PART 2 - Injury Prevention for our Young Athletes

Fortunately this ACL/knee/female athlete issue is becoming well known. There are numerous places (physical therapy, sports medicine, private soccer clubs, athletic performance centers, private gyms, YMCAs) that have ACL prevention programs. They don’t actually improve the quality of your ACL, but they attempt to properly strengthen and balance the leg muscles which can protect the ACL, they improve your overall flexibility and core strength, teach the athlete how to run with a better alignment if needed, and also how to land in a safer way after a jump. Additionally, there is a push for clubs and coaches to adopt a certain type of warm up (PEP program) before each practice that has certain types of exercises and stretches that focus on ACL injury prevention, it only takes about 15 minutes and has been shown to decrease risk for ACL. I was very happy to see my daughters team this year is doing a very similar warm-up to the PEP program.

I know the additional training guarantees me and my daughter nothing, but she reports her knee pain is gone and her legs and core are much stronger overall. Fingers crossed. What I’m (and fellow parents) trying to prevent is what’s happened to a U16 team in my area that I have friends on. They’ve had 5 ACL tears in her age group in one year, one meniscus tear and numerous less serious injuries. 2 of the ACL tears were on the same girl/both knees, the 2nd coming 1 week after coming back on the field from her 1st tear.

I know youth sports injuries are not just a ‘girls soccer player’ issue. Little league baseball has been a pioneer and has dealt with injury prevention by limiting the number of pitches a kid can pitch per game and has mandated forced rest periods (1-3 days depending on pitch count). I know the coaches hate it, but who wants their kid to screw up their arm or shoulder at age 14 (or younger). High schools are forced to limit the amount of practice time for lots of sports, have a legal start date, and have a day there is no practice or games each week (usually Sunday). Otherwise overzealous coaches would have our kids out there 24/7. And….to make it worse, the kids at this level want to be out there 24/7, they want to be the best, they want to show they are the hardest worker, quickest recoverer, etc. so we as parents are fighting not just the culture, but our own kids sometimes.

Bottom line, in my mind, is that, at the high level, young athletes are being pushed to become perfect players on perfect teams who need to win every game and every tournament. The girls with the ‘best’ coaches start to adopt that winning attitude and will do anything to please the coach, including playing when in pain, playing too aggressively, toughing it out, practicing as much as possible, and on off days the run or lift. We, as parents, have to be the ones who safeguard our kids health, because everyone else (including your child) has another agenda. If 4 practices a week are too much, put your foot down; if your coach doesn’t seem to be doing a proper warm up or stretching, have a word with him (or his director), if your kid is exhausted and in pain every night make him skip a training every so often, if your kid is trying to play on two teams per season (club and school) etc, you may have to make the difficult decision to pick one—two teams at that level is a LOT of wear and tear.

Quick tip sheet for parents:

--see the big picture—don’t have a win at all costs attitude, and don’t encourage it in your child (she’ll get enough of that from her peers and coach)
--discuss health and injury prevention often at home
--think about checking out an ACL program
--ask your coach how he is trying to prevent knee injuries
--ask club how they are trying to prevent knee injuries
--encourage your kid to stretch often, not just for 2 minutes before practice
--consider having your kid do a bit of gymnastics, yoga, pilates, or ballet to help with flexibility, balance, coordination
--if your daughter has a Warrior Girl personality and focus, try (good luck!) to encourage other interests, sometimes these kids are at highest risk because they (and their self-esteem) is completely wrapped up in the sport and they do 'LOVE it LIVE it' just like the T-shirts say. French Immersion and Math Camp might be a tough sell but start with something less frightening like Rock Climbing or Horseback riding.
--ask your Doctor if taking Glucosamine and/or Chondroitin is recommended for your athlete (I’m no expert on that, so I'll let you do that research, but it's worth a look).


Back to us parents: Here's a similar situation for all levels of youth sports: Have you ever been at practice and heard thunder, seen lightning, then watched as the coach continued practice, pretending he heard nothing? It’s up to you to safeguard your kid by stepping in and getting him/her off the field. Same with injury prevention, you may be the only one looking out for your kid, so just do it.

