Overuse Injuries in Young Athletes

Injuries in young athletes are on the rise, but elbow and shoulder injuries in children are on the verge of becoming an epidemic. Thousands of children are seen each year complaining of elbow or shoulder pain. Damage or tear to the ulnar collateral ligament (UCL) is the most common injury suffered and is often caused by pitchers throwing too much. This ligament is the main stabilizer of the elbow for the motions of pitching. When it becomes damaged, it can be difficult to repair and rehabilitate.

HOW IS AN ELBOW OR SHOULDER INJURY DIAGNOSED?

If a young athlete is throwing too hard, too much, too early, and without rest, a serious elbow or shoulder injury may be on the horizon. If the athlete complains of elbow or shoulder pain the day after throwing, or movement of the joint is painful or restricted compared to the opposite side, see a physician familiar with youth sports injuries immediately.

HOW CAN OVERUSE BASEBALL INJURIES BE PREVENTED?

Overuse injuries – especially those related to the UCL and shoulder – are preventable. Some tips to keep you in the game throughout your life include:

photo: youth baseball athlete

  • Warm up properly by stretching, running, and easy, gradual throwing
  • Rotate playing other positions besides pitcher
  • Concentrate on age-appropriate pitching
  • Adhere to pitch count guidelines, such as those established by Little League Baseball (See tables)
  • Avoid pitching on multiple teams with overlapping seasons
  • Don’t pitch with elbow or shoulder pain, if the pain persists, see a doctor
  • Don’t pitch on consecutive days
  • Don’t play year-round
  • Never use a radar gun
  • Communicate regularly about how your arm is feeling and if there is pain
  • Develop skills that are age appropriate
  • Emphasize control, accuracy, and good mechanics
  • Master the fastball first and the change-up second, before considering breaking pitches
  • Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

HOW IS AN OVERUSE ELBOW OR SHOULDER INJURY TREATED?

The most obvious treatment for overuse is rest, especially from the activity that created the injury. Ice is also used to reduce soreness and inflammation. Ibuprofen can be taken to help with any pain. If symptoms persist, it is critical that a physician be contacted, especially if there is a lack of full-joint motion. An examination and radiographs should be done. An MRI scan may also be helpful.

Usually a simple “rest cure” approach will not be enough, because even though it allows symptoms to subside, it also creates loss of muscle bulk, tone, flexibility, and endurance. Once pain is gone and full motion is present, a throwing rehabilitation program can start.

Under some circumstances, surgery may be necessary to correct a problem. Overuse and stress related problems can affect growing parts of bone, not just the soft tissue (muscles, tendons, and ligaments). If the condition is not treated, it could cause deformity of the limb and permanent disability. The athlete should return to play only when clearance is granted by a health care professional.

Provided by The Andrews Institute

BASEBALL COMMON INJURIES AND PREVENTION TIPS

screenshot of the Baseball injury prevention info

Download .pdf

Injuries in young athletes are on the rise, but elbow and shoulder injuries in children are on the verge of becoming an epidemic. Thousands of children are seen each year
complaining of elbow or shoulder pain. Damage or tear to the ulnar collateral ligament (UCL) is the most common injury suffered and is often caused by pitchers throwing too much. This ligament is the main stabilizer of the elbow for the motions of pitching. When it becomes damaged, it can be difficult to repair and rehabilitate.

HOW IS AN ELBOW OR SHOULDER INJURY DIAGNOSED?

If a young athlete is throwing too hard, too much, too early, and without rest, a serious elbow or shoulder injury may be on the horizon. If the athlete complains of elbow or shoulder pain the day after throwing, or movement of the joint is painful or restricted compared to the opposite side, see a physician familiar with youth sports injuries immediately.

HOW CAN OVERUSE BASEBALL INJURIES BE PREVENTED?

