Description:
From the most renowned sports surgeon in the country, “a gold mine of contemporary cautionary information for the sports-minded” (Kirkus Reviews) to promote the prevention of sports injuries, especially among young people—featured on CBS This Morning.
Every year more than 3.5 million children will require medical treatment for sports-related injuries, the majority of which are avoidable through proper training and awareness. Dr. James Andrews, an orthopedic surgeon, sports medicine pioneer, and consultant to some of the fiercest teams in college and professional sports, distills his practical wisdom and professional advice to combat a growing epidemic of injury among sports’ most vulnerable population: its young athletes.
Any Given Monday is a sport-by-sport guide to injury prevention and treatment, written specifically for the parents, grandparents, and coaches of young athletes. Dr. Andrews covers every major sport, including football, gymnastics, judo, basketball, tennis, baseball, cheerleading, wrestling, and more. From identifying eating disorders to preventing career-ending ACL tears and concussions, Dr. Andrews reveals how young athletes can maximize their talent and maintain a lifetime of health—both on the field and off.
Every year more than 3.5 million children will require medical treatment for sports-related injuries, the majority of which are avoidable through proper training and awareness. Dr. James Andrews, an orthopedic surgeon, sports medicine pioneer, and consultant to some of the fiercest teams in college and professional sports, distills his practical wisdom and professional advice to combat a growing epidemic of injury among sports’ most vulnerable population: its young athletes.
Any Given Monday is a sport-by-sport guide to injury prevention and treatment, written specifically for the parents, grandparents, and coaches of young athletes. Dr. Andrews covers every major sport, including football, gymnastics, judo, basketball, tennis, baseball, cheerleading, wrestling, and more. From identifying eating disorders to preventing career-ending ACL tears and concussions, Dr. Andrews reveals how young athletes can maximize their talent and maintain a lifetime of health—both on the field and off.
Editorial Reviews
Review
"Young athletes are one of our most important resources, and in Any Given Monday Dr. Andrews provides them with the caution, wisdom, and inspiration they need to succeed in sports and in life." -- Brett Favre
"Dr. Andrews has long been recognized as a preeminent leader in sports medicine, and I have been fortunate to have him as my “go to” doctor throughout my career. Not only does he have a unique ability to truly understand athletes and the demands they place on their bodies to perform at the highest level, he also understands faith, family, and the balance we all need to live life to the fullest. This book belongs in the library of every parent and coach in the country." -- Bo Jackson
"Dr. Andrews is certainly among the best, and the best athletes come to him. I could not have played 16 years in the NBA without him—and most importantly he’s always been my friend." -- Charles Barkley
“Andrews, a pioneering orthopedic surgeon in his fifth decade of practicing sports medicine, is uniquely qualified to pen this type of medical sourcebook….A gold mine of contemporary cautionary information for the sports-minded.” ― Kirkus
“Andrews offers quick recommendations for a wide variety of high-participation sports…. [Any Given Monday is] a great pass-around for parents and grandparents and demands to be read by youth coaches, trainers, and sports administrators who, hopefully, will heed Andrews’ call for change.” ― Booklist
Dr. James Andrews has one of those names you’ve read a million times. But you’ve never really heard what’s on his mind until now." ― National Football Post
Both educational and entertaining, Any Given Monday includes anecdotes about Andrews’ remarkable career (he was a champion pole vaulter in his youth and later a successful yacht racer) as well as tips for coaches and trainers. ― National Post
Parents who have kids in sports - any sport, on any level - need to pick up a copy of Dr. James Andrews' new book ― Tulsa World
"Dr. Andrews has long been recognized as a preeminent leader in sports medicine, and I have been fortunate to have him as my “go to” doctor throughout my career. Not only does he have a unique ability to truly understand athletes and the demands they place on their bodies to perform at the highest level, he also understands faith, family, and the balance we all need to live life to the fullest. This book belongs in the library of every parent and coach in the country." -- Bo Jackson
"Dr. Andrews is certainly among the best, and the best athletes come to him. I could not have played 16 years in the NBA without him—and most importantly he’s always been my friend." -- Charles Barkley
“Andrews, a pioneering orthopedic surgeon in his fifth decade of practicing sports medicine, is uniquely qualified to pen this type of medical sourcebook….A gold mine of contemporary cautionary information for the sports-minded.” ― Kirkus
“Andrews offers quick recommendations for a wide variety of high-participation sports…. [Any Given Monday is] a great pass-around for parents and grandparents and demands to be read by youth coaches, trainers, and sports administrators who, hopefully, will heed Andrews’ call for change.” ― Booklist
Dr. James Andrews has one of those names you’ve read a million times. But you’ve never really heard what’s on his mind until now." ― National Football Post
Both educational and entertaining, Any Given Monday includes anecdotes about Andrews’ remarkable career (he was a champion pole vaulter in his youth and later a successful yacht racer) as well as tips for coaches and trainers. ― National Post
Parents who have kids in sports - any sport, on any level - need to pick up a copy of Dr. James Andrews' new book ― Tulsa World
About the Author
James R. Andrews, MD, is an orthopedic surgeon in sports medicine and a pioneer in arthroscopic surgery. His patients and consultations include Albert Pujols, Drew Brees, Brett Favre, Roger Clemens, John Smoltz, Charles Barkley, Jack Nicklaus, Hope Solo, Bo Jackson, Troy Aikman, Emmitt Smith, and both Manning brothers. Sports Illustrated recently named him as one of the top forty most influential people in the NFL. He is the team doctor for Auburn University, the University of Alabama, the Washington Redskins, and the Tampa Bay Rays. He is a founder of the American Sports Medicine Institute (ASMI) in Birmingham, Alabama, and the Andrews Research and Education Institute in Gulf Breeze, Florida.
Don Yaeger is a New York Times bestselling author, longtime associate editor at Sports Illustrated, and one of the most in-demand public speakers on the corporate circuit. He is the host of the highly rated Corporate Competitor Podcast. He lives in Tallahassee, Florida, with his wife and two children. Visit DonYaeger.com for more information.
Don Yaeger is a New York Times bestselling author, longtime associate editor at Sports Illustrated, and one of the most in-demand public speakers on the corporate circuit. He is the host of the highly rated Corporate Competitor Podcast. He lives in Tallahassee, Florida, with his wife and two children. Visit DonYaeger.com for more information.
Excerpt. © Reprinted by permission. All rights reserved.
Any Given Monday Introduction What Is the Point of This Book?
Why, after nearly forty years of practicing medicine and preparing for inevitable retirement, would I want to write a book? And since the focus of my practice for the majority of my career has been on adults, why would I choose to write a book about youth sports injuries?
The reasons are simple but tragic. I am writing this book because it absolutely needs to be written to help curb the growing epidemic that is endangering our most athletically talented children, adolescents, and young adults. I want to make sure that parents, grandparents, coaches, trainers, and all medical personnel are taking the steps now to maximize the opportunities for the next generation of young athletes. This book is intended to do just that: to raise awareness of the most common youth sports injuries and the best ways to prevent them, while explaining the most constructive ways to build a child’s potential. My hope is to educate all adults on how to protect an active child already involved in organized sports and how to select the best activities and safest exercises for a child who is looking to get physically fit.
Juvenile obesity (and the health risks brought on by the condition, such as diabetes and cardiovascular disease) has captured a great deal of media and political attention in recent years, and poor dietary choices and a more sedentary lifestyle are often to blame.
But what about the children at the other end of the spectrum: the ones who are not only physically active but also follow a strict athletic training regimen and dedicate dozens of hours every week to exercise and activity? The serious health risks facing those children are often overlooked or simply shrugged off as “just part of growing up.” But the truth is that youth sports injuries are an epidemic in American society, and we can do more to combat them.
Every year, more than three and a half million children under the age of fourteen require medical treatment for injuries incurred while participating in team or individual sports, and this number is on the rise. Over the past fifteen years, children have gone from being a rarity on my operating table to constituting nearly half of all my patients. More than one-fifth of all traumatic brain injuries in children are the direct result of athletic activity. Almost one-half of all sports injuries in adolescents stem from overuse, in which specific muscles and joints are damaged due to repetitive motion as part of athletic training or conditioning.
Yet despite these startling statistics, sports injuries are largely preventable, especially in children and adolescents. Even something as seemingly harmless as overuse of a joint or muscle can have a dramatic impact on future athletic ability, and even basic functions of movement and control. Both the short-term and long-term repercussions need to be considered when a child begins participating in any kind of sport.
Over the course of my nearly forty-year career, I have been the go-to surgeon for high-profile professional athletes such as Roger Clemens, Albert Pujols, Charles Barkley, Scottie Pippen, Kerri Strug, Jack Nicklaus, Raymond Floyd, Jerry Pate, Troy Aikman, Drew Brees, Brett Favre, Bo Jackson, Emmitt Smith, Terrell Owens, Sam Bradford, Matthew Stafford, and both Manning brothers, just to name a few. My goal has always been not only to return these great sports icons to the top of their game but also to help spread awareness of the causes and prevention of potentially career-ending injuries. Any Given Monday refers to the major consultation day in my clinic, when many of America’s premier athletes, fresh off broadcast TV, arrive at the Andrews Clinic in Birmingham, Alabama, or at the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Florida, for an examination of any injuries from their weekend matchups.
At least once a week, concerned parents will come into my clinic to inquire about their child’s hurt shoulder, swollen elbow, or aching knee and how that injury could affect his or her athletic participation. As part of the exam, I will ask the parents to detail the child’s practice schedule for the past month and year on a blackboard in the examination room so that we can look at it together. More often than not, the intensity, amount, and duration of the exercises are staggering—sometimes they are actually comparable to the training regimen of a pro. I sit down with the family and try to make them understand the potentially irreversible damage that such a schedule can do to a growing body; then we discuss better options. I want parents to seriously consider the implications of putting a twelve-year-old through the same paces as a twenty-five-year-old. Many times they have no idea as to the extent of the injury that their child is suffering; the focus of many parents and coaches is simply on pushing the child to achieve at the highest level possible for college opportunities or to gain a big break into the professional realm. What they often don’t seem to realize is that if a child’s body is overworked at an early age, he or she might not be able to stay in that sport long enough to make it to high school varsity, let alone to the elite level they so desperately desire. Families come to me to put their dream back together, but I want to make sure that parents and coaches understand how to prevent those dreams from shattering in the first place. Those adults have the child’s best interest at heart, but most do not fully understand the risk factors at play in a specific sport.
This dangerous trend is continuing to rise year after year, while the average age of the patients on my table continues to drop. Baseball, in particular, posts some of the highest numbers in terms of serious injuries in youth sports. Recently, in a single day, I completed eight Tommy John surgeries—an operation to repair an injured elbow. Two of my patients were major league pitchers, two pitched for college teams, and four were high schoolers ranging in age from fourteen to seventeen. The following day, I took a photograph of them all together, their arms in splints and ice bags on their shoulders. It was a remarkable day because it reminded me how widespread the problem of professional-level injuries has become, even at the teenage level.
This book will pull from the hundreds of anecdotes and examples I have collected over the past four decades to highlight the types of injuries that are common in athletics; the consequences of childhood injuries; and the advice, treatment, and rehabilitation plans I have prescribed for many of the sports stars you see dominating the field or court every week. Because of the real-life experiences of sports figures who have been on my operating table and now are outspoken advocates for youth sports injury prevention, this book offers readers a personal connection to the headliners who promote this important cause.
Additionally, Any Given Monday provides a reference guide to the twenty-eight most popular youth sports, outlining the health concerns most common to each, how best to treat them, and how to prevent them from happening again—or from happening in the first place. It also addresses the various myths and misconceptions surrounding juvenile orthopedic sports medicine and serves as an overall guide to raising healthy, injury-free children and young adults.
I want to take a moment to speak specifically to the grandparents who might be reading this book. I want to thank you for the interest you’ve taken in the lives of the grandchildren you love, and I hope you know that the role of grandparents in looking out for young athletes is now more important than ever. In some cases, grandparents are also primary caregivers, which is a serious undertaking. Athletics may have changed since you were in high school—both the types of sports that are now popular as well as the style or roughness of play. Safety equipment and rules may also have undergone some changes. I hope that this book will help you to gain a better understanding of current trends, rules, and modes of thinking surrounding youth sports.
For those grandparents, I also believe that the information presented here will help you feel more connected to the world of training and competition in which your grandchild is involved. But even more than that, I hope it helps empower you to voice any concerns you may have. Very often in my practice, I have seen that it was the grandparents who first recognized an overuse injury or burnout in a child or teen. Sometimes the parents are too close to the situation and so wrapped up in carpools, prepping postpractice snacks, and making sure that homework is completed after practice that they miss some of the warning signs right in front of them. Other times, a child might admit to a grandparent that he is experiencing pain or exhaustion due to participation in a certain sport but doesn’t want to tell his parents for fear of disappointing them. If grandparents sense that a grandchild is being overworked or overcommitted, I urge you to express your worries and your desire to see your grandchild live as healthily as possible. By gently explaining the long-term risks of year-round leagues and overuse injuries, you might be able to help protect the growing joints, muscles, and bones of the young athlete’s body, enabling him to maximize his talent as he grows older.
Because of the work conducted at my clinics in Birmingham and Gulf Breeze by my highly talented staff of physicians, surgeons, physical therapists, athletic trainers, and other experts, in 2010 Sports Illustrated named me one of the forty most influential people in the National Football League. It was an honor I both greatly appreciated and deeply regretted. It is my sincere desire to see a generation of athletes grow up knowing how to care properly for their bodies, how to explore and grow their talent in the most effective way, and how to reduce the need for work such as mine through proactive treatment.
As part of my effort to see this goal through to reality, all of my personal proceeds from Any Given Monday will go directly to the STOP (Sports Trauma and Overuse Prevention) Sports Injuries Campaign I helped to initiate as president of the American Orthopaedic Society for Sports Medicine (AOSSM) during 2009 and 2010. Together with members of our “Council of Champions”—including Hank Aaron, Bonnie Blair, Shaquille O’Neal, Bart Starr, Matthew Stafford, and industrialist Jim Justice, among many others—I have appeared on numerous public service announcements and talk shows on networks ranging from ESPN to HBO. To learn more, please visit the STOP website at www.stopsportsinjuries.org.
