CHILDREN AND SPORTS
A GUIDE FOR PARENTS
CHRIS G. KOUTURES, MD
PEDIATRICIAN
SPORTS MEDICINE PHYSICIAN
INTRODUCTION
I welcome comments and further
questions- please log on to my website at www.koutures.com or schedule an appointment.
Chris Koutures, MD
500 S. Anaheim Hills Road, Suite 140
Anaheim Hills, CA 92807
(714) 974-2220
16300 Sand Canyon Road, Suite 100
Irvine, CA 92620
(949) 754-1344
PART ONE- MY PHILOSOPHY ON SPORTS
My core goals of childhood sports
are to have fun, learn the value of both hard work and life-long exercise, and
take pride in self-improvement and teamwork.
In younger children, I think these
goals are more commonly met.
I find many 5-8 year old children
eager to tell me all about all the fun they have in their various sports and
activities.
However, when I see adolescents, I
tend to see two extremes. On one hand, many of them are “burned out” or
disinterested in sports or any exercise- and I worry that these negative
attitudes will persist into adulthood.
The opposite group includes an
increasing number of young adults putting such an emphasis on sports that they
are suffering from overuse injuries or overtraining ailments.
As a parent, you are a role model-
your participation in sports sends a message to your child, as does your
behavior at sporting events. If you enjoy exercise and make it an appropriate
part of your life, odds are your children will be more receptive to regular
exercise or sport participation. Negative adult attitudes or poor sideline
behavior set bad examples for children, and take away much of the enjoyment of
youth sports. You may have to make tough decisions or set limits on sports
participation- that indeed is part of your role as a parent, and do take that
role seriously.
Sure, winning records, all-star
teams, college scholarships, and pro contracts are cool goals- but these should
not be the ultimate measure of success. Sports should be enjoyable for all-
athlete and family…
“When can I start my child in organized sports?”
“Can a four year-old start tennis lessons?”
“When should I teach my child how to kick a ball?”
Simple skills, such as throwing
an object or kicking a ball, are part of normal toddler development. However,
children this young are not developmentally ready for more complex tasks- like
“proper” throwing or kicking technique. All play at this age should be fun and
spontaneous with minimal organization.
Formal introduction of organized
sports should begin at age 5, at the earliest.
“Why age five?”
Try to teach four year-olds how
to swing a tennis racquet, and you will likely find inconsistent results. Yes,
there are occasional prodigies like Tiger Woods who may show amazing talent at
the age of three, but he is a great exception to the rule. No relation has been
found between skill training in the early years and later development of sports
skills.
Most five year-old children have
developed an attention span to listen to adult teachers, work with other
children, and follow simple, multi-step commands. They also can learn a task in one situation
(school) and repeat it in a new situation (home)- all these reasons explain why
children start kindergarten at age five.
.
From age 5-8, the main emphasis
should be on fun and learning of the basic sport skills. There should be no
competition- competition is so complex it may interfere with learning
skills. Repeat as many times as necessary: there should be no competition.
Contrary to the beliefs of many
parents and coaches, an early start or early “success” in sports is not
consistently correlated with success in later years. Thus, the key to five
year-olds is to teach proper technique and focus on the basics. At this young age, the “winning percentage”
should not be based on any measure of wins and losses, but rather on how much
fun the children have and how many want to play again the next season.
“Should my child
play more than one sport?”
Most definitely.
Childhood is a time for challenge
and exploration- a variety of sporting activity allows the child to develop
multiple skills and self-interests, which usually leads to more overall sport
enjoyment.
However, this doesn’t mean that
children should participate in so many different sports at the same time that
the parents feel like virtual taxicab drivers.
Make certain that there is ample time for schoolwork, family time,
friends, and just being a kid.
Unfortunately, the concept of
sport-specialization- or children playing just one sport- is becoming more
commonplace, at increasing younger ages. In fact, the American Academy of
Pediatrics Committee on Sports Medicine recently cautioned against early
sport-specialization. The concerns of physical injuries and emotional burnout
often outweigh the benefits of concentrating on one particular sport.
Most high school and collegiate
coaches that I know really like to see the “multi-sport” athlete (aka 2-3 sport
letterman in high school) because they know these kids are “well-rounded”
athletes and not just good in one particular activity. The multi-sport athletes
also have more “up-side” potential- when they get to college and then focus on
one sport- they often have more improvement than the athlete who has already
focused on one sport and may not get much better.
