Youth Sport Injury: Prevention is Key

 

By Jane M. Shimon

Whatever happened to the days when children pretended to be DiMaggio or the Babe and played unsupervised stickball in vacant lots? Sport-related injuries were not so apparent during those carefree days. Now, due to a tremendous increase in organized sports, youth are participating in longer sport seasons, more intense practice sessions, more tournament play and summer camps. These developments have led to new injury patterns among young athletes.

It has been estimated that approximately 40 million American youth participate in various organized sports. Coaches, physical educators and parents most often implement and supervise these sport programs, and one of their responsibilities is the care and prevention of sport injuries. Approximately one half of all youth sport injuries are likely preventable (AGSM, 1993). Providing a well-designed injury prevention program that includes attention to growth and development, training and conditioning, protective equipment, and emergency care can minimize youth sport injuries.

Growth and Development

Young athletes (pre-pubescent through puberty) are not miniature adults. Their bodies are still growing, making them more susceptible to injury especially to growth areas. Injury to joint surfaces is one example, as these areas are less resistant to repetitive stress in the young than in adults. Younger pitchers who throw too hard and/or too often, use improper technique and limit rest periods, can develop a condition called osteochondritis dissecans, where the articular joint surfaces of the elbow are compressed and damaged. Another concern involves the bone-growth regions near a joint (apophysis). The apophysis region of youth receive more stress from the muscular/tendon attachment during repeated and intense movement, and this can lead to possible avulsion-type fractures (partial or complete tendon separation from the bone), or structural changes in the apophysis over an extended period of time. Lastly, it is known that growth plates, the areas of developing cartilage where bone growth occurs, are weaker than the nearby ligaments and tendons. What is often a ligament sprain in an adult can be a potentially serious growth plate injury in a young athlete. A possible ligamentous sprain in children should always be considered a fracture until proven otherwise (Omey & Micheli, 1999).

Coaches, educators and parents must continually remind young athletes to report any pain or discomfort during or after play so proper treatment can be initiated; acute injuries as well as chronic, repetitive micro trauma or overuse injuries to growth centers can lead to growth restriction and cause permanent joint changes that lead to chronic pain, disability, and premature degenerative changes in the adult skeleton (Burgess-Milliron & Murphy, 1996).

Training and Conditioning

Conditioning activities prior to the start of a sport season should be geared toward the strength, endurance, and flexibility of the particular sport. The National Standards for Athletic Coaches (NSAC) state that coaches must recognize that proper conditioning and good health are vital to the prevention of athletic injuries (NASPE, 1995). One, of the most common mistakes is made when a young athlete goes from being relatively inactive to considerably active in a short period of time. The musculoskeletal system is not ready to adapt to the sudden increase in activity. General guidelines suggest that a 4-6 week period be designated to gradually accustom young athletes to training time, intensity levels and skill development. A useful model to follow is the 10% rule. Each week there should be no more than a 10% increase in the amount of training time, amount of distance covered, or number of repetitions performed in the activity (American College of Sports Medicine, 1993). It is also important to increase only one aspect of the training program at a time (i.e., if the intensity is increased, then the distance should not). Each practice and training session should, of course, include a warm-up and cool-down period. Flexibility exercises are important during the warm-up and cool-down periods, particularly for young athletes in rapid growth phases.

What is recommended as acceptable resistance training for youth?

Youth should use sub-maximal lifts during resistance training sessions. Approximately 70-80% of a projected best lift should be used, or the amount of resistance should be no larger than the amount with which the player can complete at least 10 times in good form (Zito, 1996). It has been shown that youth who perform higher repetitions with moderate loads (e.g., 13 to 15 repetitions with fatigue on the last rep) can experience significant gains in both strength and muscular endurance (Faigenbaum, et al., 1999). A quality supervised progressive resistance training program can and should be used to help increase strength and decrease the occurrence of some overuse and acute sport injuries in youth.

What is recommended for practice during hot and humid weather?

Numerous sport camps and leagues occur during the summer, and high heat and humidity can be tragic to youth practicing under such conditions. Regardless of the climate, when sweat loss exceeds fluid intake during activity, children (and adults) become dehydrated. NSAC address this concern in Standard 4: Prevent exposure to the risk of injuries by considering the effects of environmental conditions on the circulatory and respiratory systems when planning and scheduling practices and contests and implementing programs for physical conditioning.

