DEAR MAYO CLINIC: I am an athletic director at a middle school, and a new school year is almost here. I anticipate seeing an increase in sports-related injuries from soccer, football, cheerleading, flag football and other activities. Young athletes get plenty of bumps and bruises, but how can they avoid injuries? Any advice on how long they should sit out before getting back on the field or in the game?
ANSWER: Sports are such a fantastic opportunity for young people. Sports provide not only physical health benefits, but also social, emotional, mental and educational benefits. When comparing those who participate in youth sports against those who do not, young athletes have lower rates of anxiety and depression, improved self-esteem, decreased substance use, improved life skills, higher academic achievements, and overall higher quality of life.
However, participation in sports comes with potential risks, including injury. Young athletes have different injuries since they are still growing and are more vulnerable to injury. Certain sports come with the risk of common injuries, but any injury can occur in almost any activity.
Types of injuries include traumatic injuries and overuse injuries.
Traumatic injuries are typically sudden and caused by a twist, fall or collision. These injuries typically occur when the player is interacting with the sporting environment. Common examples are fractures of bones, sprains of ligaments, strains of muscles and tendons, and cuts or abrasions of the skin. Other injuries, like concussions or those affecting other organ systems, are less common.
Traumatic injuries are more difficult to avoid. For example, some sports, like football, have numerous intentional collisions per game, creating an increased risk for injury. Soccer has less collisions, but it still has significant potential for body parts to get hit or twisted. This means athletes are predisposed to lower extremity, head and neck injuries.
Sometimes these injuries occur simply from stepping or running on an uneven surface. Other sports, like cross-country running, cheerleading and dance, do not have the same volume of traumatic injuries. But they have risks of falls and broken bones.
Some strategies that can be considered to decrease the risk of traumatic injury include:
Overuse injuries occur gradually over time, often when a certain motion or stress is repeatedly placed onto certain structures of the body. This, combined with inadequate rest and recovery, results in injury. Some examples of this include stress fractures; tendonitis and tendinopathy; and apophysitis, which is a stress injury to growth centers in bones.
Like traumatic injuries, certain sports pose a higher risk for certain overuse injuries than others. Runners have a higher risk for lower extremity overuse injuries, and tennis players, swimmers and baseball players have a higher risk for upper extremity overuse injuries. Overuse injuries are more preventable, as they are commonly the result of training errors or excessive load or stress placed onto a specific body part.
Some strategies that can be considered to decrease the risk of overuse injuries include:
Despite best efforts to decrease risk, an injury still can occur.
It can be challenging to differentiate between pain and injury, but consider these tips, recommendations for treatment, and guidance to decide when student athletes can step back onto the playing field:
A medical evaluation is necessary for an injury if:
After an injury, take these initial steps:
Each injury and athlete are going to be different, and I always recommend following the advice of a medical professional. However, before athletes return to play, they should have minimal or no pain; a full range of motion; be back to full strength; and, most importantly, be able to safely do specific activities and meet the demands of the sport. I also tell my patients: When in doubt, sit out.
Sports can bring many benefits to youth athletes. With the proper training, reminders and coaching, hopefully this school year will bring less injuries. If you have students with significant issues, consider referring them to a Sports Medicine practice to help with recovery and personalized development. — Dr. David Soma, Pediatric and Adolescent Medicine and Sports Medicine, Mayo Clinic, Rochester, Minnesota