Work Samples

Young athletes feeling the pain of too much play


August 3, 2013

Former major league pitcher Tommy John and Dr. Frank Jobe, the man who pioneered the elbow-reconstruction surgery that saved John’s career, used the Baseball Hall of Fame ceremonies last weekend to discuss an issue important to them — overuse injuries in kids who play one sport year-round.

There is an “epidemic,” John said at a news conference in Cooperstown, N.Y., of 12- to 17-year-old kids having his namesake operation because they are pitching too much.

“[Detroit Tigers pitcher] Justin Verlander is the best in baseball, [but] does he throw the ball year-round? No. So why should your son, who can’t walk and chew gum at the same time?” John said last week in a telephone interview continuing the discussion.

“Rest is part of the program,” the Sussex County resident said. “Rest is part of the program, and parents don’t understand that.”

It’s not just about baseball.

The rising trend toward year-round play and overspecialization at younger and younger ages in all sports is putting kids more at risk for injuries, according to a recent study.

Doctors are trying to emphasize the importance of rest.

“I think we’re doing a pretty good job of elucidating the concept of rest being part of practice, and that too much of a good thing can start to be a bad thing,” Englewood pediatric sports medicine specialist Thomas Bottiglieri said.

Maybe. But parents, coaches and kids aren’t changing their schedules despite the evidence and advice.

The stories are everywhere. A 13-year-old softball player’s hand shakes uncontrollably. A 14-year-old baseball pitcher fractures his arm. A 17-year-old soccer player’s only time off is when serious injuries force her to the sideline.

Throughout North Jersey and around the country, the number of kids, some as young as 8 and 9, who specialize has increased significantly in the last five to 10 years. Kids, parents and coaches believe it will lead to success. Some of these athletes escape injury and perform at a high level. But many will find that the extra practice hours and singular focus result in injuries, according to medical experts and the largest study of its kind.

One Bergen County teen and her mother agreed to be interviewed if their names weren’t used. When the daughter was in elementary school, she discovered a love of softball and found early success. At age 9, she started playing year-round — fall ball, winter workouts, spring and summer seasons. A year later, she became a pitcher and threw two or three games during the week followed by four to six complete games during weekend tournaments.

Her parents were told by coaches the workload wouldn’t hurt her. She continued that schedule from fifth through eighth grade.

Such excess is an issue that goes beyond athletics, according to soccer coach Evan Baumgarten.

“We’re talking about sports, but I believe this is in every facet of our society,” said Baumgarten, who coaches the Ramapo High School boys team and also volunteers to coach Wyckoff travel teams of 8- and 12-year-olds. “You look at music, dancing, acting, academics. How many kids have tutors now? I think it’s more of a societal issue than just an athletic issue.”

With sports, however, there is a physical consequence. In eighth grade, the softball player struggled uncharacteristically on the field and her pitching hand started shaking uncontrollably. It happened not only when she was throwing but also when she tried to write or open a jar or use the hand in any way. The muscles in her right forearm became so tight, they were squeezing the nerves. The doctor called it an overuse injury, a classification of injuries caused by the repetitive motion of the same parts of the body.

A study presented to American Medical Society for Sports Medicine in April looked at specialization in youth athletes and the risk of injury. Of the 1,206 specialized athletes ages 8 to 18 who were involved in the study, 859 of them were injured, 564 with injuries caused by overuse — 139 serious — according to “Risks of Specialized Training and Growth in Young Athletes” by Neeru Jayanthi, an orthopedic surgeon and sports medicine doctor, and his colleagues at Loyola University and Lurie Children’s Hospital of Chicago. The study’s authors concluded, “Risks of early sports specialization include higher rates of injury, increased psychological stress and quitting sports at a young age.”

It is not news to the sports medicine community.

“The conclusions they come up with in this study are things many of us have already been preaching to our patients,” Bottiglieri said. “The question is, will pediatricians be more aware of it now? Will family doctors, coaches, parents, youth organizations and administrators who deal with scheduling practices and games? That’s where we really need this to get to.”

Name the sport, doctors say, and they’ve treated an injury related to overuse, lack of necessary rest and premature specialization — soccer, baseball, softball, basketball, hockey, swimming, tennis, gymnastics, cheering or even any demanding physical activity like dance.

Specialization and overuse at a young age, however, is not the only reason for the rise in reported injuries, according to pediatric orthopedist David Konigsberg. There’s a lot more attention paid to injuries now than 15 or 20 years ago.

