Youth sports are more popular than ever — about three in four families with school-aged children have at least one child in organized athletics — and for good reason.
Among its first virtues is the outlet it provides for kids to do what comes naturally, to get moving. If your kids are getting at least an hour of day of physical activity, as health guidelines recommend, they’re already doing better than most.
And, just as you’d guess, sports are also associated with better grades, a healthier mental life and lower risk of long-term illness like diabetes and heart disease. Of course, kids like it because it’s fun to get moving with friends.
But as the popularity of youth sports has risen, so have the number of injuries. About 2.6 million children 18 and younger are treated in emergency departments every year for muscle or bone injuries sustained in a sporting event.
Some of these injuries are caused by children specializing in a single sport at too young an age, says, Sean Keyes, DO, an orthopedic surgeon with advanced training in the field of childhood sports injuries.
“As our society grows more and more competitive, this pressure is passed down to our kids with increased focus on ‘being the best,’” Dr. Keyes says. “We want our children to stand out, be successful and earn scholarships, but it all comes at a cost.”
In other words, keeping your kids safe is as much about your values, preparation and attitude as it is about them being careful on the field.
Florida Hospital’s experts have experience in caring for children who are hurt on the field, but we’d prefer to protect your child’s whole health and prevent injuries when at all possible. Your kids want to have fun out there, and you want them to do have it while staying safe.
Preventing Broken Bones
The discussion about bone health and youth sports should begin by noting that weight-bearing physical activity is great for growing bones. Though, as we’ll see in a moment, football players are most likely to be injured, their sport also promotes bone growth.
A previous study found similar bone-building result in soccer players, and the same is likely true of any activity involving lots of running.
Furthermore, muscle and bone health in growing teens could echo through their life decades later. Our bones get larger and stronger in youth, but will become weaker as we age through adulthood.
Think of strong nutrition, exercise and injury prevention as making “deposits” into a bank account from which your child will begin making withdrawals in middle age. Building up a healthier balance as a youth means there will be a lower chance of going into the red — and developing osteoporosis, or brittle bones — when they become older adults.
In addition, sports can help your child stay healthy and gain a lifelong love of exercise. Childhood obesity, too, can have far-reaching effects, both leading to being overweight as an adult and putting your child at risk for diabetes, high blood pressure and asthma, among others.
The Riskiest Sports
When it comes to their injury risk, not all sports are created equal.
A 2017 study that compared the most popular youth sports ranked them by the injury rate per 1,000 games or practices. They found that, across all sports, the average player was hurt 2.32 times for every 1,000 games or practices they played in.
At those odds, each player would have a 50 percent chance to sustain an injury after playing about 350 times. To count in the study, an injury had to be severe enough to result in stopping play for at least one day.
Here’s what they found when they compared the injury rates for different sports:
- Football (4.08 injuries per 1,000 games)
- Wrestling (2.23)
- Soccer (1.87)
- Basketball (1.48)
- Baseball (.84)
- Soccer (2.59 injuries per 1,000 games)
- Basketball (2.14)
- Softball (1.3)
- Volleyball (1.19)
As you may have guessed, girls are injured less often, overall, than boys. But this is largely because they play less dangerous sports, and for fewer hours.
When compared within the same sport, the girls were actually more likely to be injured.
Young female athletes are particularly vulnerable to ankle and knee injuries. Researchers don’t know exactly why girls are more vulnerable to certain types of injury but what we do know is that there is a dynamic muscle imbalance in this athletic population.
Most ACL injuries — serious tears to a crucial connection between the leg and shin bones — happen without contact. This suggests that improved strength and flexibility of the hip, which can better direct and control the muscles, ligaments and tendons in the knee, would likely prevent many injuries.
If your child plays a sport with a lot of acceleration and side-to-side movement like basketball or soccer, consider asking a physical therapist or participating in a sports metrics program designed to lower your risk for ACL injury, such as the program at Florida Hospital Sports Medicine and Rehabilitation.
