Ask the Doctor: Competitive Sports

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.


There will be no time for them to turn into a couch potato, hooked on texting and Facebook. Instead, they will get the opportunity to excel in a sport they love. 


But, before you head for the sign-up sheet, there are a few things you should know. All that intense training comes with its own risks, since teenagers’ bodies are vulnerable to injury. Their bones, muscles, tendons, ligaments and joints are going through their most rapid period of growth, and the “no pain, no gain” attitude of many competitive sports coaches can easily result in serious injuries – some with lasting effects.


There are basic steps you can take, however, to alleviate the risks and help your teen enjoy a safe – rather than a sore – season. Most important are making sure s/he is properly prepared, avoids playing the same sport year-round and never plays when in pain.


Q: 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 like soccer. Is that true?


A: 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 four that 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. 


Girls (and women) are thought to be more prone to ACL injuries due to a muscle imbalance in the thigh, as well as the way they move while playing. That’s because female athletes 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.


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. 

But, surgery to replace a torn ACL is often recommended for young athletes, so they can return to full participation in a sport they love.


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


A: It may possibly 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.


Q: 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?


A: It’s important 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:


  • Soreness lasting several hours or less, only after the activity.


  •  Soreness or pain during and after the activity that does not improve by the next morning.


  • 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.


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


A: There are many common sense steps your teen athlete can take for a healthy, pain-free sports season, including: 


  •  Maintain good physical conditioning during the off-season and ease into a new sports season gradually. Gradually increase high-impact activities, such as running and jumping. 


  • 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 obtaining 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. She 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.




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Bay Area Parent

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