Preventing & Treating Youth Sports Injuries

September 11th, 2017

Are you ready for some football? If your kids are athletes, odds are they started practice for their fall sports several weeks ago. If your children have been involved in sports for a while, you are no doubt familiar with the risks of injury inherent in any sport. You have probably heard the warnings about overuse injuries, concussions, and various other issues common to youth athletics. If, however, your child or children are new to sports, you may not be as familiar with the risks.

No matter the level of familiarity you bring to the table, there are a few things that bear repeating and brushing up on as we head into the fall sports season. To start with, here are some statistics:

In light of these figures, it might be tempting to simply pull your kids out of all athletics, but there's a lot of good to be gleaned from sport, and it isn't all related to physical fitness. For many students, the gridiron, the track, or the gymnasium is where grit is developed, leading to greater success in academics, as well as other areas. Many successful individuals point to their time in team athletics as a training ground where important qualities like teamwork, leadership, and perseverance were honed in their lives.

So how can parents and students mitigate risk as they engage in sports? Joe Congeni, MD is the director of the sports medicine program at Akron Children's Hospital and a national expert on concussions. Not only does he treat young athletes, but he has also spent many years coaching youth sports in his spare time. We recently spoke with Dr. Congeni and asked him about managing risk and how to respond if your child is injured playing sports.

Q: Dr. Congeni, what are some of the health risks to young athletes today?

A: Overuse injuries make up 75 percent of the cases we see. We also see injuries resulting from direct trauma, but damage from repetitive activities in sport is the number one reason we see young athletes.

Q: What makes young athletes more susceptible to certain injuries?

A: Young athletes are not made the same way adults are. Their bones are still growing, so the over 200 growth plates in their bodies are particularly susceptible to injury. In the case of overuse injuries, young athletes who repeatedly throw a baseball or jump may experience fractures at those sites.

Another fundamental difference between kids and adults is that kids don't always have the strength of the core and shoulder girdle to do the things adult athletes do, such as absorb a hit in contact sports. There are mechanical differences due to age that put them at risk for injuries that are not as much of a concern in adults.

Where both overuse and head trauma are concerned, some injuries are subtle, and many young athletes can and do play through them. Most youth teams (prior to high school) do not have an athletic trainer present while they play, so injuries they would likely notice go unobserved.

One of the main reasons we may be seeing more overuse injuries today is because kids generally are not participating as much in free play as was the case even 20 to 40 years ago. If a child is athletic, in many cases they are participating in organized sports that have been put together by parents or coaches. Rather than strengthening and exercising the entire body, they are focused on improving competence in that particular sport, which necessarily puts them at risk for repetitive stress injuries.

Q: Are there ways to mitigate the risk of overuse injuries?

A: I recommend trying to expose kids to a variety of different sports at an early age. Before high school, they ought to be encouraged to get involved in multiple sports rather than specializing in one.

There is a theory in which kids are encouraged to specialize early so they get better, hone their skills, and have a better chance at scholarships, but study after study in sports medicine literature shows this does not ensure elite athleticism. When you look at college athletes and pros, most of them played multiple sports. In many cases, the best athletes will rise to the top regardless of whether they specialize early.

It's important to consider the fact that when kids specialize too early, there is also a greater likelihood of burnout. When they aren't the best at something they've specialized in, they might just drop out altogether rather than staying active.

Q: Last month's JAMA study on the instance of chronic traumatic encephalopathy (CTE) in football players has resulted in several pros making an early exit from the sport. How should parents process this information?

A: The issue of brain injury, particularly as regards concussion (the most common issue in sports), is still somewhat confounding. Parents need to know that this CTE study has been ongoing for years. It is not brand new information, and it's based on a population who already showed symptoms of brain trauma. The inference that 90-100% of people who play football wind up with CTE is a bit misleading. We don't actually know that this proportion of athletes would show signs of CTE across the board.

Of course, we still are very concerned about concussions in young athletes. They are hard to identify, as diagnosis is based on subtle signs. No x-ray, CT scan, or MRI can show concussion. For these reasons, they're often missed early on and can become more significant and problematic later if they are missed.

Although football is the most discussed and studied, all contact sports are struggling with this problem. For instance, women's soccer and women's basketball are the two fastest growing sports for incidence of concussion.

Q: If a parent believes their child may have experienced a concussion, what should they do?

A: Concussion is a clinical diagnosis, meaning it's based on symptoms, not test results. There are 22 different symptoms, and athletes can exhibit all or just one or two of them.

