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.

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.

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.

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.

Are You Really What You Eat?

There is an old popular adage that states, “You are what you eat,” implying that in order to be fit and healthy you need to eat good food. While this notion is certainly true, it is complicated by our modern food supply. It is no longer enough to eat a balanced diet full of whole grains, lean meats, and fresh fruits and vegetables and expect to have adequate nutrition. Data collected by the US government shows that there has been a decline in the nutritional content of our fruits and vegetables. The USDA has proven that store-bought fruits and vegetables have far less vitamins, minerals, and nutrients than they did 40-50 years ago. One study shows we would have to eat 8 oranges today to get the same amount of vitamin A our grandparents would have gotten from one orange!
The past five decades have been known as the “Green Revolution” which is demonstrated by the increased production and yield of the fastest growing and greatest producing plants. The decline of the nutrients in our crops is due to soil depletion during this mass agricultural phenomenon. The soil that most of our crops is grown on is so deficient in mineral content that our produce contains only about 10% of the vitamins and minerals they should have! Our soil quality has decreased because of the modern intensive agricultural methods that are used to improve size, growth and pest resistance.
Most plants require nitrogen, phosphorus and water in order to grow. However, if they are grown in soil without other nutrients present, the plants will be devoid of any nutrition, even though they will look good to the naked eye. The absence of nutrients in the soil creates plants that are less able to defend themselves against natural predators, and thus they require pesticides in order to protect themselves from damage. These chemicals sprayed on our fruits and vegetables are poisonous and have not been properly tested to determine their effects on humans.
Even though fruits and vegetables are not as healthy as they used to be, we should not avoid eating them. They still have beneficial nutrients, fiber, and phytochemicals, and they are much healthier than processed foods and other snacks. Buying organic and local fruits and vegetables helps preserve the nutrient content in our produce and helps us avoid damaging chemicals and pesticides.
So, continue to eat the rainbow of foods in front of you, but also realize that it might not be enough. You may need to replace the missing vitamins and minerals in your diet with nutritional supplements. A good multivitamin might go a long way in helping to ensure optimal health and nutrition and to make sure that you are, in fact, what you eat.

How to Effectively Use a Self-Talk Strategy: New Research Findings Will Surprise You

Self-talk has been used by athletes for years for the purpose of controlling emotions and bringing focus back to task. Short phrases expressed in a positive present tense help to alleviate normal performance pressures. “I can do it,” or “I am in the zone” are typical self-talk statements that are commonly expressed to bring attention to the task at hand. They are short, straight to the point, and easy to remember.

But, did you know that expressing a self-talk statement in the second or third person may actually improve its effectiveness? In a recent observation, psychologist Ethan Kross noticed that a self-talk expressed in a second or third person (you or he/she), instead of in first person (I), creates further cognitive clarity and an emotional distance from the person expressing such a statement. In other words, expressing a self-talk that does NOT start with “I”, but rather a second or third person, helps to not only regain focus for the task at hand, but also to push away the emotional response linked to expressing such a self-talk.

Dr. Kross noticed that when LeBron James was explaining his frustration, he referred to it as, “I wanted to do what was best for LeBron James, and to do what makes LeBron James happy.” Just listening to how he talked, it seemed as if he was talking to another person also named LeBron James. The way LeBron James expressed his frustration allowed for the creation of an emotional distance between his own upsetting words and its understandable emotional reaction. He was able to remain calm and collected while talking about an upsetting experience. A self-talk used in a second or third person lessens the emotional connection of the words being expressed.

In an article written by Weintraub, she explains that the benefits of this style of self-talk are engrained in a communication pattern used during our early developmental stages. When toddlers play with their imaginary friends, it is quite common that they engage in a dual verbal interaction. Toddlers typically provide words to their imaginary friends for the sake of continuing the playing engagement. For example, little John is playing with his trains and says something like: “Now, we put that train there and then we can push it to the end, but do not start yet, ok?”

Unbeknown to the toddler, at a very early age, he/she is starting to develop a coping skill that sooths the playing experience and saves him/herself from the stress of playing by him/herself. The early brain, which is in its prime stage to develop long-term memory, stores these engaging and soothing experiences, which may be retrieved in adulthood. Beck, a child psychologist, believes that early self-talks elicit neural connections in the emotional area of our brains, which lead to lifelong learning while enhancing soothing responses.

Even as adults, we can still express upsetting emotions in second or third person and not feel the concurrent distress. For example, a tennis player feels quite nervous as he is about to play an opponent who is ranked much higher than he is. His palms are sweating, he is short of breath, and his heart is pounding quite fast. At this moment, he would greatly benefit from using this style of self-talk to soothe his nerves. He may say something like: “John, you have trained very hard and put a lot of effort to make it this far; go out there and give it your best try. It does not matter if you win or lose. Just enjoy this great playing opportunity.”

This style of self-talk invites a combination of calmness and concentration. The self-talk is still zeroed in on bringing the best out of his game and is presented in an optimistic and empowering chat. However, its content projects an emotional distance, which allows for clarity in his thinking and more calmness of his emotions.

Whether you are on a golf course, a tennis court, a soccer field, a running track or just about to give an oral presentation before many unknown people, remember that it is normal to feel nervous. Secondly, use a self-talk style that is expressed as if you were talking to yourself. And, thirdly, envision yourself having fun and successfully accomplishing your task.

Enjoy your summer and every opportunity you get to play your favorite sport!!

Alex Diaz, PhD
Sports Mental Edge®

How to Find a Good Doctor and Surgeon

How to Find a Good Doctor and Surgeon

Rick Weinstein, MD, MBA

Director of Orthopedic Surgery

It is extremely important to make sure the doctor who takes care of you is a good doctor. You are entrusting him/her to either maintain your health or to get you back to good health. This is even more important when it comes to finding a good surgeon. You are entrusting this person to diagnose you correctly and then cut you open to fix something internally.

When choosing a doctor, I think the most important criteria is to make sure you have a person with whom you can have good relationship. It should be someone you trust and who you feel comfortable asking questions to. There are too many doctors who don’t make eye contact with their patients or can’t have a conversation with them. If this describes your doctor, go somewhere else! If your doctor spends more time looking at the computer than at you, go find someone else! Do you need to make an urgent appointment, and there is no availability for a few days? Then go somewhere else and find a doctor who values your time as much as his/her own.

How about a surgeon? How do you find a good one? First, ask your family, friends and co-workers who they have used and if they were happy. The best source for a surgeon is the doctors or nurses who work directly with the surgeon; if you can get their input, you are more likely to find a good surgeon. Does this surgeon work on amateur and professional athletes? If your medical doctor sends you to a surgeon, it may be just because he is required to recommend this surgeon as being part of the same practice. Ask your doctor if he has used this surgeon or would trust this surgeon to operate on his own family.

One of the best determinants of a good result for surgery is the number of procedures that surgeon performs. If he only does that procedure a few times per year, you are better off finding a doctor who practices more. Surgeons who do more of the procedure have fewer complications. Also, doctors who have to spend a lot of time performing a surgery because they are less experienced will require you to have more anesthesia, which leads to significantly more problems and complications.

The bottom line to finding a good doctor or good surgeon is to get references from reliable sources (friends, family, other doctors), to make sure you have a good relationship with the doctor, and to have faith in his/her abilities. You need a surgeon who is good at what he/she does, so make sure that surgeon has a lot of experience and performs a lot of that specific surgery.