Sports hurts

Stress, overuse injuries can sideline student athletes
Article By RACHEL V. KATZ

North Brunswick Township High School sophomore Jenna Lonczak had been careful to stretch before her track and cross country practices. She also heeded her coach's warnings about shin splints. Still, that didn't keep her from being sidelined for four months after being diagnosed with three stress fractures in her legs last spring.

"I knew something was wrong," after the pain didn't go away for several weeks, said Lonczak, who has run cross country for about three years, and track for one. Staying off her feet to ensure a full recovery "was hard," she said.

As participation in youth sports has skyrocketed, including the increasing number of girls taking to the fields, the number of injuries caused by overuse or repetitive stress have followed suit. One study found that about half of all youth sports injuries are due to overuse, according to the American Academy of Pediatrics. Repetitive stress or overuse injuries often involve wear and tear on joints, muscles and tendons and results in swelling and pain.

Unlike a broken leg or sprained ankle, such injuries often creep up gradually on athletes, who may recognize there's a problem only after serious damage has been done, said Stephen Rice, director of the Jersey Shore Sports Medicine Center at Jersey Shore University Medical Center in Neptune.

 

"In overuse, you have repetitive mini-trauma, where you do something once or twice or ten times and if you stopped, you'd never notice anything," Rice says. "When you go past the point where you're really tired, that becomes a real vulnerable moment."Careful exercise plans and an awareness of potential symptoms are key to reducing the potential for such injuries, experts said.

 

 

Just as tennis players have long been warned of tennis elbow, baseball and softball players can face shoulder and elbow strains, says Heather Harnly of Pediatric Orthopedic Associates in East Brunswick. Basketball players see wear and tear on the knees, gymnasts may develop stress fractures in their backs, and swimmers might have to deal with tendonitis, such as "swimmers' shoulder," and other pain in the shoulders or back. Runners like Lonczak, who went to see Harnly after she told her parents about the pain, can develop stress fractures in the legs and feet.

Athletes of any age face these risks, but damage in younger bodies can be more serious. "Their bodies are growing," Rice said. "During the growth, you have to deal with open growth plates and other things that make it difficult to handle this stress."

With students eager to compete, and parents excited about seeing their children excel, doctors often become the ones that must draw the line when injuries loom, Harnly said.

"We often wind up being the bad guys. We're the ones who have to stay "No sports,' " Harnly said.

 

 

Overuse injuries manifest themselves in four stages, Rice outlined. In the first stage, the pain begins after the activity and lasts for a few hours. Pain begins toward the end of the activity in stage two, but doesn't affect an athlete's overall performance, leading many to continue ignoring the injury. By the third stage, the pain lasts through most of the practice and affects performance.

"That's when coaches and others sense something is wrong," Rice noted.

 

If left untreated, the injury in stage four will begin affecting other aspects of daily life, such as walking, going up stairs or carrying large items.

 

Treatment varies depending on how long the injury has been allowed to continue. In the first two stages, cutting back on the activity by as much as 35 percent may alleviate the pain while permitting an athlete to continue competing, Rice said. By stage three, an athlete will have to decrease participation by as much as 75 percent. At stage four, the athlete will have to cease all participation and possibly rely on crutches or braces to provide relief for the injured limb or joint for up to two months.

 

In some cases, overuse can lead to torn ligaments, which require surgery and a potentially longer recovery period.

 

 

While it may not be possible to completely avoid some overuse injuries, some simple steps can help reduce the risk.

 

Warm up/cool down: Stretch — before and after exercise — to help improve the muscles' flexibility and ease them into and out of strenuous activity. "Many coaches and athletes concentrate on warm up. What we're finding more and more now in soccer and any sport is, it's how you finish up your practice," noted Mark Wilson, director of marketing for the United Soccer Academy, which is based in Branchburg, New Jersey.

 

Focus on overall fitness: Strength training and aerobic activity outside a sport will help strengthen an athlete's overall body. Regular conditioning in the off-season is also important, Harnly said. Students who have taken the summer off may find themselves more prone to injuries come fall when they jump right back into practice, she warned.

 

Space out sports and take a break: Guidelines recommended by the American Academy of Pediatrics' Council on Sports Medicine and Fitness include:

 

Limit weekly increases in training time, the number of repetitions, or distance to no more than 10 percent each week. For example, a runner shouldn't add more than 1 mile if his or her current total is 10 miles.

 

Take at least one or two days a week off from training and competition to allow for some rest.

 

Take breaks every two to three months from a specific sport to allow injuries to heal and to focus on conditioning and cross-training.

 

Find the right equipment: Providing a proper training surface and footwear can help reduce the strain, Rice suggested. Shoes should be replaced regularly.

 

Sometimes an athlete's own body, such as joint alignment, might make him or her more susceptible to certain injuries. Some of these conditions can be rectified by the use of orthotics, such as shoe inserts, Rice said.

 

Balance schedules: Parents and athletes should keep track of the amount of time spent on sports and encourage coaches to be aware of how many training and playing hours team members regularly face. With many students playing in different leagues, it can become a challenge to balance the child's health with the demands of several coaches, said Wilson, of the United Soccer Academy.

 

"If they're playing at a decent or reasonable level, they might be obligated to perform by three or four different coaches," said Wilson, who is also a soccer coach. "Those kids don't want to let those coaches down." Even if one league limits games to reduce the potential for injury, that won't help if the athlete is juggling two or three schedules in the same season, he added.

 

The AAP recommends encouraging young athletes to play on only one team each season.

Back on her feet with the new school year, and season, Lonczak said she's paying closer attention. Her advice to others: "If it hurts, don't keep running anyway," she said.