By Dr. John Stavrakos, PLC Consultant and Sports Medicine Specialist
As we enter another school year, thousands of young athletes from grade school to high school are preparing for fall sports by participating in preseason workouts, and family doctors nationwide are swamped with filling out preparticipation sports physicals. This is a fun and exciting time of year for parents, coaches and students alike – but also a high time of year for sports related injuries. In this article, I wanted to touch on a few issues that invariably come up when kids go from vacation time fun to early school year training schedules, and how to best evaluate and treat them.
1) Strains, sprains & aches: It’s a safe bet that all sports doctors are going to see young athletes marching into their offices within the first three weeks of preseason camps from one of these. Most muscle strains and joint aches are a result of a rapid increase in demands on the musculoskeletal system – going from summer fun of getting a tan and throwing a frisbee around to two-a-day strength, speed and conditioning drills is going to produce some aches – so some of these pains are unavoidable. Teaching kids to keep with a summer conditioning program will usually lessen these issues. In children undergoing a growth spurt, keep in mind that that bones are growing faster than muscles, and this can lead to relative muscle weakness and inflexibility, as well as pain from traction of the muscle tendons at their insertion points on the bone, called an apophysitis. The 15 year old female track runner who had no problems last fall, for example, who now (one year later and 3 inches taller) is complaining of a sharp or achy pain in her anterior hips when running, may be suffering from this. Year round muscle conditioning (keep in mind that most active playtime activities are great conditioning) and stretching in growing kids can help to diminish these problems; if you have any questions or concerns, be sure and ask your physician.
2) Heat and overexposure: not long ago, the dangers of hyperthermia, or overheating, made national headlines when a college football player at a Division I school passed away in training camp from this condition. In humid areas of the country, the risk of hyperthermia is even greater, as humid air lessens the body’s ability to dissipate heat from the skin. Always keep in mind that children have a decreased tolerance to excessive heat and a diminished ability to cool off when compared to adults. If an athlete shows signs of listlessness, walking with a staggered gait, not focusing or not speaking intelligently, get them into shade/cool area, lay them down and elevate their legs and seek medical attention. Advise your athletes to drink well before and after practice (drinking until you’re no longer thirsty is a good rule of thumb), and to cool down afterwards. Drinking excessive amounts of water when exercising can be dangerous as well, and can lead to dilutional hyponatremia, an electrolyte imbalance where the sodium level in the blood gets “watered down” from too much water intake, and can present with symptoms similar to dehydration and hyperthermia. Kids should avoid caffeine (which causes dehydration), and most especially energy drinks – these beverages (e.g. Monster, Amp, Spike Shooter, etc.) not only carry much more caffeine than a 12 oz can of Coca Cola (up to 11 – 12.5 times more!), but have other substances in them that act as stimulants, which your kids don’t need in 90 degree heat when they’re running a 5K, doing push-ups and crunches or doing tackling drills.
3) Stress Fractures: another potential problem of ramping up activity level beyond what the bones can handle. Stress fractures (also called insufficiency fractures) are micro fractures, or “cracks” in the architecture of bones that happen when the forces exceed the shock absorbing ability of the bone and surrounding tissues, and overcome the bone’s ability to heal. Stress fractures tend to occur most commonly in the shins (“shin splints” are an early stage stress fracture) and in the midfoot (just past the ankle), and are more common in girls than boys. Typically they present as a achy pain that occurs with impact activity at a bony weight bearing area (foot, shin, hip, etc.), that is worse with impact and gets better with rest, and may progress to hurting with every day activities such as walking. These are most common when young athletes go to ‘the next level’ – i.e. 8th grade to high school, high school to a competitive college program. They usually require an xray and possibly further imaging, such as a CT or MRI, if the clinical suspicion is high, because many stress fractures do not show up on plain xrays. If your young athlete has a pain that will not go away when doing their sport, even with rest, and especially if it is present even when not in sport, you should seek medical attention.
Sports are an important and enjoyable aspect of returning to school, but as with every activity, as responsible adults who love and care for the children we are responsible for, we need to be vigilant for conditions that can adversely affect them. May all your young athletes have a healthy, successful season!
