Wendy Vismara is kicking herself for allowing her daughter to participate in a soccer camp this summer.
Eleven-year-old Marissa came home with a stress fracture in her goal-kicking foot after a week of drills designed to make her a better league player. She lost three weeks of practice, but she's back in the sport now.
"Missy's pretty intense," said her mother, who has suffered stress fractures as an adult while training for marathons. "Knowing her, she spent too much time working on that kick."
Millions of children are reporting sports-related injuries that could have lasting effects on young bodies, a pediatric sports physician recently told colleagues at the American Academy of Pediatrics.
Stress fractures, torn ligaments and tendinitis once commonly associated with adults in rigorous training disciplines now are frequent complaints of children because of high-intensity practices and competition, Dr. Paul Stricker of La Jolla told a group gathered in San Francisco.
In extreme cases, children could face premature closure of growth plates, stunting the growth of certain bones, Stricker said.
"These are things we didn't used to have to worry about," Stricker said in a telephone interview. "Now, they're common."
Vismara, of Sacramento, said she has no qualms about soccer itself, which requires about 10 hours a week of practice and games, even more on tournament weekends, which can include four games plus hourlong warmups beforehand.
"She would be outdoors running around playing anyway," Vismara said. "And it's been a wonderful experience. It builds a lot of self-esteem. ... And my understanding is that it's not uncommon for children in competitive soccer to have stress fractures."
With an estimated 20 million to 30 million children playing sports each year, Stricker said more than 4 million are reporting sports-related injuries. But he cautioned against overreacting and pulling children from athletics entirely.
"A 7-year-old who's playing normal youth league soccer is a great thing," Stricker said. "He's increasing skills, muscle tone, aerobic fitness. They're doing things for their body, good social things, and that's why we love kids being in activities.
"It's when you take that child, and they're 8 and on the local youth team, a traveling team and the superstars team. Then you have a kid who's playing hours and hours of soccer a week. And that's a setup for problems."
Stricker's warning rings true to parents of young athletes who embrace the idea of youth sports but worry that some coaches are pushing children too hard.
Fred Baldini's son, Daniel, started playing team sports at age 5 and joined his first competitive soccer team at age 11. Now a junior in high school, Daniel is a three-sport athlete football, basketball and baseball and has been since junior high school.
Baldini monitors his son's training schedule carefully.
"Coaches tend to overtrain the athletes," said Baldini, who is chairman of the kinesiology department at California State University, Sacramento. "When you're in a multisport situation, you have more than one coach trying to overtrain you. And yeah, that worries me. There are times I don't let him participate in training because of that."
He said that over the past generation, training and playing seasons have been lengthened so that most competitive sports now require year-round training, increasing the risk of injury.
"There was an off-season," he said. "But now, younger athletes are training harder and at an earlier age."
Even Baldini's 11-year-old daughter, Amy, is complaining of back pain related to volleyball, which she plays competitively. She also plays recreational soccer, but her father said she probably will soon move up to league play.
"We took her to a chiropractor last week for the first time," Baldini said. "She's been serving a lot, and she's been experiencing some pain in her back. So we have multiple ice packs (at home), and lots of Advil."
Coaches of some sports say injuries are inevitable. The question becomes how to minimize them.
Competitive gymnasts at Byers Gymnastics Center in Roseville, Calif., are put through a set of injury-prevention exercises designed to strengthen young athletes' wrists, ankles and backs.
But with five levels of teams practicing from 10 to 25 hours per week, coach Kim Bruns said she expects there will be some stress fractures.
"I don't think you can be completely injury-free," she said.
Stricker singled out gymnastics for special attention because of the repeated pounding on young joints and bones. Some gymnasts, he said, are at increased risk of wrist plate closure a condition in which the bones in the body close prematurely. If one bone stops growing and an adjoining wrist bone continues to grow, he said, the gymnast can face lifelong pain.
Bruns said she doesn't know of any gymnasts with that condition. But she does see increased numbers of stress injuries just before the competitive season begins, when training is most intense.
"Their bodies can take only so much pounding," she said.
High school trainer Michele Roelofs said she is working with three athletes: one with shin splints, another with a torn knee ligament and one who suffered a concussion and complains of continuing dizziness.
She said it isn't the coaches pushing for these athletes to return to the competitive arena it's the athletes themselves.
"They have a huge desire to play the game," Roelofs said. "It's not any different from the college level. However, they do get more upset when they can't play."
But Stricker and some others are questioning whether it is appropriate to encourage such intense levels of play among children.
Jeff Hogan is in his 18th year as University of California, Davis' athletic trainer. He said over that time he's seen an evolution in adolescent injuries.
"More athletes are showing up either injured or having had significant injuries in high school," he said. "We're seeing freshmen entering our athletic programs with knees that have been reconstructed. We didn't see this type of thing 15 years ago."
He blamed the increase on a trend among young athletes to pursue sports specialties and the increased intensity with which young athletes in all sports now play. Both increase the likelihood of overuse injuries.
He said an athlete who continues to play despite injury to a knee ligament can risk tendinitis and degenerative bone problems. In the end, Hogan said, athletes may end up losing their chance to play at higher levels.
"If the joint is not healthy, it's not allowing them to throw a ball properly or run and cut, because they're just not strong enough to put up with the stresses," he said. "And if you start that at age 14, there's a whole lot more wear and tear going on."
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