“How often
should my child exercise for good health benefits?”
Ideally, young children should
spend at least one hour a day engaging in play- this can be a formal sport
practice or game, or it can include working in the garden, walking the dog, or
chasing other kids around the neighborhood. Don’t worry about structure- most
children have enough organization in their lives- allow spontaneity and
creativity. Emphasize easy and fun activities that captivate the child’s
attention, and if you try to participate on occasion with your child- this will
be a benefit for both of you.
For adolescents and young adults,
the American College of Sports Medicine recommends 45 minutes of vigorous
physical activity at least 4 days a week. This doesn’t have to be 45 minutes
all at once- 15 minute activities done three times a day counts just the same.
Vigorous activity is anything that raises your heart rate and increases your
breathing rate. I like to use the “talk test” to measure exertion- if you can
say one or two sentences before needed a breath, that is an appropriate activity
level.
PART THREE- INJURY AND BURNOUT PREVENTION
“When do you usually see
injuries in sports?”
1) When an athlete
is not wearing appropriate protective equipment
Bike helmets do no good when they are strapped
to the handlebars, just like shin guards can’t work if they are left in the gym
bag. Make sure the equipment is in good condition, fits well (especially with
growing children), and is always used.
2) Within a month
of a new season or activity
Good studies on
Marine recruits show that foot stress fractures and other overtraining injuries
are most commonly seen three weeks into boot camp. My experience with young
athletes is quite similar- about three weeks into a new sport, I will start to
see overuse injuries. The body is unable to handle the stress of a new
activity, and breakdown occurs. How can this be minimized? Have the athlete
prepare for the new activity with some light conditioning- going straight from
Sega football to double-days is a recipe for disaster. Also, start slow and
increase intensity or length of workouts slowly to allow the body to adjust-
and don’t forget those rest days.
3) When an athlete
steps up to a higher level
Stepping up to a
higher level often includes playing with older, more mature (and bigger)
athletes, attending an intense sport camp, or starting high school or college
training. No matter what success the athlete has enjoyed in the past, these
situations can overtax a young body. Limiting the situations where 9 year-olds
are playing with 12 year-olds can reduce development discrepancies and the risk
of injury. Preparing well for camp or a new school, and gradually increasing
the training are other ways to minimize the “shock value”. Sports medicine
physicians use the mantra “TOO MUCH, TOO FAST, TOO SOON” to describe a situation
that creates overuse or overtraining injuries. Realize, however, that the
damage done by overtraining may not become immediately apparent- it may take
several months or years before the signs and symptoms catch up with the young
athlete.
4) Playing more
than one sport at a time
Some athletes
can handle playing club soccer and running cross country at the same time- many
cannot. Other athletes can handle summer football, baseball, and basketball camps
without missing a beat- many
cannot. I’ll often see athletes
who are listless from too much activity- and once I request that they take a
brief rest period and then focus on just one sport- the majority are refreshed
and more successful.
5)
Playing too much of one sport
The “more is
better” philosophy may work for some, but is has also caused the demise of many
young bodies. Repetitive activity strengthens bones and joints, but too much
repetitive activity can overstress bones and joints, leading to injury. Thus,
swimming for two club teams, or playing on three baseball teams may be
detrimental in the long run. Don’t forget that private throwing lessons or
personal training sessions also count to the cumulative stress placed on the
body. Factor all activities into the equation when determining limits for your
young athlete.
6) Playing through
pain or discomfort
No child should
ever play through any pain. Schedule an appointment if there also is pain that causes
a limp, changes technique, or forces a child to change position or not want to
continue play.
7) When an athlete
is tired
Fatigue
minimizes the ability to make quick decisions and movements that can help avoid
injuries. Tired muscles and ligaments are less able to withstand forces on the
field. Make certain the athlete is getting sufficient sleep (8-10 hours a
night) and enough rest between practices and games. Despite what many young
athletes think, “Rest is your friend”. As a parent, it is your responsibility to
convince your child of the importance of appropriately placed rest days.
Younger children
(ages 5-10) should participate in sports no more than 3 or 4 days a week, while
older children (ages 11-15) should take at least two rest days off per week.
High school-aged athletes should take at least one day off
per week. More
sport-specific recommendations can be found in the following sections on
particular sports
“What happens if
an injury is not treated correctly?”
