March 12, 2008
Wednesday AM

Nicole Simon was 13 when she injured her knee the first time, playing soccer in a competitive girls league.

She was 15 when she injured the other knee -- less than one minute into her first basketball game after recovering from the earlier injury -- and ended her athletic career before it had ever really started.

"My whole life revolved around sports, and then it was over," said Simon, who is going through her second round of rehabilitation at the Sports Medicine Center for Young Adults at Oakland (Calif.) Children's Hospital. "I guess I'll focus on other things now, like school. I'm trying to make the best of it."

Pediatricians and sports-medicine experts say that cases like Simon's have become depressingly common in young athletes. The topic of pediatric sports injuries -- from strains and sprains to tendon tears and fractures that need surgery to repair -- is a focus of an upcoming meeting of the American Academy of Orthopaedic Surgeons.

It's a new enough phenomenon that few national numbers on sports injuries in children exist, but anecdotally, doctors say in recent years they've seen an explosive increase in injuries that once were associated mostly with pro athletes.

The trend is a result of youth sports becoming increasingly competitive as children and teen-agers face growing pressure to perform their best and win college scholarships or even a professional gig. Even young athletes who don't intend to make a career of sports are playing harder and longer -- joining teams that practice year-round and require a level of skill and training that growing bodies aren't necessarily made for.

"When I was a resident, back in the late '90s, we were taught that these injuries didn't occur in children, and that's clearly not the case anymore," said Dr. Jim Policy, an orthopedic surgeon at Oakland Children's Hospital. "More and more kids are involved in organized sports, and even 10 years ago, the level of competition was nothing compared to what it is today."

Drawing special concern from doctors are the more serious injuries: tears of the anterior cruciate ligament, or ACL, which stabilizes the knee; damage to an elbow ligament that is so severe it needs replacement using a procedure known as Tommy John surgery; strains and sprains that are minor at first, but eventually lead to recurrent and severe injuries.

About half of sports injuries in children are from overuse -- think Little League pitchers or high-school swimmers who make the same motions over and over. Adult bodies can often take the strain of constant use, but younger bodies, especially pre-adolescents who haven't finished growing, are more vulnerable to injury.

The typical treatment for such injuries is rest from the sport, although it can be tough to convince children, and even their parents, to take a few weeks off. Young athletes see their pro heroes work through pain and sometimes lose sight of the difference between a pitcher who throws fastballs for a living and their own desire to make their Little League all-star team, said Dr. Mark Davies, assistant chief of the department of orthopedics at Kaiser San Jose.

Studies have shown that as many as a quarter of young athletes have been injured. Part of the problem, sports-medicine doctors say, is that youth sports have become explosively popular in the past 10 or 20 years, and coaching and preventive medicine haven't caught up with the growth.

For boys, the highest-risk sports are ice hockey, football and soccer; for girls, soccer, basketball and gymnastics. Girls are particularly vulnerable to injury, in part because they only fairly recently started playing sports at the same competitive levels as boys, doctors say. Girls' bodies are different from boys', and they are more prone to certain injuries, especially knee injuries.

It's crucial, doctors say, that girls learn how to properly train to avoid injury -- that could mean strength training to keep their muscles in balance, or practicing how to jump and pivot in ways that reduce the strain on fragile joints.

But most youth coaches haven't learned these techniques, say doctors and physical therapists. That's where someone like Michelle Cappello at Oakland Children's Hospital comes in. She is coordinator of the sports-medicine center, which opened in 2004 and has grown from just one physical therapist to five.

The most important things young athletes can do, doctors say, is learn to take a break.

Children are starting to specialize in one sport at a much earlier age than they used to, doctors say. Twenty years ago, it wasn't unusual for young children to play several sports throughout the year, and even high-school athletes would play two or three sports.

Specializing in one sport puts a lot of repetitive strain on the body. Simply switching to another activity for a few months -- something that uses different muscles -- can reduce injuries, doctors say.

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