But lest this come across as a thinly veiled self-promotion, I need to stress that this book is not about me. My life and my career have never been an “I” statement but a “we” situation!
There are doctors out there doing far more to saves lives and combat serious illnesses than I have ever done or will ever do. There are many surgeons in my own field of orthopedics who are working continually to improve the lives of men, women, and children with devastating injuries. There are specialists dedicated to helping wounded veterans learn to adapt to life with prosthetic limbs and others who are focused on helping children with physical birth defects achieve full, enriching lives. These are the real heroes of the medical field: the doctors, nurses, and therapists who are helping one person at a time reclaim his or her birthright of “life, liberty, and the pursuit of happiness.”
But me? I have just been fortunate enough to work with famous people who throw or bat around a ball for a living.
Of course, athletes have every right to those goals as do the rest of us, but sometimes it seems a little backward that people know my name because they’ve seen it mentioned in articles or interviews with A-list sports celebrities and not because I’ve cured anything or changed the world for the better.
I think that’s important to state at the opening of this book. While I am writing about some of my experiences and philosophies, this book is not intended to celebrate my accomplishments or contributions to the world of sports medicine. Anything I share about my life and career is intended to introduce myself to the reader and establish a sense of credibility for my recommendations.
It is my hope that the long-standing relationships I have had the privilege of sharing with many high-profile athletes will help to make this book an automatic and authoritative platform from which to reach parents, grandparents, coaches, and children with the message: “Safe on the playing field, out of the operating room.”
It’s time to put a stop to this pervasive problem that is, quite literally, crippling our children before they even have a chance to live their dreams—and to focus on the behaviors and practices that can help a child maximize his or her athletic potential.
If that is the goal you have for your child, then we have a great deal in common and a lot to discuss. I urge you to read on.
Any Given Monday Chapter 1 The Epidemic
Approximately forty-five million children and adolescents are involved in organized athletics in the United States and, as I stated earlier, nearly three and a half million of them under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children. The majority of injuries, of course, are relatively mild sprains, strains, and bruises, but a significant percentage will be more severe, with some even requiring hospitalization. What is even more troubling is that roughly 50 percent of all sports injuries are related to overuse, and studies show that at least 60 percent of overuse injuries can be prevented simply by employing a little common sense—and even more by taking just a few safety precautions. It must be the primary responsibility of the parents, grandparents, coaches, paramedical personnel, and young athletes themselves to help prevent these injuries the best they can.
These statistics are followed carefully by the American Sports Medicine Institute (ASMI) and the Andrews Research & Education Institute (AREI) in Gulf Breeze, two organizations of which I am the chairman. Each year, as new numbers come in, it is a sobering experience for many reasons. Injuries certainly reduce participation in sports and fitness activities, thus contributing to the childhood obesity epidemic as well as other social misgivings. Some injuries can be career ending or even life limiting well before the child or teen has had a chance to pursue his or her dreams. Even less serious injuries can have long-term implications, as damage to joints in childhood contributes exponentially to the chances of developing arthritis later in life. Additionally, there is no question that the evaluation, treatment, and rehabilitation of youth sports injuries is expensive and can lead to lost time and productivity at work for parents. Recent reports have placed the costs associated with youth sports injuries between $2.5 billion and $3 billion annually.
As stated above, many of these sports-related youth injuries are preventable through educational programs at the grassroots level. I will discuss some of the more common youth sports and associated injuries and provide some information related to their prevention, including rule changes, safety equipment, and preseason and in-season conditioning programs.
Our statistics at the American Sports Medicine Institute indicate a five- to seven-fold increase in injuries in youth sports since 2000. Further statistics show that in high school alone, each year some two million injuries result in five hundred thousand doctor visits and approximately thirty thousand hospitalizations for treatment. The statistics for certain sports are particularly troubling.
Cheerleading, for example, is out of control. There are three million young cheerleaders in the United States, ranging from squads of preteens at local cheer gyms, to approximately four hundred thousand at the high school level, to the college cheerleaders you see on TV, smiling and leaping on the sidelines at football and basketball games. The National Collegiate Athletic Association’s (NCAA) medical reports indicate that of all the insurance monies spent on treatment for college athletes across roughly ninety sports, fully 25 percent is for cheerleading injuries. This might not seem as dramatic a number when compared to the 57 percent of NCAA medical expenses spent on football; however, football has ten times the participation of cheerleading. The rate of emergency room visits for cheerleaders at any level has increased sixfold since 1981. In 2008 alone, roughly thirty thousand young women and men landed in the ER as a result of injuries sustained while cheering. During the twenty-six years between 1982 and 2008, there were seventy-three catastrophic injuries reported in cheerleading, with two deaths. Gymnastics, which incorporates many of the same tumbling passes and boasts similar numbers of participants, had a total of nine catastrophic injuries during that same period. That’s a pretty drastic difference. Clearly, something needs to be done to protect cheerleaders from increasingly common and increasingly serious injuries. Football, too, deserves a critical examination. In 2007 there were 920,000 players under the age of eighteen treated in emergency rooms for injuries.
One factor that contributes significantly to the rate of injury is specialization. In other words, children are pigeonholed into one sport fairly early on, which means that they have little variation in terms of the muscles and joints employed and skills practiced, which can lead to fatigue and a much higher rate of injury. And one of the main causes of early specialization is parents who stress the pursuit of one specific sport for the sake of gaining college scholarships and professional recruiting buzz. It should be noted, though, that the odds of a football player actually making it to the NFL—not as a starter or even taking the field at any point in his life, but just making it on a professional roster—is greater than 6,000 to 1.
I don’t mean to come down too hard on parents here; after all, we all want the best possible opportunities for our children. And most parents are very responsible in the emphasis they place on pursuing sports. But at some point, there needs to be a reality check. Ambitious parents and coaches need to understand that encouraging a child’s talent is one thing but controlling it or obsessing over it is quite another. Before you pin your future retirement plans on how well your child performs athletically, consider this: The National Federation of State High School Associations estimates that less than 0.1 percent of kids who participate in sports at school will receive a scholarship to continue that sport in college.
The American Orthopaedic Society for Sports Medicine (AOSSM) initiated the STOP Sports Injury Campaign in 2010 to prevent overuse and trauma injuries among young athletes. The STOP acronym, which stands for Sports Trauma and Overuse Prevention, makes clear the organization’s intentions. As president of the society from 2009 to 2010, I expressed my desire to launch a national program for preventing injuries in youth sports. The AOSSM unanimously agreed that the time was right to begin our education campaign.
Founding partner organizations in the STOP Sports Injury Campaign include the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine (AMSSM), the National Athletic Trainers’ Association (NATA), the National Strength and Conditioning Association (NSCA), the Pediatric Orthopaedic Society of North America (POSNA), the Sports Physical Therapy Section of the American Physical Therapy Association (APTA), Safe Kids USA, and the Professional Baseball Athletic Trainers Society (PBATS). Today there are more than 250 other local and national organizations that have taken the pledge to prevent youth sports injuries at the grassroots level.
When it comes to sports injury prevention, we must establish a priority in basic research principles. The STOP program’s mission is fourfold: Number one is to establish the extent of the problem. Number two is to identify the risk factors and the mechanism of the injuries. Number three is to develop preventive interventions. And number four is to evaluate the effects and results of those interventions from a scientific standpoint. The STOP program has all of these objectives in its mission and focus. The AOSSM has identified several areas of research that need to be undertaken to take prevention to a scientific conclusion and to be able to show definitive results.
The first high-priority proposal addresses the prevention of anterior cruciate ligament (ACL) knee injuries in young female athletes, who have a three to six times ACL injury rate when compared to their male counterparts. This study will emphasize “cutting” sports, which require a sudden change of direction or darting to one side while running, such as basketball, lacrosse, soccer, and volleyball. Cheerleading and gymnastics will also be included.
The second priority is the prevention of repeated concussions and related complications. Approximately two million to three million young athletes suffer concussions each year in America. A number of long-term studies have shown that repeated concussions have an impact on mental health later in life, especially among former athletes.
The third priority is related to overuse injuries of the shoulder and elbow and their prevention in youth baseball and youth softball for both pitchers and fielders. The number of young men and women who require surgical repair to their pitching arms because of overuse damage is on the rise. This is a serious problem and one that is especially close to my heart, as it is now one of the most common procedures I have to perform on young people. When I started in this career, I never imagined that it would become routine for a fifteen-year-old to have to undergo such drastic treatment.
In a study published in the September 2009 issue of the American Journal of Sports Medicine, researchers examined severe injuries broken down by specific sports and injury type. Researchers captured injury data during the 2005–06 and 2006–07 school years from one hundred nationally represented US high schools. Information was collected for various sports, including football, soccer, volleyball, basketball, wrestling, baseball, and softball. “Severe injury” was defined as any mishap that resulted in an athlete losing more than twenty-one days of sports participation; according to the study, over the course of those two years, severe injuries accounted for 14.9 percent of all high school sports–related injuries. After football injuries, the highest level of injury was reported in wrestling, followed by girls’ basketball and girls’ soccer. While no one was surprised that football emerged as number one, there were some unexpected findings. Among the directly comparable sports of soccer, basketball, and baseball/softball, girls actually sustained a higher severe injury rate than boys. There were also patterns in injury sites, with the knee sustaining a severe injury nearly 30 percent of the time, followed by the ankle at 12.3 percent and the shoulder at 10.9 percent. Additionally, 5 percent of the severe injuries recorded resulted directly from illegal player activity such as tripping or spear tackling. While ankle sprains still tend to be the most common “nonsevere” injury among young players, these findings highlighted the importance of finding ways to protect the knees from more traumatic damage, and suggested that not enough is being done to educate and protect young women athletes. According to this very important and revealing article, future studies should focus on risk factors to develop prevention and intervention. Decreasing sports-related injuries is critical to keep kids playing sports long-term and minimizing the health care cost both to the family and to the health care system itself.
According to the National Federation of State High School Associations, some 7.34 million athletes now participate in high school sports programs, up from 5.2 million just ten years ago. The boy-to-girl ratio is not quite even, although the number of girls participating in sports is on the rise: The total numbers are approximately 4.32 million boys compared to 3.02 million girls, yet the number of serious injuries in many girls’ sports is higher than the rate in comparable boys’ sports. This is certainly a cause for concern.
In light of these statistics, I’d like to make some general recommendations for athletes of both genders that I will elaborate on in part 2’s sports-specific chapters. The vast majority of sports medicine professionals, coaches, and trainers agree that training in the months prior to the sports season is critical to an athlete’s success. The old saying “Preparation is ninety-nine percent of execution” is certainly true in the athletic arena. A very successful preseason strength and conditioning program will dramatically decrease the risk of both minor and major injuries. It is the responsibility of coaches in all youth sports to educate their players in proper periodization on a twelve-month basis in preparation for a season. That is, fitness must begin prior to the first day of practice, and, ideally, some form of physical fitness should be maintained year-round, with training increasing gradually two to three months before the season starts. Statistics show that the majority of injuries occur in the first few weeks of a sports season due to inadequate preseason preparation.
It is also critical for coaches and players to realize that there must be a balance between work and rest. A young athlete should not work out at peak levels twelve months out of the year—especially not with an eye toward specializing in a specific sport. Overtraining always increases the risk for injury, especially in growing bodies. Therefore, athletes should not neglect off-season training, specifically cross-training and participating in other sports. But they should also be willing to take off a few weeks or a month from intense exercise each year in order to allow their body to rest. Low-impact activity should be pursued during that time, but the body needs a chance to recover and repair itself from the constant wear and tear of training.
Coaches should also be aware that the US Consumer Product Safety Commission (CPSC) indicates that 62 percent of sports injuries occur during practice rather than in a game or match. This does make sense: although an athlete’s adrenaline tends to be higher in competitive settings—contributing to more aggressive play—the vast majority of his or her time is spent in practice versus actual time going head-to-head with another team. For that reason, practices should always be well supervised for safety of technique as well as the intensity of the workout.
No matter the sport, it is important to focus on general conditioning and core stability, as well as overall cardiovascular fitness and endurance through long-duration, low-intensity workouts. Cross-training during the off-season is especially important when participating in a predominantly one-sided sport, such as baseball. By pursuing different types of sports, young athletes can develop more complete musculature and hone other athletic skills to avoid fatiguing a specific part of the body.
Young athletes, particularly those who have not yet gone through puberty, should avoid overtraining and overuse, as the body is not fully equipped to rebuild muscles following workouts. I recommend that younger athletes follow a simple 10 percent rule: do not increase weight, training activities, mileage, or pace by more than 10 percent a week. This prevents stressing the body beyond capacity by allowing it to rest, rebuild, and recover. In fact, increasing training intensity too quickly can actually decrease high-level athletic activity.
It is essential for coaches to understand the basic principles related to preparing an athlete for a season. Thanks to Avery D. Faigenbaum, EdD, at the College of New Jersey, and Larry Meadors, PhD, at Sports Spectrum Training, here’s a list of twelve fundamentals for building young and healthy players, which the authors aptly entitle “The Coaches Dozen,” originally published in Strength and Conditioning Journal in 2010:
1. Young athletes are not miniature adults.
2. Value preparatory conditioning.
3. Avoid sports specialization before adolescence.
4. Enhance physical literacy.
5. Better to undertrain than to overtrain.
6. Focus on positive education.
7. Maximize recovery.
8. It is not what you take, it is what you do.
9. Get connected.
10. Make a long-term commitment.
11. There are no secrets.
12. Never stop learning.
Coaches and parents alike should remember that sports are meant to be fun, while facilitating a young athlete’s social development. Never push the training or make the competition so serious that the child feels stressed or comes to dread the activity. This can easily lead to burnout in the sport or in athletics in general. I also recommend avoiding “professionalism” in youth sports—that is, harping on how young athletes need to develop their talent if they ever want to make it in the pros, or obsessing over their training to the point of tunnel vision. Adolescents have plenty of time to develop into professional athletes if their talent and interest point them in that direction. Genetically, 99.9 percent of young athletes are not ready for such serious professionalism at a young age.
