Every year millions of young athletes end up in the hospital with injuries ranging from sprains to broken bones to concussions. Learn what you can do to make school sports safer for your kids.

By Annie Finnigan

High Price to Play

Since first laying his hands on a pigskin at age 7, Charles McCall has been mad about football. A senior and star running back at Los Osos High in Rancho Cucamonga, California, he puts in 30 hours a week playing, practicing, and working out at the gym. "Playing pro — that's definitely my goal," he says. Last June, while attending football camp in Idaho, the 17-year-old collided with another player in midair as he went out for a pass. Charles came down — hard — on his right leg. "It felt wobbly, like it was asleep, and I had to limp off the field," he says. Within minutes he was in excruciating pain. X-rays revealed a badly ripped ligament behind the knee.

But Charles refused to be sidelined. He put in hours of physical therapy daily and doubled his weight training routine in order to strengthen the muscles around his knee. By the opening of his high school's August football practice — a.k.a. Hell Week — he was back in the game, with his doctor's permission, his leg steadied by a brace. "I knew I was putting myself at risk," says Charles, who went on to lead his team in receptions and receiving yards for the season. "But I live, eat, and breathe this sport. If I didn't play, what would I do?"

Strains and Sprains

Sprains, strains, contusions, fractures, concussions — experts say that these and other injuries are on the rise among our sports-obsessed kids. It's estimated that high school sports are responsible for 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations every year. About 3 million children under age 14 are hurt annually playing sports, a quarter of them so seriously they are sent to emergency rooms, according to the American Academy of Pediatrics. And it's not just tough-guy games that are to blame. While football injuries have climbed 43 percent in the last decade among 7- to 18-year-olds, cheerleading — hardly a contact sport — is a close second, with a 38 percent increase.

What's behind the epidemic? From Little League to high school varsity teams, sports have become more organized and competitive, and the pressure to excel — from coaches, schools, parents, and the kids themselves — is intense. "More kids are also specializing in a single sport early on and playing it year round," says Lyle Micheli, MD, founder and director of the sports medicine division at Boston Children's Hospital. "And they're training harder than ever without giving themselves a break. Anything less, and they'll fall behind the curve." But young bodies aren't built to stand up to all that stress. "Kids are more vulnerable than adults because their muscles, bones, even their brains, are still growing and don't recover from injuries as well," explains Jason Theodosakis, MD, assistant professor at the University of Arizona College of Medicine in Tucson.

Despite the alarming increase in injuries, many parents are reluctant to curb their kids' activities — and their dreams. Charles McCall was determined to play this season because he knew college scouts would be watching, and his mom, Darcey, couldn't say no. "I told him to be careful, since another knee injury would affect him for the rest of his life," she says. "But it was his turn to shine, and I couldn't take that away from him." Still, there are steps parents can take — including knowing which injuries are most common and how to avoid them — to help kids play safe.

Too Much, Too Soon

Nick Mulcahy is only 17 years old, but he's already had as many surgeries as a professional athlete. A baseball pitcher for two league teams as well as for the Lancers at Malden Catholic High School outside Boston, he's been throwing hundreds of pitches a day for years — and it's taken a toll. He was 12 when he heard "a funny clicking sound" in his right arm while lifting weights in gym class. "My elbow got stiff, then locked up so badly I couldn't straighten it," he says. X-rays revealed that a sliver of bone had chipped off and lodged in the joint, and there were similar fragments in his left arm as well. Nick had two operations to remove them, but so much scar tissue developed he had to go back under the knife twice to have it removed.

Pitcher's arm, runner's knee, swimmer's shoulder, gymnast's wrist, and more — all are overuse injuries caused by repetitively stressing tendons, muscles, or bones, without giving them sufficient time to heal. According to the American Academy of Pediatrics, such cases now account for as many as half of all injuries among student athletes. Dr. Micheli says 70 percent of the patients he treats suffer from exercise overload, up from 10 percent in the 1980s. Injuries that were once prevalent among 15- to 18-year-olds are now common in kids as young as 6. Depending on the type of damage, the long-term effects include chronic pain, premature arthritis, and stunted bone growth.

To prevent injury, experts recommend limiting playing and practicing to 12 hours a week in any one sport, or 20 hours per week for multiple sports; anything more and your kids should be supervised by a sports doctor. Workouts should proceed slowly, with increases in time, distance, or intensity not exceeding 10 percent over the course of a week.

For Nick, a safe regimen includes counting the number of pitches he throws (experts advise no more than 100 a day for a 16-year-old). "With all the surgeries he's had, we've made sure he did all the physical therapy and was cleared to play by his doctor," says his dad, Steve. "And his coach would break him in slowly, by putting him in for only a couple of innings at a time until he was back to full strength." Even so, the last season hasn't been pain free. "Sometimes I feel a twinge — or worse," says Nick. "But the whole game's on you, and you have to keep going. You play through the pain."

Turn for the Worse

Molly Federl of Scituate, Massachusetts, started out shaking pom-poms and doing forward rolls as a cheerleader in sixth grade. By high school she was performing acrobatic midair maneuvers like the front hurdler and the pike, at both varsity games and statewide competitions. In February 2007, while the 16-year-old was performing a tricky series of jumps at a league meet, she heard her knee literally pop. It didn't hurt too much, so she kept going. By the time the two-minute routine was over, Molly had to be carried out of the gym and rushed to the ER. She'd ripped her front knee ligament, or ACL, clear off the bone. After reconstructive surgery, she hobbled on crutches to the prom that spring and endured extensive rehab therapy all summer. Still, Molly has no regrets. "Maybe staying out there wasn't the best idea," she says. "But if I hadn't, our team would have lost. Instead, we came in second."