Children tend to heal quickly
(that’s why I chose pediatrics)- so most injuries are not a long-term concern.
However, in a worst-case scenario: the athlete has life-long pain or
disability. A 35 year-old man shouldn’t be limited in playing catch with
his son because his parents wouldn’t stop him from playing with shoulder pain
as a 12 year-old baseball pitcher.
Serious growth issues can develop
if a “minor” injured is allowed to mature into a “major” injury.
Injuries are a common reason why
kids stop playing sports, and why athletes fail in the quest for a starting
job, a varsity letter, or a scholarship. Certain injuries label the child as
damaged goods- once a pitcher has a shoulder or elbow injury- it is common for
coaches and scouts to automatically write off that athlete.
Have no regrets- call or get a
qualified opinion on any childhood injury.
PART FOUR- BASIC INJURY CARE
Some injuries are rather
dramatic- the athlete who is “knocked out” or a player who suffers a broken
leg. However, most injuries are not so obvious, so here are some “softer” signs
of concern:
1)
Any limp or limited use of an arm or leg
2)
Any change in technique to protect an injured area
3)
Obvious swelling or bleeding
4)
Dramatic fall-off in performance (running speed, usual
aggressiveness)
5)
Discomfort that is greater than usual post-activity
soreness or lasts more than 1-2 hours after a game or practice
6)
Lack of willingness to play or practice
“What should I
do when my child gets hurt?”
Nobody expects a
parent or athlete to diagnose or completely treat injuries. However, some basic
first aid and a bit of common sense can help.
In any injury
situation, if there are any doubts about the severity of the injury- any doubts
whatsoever, do not try to move the athlete. Try to remain calm
and dial 911 to activate the emergency response system. No one should
ever fault you for holding up the activity and calling for trained medical help.
For most bone and joint injuries,
use a bit of R.I.C.E.
R= Rest- Remove the
player from activity and evaluate the injury to the best of your ability. Rest
may also include using crutches, splint, or sling to protect the injured
area. The athlete should not return to
activity until they have no lasting complications from the injury. Any
doubts-get a qualified evaluation. Realize that prolonged immobilization or
crutch use can actually complicate an injury- thus expert evaluation is key.
I= Ice-In the first 48
hours after injury, experience has shown that cold (ice, cold packs) best
reduces pain and swelling. Cold should be applied for 20 minute intervals every
1-2 hours in those first few days.
C= Compression- Ace wraps or
other large bandages applied firmly (but not too tightly) around the injury
site can also help reduce swelling and pain.
E= Elevation- Keep the
injured body part above the level of the heart to reduce swelling. This may
require propping a leg on pillows when the player is seated or even using those
pillows under the leg for sleep.
“When should I
go to the Emergency Room or call you right away versus waiting to see you the
next few days?”
Injuries that
deserve evaluation within 2-4 hours:
1)
Obvious bone deformities, bone fractures with open skin
2)
Joints which have large swelling within 1-2 hours after
injury
3)
Inability to walk on an injured ankle or knee (definition
of walking= taking more than four steps)
4)
Little or no use of a joint
5)
Immense pain
6)
Any symptoms of a head injury (see next section)
7)
Any injury which causes great concern for the athlete or
parent
Always feel free to call for
advice or to schedule an evaluation.
Whether or not you seek care in
the Emergency Room- call for an appointment within a few days after the injury
so we can review the injury and develop an appropriate treatment plan. Often,
pain and swelling limit the physical examination right after the injury, so I
will likely get a better idea if 2-3 days have passed with reduced pain and
swelling. Further diagnostic tests may be needed to better evaluate the injury
and give a more accurate diagnosis.
The post-injury rehabilitation
plan by a sports medicine physician might be the most important difference between
a safe and efficient return to play or prolonged disability and recurrent
injury. Very rarely will I prescribe “rest for three weeks” or “just ice it” –
in most cases, there are particular exercises or alternate activities that can
be done to aid the healing process. I may even recommend working with a physical
or occupational therapist (specialists in rehabilitating and strengthening
athletes), while special braces/supports and medications may also be needed.
Regular
follow-up visits are often scheduled to determine when an athlete can safely
advance in the rehabilitation program.
PART FIVE- NUTRITION GUIDELINES
Young athletes are bombarded with
nutritional claims to gain/lose weight, build amazing strength, and workout
longer- yet many of these claims have little or no scientific basis and the
side effects are not well studied.
