For this week’s Expert Advice, I turned to a specialist in the field to offer some guidance on sports and safety. Below, Dr. James Kinderknecht, a sports medicine physician from New York’s Hospital for Special Surgery, shared with me the top questions he fields every year from parents (some general, some specific) and — better — his answers:
Question 1. .How should I choose which sports my young child joins? What factors should I keep in mind?
A. Research has shown that the number one reason kids play sports is to have fun with the friends on their teams, which tends to be an under-appreciated factor. Most importantly, keep in mind what sports your child expresses interest in.
Another factor to consider is that sports that teach a lot in terms of running, jumping and coordination, like soccer and basketball, can be a really good baseline, because athletes can then use those skills with other sports as they get older. I think it is important to de-emphasize aptitude, because while this influences the decision to a degree, the most important thing for kids is having fun.
Q 2. My daughter wants to start playing lacrosse or field hockey. Which is safer? Is it really safe for her not to be wearing protective head equipment?
A. When you look at the injury patterns with those two sports, they’re about the same through middle school and high school. Girls’ lacrosse and field hockey have been in a state of flux because they went from no protective gear to requiring eyewear. It’s a situation where the guys mandate headgear and the girls don’t, but that could certainly change. The use of helmets would be more to prevent eye, nose and mouth injuries, rather than head injuries. It’s a bit counterintuitive, but when we don’t require headgear, athletes are likely to be more cautious.
With sports like football, for example, because they are covered by the helmet and facemask, players are more likely to lead with their head and use it as a weapon. This is a problem because concussions result more from the twisting effect that occurs during collisions in these contact sports, rather than from purely the force of the impact.
Q 3. My 10- year-old wants to start gymnastics. Will that stunt his/her growth? What can I do to make sure this doesn’t happen?
A. With gymnastics, the biggest issue we run into is with the wrist. Young athletes tend to use their wrists and hands as pogo-sticks, especially in events like the floor exercise and vault, which can stress the growth plates in the wrist as they absorb continued weight and impact. In this case, the radius (which extends from the thumb side of the wrist) bears all the weight and can prematurely close. This creates an imbalance with the ulna (the bone that extends from the pinky side of the wrist), which bears no weight in these exercises, and will keep growing. This means it’s all about controlling repetition.
My advice is for parents to be attentive to their young athletes complaining of wrist pain. Usually this is a function of how many repetitions they do, especially on the floor and vault, in a weight-bearing sort of way. While many may think that gymnastics tends to stunt an athlete’s height, it’s much more likely that since athletes of shorter stature tend to succeed in the sport, that that body type is favored.
Q 4. My son/daughter was complaining of a sore ankle yesterday, but now it “doesn’t hurt,” just in time for the most important game of the year. Should I let him/her participate?
A. I think a good rule of thumb with kids and pain is limping. Kids are not always easy to read when it comes to pain measurement, but if they aren’t walking regularly, that’s telling you something. If a parent calls my office asking if their children are good to compete when they were previously complaining of ankle pain, I usually say if they are not limping than they can play. It’s really important though, that if the athlete starts limping during the game, he or she comes out to avoid further, potentially more serious injury.
Q 5.My son wants to start golf this year, like his father, but back problems run in our family. Are there any ways we can try to prevent that?
A. The issue with golf and back pain most of the time is lack of flexibility and lack of core strength, which tend to be less of an issue the younger the athlete. For an adolescent that was about to start golf, you would want to make sure, as with any sport, that he is in shape and that he doesn’t go straight to two weeks of intense golf camp when he hasn’t been doing any athletic activity.
To prevent back pain, it can be helpful to incorporate core strength and stretching programs, including the hip muscles as well. In sports that require a lot of twisting and extending, such as baseball, gymnastics and including golf, stress fractures can be a common injury in adolescents. If the athlete is experiencing any pain in the back, have him evaluated by a specialist. The good news with these injuries is that they can usually be addressed through strength exercises and stretching regimens.
Q 6. My 10-year-old is going to start football this fall. What should I watch out for during the season?
A. Most of the rules in youth football take care of the concerns that parents typically have. The most injuries occur in football when you see a big disparity in size, for example, with an 80-pound athlete and a 140 -pound athlete, the force coming from each side will be much different. At age 10, you don’t see as much of a difference because these players haven’t yet hit puberty. This means the injury rate is fairly low, mostly because they aren’t strong enough to generate enough force to produce injuries.
The 13- and 14-year-olds have a much larger differential, which makes for a mismatch in size and strength. The most important thing is to make sure that your son is somewhat matched in terms of his size with the kids he is playing with.
Good technique is also very important. You want to make sure that the team’s coach is teaching proper blocking and tackling, so that kids learn early on how best to position their body to avoid injury.
Q 7. I have heard that girls are much more likely than boys to have problems with their ACL. My daughter is starting basketball this year. What can she do to help prevent injury?
A. The fact is that girls, especially when playing soccer or basketball, tear their ACL about six times more often than guys do. There are exercises that can be done to strengthen the surrounding muscles, which can help prevent tears.
The reason for the differential between boys and girls has a lot to do with techniques in jumping and cutting. Girls tend to land jumps and cut across courts or fields with their knees straight, which leaves the ACL more vulnerable to injury. Boys are more likely to bend their knees and stay lower to the ground, which cushions their landing and protects the knee ligaments. I often refer my patients to sources on the HSS Web site for more details on helpful exercises and stretches.
Q 8. My son is a baseball pitcher and I’m worried about his throwing arm. What types of injuries is he susceptible to?
A. The most important factors in young athlete pitching injuries are pitch count and throwing technique. Elbow and shoulder problems are more likely to arise with the more pitches thrown, because overuse is such a significant trigger for injury.
The other aspect is technique. For example, physicians and coaches alike will discourage trying to throw a curve ball at an early age because most kids can’t perform the proper technique, and can end up getting injured.
In my experience, most little leagues have done a nice job of controlling pitch count. Where athletes have run into trouble though, is if the child or teen is playing in three different leagues, with three different pitch counts. I tell parents in this case to not let their son pitch in more than one league.
If your child hasn’t hit adolescence yet, his skeleton hasn’t matured and he typically can’t throw the ball that hard, which limits his risk for injury. This becomes more of an issue in the 14- to 15-year-old range, as the skill level can get ahead of skeleton development, which leaves the athlete more susceptible to growth plate injuries.