease (a painful inflammation below the knee); Sever’s disease (an injury to the heel’s growth plate); shoulder and elbow injuries (common in baseball and softball) and stress fractures.  It is critical to remember that children are growing and as such their bodies can change on a daily basis.  What might seem like an insignificant pain in an adult could compromise a child’s growth and/or ability to excel later on.  The article states that the “American Academy of Pediatrics has said the goal of youth participation in sports “should be to promote lifelong physical activity, recreation and skills of healthy competition” — not the hopes of obtaining a college scholarship, or making an Olympic or professional team.”

Because of the increased incidence of overuse injuries the National Athletic Trainers’ Association (NATA) issued a paper in March 2011.  This paper should be read by parents of children (through high school age) across America.  Since most people are not going to read the paper you will get the Cliff Notes here!  A lot of the paper refers to and gives examples from baseball/softball - appropriate enough since that season is here.

The NATA says there are five ways parents, coaches and athletes can help to reduce the number of repetitive stress injuries in children and adolescents.
1. Proper education and supervision.

• Athletes, parents and coaches should be aware of the signs of overuse injuries - for example arm pain, fatigue and decreased throwing performance should be recognized as a potential issue in a young thrower.
• Coaches should be trained in safety, sport specific training techniques and skills, psychosocial aspects of childhood and adolescence, child development and common health and medical concerns.
• Organized youth and interscholastic sports should be led by adults with knowledge of and training in monitoring for overuse injuries.

2. Pre-participation physical exams (PPEs).  Student athletes should undergo a PPE before beginning a new sport (or prior to the start of a new sports season) to screen for potential risk factors, including:

•  injury history, stature, maturity, joint stability, strength, and flexibility, which may be important for preventing recurrent injuries.
• Athletes with deficits should be referred to specialists

3. Guidelines and rule modifications. The biggest predictor of overuse injury is the sheer volume of sports activity (can measure throws or quantity of time playing/participating). The NATA recommendations:

• Youth athletes should play no more than 16 to 20 hours of sports a week.
• Youth athletes should take at least 1 to 2 days off per week from competitive practices, competitions, and sport-specific training. Breaks should be worked into the training schedule.
• Youth athletes should participate on only 1 team of the same sport per season when participating on 2 or more teams in the same sport (e.g. high school and club) would involve practices or games (or both) more than 5 days per week.  Younger than high school should have a lighter schedule.
• Rules should be modified:  *these are detailed in the report
• shorter quarters or halves
• bases closer together
• less frequent games or practices
• age-related limits on number and type of pitches for baseball pitchers
• gear-ratio limits for cyclists
• age-related distance limits for runners (e.g. 5 km at age 12, 10 km at age 14 etc.),
• limits on number of practices and length for swimmers at various levels of competitive age-groups swimming)

4. Training and conditioning programs. Proper training and conditioning, both before and during the season, may prevent overuse injuries.  In the old days kids ran the neighborhood, rode bikes everywhere and got a lot of cardiovascular exercise.  USA Triathlon encourages coaches to educate youth on the need for more cardiovascular exercise in the form of fun games and outdoor activities.

• Kids today do not have aerobic conditioning.  This should be built before throwing them into high intensity workouts.
• Youth athletes should work on general conditioning 2 months before a sport season starts.  This should include flexibility and mobility.
• As with adults, young athletes should begin to gradually increase training loads following the 10% rule, which allows for no more than 10% increase in the amount of training time, distance, repetitions, or load per week.
• Coaches should be encouraged to follow dynamic warm ups including balance, neuromuscular exercises and strengthening work.  Exercises knee hugs, high knees, hamstring kicks, frankenstein walks, side shuttle, grapevine, backward jog, walking lunges, leg swings, arm swings,  hops (lateral, fore/back, single leg), and core work (planks) are all great.
• Coaches should have an injury prevention mentality.

5. Delayed sports specialization.  There is little research that shows that year round same sport participation has negative consequences on physical growth, bit more experts in the medical and physical fitness field are calling for diversity in participation and delayed specialization.

• Participation in 1 sport may increase the chance of repetitive micro-trauma and overuse as well as muscular imbalances.  Youth athletes who participate in 2 sports that emphasize the same muscle groups are at more risk that those utilizing different muscle groups and joints.
• There is a concern that specialization in one sport leads to more burnout.

• Young athletes who participate in a variety of sports tend to have fewer injuries and play longer, thereby maintaining a higher level of physical activity than those who specialize before puberty.
• The focus for youth athletes should be to enhance general fitness and aid in motor development by participating in a number of different sports.
• Youth athletes should take time off between sports seasons and take two to three non-consecutive months away from a specific sport, if they participate in a single sport year-round.
• Athletes who participate in simultaneous (e.g. involvement in high school and club sports at the same time) or consecutive seasons of the same sport should follow the recommended guidelines with respect to the cumulative amount of time or pitches over the year.

So what can parents do?  

1. Encourage your kids to play outside - run around, ride bikes and play games like tag
2. Teach them to talk about how their muscles feel and know the difference between muscle pain and other pain.  
3. Make sure your child does a dynamic warm up before any sporting practice or game.  It is as simple as arm swings (small to large forward and backward), hips rolls (like with a hula hoop) in both directions, walking knee hugs, high knees (lifting knees up as they jog), hamstring kicks (jog and pull feet up under the butt - not kicking themselves in the back), exaggerated skips and frankenstein walks (legs kick straight out with opposite arm reaching to toes).
4. Make sure you child hydrates before, during and after activity.  Kids body temperature will ride more quickly than an adult and their sweat rates are very different.
5. Stretch after activity.
6. Make sure your pediatrician knows what sports and activities your child participates in and the weekly volume.   
7. Have a trained professional look at your child for muscular imbalances, mobility issues and flexibility issues.
8. Keep the lines of communication open with your children so if they are in pain they know it is OK to tell you.  Never force your child to play through pain - no game is worth your child’s health.

Here is to a healthy sports environment for our children.  Go team go!