Have we gone too far?

Editor's note: Nancy Justis, a former competitive swimmer, is a partner with Justis Creative Communications.

By Nancy Justis, correspondent

I don't remember hearing as a young athlete about my friends suffering from injuries while competing in sports.

I was a competitive swimmer. The only mishaps I fought through were multiple instances of swimmers' ear - painful at the time, but nothing that kept me from participating. I actually taped over my ear so I could continue with my training on a daily basis.

I do remember hearing about broken bones caused by falling from a tree, or scrapes and bruises from falling off a bike, or black eyes from tussles among friends. I don't remember hearing about shoulder strains, knee surgeries or any of that other stuff that seems prevalent today.

Youth sports have changed since I was a kid. Games are highly competitive now. Kids don't play just for fun anymore. Travel teams and the pressures of winning over having fun have led to more intense training at younger ages, sport specialization and year-round competition.

All that has led to overuse injuries to athletes at younger and younger ages.

According to Safe Kids Worldwide, more than 3.5 million children ages 14 and under receive medical treatment for sports injuries each year. That figure was reported several years ago. It's a sure bet the number has increased over time. It also reports almost half of those injuries are caused by overuse - Sever's disease, a heel injury often seen in soccer players; Osgood-Schlatter disease, knee pain frequented in male soccer and basketball players; and gymnast's wrist, runner's knee, swimmer's shoulder, shin splits and Little League elbow or shoulder, caused most often by throwing breaking balls.

A recent position statement by the American Medical Society for Sports Medicine said the relationship between injury and sports specialization 'has not been clearly demonstrated,” but many experts attribute the increase of overuse injuries to year-round play and kids playing on too many teams at the same time, which takes a toll on growing bones, joints and muscles. Many say before high school, most children are not physically mature enough to handle the stress that playing the same sport 12 months a year places on their bodies.

The website momsTEAM lists probable causes of overuse injuries as:

- Organized youth sports. 'Left to themselves, children engaged in spontaneous and unstructured sport and recreational activity are generally free of overuse injury. It is when adults step into the picture that ‘injury free' status seems to change.”

- Elite-level travel teams. 'Increased emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership, and even professional contracts, has become widespread, resulting in increased pressure to begin high-intensity training at young ages. Excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury ...”

The site also lists risk factors. Intrinsic factors include:

- Prior injury is the strongest predictor of future overuse injury. 'Repeated overuse injury may occur as a result of inadequate rehabilitation of the injury and/or failure to recognize the factors that contributed to the original injury.”

- Adolescent growth spurt. 'Overuse injuries may be more common during the adolescent growth spurt.”

- Menstrual irregularity. 'A history of amenorrhea (irregular periods), especially in sports that emphasize leanness (gymnastics, figure skating, dance (track), is a significant risk factor for bone stress injury.”

Extrinsic factors include:

- Workload. 'Higher training volumes have consistently been shown to increase the risk of overuse injury in multiple sports. (A study of high school athletes found a linear relationship between hours of sports participation and risk of injury, with training more than 16 hours weekly associated with a significant increased risk of injury requiring medical care.)

- Volume. The amount of activity in a single season. Intensity (number of sessions per week/month/year) is correlated with overuse injury risk, such as the number of pitches per game.

- Year-round play. A 42 percent increase in self-reported overuse injuries in high school athletes who participated all year, as opposed to three or fewer seasons per year.

- Less free play. 'There is emerging evidence to suggest that athletes who spend most of their time in organized sports and little time in free play or recreation are more likely to be injured. One study ... found that the athletes who suffered sport-related injuries spent an average of 12.6 hours per week in tennis and only 2.4 hours per week in free play ... while the uninjured players spent only 9.7 hours per week in organized tennis and 4.3 hours in unstructured free play.”

Children seem to love the emphasis placed on competitive sports. The parents love it. The coaches love it. But have we gone too far?

The National Athletic Trainers Association (NATA) recommends six steps for making school athletics more safe by reducing repetitive stress injuries in children ages six through 18.

- Injury surveillance. Be vigilant in the 'surveillance and reporting of all injuries. In addition, pain, fatigue and decreased performance should be recognized as early warning signs of potential overuse injuries.”

- Competitors are encouraged to undergo a physical exam before beginning a new sport or at the start of a new season 'in order to screen for potential risk factors, including injury history, stature, maturity, joint stability, strength and flexibility.”

- Health care professionals, parents and coaches should 'also learn to recognize the anatomical factors that may predispose an athlete to overuse injuries, including bowed legs, knock knees, pelvic rotation and joints that easily move beyond their normally expected range.”

- ”Emerging evidence indicates that the sheer volume of sports activity, whether measured as number of throwing repetitions or the amount of time participating, is the most consistent predictor of overuse injury. Efforts should be made to limit the total of repetitive sports activity engaged in by pediatric athletes ...”

- ”... incorporating a preseason or in-season preventive program that focuses on neuromuscular control, balance, coordination, flexibility and strengthening to reduce the risk of overuse injuries ... young athletes should only participate in one team of the same sport per season. Training intensity, load, time and distance should only increase by 10 percent each week ...”

- ”Youth athletes are encouraged to participate in multiple sports and recreational activities ... to enhance general fitness and aid in motor development ... 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.”

l Let us know what you think by contacting Justis at njustis@cfu.net