A Lesson on Youth Sports Injuries

Youth Sports Injuries Can Be Avoided

Jim Ochse is an athletic trainer and strength and conditioning coach at DeSales University in Center Valley, Pa. He serves as athletic trainer for the women’s Volleyball, men’s and women’s cross-country, women’s tennis, and baseball.

During the summer, Jim presents SAQ camps for athletes from 10-18 years of age in northeastern PA.

IYCA: What’s your background in youth sports and athletics? Have you worked with young athletes?

JO: I started out as a Health and Physical Education teacher for K- 6 for several years, but was disenchanted in how physical fitness was instituted in the educational system. I then became certified as an athletic trainer and have covered all aspects of youth sports for the past 22 years. I serve as a volunteer coach for soccer, basketball, and baseball for my local youth association. During the regular school year from September to May, my main responsibility is to the college athletes at DeSales University in Pennsylvania ; however, I do talks and clinics whenever possible to youth, and have a few personal training clients that I collaborate with. During the summer months I direct a number of Speed, Agility, and Quickness camps in my local area for youth from ages 10-18. I also do one day seminars on running, and other topics such as how to incorporate stability ball training to their strength programs.

IYCA: There are a lot of coaches, parents, and even trainers who treat young athletes as if they were "little adults." What I mean by that is they will take the training routine of a superstar athlete and use it as a guide when working with youngsters. Why, if at all, should we warn them against that kind of training?

JO: I see this mentality used by both parents and youth coaches, and obviously, this type of mentality is not appropriate for developing athletes. A training routine for youth should be individualized for that particular athlete. A young athlete is not mature enough physically, psychologically, or emotionally to even perform the same type of training as an adult. They do not have the base of aerobic/anaerobic conditioning that a more mature athlete has acquired, nor should they attempt a strength program that is meant or written for an adult. With their growth plate still immature, performing strength exercises for mature athletes may predispose them to unnecessary injuries. Weight training does have its place among young athletes; however, emphasis should be place on light weights, proper form and techniques, an implemented by a well qualified coach or personal trainer.

IYCA: The age old debate is "How old should an athlete be before beginning to lift weights." What’s your view on that controversial topic?

JO: I go along with the NSCA position on weight lifting. I believe that children can even be taught Olympic type weight lifting techniques, but not use extremely heavy weights. In fact, most of my teaching at this level is with either a broomstick or at most a light barbell. I even have my 8-year daughter lifting light dumbbells, and even perform modified pushups on a Swiss Ball, and performing abs curls. Physiologically youth athletes physiologically are not capable of withstanding great weights, due to their anatomical structure and rate of maturity. I use a lot of body weight exercises such as squats, lunges, and step ups. I use upper body exercises such as push-ups, chin-ups, and resistance bands, in place of weights. I want to make sure that the young athletes have the proper techniques down. When they are older, they can worry about increasing their resistance training.

IYCA: Using your ideals, could you define "functional conditioning" for us?

JO: Functional conditioning in terms of whom I train youth through collegiate level athletes involves replicating the movements of their particular sport. I use more body weight exercises with minimal external resistance. At times I will have every young athletes perform push-ups on the stability ball, and then perform a bench type press with dumbbells – a lot of super sets. I try to train as many muscle groups synergistically and believe in Vern Gambetta’s adage of, "It’s better to train movements rather than just muscles." I also use cables and bands and try to involve triplanar movements, or just attach a band to their body to give them some external resistance while performing a movement skill specific to their sport.

IYCA: If you were prescribing a training program or health ten-year- old athletes, what would the session entail? Length? Exercises?

JO: If I were prescribing a training program for a healthy ten year old, the session would not be older longer than 1 hour, including flexibility and warm down sessions. Two-hour practices are too much for an athlete at this age. Their attention span and cognitive development are still in their infancy-again you cannot expect a 10 year old athlete to perform as a 25 year old. Teaching the athlete how to move properly, and working on running mechanics. I have found that rubber tubing exercises are quite effective to work on the overall strength of an individual. Upper body exercises such as triceps, biceps curls, movements in triplanar directions and other multidirectional agility exercises can be implemented with tubing. Balancing on a mini-tramps or Bosu increases proprioceptive awareness, and strengthens muscles at the same time. Using light dumbbells, light medicine balls, and body weight circuits are other exercise modalities that can be incorporated into a youth’s program.

