Brian Schiff’s Blog

The News and Observer (our local paper here in the Triangle) recently ran a great story on overuse injuries in young athletes.  I firmly believe this is one of the fastest growing injuries I see in the clinic and in many cases it is preventable.  One of the biggest issues now is this commonplace idea that gifted athletes should play the same sport year-round to get ahead.

I remember growing up as a kid and playing football, basketball and baseball in the fall, winter and spring.  While AAU basketball and Legion ball existed, most kids were still playing multiple sports.  Over my 15 years as a physical therapist I have witnessed several of these one sport stars see their playing time and bodies take a hit due to injury.

The American Orthopedic Society for Sports Medicine (AOSSM) and the American Academy of Orthopedic Surgeons (AAOS) state that overuse injuries account for nearly half of the 2 million injuries seen among high school athletes each year.  While soccer and swimming seem to send many athletes into PT, any repetitive throwing or overhead activity bears considerable risk for an eventual shoulder or elbow problem as well.  Some of the common injuries I typically see are:

• Patellofemoral pain
• Shin splints
• Rotator cuff injury
• Bursitis
• Shoulder instability
• Little League elbow

Little League Elbow (medial epicondylar apophysitis)

These injuries are just some of the most common ones I see.  In the article, the reporter focused on baseball and throwing.  With that in mind, consider research published in the American Journal of Sports Medicine this past February from renowned surgeon James Andrews that revealed players who pitch more than 100 innings in a calendar year are 3.5 times more likely to be injured.

He goes on to say that “these injuries are the result of a system that prepares genetically gifted athletes to play at the highest levels, but eliminates most players because their bodies cannot withstand such intense activity at such an early age.”  Sadly, he told the reporter that in 1998 he performed the Tommy John procedure on 5 kids high school age or younger, while in 2008 he did the same procedure on 28 children in the same age range.  This injury is usually caused by throwing too much too soon.

Consider the following data on suggested pitch counts per game (source James Andrews, MD & Glenn Fleisig, MD):

• 8-10 y/o = 52 plus/minus 15 pitches
• 11-12 y/o = 68 plus/minus 18
• 13-14 y/o = 76 plus/minus 16
• 15-16 y/o = 91 plus/minus 16
• 17-18 y/o = 106 plus/minus 16

Unfortunately, I can personally relate to this blog post and story.  I was a promising young pitcher up until the point I threw my arm out in travel baseball at age 13.  The pain got so bad in my arm I could barely throw a ball 10 feet.  I remember the orthopedic surgeon telling me that I could not throw again the rest of the summer.  The pain (and memory of it) was so bad I elected to focus on position play and not to pitch again until my senior year of high school.  At that point, my arm was no longer the same as I had missed three years of practice and development.  Now, I too had become one of those kids whose body was never the same.

So, as a rehab and strength & conditioning professional, I want to help educate and promote better awareness to athletes, parents, coaches, trainers, AD’s, ATC’s and anyone who is involved in the care and training of young athletes.  Fortunately, people are taking positive steps to reduce overuse injuries.  One great initiative is STOP – Sports Trauma Overuse Prevention and you can learn more by clicking here to visit their website.

In the end, we must continue to educate everyone that the old motto of “No Pain, No Gain” is NOT the way to handle overuse injuries as this mentality may ruin the careers of young athletes or lead to an otherwise preventable injury and/or premature musculo-skeletal damage.  Pain truly is a warning signal the body gives us to detect mechanical problems and make changes in our training/activity level until we sort out the cause and solution.  I hope you will join me in supporting this mission and working hard at making sports fun, safe and free of overuse injuries for young athletes of all ages in the years to come.

References – The News & Observer – May 15, 2011

So, I am about 4 weeks into my new job at as a supervisor and sports physical therapist at the Athletic Performance Center (www.apcraleigh.com).  So far, I am really enjoying it.

I have seen lots of different athletes ranging from youth to professionals.  The one thing people often seek to eliminate with rehab is pain.  Ironically, what most people fail to realize is that this pain is actually one of the biggest tools they need to rely on in the recovery process.

You see, most injuries I encounter are related to repetitive micro-trauma or overuse.  Such injuries include tendonitis, bursitis, stress fractures, muscle strains, cervical and lumbar disc bulges, and so on.

It is critical that people learn to read their own pain as a marker of how well their body is holding up to the stress they are subjecting it to each day.  If they simply learn to recognize and respect pain and what it tells them, they would be able to rehab and recover much faster.

Pain, while undesirable, is one of the most important tools we can use as therapists, strength coaches, ATC’s and fitness enthusiasts to judge how best to move forward or step back.

No pain, no gain is old school and best left in the past.  To help athletes today and long term, it is best to educate them how best to recognize and react to pain when it occurs.  Too many times they ignore it or fail to report it because they believe they will be held out of participation, or it is not a big deal.

Little do they know that this mentality often costs them more playing time long term or even may jeopardize their health in later years.  So, as I tackle patella tendonitis, lateral epicondylitis, muscle strains and such, I teach my clients how to interpret pain in response to their daily life and sport.

Pain is not the enemy, but rather a warning signal our body sends us when it simply needs a break or is beginning to break down.  Therefore, learn to listen more closely to your body and let pain guide your training, play and rehab process.

I advise people to consider the following:

• Soreness up to 3-4/10 on a 0-10 pain scale (10 being the worst) is acceptable provided it does not escalate with activity
• Any increased soreness after an activity should subside or return to baseline within 24 hours
• Pain that is at 5/10 or greater is a red flag and precursor to mechanical failure

Finally, keep in m ind that once pain subsides, that does not necessarily mean your body is done healing.  Pain is a symptom and there is often a mechanical cause or disruption that leads to it.  So, just remember to pay close attention to soreness and pain with activity as your body was programmed to let you know when tissue is starting to break down.