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Monday, June 19, 2006

To Play or Not To Play

Those of us with kids involved in youth sports know how consuming it can be for our families. Weekends are dominated by games and weekdays by practices. The ties that bond us together are often tightened during these activities, but do our kids do too much too soon? When many of us were kids, there were not nearly as many organized activities; now that we have martial arts, religious studies, team and individual sports, family time and, of course, homework. Is there a right time to start to play or not to play? Like many parenting decisions, including those for youth sports, there are no black and white answers. Of the many variables to consider, this month we’ll focus on the potential injury risks.

What is the likelihood of Injury?

A common concern is that younger kids may be more susceptible to severe injuries before they have fully developed. Is there a greater risk of arm damage for kids who start pitching at age of 7 instead of waiting until they are 9? Should kids avoid tackle football until the reach a certain age? Does specialization in an individual sport increase the risk of injury for that child due to overuse and make them more susceptible to continuous motion injuries?

Injuries are certainly a concern for all of us and the risk of injury is considered a growing problem by many experts. According to the “Kids’ Health” supplement in the October 18-20, 2002 weekend edition of USA Today, there are over 3.5 million sports related injuries that require treatment reported each year for kids under 15 years old. Many of these injuries are from playground equipment, bike riding and other activities, but organized youth sports certainly contribute to the total. Fortunately, there are very few deaths, but the information suggests that 40% of all sports related injuries occur in children under 14 years old and more than half of those injuries take place in practices instead of games. In 2002, from information accumulated from the “Connecticut Safe Kids Sports/Recreation Activity Injury Fact Sheet”, here is a breakdown of emergency room treated injuries broken down by activity:

While this data is certainly misleading and flawed because it doesn’t break down the number of participants in each sport, the frequency of the activity or the severity of the injury, it does demonstrate that injuries are something we should pay attention to.

Types of Injuries

In the newsletter published by the Yale-New Haven Children’s Hospital, pediatrician Deiter Lindskog, MD exclaims that the largest increase in youth sports injuries are due to repetitive use. He states “Recent studies estimate that 30 to 50 percent of pediatric sports injuries are caused by overuse, with the frequency of injury equal among boys and girls.” Because they’re still not fully developed, kids are more susceptible to repetitive use problems like stress fractures, caused by use without enough recovery time, growth plate injuries, due to excess strain, and soft tissue damage to muscles, tendons or ligaments.

This would lead to the question of “how much is too much? The research on this isn’t clear at all. With increased specialization where kids participate in only one sport year round, start playing at a younger age and participate in multiple leagues at once, what is clear is that many are crossing that unknown line. In baseball, a study created in 1996 and updated in 2004 by USA Baseball Medical & Safety Advisory Committee Position Statement on Youth Baseball Injuries developed a standard for rest based on pitch counts:

While there is a tremendous amount of flexibility in these recommendations, the main issue is that care should be taken to watch for signs of trouble. There is no evidence to suggest a higher injury rate for Pony League Baseball, which often starts kids pitching at age 7, when compared to Little League Baseball, which often starts kids pitching at age 9.

Studies done with Pop Warner Football players also show that there is a risk of injury, but surprisingly, younger players are less likely to be injured than older players. Supported by studies done by the Institute of Sports Medicine and Athletic Trauma in New York which completed a study in 71 towns covering 5,000 players, the Pop Warner Website (www.popwarner.com) states that because of the weight restrictions “injuries in youth football are normally mild and older players have a higher injury rate than younger players.”


As people involved in youth sports we need to be aware of safety and injury risks associated with the children we watch. Kids specializing in single sports or playing in multiple leagues have exacerbated the risk of repetitive motion “overuse” injuries. We need to be especially aware for these young athletes and be cognizant of the warning signs. Some things to watch for include pain, changes in gait or other observable behavior, changes in performance and psychological effects. Kids should not be encouraged to play through any real injury because they don’t want to let down their parents or teammates even though they may feel like they can do it.

We want to help prevent injuries through proper training and conditioning. An effort can be made to have children compete at levels commensurate with their skill so that they don’t overdo it. Furthermore, efforts must be made to teach proper fundamentals for all aspects of the game since mechanical errors are more likely to lead to flaws that can cause injury. Because practice makes permanent, it is crucial to work on these fundamentals even at an early age. As youth sports enthusiasts, we all have an obligation to take care of the kids.


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