Too much, too soon: Doctors say young athletes are being worn out

Elijah Torrez had pitched throughout the school year and Cal Ripken season, and the Mendota seventh-grader wanted to play when his travel team made it to a World Series.

Pain in his right arm, however, could scuttle plans to pitch for a championship.

So Elijah didn’t tell his father, Anthony Torrez, how much his arm hurt or the location of the pain on the back side of his arm. His father thought a little rest and some icing of a sore muscle should resolve the problem.

The coach agreed to ease him off the pitching schedule. But this summer, when the team was losing at a World Series game in San Diego, Elijah told the coach a fib: “I’m good,” and he got in the game.

He threw a few pitches before he felt pain and a “pop” near his elbow. In September, Elijah, 14, had surgery at Valley Children’s Hospital. He had pulled bone off ligament on the inside of his elbow. A screw had to be inserted to hold the bone in place. The surgery is similar to a Tommy John elbow ligament repair, normally done on adult baseball players like its namesake.

Anthony Torrez said his son’s surgery “tore me apart.” He should have questioned Elijah more about the soreness in his arm, he said.

Increasingly, doctors are diagnosing overuse injuries – stress fractures, bone separations and strained tendons – in young athletes. The injuries have become common enough for researchers to be studying their occurrence, and they suspect more happen than get reported. Sports and medical experts don’t see the trend reversing anytime soon.

Dr. Kerry Loveland, a pediatric orthopedic surgeon at Valley Children’s Hospital, is seeing more sports-related injuries in young athletes in the central San Joaquin Valley.

He attributes the increase in overuse injuries to several factors.

“Just the sheer number of kids who play sports is up,” he said. It’s difficult to get an exact number of student athletes, but it’s safe to say tens of thousands of school-age children in the Valley are participating in organized sports.

Fresno is a competitive-sports town, which adds to the pressure on young athletes to specialize in one sport from an early age, Loveland said. The Valley weather contributes, allowing outdoor sports, such as baseball and soccer, to be played year-round without having a season to rest.

It’s common for elite young players in the Valley to play softball, baseball, soccer or volleyball on school teams, continue on summer school teams and play on outside-of-school club teams. Children as young as 8 can be in competitive play year-round or nearly year-round.

Loveland said he sees the effects of young athletes doing too much, too often. “Everybody needs an off-season from their sport.”

Value of early specialization questioned

The American Medical Society for Sport Medicine agrees.

In a position statement issued in January 2014 in the Clinical Journal of Sport Medicine, the society recommended young athletes have scheduled rest periods, limits on weekly and yearly participation time and limits on sport-specific repetitive movements, such as pitch counts.

Dr. Holly Benjamin, one of the authors of the position paper, said doctors don’t want to discourage children from being active year-round. Involvement in athletics is healthy, and being a part of a team also can build self-esteem. The issue, she said: “We’re concerned about the sports specialization and the year-round training in a single sport.”

Benjamin, professor of pediatrics and orthopedic surgery at the University of Chicago, equates the stresses from repetitive sports movements to “mileage on the body.”

Researchers have found that the more hours a week youths participate in a sport appears to increase the risk of them getting hurt, said Dr. Neeru Jayanthi, who also was an author on the society’s position paper on overuse injuries.

While specialization may be necessary from an early age for certain sports, such as gymnastics, figure skating and swimming/diving, sport medicine doctors said there is growing concern about negative effects of early specialization, including the risk of injury and of burnout.

Doctors said determining the extent of burnout is difficult, but one study cited in the position paper found 30-35 percent of adolescent athletes had experienced it.

Studies also suggest that specializing in a single sport increases the risk of injuries, said Jayanthi, who is an associate professor of orthopedics at Emory University and director of tennis medicine at the school’s sports medicine center.

At the same time, the supposed benefits of early sport specialization in developing athletic prowess also are coming under scrutiny.

Early specialization may not have the desired effect of guaranteeing success in a sport, Benjamin said. “Late specialization may have a better likelihood of leading to elite status,” she said. For example, a study of players invited to the NFL Scouting Combine – where college football players have an opportunity to demonstrate their abilities to coaches and scouts – found 87 percent had played more than one sport at younger ages.

The lure of college athletic scholarships and lucrative professional sports careers drives young athletes into specialization, said those who see injured young athletes.

And training young athletes has become a money-making business, too.

“It’s all financially driven. It’s no question,” said Richard Lembo, director of sports medicine at Sierra Pacific Orthopedics in Fresno.