Overuse injuries – especially those related to the UCL and shoulder – are preventable. Some tips to keep you in the game throughout your life include:

photo: youth baseball athlete

  • Warm up properly by stretching, running, and easy, gradual throwing
  • Rotate playing other positions besides pitcher
  • Concentrate on age-appropriate pitching
  • Adhere to pitch count guidelines, such as those established by Little League Baseball (See tables)
  • Avoid pitching on multiple teams with overlapping seasons
  • Don’t pitch with elbow or shoulder pain, if the pain persists, see a doctor
  • Don’t pitch on consecutive days
  • Don’t play year-round
  • Never use a radar gun
  • Communicate regularly about how your arm is feeling and if there is pain
  • Develop skills that are age appropriate
  • Emphasize control, accuracy, and good mechanics
  • Master the fastball first and the change-up second, before considering breaking pitches
  • Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

MAXIMUM PITCH COUNTS

Age Pitches / Game
7 – 8 50
9 – 10 75
11 – 12 85
13 – 16 95
17 – 18 105

Source: Little League Baseball

REST PERIODS REQUIRED

Ages 7–16 Ages 17–18 Required # of Rest Pitches
61+ 76+ 3 calendar days
41 – 60 51 – 75 2 calendar days
21 – 40 26 – 50 1 calendar day
1 – 20 1 – 25 None

Source: Little League Baseball

AGE RECOMMENDED FOR LEARNING VARIOUS PITCHES

Pitch Age
Fastball 8 ± 2
Slider 16 ± 2
Change-up 10 ±3
Forkball 16 ± 2
Curveball 14 ± 2
Knuckleball 15 ±3
Screwball 17 ± 2

Source: From work by James R. Andrews, MD, and Glenn S. Fleisig, PhD

HOW IS AN OVERUSE ELBOW OR SHOULDER INJURY TREATED?

The most obvious treatment for overuse is rest, especially from the activity that created the injury. Ice is also used to reduce soreness and inflammation. Ibuprofen can be taken to help with any pain. If symptoms persist, it is critical that a physician be contacted, especially if there is a lack of full-joint motion. An examination and radiographs should be done. An MRI scan may also be helpful.

Usually a simple “rest cure” approach will not be enough, because even though it allows symptoms to subside, it also creates loss of muscle bulk, tone, flexibility, and endurance. Once pain is gone and full motion is present, a throwing rehabilitation program can start.

Under some circumstances, surgery may be necessary to correct a problem. Overuse and stress related problems can affect growing parts of bone, not just the soft tissue (muscles, tendons, and ligaments). If the condition is not treated, it could cause deformity of the limb and permanent disability. The athlete should return to play only when clearance is granted by a health care professional.


From work by James R. Andrews, MD, and Glenn S. Fleisig, PhD

BASKETBALL COMMON INJURIES AND PREVENTION TIPS

screenshot of the Basketball injury prevention info

Download .pdf

Basketball was first introduced to the world in 1891 by Dr. James Naismith, using a soccer ball and two peach baskets. Today’s high-speed, physical sport scarcely resembles the original game. With modern basketball’s fast pace game come many opportunities for injuries. It is estimated that more than 1.6 million injuries are associated with basketball each year.

WHAT TYPES OF INJURIES ARE MOST COMMON IN BASKETBALL?

  • Ankle Sprains
  • Jammed Fingers
  • Knee Injuries
  • Deep Thigh Bruising
  • Facial Cuts
  • Foot Fractures

HOW ARE BASKETBALL INJURIES TREATED?

Ankle Sprains
Treatment for an ankle sprain involves rest, ice, compression, and elevation (RICE). The need for X-rays and evaluation by a physician is determined on aphoto: youth basketball player case-by-case basis and depends on the severity and location of pain. Pain and swelling over the bone itself may need further evaluation. An injury to the ankle in a child who is still growing could represent a simple sprain or could be the result of an injury to the growth plates located around the ankle and should be evaluated by a physician.
Jammed Fingers
Jammed fingers occur when the ball contacts the end of the finger and causes significant swelling of a single joint. Application of ice and buddy taping the finger to the adjacent finger may provide some relief and allow the athlete to return to play. If pain and swelling persist, evaluation by a physician or athletic trainer is recommended and an x-ray of the finger may be needed.
Knee Injuries
Basketball requires extensive stop and go and cutting maneuvers which can put the ligaments and menisci of the knee at risk. Injury to the medial collateral ligament is most common following a blow to the outside of the knee and can be often be treated with ice, bracing and a gradual return to activity. An injury to the anterior cruciate ligament is a more serious injury and can occur with an abrupt change in direction and landing for the jump. Although this ligament tear is most commonly a seasonending injury that requires corrective surgery, current techniques used to repair the ACL ligament generally allow the player to return to play the following season.
Deep Thigh Bruising
Treatment includes rest, ice, compression, and elevation. Commercially available girdles with thigh pads are now available for protection.