“The parent awareness, the athlete awareness is a lot greater than it was when I was a kid growing up in a cul-de-sac throwing the ball all day long and, yes, my arm hurt, but ‘Yeah, your arm hurts, whatever, kid,’Ÿ” said Konigsberg, who has offices in Hackensack and Midland Park and is on staff at The Valley Hospital in Ridgewood.

Konigsberg has seen the rise in the injuries and he counsels patients on ways to avoid them. The Loyola study made clear recommendations. For example, no child should play organized sports for more hours a week than his age.

“It makes perfect sense,” Bottiglieri said. “Think about the 8-year-old who’s playing baseball six days a week. That’s going to lead to long-term consequences.”

‘I just didn’t stop’

Many of the better players are on multiple teams with overlapping schedules. Parents and coaches push the players. Sometimes, the kids drive their excessive level of activity.

Soccer goalie Rachel Egyed is entering her senior year at Clifton High School in September. She has verbally committed to attend the University of Maryland. She has played only soccer, year-round since sixth grade, and is a success story as measured by on-field achievement and a college scholarship.

In the last couple of years, however, she lost significant time to injuries — torn tendons and a broken bone in her foot put her out for more than six months and, more recently, a quadriceps injury forced her to sit for two months.

“That might have been overuse,” she said of the latter. “I just didn’t stop when I started to feel it and continuously playing on it made it worse and worse. I did that to myself.”

Egyed repeatedly took responsibility for her physical issues and made a point to say that her coaches do give the players rest.

“Usually after a big tournament or big event where we travel, when we come home, they give us a couple of days off or maybe a week off,” said Egyed, 17. “That’s always nice, to be able to relax.”

In the past when doctors told her she should take some time off to let her body heal, she says she never felt like she could follow that medical advice completely.

“Most of the times when the doctors would tell me I needed a break, we were in the middle of a really important part of the season,” she said. “I tried to take off as much as I could, but I could only do that to a certain extent.”

Adults’ responsibilities

The pressure to keep playing, she insists, was something she put on herself. That is not uncommon. Athletes always want to play. Kids, however, should not be the ones making those decisions, medical experts say. Adults need to act with the player’s long-term health in mind. Otherwise, the consequences can be serious.

Konigsberg pulls out a recent X-ray as part of his cautionary tale for young baseball pitchers who come to him with sore arms and plummeting velocity.

“It’s a scary X-ray,” Konigsberg said of the film of the middle-schooler who has been pitching year-round since he was 8 and has consequently seriously injured his shoulder.

A week later, Konigsberg examined another young pitcher — different shoulder injury, same cause. This athlete had played baseball all year for six years.

“He probably needs shoulder surgery at the ripe old age of 14,” said Konigsberg, who called the injury a “direct result of overuse.”

These are familiar stories in sports medicine. Dr. William Levine is an orthopedist and co-chairman of the advisory committee of a public education campaign called STOP — Sports Trauma and Overuse Prevention — initiated by the American Orthopaedic Society for Sports Medicine. He was recently taking the athletic and medical history of a 14-year-old boy who came to his Manhattan office with an injured elbow.

“It became painfully obvious that this kid had no time off ever to rest his arm and he was being overused in the games he was playing because he was the best pitcher,” Levine said. “He has a partial tear in [a] ligament already in his elbow. So he’s toast.”

A shot at the major leagues — if it was ever a realistic possibility — is gone. Successful high school or college careers are in doubt.

“You never say never, but it is really unlikely when you have allowed yourself to have that type of injury to a skeletally immature and growing body,” Levine said. “It’s sad.”

Doctors are seeing this type of severe injury more and more, according to Levine.

Chance vs. overuse

The Loyola study looked only at overuse injuries, using that classification separately and excluding acute traumatic injuries like a torn anterior cruciate ligament, which theoretically could happen to anyone. It was a necessary designation for the science of the study, said Bottiglieri, but not that simple in reality.

“It’s important to realize the kid who’s playing on four different travel soccer teams is going to have a much greater risk of rupturing an ACL than the kid who’s not,” said Bottiglieri. “You can look at an ACL injury or rupture or shoulder dislocation as a chance [injury] because it could potentially happen to anybody. But we also know that those injuries happen when athletes are fatigued. They happen when athletes are overcompensating. They happen with repetitive exposure, overexposure.”

Trying to prevent these injuries requires educating the parents.

“In most of these circumstances, the child is ultimately not going to make the decision,” Bottiglieri said. “If the parent is receptive and is not the one driving the level of activity, you are much more likely to have success with recommendations.”