He can’t place a number on how many injured young athletes he’s seen at his office, but “I know I’m seeing them younger than I did 10 years ago,” Lembo said. For example, girls begin playing volleyball in fourth grade and continue playing into high school. By their freshman year, they have chronic back pain, he said.

Terance Frazier, owner of Central Cal Baseball Academy, said parents worry their children will miss out on a scholarship if they don’t play a sport year-round. “Some coaches, in my opinion, are feeding off of that,” he said.

No guarantee of scholarships

Playing year-round does not guarantee a free ride through college, Frazier said, but a parent will spend thousands of dollars on trainers, special coaches and club teams in an effort to get an athletic scholarship. With the money spent on camps and training “you can send your kid to college without a scholarship,” he said.

It’s unfortunate that so many parents are chasing the scholarship dream, said Roger Blake, executive director of the California Interscholastic Federation. The CIF is the governing body for high school sports in the state. “Too many people are being sold a bill of goods about the magic scholarship pot of gold at the end of the rainbow,” he said. “Only 1.8 percent of high school athletes get a scholarship to go to another level.”

Ron Murray, 43, who operates Clovis Jets, a track and field club, said he understands the importance of college scholarships. He earned an athletic scholarship at Fresno State, which gave him an educational opportunity, but he’s concerned about children specializing in a sport too early.

Children no longer ride bicycles and climb trees and balance on brick walls – physical activities he did as a child that improved his strength and coordination, he said. “I’m not saying we were better athletes, but we didn’t get hurt like these kids get hurt.”

Murray supported a decision last year by Joann Barry, a Clovis mother, to suspend her son, Nathaniel Barry, a sprinter, from running for the club and at school. Nathaniel, 15, grew about two inches in about a year. He’s now 6 feet 2 inches. A growth spurt can increase the risk of injury in children.

Nathaniel had complained of knee pain, Barry said. A physical therapist at Valley Children’s Hospital suggested he needed a break from running to help him heal.

Nathaniel, now a sophomore, continues to play basketball. He’s on the Clovis High varsity team. Barry said she’s involved Nathaniel in the decisions she’s made. Nathaniel excels in both track and basketball but prefers basketball, so she let him keep playing.

But Barry said she is watchful for any sign of injury. “I’m now cautious about how much pressure is put on his knees.”

The CIF Sports Medical Advisory Committee shares the concerns of doctors who are seeing more young athletes with overuse injuries, Blake said. In 2012 the CIF reduced the allowed hours for athletic practice to 18 a week. Prior to that, coaches would have players practicing three to five hours a day, he said.

Blake expects recommendations in the next few years that will set pitching limits for high school baseball and softball players. “It’s coming. We just don’t know when it is yet.” The CIF also could define the age at which a pitcher can throw a curve ball, he said. Pitching a curve ball can be particularly hard on the arm.

Little League currently has guidelines for how many pitches can be thrown by one player in a game. According to the organization’s Pitch Smart website, an 8-year-old, for example, should not have more than a daily maximum of 50 pitches. A 12-year-old can pitch 85.

Anthony Torrez said he coached his son quite a lot when he was younger, and his pitches were kept within the Cal Ripken guidelines.

“I didn’t really think he was overusing his arm because of the amount of innings he pitched,” Torrez said. He now believes his son strained his arm when he began playing on his Mendota Junior High team. He had to throw 60 feet as a school pitcher. In Cal Ripken he threw only 46 feet. “The 60 feet probably wore him out, being 12 years old,” he said.

Lembo said schools are paying attention to overuse injuries. He oversees the athletic trainers at the five Clovis Unified high schools, and most school districts of any size in the Valley have athletic trainers for high school athletes, he said.

But he’s convinced trainers and coaches can’t break the cycle of early specialization in a sport and year-round competition. That has to involve parents, who he said could get a wake-up call from the increasing costs of medical care. “It’s expensive to take your child to the doctor, to an orthopedic surgeon, or whatever it may be.”

Allen Co, a physical therapist at Valley Children’s, said coaches do play a big role: “They need to understand their players,” he said. “They have to be an advocate for their health and safety, even though the kids will really want to play.”

Parents need to be educated for signs of injury in their children – a limp, a favored knee, swelling – because too often, children will not speak up, Co said.

Torrez said he realizes his mistake with Elijah: “As a parent, I should have done more investigating of what was going on with his arm.”

As for Elijah, he’s learned something too. “Next time, I’ll tell them that it hurts.”

This story was originally published December 26, 2015 at 8:00 AM with the headline "Too much, too soon: Doctors say young athletes are being worn out."