Overuse injuries and kids Pain: Emphasis on training children early and intensively for sports and other factors can injure growing bodies.

March 24, 1998|By Jan Brogan | Jan Brogan,PROVIDENCE JOURNAL-BULLETIN Sun intern Ameer Benno contributed to this report.

After four junior varsity soccer players came into his office on the same day with shin splints, Marshall Steele, a surgeon at the Orthopedic and Sports Medicine Center of Annapolis, called their coach to tell him he was running them too much.

The coach had no idea -- none of the young athletes had mentioned any pain -- and thanked Steele for letting him know. Unfortunately, "Kids are afraid to talk with their coach about things like that," says Steele, team doctor for Annapolis High School. And, "just like in anything else, people are at different levels, and the coach will tell all of them to run 10 laps."

Incidents like this are not rare these days. Although there are no hard figures, many experts in youth sports consider what are known as overuse injuries to be at an epidemic level, according to Rita Glassman, associate executive director of the National Youth Sports Safety Foundation.

"It's not because children are different or bones are any different today," says Dr. Michael J. Goldberg, chairman of the department of orthopedics at New England Medical Center, in Boston. "These overuse injuries do not come from pickup games where neither coaches nor parents are involved. They don't happen when a child who is tired of running stops, or when a child who is not in the mood to play, decides not to play."

Overuse injuries occur with repeated physical motions to perfect athletic skills. In other words, they come from organized sports.

Parents and coaches tend to think that children are naturally in shape, but many kids are more sedentary than their parents were -- despite their participation in organized sports.

Television, computer games and a lack of free play in neighborhoods mean kids tend to go from an "off" position to "on" without any of the natural conditioning and strengthening they used to get from climbing trees and racing around with each other on the playground, experts say.

And Lorie Bristow, head athletic trainer at Gilman School in Baltimore, says a lot of injuries this spring had to do with athletes who played ice hockey in the winter, then lacrosse in spring. "Coming from ice hockey, they had no running during the winter, just skating. The transition to lacrosse wasn't good, and they developed a lot of Achilles tendinitis."

This sort of injury happens during the regular season as well. In practices, the athletes who are not in the best shape tend not to play on the first string, says Steele. "However, after sitting on the bench through practices and scrimmages, the coach will have them run wind sprints. They're just not conditioned enough."

Added to all this is the fact that growing bones are not as strong as adult bones. The growth plates, which are at the ends of the long bones, are often weaker than the ligaments that connect bones, and the nodules where the tendon attaches also have smaller growth plates beneath.

The typical growth spurt occurs over 18 to 36 months before the onset of puberty. Girls can grow as much as 10 inches, and boys a foot during this period.

For girls, the period can be between 18 and 24 months, with the peak spurt usually occurring between 11 and 12 years old. For boys, the period can last 24 to 30 months, and usually occurs between 13 and 14 years old. However, with boys, a minority are "late growers" who may have a delayed growth spurt at age 16.

Many experts believe that because muscle, tendons and soft tissue do not grow concurrently with bones, children have periods of tightness and dramatically decreased flexibility, making them prone to injury.

This was less of a problem in the old days, when the intensity of organized sports didn't heat up until high school -- after most of the major growing was already done -- and most kids played a variety of sports instead of intense specialization in a single sport.

Overuse injuries can range from Osgood-Slatter disease, a knee condition caused by a combination of rapid growth and overuse, and Sever's disease, a similar problem at a growth plate in the foot, to stress fractures, strains, sprains, tendinitis, torn cartilage, bursitis and shin splints.

Bristow, the Baltimore trainer, says middle-school children have a lot of Osgood-Slatter and Sever's, and in upper school, injuries depend on the sport. In baseball, tendinitis in the shoulder and HTC elbow can come from incorrect form or from throwing too hard.

In track, shin pain is the most predominant complaint. "This can be the result of poor mechanics of running, poor feet, bad shoes or shoes that are too big," Bristow says. "Also, a sudden increase in mileage or switching from running on a track to running on pavement can cause problems."

Bristow says parents "like to buy shoes that are one-half to one size too big for their child" to allow room for growth, but instead, the lack of support and sliding this creates causes overuse injuries.

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