With sports called off amid COVID-19, doctors seeing injuries in kids trying to stay active

If your gangly adolescent suddenly seems clumsy, it’s not your imagination. Rapid growth spurts during puberty can cause balance problems and fast-growing bones that make them prone to injury, especially if they play sports.

“Growth spurts are related to sports injuries in youths because as they grow, their bones tend to grow a little bit faster than the soft tissue — their ligaments and tendons,” said Dr. Carolyn Kienstra, a pediatric orthopedist and sports medicine specialist with the University of Miami Sports Medicine Institute.

This causes inflexibility and affects balance, she said. “You can imagine trying to find your balance where every morning you wake up and you’re a little bit taller and a little different shape than you were the day before,” Kienstra said. “That makes having good balance really difficult, which predisposes you to a lot of extra motion and extra muscle work when you’re active.”

When a kid grows, bones get longer as they respond to special hormones in the body, said Dr. Roger Saldana, pediatric orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute, part of Baptist Health South Florida. Ligaments and tendons take longer to respond, “so our bones grow longer, but the rubber bands that are stuck to it, the muscles and tendons, get tighter until they catch up,” he said.

During times of rapid growth the growth plates, areas of new bone growth, can get a little weaker because they increase in size with cartilage, Saldana said. “This combined with the tightness can cause growth plate injuries or other injuries associated with rapid growth,” he said.

Because of COVID-19, sports in general have taken a turn, said Dr. Andrew Gupta, pediatric and sports medicine orthopedic surgeon at Joe DiMaggio Children’s Hospital’s U18 Sports Medicine Clinic, part of Memorial Healthcare System in Broward.

“We’re not seeing many organized sports, but we’re seeing a lot of kids try to stay active, so the most common injuries are related to running, weightlifting and conditioning,” he said.

“Overuse injuries are common with conditioning sports,’’ he added. “With growth plate injuries, the most common are things like patellar tendonitis, which is basically where the patellar tendon inserts into the shin bone. Because of repetitive use, we get an inflammation in that area. Tendinitis in the shoulder and around the kneecap are the most common injuries we are seeing right now related to growth plate injuries.”

During normal times, elbow injuries are common in baseball players, where the growth plates around the elbow sometimes gets injured or aggravated, especially in pitchers, Gupta said.

“With sports like football, track, basketball and gymnastics we’re seeing mostly tendinitis of the patellar tendon or the quadriceps tendon, so a lot of tendinitis issues around the knee, in both male and female athletes,” he said.

Saldana said he sometimes sees growth plate injuries to the wrist in sports like gymnastics, where the athlete is doing handstands, cartwheels, tumbling and landing on their arms hard.

“Gymnasts who are doing a lot of extensions to their back can hurt areas of growth in their spine. Athletes doing a lot of running or jumping can hurt cartilage areas in their knees and cause pain in the front of their knees,” he said. “So we see some sports are causing a bit more than others depending on the patient’s age and how long they’re doing the sport.”

With Osgood-Schlatter disease, youths have pain at the front of the knee due to inflammation of the growth plate at the upper end of the shinbone. “We see more Osgood-Schlatter disease in boys than girls, especially in boys that play basketball or run track,” Saldana said.

It’s common to see growth-related injuries in knees, hips, elbows, feet and ankles in both sexes, Kienstra said. Playing only one sport year-round without adequate rest or breaks throughout the year probably contributes to these types of injuries, she said.

“The general recommendation is that kids get at least one day off per week and about two months off per year, which can be broken up throughout the year,” Kienstra said. “A way to protect yourself is to get adequate rest and to be involved in multiple sports so that you’re working and training your body in different ways.”

Injury prevention is becoming more of a focus in sports medicine, Saldana said. For example, neuromuscular training can help improve mechanics in jumping and landing to help decrease injuries.

“We also know, at least anecdotally, that maintaining flexibility decreases the incidence and at least improves the symptoms from things like runner’s knee and Osgood-Schlatter’s,” he said.

Gupta said the first thing he recommends to athletes is a good stretching program. “When kids are going through growth spurts, which is around age 10 or 11 in girls, and 13 or 14 in boys, we see that rapid growth. If the kids aren’t stretching properly, the tendons and ligaments become tighter and cause more stress across the growth plate as they’re pulling.”

U18 offers free home exercise and stretching programs on its website, KidBones.net, he said. “Anyone could use those as a home exercise or home stretching program to help prevent and treat their injuries,” Gupta said.

But seeing a professional is always a good idea, they say. If you’re having chronic aches and pains that sneak up and are persistent in one spot, particularly rated related to an activity, “the sooner we are able to address the underlying causes, the easier it will be for them to get better,” Kienstra said. “The sooner you try to fix it, the easier it is to fix.”

This story was originally published July 25, 2020 at 7:00 AM.