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Posted: Tuesday April 7, 2009 2:45PM; Updated: Wednesday April 8, 2009 9:17AM

Until It Hurts (cont.)

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DiFiori recalls a mother bringing her 10-year-old son to his office with complaints of a pain in his knee. The boy was a gifted soccer player, and his father was his coach. DiFiori diagnosed the boy with a growth-plate injury, similar to ones suffered by gymnasts and marathon runners. Growth plates are areas of growing tissue at the ends of bones in children. They're among the weakest structures in the human skeleton -- weaker than ligaments and tendons, which join bones to one another. Growth-plate injuries among youth athletes are common -- and often serious. A damaged growth plate may interfere with the normal growth of a child's bone.

The injury clearly was the result of overuse. From the mother, DiFiori learned that the boy had been playing soccer nearly nonstop, multiple games and practices each week, for two years. The previous year, he had just two weeks off. DiFiori prescribed a lengthy break. The mother approved and, within a year, the boy had recovered. In the life of a sports medicine physician, the case was uneventful stuff. DiFiori recalls it vividly only because of the reaction of the boy's father to the diagnosis -- angry and defiant. "He kept asking, 'How could he have this injury? Why does he have to stop playing?' Later, I got an e-mail from the mother thanking me and apologizing for [her husband's] behavior."

The father's reluctance to accept his son's diagnosis troubled DiFiori. "You have a kid who is not capable intellectually of understanding the situation and a parent who is insisting on behavior resulting in an injury," DiFiori says. "Some people would have viewed it as child abuse."

start quote There is no shortage of cultural cues to disable a parent's normally good sense. The pressure to compete, to win, to stay even with the family next door recedes at times, but it is the rare family that banishes it altogether. end quote
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Joseph Chandler has had similar issues with adults he had not even met yet. When he was the team doctor for the Atlanta Braves, the parents of youth pitchers in the area often would seek him out in times of great urgency. Unlike other patients who explained their problems when they came to the office, these moms and dads would call weeks before their appointments, Chandler remembers, with warnings like, " 'I can't really talk about this in front of my son. But you need to understand that he has big league potential; he's something special!' " Chandler says, "It floored me. What kind of pressure must 12-year-old kids be under from their parents?"

It's not all our fault. There is no shortage of cultural cues to disable a parent's normally good sense. The pressure to compete, to win, to stay even with the family next door recedes at times, but it is the rare family that banishes it altogether. Sports psychologist Richard Ginsburg likens it to a river's current that, once waded into, requires great effort to escape. "Once the flow grabs you and takes you, it's hard to step back," he says.

Then there is the coterie of adult accomplices who stand ready to help a child get to the next level -- professional coaches. In individual sports such as gymnastics, figure skating and tennis, they're ubiquitous. Every child needs one, and just about every child has one. Such coaches can spend several hours with a young athlete each day, honing skills and, in healthy relationships, building friendship and trust. But when the ambition of the child, the coach, or both, goes unchecked, things can go terribly wrong.

* * *

Joe Chandler is a trim, mustachioed man with a piercing voice that squeaks higher when he laughs, which is often. A first meeting with him ends with Chandler shaking hands and opening his arms to give a visitor a bear hug. He spent the first half of his professional life in the operating room inserting screws and pins into broken bones. He ran a busy orthopedic practice in Atlanta and was team orthopedist for the Braves, caring for the million-dollar arms of star pitchers such as Tom Glavine and John Smoltz. Over the last half of his career he hopes to do as much for eight- and nine-year-old baseball pitchers.

Chandler's changed course was not entirely voluntary. In 1997, while performing surgery, he damaged his hand, an injury that eventually forced him out of the operating room. He continued seeing patients, however, including many with overuse baseball injuries. At that same time, overuse injuries were spiking among pitchers in the Braves minor league organization. Chandler wondered why. He knew the Braves weren't responsible -- he had the pitch logs proving that. But what was? Curious, he quizzed Braves players, trying to piece together their baseball lives as children. How old had they been when they became pitchers? When had they thrown their first curveball?

Then, Chandler embarked on another project. For years he'd watched the Little League World Series on TV, marveling at the poise and talent of the young pitchers. The laws of probability, if nothing else, dictated that some would become stars in professional baseball. Yet, as far as Chandler knew, none had. Somewhere between the little green diamonds in Williamsport and the 50,000-seat ballpark where Chandler worked in Atlanta, these young pitchers were vanishing. It didn't fit with Little League Baseball's record of keeping youth players safe, one that officials deservedly call attention to and take pride in. After all, it was Little League Baseball that introduced batting helmets with ear flaps in 1959. And Little League Baseball has stayed on message under Stephen Keener, the organization's president and CEO since 1994, banning on-deck circles (to protect waiting batters from being slammed by batted balls) and, beginning in 2008, mandating breakaway bases, to reduce injuries from tumbling awkwardly into the next base.

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