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

America's Obsession with Youth Sports and How It Harms Our Kids

Story Highlights

The number of young athletes with injuries from overuse is on the rise

One doctor sees overworked pitchers ushered into her waiting room at age eight

Overly competitive parents and coaches are a major reason for such injuries

By Mark Hyman

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Until It Hurts
Courtesy of Beacon Press

Reprinted from Until It Hurts: America's Obsession with Youth Sports and How It Harms Our Kids, by Mark Hyman. Copyright 2009 by Mark Hyman. By permission of Beacon Press, www.beacon.org.

* * *

Even 27 years after playing his last Little League game, Patrick Grady still can't forgive coaches and league officials for what they took from him.

At the time, Grady was 12 years old and playing Little League baseball in Westchester County, New York. By his account he was one of the league's star pitchers, striking out most of the batters he faced and winning almost all the games he pitched. His coaches were impressed. They pitched him constantly. During his two Little League seasons Grady estimates that he was his team's pitcher in two-thirds of its games. There are Little League rules to prevent such abuse. But as Grady recalls, his coaches disregarded them, and league officials didn't object.

Even when Grady's arm began to show alarming signs of overuse, grownups failed to step in. First his elbow ached. Then he began to lose feeling in his pinkie and ring fingers. Through it all he kept pitching. During an all-star game featuring the most talented players from the local league, Grady was the pitcher and alerted his coach to a terrible pain. When rain delayed the game for a while, the coach led Grady off the diamond to the snack bar. There, Grady insists, the coach stuck his star pitcher's arm in the freezer next to the ice pops, so that with his arm at 30-degree temperature, "I'd be numb enough to pitch the last four innings."

Grady's coaches presumably got what they wanted from their Little League experiences. With the aid of their top-notch pitcher, they had the thrill of seeing their teams win championships. They lived out their dreams and showed off their coaching prowess for approving parents and other spectators. The cost to Patrick Grady was high. His dream of playing for a college or even a high school baseball team never materialized. At 15, he had surgery to transpose a nerve in his elbow and never pitched again. "My potential career in baseball vaporized," he says.

Make no mistake: Injuries are inherent to youth sports, as inevitable as car pools and grass stains. In 2003 more than 3.5 million children under age 15 suffered a sports injury that required medical treatment -- about one attended injury for every 10 players. Many were the result of garden-variety mishaps: a base runner turning an ankle at second base or a field hockey goalie nicked by a point-blank shot.

Yet within the statistics is a hidden stat not as easily shrugged off. Each year as many as half of all youth sports injuries are the result of overuse -- a regimen of sports play and training so intense that a child's body rebels. In some high-volume clinics the picture is still worse. Lyle Micheli, the youth sports medicine pioneer, estimates that of the 70 young patients who file into his clinic each Thursday at Children's Hospital Boston, 75 percent are victims of overuse injuries -- soccer players with tender knees, swimmers whose shoulders hang like limp spaghetti and the never-ending line of baseball pitchers accompanied by their aching elbows. Back in the early 1990s the figure was at about 20 percent. That tells Micheli that in his decades-long battle against overuse injuries, the frayed muscle fibers and inflamed tendons are winning. "As a medical society, we've been pretty ineffective dealing with this," he says. "Nothing seems to be working."

start quote "We always hear about the obesity epidemic," says pediatrician Joel Brenner. "Yet, on the other end of the spectrum, there's definitely a group of kids who are too active." end quote
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What makes overuse injuries so infuriating to the Michelis of the world are two simple truths. First, unlike acute traumatic injuries -- dislocations, hyperextensions, and other mishaps -- injuries caused by overuse are easily prevented. By introducing variety, moderation and rest into an everyday sports routine, a child's risk can be cut to nearly zero. Second, adults are the great enablers of overuse injuries. Where we go, ruptured ligaments and chronic tendonitis inevitably follow. Before the adult-dominated era of youth sports, "We didn't talk about these kinds of injuries, at least in the [medical] literature," notes Dr. John DiFiori, chief of sports medicine at UCLA's Comprehensive Sports Medicine Center and physician for UCLA's intercollegiate sports teams. And for good reason. Until parents showed up there wasn't much to discuss. Children entertaining themselves at their own pace, in their own way, simply did not play sports until it hurt. "Little League shoulder, tennis elbow, you don't see it unless kids are in an organized sport," notes DiFiori.

It's not just pitcher's elbow. And it's not just adolescent boys. The rainbow of overuse injuries is strikingly diverse. In an average year, pediatric sports medicine specialist Eric Small treats children who've overdone it in baseball, basketball, track, figuring skating, volleyball and football. "I see one or two fencers a year," he says, and their issues are no joke -- wrist and elbow tendonitis and sometimes a condition known as thoracic outlet syndrome, a pinched nerve in the shoulder blade that leaves its victims with numbness in their fingers and hands. Two-thirds of Small's patients are girls, many suffering the King Kong of girls sports injuries -- ACL tears. The age of overuse patients also is cause for alarm -- it's falling fast. Pediatrician Rebecca Demorest, who practices at New York City's Hospital for Special Surgery, sees youth baseball pitchers ushered into her waiting room at age eight.

The American Academy of Pediatrics is worried enough to have issued two policy statements on overuse injuries in three years, the latest in 2007. Says pediatrician Joel Brenner, its principal author, "We always hear about the obesity epidemic. Yet, on the other end of the spectrum, there's definitely a group of kids who are too active."

* * *

For every overuse injury, there's a story of a risk recognized too late or an adult's burning ambition left unchecked. Orthopedic surgeon Scott Maughon recalls an anxious mother who came to his Atlanta office with her 10-year-old daughter, a tennis player with an aching shoulder. The mother explained to Maughon that her daughter was rapidly climbing the Georgia state junior tennis rankings. To meet the family's goals for her, the girl had two weeks to reach number 5. Maughon tells me that, during an exam, he diagnosed a stress fracture, a potentially serious injury that could interfere with the normal growth of the girl's shoulder. He explained to the mother that her daughter should take an extended break from tennis of up to six months. It wasn't the answer the mother had come for. As Maughon recalls, she flew into a "yelling, screaming, stomping" rage, assailing the doctor for being overly cautious and insisting that her daughter didn't need any time off -- she could be treated just as well with physical therapy. "It was one of those cases where a parent absolutely, totally refuses to deal with reality," says Maughon. "Do parents think I get a thrill out of shutting a kid down? That I'm telling them their child needs rest when their child doesn't need rest? You can go to a chiropractor. Wish on a star. Try a magnet. Wear garlic. The fact of the matter is your child needs rest."

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