According to the American Academy of Pediatrics, more than 3.5 million children ages 14 and younger get hurt annually playing sports or participating in recreational activities. More than 775,000 of these children are treated in hospital emergency rooms for injuries caused by falls, collisions, and overexertion during unorganized or informal sports activities.

“Sport injuries are becoming more common in children and teens as the level of play intensifies and more kids play sports such as soccer on a year-round basis,” observes Chad Cherny, PT, MS, CSCS, of the Sports Medicine Biodynamics Center at Cincinnati Children’s Hospital in Ohio. “Anterior cruciate ligament (ACL) tears, once thought to be primarily an adult injury, are also becoming more routine in pediatric rehab.” ACL injuries can pose future problems for young athletes. Experts estimate that nearly 70% of ACL injuries in young athletes will lead to an early onset of osteoarthritis.

Although prompt attention is necessary for sports injuries, careful evaluation and follow-up become even more important in children and adolescents to prevent problems with future bone and joint development.

“Education is 75% of our job,” Cherny says. “Our goal is for our young patients to prevent further injuries and return to the sport feeling better and stronger than before.”

Down time

Cherny admits that mandating a proper recovery time can often be challenging with young athletes who engage in year-round sports such as soccer, and those who play in multiple leagues.

“Often it’s the parents who are anxious and pushing their child to return to the sport. They have paid to be in multiple leagues and they want to get their money’s worth,” he says. “We often need to explain that injuries can be a result of too much pushing. Their children are feeling tired and fatigued, making them more prone to injury.”

Cherny also discusses the risk of overuse injuries with his young patients and their families. “Overuse injuries occur from repetitive actions that put too much stress on the bones and muscles,” he says. “They are more problematic in children than adults because of the effect they may have on the child’s bone growth. Any child who plays sports can develop overuse injuries, although the more time spent playing the sport, the greater the chance of sustaining an overuse injury.”

Cherny says overuse injuries, including sprains and strains, are rarely seen in seasonal sports such as football, but rather in sports that have become year-round activities, such as soccer. And for a lot of kids, injuries aren’t the result of a sudden injury but are caused from overuse injuries that occur over time and aren’t appropriately addressed. He sees injuries including torn ligaments, sprained ankles, and dislocated shoulders.

“The problem is many parents, coaches, and even the kids themselves can quickly bounce back from an injury and feel as if they are well enough to keep playing,” Cherny says. “The reality is they need to take a rest from the sport and give themselves a chance to heal.”

Cherny often demonstrates to his young patients and their parents how despite feeling better, the child may not be fully healed.

“Often I’ll ask my patient to try balancing exercises in front of the mirror where they will squat down on one leg and try to balance,” he says. “This shows them their abilities haven’t completely returned to normal. We teach them that playing through their pain can cause their injury to become more serious.”

Because many sports injuries are both predictable and preventable, Cherny also places a big emphasis on teaching youth athletes how to properly warm up before a game and giving them exercises that can help with strength and endurance. Working on flexibility and conditioning before the sport season starts can help prevent injuries.

Winning attitude

Mary Hydorn, PT, of Kids in Motion in Highland, Mich., sees many young athletes who start specializing in one sport at a young age, play year-round, and join competitive clubs rather than just playing the sport for fun.

“Children used to play more for the love of the game, engage in different sports throughout the year, and take breaks in between sports,” she says. “By going from sport to sport, they were cross training and it helped them to avoid repetitive injuries.”

The NIH notes that children are particularly susceptible to repetitive injuries because they’re still growing, and are vulnerable to injuries in the growth plate areas where the bone hasn’t completely calcified. According to the NIH, many growth plate injuries are fractures that account for 15% of all childhood fractures. They occur twice as often in boys as in girls, with the greatest incidence among 14- to 16-year-old boys and 11- to 13-year-old girls.

“It’s important to emphasize downtime to both our patients and their parents,” Hydorn says. “Even if the child insists on playing, it’s up to the parent to insist they allow their injury to properly heal. It can mean the difference between being off the team for several weeks or months or having to someday give up the sport altogether because of repetitive injury.”

Hydorn has sometimes found it easier to take young athletes through a PT regimen while their parents aren’t present and then to include parents and their children in a debriefing at the end of the session where they can discuss expectations and goals.

“I also try to customize a home exercise regimen that both the patient and their parents feel good about,” she says. “So many people have such busy schedules that it’s important to make their home PT seem fun and not overwhelming.”

Team approach

Peter Quinn, PT, ATC, owner of Livermore Physical Therapy in Livermore, Calif., has found that a team approach works best when addressing injuries incurred by young athletes.

“I work closely with the child, their physician, parents, and coach to ensure that we set the standard early on what can be expected from PT and when it will likely be safe for the child to return to their sport,” he says. “This reduces confusion and also helps if either the child or the parent is pushing for a return to the sport before it’s medically advisable.”

Quinn also communicates with a child’s coach in writing, informing him or her of the child’s progress.

“One of my patients was required to go to her cross-country meets even though she wasn’t able to actively participate,” he says. “I sent her coach a note stating what she could and could not do to ensure an optimal recovery. It makes it easier on everyone if the directions are coming from the PT.”

Quinn, who has also served as a coach, encourages coaches and young athletes to adopt a program that includes training rather than just playing the particular sport. “For example, in Little League, coaches may want to encourage strength training among their team members to help with their rotator cuff,” he says. “When kids and teens come to us for PT, we show them exercises they should be doing either at home or in a gym to stay in shape for their specific sport.”

Quinn also encourages his young athletes who are engaged in year-round sports to take a break to allow their injury to heal properly. “If we catch a condition in time, and our patient follows the prescription of rest and rehabilitation, they can return to the game,” he says. “But if the wear and tear goes too far, and the athlete is being encouraged to play through their pain, it can signal the end of their athletic career.”

He also reminds his young patients and their families to keep sports fun. “I’ve seen too many young athletes drop out of a sport because they’re burned out,” he says. “They can’t keep up with the pace and the sport is no longer fun for them.

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Linda Childers is a medical writer for the Gannett Healthcare Group.