Going into overtime
Young athletes in the Capital Region are pushing harder in sports but sustaining more injuries
A back injury nearly ended the promising softball career of Abby Gilbert when she was 11 years old. For as long as she could remember, Gilbert had been mesmerized by the game.
“As a six-year-old, I would stand at the fence after T-ball practice and watch the older girls play softball,” the St. Joseph’s Academy junior recalls. “I knew I wanted to do that, and I love being part of a team.”
By the age of 8, Gilbert had developed into a tall, strong player who pitched every game. A year later, she was recruited by the competitive LA Patriots—an elite softball organization based in Baton Rouge. Soon, Gilbert was playing on school and travel teams and often practicing five days a week to prepare for weekend tournaments.
Besides acquiring tremendous skills and a tenacious work ethic, Gilbert developed the ability to shake off injuries and persevere through pain. “You don’t ask the coach to take you out and put somebody else in when you’re a pitcher,” she says.
But in the sixth grade, the wear and tear on her body caught up with her: She experienced such severe back pain she could barely get out of bed. The diagnosis was a slipped vertebra in her lower spine, a common injury among athletes who perform hyperextensive motion.
That was six years ago, and thankfully Gilbert recovered from that injury and others. She has also rallied back from a sprained ankle, elbow tendonitis and a rotator cuff inflammation due to overuse—a result of her switching from underhanded pitching to overhand throwing as a third baseman. Fortunately for Gilbert, each injury has been successfully treated with physical therapy rather than surgery.
Other year-round athletes are not so lucky.
Craig Greene, a local orthopedic surgeon, reports that patients younger than 18 comprise nearly 80% of his sports medicine practice. Over the past 24 years, BRPT-Lake President and CEO Seth Kaplan estimates the percentage of pediatric patients with sports-related injuries has risen from 25% to 40%. At certain times of year, 50% to 70% of those injuries result from impacts, usually with another player.
During football and baseball seasons, boys constitute a larger percentage of the patient base. But overall, half the athletes treated are girls. Doctors are documenting a higher incidence of anterior cruciate ligament problems in female athletes, which may be due to the position of their hips relative to their knees or the effect of estrogen on ligaments.
Viewed alone, the increased incidence of injury isn’t that alarming because it seems to parallel growing participation among girls and women in team sports in recent decades. However, the types of injuries that are landing kids in doctors’ offices reflect a reality that’s attracting the attention of health care professionals.
“A trending problem in our culture today is that kids don’t have an off-season from sports,” says Greene. “We see lots of chronic overuse injuries like tendonitis and bone contusions. Extended rest is often necessary for optimal healing.” And many parents aren’t willing to sideline their kids.
Besides the sprains, bumps and bruises, and occasional broken bone, kids are now sustaining the kind of severe joint and ligament issues common in professional athletes. In many cases, the cause of the injuries is participation in year-round sports.
Track and cross-country coach Pete Boudreaux, a Catholic High School coach since 1966, says the seasonal sports rotation among serious student athletes began to decline around 15 year ago, and specialization in one sport and one sport only has increased in the last five years. Now, some second- and third-graders play only a single sport, and many train and practice for that sport year-round.
“Specialization is one of the greatest farces that has been perpetrated on our young people and their parents,” Boudreaux says. “At a very early age—8 and 10 years old—some have to make a decision as to which sport they are going to specialize in. It’s totally ridiculous.”
Specialization at an early age can increase the chance of injuries. “If they only have practiced one skill, they may get a little bit better at that sport,” Boudreaux says. “But by not having been involved in these different activities that use different muscles, skills and motor movement, parts of their body aren’t developed as they should be. That’s when they can become susceptible to injuries.”
The two most common mechanisms of injury are collisions and overuse.
When student athletes train year-round, their regimens include not only drills for proficiency in their sport but also weight training and cardio to increase speed and agility.
While the number of incidents has increased, injuries from accidental collision have always occurred in school sports. However, until recently, the incidence of overuse injuries in kids was relatively low. Now, the CDC reports overuse is responsible for nearly half of middle and high school student’ sports injuries.
As a former football walk-on at LSU, Greene understands the desire and drive to excel in athletics as well as the wear and tear it puts on the body. He even jokes his six knee surgeries during college were responsible for launching his orthopedic career.
“Oftentimes in youth sports, we hear: No pain, no gain,” says Greene. “But if there’s an injury, pain is the signal that indicates your body needs a break and time to recover.”
That medical advice is rarely popular with patients, and even parents baulk at imposing a period of rest on their children. Frequently disbelief or disregard impels them to shop for a doctor who will dispense different advice—especially if the athlete has an impending tournament or important tryout.
“You have to let an injury heal,” Greene says. “If you’re not 100 percent, what use are you to your team? If you’re a pitcher and you’re only 60 percent better, [opponents are] going to hit you out of the park. You can rest this and get to 100 percent, or this injury is going to nag.”
When rest isn’t enough, physical therapy is the best defense to avoid surgery. With overuse injuries, physical therapists identify the repetitive action that is causing the problem, restore motion, increase strength, minimize impact of the injury on the body, and return athletes to their sport.
Although the goal of constant conditioning is to maximize athletic performance during competition, CDC statistics indicate 62% of organized sportsrelated injuries occur during practice. One reason is one-third of parents do not insist their children take the same safety precautions at practice that they would during a game. Another contributing factor is improper technique.
For example, if weight lifting results in a severe leg pain, a therapist’s assessment might reveal adequate leg strength but limited range of motion in the hip. Once the ability to squat is improved, it minimizes the stress and prevents re-injury to the leg. Likewise, if therapists can strengthen a swimmer’s shoulder girdle, it can minimize the stress on the shoulders.
“You’re not just a knee, shoulder or ankle patient,” Kaplan says. “You’re a person who wants to participate in a sport. What we have to do is to identify the specific ranges of motion that you need and the specific strength issues that we have to deal with to get you back to that sport and minimize the potential for re-injury.”
But that doesn’t mean a patient won’t return after discharge. “We have seen Abby for a multitude of different injuries,” says Kaplan, Gilbert’s therapist, “because she continues to play at such a high level.” Despite her host of injuries, Gilbert recovered sufficiently to be part of the LA Patriots team that won the 2012 national championship in Indiana.
And Gilbert’s stints in therapy have given her a greater understanding of the toll softball has taken on her body. It has also given her time to contemplate her future in the sport she loves. While Gilbert hasn’t ruled out playing college ball, she’s not planning to go pro. Instead, she’s considering coaching or maybe a career in physical therapy, to help others heal.
She is not alone.
Many who love sports and who have sustained injuries choose a future that is sports or injury related. Just ask Greene. It is a quest for balance that is imperative, as is the recognition that the sport is not the destination but only part of the journey in a long life.
“Every child should be involved in team sports,” says Greene. “If you play competitively, sports will end prematurely at some point in your life. But that’s OK. Sports prepare you for life, and life is bigger than sports.”