Positive Pushing: Sports

Reported February 7, 2006

Richard Lehman, M.D., a sports doctor and orthopedic surgeon at U.S. Center for Sports Medicine in St. Louis, explains how sports injuries, hospitalizations and surgeries in children have changed over the years.
Ivanhoe Broadcast News Transcript with
Richard Lehman, M.D., Sports Doctor, Orthopedic Surgeon,
U.S. Center for Sports Medicine, St. Louis, Mo.,
TOPIC: Positive Pushing: Sports (Part 2 of 3)

How have sports injuries changed for kids?

Dr. Lehman: I think the first thing that's happened is that you have kids starting sports much, much earlier, and they're starting organized sports. When we were kids, you went, you played -- you played outside with a number of your friends, and there really weren't any organized sports. Now you have kids that are starting 4 and 5 years old. They're in a gym. They're doing gymnastics. It's organized, maybe they're training three, four hours a day. They're doing exercises or lifting weights, and not only has the level increased, the time increased, but the intensity has increased. And because the intensity has increased, you're seeing much more injuries, not just based on the time spent, but the difficulty and the level of intensity that these athletes are performing.

What kinds of injuries are you seeing more of in smaller kids?

Dr. Lehman: We're seeing a lot of ACL injuries in kids under 12, which was unheard of. We're seeing a lot of stress fractures. We're seeing a lot of growth plate injuries I'll see in Olympic gymnasts. They'll be 12 or 13 years old, and they'll already have had two or three fractures, growth plate fractures, fractures of the heel, or fractures of the foot. These were injuries that we never saw before.

Now with these injuries, is it too early to figure out what it's going to do to them later on in life?

Dr. Lehman: Oh, I don't think it's too early, because I think we know the long-term effects of these. In some fractures, it's not a big deal, the fractures heal uneventfully. Some fractures, like some of the spine injuries you see in gymnasts and some of the spine injuries we see in young athletes, are going to affect them later on. They're going to get degenerative arthritis, and they're going to have early problems in terms of breakdown, just in their joints.

Is there anything that kids and parents should be doing to try to avoid these types of injuries?

Dr. Lehman: That's a good question. I think baseball is a perfect example. If you have a son or a daughter and they're pitchers -- softball pitchers, overhand pitchers -- you need to limit their pitch count. You need to think about recovery time. How long does it take your athlete, let's say they're 12 years old or 15 years old, how long does it take that athlete to recover, so if they play a game -- where whether it's soccer, gymnastics or baseball on Monday -- when are they really back to baseline? I think we really have to increase their recovery time. If they pitch a game, they need three our four days to come back and play another game. If they're in the gym for two or three hours or they're at a meet, they might need two days, three days to get back. So it's not so much decreasing their activities. It's giving them enough time to get back and heal before they have another activity.

I've always heard when you break your arm as a kid, it heals pretty fast, but when you break your arm as an adult, it takes forever to heal.

Dr. Lehman: That's right, that's exactly right, but because you heal faster and you recover faster, it doesn't mean that if you have repetitive stress, or you have that stress fracture or that stress reaction and you heal, the cumulative effect is actually a lot worse in kids than it is in adults. In adults, you don't really have as much cumulative stress, because you don't have open growth plates or such elastic tissues, and those tissues have more cumulative trauma creating long-term problems down the line.

What are a few of the most common injuries?

Dr. Lehman: Growth plate fractures in the shoulder, stress fractures in the tibia, anterior cruciate ligament tears, meniscal tears in the knee, dislocated shoulders, and torn rotator cuffs, which is in the old days you'd never see.

Kids are getting injuries that we would normally treat at 21 or 22 in a Major League pitcher or an NFL football player. We're seeing ACL injuries in kids that are 12 and 13 years old, when normally we would see that in a B1 or normally a college basketball player, NBA player, or NFL football player. So we're seeing injuries that we never, ever saw in kids before. We're seeing rotator cuff tears in kids that are 12 and 13 years old, and if you look at the orthopedic literature, it's unheard of. They'll just tell you it doesn't happen, yet we probably see one or two a month.