IYCA: Is there a particular criteria or path that you follow when developing young athletes over a long period of time? For example, at what age is it best to develop flexibility? Power? Coordination?

JO: Developing a young athlete over time is quite important. Both the parent and coach must see the progressions go over a period of time. Flexibility should be incorporated early and continued. As the athletes gets older, males particularly tend to lose flexibility, so it is important to continue this aspect of conditioning. By increasing their range of motion the parent or coach will decrease their incidence of injury, and increase their range of motion, which in turn, will increase their stride, and produce better leg speed.

Coordination, balance, and the youth athlete’s ability to movement in different directions rapidly need to be emphasized. Basic agility patterns such as shuffling, forwards and backwards running, zigzag running, change of direction through voice command, are all attributes that the youth athletes needs to constantly work on. Many youth coaches incorporate some type of dynamic flexibility warm-up exercises, however, not many emphasize static stretching during their post workout practices of competitions. These stretching exercises aid in the recovery process, increase range of motion in the muscles, and aid in recovery from hard workouts. Not many youth have sufficient strength to be engaged in heavy plyometrics development exercises, however, drills that include bounding, skipping, double knee tuck jumps, can be incorporated into their programs.

The coach or parent has to be cognizant of what number of contacts and the duration of the interval of sets of plyometrics. Power should not be emphasized until later (15-18) years of age. It should not be emphasized at the 10 year level. Coordination can be emphasized through agility ladder training starting with double leg drills and then progress to single leg drills. Performing multidirectional drills with cones, shuffling movements, carioca, will help their kinesthetic and spatial awareness of their bodies.

IYCA: Should athletes specialize in particular sports at a young age or participate in a number of different sports? Why?

JO: One of my pet peeves is having young athletes (10-15) starting to specialize in sports.

This is a mistake many coaches and parents do at all levels. Coaches and parents encourage young athletes to be involved in one sport year round. This is a mistake, because the young athlete needs to develop all types of motor patterns and movements. All sports involve some type of running; however, there are specific movement patterns inherent in each sport. Only by participating in multi-sports can a child develop all the patterns of movement. Unfortunately, many of these movement patterns use to be taught in physical education classes. Now more than ever, we must encourage the young athletes to be involved in as many sports as possible to attain these movement skills.

IYCA: Are there age ranges in which certain injuries are more prevalent?

JO: There are many injuries in youth athletics that should be recognized. I will try and discuss some of the more common injuries that youth athletes suffer. One of the most common injuries is "Little League Elbow" The young athlete’s needs strength and conditioning exercises for the wrist flexors, extensors, along with anterior and posterior rotator cuff exercises. All these exercises can be done with rubber tubing. One of the most common reasons this malady occurs if the throwing of off-speed pitches such as the curve ball, throwing too hard too often, and not properly taking care of the pitching arm, particularly in cool and damp weather. If the arm is sore, make sure the athlete ices the arm for at least 15-20 minutes.

Most developing athletes get acute ankle sprains. An ankle sprain takes 2-6 weeks to recover until they can return to their sport. The athletes must be able to change direction, perform zigzags, figure eights, run forwards and backwards, and be able to move laterally in both directions before being cleared for practices and games. Strengthening exercises, balance and wobble boards exercises, Bosu trainer exercises, along with agility ladder training emphasizing footwork forward, backward, and laterally should be utilized.

Overuse injuries such as shin splints occur during pre-season or early in -season. Pain up and down the front, inside, or outside part of the leg could be felt by the athletes. If ignored, shin splints could develop into a stress fracture. Parents and coaches should have the athlete decrease activity, and have an athletic therapist show the athlete stretching and strengthening exercises. Ice initially is the therapeutic modality of choice. Ice massage is very effective in reducing inflammation caused by shin splints. Heel cord stretching with the knee bent and straight should be implemented into the athletes program. Theraband tubing exercises for the ankle are excellent strengthening exercises that can be utilized to increase strength in the shin and calf muscles.

