Advances in medical knowledge and technology have enabled sports physicians and trainers to help young athletes get back on the field, but one of the most effective treatments they can prescribe is also one that many patients won't use: rest.
The crowded sports calendar doesn't give young athletes time to rest their muscles, sometimes causing permanent damage, according to Jack VanderSchilden, MD, the director of the Sports Medicine Service at the University of Arkansas for Medical Sciences and the head team physician for the University of Arkansas at Little Rock.
Sports such as baseball now last year-round, and Little Leaguers, particularly pitchers, are undergoing reconstructive surgery as young as 10 years old. "You have to realize, pitching is Darwinian," he said. "It's survival of the fittest, and some people are just meant to pitch, and some aren't. Pitching is a very abnormal activity for the arm, so it's very easy to have overuse problems."
For female athletes, the biggest problem is tears of the knee's anterior cruciate ligament. VanderSchilden said female basketball players are four times as likely as their male counterparts to suffer an ACL injury, and that only one group of athletes suffers as many: spring football players. VanderSchilden said there are many medical reasons why females are more vulnerable to such an injury, including the fact that they have smaller ACLs than men but still absorb a pounding on the basketball court.
VanderSchilden said great strides in arthroscopic surgery have been made in ACL repairs in the past 10 years, but while surgeons can put those athletes back on the field, the ligament is prone to being re-injured. Meanwhile, surgeons are also using arthroscopic surgery techniques not only on shoulders and knees but on smaller joints like elbows and wrists. The new techniques allow physicians to make smaller incisions at those joints and employ techniques that aren't possible with open procedures.
Athletes who are somewhere between perfectly healthy and needing surgery often work with athletic trainers such as Dean Weber, the former head athletic trainer at the University of Arkansas, and Bo Renshaw, a physical therapist and athletic trainer with Central Arkansas Sports Medicine. While Renshaw often works with high school and adolescent athletes and Weber works with those already in college, they both see the same problems – kids suffering overuse injuries.
If parents brought their young athletes to Renshaw when their muscles and joints were simply sore, he could advise them on strategies and techniques to keep them healthy. Unfortunately, he usually doesn't see them until they are already injured. Then he has to manage not only an injury but, often, unrealistic expectations. Parents sometimes ask that he get an injured son or daughter ready to play that weekend, which sometimes is possible and sometimes is not.
Many athletes already have done serious damage to their bodies by the time they reach the college level, where the demands are even higher. Weber said many injuries can't be repaired by that point – only managed. Moreover, the 12-month grind of college athletes only worsens the problem. By the end of the football season, virtually everyone on the team is nursing some kind of ache or pain, and the same is true for most other sports.
Unfortunately, the competitiveness of the modern college game doesn't give athletes a chance to completely heal once the season is over. A veteran of 40 years in the business, Weber remembers the days when Razorbacks left for summer in May and returned to school in August having spent the past three months working on the farm or in the grocery store rather than working out in the weight room and the practice field. Those players returned physically healthy and mentally refreshed. "Sometimes I think we forget the phrase that 'less is more,' that overuse will set in to just about everybody at some point – not everybody at the same amount of time, but when you train for 12 months a year with not much time off, you're going to get some overuse type things," he said.
One positive development is that athletes have learned to be forthcoming with trainers when they are injured – admissions they would have been unwilling to make in the past.
But Weber said that while trainers can help athletes return to the field, they can't help injuries heal faster than they would naturally. All they can do is manage the injury and help players play through the pain. "That's what athletic trainers do," he said. "You get them to overcome and manage this thing the best you can. The healing takes place – bone heals, ligaments heal, muscle heals – at a pre-designated time. What you try to do is to fool Mother Nature a little bit, and it's a mind game; it's a psychological thing."
While an injury to a joint or muscle is easy for players and their trainers and physicians to spot, other injuries can be overlooked – a mistake that can have long-lasting, even catastrophic results. Among these are heat injuries and concussions.
According to Dr. Bryan James, a primary care sports physician who works with the Arkansas Travelers baseball team, athletes pushed past their limits can face heat exhaustion, heat cramps or heat strokes – all with long-term effects. Athletes and others who suffer from a single case of heat stroke are much more prone to suffer from another one because it permanently upsets the body's thermoregulatory function. When the body's temperature exceeds 106-107 degrees, athletes can suffer injuries to the brain as well as a breakdown of muscle cells that can damage the kidneys, a condition known as rhabdomyolysis. Even a single case of heat cramps injures the muscle so that it is more likely to cramp during the season.
Concussions are common in football and require monitoring and, as with other injuries, rest. These harm the still-developing adolescent brain more seriously than they do adults, and players can suffer symptoms in the weeks following the event. Young athletes may see deteriorating math and organization skills and even have minor psychological problems that resemble attention deficit disorder. James said these players need not only physical rest but mental rest as well; he said teachers might even consider putting off big assignments until the athlete has had time to recover. According to Renshaw, multiple concussions can take a young football player out of action for the season and possibly permanently. Ten or 15 years ago, they probably would have kept playing.
Still, football is a violent game, and players are going to get their bells rung. According to James and Renshaw, such a player can return to action within a few minutes if he shows no symptoms of damage, such as dizziness or blurred vision. "If you sat out every single kid that had symptoms that went away immediately ... then you would basically sit out most of the team or half the team from a mild concussion," Renshaw said. "It's that significant, and it happens that much."