The Dangers of Sports Specialization

Every young athlete dreams of the pride and exhilaration of hitting the game winning home run, or scoring the goal that clinches the championship.  In today’s competitive sports environment, youth are under more pressure than ever to train harder and longer to excel in their sport, often with debilitating consequences, writes sports medicine specialist and orthopedic surgeon, Demetris Delos, MD in the latest issue of The Magazine for Greenwich Hospital.Sports Medicine Discussion

The greatest shift in youth sports in the last generation has been the trend toward sports specialization and year-round training. Twenty years ago, young athletes typically played a particular sport only during that sport’s season (i.e. football in the fall, baseball in the spring and summer), and most kids sat out a season or a summer.  Today’s young competitors don’t seem to enjoy that luxury.  Unfortunately, this has also led to a surge of sport specific injuries.

A recent study at the Departments of Kinesiology, Orthopedics and Rehabilitation at the University of Wisconsin-Madison, for instance, found that high school athletes who trained in one sport for more than 8 months were more likely to report a history of overuse knee and hip injuries, than those who had played a variety of sports throughout the year or played sports at less intense levels.

The results of this study reflect what orthopedists have noticed in the last decade with the increasing number of kids showing up in our offices with throwing injuries, torn knee cartilage and stress fractures.

PROFESSIONAL LEVEL INJURIES 

 The growing corps of young adolescents and pre-adolescent baseball pitchers is now throwing excessive numbers of pitches during an unusually high number of innings for immature arm muscles. This has led to an epidemic of young athletes suffering ulnar collateral ligament (UCL) injuries, requiring the so-called Tommy John Surgery. Tommy John was a left handed pitcher for the Los Angeles Dodgers in the 1970’s, who was the first baseball player to undergo UCL reconstruction surgery.  His successful recovery and return to achieve a record of 288 career victories.

Anterior cruciate ligament (ACL) tears in youth athletes are also increasing at an alarming rate. While ACL tears are not so closely related to a particular sport statistic the way  UCL injuries are tied to pitch count, clearly the rapid rise of sports that involve running and sudden pivoting – think soccer, lacrosse, football, basketball and rugby – increases the likelihood of season ending ACL tears and reconstructive surgery.

OVERUSE INJURIES 

Unlike ACL injuries, which can be dramatic on-field experiences with players being helped off the field, 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.  Ironically, these injuries are relatively easy to treat with a period rest and activity modification.  All too often, 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 tears in the muscles and tendons of the affected area, which require a lengthier rehabilitation and sometimes surgery.

Overuse injuries are typically sport specific. In baseball, the upper extremity is most often affected.  With Little league shoulder, the growth place of the humerus (arm bone) becomes inflamed by the repetitive motion of throwing with excessive force.  Similarly, Little league elbow involves injury to the growth plate along the inner portion of the elbow.

In the lower extremity, overuse injuries of the knee and ankle are very common. Osgood Schlatter and Jumper’s knee are injuries to the growth plate of the knee that can be a frustrating source of pain. These injuries are typically associated with repetitive impact activities (running, jumping, etc.) as seen in basketball, soccer and track.  In the ankle, Sever’s disease can lead to pain in the back of the heel.

HOW CAN WE PREVENT INJURIES?

The solution is simple but that doesn’t mean it is easy. Rest and activity modification can be difficult to execute in the middle of the season when the athlete is invested in playing and when parents have already invested much time and money to the sport.

Nevertheless, it is incumbent upon parents to insist their child rest to give the body the opportunity to heal before more serious injury occurs. If a week or two of rest doesn’t resolve the condition, the young athlete should be evaluated by an orthopedist or sports medicine specialist.

Repetitive activities such as throwing or running can lead to changes in the development of growing bones and joints. It has been known for some time now that significant amounts of pitching during adolescence can change the rotation and shape of the shoulder.

Moreover, there is a growing body of evidence indicating certain sports played excessively during adolescence are associated with the development of femoroacetabular impingement syndrome (hip impingement), which can lead to hip problems often requiring surgery in adulthood.

In addition, numerous studies have shown that exposure in youth to a range of different sports that utilize different muscle groups and mechanical skills lead to the greater overall athleticism and better athletes.

Shoulder and Elbow Throwing Injuries Rise for Young Athletes

SURGE IN ELBOW AND SHOULDER INJURIES FOR YOUTH INVOLVED IN THROWING ACTIVITIES. 

Young male baseball player

For youth involved in repetitive throwing activities, there is an epidemic of elbow and shoulder injuries, usually due to overuse, poor training, improper throwing mechanics, and fatigue, according to sports medicine physician, Demetris Delos, MD, who specializes in shoulder and knee conditions.

The dreaded injury to the ulnar collateral ligament (UCL)  is usually caused by excessive pitching. If the UCL is injured, it can sometimes be difficult to repair or rehabilitate and may require the so-called Tommy John procedure in order to return to competitive pitching. The surgery is named after Tommy John, the first baseball pitcher to undergo successful UCL reconstruction surgery in the 1970’s.

Other common throwing-related injuries include Little League shoulder, which occurs when the growth plate of the humerus (arm bone) becomes inflamed by the excessive forces produced by repetitive throwing. Similarly, Little League elbow involves injury to the growth plate along the inner portion of the elbow.