There are essentially two different types of injuries: acute injuries and overuse injuries. Acute injuries are the result of a single traumatic event. Common examples include wrist fractures, ankle sprains, shoulder dislocations, or hamstring muscle strains. Overuse injuries, on the other hand, usually occur over time, making them more challenging to diagnose and sometimes more difficult to treat, as the damage is often not as clearly defined as in acute injuries. They are usually a result of overtraining: repetitive microtrauma to tendons, bones, cartilage, and joints, such as shin splints or tennis elbow. Whenever an athlete trains for a sport, even as a child, he or she is trying to make the bones, muscles, tendons, and ligaments of the body stronger and more functional. Unfortunately, there is a very thin line between beneficial training and training that is ultimately detrimental to the body.
The process of breaking down and building up muscle has a fine balance as well. When is the soreness a good thing, meaning that the muscles were stretched and worked to the point of growing stronger? And when does it mean that the muscles were damaged and are struggling to repair themselves? Training errors tend to involve a rapid acceleration of the intensity, duration, or frequency of an activity. They are especially associated with specialization.
Parents, coaches, and athletes must remember that the goal is always to feel better, not worse. Although soreness is to be expected when working new muscles, and anyone is likely to feel winded when doing cardio conditioning, the pain should never be debilitating. A common philosophy in training for sports is that “more is better”: in other words, if pitching a ball twenty times is good, pitching it forty times is twice as good. That’s simply not true. “No pain, no gain” should have no place in youth sports. Young athletes should not participate with pain. Athletes should have an open dialogue with their coaches, parents, or other trusted adults regarding their pain patterns, as these may be early indications of overuse injuries.
When an imbalance between strength and flexibility occurs, the injury pattern for overuse injuries increases rapidly. Young athletes who are still developing and growing often have bony malalignment, which simply means that the bones are growing at a rate that temporarily puts them out of the normal position in relation to their joints. This condition makes young athletes even more prone to overuse injuries. Other factors include equipment (such as the type of running shoe or ballet shoe), whether the terrain is uneven, hard surfaces versus soft surfaces in training, and whether proper techniques are being taught and practiced. These are just a few of the reasons why expert, certified coaches are so important in bringing their knowledge and understanding of the safest and best possible practices to their teams.
Some guidelines for treating overuse injury include:
1. Cut back the intensity, duration, and frequency of an activity.
2. Adopt a hard/easy workout schedule to vary the intensity each day, and incorporate cross-training with other activities to maintain fitness levels.
3. Learn proper training and techniques from a qualified coach or athletic trainer.
4. Perform proper warm-up and cool-down activities before and after practicing. Flexibility stretches can be particularly helpful when combined with ballistic exercises that get the muscles ready for intense bursts of energy, such as squats or tossing a medicine ball. (See chapter 32 for more information and illustrations.)
5. Apply ice for minor aches and pains after any activity.
6. Use nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, and naproxen, as necessary. Communication between athletes, parents, and coaches is particularly important if symptoms persist, at which point a visit to a sports medicine specialist is in order.
7. Consult athletic trainers and physical therapists for guidelines about early recognition and treatment of suspected overuse.
Keeping our kids safe needs to be a team effort, with all involved parties pitching in. Parents, grandparents, coaches, trainers, and athletes should all work toward the brightest possible future for every young athlete: one that is healthy and active thanks to the safe decisions we make together now.
Why, after nearly forty years of practicing medicine and preparing for inevitable retirement, would I want to write a book? And since the focus of my practice for the majority of my career has been on adults, why would I choose to write a book about youth sports injuries?
The reasons are simple but tragic. I am writing this book because it absolutely needs to be written to help curb the growing epidemic that is endangering our most athletically talented children, adolescents, and young adults. I want to make sure that parents, grandparents, coaches, trainers, and all medical personnel are taking the steps now to maximize the opportunities for the next generation of young athletes. This book is intended to do just that: to raise awareness of the most common youth sports injuries and the best ways to prevent them, while explaining the most constructive ways to build a child’s potential. My hope is to educate all adults on how to protect an active child already involved in organized sports and how to select the best activities and safest exercises for a child who is looking to get physically fit.
Juvenile obesity (and the health risks brought on by the condition, such as diabetes and cardiovascular disease) has captured a great deal of media and political attention in recent years, and poor dietary choices and a more sedentary lifestyle are often to blame.
But what about the children at the other end of the spectrum: the ones who are not only physically active but also follow a strict athletic training regimen and dedicate dozens of hours every week to exercise and activity? The serious health risks facing those children are often overlooked or simply shrugged off as “just part of growing up.” But the truth is that youth sports injuries are an epidemic in American society, and we can do more to combat them.
Every year, more than three and a half million children under the age of fourteen require medical treatment for injuries incurred while participating in team or individual sports, and this number is on the rise. Over the past fifteen years, children have gone from being a rarity on my operating table to constituting nearly half of all my patients. More than one-fifth of all traumatic brain injuries in children are the direct result of athletic activity. Almost one-half of all sports injuries in adolescents stem from overuse, in which specific muscles and joints are damaged due to repetitive motion as part of athletic training or conditioning.
Yet despite these startling statistics, sports injuries are largely preventable, especially in children and adolescents. Even something as seemingly harmless as overuse of a joint or muscle can have a dramatic impact on future athletic ability, and even basic functions of movement and control. Both the short-term and long-term repercussions need to be considered when a child begins participating in any kind of sport.
Over the course of my nearly forty-year career, I have been the go-to surgeon for high-profile professional athletes such as Roger Clemens, Albert Pujols, Charles Barkley, Scottie Pippen, Kerri Strug, Jack Nicklaus, Raymond Floyd, Jerry Pate, Troy Aikman, Drew Brees, Brett Favre, Bo Jackson, Emmitt Smith, Terrell Owens, Sam Bradford, Matthew Stafford, and both Manning brothers, just to name a few. My goal has always been not only to return these great sports icons to the top of their game but also to help spread awareness of the causes and prevention of potentially career-ending injuries. Any Given Monday refers to the major consultation day in my clinic, when many of America’s premier athletes, fresh off broadcast TV, arrive at the Andrews Clinic in Birmingham, Alabama, or at the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Florida, for an examination of any injuries from their weekend matchups.
At least once a week, concerned parents will come into my clinic to inquire about their child’s hurt shoulder, swollen elbow, or aching knee and how that injury could affect his or her athletic participation. As part of the exam, I will ask the parents to detail the child’s practice schedule for the past month and year on a blackboard in the examination room so that we can look at it together. More often than not, the intensity, amount, and duration of the exercises are staggering—sometimes they are actually comparable to the training regimen of a pro. I sit down with the family and try to make them understand the potentially irreversible damage that such a schedule can do to a growing body; then we discuss better options. I want parents to seriously consider the implications of putting a twelve-year-old through the same paces as a twenty-five-year-old. Many times they have no idea as to the extent of the injury that their child is suffering; the focus of many parents and coaches is simply on pushing the child to achieve at the highest level possible for college opportunities or to gain a big break into the professional realm. What they often don’t seem to realize is that if a child’s body is overworked at an early age, he or she might not be able to stay in that sport long enough to make it to high school varsity, let alone to the elite level they so desperately desire. Families come to me to put their dream back together, but I want to make sure that parents and coaches understand how to prevent those dreams from shattering in the first place. Those adults have the child’s best interest at heart, but most do not fully understand the risk factors at play in a specific sport.
This dangerous trend is continuing to rise year after year, while the average age of the patients on my table continues to drop. Baseball, in particular, posts some of the highest numbers in terms of serious injuries in youth sports. Recently, in a single day, I completed eight Tommy John surgeries—an operation to repair an injured elbow. Two of my patients were major league pitchers, two pitched for college teams, and four were high schoolers ranging in age from fourteen to seventeen. The following day, I took a photograph of them all together, their arms in splints and ice bags on their shoulders. It was a remarkable day because it reminded me how widespread the problem of professional-level injuries has become, even at the teenage level.
This book will pull from the hundreds of anecdotes and examples I have collected over the past four decades to highlight the types of injuries that are common in athletics; the consequences of childhood injuries; and the advice, treatment, and rehabilitation plans I have prescribed for many of the sports stars you see dominating the field or court every week. Because of the real-life experiences of sports figures who have been on my operating table and now are outspoken advocates for youth sports injury prevention, this book offers readers a personal connection to the headliners who promote this important cause.
Additionally, Any Given Monday provides a reference guide to the twenty-eight most popular youth sports, outlining the health concerns most common to each, how best to treat them, and how to prevent them from happening again—or from happening in the first place. It also addresses the various myths and misconceptions surrounding juvenile orthopedic sports medicine and serves as an overall guide to raising healthy, injury-free children and young adults.
I want to take a moment to speak specifically to the grandparents who might be reading this book. I want to thank you for the interest you’ve taken in the lives of the grandchildren you love, and I hope you know that the role of grandparents in looking out for young athletes is now more important than ever. In some cases, grandparents are also primary caregivers, which is a serious undertaking. Athletics may have changed since you were in high school—both the types of sports that are now popular as well as the style or roughness of play. Safety equipment and rules may also have undergone some changes. I hope that this book will help you to gain a better understanding of current trends, rules, and modes of thinking surrounding youth sports.
For those grandparents, I also believe that the information presented here will help you feel more connected to the world of training and competition in which your grandchild is involved. But even more than that, I hope it helps empower you to voice any concerns you may have. Very often in my practice, I have seen that it was the grandparents who first recognized an overuse injury or burnout in a child or teen. Sometimes the parents are too close to the situation and so wrapped up in carpools, prepping postpractice snacks, and making sure that homework is completed after practice that they miss some of the warning signs right in front of them. Other times, a child might admit to a grandparent that he is experiencing pain or exhaustion due to participation in a certain sport but doesn’t want to tell his parents for fear of disappointing them. If grandparents sense that a grandchild is being overworked or overcommitted, I urge you to express your worries and your desire to see your grandchild live as healthily as possible. By gently explaining the long-term risks of year-round leagues and overuse injuries, you might be able to help protect the growing joints, muscles, and bones of the young athlete’s body, enabling him to maximize his talent as he grows older.
Because of the work conducted at my clinics in Birmingham and Gulf Breeze by my highly talented staff of physicians, surgeons, physical therapists, athletic trainers, and other experts, in 2010 Sports Illustrated named me one of the forty most influential people in the National Football League. It was an honor I both greatly appreciated and deeply regretted. It is my sincere desire to see a generation of athletes grow up knowing how to care properly for their bodies, how to explore and grow their talent in the most effective way, and how to reduce the need for work such as mine through proactive treatment.
As part of my effort to see this goal through to reality, all of my personal proceeds from Any Given Monday will go directly to the STOP (Sports Trauma and Overuse Prevention) Sports Injuries Campaign I helped to initiate as president of the American Orthopaedic Society for Sports Medicine (AOSSM) during 2009 and 2010. Together with members of our “Council of Champions”—including Hank Aaron, Bonnie Blair, Shaquille O’Neal, Bart Starr, Matthew Stafford, and industrialist Jim Justice, among many others—I have appeared on numerous public service announcements and talk shows on networks ranging from ESPN to HBO. To learn more, please visit the STOP website at www.stopsportsinjuries.org.
But lest this come across as a thinly veiled self-promotion, I need to stress that this book is not about me. My life and my career have never been an “I” statement but a “we” situation!
There are doctors out there doing far more to saves lives and combat serious illnesses than I have ever done or will ever do. There are many surgeons in my own field of orthopedics who are working continually to improve the lives of men, women, and children with devastating injuries. There are specialists dedicated to helping wounded veterans learn to adapt to life with prosthetic limbs and others who are focused on helping children with physical birth defects achieve full, enriching lives. These are the real heroes of the medical field: the doctors, nurses, and therapists who are helping one person at a time reclaim his or her birthright of “life, liberty, and the pursuit of happiness.”
But me? I have just been fortunate enough to work with famous people who throw or bat around a ball for a living.
Of course, athletes have every right to those goals as do the rest of us, but sometimes it seems a little backward that people know my name because they’ve seen it mentioned in articles or interviews with A-list sports celebrities and not because I’ve cured anything or changed the world for the better.
I think that’s important to state at the opening of this book. While I am writing about some of my experiences and philosophies, this book is not intended to celebrate my accomplishments or contributions to the world of sports medicine. Anything I share about my life and career is intended to introduce myself to the reader and establish a sense of credibility for my recommendations.
It is my hope that the long-standing relationships I have had the privilege of sharing with many high-profile athletes will help to make this book an automatic and authoritative platform from which to reach parents, grandparents, coaches, and children with the message: “Safe on the playing field, out of the operating room.”
It’s time to put a stop to this pervasive problem that is, quite literally, crippling our children before they even have a chance to live their dreams—and to focus on the behaviors and practices that can help a child maximize his or her athletic potential.
If that is the goal you have for your child, then we have a great deal in common and a lot to discuss. I urge you to read on.
Any Given Monday Chapter 1 The Epidemic
Approximately forty-five million children and adolescents are involved in organized athletics in the United States and, as I stated earlier, nearly three and a half million of them under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children. The majority of injuries, of course, are relatively mild sprains, strains, and bruises, but a significant percentage will be more severe, with some even requiring hospitalization. What is even more troubling is that roughly 50 percent of all sports injuries are related to overuse, and studies show that at least 60 percent of overuse injuries can be prevented simply by employing a little common sense—and even more by taking just a few safety precautions. It must be the primary responsibility of the parents, grandparents, coaches, paramedical personnel, and young athletes themselves to help prevent these injuries the best they can.
These statistics are followed carefully by the American Sports Medicine Institute (ASMI) and the Andrews Research & Education Institute (AREI) in Gulf Breeze, two organizations of which I am the chairman. Each year, as new numbers come in, it is a sobering experience for many reasons. Injuries certainly reduce participation in sports and fitness activities, thus contributing to the childhood obesity epidemic as well as other social misgivings. Some injuries can be career ending or even life limiting well before the child or teen has had a chance to pursue his or her dreams. Even less serious injuries can have long-term implications, as damage to joints in childhood contributes exponentially to the chances of developing arthritis later in life. Additionally, there is no question that the evaluation, treatment, and rehabilitation of youth sports injuries is expensive and can lead to lost time and productivity at work for parents. Recent reports have placed the costs associated with youth sports injuries between $2.5 billion and $3 billion annually.
