Conference Notes
Conference NotesThe following was reprinted with permission of Lyle J. Micheli, MD and the Massachusetts Department of Public Health, Bureau of Family and Community Health, Division of Prevention, Injury Prevention and Control Program. Presented September 18, 1996, Safe State, Injury Prevention in Massachusetts.
Types of Sports Injuries and
How They Can Be PreventedLyle J. Micheli, MD, Children's Hospital, Division of Sports Medicine, Boston, MA
The growth of organized competitive sports for children continues unabated in North America, despite cautious concern and occasional protests from certain physicians, parents and media. In 1974 the American Academy of Pediatrics adopted a position stand against organized competitive athletics for children under the age of fourteen, primarily because of concern for excessive emotional and physical stresses in the growing child. This stand has had little noticeable impact on this trend and received little support from either sports or sports medicine organizations in this country.
There is no question that properly organized athletic programs for youngsters can be highly enjoyable. Unfortunately, poor leadership and the emotional involvement of coaches and parents can, at times, turn organized children's sports into a parody of true sportsmanship. Of as much concern as the potential for physical injury is concern for the emotional stress to which some of these young athletes may be exposed.
It is important to realize why the young athlete is particularly vulnerable to injuries. The child is growing and this growth tissue is localized at three particular sites in the bones. These sites are at the very ends of the bones which include the joint surfaces, the growth plates, and the sites of major muscle-tendon insertions. Because this growing cartilage tissue is relatively softer than the adult cartilage and bone, it has a greater chance of injury. In contact sports, of particular concern are injuries to the growth plate. This risk may be increasing because these young players are now training harder and playing more intensely. In the non-contact sports in which high velocity trauma is not likely, the recurrent microtrauma of repetitive training, as in throwing sports, gymnastics, or distance running, may be harmful. The young runner may be hurt by training too hard. The young lineman, because of his training, may be playing too hard.
Children are susceptible to many of the same injuries as adults, including sprains, strains and contusions, as well as long bone fractures of their extremities. In addition, four special types of injuries can be sustained by children as a result of musculoskeletal trauma: (1) growth plate injuries; (2) injuries to the epiphysis, or ends of the bone; (3) avulsions (pulling away) of a major muscle-tendon insertion to the bone; and (4) overuse injuries of bones, cartilage, or muscle-tendon structures of the upper and lower extremities, particularly stress fractures.
The simplest way to prevent serious injury in the young athlete is to give early attention to the complaints of pain or dysfunction, particularly about the major joints where growth cartilage injuries may occur. With proper early attention and appropriate treatment, which often involves nothing more than rest of the painful extremity, the enhanced healing of the young athletes can take care of most of these conditions and complete healing and total resumption of activities can be anticipated.
The second important way to prevent injuries in children is to take particular care to match the child to the appropriate sport. As important as the physical match-up is the emotional match-up for the child. Loose-jointed children appear to be particularly susceptible to injuries in contact sports; the best sports for these children are non-contact sports such as track and field or rowing. As the opposite extreme, children with very tight ligaments appear to have an increased risk of injury, particularly to the back and spine, from such activities as ballet and gymnastics. Children are particularly susceptible to injuries to the extremities and spine during growth sports.
Unfortunately, there are not yet sufficient criteria for proper classification of youngsters into body type and relative degree of ligamentous laxity or tightness and muscle strength. We often have to use our own judgment. In the future, we may have the ability to come up with specific numbers regarding a given child's strength, flexibility, cardiovascular fitness and nutritional status.
Another way in which injuries can be reduced in children's sports is to carefully assess the rules of the games they are playing and tactics involved in these games. Every organized team sport played in this country was initially designed to be played by adults. We have not yet paid enough attention to the physical demands of some of these sports and the ways in which rules should be tailored to the particular capabilities and risk of injury in the child. Good examples of positive changes are the Little League pitcher's limit of six innings per week and rule changes in Pop Warner football limiting cross-body blocking or spearing. Coaching at this level should be concerned with the teaching of fundamentals and the development of basic game skills with particular emphasis on long-term conditioning.
It is now evident that the child is capable of levels of cardiovascular training similar of those of the adult without risk of injury. In addition, weight training, if properly performed, can strengthen the bones, joints and ligaments of the child and increase resistance to musculoskeletal trauma. The use of heavy weights or low repetition techniques must be avoided in training a child.
The role of protective equipment in preventing injury in the young athlete has frequently been overemphasized. It is dangerous to think that increased use of protective equipment will allow youngsters to participate safely in adult-style games.
Finally, techniques of athletic preparation that violate basic health principles, such as rapid weight reduction in wrestlers, may have a particularly serious effect on the child and should never be allowed. Excessive emphasis on "thinness" in young female gymnasts and dancers has resulted in a number of cases of anorexia nervosa.
Perhaps the most effective technique for injury prevention in the young athlete is encouragement of a relaxed attitude toward sports. Children must be able to enjoy sports participation without being excessively pressured to win at all costs by adults who lack proper consideration for the developing nature of children's bones, joints and emotions.
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