July 01, 2014
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Orthopedic surgeons should address challenges of youth sports from a team approach

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From the time children can interact with the world around them, they not only challenge themselves physically, but also work to master challenges with their minds. From learning to walk to learning to run as fast as they can, children continually learn about their personalities and drive. When they put their physical talents and interests together, many children find a love of sports at an early age.

The goal of sports is participation at first. But as competition and team play ensues, children learn about teamwork, helping others and fairness, and begin to define social values. During this time, they experience a growth and further development of their intellect. The growth in intelligence, related to both genetics and environment, happens rapidly during youth. The ability to gain new knowledge may be at its highest point. This coincides with physical growth and development. Children learn about the balance and synergy between their minds and physical abilities. They learn about exercise, proper nutrition, sleep and coping mechanisms for stress. The lessons are fostered and enhanced through their relationships with parents, siblings, other family members, teachers and coaches.

 

Anthony A. Romeo

As the challenges of youth sports increase, other positive attributes become more obvious. Children who participate in sports on a routine basis are more likely to be better organized, have better time management skills and grades, show less antisocial behavior, are less likely to be addicted to drugs or alcohol, and more likely to attend college. They are also less likely to be obese or have diabetes, hypertension or depression. In all, exercise is the most effective and advanced medical care that helps children avoid many of the problems affecting youth today.

Find a balance

As with everything else in life, however, too much of a “good thing” has its own downside. In the United States, more than 3 million children younger than 14 years need medical care each year for a sports-related injury. Also, exercising beyond one’s physical capability without a proper recovery period can reverse its benefits, leading to poor sleep, injury and failure to maintain coping mechanisms for social interaction and intellectual challenges. Parents and coaches often do not recognize the point at which sport and exercise become counterproductive, and this can lead to life-changing injuries. Unfortunately, it is not until injury occurs that parents and coaches recognize exercise has gone too far.

In the past, the primary focus has been on the treatment of injury, with limited insight into the prevention and nonoperative management of the factors that predispose athletes to serious injury. During the last decade, however, there has been an increased study of the epidemiology of sports injuries, the factors that lead to injury and the methods to prevent injury.

As discussed in this month’s Orthopedics TodayCover Story, many of the injuries that affect children and youth result from the lack of recognition of fatigue in athletes. In principle, the muscles become overused and tired, leading to changes in the structures around joints, which results in the distortion and eventual disruption of key musculoskeletal areas that prevent continued participation even when the muscles have finally had time to recover. The spirit of competition, both from children as well as from their peers, coaches and parents, can drive young athletes to persist at an activity far beyond what is safe to avoid injuries. Whether an orthopedic practice is focused on general orthopedics, sports medicine, or other subspecialties such as spine, the result is that all orthopedic surgeons see an increase in overuse or fatigue-related injuries.

As one study after another has proven, once injury occurs the likelihood of return to the same sport is significantly diminished, and even more difficult is the return to the same level of play. Even the most gifted athletes who make it through the gauntlet of youth, adolescent and college sports to become professional athletes are not immune to injury. Once injury occurs, it is not unusual for professional athletes to struggle and often fail to achieve the same level of performance prior to injury. As orthopedic surgeons, we have been provided with an incredible education and technological advances that allow us to treat and reconstruct torn ligaments, tendons and other structures. We can give athletes the hope of returning to the sport when they could no longer participate, even if it is at a lower level of accomplishment.

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Sports-related injury patterns

There are numerous examples of how the analysis of a sports-related injury pattern can lead to research and education that protects youth from injury. For example, the recognition of frequent foot and ankle injuries in baseball led to the development of breakaway bases. It has been estimated that this technology reduced the incidence of foot and ankle injuries by more than 95%, saving billions of dollars in medical care and making baseball and softball safer for young players. Preventative training programs have also helped reduce ACL injuries, especially in young female athletes. It has been estimated that their risk of serious knee injuries in jumping sports, such as basketball, is six to 10 times higher than young men. A formal analysis of jumping, landing and pivoting skills, combined with assessment of muscle balance and core training, leads to programs that can successfully reduce the incidence of serious knee injuries that occur in one of 100 high school female athletes.

More recently, the American Sports Medicine Institute and other baseball-centric programs have begun to clearly define the risk factors for shoulder and elbow injuries in young athletes. Whether the injury is from throwing a baseball, softball or football or hitting a tennis ball or volleyball, athletes of all of these sports share a common arm position of abduction and external rotation at the key moment of sports participation. Fatigue leads to changes in the shoulder motion that predisposes athletes to shoulder stiffness, labral tears, rotator cuff and biceps tendon injuries, as well as elbow ligament and bone injuries. A heightened effort has been directed toward better recognition of when the biomechanics of the upper extremity is altered to the point that continued participation will dramatically increase the risk of injury. We have also developed better guidelines to help athletes, coaches and parents determine when it is time for athletes to rest and recover.

Use a team approach

Orthopedic surgeons need to address the most significant challenges from a team approach. Orthopedic surgeons know the benefits of sport, not only as a child or young adult, but also as part of a life-long commitment to better health and a greater sense of responsibility for our own well-being. We need to find the time and take the opportunities to lead the team in the prevention of sports-related injuries. The benefits of sport can be taken away from a child with one serious injury — an injury that may be prevented with the current knowledge available.

With the help of the American Orthopaedic Society of Sports Medicine, along with other medical societies and ancillary professional groups such as the Sports Physical Therapy Section of the American Physical Therapy Association, resources are available to help educate young athletes, parents, coaches and others involved in the health and well-being of children. As leaders of the team, we need to use these resources to increase public awareness and help institute programs to protect young athletes. We need to educate coaches, parents and athletes about injury prevention. We need to continue to observe, analyze and research the causes of sports injuries so we improve the chances that children realize the benefits of a healthy balance of mind and body through the safe participation in sports throughout their most important developmental years.

  • Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: orthopedics@healio.com.
    Disclosure: Romeo receives royalties, is on the speakers bureau and a consultant for Arthrex Inc.; does contracted research for Arthrex Inc. and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex Inc., Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.