If you think your child has a concussion, seek medical attention from a medical professional who has experience dealing with concussion in particular. There's a great deal of new information from studies conducted in recent years, and many medical professionals who don't have experience still have misconceptions on the topic.

For high schoolers, athletic trainers are a good first line of defense. They have the title for a reason and are very knowledgeable on the subject. If your athlete is not yet in high school, start with a primary care doctor and, if necessary get a referral to see someone who is experienced in diagnosing and treating concussion.

Q: Can a student continue to play sports following a concussion? If so, when?

A: If a young athlete is diagnosed with concussion, there is a protocol that should be followed in order to return him or her to sport. This can include treatments to correct the concussion, a period of rest from activity, non-contact physical activity to get the blood flowing to the brain, and "return to play", which involves stages of return to their sport. This is known as the ‘concussion protocol’.

There is also a need for brain rest followed by a gradual return to school, known as "return to learn". Many student athletes are worsened by returning to the classroom too early, doing too much too soon can cause them to continue to be symptomatic.

Q: How can young athletes protect themselves from concussion?

A: Helmets continue to present a challenge for sports medicine practitioners. I'm not sure they're going to find a "holy grail" for head protection. In truth, it's not necessarily the hit as much as the whiplash or snap back that causes concussion. However, there are some preventative measures that can and should be taken:

First off, training: young kids who want to play contact or collision sports should be on a strengthening program for their neck, shoulder girdle, and core so that when they are hit, it dampens the blow of the whiplash/snap back mechanism. Those students who go through this type of prevention program do better.

Second, education: we work with parents, coaches, and athletes on this topic. In the last few years, legislation was passed requiring coaches and parents to complete curriculum and testing so they know what concussion looks like and so they can ensure students don't play through it.

As I mentioned before, athletic trainers are a boon to athletes at risk for injury. Although athletics organizations for young athletes (pre-high school) don't typically employ trainers, they are occasionally present at tournaments and meets, so they can be helpful in those settings.

In the background, there is ongoing research on the topic of concussion. My own hospital, Akron Children's, is involved in five such studies.

Q: Through your interactions with young athletes on and off the field, what are some of your observations concerning the positive effect athletics can have on kids?

A: My last child of 6 just left for college, so for the first time in years, I am not currently coaching. However, I coached 18 years in basketball, football, and to a lesser extent other sports. I probably got just as much of an education about sports medicine on the sidelines as I did from my training in the clinic. I also played several sports, most notably basketball, and can say I personally learned more from some of my own coaches than from some of my teachers.

I'm in sports medicine because there are so many life lessons kids learn from sport, many of which they use later in life. In fact, I recently gave a talk entitled, "Everything I Need to Know I Learned in Youth Sports". Can kids learn these things other places? Yes. But for kids who love sports, they are an excellent place to pick up important lessons, such as how to win (and lose), how to get up when you get knocked down.

I'm an advocate of keeping youth sports around despite the risks because there are so many positives. Football is such a unique, passionate sport, where players care for their teammates and learn to play even when they have pain (please note: this is not the same as when you're injured). Football players understand they might only play for a short time but the lessons they learn in their football career last for a long time. To know that anytime you step on the field could be the last time you play - that makes it an intense experience.

We want to thank Dr. Congeni for taking the time to speak with us on this practical topic. Visit this page to read other interviews and articles related to his work at Akron Children's Hospital.

As a Christian healthcare sharing ministry, we are a group of self-pay patients who have voluntarily agreed to share in one another's eligible medical costs. All members should make themselves familiar with our Sharing Guidelines document, in which we detail the parameters for sharing of eligible medical costs.

As you plan ahead for your students' athletic seasons, it would be worthwhile for you to think through how you will respond if your child is injured. Instead of using the Emergency Room in these situations, consider that there may be a less expensive way to diagnose and treat certain injuries or conditions, such as a primary care office. Of course, we understand this may not be an option in the case of true emergencies. However, we encourage our members to conservatively access their healthcare with careful consideration of the cost, as the finances used to share in eligible costs are coming from your pockets and the pockets of your fellow members.

As parents seek to wisely encourage their kids' participation in athletics, we are happy to support the ways in which this involvement can benefit the achievement and character formation of our young members. For some great information and free tools for parents on sports safety, visit Safe Kids Worldwide. We are rooting for you!

Dr. Congeni is not associated with Liberty HealthShare in any capacity, and his comments here should not be taken as an endorsement of Liberty HealthShare.