As stated above, many of these sports-related youth injuries are preventable through educational programs at the grassroots level. I will discuss some of the more common youth sports and associated injuries and provide some information related to their prevention, including rule changes, safety equipment, and preseason and in-season conditioning programs.
Our statistics at the American Sports Medicine Institute indicate a five- to seven-fold increase in injuries in youth sports since 2000. Further statistics show that in high school alone, each year some two million injuries result in five hundred thousand doctor visits and approximately thirty thousand hospitalizations for treatment. The statistics for certain sports are particularly troubling.
Cheerleading, for example, is out of control. There are three million young cheerleaders in the United States, ranging from squads of preteens at local cheer gyms, to approximately four hundred thousand at the high school level, to the college cheerleaders you see on TV, smiling and leaping on the sidelines at football and basketball games. The National Collegiate Athletic Association’s (NCAA) medical reports indicate that of all the insurance monies spent on treatment for college athletes across roughly ninety sports, fully 25 percent is for cheerleading injuries. This might not seem as dramatic a number when compared to the 57 percent of NCAA medical expenses spent on football; however, football has ten times the participation of cheerleading. The rate of emergency room visits for cheerleaders at any level has increased sixfold since 1981. In 2008 alone, roughly thirty thousand young women and men landed in the ER as a result of injuries sustained while cheering. During the twenty-six years between 1982 and 2008, there were seventy-three catastrophic injuries reported in cheerleading, with two deaths. Gymnastics, which incorporates many of the same tumbling passes and boasts similar numbers of participants, had a total of nine catastrophic injuries during that same period. That’s a pretty drastic difference. Clearly, something needs to be done to protect cheerleaders from increasingly common and increasingly serious injuries. Football, too, deserves a critical examination. In 2007 there were 920,000 players under the age of eighteen treated in emergency rooms for injuries.
One factor that contributes significantly to the rate of injury is specialization. In other words, children are pigeonholed into one sport fairly early on, which means that they have little variation in terms of the muscles and joints employed and skills practiced, which can lead to fatigue and a much higher rate of injury. And one of the main causes of early specialization is parents who stress the pursuit of one specific sport for the sake of gaining college scholarships and professional recruiting buzz. It should be noted, though, that the odds of a football player actually making it to the NFL—not as a starter or even taking the field at any point in his life, but just making it on a professional roster—is greater than 6,000 to 1.
I don’t mean to come down too hard on parents here; after all, we all want the best possible opportunities for our children. And most parents are very responsible in the emphasis they place on pursuing sports. But at some point, there needs to be a reality check. Ambitious parents and coaches need to understand that encouraging a child’s talent is one thing but controlling it or obsessing over it is quite another. Before you pin your future retirement plans on how well your child performs athletically, consider this: The National Federation of State High School Associations estimates that less than 0.1 percent of kids who participate in sports at school will receive a scholarship to continue that sport in college.
The American Orthopaedic Society for Sports Medicine (AOSSM) initiated the STOP Sports Injury Campaign in 2010 to prevent overuse and trauma injuries among young athletes. The STOP acronym, which stands for Sports Trauma and Overuse Prevention, makes clear the organization’s intentions. As president of the society from 2009 to 2010, I expressed my desire to launch a national program for preventing injuries in youth sports. The AOSSM unanimously agreed that the time was right to begin our education campaign.
Founding partner organizations in the STOP Sports Injury Campaign include the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine (AMSSM), the National Athletic Trainers’ Association (NATA), the National Strength and Conditioning Association (NSCA), the Pediatric Orthopaedic Society of North America (POSNA), the Sports Physical Therapy Section of the American Physical Therapy Association (APTA), Safe Kids USA, and the Professional Baseball Athletic Trainers Society (PBATS). Today there are more than 250 other local and national organizations that have taken the pledge to prevent youth sports injuries at the grassroots level.
When it comes to sports injury prevention, we must establish a priority in basic research principles. The STOP program’s mission is fourfold: Number one is to establish the extent of the problem. Number two is to identify the risk factors and the mechanism of the injuries. Number three is to develop preventive interventions. And number four is to evaluate the effects and results of those interventions from a scientific standpoint. The STOP program has all of these objectives in its mission and focus. The AOSSM has identified several areas of research that need to be undertaken to take prevention to a scientific conclusion and to be able to show definitive results.
The first high-priority proposal addresses the prevention of anterior cruciate ligament (ACL) knee injuries in young female athletes, who have a three to six times ACL injury rate when compared to their male counterparts. This study will emphasize “cutting” sports, which require a sudden change of direction or darting to one side while running, such as basketball, lacrosse, soccer, and volleyball. Cheerleading and gymnastics will also be included.
The second priority is the prevention of repeated concussions and related complications. Approximately two million to three million young athletes suffer concussions each year in America. A number of long-term studies have shown that repeated concussions have an impact on mental health later in life, especially among former athletes.
The third priority is related to overuse injuries of the shoulder and elbow and their prevention in youth baseball and youth softball for both pitchers and fielders. The number of young men and women who require surgical repair to their pitching arms because of overuse damage is on the rise. This is a serious problem and one that is especially close to my heart, as it is now one of the most common procedures I have to perform on young people. When I started in this career, I never imagined that it would become routine for a fifteen-year-old to have to undergo such drastic treatment.
In a study published in the September 2009 issue of the American Journal of Sports Medicine, researchers examined severe injuries broken down by specific sports and injury type. Researchers captured injury data during the 2005–06 and 2006–07 school years from one hundred nationally represented US high schools. Information was collected for various sports, including football, soccer, volleyball, basketball, wrestling, baseball, and softball. “Severe injury” was defined as any mishap that resulted in an athlete losing more than twenty-one days of sports participation; according to the study, over the course of those two years, severe injuries accounted for 14.9 percent of all high school sports–related injuries. After football injuries, the highest level of injury was reported in wrestling, followed by girls’ basketball and girls’ soccer. While no one was surprised that football emerged as number one, there were some unexpected findings. Among the directly comparable sports of soccer, basketball, and baseball/softball, girls actually sustained a higher severe injury rate than boys. There were also patterns in injury sites, with the knee sustaining a severe injury nearly 30 percent of the time, followed by the ankle at 12.3 percent and the shoulder at 10.9 percent. Additionally, 5 percent of the severe injuries recorded resulted directly from illegal player activity such as tripping or spear tackling. While ankle sprains still tend to be the most common “nonsevere” injury among young players, these findings highlighted the importance of finding ways to protect the knees from more traumatic damage, and suggested that not enough is being done to educate and protect young women athletes. According to this very important and revealing article, future studies should focus on risk factors to develop prevention and intervention. Decreasing sports-related injuries is critical to keep kids playing sports long-term and minimizing the health care cost both to the family and to the health care system itself.
According to the National Federation of State High School Associations, some 7.34 million athletes now participate in high school sports programs, up from 5.2 million just ten years ago. The boy-to-girl ratio is not quite even, although the number of girls participating in sports is on the rise: The total numbers are approximately 4.32 million boys compared to 3.02 million girls, yet the number of serious injuries in many girls’ sports is higher than the rate in comparable boys’ sports. This is certainly a cause for concern.
In light of these statistics, I’d like to make some general recommendations for athletes of both genders that I will elaborate on in part 2’s sports-specific chapters. The vast majority of sports medicine professionals, coaches, and trainers agree that training in the months prior to the sports season is critical to an athlete’s success. The old saying “Preparation is ninety-nine percent of execution” is certainly true in the athletic arena. A very successful preseason strength and conditioning program will dramatically decrease the risk of both minor and major injuries. It is the responsibility of coaches in all youth sports to educate their players in proper periodization on a twelve-month basis in preparation for a season. That is, fitness must begin prior to the first day of practice, and, ideally, some form of physical fitness should be maintained year-round, with training increasing gradually two to three months before the season starts. Statistics show that the majority of injuries occur in the first few weeks of a sports season due to inadequate preseason preparation.
It is also critical for coaches and players to realize that there must be a balance between work and rest. A young athlete should not work out at peak levels twelve months out of the year—especially not with an eye toward specializing in a specific sport. Overtraining always increases the risk for injury, especially in growing bodies. Therefore, athletes should not neglect off-season training, specifically cross-training and participating in other sports. But they should also be willing to take off a few weeks or a month from intense exercise each year in order to allow their body to rest. Low-impact activity should be pursued during that time, but the body needs a chance to recover and repair itself from the constant wear and tear of training.
Coaches should also be aware that the US Consumer Product Safety Commission (CPSC) indicates that 62 percent of sports injuries occur during practice rather than in a game or match. This does make sense: although an athlete’s adrenaline tends to be higher in competitive settings—contributing to more aggressive play—the vast majority of his or her time is spent in practice versus actual time going head-to-head with another team. For that reason, practices should always be well supervised for safety of technique as well as the intensity of the workout.
No matter the sport, it is important to focus on general conditioning and core stability, as well as overall cardiovascular fitness and endurance through long-duration, low-intensity workouts. Cross-training during the off-season is especially important when participating in a predominantly one-sided sport, such as baseball. By pursuing different types of sports, young athletes can develop more complete musculature and hone other athletic skills to avoid fatiguing a specific part of the body.
Young athletes, particularly those who have not yet gone through puberty, should avoid overtraining and overuse, as the body is not fully equipped to rebuild muscles following workouts. I recommend that younger athletes follow a simple 10 percent rule: do not increase weight, training activities, mileage, or pace by more than 10 percent a week. This prevents stressing the body beyond capacity by allowing it to rest, rebuild, and recover. In fact, increasing training intensity too quickly can actually decrease high-level athletic activity.
It is essential for coaches to understand the basic principles related to preparing an athlete for a season. Thanks to Avery D. Faigenbaum, EdD, at the College of New Jersey, and Larry Meadors, PhD, at Sports Spectrum Training, here’s a list of twelve fundamentals for building young and healthy players, which the authors aptly entitle “The Coaches Dozen,” originally published in Strength and Conditioning Journal in 2010:
1. Young athletes are not miniature adults.
2. Value preparatory conditioning.
3. Avoid sports specialization before adolescence.
4. Enhance physical literacy.
5. Better to undertrain than to overtrain.
6. Focus on positive education.
7. Maximize recovery.
8. It is not what you take, it is what you do.
9. Get connected.
10. Make a long-term commitment.
11. There are no secrets.
12. Never stop learning.
Coaches and parents alike should remember that sports are meant to be fun, while facilitating a young athlete’s social development. Never push the training or make the competition so serious that the child feels stressed or comes to dread the activity. This can easily lead to burnout in the sport or in athletics in general. I also recommend avoiding “professionalism” in youth sports—that is, harping on how young athletes need to develop their talent if they ever want to make it in the pros, or obsessing over their training to the point of tunnel vision. Adolescents have plenty of time to develop into professional athletes if their talent and interest point them in that direction. Genetically, 99.9 percent of young athletes are not ready for such serious professionalism at a young age.
There are essentially two different types of injuries: acute injuries and overuse injuries. Acute injuries are the result of a single traumatic event. Common examples include wrist fractures, ankle sprains, shoulder dislocations, or hamstring muscle strains. Overuse injuries, on the other hand, usually occur over time, making them more challenging to diagnose and sometimes more difficult to treat, as the damage is often not as clearly defined as in acute injuries. They are usually a result of overtraining: repetitive microtrauma to tendons, bones, cartilage, and joints, such as shin splints or tennis elbow. Whenever an athlete trains for a sport, even as a child, he or she is trying to make the bones, muscles, tendons, and ligaments of the body stronger and more functional. Unfortunately, there is a very thin line between beneficial training and training that is ultimately detrimental to the body.
The process of breaking down and building up muscle has a fine balance as well. When is the soreness a good thing, meaning that the muscles were stretched and worked to the point of growing stronger? And when does it mean that the muscles were damaged and are struggling to repair themselves? Training errors tend to involve a rapid acceleration of the intensity, duration, or frequency of an activity. They are especially associated with specialization.
Parents, coaches, and athletes must remember that the goal is always to feel better, not worse. Although soreness is to be expected when working new muscles, and anyone is likely to feel winded when doing cardio conditioning, the pain should never be debilitating. A common philosophy in training for sports is that “more is better”: in other words, if pitching a ball twenty times is good, pitching it forty times is twice as good. That’s simply not true. “No pain, no gain” should have no place in youth sports. Young athletes should not participate with pain. Athletes should have an open dialogue with their coaches, parents, or other trusted adults regarding their pain patterns, as these may be early indications of overuse injuries.
When an imbalance between strength and flexibility occurs, the injury pattern for overuse injuries increases rapidly. Young athletes who are still developing and growing often have bony malalignment, which simply means that the bones are growing at a rate that temporarily puts them out of the normal position in relation to their joints. This condition makes young athletes even more prone to overuse injuries. Other factors include equipment (such as the type of running shoe or ballet shoe), whether the terrain is uneven, hard surfaces versus soft surfaces in training, and whether proper techniques are being taught and practiced. These are just a few of the reasons why expert, certified coaches are so important in bringing their knowledge and understanding of the safest and best possible practices to their teams.
Some guidelines for treating overuse injury include:
1. Cut back the intensity, duration, and frequency of an activity.
2. Adopt a hard/easy workout schedule to vary the intensity each day, and incorporate cross-training with other activities to maintain fitness levels.
3. Learn proper training and techniques from a qualified coach or athletic trainer.
4. Perform proper warm-up and cool-down activities before and after practicing. Flexibility stretches can be particularly helpful when combined with ballistic exercises that get the muscles ready for intense bursts of energy, such as squats or tossing a medicine ball. (See chapter 32 for more information and illustrations.)
5. Apply ice for minor aches and pains after any activity.
6. Use nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, and naproxen, as necessary. Communication between athletes, parents, and coaches is particularly important if symptoms persist, at which point a visit to a sports medicine specialist is in order.
7. Consult athletic trainers and physical therapists for guidelines about early recognition and treatment of suspected overuse.
Keeping our kids safe needs to be a team effort, with all involved parties pitching in. Parents, grandparents, coaches, trainers, and athletes should all work toward the brightest possible future for every young athlete: one that is healthy and active thanks to the safe decisions we make together now.