One of the most common type of sports injuries, ACL tears are the bane of athletes whose sports require quick pivoting or jumping. Soccer, basketball, and football players, along with cheerleaders and skiers, are especially vulnerable. Some 20,000 cases occur among high school students each year — most of them girls — according to the American Orthopedic Society for Sports Medicine. Compared with boys, girls have looser muscles overall, offering them greater flexibility but less support for bones and ligaments. And their leg muscles tend to be unevenly developed, with stronger quadriceps at the front of the thigh and weaker hamstrings at the back. As a result, girls are two to eight times more likely to incur ACL damage — and suffer the long-term consequences, which include progressive and permanent loss of cartilage, stiffness, pain and, in some cases, osteoarthritis of the knee showing up as early as 30 years of age.

The good news is that ACL injuries can largely be avoided with strength training, which corrects the muscle imbalance, and plyometrics, a form of jumping exercise that increases power and speed. Unfortunately, many coaches don't put enough stress on preventive measures, and even when they do, it's still up to students to do their part. "The routines we do are so hard and take so long to learn, there's not a lot of time left over for conditioning," says Molly. Since returning to cheerleading last August, she tries to hit the gym three times a week, but admits she often doesn't make it. At her doctor's recommendation, Molly now uses a knee brace, which reduces the risk of re-injury. "She has to wear it when she does her routines," says her mom, Beth Baron. "As long as she is in good physical shape, we're happy."

State of Confusion

The accident happened three years ago, but Alex Artino's memories are painfully vivid. "It was a night game, start of the second quarter," says Alex, then a 17-year-old running back for the Fairview High Knights, in Boulder, Colorado. "The ball was thrown behind me, so I turned, jumped, and got my hand on it. That's when a linebacker hit me — right in the face with his helmet." Alex collapsed in a heap on the ground. "I felt like I was floating and that everything was in slow motion," he recalls. The team trainer concluded Alex had suffered a concussion and took him out of the game. "I sat on the bench feeling dazed," he says. "My head ached. The lights hurt my eyes, and I couldn't see clearly."

His symptoms were gone by morning, and after a week Alex's doctor said he could resume playing. His first game back Alex was barreling down the field when he and another player collided head to head. "For the next few months I wasn't myself," he says. "I had no emotions — it was like I'd lost my personality. I couldn't concentrate, and my grades dropped from A's to C's." A neurologist diagnosed him with post-concussion syndrome, a cluster of physical, emotional, and cognitive disorders that can last weeks, months, or years after a jarring impact to the brain. After talking with his parents, Alex decided to hang up his cleats for good.

Concussion is one of the most serious threats to young athletes, especially high school football players, who account for 40,000 of the estimated 300,000 sports- and recreation-related brain injuries that occur each year. Baseball, basketball, and soccer players are also at high risk — as are teen girls, who have a 68 percent higher rate of concussion in soccer and a 300 percent higher rate in basketball, according to a 2007 report in the Journal of Athletic Training. Even worse, concussions are drastically underreported. That's partly because many kids — and parents — still mistakenly believe the injury always involves loss of consciousness. And even when they know they've likely suffered a concussion, athletes often don't tell their coaches for fear of being benched.

It's a dangerous deception. People who sustain one concussion have a greater risk of suffering another with each new injury. Multiple concussions may increase the risk of developing Alzheimer's, Parkinson's, and other conditions affecting brain function. Studies also show that incurring a concussion while still healing from a previous one can result in "second-impact syndrome," a rapid swelling of the brain that may result in respiratory failure and can be fatal.

Alex is lucky. He got straight A's his final semester at Fairview High School and is now doing well at the University of Colorado, where he plays the occasional game of touch football with his friends. "He's got his sparkle back," says his mom, Sharyl. "Quitting was hard for him, but he knows he made the right decision. The risk was just too great."

Damage Control

Parents can't afford to sit on the sidelines when it comes to kids' safety. Help yours avoid injuries by doing the following:

  • Take them for a physical. Do this before they start any sport, preferably with a pediatric sports specialist. He can administer specific tests to pinpoint weaknesses — and suggest appropriate exercises or precautions.
  • Check up on your child's coaches or trainers. Make sure they've had formal training in sports safety or that someone who has is always present during games and practice. Watch how they treat injured players — do they keep them in the game or put them back in too soon? Are athletes outfitted with proper safety gear? If you have concerns, don't let your child participate until you get a satisfactory response from school, camp, or league officials. For a good list of questions to ask coaches, see MomsTeam.com.
  • Insist that your child pace herself. Once your kid takes up a single sport, insist that she vary her weekly activities, whether it's riding her bike or going hiking with the family. Experts advise taking one to two days off from competitive games or practice every week, and at least two months off from a specific sport each year.
  • Be alert for burnout. Red flags include overall fatigue, poor academic performance, nonspecific muscle or joint problems, and sluggishness or lack of focus during games or practice. Exhaustion — and the inattentiveness and carelessness that go along with it — can set your kids up for injury. Tell them they've got to be rested and alert or you won't let them play. If you suspect they've already been hurt, take them to a doctor immediately.
  • Stay real. Constantly remind them — and make sure they understand — the difference between wanting to win and winning at any cost. You can draw from news headlines — like the baseball steroid scandal — to help drive your point home. And check your own competitive urges too. For you and your kids, having fun should be the payoff.

Copyright © 2008. Used with permission from the March 2008 issue of Family Circle magazine.