Parent's Field Guide to Spotting Trouble (and possible injury)

As a parent, my number one job at all times is to make sure my children are safe. Period. 

When they’re young, what we’re looking for as parents is a piece of cake: things like shouting “Look both ways!” as they get ready to cross the street. Or, “have you washed your hands?” before dinner. But, as our children turn into young adults with their physical abilities developing at lightning speed, it can become less obvious to know what to do, say, or ask when you sense *something’s* not right.

At the youth levels (under age 15, especially), coaches are almost always under supported, so waiting on the coach or a member of the medical staff (ha, the team doesn’t have that - you’re it!) to make the call or assessment is likely inefficient.

Get Certified!

Before I dive into my tips, please be sure to take the time to take and/or maintain a current CPR/First Aid course. This is a crucial step helping to identify and respond to emergencies. Having as many people around sporting competitions who are trained in these areas is extremely important and falls under the “it takes a village” category.

Let’s Get to It

Alright, to help with spotting signs of trouble early, below is a field guide of sorts based on the information I’ve gathered over the years. Injury and potential for injury is something that I’ve spent countless hours and many years cataloging as I watched thousands of practices and competitions.

Here’s the thing I want to get across: I’ve learned to greatly appreciate how important it is to put the health of the athlete’s body over all else. As a parent, I’m sure you agree and want you to know that you can and should help.

You may read some of my below recommendations and think: there’s no way my kid is going to get taken out of practice simply because of X, Y, or Z. But, if the consequence of NOT taking action is life altering pain or surgery, would it be worth it?

Here are five things to look out for:

1. Trust your gut. No one knows how your child moves, feels, and responds to questions better than you. If something feels off, you should investigate further.

2. Discuss the realities of injury with your child at a time outside of practice/competition. Explain that your main goal is to keep them safe/healthy and if you notice something you want to know more about that you may pull them aside to find out more. Setting expectations ahead of time can go a long way “in the moment” when they don’t want to answer your questions.

3. Watch locomotor patterns: this is a big one! If your child’s gait becomes visibly abnormal and doesn’t smooth back out after a few minutes, you will need to find out what’s going on. A stride with a visible limp or another compensatory pattern of some kind (leaning to one side, for example) must be addressed.

   1. Possible causes to consider: previous injury, strained muscle(s), stress fracture, growth, stress reaction

      1. If your child is coming back from muscle strain or another known injury, just a brief check in to find out how they’re doing and then reverting to the action plan, as needed

      2. If there is no known injury, ask questions and use your best judgement.

   2. If your child is able to normalize their gait within a few minutes, make a mental note and follow-up afterwards.

4. Repeatedly grabbing a body part after movement: you usually see athletes do this who are working through some kind of discomfort (ex, pitchers and their shoulders or elbows). Use this as a trigger to ask questions.

   1. It is worthwhile to find out where the discomfort is coming from: joint, muscle, or something internal? As this will give you insight on any subsequent actions that need to be taken.

   2. Young athletes will often give a response indicating they’re “working it out” or “a little tight”. From experience, I can tell you that something at least slightly more significant is underlying those answers. Root causes often harken back to a strength deficit and/or overuse.

5. Head impact: this could be a fall to the ground or an impact with another player or object. Head injury should be taken very seriously and always err on the side of caution. If your child was knocked unconscious, seems disoriented, or vomits as a result they need to be removed from practice/competition and evaluated by medical personnel.

A couple other tips to help your kids succeed: keep an eye on hydration (all sports) and temperature (outdoor sports) - climate change is real and exposure to extended periods of extreme heat should be considered and planned for; check out the warm-up - a thorough warm-up is important to reduce injury; have the proper equipment - you don’t have to buy the most expensive options, just be sure shoes, clothing, gloves, etc fit well.

This is a light list of what to watch out for, but in my experience these cover the majority of trouble areas for most sporting activities. If you are a parent reading this, I hope that you feel encouraged and supported to raise the red flag when things are off. Just remember to trust your gut and ask questions.

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Thank you! SAPT

Early Sport Specialization: Why This Needs to Stop (with a capital "S")

Here in northern Virginia, and in other hub-bub places too, it's not uncommon for an athlete to play a sport during the high school season, and then transition straight into the club season (which lasts f-o-r-e-v-e-r), leaving the athlete with maybe 2-3 weeks rest before try-outs for the next year's high school season start. Does this sound familiar? Does this sound healthy? Today we're going to address a growing (alarmingly so) problem with youth athletics: early sport specialization. As a strength coach, I see some messed up kids when it comes to movements, joint integrity, and muscle tissue quality (all = poop) who play year-round sports at young ages (that is, under 16-17 years old). I see year-round volleyball players who can't do a simple medicine ball side throw. Why? Because they spend ALL YEAR moving in the saggital (forward/backward) plane with a little bit of the frontal plane (side to side shuffling, but even that is dominated by their inability to actually move sideways; they tend to fall forward and/or move as if they're running forward, just facing a little bit to the side.) They have limited movement landscape (remember this?) and therefore are limited athletes.

I see young baseball players with chronic elbow or shoulder pain. Why? Because they throw a ball the same way ALL YEAR ROUND. And they're not strong enough to produce the force needed to throw it properly, (because, heaven forbid, they take some time off to actually weight train and get stronger) so they rely on their passive restraints (ligaments, tendons, and joint capsules) to throw.

This topic gets me fired up because I see SO MANY injuries and painful joints in kids who shouldn't have injuries or painful joints. I see kids who can't move like a normal human being because they're locked up and, worse, don't even have the mind-body connection to create movements other than those directly related to their chosen sport.