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Any Given Monday: Sports Injuries and How to Prevent Them for Athletes, Parents, and Coaches - Based on My Life in Sports Medicine
Product ID: U1451667094
Condition: New
Type: Paperback
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Description:
From the most renowned sports surgeon in the country, “a gold mine of contemporary cautionary information for the sports-minded” (Kirkus Reviews) to promote the prevention of sports injuries, especially among young people—featured on CBS This Morning.
Every year more than 3.5 million children will require medical treatment for sports-related injuries, the majority of which are avoidable through proper training and awareness. Dr. James Andrews, an orthopedic surgeon, sports medicine pioneer, and consultant to some of the fiercest teams in college and professional sports, distills his practical wisdom and professional advice to combat a growing epidemic of injury among sports’ most vulnerable population: its young athletes.
Any Given Monday is a sport-by-sport guide to injury prevention and treatment, written specifically for the parents, grandparents, and coaches of young athletes. Dr. Andrews covers every major sport, including football, gymnastics, judo, basketball, tennis, baseball, cheerleading, wrestling, and more. From identifying eating disorders to preventing career-ending ACL tears and concussions, Dr. Andrews reveals how young athletes can maximize their talent and maintain a lifetime of health—both on the field and off.
Every year more than 3.5 million children will require medical treatment for sports-related injuries, the majority of which are avoidable through proper training and awareness. Dr. James Andrews, an orthopedic surgeon, sports medicine pioneer, and consultant to some of the fiercest teams in college and professional sports, distills his practical wisdom and professional advice to combat a growing epidemic of injury among sports’ most vulnerable population: its young athletes.
Any Given Monday is a sport-by-sport guide to injury prevention and treatment, written specifically for the parents, grandparents, and coaches of young athletes. Dr. Andrews covers every major sport, including football, gymnastics, judo, basketball, tennis, baseball, cheerleading, wrestling, and more. From identifying eating disorders to preventing career-ending ACL tears and concussions, Dr. Andrews reveals how young athletes can maximize their talent and maintain a lifetime of health—both on the field and off.
Editorial Reviews
Review
"Young athletes are one of our most important resources, and in Any Given Monday Dr. Andrews provides them with the caution, wisdom, and inspiration they need to succeed in sports and in life." -- Brett Favre
"Dr. Andrews has long been recognized as a preeminent leader in sports medicine, and I have been fortunate to have him as my “go to” doctor throughout my career. Not only does he have a unique ability to truly understand athletes and the demands they place on their bodies to perform at the highest level, he also understands faith, family, and the balance we all need to live life to the fullest. This book belongs in the library of every parent and coach in the country." -- Bo Jackson
"Dr. Andrews is certainly among the best, and the best athletes come to him. I could not have played 16 years in the NBA without him—and most importantly he’s always been my friend." -- Charles Barkley
“Andrews, a pioneering orthopedic surgeon in his fifth decade of practicing sports medicine, is uniquely qualified to pen this type of medical sourcebook….A gold mine of contemporary cautionary information for the sports-minded.” ― Kirkus
“Andrews offers quick recommendations for a wide variety of high-participation sports…. [Any Given Monday is] a great pass-around for parents and grandparents and demands to be read by youth coaches, trainers, and sports administrators who, hopefully, will heed Andrews’ call for change.” ― Booklist
Dr. James Andrews has one of those names you’ve read a million times. But you’ve never really heard what’s on his mind until now." ― National Football Post
Both educational and entertaining, Any Given Monday includes anecdotes about Andrews’ remarkable career (he was a champion pole vaulter in his youth and later a successful yacht racer) as well as tips for coaches and trainers. ― National Post
Parents who have kids in sports - any sport, on any level - need to pick up a copy of Dr. James Andrews' new book ― Tulsa World
"Dr. Andrews has long been recognized as a preeminent leader in sports medicine, and I have been fortunate to have him as my “go to” doctor throughout my career. Not only does he have a unique ability to truly understand athletes and the demands they place on their bodies to perform at the highest level, he also understands faith, family, and the balance we all need to live life to the fullest. This book belongs in the library of every parent and coach in the country." -- Bo Jackson
"Dr. Andrews is certainly among the best, and the best athletes come to him. I could not have played 16 years in the NBA without him—and most importantly he’s always been my friend." -- Charles Barkley
“Andrews, a pioneering orthopedic surgeon in his fifth decade of practicing sports medicine, is uniquely qualified to pen this type of medical sourcebook….A gold mine of contemporary cautionary information for the sports-minded.” ― Kirkus
“Andrews offers quick recommendations for a wide variety of high-participation sports…. [Any Given Monday is] a great pass-around for parents and grandparents and demands to be read by youth coaches, trainers, and sports administrators who, hopefully, will heed Andrews’ call for change.” ― Booklist
Dr. James Andrews has one of those names you’ve read a million times. But you’ve never really heard what’s on his mind until now." ― National Football Post
Both educational and entertaining, Any Given Monday includes anecdotes about Andrews’ remarkable career (he was a champion pole vaulter in his youth and later a successful yacht racer) as well as tips for coaches and trainers. ― National Post
Parents who have kids in sports - any sport, on any level - need to pick up a copy of Dr. James Andrews' new book ― Tulsa World
About the Author
James R. Andrews, MD, is an orthopedic surgeon in sports medicine and a pioneer in arthroscopic surgery. His patients and consultations include Albert Pujols, Drew Brees, Brett Favre, Roger Clemens, John Smoltz, Charles Barkley, Jack Nicklaus, Hope Solo, Bo Jackson, Troy Aikman, Emmitt Smith, and both Manning brothers. Sports Illustrated recently named him as one of the top forty most influential people in the NFL. He is the team doctor for Auburn University, the University of Alabama, the Washington Redskins, and the Tampa Bay Rays. He is a founder of the American Sports Medicine Institute (ASMI) in Birmingham, Alabama, and the Andrews Research and Education Institute in Gulf Breeze, Florida.
Don Yaeger is a New York Times bestselling author, longtime associate editor at Sports Illustrated, and one of the most in-demand public speakers on the corporate circuit. He is the host of the highly rated Corporate Competitor Podcast. He lives in Tallahassee, Florida, with his wife and two children. Visit DonYaeger.com for more information.
Don Yaeger is a New York Times bestselling author, longtime associate editor at Sports Illustrated, and one of the most in-demand public speakers on the corporate circuit. He is the host of the highly rated Corporate Competitor Podcast. He lives in Tallahassee, Florida, with his wife and two children. Visit DonYaeger.com for more information.
Excerpt. © Reprinted by permission. All rights reserved.
Any Given Monday Introduction What Is the Point of This Book?
Why, after nearly forty years of practicing medicine and preparing for inevitable retirement, would I want to write a book? And since the focus of my practice for the majority of my career has been on adults, why would I choose to write a book about youth sports injuries?
The reasons are simple but tragic. I am writing this book because it absolutely needs to be written to help curb the growing epidemic that is endangering our most athletically talented children, adolescents, and young adults. I want to make sure that parents, grandparents, coaches, trainers, and all medical personnel are taking the steps now to maximize the opportunities for the next generation of young athletes. This book is intended to do just that: to raise awareness of the most common youth sports injuries and the best ways to prevent them, while explaining the most constructive ways to build a child’s potential. My hope is to educate all adults on how to protect an active child already involved in organized sports and how to select the best activities and safest exercises for a child who is looking to get physically fit.
Juvenile obesity (and the health risks brought on by the condition, such as diabetes and cardiovascular disease) has captured a great deal of media and political attention in recent years, and poor dietary choices and a more sedentary lifestyle are often to blame.
But what about the children at the other end of the spectrum: the ones who are not only physically active but also follow a strict athletic training regimen and dedicate dozens of hours every week to exercise and activity? The serious health risks facing those children are often overlooked or simply shrugged off as “just part of growing up.” But the truth is that youth sports injuries are an epidemic in American society, and we can do more to combat them.
Every year, more than three and a half million children under the age of fourteen require medical treatment for injuries incurred while participating in team or individual sports, and this number is on the rise. Over the past fifteen years, children have gone from being a rarity on my operating table to constituting nearly half of all my patients. More than one-fifth of all traumatic brain injuries in children are the direct result of athletic activity. Almost one-half of all sports injuries in adolescents stem from overuse, in which specific muscles and joints are damaged due to repetitive motion as part of athletic training or conditioning.
Yet despite these startling statistics, sports injuries are largely preventable, especially in children and adolescents. Even something as seemingly harmless as overuse of a joint or muscle can have a dramatic impact on future athletic ability, and even basic functions of movement and control. Both the short-term and long-term repercussions need to be considered when a child begins participating in any kind of sport.
Over the course of my nearly forty-year career, I have been the go-to surgeon for high-profile professional athletes such as Roger Clemens, Albert Pujols, Charles Barkley, Scottie Pippen, Kerri Strug, Jack Nicklaus, Raymond Floyd, Jerry Pate, Troy Aikman, Drew Brees, Brett Favre, Bo Jackson, Emmitt Smith, Terrell Owens, Sam Bradford, Matthew Stafford, and both Manning brothers, just to name a few. My goal has always been not only to return these great sports icons to the top of their game but also to help spread awareness of the causes and prevention of potentially career-ending injuries. Any Given Monday refers to the major consultation day in my clinic, when many of America’s premier athletes, fresh off broadcast TV, arrive at the Andrews Clinic in Birmingham, Alabama, or at the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Florida, for an examination of any injuries from their weekend matchups.
At least once a week, concerned parents will come into my clinic to inquire about their child’s hurt shoulder, swollen elbow, or aching knee and how that injury could affect his or her athletic participation. As part of the exam, I will ask the parents to detail the child’s practice schedule for the past month and year on a blackboard in the examination room so that we can look at it together. More often than not, the intensity, amount, and duration of the exercises are staggering—sometimes they are actually comparable to the training regimen of a pro. I sit down with the family and try to make them understand the potentially irreversible damage that such a schedule can do to a growing body; then we discuss better options. I want parents to seriously consider the implications of putting a twelve-year-old through the same paces as a twenty-five-year-old. Many times they have no idea as to the extent of the injury that their child is suffering; the focus of many parents and coaches is simply on pushing the child to achieve at the highest level possible for college opportunities or to gain a big break into the professional realm. What they often don’t seem to realize is that if a child’s body is overworked at an early age, he or she might not be able to stay in that sport long enough to make it to high school varsity, let alone to the elite level they so desperately desire. Families come to me to put their dream back together, but I want to make sure that parents and coaches understand how to prevent those dreams from shattering in the first place. Those adults have the child’s best interest at heart, but most do not fully understand the risk factors at play in a specific sport.
This dangerous trend is continuing to rise year after year, while the average age of the patients on my table continues to drop. Baseball, in particular, posts some of the highest numbers in terms of serious injuries in youth sports. Recently, in a single day, I completed eight Tommy John surgeries—an operation to repair an injured elbow. Two of my patients were major league pitchers, two pitched for college teams, and four were high schoolers ranging in age from fourteen to seventeen. The following day, I took a photograph of them all together, their arms in splints and ice bags on their shoulders. It was a remarkable day because it reminded me how widespread the problem of professional-level injuries has become, even at the teenage level.
This book will pull from the hundreds of anecdotes and examples I have collected over the past four decades to highlight the types of injuries that are common in athletics; the consequences of childhood injuries; and the advice, treatment, and rehabilitation plans I have prescribed for many of the sports stars you see dominating the field or court every week. Because of the real-life experiences of sports figures who have been on my operating table and now are outspoken advocates for youth sports injury prevention, this book offers readers a personal connection to the headliners who promote this important cause.
Additionally, Any Given Monday provides a reference guide to the twenty-eight most popular youth sports, outlining the health concerns most common to each, how best to treat them, and how to prevent them from happening again—or from happening in the first place. It also addresses the various myths and misconceptions surrounding juvenile orthopedic sports medicine and serves as an overall guide to raising healthy, injury-free children and young adults.
I want to take a moment to speak specifically to the grandparents who might be reading this book. I want to thank you for the interest you’ve taken in the lives of the grandchildren you love, and I hope you know that the role of grandparents in looking out for young athletes is now more important than ever. In some cases, grandparents are also primary caregivers, which is a serious undertaking. Athletics may have changed since you were in high school—both the types of sports that are now popular as well as the style or roughness of play. Safety equipment and rules may also have undergone some changes. I hope that this book will help you to gain a better understanding of current trends, rules, and modes of thinking surrounding youth sports.
For those grandparents, I also believe that the information presented here will help you feel more connected to the world of training and competition in which your grandchild is involved. But even more than that, I hope it helps empower you to voice any concerns you may have. Very often in my practice, I have seen that it was the grandparents who first recognized an overuse injury or burnout in a child or teen. Sometimes the parents are too close to the situation and so wrapped up in carpools, prepping postpractice snacks, and making sure that homework is completed after practice that they miss some of the warning signs right in front of them. Other times, a child might admit to a grandparent that he is experiencing pain or exhaustion due to participation in a certain sport but doesn’t want to tell his parents for fear of disappointing them. If grandparents sense that a grandchild is being overworked or overcommitted, I urge you to express your worries and your desire to see your grandchild live as healthily as possible. By gently explaining the long-term risks of year-round leagues and overuse injuries, you might be able to help protect the growing joints, muscles, and bones of the young athlete’s body, enabling him to maximize his talent as he grows older.
Because of the work conducted at my clinics in Birmingham and Gulf Breeze by my highly talented staff of physicians, surgeons, physical therapists, athletic trainers, and other experts, in 2010 Sports Illustrated named me one of the forty most influential people in the National Football League. It was an honor I both greatly appreciated and deeply regretted. It is my sincere desire to see a generation of athletes grow up knowing how to care properly for their bodies, how to explore and grow their talent in the most effective way, and how to reduce the need for work such as mine through proactive treatment.
As part of my effort to see this goal through to reality, all of my personal proceeds from Any Given Monday will go directly to the STOP (Sports Trauma and Overuse Prevention) Sports Injuries Campaign I helped to initiate as president of the American Orthopaedic Society for Sports Medicine (AOSSM) during 2009 and 2010. Together with members of our “Council of Champions”—including Hank Aaron, Bonnie Blair, Shaquille O’Neal, Bart Starr, Matthew Stafford, and industrialist Jim Justice, among many others—I have appeared on numerous public service announcements and talk shows on networks ranging from ESPN to HBO. To learn more, please visit the STOP website at www.stopsportsinjuries.org.
