Saturday, May 26, 2012

Turn Your Head and Cough...

Overuse injuries – found most often in low-contact sports that involve long training sessions or where the same movement is repeated numerous times – make up nearly 30 percent of all injuries sustained by collegiate athletes.

And a majority of overuse injuries (62 percent) occurred in female athletes, according to a new study published in the current edition of the Journal of Athletic Training, the National Athletic Trainers' Association scientific publication.

"Overuse injuries may present not only physical challenges but also psychological ones that could significantly affect an athlete's recovery and performance," said study co-author Tracey Covassin, a certified athletic trainer at Michigan State University and a member of the Department of Kinesiology.

"Understanding the frequency, rate and severity of overuse injuries is an important first step for designing effective injury-prevention programs, intervention strategies and treatment protocols to prevent and rehabilitate athletes with these types of injuries."

According to the study, overuse injuries tend to occur gradually and are caused by repeated small injuries, without a single, identifiable event responsible for the injury, in sports such as long-distance running, baseball/softball pitching and swimming. By comparison, injuries occurring in high-speed and full-body-contact sports are more likely to be acute injuries, which result from a specific and identifiable event.

The study sample consisted of 573 male and female collegiate athletes from an NCAA Division I institution participating in 16 team sports. Participants reported 1,317 injuries during a three-year period. Of those injuries, 386 (29.3 percent) were overuse injuries and 931 (70.7 percent) were acute. A total of 319 male athletes sustained 705 injuries, and 254 female athletes sustained 612 injuries.

The most common overuse injuries were general stress (27 percent), inflammation (21 percent) and tendinitis (16 percent).

The long-term consequences of overuse injuries include loss of playing time, reduced function and psychological exhaustion. Overuse injuries also are associated with a gradual increase in symptoms, which means athletes may go undiagnosed and untreated for longer periods of time leading to long-term residual symptoms and chronic health consequences, including deformities and arthritis.

Wrestling, football, women's soccer and other contact sports were associated with a higher acute injury risk; while overuse injuries were found more frequently in baseball, softball, volleyball, cross country, track and field and other low-contact sports.  [1]

"Better strategies for the prevention and early intervention of overuse injuries in all sports and for both sexes are imperative in order to reduce their number and severity," Covassin said.

If you have a child that plays sports you are likely familiar with the rather routine in and out style sport physical that is often a prerequisite for participation.  Is any valuable information actually attained with these physicals? The more relevant question we should consider is how much do these routine physicals miss or ignore that could be critical to keeping children injury free?

“The sports physical required by schools and sports leagues just skims the surface and doesn’t dive deep enough into the real issues that impact teen’s health,” said Jerold Stirling, MD, pediatrician at Loyola University Health System and chair of the Department of Pediatrics at Loyola University Chicago Stritch School of Medicine.

“Many parents see the sports physical done in a school gym or quick clinic as the only medical attention their child needs when this isn’t the case,” said Stirling. “There are many issues that can’t be detected in a simple physical. In fact, many young athletes don’t get the care they need. It’s just assumed that they are healthy because all the boxes on the sports physical have been checked off, and that can be dangerous.”

“If parents wait too long if we do find a problem, we won’t have time to address it. By bringing a young athlete in early enough before the season begins, if we do find something, we can work on treatments and therapies to resolve the issue so the child won’t miss any time of the field,” said Stirling.  [2]

Dr. Stirling is referring mostly to deeper issues that impact a child’s health from a mental, social and emotional level.  While these topics are of the utmost importance to a child ‘s overall well being they are not the type of issues you would normally address during a sport physical.  And while the sport physical may be an effective vehicle to more effectively reach out to children Dr. Stirling suggests a more prudent approach would be a scheduled check up with the pediatrician or primary care physician.  

“As children grow into their teen years, social and mental health needs to be addressed in a safe, private environment. Teens need to know they can bring their questions and concerns to someone who cares and will keep it confidential,” said Stirling. “No one knows your young athlete like his or her primary care doctor. That relationship can open a door for teens to feel comfortable asking questions about their health and overall well-being.”

Clearly the express sport physical is inadequate to screen for the issues a pediatrician is most concerned with and I believe they are just as inadequate in determining a child’s physical preparation.  During the physical is posture assessed?  Do they have the child remove their shoes to examine their feet (flat feet, big red flag for injury potential)?  Muscle imbalances (from sport specialization) or motor control problems (can they skip)?  The answer to all of these questions is no and along with the concerns of Dr. Stiriling should lead to the retirement of the old model of sport physical replacing it with a model that considers the current youth sporting culture.

I have been coaching children for 14 years and times are different now compared to when I first started.  There is less general physical preparation in favor of more skill practice and game play.  Children are less physically prepared to meet the demands of sport because their base of overall athleticism is so narrow.  I have witnessed children that don’t know how to fall for example.  That might sound crazy but kids don’t experience free play when they used to roll down hills or dive into a pond.  Instead they take pitching or goalie lessons.  They never experience falling and how to manage that and keep themselves safe.  I coach children that don’t know how to fall or roll to the ground.  If you think rolling or diving isn’t a fundamental athletic skill watch a baseball, football or soccer game.  When kids fall now it makes an awful thud sound and that’s how kids get hurt.  That is only one example, and there are many more (skipping anyone), of a simple and fundamental skill that should be learned through child like experimentation but that window was closed while hitting ground stroke after ground stroke.

In my opinion the best form of injury prevention is long-term athletic development and honoring the natural childhood developmental process.  When a child learns to master the basic fundamentals of human movement then they are ready and prepared to develop and maximize more advanced sport skills.  Attempting to master the more advanced skills prior to mastering foundational skills will lead to a rash of acute and overuse injuries highlighted in the MSU study above.

I have undoubtedly revealed myself over the years regarding my thoughts and feelings on youth athletic development and sport specialization.  That said I must be aware of the brutal facts in order to make a difference in the long-term development of the children that I coach.   The brutal fact is the youth sport culture isn’t going to change.  8 year-olds are still going to play on travel teams and 10 year-olds will continue to “specialize” in one sport 10 months out of the year.  But we can still make a difference by applying relevant strategies that take into account the current youth sport and fitness culture.  A great first step would be replacing the current youth sport physical, dinosaur that it is, with a more practical approach that reveals and provides more relevant information.  Fortunately, I am putting together a team that is preparing to meet the current demands.

Food For Thought:

Many food products that are marketed to children are often times heavily processed and loaded with low-quality sweeteners like high fructose corn syrup, breakfast cereal can be a big culprit.  A few things you should be aware of especially considering cereal that is marketed as healthy is anything but:

Is Breakfast Cereal Toxic?

Kashi Cereal Stirs Anger

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