How have surgery and hospitalization statistics changed for kids?

Dr. Lehman: Surgeries are way up in kids under 15 years old. ER visits are way up in kids under 12 years old.

Is there one sport that you see more injuries in than another sport?

Dr. Lehman: The sport we, by far, see the most injuries is gymnastics, and we see high, high-level gymnastic athletes. But if you take a child, and let's say they're 9 or 10 years old, and you put them in a setting where they're doing gymnastics 10 hours a week, which is not a lot of gymnastics, you're going to start to see injuries at a very, very young age, and they're going to have that repetitive process throughout their whole gymnastics career. But you see it in a lot of sports. You see a lot of shoulder injuries in young kids playing baseball, and you'll see a lot of injuries in swimmers. Our young swimmers, where they're swimming 4,000 meters or 5,000 meters a day, they may be in the pool at 5:00 in the morning, they're swimming again at 6:00 in the afternoon, and they're going to break down.

What sport is linked to the most serious ones?

Dr. Lehman: Gymnastics are the worst. It's so repetitive, and there really can't be recovery time, and that's the problem. So if they have an injury, they really don't have enough time to rehabilitate that injury, because the next meet's coming, the Olympic trials are coming, the Olympics are coming, and there really isn't time to heal. So these kids go back way too early from their injuries. That just creates more trauma, and then they get hurt again.

Is there a danger for parents pushing, for having their kids work so hard at an early age?

Dr. Lehman: I think you have a couple things going on. I think you have both parents and coaches that are really pushing their kids, and then I think you have kids that really want to excel, so that's a bad combination. I think the danger is long-term trauma, end-stage problems when the kids are older, and then the real thing we're seeing mostly is burnout. We'll see a kid who's maybe an Olympic gymnast or pre-Olympic gymnast at 13, and at 15 years old, they walk in the office and they say, "Mom, I never want to do gymnastics the rest of my life, in fact, I don't want to do anything the rest of my life, I just want to play PS2 all day."

Do you see a lot of burnout a lot earlier than you did before?

Dr. Lehman: If you would sit here and listen to some of these kids -- and I'm talking about great athletes, kids that are second and third in the nation and kids who are destined to be in the next Olympics -- they'll walk in, and they've had it. Sometimes they'll use the injuries as a little bit of a crutch, and they'll say their shoulder's sore, their ankle's sore, or their knee's sore they really don't want to play. But a lot of times, after four to six weeks, they've just had it with the injuries, and they've just had it with the sport. They just walk in and say, "You know, I'm going to do something else. I'm going to learn to play the piano, or I'm going to do a different activity, but I'm done with sports," and that's a pretty common occurrence.

Then you have kids on the other hand who can't get enough of it?

Dr. Lehman: Absolutely. I mean, I arthroscoped the knee of a little girl two or three weeks ago who's about 10 years old and a national champion in martial arts at 10 years old. She came in with her cast and wanted to know if she could start sparring in her cast. Some kids are very aggressive and just love their sports, just want to get back and play, and that's healthy. What you don't want is: You don't want the parent and the coach saying, "OK, let's just pitch another two or three innings," or "Let's just pitch in for an inning here," when they're already hurting, and there's already a little bit of damage.

What's one thing that you want to tell parents about if they have kids in sports?

Dr. Lehman: Good question. I think the number one thing I would tell parents is give your kids enough time to recover. Talk to them -- you really just have to talk to your kids -- and make sure they're enjoying their sports and they don't feel a lot of pressure. You have to talk to their coaches, because the coach wants to win, like any coach, and you have to make sure that that coach realizes this could be a problem. They need to know what's going on, and the parents really have to communicate with the coaches.

END OF INTERVIEW

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