Imagine this. You are sitting at home one evening and you hear the phone ring. When you pick it up, you hear the following: “Your son John has badly injured his ankle playing basketball. We are thinking of sending him to the emergency room. Please get here as soon as you can.” This situation is something that many parents fear. Was there anything John could have done to prevent this?
There are a number of factors that make kids more susceptible to athletic injury:
• Due to their developing nervous and musculoskeletal systems, children are somewhat less coordinated and have slower reaction times than adults.
• Kids tend to mature at different ages. As a result, there may be children of different weights and heights present on the same playing field at one time. In addition, if a child is particularly skilled at a particular sport, at some time she may find herself competing against children older and larger than her. The combination of children of different sizes on the court is an accident waiting to happen.
• In general, children are willing to take more risks than adults are and they may be less likely to properly assess a dangerous situation.
• Over the years, professional sports has become more and more violent. Even those sports that have always been thought of as non-contact, have evolved into full contact sports. There is no question that kids will imitate the play of professional athletes and this style of competition has found its way into children's sports as well.
• As sport becomes more and more important in the American culture, there is ever more pressure on children at younger and younger ages to compete in high-level sporting activities.
All of the above factors make children very likely to sustain some sort of injury on the playing field. So what can be done to prevent these injuries from occurring?
EXERCISE
Children must be encouraged to develop the necessary strength and flexibility to combat injury. It is well documented that muscle and flexibility imbalances predispose to injury. Muscle strains and joint sprains are very likely related to inequalities and deficits in the musculoskeletal system. For the most part, a daily strengthening and stretching program is sufficient. In more complex cases, a consultation with a sports medicine physician or a certified athletic trainer may be necessary to develop a proper exercise program.
Endurance training and aerobic exercise are essential to make sure kids do not “overdo” it. Many overuse injuries may be tied to fatigued muscles, tendons and ligaments. Proper cardiovascular conditioning ensures that children may be able participate longer before fatigue sets in.
Before competition, a proper warm-up period reduces muscle and ligamentous tightness and facilitates blood flow to the exercising muscles. At the completion of activity, an appropriate cool-down period allows the body to safely redistribute blood flow from large muscle groups back to the rest of the body.
Appropriate technique for each sport should be emphasized. Proper coaching is fundamental to ensure that children do not injure themselves as a result of poor form.
NUTRITION
It goes without saying that an appropriate diet is essential to provide the nutrients necessary for a growing body. Adequate protein and carbohydrate intake is vital to allow continued and sustained participation in high-energy athletic activities. The current recommended dietary allowances are 130 g of carbohydrates per day for adults and children. These levels will need to be exceeded when the energy requirements are higher as in athletic competition. Adult protein requirements are 0.8 g of good quality protein per kg body weight per day. The requirements for growing children (usually below 18 years old) are even higher than this. For a more complete description of the current US nutritional guidelines, see the links below.
Children perspire less than adults and require a higher core body temperature to trigger sweating. Therefore, it is even more important that proper fluid intake is maintained before, during, and immediately following vigorous exercise. It should always be remembered that, if not addressed appropriately, dehydration, heat exhaustion and heat stroke are potentially dangerous and fatal side effects. Parents, coaches and training staff, where available, should be vigilant in ensuring adequate hydration for the child athlete.
PROTECTION AND ATHLETIC EQUIPMENT
Wearing appropriate and approved equipment relative to the particular sport can be helpful in preventing injuries. Helmets, gloves, mouthguards, padding, protective eyewear and athletic cups and supporters in males may all be helpful in protecting and preventing serious injury from occurring. Children should be encouraged by parents, coaches and league officials to wear the appropriate protective devices. Helmets should always be worn in baseball, hockey, football and lacrosse. Mouthguards should be worn in every sport to prevent injury. In the proper circumstance, suitable equipment should become a prerequisite for participation.
Appropriate sized equipment and gear should always be utilized. This may help to prevent overuse or repetitive strain injuries. For example, a junior tennis racquet should be only as long as the child can handle. Too small a racquet length encourages excessive wrist and elbow action which, over the long run, may harmful to the arm. Attention to grip size is also important, as too small a grip size may predispose to hand and elbow injury. String tension should be somewhat slack to prevent excessive transmission of force to the elbow. All of the above recommendations are important for the prevention of a condition called lateral epicondylitis or tennis elbow .
The selection of suitable footwear is an important decision that should not be overlooked. The following general suggestions are based on the most current recommendations of the American Academy of Podiatric Sports Medicine:
1. Pick a sport-specific shoe
2. Shop at stores that specialize in athletic shoes.
3. Bring your old shoes to the store. This may give some indication of the wear pattern and may be helpful in selecting a new model.
4. Have your feet measured each time you purchase a new pair of shoes.
5. Bring any socks or inserts you plan on wearing with a particular shoe. This will ensure that the fit will be correct.
6. Allow at least one finger's width between your longest toe and the end of the shoe.
7. Check the new shoe for defects before you purchase them.
8. Regularly inspect the shoe for wear.
9. Instead of wearing shoes for the first time in a race or while competing in a game, make sure they are thoroughly broken in first.
10. Socks constructed from synthetic fibers are better at wicking away moisture than cotton.
See the links below for more useful information.
SUPERVISION AND FIRST AID EQUIPMENT
Children should never be left alone whenever potentially dangerous sporting activities are involved. If this is not feasible, children should know, at the very least, how and where to contact a responsible adult in case of an emergency. For organized sporting events, appropriate first aid equipment and emergency medical personnel should always be readily available. It has become increasingly apparent that the timely use of defibrillation devices, in the right setting, can be life-saving. For this reason, it is wholly appropriate that automated external defibrillators (AEDs) be readily available whenever possible.
MEDICAL CARE
If an injury does occur, it is imperative that it be treated immediately. Often, small injuries may turn into big ones if not properly ministered to. A period of complete or relative rest may be appropriate. Sprains or strains may take weeks or months to heal completely. Parents and coaches should ensure that the child is not rushed back to play before they are ready or else reinjury is likely to occur. Once healed, splints or braces may need to be worn for some time to protect the injured area. These should fit properly and be able to be worn with existing athletic equipment.
EASY DOES IT
In today's day and age, sports and athletics are a significant focus in society. Children are expected to compete at a high level at younger and younger ages. There must be guidelines in place that govern what and when kids can participate. Many leagues have already adopted these restrictions. For instance, according to current national Little League guidelines, a pitcher must observe specific rest periods between pitching appearances. If a pitcher works in three innings or fewer, that pitcher may not work on the next calendar day. If a pitcher works in four innings or more, three calendar days' rest must be observed. Delivery of a single pitch constitutes pitching in an inning. In addition, a player is limited to pitching in six innings in a calendar week, Sunday through Saturday. There is talk about instituting a pitch count restriction in addition to the above, but there is no existing rule limiting the number of pitches thrown. Any rules enacted should be sport and age appropriate and based on scientific evidence, when possible.
In summary, childhood athletic injuries can never be entirely abolished. But if the above recommendations are adhered to, the chance of significant harm may be significantly reduced.
JEFFRY BEER, MD
USEFUL LINKS:
http://www.niams.nih.gov/hi/topics/childsports/child_sports.htm
http://kidshealth.org/parent/firstaid_safe/outdoor/spor t s_safety.html
http://www.princetonol.com/family/columns/pedgroup25.html
http://www.momsteam.com/alpha/departments/regularseason/factors.shtml
http://www.drfoot.co.za/conSports.htm
http://www. aapsm.org
http://www.nap.edu/books/0309085373/html/
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