But lest this come across as a thinly veiled self-promotion, I need to stress that this book is not about me. My life and my career have never been an “I” statement but a “we” situation!
There are doctors out there doing far more to saves lives and combat serious illnesses than I have ever done or will ever do. There are many surgeons in my own field of orthopedics who are working continually to improve the lives of men, women, and children with devastating injuries. There are specialists dedicated to helping wounded veterans learn to adapt to life with prosthetic limbs and others who are focused on helping children with physical birth defects achieve full, enriching lives. These are the real heroes of the medical field: the doctors, nurses, and therapists who are helping one person at a time reclaim his or her birthright of “life, liberty, and the pursuit of happiness.”
But me? I have just been fortunate enough to work with famous people who throw or bat around a ball for a living.
Of course, athletes have every right to those goals as do the rest of us, but sometimes it seems a little backward that people know my name because they’ve seen it mentioned in articles or interviews with A-list sports celebrities and not because I’ve cured anything or changed the world for the better.
I think that’s important to state at the opening of this book. While I am writing about some of my experiences and philosophies, this book is not intended to celebrate my accomplishments or contributions to the world of sports medicine. Anything I share about my life and career is intended to introduce myself to the reader and establish a sense of credibility for my recommendations.
It is my hope that the long-standing relationships I have had the privilege of sharing with many high-profile athletes will help to make this book an automatic and authoritative platform from which to reach parents, grandparents, coaches, and children with the message: “Safe on the playing field, out of the operating room.”
It’s time to put a stop to this pervasive problem that is, quite literally, crippling our children before they even have a chance to live their dreams—and to focus on the behaviors and practices that can help a child maximize his or her athletic potential.
If that is the goal you have for your child, then we have a great deal in common and a lot to discuss. I urge you to read on.
Any Given Monday Chapter 1 The Epidemic
Approximately forty-five million children and adolescents are involved in organized athletics in the United States and, as I stated earlier, nearly three and a half million of them under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children. The majority of injuries, of course, are relatively mild sprains, strains, and bruises, but a significant percentage will be more severe, with some even requiring hospitalization. What is even more troubling is that roughly 50 percent of all sports injuries are related to overuse, and studies show that at least 60 percent of overuse injuries can be prevented simply by employing a little common sense—and even more by taking just a few safety precautions. It must be the primary responsibility of the parents, grandparents, coaches, paramedical personnel, and young athletes themselves to help prevent these injuries the best they can.
These statistics are followed carefully by the American Sports Medicine Institute (ASMI) and the Andrews Research & Education Institute (AREI) in Gulf Breeze, two organizations of which I am the chairman. Each year, as new numbers come in, it is a sobering experience for many reasons. Injuries certainly reduce participation in sports and fitness activities, thus contributing to the childhood obesity epidemic as well as other social misgivings. Some injuries can be career ending or even life limiting well before the child or teen has had a chance to pursue his or her dreams. Even less serious injuries can have long-term implications, as damage to joints in childhood contributes exponentially to the chances of developing arthritis later in life. Additionally, there is no question that the evaluation, treatment, and rehabilitation of youth sports injuries is expensive and can lead to lost time and productivity at work for parents. Recent reports have placed the costs associated with youth sports injuries between $2.5 billion and $3 billion annually.
As stated above, many of these sports-related youth injuries are preventable through educational programs at the grassroots level. I will discuss some of the more common youth sports and associated injuries and provide some information related to their prevention, including rule changes, safety equipment, and preseason and in-season conditioning programs.
Our statistics at the American Sports Medicine Institute indicate a five- to seven-fold increase in injuries in youth sports since 2000. Further statistics show that in high school alone, each year some two million injuries result in five hundred thousand doctor visits and approximately thirty thousand hospitalizations for treatment. The statistics for certain sports are particularly troubling.
Cheerleading, for example, is out of control. There are three million young cheerleaders in the United States, ranging from squads of preteens at local cheer gyms, to approximately four hundred thousand at the high school level, to the college cheerleaders you see on TV, smiling and leaping on the sidelines at football and basketball games. The National Collegiate Athletic Association’s (NCAA) medical reports indicate that of all the insurance monies spent on treatment for college athletes across roughly ninety sports, fully 25 percent is for cheerleading injuries. This might not seem as dramatic a number when compared to the 57 percent of NCAA medical expenses spent on football; however, football has ten times the participation of cheerleading. The rate of emergency room visits for cheerleaders at any level has increased sixfold since 1981. In 2008 alone, roughly thirty thousand young women and men landed in the ER as a result of injuries sustained while cheering. During the twenty-six years between 1982 and 2008, there were seventy-three catastrophic injuries reported in cheerleading, with two deaths. Gymnastics, which incorporates many of the same tumbling passes and boasts similar numbers of participants, had a total of nine catastrophic injuries during that same period. That’s a pretty drastic difference. Clearly, something needs to be done to protect cheerleaders from increasingly common and increasingly serious injuries. Football, too, deserves a critical examination. In 2007 there were 920,000 players under the age of eighteen treated in emergency rooms for injuries.
One factor that contributes significantly to the rate of injury is specialization. In other words, children are pigeonholed into one sport fairly early on, which means that they have little variation in terms of the muscles and joints employed and skills practiced, which can lead to fatigue and a much higher rate of injury. And one of the main causes of early specialization is parents who stress the pursuit of one specific sport for the sake of gaining college scholarships and professional recruiting buzz. It should be noted, though, that the odds of a football player actually making it to the NFL—not as a starter or even taking the field at any point in his life, but just making it on a professional roster—is greater than 6,000 to 1.
I don’t mean to come down too hard on parents here; after all, we all want the best possible opportunities for our children. And most parents are very responsible in the emphasis they place on pursuing sports. But at some point, there needs to be a reality check. Ambitious parents and coaches need to understand that encouraging a child’s talent is one thing but controlling it or obsessing over it is quite another. Before you pin your future retirement plans on how well your child performs athletically, consider this: The National Federation of State High School Associations estimates that less than 0.1 percent of kids who participate in sports at school will receive a scholarship to continue that sport in college.
The American Orthopaedic Society for Sports Medicine (AOSSM) initiated the STOP Sports Injury Campaign in 2010 to prevent overuse and trauma injuries among young athletes. The STOP acronym, which stands for Sports Trauma and Overuse Prevention, makes clear the organization’s intentions. As president of the society from 2009 to 2010, I expressed my desire to launch a national program for preventing injuries in youth sports. The AOSSM unanimously agreed that the time was right to begin our education campaign.
Founding partner organizations in the STOP Sports Injury Campaign include the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine (AMSSM), the National Athletic Trainers’ Association (NATA), the National Strength and Conditioning Association (NSCA), the Pediatric Orthopaedic Society of North America (POSNA), the Sports Physical Therapy Section of the American Physical Therapy Association (APTA), Safe Kids USA, and the Professional Baseball Athletic Trainers Society (PBATS). Today there are more than 250 other local and national organizations that have taken the pledge to prevent youth sports injuries at the grassroots level.
When it comes to sports injury prevention, we must establish a priority in basic research principles. The STOP program’s mission is fourfold: Number one is to establish the extent of the problem. Number two is to identify the risk factors and the mechanism of the injuries. Number three is to develop preventive interventions. And number four is to evaluate the effects and results of those interventions from a scientific standpoint. The STOP program has all of these objectives in its mission and focus. The AOSSM has identified several areas of research that need to be undertaken to take prevention to a scientific conclusion and to be able to show definitive results.
The first high-priority proposal addresses the prevention of anterior cruciate ligament (ACL) knee injuries in young female athletes, who have a three to six times ACL injury rate when compared to their male counterparts. This study will emphasize “cutting” sports, which require a sudden change of direction or darting to one side while running, such as basketball, lacrosse, soccer, and volleyball. Cheerleading and gymnastics will also be included.
The second priority is the prevention of repeated concussions and related complications. Approximately two million to three million young athletes suffer concussions each year in America. A number of long-term studies have shown that repeated concussions have an impact on mental health later in life, especially among former athletes.
The third priority is related to overuse injuries of the shoulder and elbow and their prevention in youth baseball and youth softball for both pitchers and fielders. The number of young men and women who require surgical repair to their pitching arms because of overuse damage is on the rise. This is a serious problem and one that is especially close to my heart, as it is now one of the most common procedures I have to perform on young people. When I started in this career, I never imagined that it would become routine for a fifteen-year-old to have to undergo such drastic treatment.
In a study published in the September 2009 issue of the American Journal of Sports Medicine, researchers examined severe injuries broken down by specific sports and injury type. Researchers captured injury data during the 2005–06 and 2006–07 school years from one hundred nationally represented US high schools. Information was collected for various sports, including football, soccer, volleyball, basketball, wrestling, baseball, and softball. “Severe injury” was defined as any mishap that resulted in an athlete losing more than twenty-one days of sports participation; according to the study, over the course of those two years, severe injuries accounted for 14.9 percent of all high school sports–related injuries. After football injuries, the highest level of injury was reported in wrestling, followed by girls’ basketball and girls’ soccer. While no one was surprised that football emerged as number one, there were some unexpected findings. Among the directly comparable sports of soccer, basketball, and baseball/softball, girls actually sustained a higher severe injury rate than boys. There were also patterns in injury sites, with the knee sustaining a severe injury nearly 30 percent of the time, followed by the ankle at 12.3 percent and the shoulder at 10.9 percent. Additionally, 5 percent of the severe injuries recorded resulted directly from illegal player activity such as tripping or spear tackling. While ankle sprains still tend to be the most common “nonsevere” injury among young players, these findings highlighted the importance of finding ways to protect the knees from more traumatic damage, and suggested that not enough is being done to educate and protect young women athletes. According to this very important and revealing article, future studies should focus on risk factors to develop prevention and intervention. Decreasing sports-related injuries is critical to keep kids playing sports long-term and minimizing the health care cost both to the family and to the health care system itself.
According to the National Federation of State High School Associations, some 7.34 million athletes now participate in high school sports programs, up from 5.2 million just ten years ago. The boy-to-girl ratio is not quite even, although the number of girls participating in sports is on the rise: The total numbers are approximately 4.32 million boys compared to 3.02 million girls, yet the number of serious injuries in many girls’ sports is higher than the rate in comparable boys’ sports. This is certainly a cause for concern.
In light of these statistics, I’d like to make some general recommendations for athletes of both genders that I will elaborate on in part 2’s sports-specific chapters. The vast majority of sports medicine professionals, coaches, and trainers agree that training in the months prior to the sports season is critical to an athlete’s success. The old saying “Preparation is ninety-nine percent of execution” is certainly true in the athletic arena. A very successful preseason strength and conditioning program will dramatically decrease the risk of both minor and major injuries. It is the responsibility of coaches in all youth sports to educate their players in proper periodization on a twelve-month basis in preparation for a season. That is, fitness must begin prior to the first day of practice, and, ideally, some form of physical fitness should be maintained year-round, with training increasing gradually two to three months before the season starts. Statistics show that the majority of injuries occur in the first few weeks of a sports season due to inadequate preseason preparation.
It is also critical for coaches and players to realize that there must be a balance between work and rest. A young athlete should not work out at peak levels twelve months out of the year—especially not with an eye toward specializing in a specific sport. Overtraining always increases the risk for injury, especially in growing bodies. Therefore, athletes should not neglect off-season training, specifically cross-training and participating in other sports. But they should also be willing to take off a few weeks or a month from intense exercise each year in order to allow their body to rest. Low-impact activity should be pursued during that time, but the body needs a chance to recover and repair itself from the constant wear and tear of training.
Coaches should also be aware that the US Consumer Product Safety Commission (CPSC) indicates that 62 percent of sports injuries occur during practice rather than in a game or match. This does make sense: although an athlete’s adrenaline tends to be higher in competitive settings—contributing to more aggressive play—the vast majority of his or her time is spent in practice versus actual time going head-to-head with another team. For that reason, practices should always be well supervised for safety of technique as well as the intensity of the workout.
No matter the sport, it is important to focus on general conditioning and core stability, as well as overall cardiovascular fitness and endurance through long-duration, low-intensity workouts. Cross-training during the off-season is especially important when participating in a predominantly one-sided sport, such as baseball. By pursuing different types of sports, young athletes can develop more complete musculature and hone other athletic skills to avoid fatiguing a specific part of the body.
Young athletes, particularly those who have not yet gone through puberty, should avoid overtraining and overuse, as the body is not fully equipped to rebuild muscles following workouts. I recommend that younger athletes follow a simple 10 percent rule: do not increase weight, training activities, mileage, or pace by more than 10 percent a week. This prevents stressing the body beyond capacity by allowing it to rest, rebuild, and recover. In fact, increasing training intensity too quickly can actually decrease high-level athletic activity.
It is essential for coaches to understand the basic principles related to preparing an athlete for a season. Thanks to Avery D. Faigenbaum, EdD, at the College of New Jersey, and Larry Meadors, PhD, at Sports Spectrum Training, here’s a list of twelve fundamentals for building young and healthy players, which the authors aptly entitle “The Coaches Dozen,” originally published in Strength and Conditioning Journal in 2010:
1. Young athletes are not miniature adults.
2. Value preparatory conditioning.
3. Avoid sports specialization before adolescence.
4. Enhance physical literacy.
5. Better to undertrain than to overtrain.
6. Focus on positive education.
7. Maximize recovery.
8. It is not what you take, it is what you do.
9. Get connected.
10. Make a long-term commitment.
11. There are no secrets.
12. Never stop learning.
Coaches and parents alike should remember that sports are meant to be fun, while facilitating a young athlete’s social development. Never push the training or make the competition so serious that the child feels stressed or comes to dread the activity. This can easily lead to burnout in the sport or in athletics in general. I also recommend avoiding “professionalism” in youth sports—that is, harping on how young athletes need to develop their talent if they ever want to make it in the pros, or obsessing over their training to the point of tunnel vision. Adolescents have plenty of time to develop into professional athletes if their talent and interest point them in that direction. Genetically, 99.9 percent of young athletes are not ready for such serious professionalism at a young age.
