Ryan Rojas, high school pitcher on the freshman team, had felt a weird sensation in his arm, but he continued to warm up without sharing his concerns with anyone. It wasn’t until his first pitch from the mound that the pain became excruciating.
“When I threw that warm up pitch, my elbow just went pop,” recalls Ryan, now 15 and a rising sophomore at Killian High School.
That was a year ago. After a trip to the emergency room, doctors there ordered two weeks total rest for a sprained elbow. When he returned to the game, however, he wasn’t any better. The eventual diagnosis: an ulnar collateral ligament sprain of the elbow, or a UCL tear. He was lucky not to need surgery but he underwent four months of three-times-a week physical therapy at Miami Children’s Hospital West Kendall Rehab and Sport Medicine Outpatient Center.
Unfortunately, Ryan’s injury is not uncommon. Millions of kids get injured practicing or playing a sport they love and pediatric orthopedists have noticed that an increasing number of those injuries are due to overuse — playing too hard for too long without rest.
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“Overuse injuries are preventable,” said Craig Spurdle, orthopedic surgeon at Miami Children’s Hospital and Ryan’s doctor. “If a young athlete is throwing too hard or too much without rest, injuries around the elbow and shoulder, including UCL sprains can occur Don’t play through the pain.”
An estimated 30 million kids participate in park-sponsored sports leagues and school teams, according to the American Orthopaedic Society for Sports Medicine. More than 3.5 million under age 14 receive medical treatment for sports injuries. Another 2 million young athletes suffer some kind of injury at the high school level. Overuse injuries account for nearly half of all sports injuries to middle and high school students, according to statistics kept by STOP (Sports Trauma and Overuse Prevention), a grassroots campaign by the orthopaedic society.
Orthopedists worry that they’re seeing these kind of injuries in younger kids and in every sport, from cheerleading to football. That’s because more kids are starting to play a sport at a younger age and they are specializing in one sport, not playing a variety of them. It wasn’t always so. Once upon a time, kids rotated through sports depending on the season and many took entire months off.
What’s more, even within a sport, kids are becoming position specific instead of playing multiple positions. This means they’re using the same muscles over and over.
“They’re playing in school, in summer leagues and on travel teams,” says Dr. Michael Swartzon, a sports medicine physician at Doctors Hospital’s Center for Orthopedics and Sports Medicine. “They’re not resting and the book requires significant rest. You need time off.”
In this case, repetition doesn’t make perfect. It causes stress and leads to injury. This is particularly true in places like South Florida, where good weather allows a player like Ryan to participate in his sport year around. But even in cold weather climates and in certain sports, kids are putting inordinate stress on their joints and muscles practicing their sport indoors.
“A lot of what we are seeing is part and parcel of where we live,” says Dr. Davida Packer, a pediatric orthopedist, also at Miami Children’s Hospital. “Our weather lends itself to playing year around.”
Packer sees young athletes, who pressure themselves to practice and play through the pain in hopes of winning the game, earning a scholarship, making it to the pros. Ryan, for example, admits he never told anyone about the pain back in May 2013. His Killian High freshman team was playing archrival Southridge High.
“I didn’t want to disappoint my teammates,” he now says. “I was a little sore, but I thought I could still play.”
Ryan’s injury is not uncommon among young pitchers. Packer says that, in addition to Little League elbow or shoulder, she also sees too many cases of stress factors, severs disease (an inflammation of the growth plate in the heel), and Osgood-Schlatter disease (an irritation of the ligament which causes pain below the knee).
“The pressure comes usually from within the kid,” laments Packer. “Sometimes the parent doesn’t even know the kid is hurting.”
Stephen Storer, an orthopedic surgeon at Joe DiMaggio Children’s Hospital in Broward, has noticed that a growing percentage of his practice is being devoted to overuse injuries. "If you asked me 10 years ago what my practice would look like, it certainly wouldn’t be this," he says.
Some of these overuse injuries aren’t typical in adults, whose biomechanics and body structure are fully mature. Gender may also play a factor in knee injuries in girls, who tend to carry more of their weight in the lower half of their bodies.
“These kids overwhelm the ability of the bone and growth plate cartilage to absorb the pulling and the tension,” laments Storer.
At Doctors Hospital, Swartzon advises his patients and their parents that rest is essential for everybody, but especially for still-growing athletes. He uses this rule of thumb: one day out of the week and one month out of six should be considered time off. He also female athletes about their menstrual cycle. “Any dysfunction is a sign, a possible screen, of overuse,” he adds.
For the Rojas family, Ryan’s therapy was a painful but valuable lesson.
“We’ve learned from this experience,” says mother Ana Maria Rojas. “His father and brother watch and count his pitches very carefully now. They’re really on top of him.”
Ryan, in turn, has changed his habits. In February, under the watchful eye of his doctor, he began limiting throwing and only pitched in two games this spring season. Now, he runs to improve his leg strength and works out his forearm and elbow area in a gym.
More important: “I now know that if I have any pain, I’ve got to tell my coach,” he says.