Children are more at a disadvantage when exercising in hot conditions:

1. Children develop more heat relative to body mass (the smaller the child, the greater the excess of heat).

2. Children have a lower sweating capacity that affects their ability to cool off.

3. Children have a shorter exercise tolerance time in the heat.

4. Children acclimatize slower to extreme changes in temperature.

5. Children increase internal body temperature more if they become dehydrated.

6. Children who suffer from anorexia nervosa or bulimia, have diabetes, or are obese, are especially at risk (Oded-Bar, 1994)

Since they possess a higher risk of heat illness, those in charge of sports must be constantly on the lookout for warning signs of dehydration and heat illnesses including thirst, irritability, headache, weakness, dizziness, cramping, nausea, and decreased performance. The National Athletic Trainers Association (NATA) recommends the following practices regarding fluid replacement for athletic participation:

1. Establish a routine for water or hydration consumption.

Remember, by the time your athletes become thirsty, they are already dehydrated. Increase water breaks during practice. Instruct and require youth to drink 7 to 10 fluid ounces every 10-20 minutes. Water is the more practical fluid to consume. However, if other types of sport drinks are used make sure to read the label; the carbohydrate concentration should read below 8%. Carbohydrate concentrations above 8% compromise the rate of fluid emptying from the stomach and absorbed from the intestine. Fruit juices, carbohydrate gels, sodas, and some sport drinks have carbohydrate concentrations higher than 8% and are NOT recommended during activity as the sole beverage. It is helpful to dilute prepared sports drinks if uncertain as to the carbohydrate levels. Discourage young athletes from drinking beverages containing caffeine or carbonation during activity. They can dehydrate the body by stimulating excess urine production, or decrease voluntary fluid intake.

2. Instruct youth to drink plenty of water prior to and after practices and games.

Two to three hours before activity, have athletes drink 17-20 ounces of water or sports drink. Approximately 10-20 minutes before the event have them drink another 7-10 ounces of water or sports drink. Within two hours after activity or the game, youth should replace any weight lost from exercise. A guideline to follow includes drinking approximately 20-24 ounces of water or sports drink per pound of weight loss (Casa, et al., 2000).

Protective Safety Equipment

The NSAC includes a standard addressing the need for protective equipment that is in good condition, fits properly, and is worn as prescribed by the manufacturer and to ensure that equipment and facilities meet required standards. Appropriate safety equipment must be selected wisely, fitted properly, maintained regularly and with correct instruction on use and application.

Selection of equipment must meet guidelines or rules of the governing body of the particular sport or activity. Inline skating helmets cannot take the place of ice-hockey helmets, nor should football helmets be used as bicycle helmets. Various certifying authorities of athletic equipment (i.e., National Operating Committee on Standards for Athletic Equipment (NOCSAE)) ensure that equipment meets safety guidelines for that particular sport; the seal Meets NOCSAE Standard is permanently stamped on the rear of each helmet. Coaches, educators and parents must make sure that safety equipment, such as helmets, are NOCSAE approved and that manufactures' guidelines are followed when reconditioning or adapting equipment.

It is prudent to buy the best equipment within the resources available to the family, school or community. Equipment, such as break-away bases for baseball and softball, should be considered standard to help reduce severity of lower extremity injuries when sliding. The use of youth soft-core baseballs have also been recommended by NOCSAE and the Consumer Products Safety Commission (CPSC) to help decrease the magnitude of head and face injuries incurred by playing with regular hard-core baseballs.

In addition, instructors need to know about proper equipment fit and how to inform parents to be educated consumers. Hand-me-downs in poor condition or oversized/undersized equipment previously used are not acceptable and may lead to serious injury. Instruct both players and parents in the purchase and use of equipment, and require players to always wear safety equipment during practice and games.

 

Emergency Care

Many injuries sustained during practice or games are overlooked, and children often continue to participate despite pain or injury. It is essential to treat any injury as soon as possible to control swelling and increase recovery time. The recognized regimen for immediate treatment of sport injuries includes rest, ice (cold application), compression, and elevation (RICE). Remove the injured child from play, apply ice to the affected area, wrap or compress the injured area with an elastic bandage, when appropriate, and elevate the injured area above heart level to reduce swelling.

Many coaches and parents play the guessing game when it comes to determining when a physician should see an injured child. Use the following guidelines to determine if one should be consulted:

1. There is obvious deformity (dislocation or abnormal looking joint or bone).

2. The child cannot bear weight (limping and painful).

3. The child cannot functionally use the upper extremity (painful),

4. There is a decreased range of motion in a limb.

5. Bleeding cannot be stopped.

6. There is difficulty in breathing.

7. There is swelling.

In addition, ask the child to rate the pain on a scale of 1 to 10, with 10 being the most painful. If the pain remains moderate to severe after five minutes and has one of the symptoms above, call a health care provider for advice or take the injured to the emergency room for further evaluation (Mayo Clinic, 1998).

Finally, it is imperative that all adults involved in youth sport programs have an emergency plan. This criteria falls under Standard 5 of the NSAC stating that coaches must be able to plan, coordinate and implement procedures for appropriate emergency care. An emergency plan should be devised before the first practice of the season so all adults involved in the program know what to do if an emergency does occur. The National Athletic Trainers Association (1999) suggest the following Emergency plan:

1. Coaches (and physical educators) should be certified in first aid and CPR.

2. Coaches (and physical educators) should have a complete first-aid kit and ice bags readily available at all classes, practices and games (including a personal medical information/ authorization card for each athlete).

