PAMF Health Blog

Be Well, Be Well Informed

Competitive Sports & Teens: A Good Challenge or Too Much of a Good Thing?

Posted on Feb 7, 2012

At first glance, having your teen join a year-round competitive sports team may seem like the perfect way to kill two birds with one stone – he or she has no time to turn into a couch potato hooked on texting and Facebook, and also has the opportunity to excel in a sport he or she loves. But before your teen signs up, you should know that teenagers’ bodies are particularly vulnerable to injury as their bones, muscles, tendons, ligaments and joints are going through their most rapid period of growth. The intensity and “no pain, no gain” philosophy of many competitive, year-round sports teams can result in your teen sustaining serious injuries, some with lasting effects.

However, you can help your teen enjoy a safe (rather than a sore) season by making sure he or she is properly prepared to play, avoids playing the same sport year round and never plays if he or she is in pain.

Many parents have similar questions, and here are my answers to some of the questions you may be wondering about with your teen athlete:

My 13-year-old daughter has started playing on a competitive soccer team. I’ve heard that girls are more prone to knee injuries from sports such as soccer. Is that true?

I can certainly understand your concern, as a female athlete’s knees are particularly vulnerable to anterior cruciate ligament (ACL) injuries. In fact, females are four to eight times more likely to sustain this serious injury than male athletes. ACL injuries are specific to sports that involve starting, stopping and pivoting such as soccer, basketball or volleyball. Typically this ligament, one of the four ligaments which stabilize the knee joint, is torn in two ways: landing on an overly straight (hyper extended) knee or pivoting the leg inward (internal rotation) with the foot planted, without the foot pivoting as well.

Female athletes are thought to be more prone to ACL injuries due to a muscle imbalance in the thigh (the quadriceps muscles overpower the hamstring muscles, which need to work together to straighten and bend the leg) and the way female athletes move during their sport. They tend to remain more upright with their knees less bent than their male counterparts.  Female athletes also tend to let their knees lean inward, rather than keeping their knees directly over their feet, when jumping and landing. Both of these positions put the ACL in a vulnerable position.

Surgery to replace the torn ACL is recommended for young athletes so they can return to fully participating in the sports they love.

Check with your daughter’s coach to find out if the team’s training sessions include an ACL injury prevention program taught by a trained physical therapist. These programs, which help athletes strengthen key muscles and teach them how to jump and land correctly, have proven to successfully reduce ACL injury rates by up to 80 percent.

My 15-year-old son is playing football on his high school team and says his back is hurting. What could be wrong?

Your son’s back pain may well be due to a pars stress fracture. This injury usually causes low back pain on one side of the back, as opposed to the center. Pars stress fractures involve a small connecting bone in the lumbar spine. During adolescence this bone is lengthening, so it is particularly thin and weak and prone to injury. If a pars stress fracture is detected and treated early, it will heal and resolve completely without increasing the risk of future back problems. However, pars stress fractures that fail to heal can cause permanent back problems in adult life. Since a pars stress fracture is a break in the bone, only significant rest and time (usually about three months) will let it heal.

My daughter plays softball almost year-round in a competitive league. After a recent weekend tournament her shoulder was quite sore from pitching – how can I tell if she is developing an overuse injury?

It’s good to listen to your daughter when she says she’s in pain. An overuse injury may be developing if any pain is occurring more frequently and lasting longer. Overuse injuries generally progress as follows:

  1. Soreness lasting several hours or less only after the activity
  2. Soreness or pain during and after the activity that does not improve by the next morning
  3. Soreness or pain during activities of daily living as well as during sports

If your daughter’s symptoms show this progression, she should be evaluated by a sports medicine specialist for a possible overuse injury.

How can I reduce the risk of injury for my teen athlete?

There are many common-sense steps your teen athlete can take to ensure he or she has a healthy, pain-free sports season. He or she should:

  • Maintain good physical conditioning during the off-season and ease into a new sports season gradually. Increase high-impact activities such as running and jumping gradually, too.
  • Take at least one day a week off from competitive sports participation, and ideally several weeks off every several months.
  • Avoid year-round participation in one sport or participating on more than one team in the same sport at the same time.
  • Stretch and warm up before all practices and games.
  • Always wear the correct protective gear and make sure all your equipment such as shoes and pads fits properly.
  • Remember R.I.C.E. (Rest, Ice, Compression and Elevation) to help soothe any minor injuries.
  • Ignore the “no pain, no gain” philosophy. If your teen is in pain or injured, he or she should stop playing until the pain resolves.

Keep in mind that overuse injuries often develop during long weekend tournaments, week-long camps focusing on a single sport, or during weeks of twice-per-day practices. Progression of these injuries can usually be prevented by having appropriate evaluation and treatment when symptoms develop.

Sally Harris, M.D., MPH, is a specialist in pediatric and adolescent sports medicine at the Palo Alto Medical Foundation and a clinical instructor of pediatrics at Stanford Medical School. A leading expert in her field, Dr. Harris has authored numerous clinical and patient articles about pediatric sports medicine and served as an editor of the American Academy of Pediatrics’ second edition of  Care of the Young Athlete.