Give Young Athletes a Break

ConcussionFor many of today’s young athletes, summer break includes a sports camp providing concentrated training in their specialized sport. But according to ONS Sports Medicine Specialist, Dr. Marc Kowalsky, early sports specialization is the last thing they should be doing with their free time.

“There is an increasing body of evidence indicating that early sports specialization does more harm than good. In fact, it seems that it actually decreases the potential for success in the sport in the long term,” he said.

Dr. Kowalsky said children who specialize in a single sport before the age of 13 don’t develop the protective neuromuscular patterns that help prevent stress to a single area of the body.  Because young athletes are less likely to perform technical repetitive skills properly, these children are more prone to overuse injuries that can sideline them later in life.

“The risk of injury doubles for children involved in excessive organized play at early ages over children who participate in an appropriate amount of free play,” Dr. Kowalsky noted.

Children who undergo early sports specialization are also at an increased risk for psychological burnout. Overtime it can manifest as mood disturbances, social isolation, and eating disorders. “These kids often drop out of the sport altogether as they get older,” he said.

Despite popular belief, early specialization does not guarantee elite performance later in life. A study of elite adult athletes at amateur and pro levels revealed that elite success did not require exclusive participation in a single sport until their high school years. Instead, top players participated in multiple sports in the preceding years, developing important movement patterns that made them stronger over time.

“Sports diversification actually increases overall athleticism, and the chance of a young athlete achieving elite status,” Dr. Kowalsky said.

The trend toward early youth sports specialization is relatively new. Twenty years ago, young athletes typically played a particular sport only during a given season (i.e. football in the fall, baseball in the spring, swimming in the summer), and most kids rested from competitive sports for a season or during the summer.

The surge in throwing injuries, stress fractures, and other overuse injuries in younger athletes reflects the physical pressures affecting today’s young athletic bodies.  A recent study found that high school athletes who had trained in one sport for more than 8 months in a year were more likely to report a history of overuse knee and hip injuries, than those who played a variety of sports throughout the year or played sports at less intense levels.

The vast majority of injuries associated with excessive specialization and training are overuse injuries. Overuse injuries develop slowly over time, starting perhaps as a mild twinge before progressing into relentless, often debilitating pain.

Thankfully, these injuries are relatively easy to treat when recognized early, with a period rest and activity modification.  All too often, however, players, their coaches and, sadly, parents, are often reluctant to have the athlete sit out a few practices and games.

Left untreated, overuse injuries can lead to more significant structural damage to an affected area. Therefore, it can require lengthier rehabilitation and sometimes surgery.

What’s more, repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. For instance, significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

“The musculature and bones of the developing thrower are not prepared for the excessive numbers of pitches they throw in a game,” said Dr. Kowalsky. This in part has contributed to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, which sometimes requires the so-called Tommy John Surgery.

The solution is simple but that doesn’t mean it is easy.  Dr. Kowalsky recommends the following practices for kids younger than 13 years:

  • Make time for unstructured play

  • Keep the ratio of weekly hours of organized sport to free play below 2:1.

  • Weekly hours of sports participation should not exceed a child’s age, or total of 16 hours in teen players.

  • Athletes of all ages should participate in some sort of supervised strength and conditioning program.

But he admits, in today’s competitive environment implementation of these steps can be easier said than done.  Parents and coaches should keep in mind that the ultimate goal is to make sure their children remain injury-free so they can maximize enjoyment and success in their sport of choice.

 

The Well-Balanced Student Athlete

Watch the panel presentation, The Well-Balanced Athlete,  delivered by ONS physicians at Byram Hills High School in Armonk, NY on February 13, 2018.  Sports medicine experts Dr. Marc Kowalsky and Dr. Demetris Delos were joined by sports psychologist Dr. Alex Diaz, to address such issues as injury prevention, the dangers of sports specialization, sleep and nutritional requirements, and the importance of mindfulness training.  The school’s television station recorded the 90-minute program. If you would like to see the presentation live, the panel will be addressing the Briarcliff Manor school district coaches, parents and students at the Briarcliff Middle School Auditorium on Tuesday, March 13 beginning at 7:00 pm.  There will be time for Q & A at the end of the presentation.  You can also view the PowerPoint presentations given by Dr. Delos and Dr. Kowalsky.

New ACL Repair Study

NEW ACL REPAIR STUDY IS PROMISING BUT LIMITED, SAID ONS KNEE SURGEON DEMETRIS DELOS, MD. 

