It takes a lot to shock Matthew Matava, M.D., an orthopedic surgeon at Washington University. During his time as a team physician for the St. Louis Blues and the St. Louis Rams, he has seen thousands of athletes and career- ending injuries. But when a 12-year-old boy came to the doctor with shoulder pain, the visit took an unexpected turn. "I informed his mother that he would need to refrain from playing football for several weeks to recuperate," he recalls. "She told me that we needed to get him back to play as soon as possible, since she expected him to be an NFL quarterback." The scenario is all too familiar: Kids as young as 6 are being hurt at increasingly higher rates, which can sideline them for months, alter the way their bodies grow, contribute to burnout and cause discomfort for the rest of their lives. At a time when the focus of childhood health is on the lack of exercise, the issues at the other end of the spectrum—like stress fractures or ACL tears—are only just now gaining attention. Although it's easy to point the finger at coaches and parents, the truth is that a competitive culture and an innate desire to succeed are driving kids off the fields and into physicians' offices, explains Neeru Jayanthi, M.D., a medical director of primary care sports medicine for Loyola University Health System. We spoke to some of the top orthopedic surgeons and sports medicine doctors in the country to find out what you need to know to help your child avoid, treat and recover from an injury.
Most common in kids going through growth spurts, apophysitis is an inflammation at the growth plate where muscles and tendons connect, such as at the knees, elbows, heels, hip and pelvis. (It is not, however, to be confused with "growing pains," says Randy Goldstein, D.O., the medical director of youth and adolescent sports at the University of Kansas Hospital.) Because apophysitis can affect so many areas of the body, almost every type of young athlete is at risk.
How It Happens
As your child grows, doing too much of an activity (think: pushing herself to log one more mile or perfect that final jump) can cause pulling on one of her bone's growth plates, leading to inflammation and pain that intensifies during exercise.
Kids are most at risk during a growth spurt—around ages 8 to 13 for girls and ages 12 to 15 for boys, says Dr. Goldstein—so be on the lookout for signs that your child is in any pain. If she has apophysitis on the heel, you can also try using heel cups—they cushion the back of the foot and help absorb shock.
Cutting activity in half or, in some cases, stopping completely for a short period of time, should resolve most of the risk for apophysitis injuries. Don't push it. If you don't limit her time on the field or court, the injury could get worse.
What to Know
In the unlikely event that she needs surgery, doctors will stretch the tendons and tissue and reattach them to the growth plate. Sounds scary, but the outcome is excellent: In one study, some young athletes who had this operation on their knee hadn't experienced any complications from their injury 10 years later.
Shoulder Impingement (Swimmer's Shoulder) & Little League Shoulder
The shoulder is one of the most versatile joints in the body, but that hasn't stopped kids from throwing it out. According to one survey, shoulder overuse problems were reported as one of the top five widespread injuries among high school athletes.
How It Happens
If your child spends too much time throwing a baseball or swimming laps, he may experience shoulder impingement. The tendons around his shoulder rub against the bone, triggering inflammation, pain and, less often, tears. Little League Shoulder is an overuse injury that occurs when his bone's growth plate widens, causing pain and altering the way he throws.
Parents and coaches should keep an eye on how often kids use their arms and shoulders, says Dr. Goldstein. The American Sports Medicine Institute says that young athletes should pitch no more than 100 innings per year and limit any overhand throws for at least two months a year. Building up the core and other scapular stabilizing muscles via a strength training program also helps prevent injuries. In the off-season, your child can stay in shape by participating in activities like cycling that don't tax the shoulder joints.
Rest, ice, rest. Dr. Goldstein advises his young athletes to lay off the injured area, undergo intense physical therapy and, for pitchers, participate in an interval throwing program. The latter helps slowly integrate the shoulder back into motion, working on technique while also strengthening the core, leg, back and arm muscles to help alleviate future pain.
What to Know
Treatment for shoulder injuries and Little League Shoulder nearly always includes rest and physical therapy, so you can most likely skip the pricey MRI, says Dr. Goldstein. Surgery, though rare, is usually preceded by physical therapy. Seek out a sports medicine physician who can help your family determine the best recovery plan.
ACL, MCL and LCL Tears
Once thought of as extremely rare, anterior cruciate ligament (ACL) tears have increased by 11 percent each year from 1999 to 2011 in kids under the age of 18, experts have found. They now account for 26 percent of all knee injuries among high school athletes, especially basketball and soccer players. Injuries to the medial lateral collateral ligament (MCL) and lateral collateral ligament (LCL)—which are located on the sides of the knee and control left-to-right movement—also occur in young athletes.
How It Happens
When a kid changes directions too quickly or lands improperly after a jump, the knee joint can get twisted, bent backward or pushed to the side, says Dr. Jayanthi. He may hear a pop and be unable to lean on his lower leg.
Neuromuscular exercises (warm-ups like skipping and high-stepping) strengthen athletes' mind-body connection, which improves coordination. Have your kid perform these drills in his free time and before practices or games. A sports medicine physician or an athletic trainer can also suggest a specific regimen.
Your child will probably need one to three weeks of physical therapy to reduce swelling and improve the knee's range of motion before undergoing reconstructive surgery. Post-op recovery can last 6 to 12 months, but experts recommend that kids take a full year off before returning to sports. "The ACL can't heal on its own," says Tracy Ray, M.D., associate professor of orthopedic surgery at Duke University, "but fortunately MCL and LCL sprains usually repair themselves and don't require surgery—just rest."
What to Know
Kids who return to the field after ACL reconstruction surgery are six times more likely to suffer another knee injury within two years, according to one study. Talk to a pediatrician about whether your child should continue to play contact sports. Other activities may be easier on the knees.
Back Stress Fractures
Adults aren't the only ones susceptible to lower back issues. Stress fractures of the back are the third most common injury in athletes 18 and younger. "It's a hidden epidemic among youth athletes," says Dr. Jayanthi.
How It Happens
If your child overextends her back—like when she does a backflip or nails a tennis serve—tiny cracks may develop in the vertebrae. The more pressure a child puts on her back, the more likely she is to become hurt. She may feel as if she's sprained a muscle, but the pain will be localized to one specific area and may worsen instead of improve over time.
Some athletes—including tennis players, gymnasts, cheerleaders and football players (especially linemen)—are more at risk than others. Limit their time on the field or court to between 16 and 20 hours per week, according to the National Athletic Trainers' Association. More than that could lead to injuries. Though the most common cause of back stress is overuse, poor form is another possible cause; check with the coach if you suspect your child is landing or falling incorrectly.
Make sure your child logs more downtime—lots of it. Most doctors recommend four to six weeks of rest; some kids may require a brace as well. Your child will need time to build up her core strength, which will take pressure off the spine. A certified athletic trainer, physical therapist, sports medicine doctor or orthopedic surgeon can develop a plan to help build up the area's surrounding muscles.
What to Know
Early recognition and treatment are critical for healing, says Dr. Jayanthi. If a back stress fracture isn't treated early enough and the bone actually cracks, the chances of it healing are nearly zero. If your child complains of pain for more than two weeks, it's time to see a doctor.
Originally published in the September 2014 issue of Family Circle magazine.