Preventing Your Child’s Injury in Competitive Sports

Doctors are finding that as children devote more and more time to excelling in one sport, their risk of injury increases.

Last spring, Sabrina D’Angelo, the starting goaltender with the Under-16 Ontario Women’s Soccer Team, was focused on preparing for an intense season packed with opportunities to showcase her talent on both a national and international level. Sabrina got into the game by playing along side her older brother at the age of five. By 10, she was playing at a competitive level with her hometown team in Welland, Ont. Now 17, she spends most weekday evenings and weekends making the hour-and-a-half drive with her parents, Bonnie and Gerry, to practices in a north Toronto suburb. It’s a hefty commitment, but one that Sabrina and her parents believe is necessary in order to get an athletic scholarship and the possibility of landing a spot on Canada’s
national soccer team.

But it all came crashing to a halt last year when Sabrina suffered an injury to her knee’s anterior cruciate ligament (ACL), a result of a bad landing at a school track meet. Her dreams of a stellar soccer season suddenly disappeared as she dealt with a grueling recovery. It’s no surprise that more elite young athletes like Sabrina are sustaining sports-related injuries, says Edmonton’s Dr. Claire LeBlanc, chair of the Canadian Paediatric Society’s Healthy Active Living & Sports Medicine
Committee, and one of a handful of Canadian sports medicine pediatricians. Many young athletes specialize in a certain sport at an earlier age and tend to play that one sport all year round. “That does not allow the muscles and bones to heal,” says Dr. LeBlanc.

Types of injuries
Overuse injuries are common among competitive athletes, not only because they are fine-tuning their athletic skills at a higher level but also because they have the added challenge of maintaining a healthy, growing body. Knee injury, shin splints, tennis elbow and swimmer’s shoulder are all injuries resulting from the over-conditioning of one body part without adequate conditioning of the surrounding joints and muscles.
A study published last year in Pediatrics looked at emergency room visits related to physical education among American students between 1997 and 2007. The numbers skyrocketed by 150 percent. It also found:

• the most common injuries were leg sprains and strains (23 percent), arm sprains and strains (14 percent), and fractures (14 percent)
• more than half of the injuries were in children ages 11 to 14
• the top six sports responsible for 70 percent of the injuries are among the most popular competitive sports: running, basketball, football, volleyball, soccer or gymnastics.

So what’s with the increase? A study from the Children’s National Medical Center in Washington, D.C., equates the rise in injuries with the rise in participation. Plus, researchers note that children are more vulnerable to injury than adults because:

• they have a larger surface area to mass ratio
• they have proportionately large heads
• they are too small for protective equipment
• their growing cartilage may be weaker than that of an adult
• they lack the complex motor skills needed for certain sports until after puberty.

Preventing injury
Don’t let kids overdo one sport, says Dr. Julia Alleyne, medical director of Sport C.A.R.E. at Toronto’s Women’s College Hospital. “What’s important is a balance between skill building and fitness building,” she explains. “We have learned that with children, it’s quality over quantity.” Be proactive and encourage your child to cross-train and participate in other activities apart from their primary sport.
“We need to encourage them to cross-train before they get injured,” says Leigh Davis, a Toronto-based physiotherapist who has worked with athletes. “A lot of young skaters do yoga or Pilates especially as they become more elite.”

Recovering from injury
As the saying goes, time heals all wounds, and recovery from any injury requires time and physiotherapy. Dr. Alleyne recommends that young elite athletes adhere to a step-by-step recovery approach that takes into account the specific movements required for their sport. Get advice from medical professionals who have dealt with sports injuries and educate yourself. Sabrina’s parents agree that staying informed helped ensure their daughter was able to access the right combination of medical and rehabilitative care. Sabrina also understood that physical therapy and training exercises were the key components to regaining her muscular strength and ultimately reclaiming her position between the posts.
“There are ways to set realistic goals and focus on overall development. We have to be careful that their body has a chance to heal,” says Dr. LeBlanc. Total recovery is key to reducing risks for sustaining another injury. But that long waiting time can be even more excruciating than the injury for young, commited athletes. “Don’t take your kid at his or her word that he or she is ready to play,” says Olive Cordes, a 17-year-old hockey player who was benched with an injury. “I’d say I was okay when I could barely skate.”
Sabrina’s father, Gerry, cautions parents to not pressure or rush their children to get back into the game either. “If kids are committed to getting back in shape, they will.” While being sidelined for a season wasn’t part of Sabrina’s plan, she remained focused and used her recovery time to renew her commitment to soccer. “I think I have more passion for the game now,” says Sabrina. “I didn’t take soccer for granted before but it’s more important to me now that I’ve had an injury and been off for so long.”
Sabrina’s dedication to her fitness regimen, coupled with the ongoing support of her parents and coaches, has kept her well positioned to get back on the pitch this season. After spending the past season cheering her team from the sidelines it’s fair to say Sabrina is healthy and inspired with a passion to compete in the game she loves.

Dr. LeBlanc says she often sees young athletes who simply aren’t getting
real nutritional value, which negatively affects their performance and
also increases their risk of injury. “Youth can get into some bad habits
of not maintaining sufficient caloric intake and a well balanced
diet.”  For a healthy gauge, look at your child’s total body health
rather than focusing on a specific number on the scale. “Nutrition is
part of sport training,” explains Dr. Alleyne. “Calculcating someone’s
energy needs is critical and can vary for each individual.” A solid
nutrition plan plays an important role in preventing injury. Nutritional
recommendations for young athletes are as follows:

60% CARBOHYDRATES (whole grains, fruits and vegetables):
“Young athletes who do not eat at least six to 10 carbs per kilogram of
body weight per day will suffer in athletic performance and may even
reduce their overall activity levels,” says Dr. LeBlanc. Pack a pre-game
and post-game snack such as raw carrots, red pepper and broccoli, a
banana or whole grain bagels or crackers, especially during activities
lasting longer than an hour.

20-25% FATS:
While fat is an important fuel source for exercise, even athletes need
to avoid saturated and trans fats that can raise bad cholesterol levels.
Instead, opt for fish such as salmon and rainbow trout along with olive
oil and peanut oil.

12% PROTEINS (eggs, dairy and soy products, beef and poultry): These
are an important source of energy when carbs and fats are not
available. Proteins also help produce enzymes, hormones and antibodies,
balance fluid levels and help maintain the strength of muscles and
tissues.

Published May 2010