It is that time of year again – school is back in session, which means early morning awakenings, the stress of getting everyone ready on time, bus rides, carpools and keeping up with school assignments.
But when I ask the children I see in clinic what they are looking forward to most, they all are excited to start back to PE and sports. It is wonderful to see our children excited about exercise but, too often, our young people have spent the summer months on the couch. As a result, this sudden increase in the volume of exercise as they return to school can put them at risk for overuse injuries.
An “overuse injury” can occur at any age, and usually occurs due to a rapid increase in activity duration and/or intensity without adequate rest and recovery. These overuse injuries can involve the muscle-tendon units, bones, ligaments, bursa, growth plates or the neurovascular structures. The treatment for these injuries varies, but if your child begins to complain of pain that has started gradually and is not the result of a specific injury, consider these initial interventions:
• Apply ice for up to 30 minutes at a time several times a day, especially after activities and at the end of the day. (Be sure to apply a towel between the skin and the ice to prevent damage to the skin.)
• Keep in mind: pain in children is not normal. Pain with activities is a sign of injury or dysfunction and should not be ignored. If your child is limping or reporting moderate pain, this is an indication to hold them out of activities, as this puts them at higher risk for sustaining other injuries. If a child or young adult is having pain that persists even after five to seven days of rest, consult your medical provider before permitting the child to return to activities.
• Beginning a rehabilitation program that includes stretching and strengthening exercises is very important, but consultation with a medical professional is recommended to assist in creating an individualized program specific to the child. (If available, athletic trainers at the schools are a great resource. Otherwise, a medical provider can give instructions.)
There also are some interventions you can try that may help to decrease the risk of overuse injuries:
• Try to avoid sudden increases in activities. If there has been more than two weeks of rest from a given activity, identify the first day of school or the anticipated date for the first sports practice session. Then four to six weeks prior to this time, plan a gradual return to activities program for your child to complete.
• Do stretching before and after activities. Prior to activities, dynamic stretching may be best (this involves stretching while moving muscles and joints). After activities, static stretching may be best (this is stretching done while sitting or standing and holding one position for 30-45 seconds without bouncing). Stretching should never cause pain.
• Prior to activities, ensure your child is spending an adequate time warming up.
• Proper nutrition is always important in overall health, including with injury prevention
• Ensure your child is getting an adequate time for rest and recovery when they are participating in sports and exercise. We recommend scheduled times off, but the exact recommendations vary based on the sport/type of exercise, the age of the child and their history of injuries.
• A child should always be properly trained and supervised if using equipment with exercise, such as weightlifting. Different guidelines exist based on the age and abilities of the child. If used incorrectly, these can cause injury.
• There is data that preseason conditioning and neuromuscular training can reduce injury risks. Coaches, athletic trainers and medical providers can be consulted to discuss these specific programs.
We want our children to be active and healthy. Exercising a minimum of one hour every day is our goal, and the healthy habits they develop when they are young helps them to become healthier adults.
But it is also important to keep in mind that not every sport or form of exercise is safe. Some do pose great risks especially for children, and it is important parents and children have an understanding of these before engaging in any given activity.
The decision to allow a child to participate in sports should be individualized, taking into consideration not only the risks but also the child’s age, level of interest and their overall readiness for sports. Encourage your child to exercise daily, but also know how to keep your children safe. If you have specific questions, the medical community is here to help.
Dr. Allison Tobola, MD, is a board certified primary care sports medicine provider with Christus Trinity Mother Frances Orthopedics and Sports Medicine.