General diet:
Total calories- difficult to
estimate, may range from 2000-4000 calories per day. Do not restrict calories
(unless directed by a physician) and do not skip meals.
Carbohydrates (55-70% of
calories)
Fat (25-30% of calories)-
favor vegetable or fish-based unsaturated fats over saturated animal based fats
Protein (12-15% of
daily calories)
Carbohydrates
Short and long-acting sugars:
fruits, pastas, breads, cereals, and athletic bars
Fat
Pre-teens may need more fat than
adults
Too much fat (over 30%) is
harmful
Bad sources of fat: chips, fries,
and most desserts…
Protein
Athletic teens need 1.2-1.5 grams
of protein per kilogram of weight
Protein supplements are not
recommended because the usual American diet supplies generous amounts of
protein. Most “expensive” supplement protein actually ends up in the urine- as
a waste product
Good sources: meat, fish, soy,
peanut butter, eggs, dairy products, and beans
Iron
Essential for optimal exercise
performance and cognitive (thinking) function
US Recommended daily allowance:
15 mg/day
Good sources: lean red meat
(three times a week), dark chicken, fish, beans, eggs, iron-fortified cereals,
and green vegetables
Vitamin C can enhance iron
absorption (drink orange juice with the above foods)
Tea, coffee, fats, and soft
drinks decrease iron absorption
Do not take iron supplements
unless low iron diagnosed
Calcium
Boys and pre-adolescent girls
need 1000 mg/day (four dairy servings)
Adolescent girls need 1500
mg/day (six dairy servings)
Calcium+physical activity=
maximum peak bone mass
Vitamin-D fortified milk is more
crucial than other dairy products
Fluids
Probably the
safest and most important nutritional supplement
Good science
shows that dehydration causing a 1% weight loss can reduce athletic
performance.
Thirst starts at
3% dehydration, so drinking only when thirsty means the athlete is already
behind in fluid needs
Pre-hydrate with 16-24 ounces of
fluids every day
Drink 12-16 ounces of fluid
within 1-2 hours of every practice or game
Drink 4 ounces of fluid every 15
minutes of activity
Post-event meals
Pre-event and post-event weights
can help determine fluid needs
Drink 16 ounces for every pound
lost after activity
Immediately after activity,
eating 1 gram of carbohydrate for every 1 pound of body weight can help
replenish lost energy sources
Supplements
(steroids, creatine, andro, glutamine…)
Do they work?
Yes, some of them have
been shown to improve exercise performance.
Do they have side effects?
In the case of andro and
steroids, yes, there are well-known serious side effects.
In the case of creatine, we don’t
have enough long-term data to say for certain. What little short-term data we
have has been collected in adults, and may not apply to growing children.
Thus, the safest route is to
avoid supplements- save your money and safeguard your health.
“Are teenaged
girls at particular risk for nutritional issues?”
In female athletes, insufficient
caloric intake can contribute to the Female Athlete Triad- that consists
of disordered eating, reduced bone density, and irregular or absent
menstrual periods. While any female athlete could be at risk, those
athletes who participate in sports that value a lean physique are at higher
risk.
Excessive exercise demands
coupled with insufficient caloric intake can lead to irregular or absent
menstrual periods. Estrogen, a hormone necessary for building bone density, is
released during normal menstrual cycles. No menstrual period means no estrogen
release, leading to a reduction in bone density that makes the athlete more
prone to stress fractures.
Confronting an athlete about
these issues is quite difficult; however, there are some signs that make a
sports medicine physician suspicious:
1)
Missing one or more meals a day, or avoiding whole classes
of foods
2)
Excessive weight loss or distorted body image (athlete is
“too fat”)
3)
Once periods have begun, more than three months between
menstrual periods, or less than six menstrual periods in one year
4)
Absence of first menstrual period by age 16
5)
History of more than one stress fracture
To prevent these issues, make
certain female athletes consume sufficient calories (often 2000-3000 cal/day),
calcium (1000-1500 mg/day) and iron (15 mg/day). In addition, excessive
pressure from coaches, parents, or other athletes regarding body shape or image
can lead to disordered and diseased eating patterns.
PART SIX- PROTECTING HEADS AND KNEES
Steve Young, Troy Aikman, Eric
Lindros…. star athletes with limited or ended careers due to troubles from
repetitive head injuries.