There are essentially two different types of injuries: acute injuries and overuse injuries. Acute injuries are the result of a single traumatic event. Common examples include wrist fractures, ankle sprains, shoulder dislocations, or hamstring muscle strains. Overuse injuries, on the other hand, usually occur over time, making them more challenging to diagnose and sometimes more difficult to treat, as the damage is often not as clearly defined as in acute injuries. They are usually a result of overtraining: repetitive microtrauma to tendons, bones, cartilage, and joints, such as shin splints or tennis elbow. Whenever an athlete trains for a sport, even as a child, he or she is trying to make the bones, muscles, tendons, and ligaments of the body stronger and more functional. Unfortunately, there is a very thin line between beneficial training and training that is ultimately detrimental to the body.
The process of breaking down and building up muscle has a fine balance as well. When is the soreness a good thing, meaning that the muscles were stretched and worked to the point of growing stronger? And when does it mean that the muscles were damaged and are struggling to repair themselves? Training errors tend to involve a rapid acceleration of the intensity, duration, or frequency of an activity. They are especially associated with specialization.
Parents, coaches, and athletes must remember that the goal is always to feel better, not worse. Although soreness is to be expected when working new muscles, and anyone is likely to feel winded when doing cardio conditioning, the pain should never be debilitating. A common philosophy in training for sports is that “more is better”: in other words, if pitching a ball twenty times is good, pitching it forty times is twice as good. That’s simply not true. “No pain, no gain” should have no place in youth sports. Young athletes should not participate with pain. Athletes should have an open dialogue with their coaches, parents, or other trusted adults regarding their pain patterns, as these may be early indications of overuse injuries.
When an imbalance between strength and flexibility occurs, the injury pattern for overuse injuries increases rapidly. Young athletes who are still developing and growing often have bony malalignment, which simply means that the bones are growing at a rate that temporarily puts them out of the normal position in relation to their joints. This condition makes young athletes even more prone to overuse injuries. Other factors include equipment (such as the type of running shoe or ballet shoe), whether the terrain is uneven, hard surfaces versus soft surfaces in training, and whether proper techniques are being taught and practiced. These are just a few of the reasons why expert, certified coaches are so important in bringing their knowledge and understanding of the safest and best possible practices to their teams.
Some guidelines for treating overuse injury include:
1. Cut back the intensity, duration, and frequency of an activity.
2. Adopt a hard/easy workout schedule to vary the intensity each day, and incorporate cross-training with other activities to maintain fitness levels.
3. Learn proper training and techniques from a qualified coach or athletic trainer.
4. Perform proper warm-up and cool-down activities before and after practicing. Flexibility stretches can be particularly helpful when combined with ballistic exercises that get the muscles ready for intense bursts of energy, such as squats or tossing a medicine ball. (See chapter 32 for more information and illustrations.)
5. Apply ice for minor aches and pains after any activity.
6. Use nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, and naproxen, as necessary. Communication between athletes, parents, and coaches is particularly important if symptoms persist, at which point a visit to a sports medicine specialist is in order.
7. Consult athletic trainers and physical therapists for guidelines about early recognition and treatment of suspected overuse.
Keeping our kids safe needs to be a team effort, with all involved parties pitching in. Parents, grandparents, coaches, trainers, and athletes should all work toward the brightest possible future for every young athlete: one that is healthy and active thanks to the safe decisions we make together now.
Why, after nearly forty years of practicing medicine and preparing for inevitable retirement, would I want to write a book? And since the focus of my practice for the majority of my career has been on adults, why would I choose to write a book about youth sports injuries?
The reasons are simple but tragic. I am writing this book because it absolutely needs to be written to help curb the growing epidemic that is endangering our most athletically talented children, adolescents, and young adults. I want to make sure that parents, grandparents, coaches, trainers, and all medical personnel are taking the steps now to maximize the opportunities for the next generation of young athletes. This book is intended to do just that: to raise awareness of the most common youth sports injuries and the best ways to prevent them, while explaining the most constructive ways to build a child’s potential. My hope is to educate all adults on how to protect an active child already involved in organized sports and how to select the best activities and safest exercises for a child who is looking to get physically fit.
Juvenile obesity (and the health risks brought on by the condition, such as diabetes and cardiovascular disease) has captured a great deal of media and political attention in recent years, and poor dietary choices and a more sedentary lifestyle are often to blame.
But what about the children at the other end of the spectrum: the ones who are not only physically active but also follow a strict athletic training regimen and dedicate dozens of hours every week to exercise and activity? The serious health risks facing those children are often overlooked or simply shrugged off as “just part of growing up.” But the truth is that youth sports injuries are an epidemic in American society, and we can do more to combat them.
Every year, more than three and a half million children under the age of fourteen require medical treatment for injuries incurred while participating in team or individual sports, and this number is on the rise. Over the past fifteen years, children have gone from being a rarity on my operating table to constituting nearly half of all my patients. More than one-fifth of all traumatic brain injuries in children are the direct result of athletic activity. Almost one-half of all sports injuries in adolescents stem from overuse, in which specific muscles and joints are damaged due to repetitive motion as part of athletic training or conditioning.
Yet despite these startling statistics, sports injuries are largely preventable, especially in children and adolescents. Even something as seemingly harmless as overuse of a joint or muscle can have a dramatic impact on future athletic ability, and even basic functions of movement and control. Both the short-term and long-term repercussions need to be considered when a child begins participating in any kind of sport.
Over the course of my nearly forty-year career, I have been the go-to surgeon for high-profile professional athletes such as Roger Clemens, Albert Pujols, Charles Barkley, Scottie Pippen, Kerri Strug, Jack Nicklaus, Raymond Floyd, Jerry Pate, Troy Aikman, Drew Brees, Brett Favre, Bo Jackson, Emmitt Smith, Terrell Owens, Sam Bradford, Matthew Stafford, and both Manning brothers, just to name a few. My goal has always been not only to return these great sports icons to the top of their game but also to help spread awareness of the causes and prevention of potentially career-ending injuries. Any Given Monday refers to the major consultation day in my clinic, when many of America’s premier athletes, fresh off broadcast TV, arrive at the Andrews Clinic in Birmingham, Alabama, or at the Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Florida, for an examination of any injuries from their weekend matchups.
At least once a week, concerned parents will come into my clinic to inquire about their child’s hurt shoulder, swollen elbow, or aching knee and how that injury could affect his or her athletic participation. As part of the exam, I will ask the parents to detail the child’s practice schedule for the past month and year on a blackboard in the examination room so that we can look at it together. More often than not, the intensity, amount, and duration of the exercises are staggering—sometimes they are actually comparable to the training regimen of a pro. I sit down with the family and try to make them understand the potentially irreversible damage that such a schedule can do to a growing body; then we discuss better options. I want parents to seriously consider the implications of putting a twelve-year-old through the same paces as a twenty-five-year-old. Many times they have no idea as to the extent of the injury that their child is suffering; the focus of many parents and coaches is simply on pushing the child to achieve at the highest level possible for college opportunities or to gain a big break into the professional realm. What they often don’t seem to realize is that if a child’s body is overworked at an early age, he or she might not be able to stay in that sport long enough to make it to high school varsity, let alone to the elite level they so desperately desire. Families come to me to put their dream back together, but I want to make sure that parents and coaches understand how to prevent those dreams from shattering in the first place. Those adults have the child’s best interest at heart, but most do not fully understand the risk factors at play in a specific sport.
This dangerous trend is continuing to rise year after year, while the average age of the patients on my table continues to drop. Baseball, in particular, posts some of the highest numbers in terms of serious injuries in youth sports. Recently, in a single day, I completed eight Tommy John surgeries—an operation to repair an injured elbow. Two of my patients were major league pitchers, two pitched for college teams, and four were high schoolers ranging in age from fourteen to seventeen. The following day, I took a photograph of them all together, their arms in splints and ice bags on their shoulders. It was a remarkable day because it reminded me how widespread the problem of professional-level injuries has become, even at the teenage level.
This book will pull from the hundreds of anecdotes and examples I have collected over the past four decades to highlight the types of injuries that are common in athletics; the consequences of childhood injuries; and the advice, treatment, and rehabilitation plans I have prescribed for many of the sports stars you see dominating the field or court every week. Because of the real-life experiences of sports figures who have been on my operating table and now are outspoken advocates for youth sports injury prevention, this book offers readers a personal connection to the headliners who promote this important cause.
Additionally, Any Given Monday provides a reference guide to the twenty-eight most popular youth sports, outlining the health concerns most common to each, how best to treat them, and how to prevent them from happening again—or from happening in the first place. It also addresses the various myths and misconceptions surrounding juvenile orthopedic sports medicine and serves as an overall guide to raising healthy, injury-free children and young adults.
I want to take a moment to speak specifically to the grandparents who might be reading this book. I want to thank you for the interest you’ve taken in the lives of the grandchildren you love, and I hope you know that the role of grandparents in looking out for young athletes is now more important than ever. In some cases, grandparents are also primary caregivers, which is a serious undertaking. Athletics may have changed since you were in high school—both the types of sports that are now popular as well as the style or roughness of play. Safety equipment and rules may also have undergone some changes. I hope that this book will help you to gain a better understanding of current trends, rules, and modes of thinking surrounding youth sports.
For those grandparents, I also believe that the information presented here will help you feel more connected to the world of training and competition in which your grandchild is involved. But even more than that, I hope it helps empower you to voice any concerns you may have. Very often in my practice, I have seen that it was the grandparents who first recognized an overuse injury or burnout in a child or teen. Sometimes the parents are too close to the situation and so wrapped up in carpools, prepping postpractice snacks, and making sure that homework is completed after practice that they miss some of the warning signs right in front of them. Other times, a child might admit to a grandparent that he is experiencing pain or exhaustion due to participation in a certain sport but doesn’t want to tell his parents for fear of disappointing them. If grandparents sense that a grandchild is being overworked or overcommitted, I urge you to express your worries and your desire to see your grandchild live as healthily as possible. By gently explaining the long-term risks of year-round leagues and overuse injuries, you might be able to help protect the growing joints, muscles, and bones of the young athlete’s body, enabling him to maximize his talent as he grows older.
Because of the work conducted at my clinics in Birmingham and Gulf Breeze by my highly talented staff of physicians, surgeons, physical therapists, athletic trainers, and other experts, in 2010 Sports Illustrated named me one of the forty most influential people in the National Football League. It was an honor I both greatly appreciated and deeply regretted. It is my sincere desire to see a generation of athletes grow up knowing how to care properly for their bodies, how to explore and grow their talent in the most effective way, and how to reduce the need for work such as mine through proactive treatment.
As part of my effort to see this goal through to reality, all of my personal proceeds from Any Given Monday will go directly to the STOP (Sports Trauma and Overuse Prevention) Sports Injuries Campaign I helped to initiate as president of the American Orthopaedic Society for Sports Medicine (AOSSM) during 2009 and 2010. Together with members of our “Council of Champions”—including Hank Aaron, Bonnie Blair, Shaquille O’Neal, Bart Starr, Matthew Stafford, and industrialist Jim Justice, among many others—I have appeared on numerous public service announcements and talk shows on networks ranging from ESPN to HBO. To learn more, please visit the STOP website at www.stopsportsinjuries.org.
But lest this come across as a thinly veiled self-promotion, I need to stress that this book is not about me. My life and my career have never been an “I” statement but a “we” situation!
There are doctors out there doing far more to saves lives and combat serious illnesses than I have ever done or will ever do. There are many surgeons in my own field of orthopedics who are working continually to improve the lives of men, women, and children with devastating injuries. There are specialists dedicated to helping wounded veterans learn to adapt to life with prosthetic limbs and others who are focused on helping children with physical birth defects achieve full, enriching lives. These are the real heroes of the medical field: the doctors, nurses, and therapists who are helping one person at a time reclaim his or her birthright of “life, liberty, and the pursuit of happiness.”
But me? I have just been fortunate enough to work with famous people who throw or bat around a ball for a living.
Of course, athletes have every right to those goals as do the rest of us, but sometimes it seems a little backward that people know my name because they’ve seen it mentioned in articles or interviews with A-list sports celebrities and not because I’ve cured anything or changed the world for the better.
I think that’s important to state at the opening of this book. While I am writing about some of my experiences and philosophies, this book is not intended to celebrate my accomplishments or contributions to the world of sports medicine. Anything I share about my life and career is intended to introduce myself to the reader and establish a sense of credibility for my recommendations.
It is my hope that the long-standing relationships I have had the privilege of sharing with many high-profile athletes will help to make this book an automatic and authoritative platform from which to reach parents, grandparents, coaches, and children with the message: “Safe on the playing field, out of the operating room.”
It’s time to put a stop to this pervasive problem that is, quite literally, crippling our children before they even have a chance to live their dreams—and to focus on the behaviors and practices that can help a child maximize his or her athletic potential.
If that is the goal you have for your child, then we have a great deal in common and a lot to discuss. I urge you to read on.
Any Given Monday Chapter 1 The Epidemic
Approximately forty-five million children and adolescents are involved in organized athletics in the United States and, as I stated earlier, nearly three and a half million of them under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children. The majority of injuries, of course, are relatively mild sprains, strains, and bruises, but a significant percentage will be more severe, with some even requiring hospitalization. What is even more troubling is that roughly 50 percent of all sports injuries are related to overuse, and studies show that at least 60 percent of overuse injuries can be prevented simply by employing a little common sense—and even more by taking just a few safety precautions. It must be the primary responsibility of the parents, grandparents, coaches, paramedical personnel, and young athletes themselves to help prevent these injuries the best they can.
These statistics are followed carefully by the American Sports Medicine Institute (ASMI) and the Andrews Research & Education Institute (AREI) in Gulf Breeze, two organizations of which I am the chairman. Each year, as new numbers come in, it is a sobering experience for many reasons. Injuries certainly reduce participation in sports and fitness activities, thus contributing to the childhood obesity epidemic as well as other social misgivings. Some injuries can be career ending or even life limiting well before the child or teen has had a chance to pursue his or her dreams. Even less serious injuries can have long-term implications, as damage to joints in childhood contributes exponentially to the chances of developing arthritis later in life. Additionally, there is no question that the evaluation, treatment, and rehabilitation of youth sports injuries is expensive and can lead to lost time and productivity at work for parents. Recent reports have placed the costs associated with youth sports injuries between $2.5 billion and $3 billion annually.