PART 1 That Which Does Not Kill Me, Makes Me Stronger…..uh…NO, The Opposite of That (Knee Injuries and Female Athletes-Part One)

I’m reading a good, but scary book, it’s like a thriller mystery: I can’t put it down, I’m petrified, and I can’t wait to see how it will end (or play out in my life, anyway). Everything I’ve witnessed in our soccer league is written down in this book in black and white. The statistics and real life examples in the book show it’s not just a fluke that in our club and league all the girls teams seem to have girls on crutches on the sidelines. They are out with ACL tears, meniscus cartilage tears, patella-femoral syndrome, stress fractures from overuse, and other knee (mostly) injuries. The book is Warrior Girls-Protecting Our Daughters from the Injury Epidemic in Women’s Sports, by Michael Sokolove. Basically, it describes

1) How seriously injured our female soccer and basketball players (mostly their knees) are getting playing the game they love
2) That the coaches, girls, and even the parents are downplaying the risks and the injuries
3) How the girls are pushing (and being pushed) to tough out their recovery after serious knee injuries and surgeries and come back to playing before they’re ready, causing re-injury, re-surgery, often guaranting chronic and future knee problems (like serious arthritis at age 30)
4) How the attitudes (trickled down from the coaches) of the players to ‘play at all costs’ and ‘win at all costs’ is exacerbating the problems
5) prevention techniques (yes, finally some positive news)

To be honest, the author goes into so much detail about the knee injuries and the actual surgery that I had to have a family intervention when my daughter caught me canceling next weeks soccer camp and replacing it with French Immersion camp. She managed to get me to chill out on that one (and Math Camp), but I’m starting to feel like she should spend a few weeks this summer laying on the couch (aaack) playing video games. I may even tell her where I hide the Funyons and Ring-Dings.

Apparently, because of their build, center of gravity, the way they run, and the way they land after jumping, girls are highly prone (8:1 compared to boys) to ACL ruptures. This repair requires a pretty invasive surgery involving taking a ligament from another part of the leg and replacing the ACL with it. The recovery time is about 6-9 months. It’s getting so common of an injury that many teams are taking extra players at tryouts knowing that at least 2 or 3 will end up with a ‘blown out’ knee before the season is out. Worse than that, and because it’s so common, the seriousness is down-played and the girls are encouraged to push it in rehab and get back to the field (or court) quicker and quicker. They all know others who’ve had ACL and it becomes a competition: how many surgeries you’ve had, how quick (and strong) you came back. And the competition is not just self-driven between the girls, but can be encouraged by the parents, coaches, physical therapists, etc. The book outlines some Case Stories, some real superstars in HS and college soccer and follows them and their injuries throughout their sports careers.

My own experience agrees with the book. On my daughters team (mind you, 12 year olds) practice has just started (July 1st) for the fall season and we have 3 girls who can’t practice yet, 2 because they are recovering from Patello-Femoral syndrome (left over from last season) and 1 who’s had knee surgery for ACL rupture. That’s 3 out of 17 twelve year olds. My own had a good bit of knee pain early last fall and then a wrenching contact injury that made us go to the orthopaedic doctor and got x-rays and an MRI. Luckily her ACL and meniscus were not torn, and she had a minor ACL sprain. Oh, and tendonitis in both knees, but the orthopaedic doc says all athletes who play and practice this often (and of a running, jumping nature) have it, so just get used to it (the pain). But it was a close enough call (and a wake up call) for me, so I started researching and got her some physical therapy and when my insurance ran out, I got her a personal trainer and he (and my research) designed an ACL prevention program for her. Yes, you read that right, my 12 year old has a personal trainer! I can’t even afford to buy kettle bells (hint, hint contest people), but I spend an exorbitant amount on a weekly personal training sessions for a kid who hasn’t even hit puberty.

In Part Two, I’m planning on talking about what we as parents can actually do to help.

PS I know this isn’t the most entertaining subject, so…… (lucky YOU)...conveniently I’ve just learned how to do the web links in a blog, so I apologize for going a bit overboard throughout this post.