Cedars-Sinai Blog
How to Prevent Sports Injuries in Young Athletes
Carlos Uquillas, MD.
Youth sports can build strong bodies, sharp minds and lifelong friendships—but growing bodies can sometimes break in surprising ways.
The injuries kids and teens endure on the field aren’t always the same as those seen in adults.
"We see a lot of injuries related to growth and overuse," said Cedars-Sinai orthopedic surgeon Carlos Uquillas, MD, a team physician for the Los Angeles Angels who specializes in pediatric and adult sports medicine. "Young athletes aren’t just small adults. Their bones, joints and muscles are changing, and they face a different set of risks."
A little more than half of all 6- to 17-year-old American youths participate in organized sports. But every year, youth sports are responsible for about 3 million emergency room visits. Many more less-critical injuries keep players on the bench.
The good news is that growing bodies usually heal faster than the bodies of grown-ups.
Our experts share ways to keep kids and teens in the game and off the sidelines recovering from injuries.
Carlos A. Uquillas, MD
"Young athletes aren’t just small adults. Their bones, joints and muscles are changing, and they face a different set of risks.”
– Carlos Uquillas, MD
Understanding Growing Bodies and the Common Causes of Injuries in Young Athletes
Growth Plates and Growth Spurts
Growth plates are how young bones get longer and stronger. They’re made of cartilage. As the cartilage grows and lengthens, it slowly calcifies, or hardens, into bone.
"A lot of pediatric sports injuries, especially at the knee, elbow and shoulder, happen around the growth plate," said Uquillas. "That’s because the growth plate is a little weaker than the bone."
Sudden growth spurts can also make young athletes more susceptible to injury.
"What's happening is their bones are getting longer faster than their muscles and their tendons are stretching out, said Natasha Trentacosta, MD, a Cedars-Sinai orthopedic surgeon who specializes in pediatric and adult sports medicine. "That leads to stiffness and tightness around the joints and more forces being put on those joints."
Natasha E. Trentacosta, MD
Rest and stretching can help loosen the muscles and alleviate some of the athlete’s pain.
Examples of growth-plate injuries include:
- Osgood-Schlatter disease and Sinding-Larsen-Johansson syndrome: These are painful injuries in the growth plates around the knee that tend to affect 12- to 13-year-old athletes playing running and jumping sports, such as soccer, basketball and volleyball.
- Sever’s disease: This condition causes pain in the heel and usually affects athletes around age 11 to 12 who are doing a lot of running.
- Little League elbow and Little League shoulder: These are throwing injuries often seen in baseball pitchers. Caused by overuse (see more about the issue of overuse and sports specialization, below), these conditions can be related to growth-plate or ligament injuries.
Weight and Muscle Mass
Not only are kids and teens getting taller as they grow, but they’re getting heavier and more muscular.
"Boys, in particular, add muscle mass as they go through puberty and adolescence," said Trentacosta. "That can put more force into their joints than before. And so sometimes we'll see injuries related to this increased force or power that's put on their joints. Added weight can have that same effect.”
Some common related injuries include:
- Sprains and ligament injuries, including anterior cruciate ligament (ACL) tears
- Muscle strains and tears
- Overuse injuries
- Tendinitis
- Cartilage injuries, including meniscus tears
- Bone fractures, including stress/hairline/minor fractures
- Dislocations
Overuse, Overtraining and Burnout: What Parents Should Know
We often talk about kids and teens being able to "run forever" and having "boundless energy," but there are limits to what their growing bodies will tolerate.
“Overuse injuries make up just about half of the injuries that are seen in pediatric sports clinics,” said Tracy Zaslow, MD, a primary care sports medicine physician at Cedars-Sinai Pediatric Orthopaedics. “Professional soccer players have mandated recovery days between games. But we'll send young athletes to play in tournaments where they're playing anywhere from two to six games in a weekend.”
The problem of overuse is compounded by an increase in sports specialization. Uquillas says young people are training in a single sport year-round starting at very young ages, and stressing the body over and over the same way can lead to repetitive-use injuries.
Trentacosta agrees.
“We are seeing so many young athletes with more severe acute traumatic injuries that we wouldn't have seen decades ago before we started seeing this trend toward early specialization,” she said. “That’s especially true here in Southern California, where you have such beautiful weather and you can play outdoor sports like soccer year-round.”
The American Academy of Pediatrics, the American Medical Society for Sports Medicine and the American Orthopaedic Society for Sports Medicine all point to studies showing that early sports specialization can lead to injuries and burnout. They recommend delaying specialization until high school or late adolescence, particularly for more physically demanding and high-endurance sports.
"Parents want to see their children succeed, and there’s often pressure from coaches to excel in a sport by training in it year-round," said Zaslow. "Injuries are an issue, but the push to succeed can also just take the fun and 'play' out of playing sports and result in early player burnout."
Success on the field and improvement in a player’s performance when they specialize at an early age may also be short-lived.
"Studies have found that athletes who stay in multiple sports perform better in the long term in their single sport of choice than those who are taken and trained solely in a single sport at a young age," said Zaslow. "And it’s important to remember that we want these young athletes to have a long, healthy life of physical activity. That's really the primary purpose of the participation."
Injury-Prevention Tips for Parents and Coaches
Limit the Amount of Training
The “age-to-hours ratio,” supported by many sports organizations such as the National Athletic Trainers Association, says young athletes should not participate in a sport for more hours a week than their age. In other words, a 10-year-old should train and play a sport no more than 10 hours a week.