Shoulder subluxations or "loose shoulders" occur in tennis players, swimmers, and pitchers. This is due to overused muscles in the anterior portion of the shoulder, the so called anterior rotator cuff muscles. Braces can be used to act like stabilizers, however, strengthening exercises to increase strength in the surrounding muscles of the rotator cuff should be emphasized. Athletes should not neglect the posterior cuff muscles of the back of the shoulder and the upper and lower back musculature. "Runners Knee," or PFPS (Patellofemoral Pain Syndrome) is prevalent, particularly in young runners. Females tend to have looser knee caps, due to weakness in the quadriceps muscle. This creates a tracking problem, where the kneecaps pull out of their natural anatomical position.

Hence, the athlete experiences pain before, during, and after activity. Ice, quad strengthening exercises, hamstring stretching, along with a decrease in activity until the pain decreases. Osgood-Schlatter Disease is very prevalent in young athletes, particularly males, form 12-15 years of age. They experience pain below the knee cap due to growing very rapidly. The tendon and muscle do not grow at the same rate. As a result, muscle imbalances occur between the quadriceps and hamstrings. Most times the tibial tuberosity (small bump just below the kneecap), increases in size becoming very painful. Strengthening exercises for the quadriceps and hamstrings should be implemented; however, the exercises should be done in a pain -free range of motion. Hamstring stretches four to five times a day should be incorporated in to a general flexibility program.

Heel cord (Achilles tendon) pain and inflammation is suffered by many young athletes; however, runners and soccer players seem to be the most prevalent. Treatment consists of calf stretching with the leg straight, and knee bent. Stretches should be done 4-5 times daily. Strengthening exercises such as heel raises, ankle theraband exercises, pool running, backwards running, ankle theraband exercises, and calf exercises can be utilized to decrease the symptoms of Achilles tendonitis.

Anterior cruciate ligament (ACL) injuries are reaching epidemic proportions among young athletes, particularly females athletes. Muscle imbalances between the hamstring and the quadriceps are the main culprits for the injuries that occur. Strengthening exercises that can be done at home with minimal equipment include stability ball exercises for the lower extremity, lateral step-up exercises, general weight machine exercises, postural balance exercises, and functional training using balance boards, mini-tramp, and other tools to increase the balance of the young athletes. By utilizing various foot and plyometric drills, landing with the knee bent is reinforced, hence, decreasing the susceptibility of an injury like this from occurring.

IYCA: Can you give any blanket advice to the athletes, coaches, and parents out their in terms of basic youth sports injuries and prevention?

JO: A general rule in terms of general injury prevention is to not increase the intensity, duration, or frequency of practice or play by greater than 10% per week. You can see my reasoning of why a young athlete should only compete in one sport at a time. I see parents encouraging their sons/daughters to play their in-season sports (Baseball/softball) then go in the evening and play in league basketball games. My advice is to play all sports, but not in the same season as another sport. Let the athlete develop gradually, and overuse injuries will not occur. This only invites the body to break down even further, due to the physical stress placed upon the young athletes. Make sure that your young athletes do not fall into this trap. Follow the "10% "rule.

IYCA: How much more important is PREVENTING an injury rather than providing REHAB once a young athletes is hurt? I think a ton of people still do not understand this point.

JO: Being an athletic trainer and strength and conditioning coach gives me a great prospective on how to condition athletes prior to their season. It is important to emphasize the importance of conditioning prior to the season. PREHABILITATION-the preventing of injury before it occurs is much better than REHABILITATATION after an injury occurs. Many of the conditioning programs that are implemented by my young athletes are based on weaknesses uncovered through a screening process. If there are potential weaknesses such as lack of range of motion in the hamstrings or quadriceps, then an extensive flexibility program is implemented.

Performing agility tests, endurance tests, for cardiovascular conditioning and muscular endurance are important tools to see if an athlete lacks a base of conditioning or lacks basic agility work. There may even be certain muscle groups that may be weaker than others. Balancing the agonist/antagonist strength ratio is important in order to prevent muscle strains from occurring. The old adage of Ben Franklins, "An ounce of prevention, is worth a pound of cure," can go a long way in youth athletics. Look at the causes of the weakness of your athletes prior to a season, and have them perform the preventative exercises, before any Youth Sports Injuries occur.