When taking a break can prevent one

Wilmington, Delaware
Tuesday, September 22, 2009 @ 09:46 AM EDT
by: The News Journal; Kelly Bothum

Throwing and other repetitive sports motions can cause injuries in young athletes, especially those who play year-round

Playing a sport has been credited with helping young athletes develop a healthy self-esteem, learn discipline and grasp the importance of working together. But as team sports become increasingly specialized and the training year-round, some players are learning another unintended lesson of the game -- how to deal with injuries.

Dario Anderson Jr. of Clayton is learning that right now as he recovers from Little League shoulder, a fracture of the growth plate in his right arm. The 12-year-old pitcher and short stop started feeling pain in his shoulder earlier this summer when throwing the ball. After short bouts of rest didn't help the discomfort, Dario saw Dr. Kathleen O'Brien, a sports medicine physician at the Alfred I. duPont Hospital for Children.

O'Brien, director of the hospital's sports medicine program, diagnosed Dario with humeral epiphysiolysis, or Little League shoulder, so named because of the young players whose repetitive throwing can put stress on the growth plate, an area of developing tissue near the ends of long bones. She prescribed 12 weeks of rest to allow the fracture to heal on its own. That means Dario can't throw a ball, can't practice and can't pick up anything heavier than a can of soup.

About the closest he can get to baseball is watching it on TV, and that's a hard adjustment for a kid who has been playing ball nearly year-round since he was 6. "It was devastating to him," said his father, Dario Anderson Sr. "But they said he'll come back bigger and stronger. And he understands the importance of getting this rest. He wants to rebuild."

Responding to the trend

As the popularity of youth sports has risen -- it's estimated that more than 30 million children and adolescents participate in organized activities annually -- the number of injuries caused by overuse also has increased. According to the American Academy of Pediatrics, up to 50 percent of all injuries seen in pediatric sports medicine are related to overuse. About half of those are preventable.

A.I. duPont Hospital recently started its sports medicine program to help young athletes recover from their injuries and also prevent future ones from occurring, said O'Brien, who joined the hospital's orthopedic department about two months ago. The program hopes to have its own dedicated space in the hospital by winter. It joins a small but growing number of children's hospitals nationwide that are opening sports medicine centers catering to young athletes.

For most simple sports injuries, a visit to a pediatrician or family doctor may be fine, O'Brien said, but more complicated injuries -- especially those caused by overuse or repetitive motion, such as throwing a ball -- may require additional treatment and rehabilitation.

The program already is seeing patients with sports-related injuries as well as those who are interested in reducing their risk of getting hurt, said Kenny Rogers, an athletic trainer in the program. That preventive effort includes education about the short- and long-term effects of concussions, a particularly important topic for athletes who play impact sports like football and lacrosse. There also are plans to offer nutritional counseling and weight management for athletes, who can face an increased risk for an injury like a stress fracture because they are too big or -- in the case of a gymnast or dancer -- too small.

Risks for young athletes

Although young athletes can tear ligaments and break bones like adults, they face other challenges associated with their age. Tweens and teens who play competitive sports like soccer, football and gymnastics face greater risks of injury than adults because their bones and muscles are still growing, said Dr. Steven C. Cuff, a physician with the sports medicine team at Nationwide Children's Hospital in Columbus, Ohio. As a result, their bones can't handle as much stress as adult bones.

Younger players in particular are predisposed to injury because of their growth plates, cartilage-like structures that are often the weakest part of a child's musculoskeletal system. Cuff said most of the overuse injuries his hospital sees are from the preadolescent population, specifically those 9 to 13 years old. In many cases, injuries around the growth plates occur because the body can't withstand the stresses caused by the repetitive motion. The result can be small breaks in the bone called microfractures that can cause swelling and pain.

Many of those younger players also are still learning the mechanics of their game, so they may be not be able to recognize the signs of overuse. They might think a little pain is part of playing the game, Cuff said, especially if a coach hasn't talked with them about the importance of speaking up about any discomfort they're feeling.

O'Brien said more children are choosing to specialize in a sport earlier than they might have in the past. In many cases, that means playing a sport year-round, with little or no breaks to let the body rest and recuperate.

"We'll see kids as young as 6 or 7," she said of the patients who are seen by pediatric sports management physicians. "Obviously the more you do and the more you do year-round, the more effect you're going to see."

'Prehab' for sports injuries

Kids enjoy playing, so it can be hard for them to understand that they could unintentionally be hurting themselves. In Dario's case, he plays Little League and is often an all-star, which extends his playing season. In the off-season, he also plays on a travel team. During the winter, he has frequent indoor practices to keep his skills up.