Facial Cuts

Depending on the depth of the injury, the cut may require stitches or a “butterfly” sterile tape. Ice may provide pain relief and decrease swelling. Players can return to play after all blood is removed and the wound is dressed.
Stress Fractures
Stress fractures can occur from a rapid increase in activity level or training or from overtraining. Stress fractures in basketball most commonly occur in the foot and lower leg (tibia). Once diagnosed, a period of immobilization and non-weight bearing is recommended. Return to play is permitted once the fracture has completely healed and the athlete is pain free.

HOW CAN BASKETBALL INJURIES BE PREVENTED?

  • Have a pre-season physical examination and follow your doctor’s recommendations
  • Hydrate adequately – waiting until you are thirsty is often too late to hydrate properly
  • Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
  • Maintain proper fitness – injury rates are higher in athletes who have not adequately prepared physically
  • After a period of inactivity, progress gradually back to full-contact basketball through activities such as aerobic conditioning, strength training, and agility training.
  • Avoid overuse injuries – more is not always better! Many sports medicine specialists believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out.”
  • Talk with your coach and/or athletic trainer about an ACL injury prevention program and incorporating the training principles into team warm-ups
  • The athlete should return to play only when clearance is granted by a health care professional.

Daniel E. Matthews, MD; Jo A. Hannafin, MD, PhD – Andrews Institute

Soccer: Common Injuries and Prevention Tips

From The Andrews Institute

Soccer is one of the most popular sports in the world and the fastest growing team sport in the United States. Although soccer provides an enjoyable form of aerobic exercise and helps develop balance, agility, coordination, and a sense of teamwork, soccer players must be aware of the risks for injury. Injury prevention, early detection, and treatment can keep kids and adults on the field long-term. Injuries to the lower extremities are the most common in soccer. These injuries may be traumatic, such as a kick to the leg or a twist to the knee, or result from overuse of a muscle, tendon, or bone.

Lower Extremity Injuries

Sprains and strains are the most common lower extremity injuries. The severity
of these injuries varies. Cartilage tears and anterior cruciate ligament (ACL) sprains in the knee are some of the more common injuries that may require surgery. Other injuries include fractures and contusions from direct blows to the body.

Overuse Lower Extremity Injuries

Shin splints (soreness in the calf), patellar tendinitis (pain in the knee), and Achilles tendinitis (pain in the back of the ankle) are some of the more common soccer overuse conditions. Soccer players are also prone to groin pulls and thigh and calf muscle strains. Stress fractures occur when the bone becomes weak from overuse. It is often diffi cult to distinguish stress fractures from soft tissue injury. If pain develops in any part of your lower extremity and does not clearly improve after a few days of rest, a physician should be consulted to determine whether a stress fracture is present.

Upper Extremity Injuries

Injuries to the upper extremities usually occur from falling on an outstretched arm or from player-to-player contact. These conditions include wrist sprains, wrist fractures, and shoulder dislocations.

Head, Neck, and Face Injuries

Injuries to the head, neck, and face include cuts and bruises, fractures, neck sprains, and concussions. A concussion is any alteration in an athlete’s mental state due to head trauma and should always be evaluated by a physician. Not all those who experience a concussion lose consciousness.

HOW ARE SOCCER INJURIES TREATED?

Participation should be stopped immediately until any injury is evaluated and treated properly. Most injuries are minor and can be treated by a short period of rest, ice, and elevation. If a trained health care professional such as a sports medicine physician or athletic trainer is available to evaluate an injury, often a decision can be made to allow an athlete to continue playing immediately. The athlete should return to play only when clearance is granted by a health care professional. Overuse injuries can be treated with a short period of rest, which means that the athlete can continue to perform or practice some activities with modifi cations. In many cases, pushing through pain can be harmful, especially for stress fractures, knee ligament injuries, and any injury to the head or neck. Contact your doctor for proper diagnosis and treatment of any injury that does not improve after a few days of rest. You should return to play only when clearance is granted by a health care professional.

HOW CAN SOCCER INJURIES BE PREVENTED?