3. Coaches (and physical educators) should have an Emergency Plan of Action. The following should be determined before the season begins:

• Who will provide emergency first aid?
• Who and how will Emergency Medical Services be summoned?
• Who will monitor noninjured members of the team during an emergency?

• How will parents be notified in the event of an emergency?
• Are emergency medical devices readily available (i.e., inhalers, EpiPens) at all times and are coaches and athletic health care providers educated in the administration?
• Is there an adequate communication system in place at all athletic practices and contests?
• Is documentation of emergency phone numbers and a list of conditions for each student readily available at all practices and games?

Prevention and recognition of sport injuries is the key to successful youth sport programs. Youth sport injuries will occur if inappropriate adult practice and training methods are employed. Be smart! Be attentive to the special considerations of active youth, and keep abreast of new developments made in the care and prevention of sports injuries. The checklist above will determine if your youth sports injury prevention program is on the road to success.

Youth Sport Injury Prevention Check List

• I understand my young athletes are still growing which makes them more susceptible to sport-related injuries if inappropriate practice and training methods are used.
• I implement an appropriate pre-season conditioning program for my athletes. I include quality warm-up and cool-down periods for all activities.
• I incorporate quality supervised progressive resistance training sessions. I understand the physiological effects of young athletes when practicing in a hot environment.
• My athletes receive appropriate rest and water breaks, especially when practicing and competing in hot and humid conditions.
• My athletes are correctly fitted and consistently wear appropriate protective gear.
• I know how to care for initial injuries and when to send my young athletes to health care professionals for proper injury care.
• I have an updated emergency plan in place for all practices and games.
• I am certified in CPR and First Aid and have a well-stocked first aid kit and ice available at all practices and games.

References

American College of Sports Medicine (1993). Current comment: The prevention of sport injuries of children and adolescents. Medicine and Science in Sports and Exercise, 25(8).

Burgess-Milliron, M J., & Murphy, S.S. (1996). Biomechanic considerations of youth sports injuries. In Oded-Bar. O. (Ed.). The Encyclopedia of Sports Medicine - The Child and Adolescent Athlete. International Olympic Committee. Cambridge, MA: Oxford.

Casa, DJ., Armstrong, L.E., Hillman, S.K., Montain, S J., Reiff, R.V., Rich, B.S.E., Roberts, W.O., and Stone, J.A. (2000). National athletic trainers' association position statement: Fluid replacement for athletes. Journal of Athletic Training, 35(2), 212-224.

Faigenbaum, A., Westcott, W.L., LaRosa Loud, R, & Long, C. (1999). The effects of different resistance training protocols on muscular strength and endurance development in children. Pediatrics, 104(1), p.e5. (electronic copy)

Mayo Clinic. (1998). Sports injuries - A parent's guide to prevention. [On-line].

NATA. (1999). Suggested safety items parents should look for in a high school athletic program. [On-line]. Available: http://www.nata.org/Departments/com-munications/Press%20Releases/ suggestedsafetyitems.htm [June, 2000].

NASPE. National Standards for Athletic Coaches. [On-line]. Available: http:// www. aahperd. org/naspe/publications-coachstandards.html [November, 2000].

NOCSAE. (1998). Standards and Certifications. [On-line]. Available: http:// nocsae.org [June, 1999].

Oded-Bar, O. (1994). Childrens responses to exercise in hot climates: Implications for performance and health. Sports Science Exchange. Gatorade Sports Science Institute. 49(2).

Omey, M.L., & Micheli, LJ. (1999). Foot and ankle problems in the young athlete. Medicine and Science in Sports and Exercise, 31(7) (Suppl). S470-5486.

Zito, M. (1990). Musculoskeletal injuries of young athletes. In Gould, J.A., III, (Ed.). Orthopaedic and Sports Physical Therapy. (2nd ed.), St. Louis, MO: C.V. Mosby.

Online Resources

American Academy of Orthopaedic Surgeons. (1996). Play it safe sports - A guide to safety for young athletes.

National Athletic Trainers Association (NATA). http://www.nata.org or (214) 6376282.

Jane Shimon (jshimon@boisestate.edu) is an Assistant Professor in the Department of Kinesiology at Boise State University, Boise, ID.

___________________________________________________________________

Title:	Youth sport injury: prevention is key.
Author:	Shimon, J.M.
Publisher:	American Alliance for Health, Physical Education, Recreation and Dance
Source:	Journal: Strategies
Volume (Issue):	15 (5)
Date:	May/June 2002
Page:	27-30 (4)

 

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