Anderson said his son's diagnosis was a surprise because he didn't realize just how much damage could be done by overuse at such an early age.

"I played a lot of sports as a youngster. When it hurt, we would just ice it," he said. "Back when I played, we didn't have baseball travel teams. We didn't continue to play all year long."

Although many physicians believe the single-sport specialty is causing more pediatric sports injuries, Cuff said his own research has shown the problem is the duration that sports are played. He studied athletes who played different sports all year long and those who played one sport year-round and found both were more susceptible to injury.

"It was just the fact you're not giving yourself any kind of break," said Cuff, a member of the American Academy of Pediatrics' committee on sports medicine and fitness. "I think just taking one season off gives your body a chance to rest."

By educating players, parents and coaches about the importance of getting days off to rest the body and not overworking the same body part, O'Brien said, the hope is that fewer players will be injured. That's why injury prevention will be a key component at duPont Hospital's Sports Medicine Center. The goal is to get athletes to understand that to be at the top of their game requires more than focusing on a single body part or exercise regimen.

"The buzz word is 'prehab' instead of rehab," she said. "We want to look at how can we prevent or help overuse injuries by looking at their whole body."

Additional Facts

LEARN MORE
Dr. Kathleen O'Brien and athletic trainer Kenny Rogers from the Sports Medicine Center at Alfred I. duPont Hospital for Children are available to talk with local sports groups, pediatricians and other youth organizations about sport safety, concussions, prevention and rehabilitation from injuries. For more information, call 651-6413.

COMMON INJURIES
Here's a look at some common pediatric sports injuries:

Jumper's knee -- Also known as Sinding-Larsen-Johansson disease, this is an overuse condition in the knee often seen in growing, active athletes. As an adolescent runs and jumps, the muscles propel the skeleton by pulling on the bones. Sometimes the repetitive stresses cause pain, tenderness and swelling around the knee area. SLJ occurs at the lower end of the knee cap where the patellar tendon originates.

Jersey finger -- Common in football, wrestling and rugby, jersey finger typically occurs when one player grabs another's jersey, and a finger -- often the ring finger -- gets caught and pulled.

Little League shoulder -- An overuse injury caused by lots of throwing. The repetitive throwing puts stress on the growth plate, causing it to become irritated. In severe cases, the stress may lead to a small break in the growth plate.

Little League elbow -- This is another growth plate injury, on the inner part of the elbow. It occurs in children and adolescents who play sports that require repetitive throwing motions. The most common symptom is pain at the inner elbow.

Sever's disease -- The most common cause of heel pain in growing athletes, it occurs when the growth plate in the heel is injured. In early puberty, bones often grow faster than muscles and tendons. As a result, muscles and tendons become tight. During weight-bearing activity, tight heel tendons may put too much pressure at the back of the heel where the Achilles tendon attaches. This can injure the heel and cause Sever's disease.

On MomsLikeMe.com
Are your children involved in year-round sports? What do you do to help keep them injury-free? Join the discussions at Delaware's MomsLikeMe site.

modified: Wednesday, September 23, 2009 @ 09:51 AM EDT
created: Wednesday, September 23, 2009 @ 09:47 AM EDT

About Nemours

Nemours, one of the nation’s largest pediatric health systems, is dedicated to achieving higher standards in children’s health. Nemours offers an integrated spectrum of clinical treatment coupled with research, advocacy, and educational health and prevention services extending to all families in the communities it serves. Starting with Alfred I. duPont’s bequest over seventy years ago, Nemours has grown into a multi-dimensional organization offering personalized clinical and preventive care focused on children.

Nemours owns and operates the Alfred I. duPont Hospital for Children in Wilmington, Delaware and major children’s specialty clinics in Delaware (Wilmington), Florida (Jacksonville, Orlando and Pensacola), Pennsylvania (Philadelphia and Bryn Mawr) and New Jersey (Atlantic City and Voorhees). Having recently received preliminary approval from the State of Florida, Nemours will establish a new full-service children’s hospital as part of an integrated pediatric health campus in Orlando. KidsHealth.org, the world’s most visited pediatric health care Web site for parents, kids and teens, is a project of Nemours.

Nemours employs over 4,400 individuals, including 430 pediatric physicians, specialists and surgeons who cared for approximately a quarter of a million children in 2007. The organization’s goal is to align with parents, physicians, community leaders, children’s advocates and elected officials to ensure optimal wellness for every child. Additional information about Nemours can be found at www.nemours.org.