Safety Is the Name of the Game
By Sandy Kauten
Fish gotta swim, birds gotta fly, kids gotta play. And that's what they do. Each year, an estimated 30 million young Americans, high-school age and under, participate in organized sports like football, basketball and soccer. Millions more race around every day on bikes, scooters, skates and skateboards and climb, jump and swing on playground equipment. The benefits of all that physical activity far outweigh the risks, especially these days, when obesity and inactivity plague the videogame generation.
Still, sports and recreation-related injuries are an ever-present threat to young athletes and a constant concern to their parents. With good reason. According to a recent study by the Centers for Disease Control, more kids receive medical attention for sports injuries each year than for injuries in automobile accidents. During the 12 months ending June 2015, nearly 2 million kids 14 and under were treated in emergency rooms for sports and recreation injuries. (Strains and sprains are the most common, followed by fractures.) The rate of sports injury among kids 5 to 14 is nearly three times the rate for people 25 to 44.
Those numbers add up to a major public-health issue, and the CDC, the American Academy of Pediatrics, the American Academy of Orthopedic Surgeons and others are promoting a variety of guidelines and strategies to reduce them. "We want kids to get up off the couch, we're big cheerleaders for that," says Dr. Julie Gilchrist, a sports-injury expert at the CDC's Center for Injury Prevention and Control. "But be realistic in how you're doing it. Make conscious choices about injury prevention. Don't just take it for granted."
Most kids get their first lumps riding their bikes and cavorting on the playground. The CDC estimates that more than 330,000 children from 5 to 14 are injured while bicycling each year. An additional 219,000 in that age group are hurt on monkey bars and other climbing equipment, swings and slides. Wearing a helmet that fits properly is the surest way to avoid serious injury on a bike. (Helmets are also the key to safer skateboarding, which accounts for about 50,000 injuries among people under 20 each year, including many head injuries.) At the playground, where 60 percent of injuries are due to falls, a soft surface to land on is a top priority. Wood chips, shredded tires and sand are good; packed-down soil is bad.
Organized sports, including football, are generally less risky for the 10-and-under crowd because the kids usually aren't big enough or fast enough to make collisions a serious problem. But that all changes when the hormones kick in. "At puberty, children gain muscle mass, speed and weight," says pediatric orthopedic surgeon J. Andy Sullivan, coeditor of the book "Care of the Young Athlete." "And the combination of those things allows them to run together hard enough to hurt each other."
There is no reliable way to compare the relative risks of various sports because the CDC doesn't track the level of participation. It knows how many people are injured playing basketball, for example (an estimated 977,000 each year, all ages), but it doesn't know how many people are playing the game, or for how long or how many days a week. "Basketball is one of the most common sports in all ages and areas of the U.S.," says Gilchrist, "and so just because it has the highest number of injuries doesn't mean that it's riskier."
Whatever the sport, injury prevention begins with the athletes and their parents. And the first thing they need to focus on, experts say, is conditioning. Being out of shape, a real problem for lots of kids, increases risk. Those who play only one sport have to be careful not to wait for their season to arrive before they begin working out; going from naps in the hammock to two-a-day football practices pretty much guarantees trouble. Appropriate gear in good condition is a must. And, simple as it sounds, knowing and learning basic skills also helps young athletes avoid injury. Baseball players should know how to slide correctly, football players how to tackle, soccer players how to head the ball.
Besides making sure their kids are fit and understand the fundamentals, parents can make any sport safer by attending games and practices, watching the coaches and encouraging them to emphasize injury prevention. (Which is hardly inconsistent with winning, since superior skill and safety go hand in hand.) Parents can also promote safety by urging officials to call stringent games. When a ref won't tolerate flagrant fouls, players usually get the message and rein themselves in (or they get ejected). The cleaner the game, the safer.
But there are no officials at practice, and that, in fact, is where most injuries happen because teams practice a lot more than they play actual games. "The safety of the athletes is really in the hands of the coaches at practice because usually you don't have trainers there," says Robert Ferraro, executive director of the National High School Coaches Association. Ferraro and Gilchrist both say trainers play a critical role in injury prevention because they focus on safety. "Coaches have other things on their minds, and to make them think about these things in addition to their other work is burdensome," says Gilchrist, who urges parents to press their local school officials to hire athletic trainers, if they don't already have them.
It's impossible to prevent all injuries, of course. Head injuries, which account for about 15 percent of the sports injuries treated in emergency rooms, are a special concern. Returning to play too soon after a concussion can be dangerous. A player who receives a second concussion before he recovers from the first can suffer long-lasting brain damage and even death. A child's brain may be more susceptible to this "second-impact syndrome" because it fits more tightly inside the skull than an adult's brain. Fortunately, such cases are rare.
Even when a kid has a common injury, the decision about when to let him play again is critical. "It depends on the diagnosis and common sense, which a lot of people don't have," says Sullivan. "Number one, you want to know if the injury is healed. Number two, have they been rehabilitated?" In Sullivan's view, a young athlete is not rehabilitated until he or she has regained the full range of motion, strength and flexibility of the affected joint. If the injury is to the left ankle, for example, it has to be equal in all ways to the uninjured right ankle. In addition, the kid has to regain the same level of fitness and conditioning he was at before he got hurt. Bottom line for parents, coaches and kids: a little common sense and a lot of vigilance can prevent unnecessary pain.