Wednesday, February 22, 2012

Play it Safe!

As the Spring sport season approaches, it is a good time to review the importance of playing safe to prevent injuries.  Parents want their children to grow up to be well rounded academically and physically.  A great way to be physically fit is to participate in sports, but often kids do too much too soon or play with an injury- which can lead to worsening the injury and removal from the game.  Unfortunately by 13 years of age many kids leave sports due to feelings of inadequacy or burnout.  They lose the many benefits of athletics, including physical exercise, mental well being, drug abuse prevention, and more.  Most young kids should not play at an elite level.  Not all will be natural athletes, but all can and should participate in life long sports to varying degrees.  Emphasizing having fun while improving performance can help kids feel less pressure to win and be the star athlete, but even the star should emphasize fun at younger ages!

In general there are two types of injuries: acute and overuse.  Overtraining syndrome is a mental as well as physical issue that can lead to decreased performance and sports burnout. Acute injuries are commonly recognized, and include things such as sprained ankle, wrist fracture, or concussion.  Overuse injuries are less often identified and are more difficult to diagnose.  They occur subtly over time from repetitive trauma to the bones, joints, and tendons.  Examples include little league elbow, gymnast wrist, or stress fractures.

Acute Injuries:  Although not all injuries can be prevented, you can decrease the risk of acute injuries  by adhering to the rules of the sport and the sport-specific safety measures recommended.  If injury is suspected, removal from the sport until injury is healed is important to prevent further injury.

Overuse Injuries:  In the child and adolescent, overuse is the cause of up to half of all pediatric sports injuries.  It is bone, muscle or tendon microtrauma caused by repetitive stress without adequate healing time.  It begins with pain after activity, then pain during activity without affecting performance, followed by pain during activity that affects performance, and finally pain even at rest.  Children are at increased risk because of their growing bones and inability to recognize or describe symptoms.

Overtraining Syndrome (“burnout”) is the psychologic, physiologic and hormonal changes that lead to decreased performance.  Symptoms include chronic muscle or joint pain, personality changes, increased heart rate at rest, decreased sports performance, fatigue, lack of enthusiasm, and inability to complete usual routines.  Prevention includes encouraging a variety of sports throughout the year, making workouts interesting and fun and having athletes take 1-2 days off per week, plus 2-3 months off per year for other activities.  Overtraining can lead to burnout in the early years, which can cause a child to end participation in sports altogether, which may cause inactivity and contribute to the obesity epidemic in our country.

In general, injury prevention begins with making sure your child is playing in a safe environment with a knowledgeable coach and well fitted safety gear.  My favorite tips:

  • Remember that many coaches are volunteers with little (or no) specific training.  Don't assume the coach knows how to prevent or treat injuries... you should ask what their experience is!  Be sure there are always at least 2 adults around (this is abuse prevention... another topic entirely, but important!) 
  • Encourage athletes to take the time to warm up and cool down.  
  • Make sure athletes drink plenty of water, especially in warm weather. 
  • Be sure they are playing at a level that meets their skills. 
  • Let them know that they should enjoy playing for the fun of the game, not to win.  
  • Be sure to remind them that you enjoy watching them play ~ not watching them win!  
  • Have kids take time off a favorite sport to try something different for a season.  This not only keeps the game fun, but it works different muscle groups and improves overall fitness.  
  • I am also a firm believer in sleep for kids of all ages! Sports practices and games can interfere with an appropriate bedtime and adequate sleep, so make sure your child doesn't suffer from sleep deprivation. 

American Academy of Pediatrics Guidelines and Recommendations Include:

  • Athletes should take 1-2 days off per week from competitive athletics and competitive practice to allow physical and psychological recovery.
  • Athletes should be a member of only one sport per season.
  • Athletes should take at least 2-3 months away from a specific sport during the year.  During this time another fun activity can be done to prevent loss of skills or conditioning.
  • The focus of participation should be fun, skill acquisition, safety, and sportsmanship.
  • Weekly training time, number of repetitions or total distance should not increase by more than 10% per week.
  • Watch for possible burnout if the athlete complains of nonspecific muscle or joint problems, fatigue or poor academic performance.  Consider time off at that time to allow physical and psychological recovery.
  • Use caution for younger athletes who participate in multiple games during a short time period.
  • Children should participate in a sport at a level consistent with their ability and interest.
  • Single sport specialization should be avoided before puberty.  Young athletes who participate in different sports at various seasons have less burnout and fewer overuse injuries.
  • Parents should be aware of the coach’s knowledge of proper training techniques, equipment and training of a particular age group.  Parents should encourage organizations to mandate coach training in these areas.
  • Never allow an injured athlete to participate in activities until completely healed or cleared by a physician.
  • Children are more at risk for heat injury.  Proper hydration should be encouraged.  Avoidance of prolonged activity in moderate temperatures or any activity in extreme temperatures should be enforced.  
  • Ensure proper nutrition:         

    Proper caloric intake is based on body size and growth rate in addition to calories burned.  Monitor for signs that the athlete is trying to lose weight to benefit performance (to the detriment of overall growth).
    Balance nutritional elements based on the Food Guide Pyramid.
    Adequate iron is needed.  The amount of iron needed in the diet is highest during the growing years and sports may contribute to iron losses.  Athletes need adequate iron to bring oxygen to tissues in the body.
    Calcium intake is important for normal bone growth and possibly to help prevent and heal stress fractures.

    Resources and References:

PEDIATRICS Vol. 106 No. 1 July 2000, pp. 154-157, AMERICAN ACADEMY OF PEDIATRICS:  “Intensive Training and Sports Specialization in Young Athletes.”  Committee on Sports Medicine and Fitness.

    PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1242-1245, “Overuse Injuries, Overtraining and Burnout in Child and Adolescent Athletes.”  Joel S. Brenner, MD, MPH and the Council on Sports Medicine and Fitness.

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