For baseball, in particular, Uquillas says proper mechanics are very important for reducing injury. Coaches should also limit the number of throws players do during training and in games.
The Value of Sleep and Recovery
Training and working out break down muscle fibers. Sleep and rest give muscles an opportunity to repair themselves and grow stronger in preparation for the next game or training session. Sleep also plays a vital role in cognitive development for children and adolescents.
“A study led by Cedars-Sinai pediatric orthopedist David Skaggs, MD, and others, showed that injury rates are higher for young athletes who don’t get enough sleep,” said Zaslow. “So, sleep is really important for recovery and also for injury prevention.”
David L. Skaggs, MD
In addition, the National Athletic Trainers Association recommends youth athletes have a minimum of two days off per week from any organized sports activity.
Injury-Prevention Training Programs
Warming up with light exercises and dynamic stretching is important before intense physical activity, as are strengthening and increasing the flexibility of sport-specific muscle groups.
Cross-training and warm-up programs have been developed for most sports, and many are available online. These programs are designed to prepare young athletes for play and reduce injuries. For example, FIFA 11+ and the Prevent Injury and Enhance Performance (PEP) program have been shown to strengthen legs, support knees and reduce ACL injuries in running-and-cutting sports like soccer.
“For throwing sports, there’s the Thrower’s 10,” said Uquillas. “It's a set of 10 exercises throwers can do to help increase strength around the rotator cuff and around their core, and it helps decrease the risk of shoulder and elbow injury.”
Hydration and Nutrition
When training for less than an hour, water is sufficient to keep athletes hydrated. Over an hour, Gatorade-type drinks with sugar and electrolytes are best. Stay away from sugar-free options, as the carbs are needed to replenish those being used in exercise.
Keep any snacks healthy. Donuts, muffins, potato chips and other fatty foods low in nutrients are a poor idea for athletes trying to get and stay fit.
“Sliced oranges are perfect for halftime. Give them a little hydration and a little something sweet, and let them go forward,” said Zaslow. “And chocolate milk is a great recovery beverage. It's got the carbohydrates you need, it's got some protein, and it's got electrolytes naturally in it.”
Uquillas says vitamin D deficiency can be a problem, even in sunny Southern California. Vitamin D helps the body build bones and keeps them healthy. He suggests parents discuss supplementation with their pediatrician.
Keep Sex Differences in Mind
Once puberty begins, boys and girls may be susceptible to different kinds of injuries.
Female athletes are at greater risk of ACL tears and other ligament and tendon injuries, such as ankle sprains. Hormones may contribute to this problem by making women’s tendons and ligaments more flexible than men’s. Women’s wider pelvis can also put more stress on their knees.
For this reason, it’s particularly important for female athletes to strengthen the supporting muscles around the knee.
Growth-plate injuries are a little more common in boys because their growth plates harden into bone later than those of girls. Boys also tend to grow more muscle after puberty, which places greater stress on the joints. Improving flexibility can be key to reducing injury risks.
When to See a Pediatric Sports Specialist
If a young athlete is complaining of pain or an injury is limiting their sports participation, the first stop should be their primary care physician. If their doctor finds or suspects an orthopedic injury—an injury to a muscle, bone, tendon or any other part of the musculoskeletal system—then they will refer the athlete to a pediatric sports specialist.
Cedars-Sinai’s pediatric orthopedists and physical therapists are leaders in the field. Many also serve as team physicians, specialists and trainers for L.A.’s professional and collegiate sports programs, such as the Los Angeles Rams, Los Angeles Angels, Los Angeles Dodgers, LA Galaxy, Angel City FC, Anaheim Ducks and Loyola Marymount University.
How to Reduce Concussion Risks
To reduce the risk of concussion, an athlete should be well-rested, alert and ready to respond to their environment.
For sports in which there is head contact, such as soccer and football, correct technique is important.
Actions should also be age appropriate. U.S. Club Soccer and other youth soccer organizations recommend soccer players not be allowed to head the ball until age 11, and that from age 11 to 13, they be taught how to do so properly in training only.
Similarly, young football players need to have well-fitting helmets and be taught good tackling technique to minimize contact to the head. It is also recommended that full-contact practice time be limited.
There is no agreed-upon age at which it’s appropriate for football players to engage in full-contact practices and games. Early exposure to tackle football has been linked to earlier development of the brain disease chronic traumatic encephalopathy, or CTE.
What to Do When a Player Gets Hit in the Head
“If a child gets hit but they get up right away and they're moving and they have no symptoms, then it's OK for them to continue,” said Tracy Zaslow, MD, a primary care sports medicine physician at Cedars-Sinai Pediatric Orthopaedics. “But if there are any symptoms at all—headaches, dizziness, nausea, vomiting—we say, ‘if in doubt, sit out.’”
California law states that any young athlete suffering a suspected head injury cannot return to play the same day. They must be evaluated by a medical provider experienced in concussion care before they can get back on the field.
“I try to explain to families that if there is a hit that is consistent with a possible concussion and the player then goes back in and gets another hit, the neurological outcome can be devastating,” said Zaslow. “So, if there’s a possibility of concussion, it’s really important to have the athlete checked out by their doctor.”
If a concussion is confirmed, the CDC has a recommended protocol for returning to play.