As stated above, many of these sports-related youth injuries are preventable through educational programs at the grassroots level. I will discuss some of the more common youth sports and associated injuries and provide some information related to their prevention, including rule changes, safety equipment, and preseason and in-season conditioning programs.
Our statistics at the American Sports Medicine Institute indicate a five- to seven-fold increase in injuries in youth sports since 2000. Further statistics show that in high school alone, each year some two million injuries result in five hundred thousand doctor visits and approximately thirty thousand hospitalizations for treatment. The statistics for certain sports are particularly troubling.
Cheerleading, for example, is out of control. There are three million young cheerleaders in the United States, ranging from squads of preteens at local cheer gyms, to approximately four hundred thousand at the high school level, to the college cheerleaders you see on TV, smiling and leaping on the sidelines at football and basketball games. The National Collegiate Athletic Association’s (NCAA) medical reports indicate that of all the insurance monies spent on treatment for college athletes across roughly ninety sports, fully 25 percent is for cheerleading injuries. This might not seem as dramatic a number when compared to the 57 percent of NCAA medical expenses spent on football; however, football has ten times the participation of cheerleading. The rate of emergency room visits for cheerleaders at any level has increased sixfold since 1981. In 2008 alone, roughly thirty thousand young women and men landed in the ER as a result of injuries sustained while cheering. During the twenty-six years between 1982 and 2008, there were seventy-three catastrophic injuries reported in cheerleading, with two deaths. Gymnastics, which incorporates many of the same tumbling passes and boasts similar numbers of participants, had a total of nine catastrophic injuries during that same period. That’s a pretty drastic difference. Clearly, something needs to be done to protect cheerleaders from increasingly common and increasingly serious injuries. Football, too, deserves a critical examination. In 2007 there were 920,000 players under the age of eighteen treated in emergency rooms for injuries.
One factor that contributes significantly to the rate of injury is specialization. In other words, children are pigeonholed into one sport fairly early on, which means that they have little variation in terms of the muscles and joints employed and skills practiced, which can lead to fatigue and a much higher rate of injury. And one of the main causes of early specialization is parents who stress the pursuit of one specific sport for the sake of gaining college scholarships and professional recruiting buzz. It should be noted, though, that the odds of a football player actually making it to the NFL—not as a starter or even taking the field at any point in his life, but just making it on a professional roster—is greater than 6,000 to 1.
I don’t mean to come down too hard on parents here; after all, we all want the best possible opportunities for our children. And most parents are very responsible in the emphasis they place on pursuing sports. But at some point, there needs to be a reality check. Ambitious parents and coaches need to understand that encouraging a child’s talent is one thing but controlling it or obsessing over it is quite another. Before you pin your future retirement plans on how well your child performs athletically, consider this: The National Federation of State High School Associations estimates that less than 0.1 percent of kids who participate in sports at school will receive a scholarship to continue that sport in college.
The American Orthopaedic Society for Sports Medicine (AOSSM) initiated the STOP Sports Injury Campaign in 2010 to prevent overuse and trauma injuries among young athletes. The STOP acronym, which stands for Sports Trauma and Overuse Prevention, makes clear the organization’s intentions. As president of the society from 2009 to 2010, I expressed my desire to launch a national program for preventing injuries in youth sports. The AOSSM unanimously agreed that the time was right to begin our education campaign.
Founding partner organizations in the STOP Sports Injury Campaign include the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics (AAP), the American Medical Society for Sports Medicine (AMSSM), the National Athletic Trainers’ Association (NATA), the National Strength and Conditioning Association (NSCA), the Pediatric Orthopaedic Society of North America (POSNA), the Sports Physical Therapy Section of the American Physical Therapy Association (APTA), Safe Kids USA, and the Professional Baseball Athletic Trainers Society (PBATS). Today there are more than 250 other local and national organizations that have taken the pledge to prevent youth sports injuries at the grassroots level.
When it comes to sports injury prevention, we must establish a priority in basic research principles. The STOP program’s mission is fourfold: Number one is to establish the extent of the problem. Number two is to identify the risk factors and the mechanism of the injuries. Number three is to develop preventive interventions. And number four is to evaluate the effects and results of those interventions from a scientific standpoint. The STOP program has all of these objectives in its mission and focus. The AOSSM has identified several areas of research that need to be undertaken to take prevention to a scientific conclusion and to be able to show definitive results.
The first high-priority proposal addresses the prevention of anterior cruciate ligament (ACL) knee injuries in young female athletes, who have a three to six times ACL injury rate when compared to their male counterparts. This study will emphasize “cutting” sports, which require a sudden change of direction or darting to one side while running, such as basketball, lacrosse, soccer, and volleyball. Cheerleading and gymnastics will also be included.
The second priority is the prevention of repeated concussions and related complications. Approximately two million to three million young athletes suffer concussions each year in America. A number of long-term studies have shown that repeated concussions have an impact on mental health later in life, especially among former athletes.
The third priority is related to overuse injuries of the shoulder and elbow and their prevention in youth baseball and youth softball for both pitchers and fielders. The number of young men and women who require surgical repair to their pitching arms because of overuse damage is on the rise. This is a serious problem and one that is especially close to my heart, as it is now one of the most common procedures I have to perform on young people. When I started in this career, I never imagined that it would become routine for a fifteen-year-old to have to undergo such drastic treatment.
In a study published in the September 2009 issue of the American Journal of Sports Medicine, researchers examined severe injuries broken down by specific sports and injury type. Researchers captured injury data during the 2005–06 and 2006–07 school years from one hundred nationally represented US high schools. Information was collected for various sports, including football, soccer, volleyball, basketball, wrestling, baseball, and softball. “Severe injury” was defined as any mishap that resulted in an athlete losing more than twenty-one days of sports participation; according to the study, over the course of those two years, severe injuries accounted for 14.9 percent of all high school sports–related injuries. After football injuries, the highest level of injury was reported in wrestling, followed by girls’ basketball and girls’ soccer. While no one was surprised that football emerged as number one, there were some unexpected findings. Among the directly comparable sports of soccer, basketball, and baseball/softball, girls actually sustained a higher severe injury rate than boys. There were also patterns in injury sites, with the knee sustaining a severe injury nearly 30 percent of the time, followed by the ankle at 12.3 percent and the shoulder at 10.9 percent. Additionally, 5 percent of the severe injuries recorded resulted directly from illegal player activity such as tripping or spear tackling. While ankle sprains still tend to be the most common “nonsevere” injury among young players, these findings highlighted the importance of finding ways to protect the knees from more traumatic damage, and suggested that not enough is being done to educate and protect young women athletes. According to this very important and revealing article, future studies should focus on risk factors to develop prevention and intervention. Decreasing sports-related injuries is critical to keep kids playing sports long-term and minimizing the health care cost both to the family and to the health care system itself.
According to the National Federation of State High School Associations, some 7.34 million athletes now participate in high school sports programs, up from 5.2 million just ten years ago. The boy-to-girl ratio is not quite even, although the number of girls participating in sports is on the rise: The total numbers are approximately 4.32 million boys compared to 3.02 million girls, yet the number of serious injuries in many girls’ sports is higher than the rate in comparable boys’ sports. This is certainly a cause for concern.
In light of these statistics, I’d like to make some general recommendations for athletes of both genders that I will elaborate on in part 2’s sports-specific chapters. The vast majority of sports medicine professionals, coaches, and trainers agree that training in the months prior to the sports season is critical to an athlete’s success. The old saying “Preparation is ninety-nine percent of execution” is certainly true in the athletic arena. A very successful preseason strength and conditioning program will dramatically decrease the risk of both minor and major injuries. It is the responsibility of coaches in all youth sports to educate their players in proper periodization on a twelve-month basis in preparation for a season. That is, fitness must begin prior to the first day of practice, and, ideally, some form of physical fitness should be maintained year-round, with training increasing gradually two to three months before the season starts. Statistics show that the majority of injuries occur in the first few weeks of a sports season due to inadequate preseason preparation.
It is also critical for coaches and players to realize that there must be a balance between work and rest. A young athlete should not work out at peak levels twelve months out of the year—especially not with an eye toward specializing in a specific sport. Overtraining always increases the risk for injury, especially in growing bodies. Therefore, athletes should not neglect off-season training, specifically cross-training and participating in other sports. But they should also be willing to take off a few weeks or a month from intense exercise each year in order to allow their body to rest. Low-impact activity should be pursued during that time, but the body needs a chance to recover and repair itself from the constant wear and tear of training.
Coaches should also be aware that the US Consumer Product Safety Commission (CPSC) indicates that 62 percent of sports injuries occur during practice rather than in a game or match. This does make sense: although an athlete’s adrenaline tends to be higher in competitive settings—contributing to more aggressive play—the vast majority of his or her time is spent in practice versus actual time going head-to-head with another team. For that reason, practices should always be well supervised for safety of technique as well as the intensity of the workout.
No matter the sport, it is important to focus on general conditioning and core stability, as well as overall cardiovascular fitness and endurance through long-duration, low-intensity workouts. Cross-training during the off-season is especially important when participating in a predominantly one-sided sport, such as baseball. By pursuing different types of sports, young athletes can develop more complete musculature and hone other athletic skills to avoid fatiguing a specific part of the body.
Young athletes, particularly those who have not yet gone through puberty, should avoid overtraining and overuse, as the body is not fully equipped to rebuild muscles following workouts. I recommend that younger athletes follow a simple 10 percent rule: do not increase weight, training activities, mileage, or pace by more than 10 percent a week. This prevents stressing the body beyond capacity by allowing it to rest, rebuild, and recover. In fact, increasing training intensity too quickly can actually decrease high-level athletic activity.
It is essential for coaches to understand the basic principles related to preparing an athlete for a season. Thanks to Avery D. Faigenbaum, EdD, at the College of New Jersey, and Larry Meadors, PhD, at Sports Spectrum Training, here’s a list of twelve fundamentals for building young and healthy players, which the authors aptly entitle “The Coaches Dozen,” originally published in Strength and Conditioning Journal in 2010:
1. Young athletes are not miniature adults.
2. Value preparatory conditioning.
3. Avoid sports specialization before adolescence.
4. Enhance physical literacy.
5. Better to undertrain than to overtrain.
6. Focus on positive education.
7. Maximize recovery.
8. It is not what you take, it is what you do.
9. Get connected.
10. Make a long-term commitment.
11. There are no secrets.
12. Never stop learning.
Coaches and parents alike should remember that sports are meant to be fun, while facilitating a young athlete’s social development. Never push the training or make the competition so serious that the child feels stressed or comes to dread the activity. This can easily lead to burnout in the sport or in athletics in general. I also recommend avoiding “professionalism” in youth sports—that is, harping on how young athletes need to develop their talent if they ever want to make it in the pros, or obsessing over their training to the point of tunnel vision. Adolescents have plenty of time to develop into professional athletes if their talent and interest point them in that direction. Genetically, 99.9 percent of young athletes are not ready for such serious professionalism at a young age.
There are essentially two different types of injuries: acute injuries and overuse injuries. Acute injuries are the result of a single traumatic event. Common examples include wrist fractures, ankle sprains, shoulder dislocations, or hamstring muscle strains. Overuse injuries, on the other hand, usually occur over time, making them more challenging to diagnose and sometimes more difficult to treat, as the damage is often not as clearly defined as in acute injuries. They are usually a result of overtraining: repetitive microtrauma to tendons, bones, cartilage, and joints, such as shin splints or tennis elbow. Whenever an athlete trains for a sport, even as a child, he or she is trying to make the bones, muscles, tendons, and ligaments of the body stronger and more functional. Unfortunately, there is a very thin line between beneficial training and training that is ultimately detrimental to the body.
The process of breaking down and building up muscle has a fine balance as well. When is the soreness a good thing, meaning that the muscles were stretched and worked to the point of growing stronger? And when does it mean that the muscles were damaged and are struggling to repair themselves? Training errors tend to involve a rapid acceleration of the intensity, duration, or frequency of an activity. They are especially associated with specialization.
Parents, coaches, and athletes must remember that the goal is always to feel better, not worse. Although soreness is to be expected when working new muscles, and anyone is likely to feel winded when doing cardio conditioning, the pain should never be debilitating. A common philosophy in training for sports is that “more is better”: in other words, if pitching a ball twenty times is good, pitching it forty times is twice as good. That’s simply not true. “No pain, no gain” should have no place in youth sports. Young athletes should not participate with pain. Athletes should have an open dialogue with their coaches, parents, or other trusted adults regarding their pain patterns, as these may be early indications of overuse injuries.
When an imbalance between strength and flexibility occurs, the injury pattern for overuse injuries increases rapidly. Young athletes who are still developing and growing often have bony malalignment, which simply means that the bones are growing at a rate that temporarily puts them out of the normal position in relation to their joints. This condition makes young athletes even more prone to overuse injuries. Other factors include equipment (such as the type of running shoe or ballet shoe), whether the terrain is uneven, hard surfaces versus soft surfaces in training, and whether proper techniques are being taught and practiced. These are just a few of the reasons why expert, certified coaches are so important in bringing their knowledge and understanding of the safest and best possible practices to their teams.
Some guidelines for treating overuse injury include:
1. Cut back the intensity, duration, and frequency of an activity.
2. Adopt a hard/easy workout schedule to vary the intensity each day, and incorporate cross-training with other activities to maintain fitness levels.
3. Learn proper training and techniques from a qualified coach or athletic trainer.
4. Perform proper warm-up and cool-down activities before and after practicing. Flexibility stretches can be particularly helpful when combined with ballistic exercises that get the muscles ready for intense bursts of energy, such as squats or tossing a medicine ball. (See chapter 32 for more information and illustrations.)
5. Apply ice for minor aches and pains after any activity.
6. Use nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, and naproxen, as necessary. Communication between athletes, parents, and coaches is particularly important if symptoms persist, at which point a visit to a sports medicine specialist is in order.
7. Consult athletic trainers and physical therapists for guidelines about early recognition and treatment of suspected overuse.
Keeping our kids safe needs to be a team effort, with all involved parties pitching in. Parents, grandparents, coaches, trainers, and athletes should all work toward the brightest possible future for every young athlete: one that is healthy and active thanks to the safe decisions we make together now.
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