When the Game is Taken Away: The Silent Injury

According to the American Academy of Pediatrics, more than 3.5 million children aged 14 years and younger are treated for sports injuries and nearly half of all injuries sustained by middle school and high school students during sports are overuse injuries.

Part 2 of a 3-Part Series on Youth Injuries.
Click here for Part I.
Click here for Part III.

Why are kids getting hurt? Overtraining + Early Specialization

According to the American Academy of Pediatrics, more than 3.5 million children aged 14 years and younger are treated for sports injuries and nearly half of all injuries sustained by middle school and high school students during sports are overuse injuries.

Consider the following – You drive your car to work every morning and usually take the same route, experience the same traffic patterns, and use about the same amount of gas. Your car probably knows the route so well it could probably drive itself if it could. Everyone once it while it gets to take a different trip here or there, but for the most part it has its routine and your daily, weekly, and yearly driving pattern is relatively the same.

As a result, your tires are going to wear a certain way, the brakes are going to wear a certain way, the transmission is going to wear a certain way…you get the picture. A lot of people will take it in for the XX,000 miles service, rotate the tires, change out the brakes, change out the fluids in the car, and maybe even some take a different route to work or a different car to work to keep their car running in good shape for the long run so they don’t have bigger problems down the road.

Why don’t we do the same with our athletes? Why do we wait for the crash to occur from letting the brakes wear out? Or wait for the engine to crack from not ensuring there is enough oil in the car? Or let the tires wear out prematurely because we don’t keep them properly inflated…you get the idea.

More injuries are occurring very simply because kids are entrenched into the same movement patterns over and over and for a longer and longer periods of time. Youth sports injuries are often called the silent injury because we don’t pay attention until we are often forced to pay attention. The tires are wearing, the brakes are wearing, if it gets ignored a bigger problem is going to surface – ACL injuries, cartilage damage in the knees, chronic knee pain, chronic ankle instability, etc.

When the human body (and especially in athletes) is presented with a task, it will find a way to accomplish it whether it is a correct/good pattern for the rest of the body or not. When it is fatigued or when a certain muscle is weak the stronger muscle will take over… the strong parts get stronger, the weak get weaker and the imbalances and compensations become greater. You are asking for the car to break down.

So what can you do? Really there are two choices…

1.Get the car on a good maintenance program – The simple way is to play different sports or take chunks of time off. Other ideas include enrolling in a quality age-appropriate strength training program or injury prevention program by a credible professional.

2.Wait for the car to crash and be forced to get it fixed or give up driving all together.

Common Youth Soccer Injuries Resulting from Overuse and Overspecialization:

Muscle Strains: Often times a result of imbalance on opposing sides of a joint and/or compensatory patterns. Hamstring and hip flexor issues often result from poor glute recruitment, groin pulls often occur because muscle imbalances are present between hip abductors and adductors. No one likes doing someone else’s work…your muscles don’t either and they will let you know.

Chronic knee injuries – Often times a result of muscle imbalance and poor movement patterns (see a pattern here?) from weakness/poor mobility at the hip or ankle or both. Examples include degenerative articular conditions such as osteochondritis dissecans (better known as OCD which often also has a genetic component) or generalized pain around the front of the knee often referred in loose terms as patellofemoral syndrome. The knee is the slave to the joints above and below; if those joints aren’t doing their job, the compensation normally presents itself at the knee.

Meniscal and Ligament Injuries –The majority are not the result of direct contact to the knee. It is usually a result of the body’s inability to control or absorb forces acting on the knee. In terms of ACL injuries, risk factors can be broken down into two types: Those you can control and those you can’t. This isn’t an exhaustive list, but includes some of the more common factors.

ACL Injuries – What You Can Control:

1. Muscle strength/function – As mentioned above, muscle weakness and imbalances in other area of your body (hips/core oftentimes) will place greater stress on your knee.

2. Neuromuscular control – Goes hand and hand with #1 but here we are talking about the ability of the body to control the position of a joint especially while moving, cutting, pivoting, and jumping. Do we allow our muscles to absorb forces or do we make our ligaments do the work?  Ligaments are meant to hold bones together, they aren’t meant to absorb the body’s weight multiple times over when landing a jump or changing direction. Remember the knee is the slave to the hip and ankle; good habits in terms of proper form when landing jumps and decelerating/cutting to stay out of both hyperextended and knocked-knee (or valgus) positions are key.

3. The sport you choose to play – Cutting, pivoting, jumping sports (and skiing) place more demands on your ACL and other knee stabilizers than predictable and linear sports such as running.

ACL Injuries – What You Can’t Control:

1. Anatomy – Females have wider hips than males and this often predisposes female athletes to a knocked knee (or valgus) position. In addition, some females have smaller intercondylar notches (think of it as the tunnel the ACL works under) or have V shaped notches instead of U shaped notches. Do either one of these things mean you will tear your ACL? No, but it does leave a smaller margin for error if the knee does get in a compromising position. This is often seen in players who suffer ACL injuries to both knees.  The good news is most surgeons widen/round out those notches during ACL surgery. The bad news is the less-than-ideal notches can sometimes be seen across members of the same family and having a sibling with an ACL injury means it’s a good idea to pay extra close attention to risk factors you can control.

2. Hormones – some researchers continue to investigate whether or not hormones that increase ligament laxity during the menstrual cycle play a role. As of right now, there isn’t any definitive evidence.

The above two factors in addition to females usually demonstrating weaker hip and core strength than males, especially after puberty, make females up to 8 times more likely to experience knee injuries in cutting, jumping, and pivoting sports than males.

Ankle Sprains –Initial ones, most commonly a result of landing on something or poor field conditions.  Recurrent ones are usually a result of return to playing when the symptoms resolve (pain, swelling) but not treating the underlying problem (muscle weakness, poor neuromuscular control). Thus, you have a stretched out ligament that now has less armor to defend itself and you have put it back in the battle only to get injured again and perpetuate the cycle.

Please note: This is general information and not meant for medical diagnosis; please see your physical therapist or sports medicine doctor if you have an injury concern.

Part 3: Specific ways to train smarter to prevent common sport injuries. Click here for Part I – Click here for Part III

About the Author: Julie Eibensteiner PT, DPT, CSCS is a physical therapist and owner of Laurus Athletic Rehab and Performance LLC, an independently owned practice specializing in ACL rehab and prevention in competitive athletes. In addition to being a regular contributor to IMS on topics of sport injury and prevention, Eibensteiner holds an USSF A License, coaches a U18G MRL team for Eden Prairie Soccer Club, and assists with the Men’s and Women’s soccer programs at Macalester College.