Francisco Metivier, a then-12-year-old running back, was racing with the ball to the goal line during football practice when a teammate hit him on the inside of the leg.
“I heard a pop, like a loud noise, and I just collapsed,” Francisco, now 14, recalled. “The pain was horrible. I couldn’t get up.”
Francisco ended up with a tear in his anterior cruciate ligament, or ACL, one of the four major ligaments of the knee, as well as a tear to the meniscus. Surgery at Miami Children’s Hospital to repair the damage was followed by a year of three-times-a-week rehabilitation. Now, three months after his last official physical therapy session, the eighth-grader at Doral Academy wears a knee brace and is back playing pick-up basketball with neighborhood friends.
His father, Rafael Metivier, said it was a difficult experience for the entire family. “I was really astounded at the length of recuperation. We were very fortunate he got such good care, but I think now we’ll have him play a less rude sport.”
Like Francisco, millions of kids get injured practicing or playing a sport. As more of them get involved with park-sponsored leagues, clubs and high school teams — 30 million at last count, according to the American Orthopaedic Society for Sports Medicine — the greater likelihood that a young athlete will sustain an injury.
More than 3.5 million kids under age 14 receive some form of medical treatment for sports injuries each year. At the high school level, athletes account for an estimated 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations each year.
“We’re seeing younger athletes who are pushing the limit of their bodies and their sport much more than what we saw 10 or 15 years ago,” said Dr. Craig Spurdle, orthopedic surgeon at Miami Children’s Hospital. “And we’re also seeing more kids doing this earlier and earlier.”
The result? Overuse injuries that doctors once saw only in adults are now more common among children. And this includes young athletes in every sport, from tennis to baseball.
Another trend that strains a young athlete’s immature bones and joints: More and more kids are also “specializing” in one sport instead of playing in several. In the past, an athlete would change sports with the season, playing football in the fall, say, then basketball in the winter and baseball in the spring. Now they’ll stick to one.
“Kids have become sport specific, and not just one sport but also position-specific” said Dr. John Zvijac of Doctors Hospital Center for Orthopedics & Sports Medicine. “Fewer and fewer are playing multiple positions and they’re the same muscles over and over.”
Repeated use of this kind can cause stress and lead to injury. Tony Millian, director of the U-18 Sports Medicine Program at Joe DiMaggio Children’s Hospital in Hollywood, said this is particularly evident in South Florida, where many kids will play their sport year around, without taking the necessary time to rest their muscles.
“We’re unique here in South Florida because of our weather,” he said. “Here, if kids play baseball, they play 12 months of the year.”
His employer, like other pediatric orthopedic specialties around the area, end up seeing “a lot of all those things that end in ‘-itis.’ And that ‘–itis’ means it’s inflammation and swelling and it’s from overuse.”
Overuse injuries are responsible for nearly half of all sports injuries to middle and high school students. Yet, these very preventable injuries are often ignored because an overuse injury “develops slowly over time due to repetitive stress on tendons, muscles, bones or joints,” according the STOP (Sports Trauma and Overuse Prevention) Sports Injuries campaign, a grass-roots initiative of the American Orthopaedic Society of Sports Medicine.
“They’re playing with pain,” said Spurdle of Miami Children’s Hospital. “They want to help the team out, but in the end a potentially small injury that can be treated with rest and rehabilitation gets worse. A small problem becomes a big problem.”
Sports medicine experts also see their fair share of acute injuries, of course. For instance, Francisco’s ACL tear is not uncommon, particularly in certain sports. Zvijac of Doctors Hospital in Coral Gables sees plenty of soccer and basketball players with such tears because of the way they plant and twist their foot. Knee injuries, he added, are also higher among girls than boys. Because of the way they are built, girls’ knees tend to get hyper-extended and a bad landing after a jump can result in injury.
Some injuries tend to happen more frequently in certain sports. Injuries to the lower extremities, from an ACL tear to ankle fractures and sprains, are more common in sports like football and soccer. Cheerleaders suffer an unusual amount of back injuries, and doctors see a lot of upper extremity injuries with tennis and baseball.
Concussions are also a problem, and they can have serious long-term effects, especially for young athletes because their developing brains can suffer permanent cognitive damage if the injury goes untreated.
Gillian Hotz, co-director of the Miller School of Medicine’s Concussion Program at the University of Miami, said concussions tend to happen more frequently among players of football and soccer, but also in any contact sport such as lacrosse and hockey. “In football these guys are going head to head,” she said. “In soccer, especially among young girls, they have weak neck muscles.”
The reporting and treating of a concussion, which is considered a traumatic brain injury, has increased as more athletes, parents and coaches become aware of the symptoms and the need for quick treatment. Hotz chaired a statewide Concussion Task Force that pushed for a Florida law that went into effect in July 2012. The new mandate requires concussion training for coaches, officials and athletes before the start of every playing season and the complete recovery documented by a physician before injured athletes are allowed back into play.
“It’s very important for kids to know the symptoms,” Hotz said. “Because if they don’t tell an adult [about headaches, dizziness and blurred vision], they don’t get treated.”
Several national organizations have launched campaigns to raise awareness of sports injuries and to teach safe playing and practice. Locally, area hospitals also have instituted specialized educational and rehabilitation programs targeting children.
Miami Children’s Hospital, for example, houses the Jump for Return to Sports, a program aimed at helping young patients who have injured their ACL — kids like Francisco — return to their sport safely by reducing other injuries. (As many as 25 percent of ACL surgery patients may suffer a second ACL injury, and secondary knee injuries also occur at a higher rate after an ACL tear.) The Jump program uses a special warm-up program, neuromotor training, as well as agility and resistance training to increase overall leg strength, improve balance, agility and jump mechanics.
“It’s great that kids are participating in sports,” Spurdle said. “We should encourage athletics. It’s a great outlet. But it’s also our job to keep them safe.”