While there remains much to
learn, sports medicine experts are growing more concerned over the long-lasting
impact of head trauma- especially on young athletes.
“My child wasn’t
knocked out, so that’s OK, right?”
Head injuries (also known as
concussions) do not necessarily require being hit in the head or getting
knocked out. The full definition of
a concussion is any fall, blow, or trauma that causes physical, emotion, or
mental changes in an athlete- with or without loss of consciousness.
What are some of these changes?
1)
Difficulty remembering events before/after the injury, poor
concentration/memory
2)
Headache
3)
Vision changes (double vision, poor peripheral vision)
4)
Emotional outbursts or personality changes (crying,
laughing at inappropriate times, acting more silent than usual)
5)
Vomiting, stomach upset
6)
Weakness or odd sensations in the arms or legs
7)
Fatigue and irritability
Athletes must
realize that it is not “tough” to play with a head injury. Parents, coaches, and medical personnel cannot
read an athlete’s mind…. many symptoms are not obvious to an outsider and we
must depend on the athlete to report problems whenever they occur. Convince
your child that it is indeed “cool” to tell coaches, parents, or a trainer of
any head injury symptoms.
“What should we
do if these symptoms occur?”
If these symptoms occur, the
athlete should be immediately removed from play- if the athlete has neck pain
or is unable to leave the playing field, dial 911 and activate the emergency
response system.
A qualified medical professional
should evaluate the athlete before any return to activity. The athlete
needs a full physical and neurologic examination, and studies such as a
CT-Scan, MRI, or neuropsychiatric testing, may be ordered to further evaluate
the injury.
“When can the
athlete return to play?”
In many cases, symptoms will
clear within several hours to days- however, because it is difficult to predict
when resolution will occur, close and regular follow-up with a sports medicine
physician is key to developing an individual recovery program. It is essential
that the athlete is free of any and all symptoms before he/she
returns to play. Often, I will initially clear an athlete to begin light
running and non-contact exercise, then later allow them to return to
full-speed, contact sports.
Incomplete healing of a first
head injury makes the athlete more prone to a second, often more severe head
injury- with death as an uncommon but possible outcome. Some athletes
may be diagnosed with post-concussive syndrome- symptoms that last for
weeks to months and not only affect sport participation, but also school and
personal relationships.
“My son has had
three concussions- is he OK to play football?”
Even when the symptoms have
finally cleared, any athlete who has suffered a previous head injury is at
greater risk for future head injuries. Often, parents of athletes with a
history of head injuries have to make tough decisions about certain sports
(football, soccer, hockey, for example) that have higher likelihood of head
injuries.
If your child has a history of
previous head injuries, or in any case of complicated head injury, call the
office or schedule an evaluation with a sports medicine physician comfortable
with managing head injuries. The brain is too valuable- obtain a complete
evaluation to reduce the long-term impact of head injuries and allow for
appropriate and safe return to activity.
“What’s going on
with all these serious knee injuries in youth sports?”
“Why do young
women seem to tear their ACL’s more than men?”
Unfortunately, most athletes and
sports fans are familiar with the term Anterior Cruciate Ligament (ACL) Tear,
as the past decade has seen a tremendous increase the in number of these
injuries.
The ACL is a support ligament
inside the knee that travels from the femur (thigh bone) to the tibia (shin
bone) and limits excessive forward motion of the tibia and is crucial to
overall knee stability. Seemingly innocent, non-contact movements such as
landing from a jump, twisting, cutting, or knee hyperextension are the most
common mechanisms for ACL tears.
Studies involving several sports
(basketball, volleyball, soccer) indicate that young women tear ACL’s at a
higher rate than young men. Several theories abound as to the reason, but there
is no consensus explanation. Does this mean that young women should not play
these type of sports? Of course not. It does mean that more study is needed,
and certain precautions should be taken (see next section).
Tearing an ACL brings up some
difficult decisions- the athlete can select sports that don’t involve cutting
or jumping, or if they wish to continue higher-risk activity, surgical
reconstruction with 6-9 month rehabilitation periods are options. Without
activity modification, very few young, active athletes can return to high-level
sports without frequent knee pain, instability and pain.
“How can an
athlete protect his/her knees?”
1)
Land from a jump on both legs- single-leg landing brings
about a higher risk for ACL tear.
2)
Land or cut with the knee slightly bent versus completely
straight.