There's this pervasive myth that if a kid doesn't play year round or get 10,000 hours of practice, then he/she will never be a good athlete. Parents get caught up in chasing scholarships and by golly, if Jonny doesn't play travel ball he'll fall behind, then he won't make varsity, then he won't get into a good college... and on and on. My friends, we need to take a step back and think about what's best for the athlete. Do the aforementioned afflictions sound good to you?

But enough of my opinion, let's look at some hard science to support the Stop-Early-Specialization-Theory.

Playing multiple sports and playing just for the sake of running around like a kid builds a rich, diverse motor landscape, especially during the years before late adolescence. Diversifying the motor landscape, or movement map, or the bag-o-skillz, or whatever you want to call it, is essential to human development and especially valuable to athletes. I'm going to sound like a broken record, but kids need a broad and varied map to:

1. Understand how to move their bodies through space

2. Create and learn new movements

3. Learn how to adapt to their environment

4. Develop better decision making and pattern recognition based on their circumstances (i.e. being able to find the "open" players in a basketball game helps in finding one on the soccer field. )

Matter fact, this really smart fellow, Dr. John DeFirio MD, who is the President of the American Medical Society for Sports Medicine, Chief of the Division of Sports Medicine and Non-Operative Orthopaedics at the David Geffen School of Medicine at UCLA and Team Physician for the UCLA Department of Intercollegiate Athletics (that's quite the title, eh?) says this:

"With the exception of select sports such as gymnastics in which the elite competitors are very young, the best data we have would suggest that the odds of achieving elite levels with this method [early sport specialization] are exceedingly poor. In fact, some studies indicate that early specialization is less likely to result in success than participating in several sports as a youth, and then specializing at older ages"

And, Dr. DiFiori encourages youth attempt to a variety of sports and activities. He says this allows children to discover sports that they enjoy participating in, and offers them the opportunity to develop a broader array of motor skills. In addition, this may have the added benefit of limiting overuse injury and burnout.

You can read his full article here. The article also notes two studies in which NCAA Division 1 athletes and Olympic athletes were surveyed regarding what they did as children. Guess what? 88% of the NCAA athletes played 2-3 sports as kids, and 70% of them didn't specialize until after age 12. The Olympians also all averaged 2 sports as kids  Are you picking up what he's putting down? Specialization doesn't make great athletes, diversification does!

Side bar: Check out Abby McCollum, who played 4 sports for a Division 1 school. The article says that she was recruited last minute... probably because she was such a great all-around athlete that she could play any sport.

Next up: injuries rates.

Dr. Neeru Jayanthi, a sports medicine physician, in conjunction with Loyola University published a few studies using a sample set of 1,026 athletes between ages 8-18 who came into the Lurie Children’s Hospital of Chicago for either sports physicals or treatment for sports-related injuries. The study ran from 2010 to 2013.  Dr. Jayanthi and her collegues recorded 859 injuries, of which 564 of them were overuse injuries (that's well over HALF). Of those 564 injuries, 139 of them were serious injuries concerning stress fractures in the back or limbs, elbow ligaments or injuries to the cartilage. All of these injuries are debilitating and can side line and athlete for 6 months or more. The broad study is reviewed here and a more specific cohort (back injuries, which carry into later in life) is here. I highly recommend reading both as the data are eye opening.

To sum up Dr. Jayahthi and co.'s recommendations on preventing overuse injuries (I took it directly from one of the articles in case you don't have time to read them both):

• If there's pain in a high-risk area such as the lower back, elbow or shoulder, the athlete should take one day off. If pain persists, take one week off. (though I think it should be more)

• If symptoms last longer than two weeks, the athlete should be evaluated by a sports medicine physician. (and go get some strength training! There's a reason that pain is occurring; something is overworking for something else that's NOT working.)

• In racket sports, athletes should evaluate their form and strokes to limit extending their backs regularly by more than a small amount (20 degrees). (this should also apply to any overhead sport like volleyball, baseball, softball, etc.)

• Enroll in a structured injury-prevention program taught by qualified professionals. (hey, like SAPT? Lack of strength is a common denominator among injured athletes.)

• Do not spend more hours per week than your age playing sports. (Younger children are developmentally immature and may be less able to tolerate physical stress.) (10 year-olds don't need 12 hours or soccer! Also check out Dr. Jayahthi's injury prediction formula.)

• Do not spend more than twice as much time playing organized sports as you spend in gym and unorganized play. (Kids, go play tag, get on the playground, play capture the flag, anything; JUST PLAY!)

• Do not specialize in one sport before late adolescence.

• Do not play sports competitively year round. Take a break from competition for one-to-three months each year (not necessarily consecutively).

• Take at least one day off per week from training in sports.

The highlights and comments are mine. Do you see the RISK involved in specializing in a sport early in life? Not only does the risk of injury skyrocket, and the ability to move fluidly and easily plummet, but there's a lot of external pressure on the athlete to perform. Stressed athletes don't perform well. I don't know how many times I've asked my year-round players what they're doing on the weekends, it's always "tournament" or "practice." They have NO LIFE outside of sports. To me, that seems unhealthy and frankly, a recipe for burn-out.

Parents, athletes, and coaches, in light of all this research, I urge you to strongly reconsider year-round playing time for kids under 16 or 17. I urge you to allow athletes time off, to play other sports besides they're favorite, and to just be a kid. I urge you to keep the long-term development of our athletes in mind; do you want to risk a permanent injury, hatred of sport (because of burn out), or development of weird compensations and movement patterns?

Let's build strong, robust athletes that can do well in the short- and long-term instead of pigeon-holing them into a particular sport and limiting their athletic potential.