On the School Field, Better Safe Than Sorry

Now that summer break is over and the little monsters -- er, darlings -- are back where they ought to be, make sure you keep an eye on their training for fall sports. The last thing you want is to have them injured and lounging on the couch where they have spent the past three months hollering for food.

Unfortunately, if your kids are loungers, the risk of injury as they get back into high school athletics is higher than for student athletes who stayed active during vacation or had a well-structured preseason (preferably both). The best prevention from the tweaks and tears that can bedevil our soccer, football, cross country and other fall athletes is for them to be in shape before they hit the field.

Regardless of where kids start, local sports medicine pros have a few suggestions to keep the young ones injury-free.

Let's begin with the boys.

My son Jack is 17 and in his senior year of high school, and about the last thing I would have worried about during football training are his "growth plates" -- the soft bone ends in children that let the bone expand until it gradually hardens in adolescence. He's taller than I am, can best me on a couple of strength tests, and I would think he is close to being done with his growing.

But here's the thing: I don't know that for sure. Particularly for boys, it is possible for the bone ends to remain soft and open to more growth later than you might expect.

Craig Miller, an orthopedic surgeon and sports medicine specialist at Shady Grove Orthopaedic Associates in Rockville, says that any swollen joint in a teenager should be treated as a warning sign. The type of ankle or knee sprains that adults can ice and wait out might signal injury to a bone that isn't finished developing -- and is at risk of stunted growth or deformity if it is put under further stress.

If the swelling does not go away in a day or two, see a doctor, and make sure the exam includes the possibility of growth plate damage. (It may take an MRI or X-ray of the non-injured side of the body to tell if the bone is still soft.)

"Children want to return to athletic participation. If a child is complaining of an injury or if they are limping, if there is a swollen joint, that is something that should not be ignored," Miller said. "A swollen joint in a child is a very big deal."

For girls playing soccer, basketball or any sport with a lot of lateral motion, knee injuries -- and specifically, injuries to the anterior cruciate ligament (ACL) -- have become a mini-epidemic, occurring at four to six times the rate for male high school athletes.

Researchers now think they know the cause: Female athletes tend to have strength imbalances between their quadriceps and their hamstrings, and also tend to be more stiff-legged in their running and jumping.

That combination is disastrous for the ACL, which connects the thigh and shin bones, said Perry Esterson, a physical therapist and sports specialist at Physiotherapy Associates in Fairfax. If the athlete is changing direction or landing from a jump, the quadriceps puts pressure on the ligament; without adequate strength in the hamstring to counteract it, the chance of a tear increases.