3)
Strengthen the hamstring muscles- these compliment the ACL
in reducing forward tibia (shin bone) motion.
4)
Controlled plyometric exercises (bounding and leaping) may
strengthen the legs and reduce risk of ACL tears
5)
Make certain the athlete has good basic jumping and
sport-specific skills before starting full speed on-field play.
6)
Knee braces have not been shown to prevent an ACL injury-
they may have a role in stabilizing the knee after an injury.
PART SEVEN- WEIGHT TRAINING
“At what age can
my child begin weight training?”
There is no magic age at which a
child can begin weight training. Readiness for weight training depends on child’s
willingness to lift weights, follow directions, and maintain the program
for several months to see results. Remember, this is for the child, not for an
adult or coach.
Weight training should supplement
regular sport activity- it is not acceptable to have weight training injuries
keep an athlete away from his/her sport. I recommend qualified supervision by a
performance or physical trainer who routinely works with children and
adolescents. The focus should be on appropriate-sized equipment, meticulous
weight lifting technique, starting with low weights/high repetitions, and
working multiple body parts. In appropriate program, a child will often lift
weights 2 or 3 days a week with at least 48 hours of rest between sessions.
The physical results, such as
muscle enlargement and weight gain, depend on the gender and developmental
stage of the child. Androgens are a particular hormone, produced more in boys
than girls, that produce muscle and strength gains. Since androgens increase
late in puberty (right after the growth spurt- age 11-12 in girls, age 13-14 in
boys) lifting before this time will not result in massive muscle bulking or
extreme strength gains. Does this mean one shouldn’t lift before this point?
No…just place the emphasis on good technique and reduce the expectations for
big-time muscle gain. Remember, due to lower androgen production than boys,
girls will have less increase in muscle mass.
“Is weight
training safe for children?”
Studies have shown that a
properly designed and supervised resistance training program can be safe for
children and young adults. Contrary to popular belief, weight training at a
young age does not stunt growth- as long as proper techniques are
utilized. There are reports of overuse
injuries- back strains are the most common- but at no greater frequency than
what is seen on the athletic field. Again, placing the emphasis on a properly
designed and supervised resistance training program will help reduce injuries
and maximize enjoyment.
“Does weight
training work?”
Both published studies and
personal experience have shown impressive strength, speed, and endurance gains
with an appropriate weight training program. There is no good scientific data
to show that this directly translates to better on-field performance, but
again, personal experience suggests that it helps create a more well-rounded
athlete. The athlete needs to be aware that he/she must stay with the program
or risk losing the gains.
“Can weight
training reduce injuries?”
Two high school-based studies
indicate that a resistance training program could decrease the number and
severity of injuries, and also reduce the rehabilitation time once an injury
has occurred. These benefits may be due to stronger supporting joint
structures, muscle absorbing more energy before tiring out, and greater muscle
balance around a specific joint.
PART EIGHT- SOME WORDS ON SOCCER
“How can we
reduce the number of knee injuries seen in soccer?”
There is a growing incidence of
serious knee injuries in soccer- especially in young women. Tears of the
Anterior Cruciate Ligament can be season or multiple season-ending injuries.
For suggestions on how to reduce the risk- see the section on Protecting
Heads and Knees.
“What about all
this we’re hearing about heading and brain injury?”
After a few studies were
published suggesting a connection between repetitive heading and long-term
neurologic issues in former soccer players, the soccer and sports medicine
community has debated the safety of heading, especially in younger players.
Based on a recent review of the scientific literature, I can make the following
observations and recommendations:
1)
There is no documented connection between repeated
heading and long-term head injury/neurologic damage. There has been no “index
case” or example of an athlete who has neurologic damage solely from repetitive
heading of the ball.
2)
There is a significant risk of head injury in
soccer- not from repetitive heading, but rather from contact with the ground,
another player, or the goalpost. Since a history of previous head injury places
a player at higher risk for further and more serious head injuries, I now take
more time when evaluating soccer participation in athletes with a history of
previous or serious head injuries.
3)
The scientific literature has not shown the ability of helmets
to reduce the risk of head injury in soccer. Thus, many sports medicine
physicians do not recommend helmets at this time.
4)
It is essential to teach proper heading technique-
striking the ball with the forehead as the head, neck and torso are in a solid
line without any twisting. Children are not developmentally ready to learn this
skill until age 10- thus I do not recommend teaching heading skills (ex:
lining kids up to head the ball) until this age.