Today’s New York Times reports that using a patient’s own blood to help heal an ACL tear has shown promising results in a small study conducted by the Boston Children’s Hospital.  While having a torn ligament heal itself could be the holy grail of ligament surgery, ONS knee surgeon, Demetris Delos, MD, cautions that more thorough research is ACL-Injury-300dpi-illustrationneeded.  The trial involved only 10 patients and recovery was tracked just a few months after surgery. “These early results are exciting,” Dr. Delos said, “but it is important to see how these patients do in the medium and long term (several years after surgery) especially when it comes to returning to active lifestyles and the trials need to be expanded to much larger groups of  people to see how it translates to the population at large.”  Until the long term safety and efficacy can be determined, he said, current ACL reconstruction surgery, which replaces the injured ligament with a tendon from other areas of the body such as the hamstring or patellar tendon, will remain the standard as it has proven successful with predictable results and allows the majority of patients to return to their pre-injury activities.

Female Athletes and ACL Injuries

DID YOU KNOW THAT FEMALE ATHLETES ARE AS MUCH AS TEN TIMES MORE LIKELY TO SUFFER AN ACL INJURY THAN THEIR MALE COUNTERPARTS? 

Woman playing tennis at the professional tournamentDifferences in pelvis width, the size of the ACL and the intercondylar notch (where the ACL crosses the knee joint), are all thought to play a role. What’s more, the upper part of a female’s shin bone at the joint is much shorter and more rounded than a male’s, which creates a greater laxity in the joint. Women also tend to have an inward angle to their knees, otherwise known as knocked knees, which places more stress across the outer knee joint and ligaments, particularly when it comes to sudden or extreme movements, such as an abrupt change in direction or pivot. Women also move differently than men. For instance, they tend to land from a jump with their knees in a somewhat straight position, pulling on the quadriceps rather than the hamstrings. Because of this, the force of the impact is transferred to the knee, creating a high risk for an ACL rupture. Men, on the other hand, are better able to absorb the impact because they tend to land with bent knees.

For these reasons, it is crucial for female athletes of all ages to modify their natural biomechanics through neuromuscular training programs that can teach them better ways to move their bodies and protect their knees, said orthopedic surgeon Katie Vadasdi, MD, who heads the Women’s Sports Medicine Center at ONS. “Through neuromuscular training programs, we can help female athletes significantly reduce the risk of ACL ruptures by developing balance between the quadriceps and hamstrings and improving the landing biomechanics with more bent knees and hips to avoid a knock-kneed position on impact.”

Preventing ACL injuries has both near and long term benefits so the sooner you get started with this kind of a conditioning program the better. Studies indicate that there is a tenfold increase in the incidence of osteoarthritis in the knees of women who suffered an ACL injury at some point in their lives. Moreover, injuries that were incurred during youth seem to result in the onset of osteoarthritic symptoms at a much earlier age in adulthood.

Learn more about ACL injuries here.

The Importance of Injury Prevention: Don’t Become a Statistic

QUALITY OF LIFE, ACTIVITY AND PRODUCTIVITY ARE AFFECTED BY PAINFUL ORTHOPEDIC CONDITIONS. 

One in two Americans over the age of 18 and nearly three out of four age 65 and older have a musculoskeletal condition costing an estimated $213 billion each year in treatment, cadolori articolari 1re and lost wages, according to a report by the United States Bone and Joint Initiative (USBJI), The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action.

The study finds that the quality of life, activity and productivity of an estimated 126.6 million American adults are affected by painful conditions and disorders affecting the bones, joints and muscles, a number which is comparable to the total percentage of Americans living with chronic lung or heart conditions. Among children, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.

The report states that arthritis and related conditions top the list of orthopedic ailments (51.8 million adults) followed by back and neck pain (75.7 million combined). With an aging population, the number of people faced with musculoskeletal discomfort can be expected to greatly increase.

Fortunately, advances in diagnostic and treatment technologies, such as those that are available from the sub-specialists at ONS, can provide patients with pain relief and a safe return to mobility. However, the report underscores the importance of injury prevention strategies for individuals of all ages and the need for prompt treatment when injuries occur and orthopedic conditions first appear. With top orthopedists, neurosurgeons, physical therapists and physiatrists, ONS is committed to finding non-surgical options as the first line of treatment. Only 10 percent of ONS patients require surgery.

ONS Surgeon Demetris Delos, MD Speaks about Knee and Shoulder Conditions on Health IQ

Demetris Delos, MD
Demetris Delos, MD

ONS orthopaedic surgeon Demetris Delos, MD, was a featured guest on Pleasantville Community Television’s series, Health IQ, hosted by Dr. Alan Siegel of ProClinix. During the fascinating thirty-minute interview, Dr. Delos, a specialist in knee and shoulder conditions, spoke in detail about common cartilage, ligament and tendon injuries. Age, gender and type of activity can play a role in a person’s susceptibility to orthopedic problems, he said. Using models and computer generated images, Dr. Delos described the non-surgical and surgical options to repair or replace damaged tissue and joints.  Functional and strength training, he stressed, are key for injury prevention and rehabilitation. Dr. Delos also provided a glimpse into future treatments including the development of synthetic tissue products and the advances in biologic medicine which uses biomedical materials such as blood, platelets and stem cells to treat pain and complex, often chronic conditions of the musculoskeletal system.