In addition to acute injuries, repetitive activities such as throwing can lead to physical changes in the development of growing bones and joints. Significant amounts of pitching during adolescence can change the rotation and shape of the shoulder which may leave the player vulnerable to shoulder injury and arthritis in adulthood.

Studies show that children and adolescents who pitch competitively for more than 8 months in a year are the most prone to injury. Throwing more than 80 pitches per game, a fastball that consistently exceeds 85 mph, or pitching while fatigued are also risk factors for injury.

According to one study, pitchers who pitched more than 100 innings in a calendar year were 3.5 times more likely to sustain serious injuries requiring elbow or shoulder surgery or retire due to the injury. This is why USA Baseball and Major League Baseball now recommend that youth pitchers of all ages and abilities take a minimum four month break from overhead throwing, with at least two months off consecutively.

However, athletes and their parents should be reassured that numerous studies have shown that kids who are exposed to a range of sports that utilize different muscle groups and mechanical skills have greater overall success in athletics than those who specialize early on. In addition, they are less prone to injury and burnout than those who focus on a single sport exclusively.

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.

“Maximizing Your Child’s Athletic Potential” Success

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Dr. Delos with Allan Houston

Last Thursday’s talk on “Maximizing Your Child’s Athletic Potential” was a success. A big thank you goes out to the Junior League of Greenwich for making it possible with their focus on improving the community and empowering others to further health and education! Ultimately they brought together the perfect combination of experts to inform the public about the youth and the sports they love.

Dr. Delos, of ONS and Greenwich Hospital, was a panel speaker at this event. He specializes in sports medicine and arthroscopic treatment of knee and shoulder disorders. Before ONS, Dr. Delos was the Assistant NFL Team Physician for the New York Giants and was team physician for a number of local high school and college athletes.

Other panel members consisted of Andy Barr, Director of Performance and Rehab for the New York Knicks, Mubarak “Bar” Malik, Head of Strength and Conditioning for the New York Knicks, and Allan Houston, one of NBA’s all-time greatest long range shooters and Olympic gold medalist, as the moderator. Each participant reinforced the importance of parents taking interest in the development of their young athlete and properly guiding them to the path of success. Parents attending this event were very attentive, and came prepared with questions.

Conversations covered the fundamental topics, like proper sleep habits and nutrition. For example, a young athlete’s nutrition should increase in relation to the amount of activity they experience daily. This may be common knowledge to an adult but for an adolescent, proper amounts of sleep and good nutrition that balances the amount of activity should be added to their routine.

Aside from the basic topics of discussion, there was a myth to be busted as well; to find out the details of the myth and for more information about the questions that were asked at the event, please read the article written by the Greenwich Freepress.

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Photography credit goes to the Delos family, thank you!

Orthopaedic Surgeon and Sports Medicine Specialist Dr. Demetris Delos on NY Giants Victor Cruz’s Injury

Dr. Delos served as Assistant NFL Team Physician for the New York Football Giants and

Demetris Delos, MD
Demetris Delos, MD

team physician for local high school and college athletes. His practice is focused on sports medicine and arthroscopic treatment of knee and shoulder disorders including knee preservation surgery, shoulder instability and rotator cuff repair. Upon hearing about the NY Giants’ Wide Receiver Victor Cruz’s knee injury, we reached out to Dr. Delos to give us insight on Victor’s type of injury. Dr. Delos said:

“Victor Cruz sustained a devastating injury to his knee last night, an injury that will cost him the rest of the season. While attempting to catch a ball in the end zone, he tore the patellar tendon in his right knee. The patellar tendon is a structure that attaches the kneecap (patella) to the shinbone (tibia). When the patellar tendon is torn, the player cannot straighten (extend) his knee and obviously cannot perform at the high level expected in the NFL.

Patellar tendon ruptures are relatively uncommon injuries that occur in otherwise healthy players without any predisposing factors. The mechanism of injury is typically eccentric overload (forcibly bending the knee while the quadricep is firing).

Studies of NFL players with this injury report that the vast majority are able to return to NFL level play after surgery and extensive rehabilitation. Let’s wish Victor a speedy recovery so we can watch him salsa in the end zone again!”

For more information on knee injuries, visit Our Specialties page.

Cartilage Transplantation Offers New Hope for Damaged Knees

Delos Office Vertical
Dr. Demetris Delos

Speaker: Orthopaedic Surgeon and Sports Medicine Specialist Demetris Delos, MD

Tuesday, October 29th, 6:30 pm, Noble Conference Room Center at Greenwich Hospital

Cartilage transplantation offers exciting new treatment options for adults under the age of 50 who have had their knee damaged through acute or chronic trauma to the knee. The surgeon uses small cylindrical plugs of good cartilage and inserts them into the damaged areas. This procedure has been shown to be highly effective in patients who have sustained a specific injury to the knee cartilage or joint lining, and who have not yet developed arthritis. Many competitive athletes who have undergone the treatment have returned to their full performance level after surgery.

To register To register for the ONS programs at Greenwich Hospital, please call (203)
863-4277 or (888) 305-9253, or register on-line at www.greenhosp.org.