5)
It is also imperative that officials strongly enforce
the 10-yard rule on restarts to reduce the risk of a ball striking a child
directly in the head.
6)
Do not let children play around or hang on the
goalposts. The sports medicine literature is full of case reports of
serious injuries and even deaths from goalpost-related injuries.
PART NINE- SWIMMING ADVICE
“Do you have any
guidelines for practice time and competition as children get older?”
Age 5-7 Two 20-60 minute sessions per week
Focus
on basic water skills and stroke, kick and diving techniques
Focus on 25-meter distances
No competition
Age 8-9 2-3 sessions per week of 45-60 minutes
More
advanced skills and techniques
Focus
on 25-50 meter distances
Competition
for self-improvement and fun
Age 10-12 3-5 sessions per week of 60-90 minutes
Introduction
to more competitive stroke techniques
Start
interval training
High-level
competition (state level)
Age 13-16 5-9 sessions per week of 90-120 minutes
per session
Gear
training for season competition with peaking for 1-2 events
Competition
at highest levels possible
“How can a
swimmer reduce shoulder problems?”
First and foremost, maintain a
sensible training schedule with age-appropriate limitations in distances and
sessions per week, with sufficient rest between training sessions. Focus on
meticulous stroke technique and vary strokes to reduce overload of one
particular stroke on the shoulder joint.
Another important recommendation:
a rotator cuff strengthening program.
The four rotator cuff muscles
keep the humerous (funny bone) in proper location within the shoulder joint- if
they get tired, which often happens during repetitive overhead activity such as
swimming, shoulder pain is usually the end result.
Realize that many coaches either
don’t understand the importance or don’t want to take away important
“pool-time” to teach the exercises. However, experience and study has shown
that an appropriate rotator cuff strengthening program can supplement swim
training and reduce shoulder pain and missed pool time.
Schedule an appointment or
contact a sports medicine professional to develop an appropriate program.
PART NINE- BASEBBALL
“How many
pitches can a pitcher throw a week?”
“When should a
pitcher learn how to throw a curveball?”
“Why does my
daughter’s arm always hurt?”
Let’s start with one statement: overhand
throwing a baseball or softball is not a natural action for the human arm or
shoulder. Underhanded softball
pitching is slightly more forgiving on the shoulder, but can place unique
stresses on the elbow.
A parent cannot let ego or
immediate gratification get in the way of an immature arm- too much throwing,
or throwing off-speed pitches at too young of an age, may create significant
damage. Sure, making all-stars at age 11 with a wicked curveball is a great
feeling, but not being able to throw at age 16 due to permanent elbow damage is
a real bummer. Remember, elbow or shoulder injuries are a common career-ender-
many pro scouts or college coaches will shy away from the athlete with a
history of arm problems. Even with the best of sports medicine care, there are
certain injuries from which no pre-professional pitcher has ever recovered to
pitch in the majors…
While pitchers get the most
attention, let’s not forget other high-volume throwing positions such as
catcher and shortstop.
If I have a personal crusade,
it’s to save the arms of all the catchers out there. There aren’t too
many willing and talented catchers, so when one shows up, he/she gets a lot of
playing time. When there is a pitching change, that catcher is still out there.
From warming up pitchers in the pen to gunning out runners at second base, I’ve
seen many a young catcher develop arm troubles. Be careful with catchers- give
them ample time at low-volume throwing positions and regular off-days.
Now, some tips on arm hygiene
1) Focus on correct
throwing technique: Every player at each position should know how to properly
throw a baseball. Of course, this is especially important for pitchers-
particularly as they fatigue in later innings. Signs of fatigue and poor
technique include: dropping the elbow (should be always at
shoulder-level), opening up too soon (chest facing the plate before the
elbow is ready to deliver the baseball) and getting pitches up in the strike
zone or poor command/velocity.
2) Proper warm-up: short toss first
(10-20 yards, 10-20 easy throws), progress to long-toss (35-40 yards, 10-15
easy throws) then finally to mound work
3) No off-speed
pitches (curve, sliders, breaking balls) until the arm is fully mature (age
13-14 in girls, 14-15 in boys).
4) No off-speed
pitches (curve, sliders, breaking balls) until the arm is fully mature (age
13-14 in girls, 14-15 in boys).
Just wanted to emphasize the point.