  • Have a pre-season physical examination and follow your doctor’s recommendations
  • Use well-fi tting cleats and shin guards – there is some evidence that molded and multi-studded cleats are safer than screw-in cleats
  • Be aware of poor field conditions that can increase injury rates
  • Use properly sized synthetic balls – leather balls that can become waterlogged and heavy are more dangerous, especially when heading
  • Watch out for mobile goals that can fall on players and request fixed goals whenever possible
  • Hydrate adequately – waiting until you are thirsty is often too late to hydrate properly
  • Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
  • Maintain proper fitness – injury rates are higher in athletes who have not adequately prepared physically.
  • After a period of inactivity, progress gradually back to full-contact soccer through activities such as aerobic conditioning, strength training, and agility training.
  • Avoid overuse injuries – more is not always better! Many sports medicine specialists believe that it is beneficial to take at least one season off each year.
  • Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid “burn-out”
  • Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

Golf: Common Injuries and Prevention Tips

From The Andrews Institute

Golf looks like an easy game to play, hitting a stationary object with a club into a relatively wide open space. Well, think again! To become a good golfer, it is recommended that you start young and practice, practice, and practice. Golf historically is perceived as being a low-risk sport when it comes to injuries. However, many young golfers, especially those who lack proper technique, suffer from acute or overuse injuries.

WHAT TYPES OF INJURIES ARE MOST COMMON IN GOLF?

Acute injuries are usually the result of a single, traumatic episode, such as hitting the ground of a submerged tree root in a sand trap. Overuse injuries are more subtle and usually occur over time. These injuries will more often stem from the stress that the golfer puts on the back and shoulders when swinging. The three most commonly injured areas of the body are the back, shoulder, and elbow. They should be treated with rest, a good stretching/warm-up program, and good, sound advice from a golf professional.

WHY DO INJURIES OCCUR?

Approximately 44 percent of all reported golf injuries in youth are from overuse.photo: golf athlete The main causes of these injuries include:

  • Lack of flexibility
  • Poor conditioning
  • Excessive play or practice
  • Poor swing mechanics
  • Ground impact forces
  • Intermittent play

Poor flexibility is a key risk factor for a golf injury. One survey showed that more than 80 percent of golfers spent less than 10 minutes warming up before a round. Those who did warm up had less than half the incidence of injuries of those who did not warm up before playing. The golf swing is broken down into four phases: backswing, downswing, acceleration/ball strike, and follow through. Any limitations in range of motion (ROM) will hamper the golfer’s ability to achieve the proper swing plane, thus increasing the stress on the involved joints and muscles.

The second main reason for golf injuries is the repetitive nature of this sport. The golf swing involves repetitive, high-velocity movement of the neck, shoulders, spine, elbow, wrist, hips, knees, and ankles. The percentage of injuries directly correlates with the number of rounds or the number of range/practice balls struck per week.

INJURY PREVENTION

To avoid golf injuries at any age level, it is important for the golfer to develop a solid swing technique. The golfer who plays with a poor swing technique will have an increased risk of injury due to the excessive stress placed on their back, shoulders, and elbows. All golfers, no matter the age level, should have a specific routine of stretching/flexibility exercises they perform prior to starting each round. Along with their stretching/ flexibility exercises, they should always hit some golf balls before a game, starting with the wedge and gradually working their way up to the driver. You should never just grab the driver and go!

Seek the advice of a sports medicine specialist in your area if any injury occurs to get an accurate diagnosis and prevent recurrent problems. You should return to the course or range only when clearance is granted by a health care professional.

THE FUTURE OF KIDS GOLF

According to the National Golf Foundation’s most recent participation report, the number of golfers age 6-17 dropped 24 percent, to 2.9 million from 3.8 million, between 2005 and 2008. The reason cited is the intimidating design of today’s golf courses. Kids need to start on family-friendly facilities where they can be provided with some good old-fashioned training and teaching.

According to the foundation, the future of golf can be summed up in two words: fun and play. Their research indicates that when golf is no longer fun for the kids, they will lose interest. According to studies from Positive Coaching Alliance, parents and coaches tend to become too technical too early with kids, and one of the drawbacks of golf is that it’s a highly technical sport. Kids should be encouraged to play and have fun for their improvement, even if their shots don’t go exactly where they want them to go.