Categorized | Youth Sports

Hidden Dangers

By Brett Teal

While most kids were still tucked in their warm beds during a week-long spring vacation from school, a group of athletes already had their cleats laced up and were launching soccer balls across Columbia University’s Baker Field in New York.  These weren’t college soccer players, nor were they in high school.  Instead, the players who arrived at 9 a.m. were as young as 6 years old.

Lily Ganser (right) has been injured several times. Photo credit: Brett Teal

Lily Ganser, a 13-year-old, was one of the children hoping to hone her skills for the current soccer season.  She has been playing since she was in kindergarten and was always “one of the better players in the league” according to her father, L.J. Ganser.  For three years she played in the recreational West Side Soccer League, which places a greater importance on fun than competition.  When she turned 8, however, her parents decided they wanted to move her to a serious league.

Ganser tried out for the Manhattan Soccer Club, a travel team that has a fall and winter season and that practices the remainder of the year with limited time off.

And that’s when the problems started.

“She’s had a lot of funky injuries during her career,” said her father at a recent soccer practice. The first came after two-years of continuous playing.  His 10-year-old daughter had developed plantar fasciitis, an injury that occurs from overuse when the tissues connecting the heel and the toes become inflamed.

“That was a pretty rough one to deal with,” the elder Ganser said.  “She would start running and suddenly she was in so much pain she would have to come out of the games.”

Lily had to wear a special ankle brace to play, but decided against taking time off from the sport.  “Part of growing up is getting hurt and challenging yourself,” she said.  “It’s worth the pain because you just love what you do.”

After a month the plantar fasciitis started to heal, but in August 2010 it was back.  Lily had to wear a boot at night to stretch her foot and she attended physical therapy in Connecticut for nearly three months.

More children, including many girls, are specializing in one sport at a younger age and overuse injuries are becoming more common in adolescents, according to an April 2011 report by the National Athletics Trainers’ Association (NATA).  And a 2007 study in the American Journal of Sports Medicine reported that the majority of youth soccer injuries for females 5 to 14 years old are sprains (stretching or tearing a ligament), strains (stretching or tearing a muscle), and fractures.

The study was conducted by three doctors from the Columbus Children’s Research Institute at the Nationwide Children’s Hospital in Columbus, Ohio.   The doctors used data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System, which tracks emergency department visits from 100 hospitals, to analyze more than 40,000 soccer injuries over a 13-year period.  The researchers used those figures to estimate that there were more than 1.5 million injuries nationwide during that time frame. In the 10- to 14-year old age range nearly half of the injuries in girls soccer were sprains and strains.

As for the NATA report, its authors included Dr. Lyle Micheli of the Children’s Hospital in Boston, Mass. and Dr. Keith Loud of the Dartmouth-Hitchcock Medical Center among other NATA members.  “Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sports-related injuries,” the report said, citing a 1996 study in London, which tracked 394 injuries of children ages 5 to 17.  Some of the most common injuries are stress fractures and growth plate injuries.  And NATA believes specialization may play a role.

“Young athletes who participate in a variety of sports tend to have fewer injuries and play longer, thereby maintaining a higher level of physical activity than those who specialize before puberty,” the report said.

That’s troubling to Dr. Jon Divine, a sports medicine specialist at the Cincinnati Children’s Hospital Medical Center. “Gone are the days of the three sport athlete,” he said in a phone interview.  Divine did not work on the study, but often treats athletes with overuse injuries.

He said when a child participates in a sport like soccer year-round the muscles used while playing don’t have a chance to heal.  If a child played another sport he or she would potentially use a different set of muscles and develop different motor skills, according to Divine.  Many soccer travel teams play for 10 months out of the year, which leads to greater chance of getting hurt.

“The more repetitions of a certain activity, the greater your risks of overuse problems,” said Divine, who recommends children take at least three months off from a single sport.  He also said he believes children should only specialize after puberty when their bodies have developed.

Lily Ganser became the victim of another overuse injury when she suffered a stress fracture in October 2010. The injury kept her away from the field for 10 weeks and her family wondered if the sport was too demanding.

“My dad was like do you really want to keep doing this because you always get hurt,” she said.  Her response?  “Definitely.”

Despite the concerns about specialization and injuries, there seems to be a growing pressure to choose one sport at a younger age from both coaches and parents.  Ganser now plays for the Manhattan Kickers and her current coach, Erwan Saunier, said he is “not interested” in coaching girls who play other sports.

“Soccer is not like baseball or other American sports where you can play three at the same time,” said Saunier.  “In baseball all you do is throw the ball and wait half an hour.  I don’t see any sport that prepares you for soccer.”

Preparing his team for soccer, though, has left many of his players sidelined with injuries.  A visit to a recent Kickers practice backed the theory.  Thirteen-year-old Erika Yamazaki has already broken her left wrist twice and has broken a toe.  Another teammate, Bianca Aguilar, 13, had to sit out an entire year after suffering a groin strain.

The researchers of the 2007 American Journal of Sports Medicine study also found girls were more likely than males to suffer ankle and knee injuries.  These areas are especially vulnerable because of open growth plates. Growth plates are the tissues located at the ends of maturing bones.  They help regulate the size and length of bones during puberty.  Once a child stops growing, the plates close and the tissue is replaced by bone.

Osgood-Schlatter disease is an overuse growth plate injury, which frequently affects adolescent athletes.  The quadriceps muscle pulls the tendon connecting the shin to knee causing swelling and pain that worsens with running and jumping.  Boys are generally more likely to get it, but in sports such as soccer, basketball and gymnastics it also affects females.

