Preventing Overuse Injuries in Youth Sports

Overuse injuries are on the rise in youth sports but many can be prevented fairly easily with the right information. These are injuries that occur over a period of time due to repetitive stress loads on tissues without adequate rest and recovery. Examples are tendinosis/tendonitis, stress fractures and strains. They are not the result of a specific major traumatic event, such as a fall, collision, etc.

There are many factors that can lead to overuse injuries. Some of these include the increased competitive nature of youth sports and lack of variety of sports/activities, overtraining, faulty biomechanics, inadequate conditioning and flexibility, inadequate warm up/cool down routines, poor nutrition/hydration, lack of sleep and genetics. The good news is that all of these, with the exception of genetics, can be changed. Let’s now take a look at some of these.

Genetics
Let’s start with the genetic factor, the one that cannot be changed. People are born with structures that will make it easier or more difficult to perform certain activities. There is such a thing as a structural advantage. The way bones are structured allowing for joint range of motion or the structure of a muscle and location of its tendon attachment determining contraction capabilities are some examples of this.

Also, levels of integrity of the connective tissues can be a genetic factor as well. Some people’s tissues can handle higher amounts of stress loads than others before breaking down. This can often be the determining factor in athletes who do end up making it to the elite levels.

Training patterns and Variety
A serious problem seems to be the increased competitive nature of youth sports. There seems to be more focus on young athletes making it to the pros instead of simply enjoying the sport. This can lead to overtraining. Well-roundedness and cross-training is very important to maintain balance in the musculoskeletal and nervous systems. Performance level will often increase when the young athlete participates in a variety of activities instead of just one year round.

Training Patterns And Mechanics
Mechanical imbalances are a major issue in the world of overuse injuries. These include limited ranges of motion due to muscle/connective tissue tension or adhesions, poor technique in the performance of the activity and poor posture in daily life. Things like prolonged sitting and looking down at a smart phone or tablet repeatedly can create a foundation of mechanical dysfunction that can increase the risk of injury.

Another major issue is that too often young athletes do not warm up or cool down properly, which significantly increases the risk of injury. Warm ups should include dynamic stretching, or stretching that involves active movement in order to stimulate circulation and neuromuscular activity and lubricate connective tissues. Cool downs should include static stretching, or holding the particular stretch position without movement. Static stretches should be held at a comfortable level of stretch tension for 30 seconds. These warm up/cool down periods are just as important than the workout itself.

Preseason conditioning is also important and can help to prevent injury. This should always include basic core conditioning, neurosensory (balance) training and flexibility, which are important in all sports, and sport-specific movement conditioning.

Although preseason physicals are usually a requirement for organized youth sports, screenings that are more movement/function-specific in addition to the physical can also help to spot subtle imbalances before they lead to something worse.

Nutrition
Adequate nutrition is an essential component of performance level, injury risk and overall health in general. It is unfortunately very common to see young athletes with terrible diets – either eating unhealthy foods, or just not eating enough. Nutrition provides the building blocks and fuel the body needs to perform. It is only logical that what we put into our bodies will directly affect the output. Consume healthy protein and fat sources, along with enough fruits, vegetables and other complex carbohydrates. Avoid junk foods, soda, juices that are not 100% fresh squeezed, and sports drinks. Consulting with a sports nutritionist can be very helpful to establish an individually appropriate routine.

Rest and Recovery
Sleep is one of the most underrated aspects of health. A recent study in the Journal of Pediatric Orthopedics shows that adolescent athletes who get under eight hours of sleep per night have a significantly higher risk of becoming injured than those who get over eight hours. This can be due the fact that growth hormone, which is largely responsible for tissue repair, is released while we sleep. If we are not getting enough time for this repair process to take place, tissues will not fully recover from the stress of exercise and will therefore be more vulnerable to break down.

Another study showed that lack of sleep can negatively affect performance, decision making and proprioception, which is something like balancing an internal coordinate system. This is a sensation responsible for positional sense of the body’s parts during movement and rest – basically where we are in space. For example if my eyes are closed and I move my arm up over my head, I know where my arm is, not because I can see it, but because I can feel it. This has a lot to do with muscles firing at the right time in order to coordinate movement. So if this system is not functioning to its fullest potential, one’s balance will be less than optimal increasing the risk of falls and other injuries.

Playing Through Pain
Playing through pain for a youth is not a good idea. Pain is an alarm system warning us that something is not right internally and there is danger of further damage. Playing through pain will often be counterproductive in the long run, because the condition can worsen leading to an injury and possibly cause other problems due to imbalances and compensatory patterns.

In athletics, as in many areas of life, persistence through hardship in order to achieve a goal is a tremendous and commendable attribute. But it is important to listen to the body when it is trying to tell us something. It is great to be tough, but we must also be smart. If there is pain during the activity, seek the advice of a sports medicine professional.

We should also note that there may be mental/emotional factors at hand, too. This can significantly affect the way we interpret stimulus and perceive pain. The issue of a young athlete under mental stress who may be afraid, or simply not want to play is certainly something to take into account. Open communication between parents, kids and coaches can help in determining what is really going on. Consulting a sports psychologist can also be very helpful in these matters.

Conclusion
The purpose of this article is simply to raise awareness on a prevalent issue. There are countless variables in this topic, so getting into specifics would be too extensive for this newsletter. Being mindful of the above factors is a great starting point in preventing injury.
When in doubt, consult a professional. Prevention is always the best medicine.

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