5) Observe age-appropriate
pitch counts- Pitch counts are a more appropriate arm-stress measure than
innings pitched
|
8-10 years old |
50-60 pitches
per week |
|
10-12 years
old |
60-80 pitches
per week |
|
12-14 years
old |
80-90 pitches
per week |
|
16+ |
100-120
pitches per week |
Realize that these pitch counts
are per week- so if a pitcher is on two or three teams at age 13, the proper
count is 80-90 pitches per week, not 80-90 per team. Also realize that all
“pitches” count- even if done in practice, private pitching lessons, backyard,
or in the bullpen between appearances.
One can compare the cumulative
pitch count on a young pitcher to the odometer on a new car. Just as a car has
so many miles before things start breaking down, the arm has so many throws
before it too starts to fall apart. Too many throws too early in life, and
there may not be much left later on….
6) Realize the symptoms of arm
trouble- then get professional advice- many throwers are accustomed to a
certain soreness that comes after games. If this soreness intensifies into
actual pain, or lasts longer than usual- call and schedule an evaluation. Other
warning signs: any joint stiffness or swelling (maybe OK in adults, unacceptable
in young throwers), decreased accuracy or velocity, poor throwing technique, or
forced changes in technique due to pain or stiffness.
“What other
safety recommendations do you have for baseball?”
1)
Have younger children use breakaway bases- greatly
reduce sliding injuries
2)
No “on-deck” circle for younger children
3)
All batters must wear a helmet when facing any type
of live pitching
4)
Catchers must wear full protective equipment- even in
warm-ups
5)
Use reduced impact baseballs for younger players
PART TEN- RUNNING
“Do you have any
guidelines for distance running and children?”
The risks of injury and illness
in distance running are related to the total mileage and number of hours
training per week. The following are
age-appropriate training recommendations:
Age up to 14 years old not more than 3-4 times per week
15-18 years old: no more than 5-6
times per week
Duration of each session should
not exceed 1½ hours
Do not increase mileage by more
than 10% per week
Some recommended maximum
distances by age
9-11 3 miles
12-14 6 miles
15-16 13 miles
17-18 25 miles
Until further data are available
concerning the relative risk of endurance running at different ages, the
American Academy of Pediatrics recommends that, if children enjoy the activity
and are asymptomatic, there is no reason to preclude them from training for and
participating in such events.
PART ELEVEN- FOOTBALL
“How can I reduce the risk of my child getting
hurt in football?”
Yes, the risk of injury is
greater in football than in many other sports- thankfully, there are proven
recommendations that can reduce both the risk and long-term impact of football
injuries.
1)
Do not tackle with the head- look straight at
the opponent when making a tackle- don’t lead with the head (spearing) or bend
the neck at the point of contact. Banning spearing and teaching proper head
position when tackling have reduced serious neck injuries and paralysis.
2)
Do not tackle with the head.
3)
Wear well-fitting, appropriate safety equipment in good
repair- Don’t even think of taking the field without a full set of
equipment- and make sure it fits the athlete well- especially the largest and
smallest members of a team. Check equipment (especially the helmet air
bladders) once a week, and make immediate repairs when needed. Don’t forget the
importance of eye protection and mouth guards- no quicker way to destroy
several thousand dollars of orthodontic work.
4)
Learn proper technique- Younger athletes should focus on
the basics- throwing, blocking, tackling, and most importantly- learning how to
absorb a tackle. Make sure coaches are well trained in safe techniques and
these skills are reviewed in every practice or game.
5)
Create teams with appropriate weight and age divisions- 2-3 year age
differences or 30-40 pound weight discrepancies have great potential for injury
in youth football.
6)
Be real careful about ‘making weight’ or weight loss
techniques- Cutting weight or rapid weight gains can create health issues for
young children- do not force any child to rapidly gain weight or lose any
weight without consulting a pediatrician or sports medicine physician.
“How can my
child survive August ‘double-days’?”
Football players should prepare
for pre-season practices- ask coaches for training recommendations. Don’t go
straight from the couch to the field- know what will be expected on the first
few days.
Adequate hydration is absolutely
essential- drink 2-3 large glasses of fluid throughout the day before practice,
then drink regularly through practice. Get in the habit of weighing players
before and after practice- for every pound lost, drink 2 large glasses of fluid
(about 16 ounces) after practice. Measures of proper hydration- the athlete has
regained all lost weight and has clear urine (looks like water).