Lydia Wiener, a 13-year-old player on the Manhattan Kickers, has been sidelined with the condition twice and sat out for three weeks in 2011.

Wiener plays multiple sports including basketball, softball and she runs track, but this year her father, Charles Wiener, is changing that.  “We definitely stepped in this year to say she shouldn’t sprint,” Wiener said.  Last year, he made his daughter miss a playoff basketball game because of her injured knees.  “She realized she had to, she didn’t fight us.”

Gymnastics is another sport in which girls are extremely vulnerable to growth plate injuries, Rachel de la Torre, 17, has been a gymnast training at Chelsea Piers in lower Manhattan since she was 3.

“It’s one of the most dangerous sports if you don’t know what you’re doing,” de la Torre said in a phone interview.

At a recent practice she worked vigorously on her vault.  She sprinted down the mat before launching herself into a double back flip.  After a few more attempts she was off to a training room to grab two basketball sized bags of ice for her ankles, one of which was recently sprained.  De la Torre is no stranger to injuries.

When she was 10 she contracted Sever’s disease, another common growth plate injuries for young females.  Sever’s occurs when the growth plates in the heel become inflamed from overuse; the pain worsens while running or jumping.

“It’s probably the most common injury I see,” said Dr. Anastasia Fischer, a sports medicine specialist at the Nationwide Children’s Hospital in Columbus, Ohio.  “We see it most often in growth spurts because when you’re growing very quickly the growth plates are very delicate.”

The pain can extend from the back of the foot to the arch and doctors recommend time off to let the growth plates heal.  But de la Torre said she couldn’t afford to stop training.  “When it started to hurt I had a competition coming up and I tried to push through it,” she said, which may have made things worse.  “It hurt all the time, even walking to school; I was crying all the time.”

She said the adrenaline rush during the competition masked the pain and now that her growth plates have closed her heels aren’t an issue. What has been an issue over the past seven years are the additional injuries she has suffered.  De la Torre has fractured her left elbow, her left foot, her right foot, two fingers in her left hand, and has had two stress fractures in her back.

“They always say gymnastics has a 100 percent injury rate,” her mother, Colleen Itzen, said during a practice at Chelsea Piers. “It’s the rare person who never gets an injury.”

Her daughter’s fractures weren’t uncommon according to a study that tracked gymnastics-related emergency department visits from 1990 to 2005.  The Nationwide Children’s Hospital’s study in Ohio looked at nearly 12,000 gymnastics injuries.  The researchers used those figures from 100 hospital emergency departments to estimate that nationwide there were nearly 426,000 gymnastic injuries.  The study included both sexes, but females accounted for more than 80 percent of those injured.  Sprains and strains were the most common injury for 6- to 11-year-olds, followed by fractures and dislocations.

Rachel de la Torre says gymnastics can be very dangerous. Photo credit: Chelsea Piers

“Gymnastics has one of the highest injury rates of all girls’ sports,” said Dr. Laura McKenzie, at Nationwide Children’s Hospital and one of the study’s lead authors, in a phone interview.  “I don’t think people typically want to think of gymnastics as a dangerous sport”

McKenzie wants parents and coaches to realize the dangers to prevent future injuries.  “We don’t want to discourage kids from being physically active or participating in these sports, but we want to make sure it’s in the safest way possible,” she said.  She recommends gymnasts use mats if they practice at home and that younger athletes should always have supervision.

In softball one of the dangers for young females involves pitching.  Softball pitchers use an underhand delivery, called the windmill.  Most people assume it’s safer, but that’s not necessarily true, according to Dr. Kevin Burroughs, the Director of Sports Medicine at the Cabarrus Family Medicine in Concord, N.C.  Burroughs is also on the American Medical Society for Sports Medicine board of directors and routinely treats softball injuries.

“There are a lot of misnomers that because it’s an underhand throw it’s more ‘natural’,” he said.  “Throwing a softball puts a different kind of strain on the arm than throwing a baseball.”

A 2005 study by the Tulane Institute of Sports Medicine shows that the windmill pitch puts a similar load on the shoulder compared to an overhand baseball pitch.  Another study by a team of researchers from the Rush University Medical Center in Chicago, Ill., the Naval Medical Center in San Diego, Calif. found that windmill pitching causes more stress on the bicep than an overhand baseball pitch.  So while girls may be less likely to get “little league elbow”, the researchers concluded they are at risk for overuse injuries in the shoulder and bicep.

Pitch counts can play a vital role in the prevention of these injuries, but are not always used. Boys’ baseball usually has stringent rules about pitch counts, but in girls’ softball, less attention is given to the issue.

In Little League, boys 9 to 10 are only allowed to throw 75 pitches in a day; boys 11 to 12 can throw 85.  Girl’s softball, on the other hand, does not have a pitch count.  There is an inning count that states girls can only pitch 18 innings a week, but games rarely last that long and there’s no limit on how long an inning can be.  Overuse injuries, though, are unlikely since most teams only play one game per week.  It becomes more dangerous if a young girl is on a year-round travel team, or if she is playing for multiple teams.

And the absence of softball pitch counts extends to high schools.  In New York’s high school league, the Public Schools Athletic League, varsity baseball pitchers are required to take four days off if they throw more than 91 pitches.  But for girls softball there are no limits.

Burroughs, a proponent of pitch counts in softball, said he believes stricter rules could reduce the amount of shoulder injuries at a later age.

“Just because it is a softball,” he said, “doesn’t mean that you can’t hurt yourself.”

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