"It is targeted at the elite athletes at the highest risk for ACL injuries, including female soccer, volleyball and basketball players,” Dr. Keyes says. “It’s a prevention program and is not 100 percent effective, but it does lower the risk.”
Most youth sports injuries occur during practice, not formal competition, according to the group Safe Kids Worldwide. But about a third of parents admit they don’t use the same safety precautions during practice as they do in games.
Here’s some reminders about ways to practice safety:
- Bring a water bottle, and encourage your child to drink from it before, during and after play.
- Set aside time before practices to stretch.
- Limit practice hours.
- Watch out for signs of overtraining (more on those below).
What’s causing injuries?
There are two broad kinds of sports injuries: those that occur suddenly, like breaking a bone, and those that happen due to a long period of repetitive activity. Tennis elbow is a common example of an overuse injury in adults.
In youth sports, some broken bones and twisted ankles are probably inevitable. But injuries caused by repeated overuse are preventable.
Research has identified five factors that are most associated with overuse injuries. They are:
- Sudden increase in intensity and duration of activity.
- Single-sport specialization too early
- Poor conditioning.
- Not enough training in a specific sport.
- Poor training.
- Wrong equipment for the sport.
According to a 2014 study, girls appear to be more vulnerable from overuse injuries, while boys were more likely to experience acute injuries like a fracture or muscle strain.
What does overtraining look like? Signs can include pain at rest but are not always physical. Others include:
- Changes in mood or enthusiasm
- Loss of appetite or fatigue
- Low self-esteem or more self-criticism
What can you, as a parent, do about it? Here are some suggestions:
- Limit your child’s play time. There is no firm standard, but one common piece of advice is to limit time in organized sports to the number of hours per week equal to your child’s age.
- Avoid specializing in one sport before late adolescence.
- Take off at least one day per week and three months per year from a specific sport.
- Gradually increase your training intensity. Don’t jump into all-day training after a lazy summer or double your workout length before a big tournament.
Also, many sports put repeated strain on a particular body part. Swimmers commonly experience shoulder pain, the elbow is a point of concern for pitchers and soccer players should be vigilant for knee pain.
Dr. Keyes says too-early specialization leads to overdeveloped muscle groups in some areas and neglected muscles in other parts of the body. This has partly contributed to higher rates of injury.
The American Academy of Pediatrics recommends kids don’t specialize in a single sport until at least the age of 15 or 16.
Early specialization doesn’t necessarily even benefit children athletically, Dr. Keyes says. A survey of Division 1 college athletes found four in five played multiple sports in high school.
“Single-sport specialization doesn’t necessarily increase their likelihood of being successful,” he says. Furthermore, “encouraging them to play multiple sports is in the best interest of both their mental and physical health.”
Balancing Healthy Competition
But we should take care not to undervalue the many benefits of youth sports out of worry about injuries. Exercise can help hone our memory, sharpen our self-control and even improve the part of the brain that lets us make and execute plans.
It does all of this while helping kids develop self-esteem and social skills, leading them to build friend networks in real life, not just online.
However, just as growing bodies are not the same as adult ones, youth sports are not simply child-sized versions of adult sports. For adults, competitive athletics is often about winning, but an overly competitive mindset in youth sports may dampen their enthusiasm.
“The value of youth sports goes far beyond the field and victories,” Dr. Keyes says. “They are about setting a foundation for morals, work ethic and healthy habits that will last our kids a lifetime.”
“Talk to your child about the sports they’re involved in and make sure that they have the same enthusiasm that you do for them being active,” he says. “And remember, you are your child’s best advocate for health and if they look injured or fatigued that’s when devastating and life altering injuries can happen.”
Florida Hospital for Children is an advocate for the social, emotional and physical benefits of youth sports. We believe young athletes can enjoy the whole-health benefits of sports while minimizing their risk of injury.
For more information, call us at (407) 303-KIDS or schedule an appointment on our website.