by John R. Mishock, PT, DPT, DC
It is estimated that 60 million children and adolescence aged 6 to 18 years participate in team sports, with 44 million participating in more than 1 sport (The National Council of Youth Sports). Of those 60 million athletes approximately 45% to 54% will develop some type of overuse injury (Clin. J Sports Med, 2014). An overuse injury occurs due to submaximal repetitive loading of the body (muscle-tendon unit, ligaments, joints, bone, bursa, growth plate) when rest is not adequate to allow for those structures to adapt and recover.
During the overload process (training or competition) it is normal for the body to fatigue and break down secondary to the micro-trauma of the physical stress. Following this degradation process, the body responds by healing and remodeling those damaged tissues.
To optimize the physiological response and create positive physical adaptation (strength, flexibility, balance, power, speed, agility, quickness, and reaction time), there must be a careful balance between training/competition dose and recovery.
The greater the physical stress put on the body, the longer the recovery time needed for remodeling (healing) and adaptation. This remodeling (healing) and adaptation process occur during passive rest (sleep and sedentary activities) and active rest (stretching, good nutrition, massage, manipulation, foam rolling…) allowing the body to recover and prepare for the next training or competition event.
The amount of time needed for adequate recovery is variable and depends much on the athletes; physical conditioning, genetics, the volume of workload, and or previous injury. Typically recovery from a bout of training or competition occurs in 48 to 72 hours.
Without adequate rest and recovery, there will be excessive fatigue, breakdown, and inhibition of the bodies healing and adaptation process. This incomplete recovery leads to poor athletic performance, reduced physical development, overuse injuries, and burnout. Thus, competition and training errors are the most common cause of overuse injuries.
Risk Factors for Overuse Injuries:
• Higher training volumes (Children shouldn’t participate in sports more hours a week than their age.)
• Overscheduling (multiple competitive events on the same day or over several days)
• Early specialization in a sport or activity (Specialization can occur in late adolescents or when growth plates have closed and the athlete has reached physical maturity)
• Equipment/footwear
• Prior injury
• Adolescent growth spurt (growth plate and muscle-tendon injuries)
• Amenorrhea (stress fractures)
• Sports technique
• Not enough free play (Less free play versus organized sports lead to a greater youth injury rate)
Overuse injury occurs due to submaximal repetitive loading of the body (muscle-tendon unit, ligaments, joints, bone, bursa, growth plate) when rest is not adequate to allow for those structures to adapt and recover. This incomplete recovery leads to poor athletic performance, reduced physical development, overuse injuries, and burnout. Thus, competition and training errors are the most common cause of overuse injuries and burnout.
In my physical therapy clinics, it is not uncommon to see an injured athlete playing for multiple sports teams with excessive training or competition schedule. For example, a basketball player is on the school and travel basketball teams at the same time. They will have practice daily and 2 games per week on the school team and 2 practices per week and weekend tournaments (up to 5 games) on the travel team. In that given week he/she could have up to 15 basketball events. In each of those basketball events, there will be normal amounts of body tissue overload and fatigue, however, there is not enough time for rest and recovery. Even when the season is over, the athlete moves into AAU basketball, more travel teams and the cycle continues throughout the year. No breaks, no opportunity for recovery leading to poor performance, reduced physical development, overuse injury, and potential burnout. This type of pattern is seen in all sports.
Now, contrast youth sports with professional sports. When was the last time you saw an NBA team playing multiple games on the same day? It is rare when NBA teams play more than 3 games per week. Remembering that the professional athlete is physically developed genetically gifted and optimally trained.
In professional sports, there is a distinct competitive season followed by time off (off-season). During the off-season; the athlete recovers from the competitive season begins training for the next season and works on specific skills needed for their individual fundamental development and advancement. For example, in the NBA, it is not uncommon to hear of a player who has; increased upper body strength improved ball-handling ability, and enhanced his shooting skill all in the off-season.
The other issue facing young athletes is burnout. Burnout is part of a spectrum of conditions that include overreaching or over-training. Burnout is a result of chronic stress that causes the young athlete to cease participation in previously enjoyable activities. It is estimated that by age 15, 70% of kids stop playing sports altogether (National Center for Health Statistics).
There are many reasons why the athlete stops playing sports; however, burnout is the most common theme. The young athlete is often bound by unreasonable time constraints and hectic schedules. Coaches at the youth level often misunderstand the athlete’s physical, mental, and emotional development treating the athlete like “little adults”. The youth athlete cannot be treated with the expectation of having adult level skill and emotional/mental maturity.
Prevention of Overuse Injuries and Burn out
• Limiting weekly and yearly participation time
• Schedule rest periods between seasons
• Play multiple sports in youth and adolescence
• Monitor training patterns during growth spurts
• Perform preseason conditioning programs
• Neuromuscular training (landing and deceleration techniques to improve lower extremity control)
• Increase skill development training versus more competitions/games (At ages less the 14 years of age, 60-70% of sports-specific playing time should be spent on skill acquisition and development)
• More focus on having fun and learning the sport (especially in youth sports)
• Less negative performance evaluations (Less focus on results with more supportive focus on the mechanics of the activity and potential improvements were seen).
• Giving the athlete more control in sports decision-making.
WE CAN HELP!
If pain or limited function that is limiting you from doing the activities you enjoy, call Mishock Physical Therapy to schedule your appointment, or request a FREE Phone Consultation (610)327-2600.
Email your questions to mishockpt@comcast.net.
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Locations: Gilbertsville, Skippack, Phoenixville, Steiner Medical, Boyertown, Pottstown, and Limerick (inside the Spring Valley YMCA)
www.mishockpt.com
Dr. Mishock is one of only a few clinicians with doctorate level degrees in both physical therapy and chiropractic in the state of Pennsylvania.
He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “ The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon.
