How Parents Can Help Their Young Athletes Avoid Burnout, Overuse Injuries

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As parents, we want to encourage our kids to participate in sports. There are great health advantages to exercising and being active. And, for some kids, there is the chance to play in college or earn scholarships.

However, with the increasing pressure on kids and parents to participate in club, travel or year-round teams, burnout and overuse injuries are becoming more common in younger athletes. James Voos, MD, Chairman, Department of Orthopedic Surgery at University Hospitals, gives advice on what we can do about it.

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Podcast Transcript

Pete Kenworthy

Hi, I'm Pete Kenworthy.

Macie Jepson

And I’m Macie Jepson. And this is Healthy@UH. Today we are tackling a subject that's going to step on some toes, because if you're a parent or you're that coach … and believe me when you hear this topic, you're going to know if you are that parent or coach … you may not like what you're going to hear.

Pete Kenworthy

Yeah, we're talking about youth sports and specifically what we're talking about today is overuse and mental burnout. So, youth athletes have more potential than maybe ever before. So, we have the specialized training, the club sports. The options, as you know, are endless here with AAU, travel baseball or softball, other sports, basically year-round leagues for whatever sport you're in.

Macie Jepson

For your daughter, it's softball. For us, it's volleyball. We call it in our house, the crazy train. You know, cross-country trips, hours of training every week, in the gym on their off days, club fees. Can we talk about club fees? You have family on two different sides of the country. So, we ask our kids on a regular basis, what's the end game? I mean, literally once a month we would ask them. And if the end game is not worth the sacrifice, then we're going to get off this crazy train. But so, they're both D-1 athletes now. Awesome. But we still ask ourselves at what price?

Pete Kenworthy

At what price, right? Yeah. And today our plan is to put the science behind it and looking at solutions that may stick here. Our guest today is University Hospital's orthopedic surgeon, Dr. James Voos. He's also the head team physician for the Cleveland Browns, the Cleveland Ballet and the Cleveland Monsters. And he serves on national boards that tackle this subject that we're talking about today. And James, thanks for joining us today.

Dr. James Voos

 Thank you very much. Appreciate being here.

Pete Kenworthy

So, let's start it off here. Are overuse and mental burnout the greatest threat to young athletes today?

Dr. James Voos

Yeah, I think so. And that's --  I did want to start by saying sports are fun. We want our kids to participate in sports. There's great health advantages to exercising and being active. So, we’re talking about a lot of concerning things with sports today. We really want to encourage kids to participate.

But I think there's some smart ways we can do it as parents and as coaches. And I do think burnout and our overuse injuries are one of our biggest risks. And the fortunate part is one of the things that we have a lot of control over and we can still keep our kids actively participating, but with a few very smart changes as families, I think we can help our kids participate in a much safer manner.

Macie Jepson

So, we're all busy, and we're all doing two, three sports in a family, a lot of us. So, what exactly is it that causes burnout that takes you to that next level?

Dr. James Voos

Yeah, with burnout, and when we consider burnout, it's an athlete stopping their sport because they're tired of it. They don't want to play anymore. They're sick of it. It's not fun anymore. So, that's our easy definition of what burnout is.

And it's often kids, 1) that are playing a sport that they may not want to play. Mom and Dad want them to play. Your brother played this; you're going to play this sport. So that's number one. It may not be a sport that they have or they're truly passionate about that they've been encouraged or coaxed to head down that level.

And the second is they may have been playing for so long at such a young age, season after season, and the term sports specialization where they started playing one sport at such a young age, it loses its fun. And you've lost that diversity as a child of learning how to move your body in other ways.

So, that's our biggest concern with burnout, and our main definition is one that sports specialization of playing the same sport over and over again and maybe being pushed down that road of playing a sport that you may not want to be doing.

Pete Kenworthy

You mentioned specialization in that answer. And, you know, the counter argument to what you just said is, well, my kid wants to play in college. Right? My kid wants play basketball or baseball or soccer or whatever the case may be, and they can't get there unless they play year-round. Right? That's certainly what the climate has become. Right? If you're not playing year-round, you're losing a step on the other guy who's going to take your spot, going to take your scholarship.

Dr. James Voos

Yeah. And that, that's certainly what you hear is that consideration. If my child isn't on this club team or they don't play in this tournament and they're 12 years old, there's no way they're going to get a college scholarship.And there's a lot of data out there that says otherwise.

So, our American Orthopedic Society for Sports Medicine, which is the Stop Sports Injury Committee, has multiple publications in both what's called the American Journal for Sports Medicine and Sports Health. Those are our two biggest publications across the country for sports medicine physicians.

So, through multiple sports, they've shown that athletes that start playing one sport at a younger age and specialize in that sport at a younger age are more likely to be injured and less likely to either get a college scholarship or reach the professional level than athletes who may start maybe a little bit later, but in particular athletes that play multiple sports.

And so, as we look at these different studies and talk with our athletes, most of our professional athletes played multiple sports all the way through high school. When you're young, your body's learning to make all of those movements, make all of those neural connections. So, it's really important that your body learns all of these different ways to move, different movement patterns.

You heard back in the 80s, the football players would all talk about doing ballet to learn how to control their body and to learn how to balance. So, that's the most important part of things. The data really is becoming increasingly prevalent that specialization is not a good thing. So, it doesn't mean we don't want our kids to play. We want our kids to play a lot of different sports, particularly as they're growing.

Macie Jepson

So, Doctor, before we talk about solutions, we want to also talk about overuse. An incredible ESPN article about athletes that are being delivered to the NBA on the verge of damaged goods because of what they put their bodies through. One expert even said the kids are broken by the time they get to college. Do you want to touch on that?

Dr. James Voos

Yeah, overuse injuries are becoming a bigger and bigger problem. And as we look at our University Hospitals sports programs where we take care of over 50 high schools and youth organizations, over a third of the injuries that we see coming through our organizations are overuse injuries. And that's just in our Northeast Ohio sample. And some of these recent articles have brought national, put a national spotlight on the problem of overuse injuries.

And our challenge is, again, we come back to that sports specialization of playing one sport over and over again. Your body is just seeing that one movement or that one stress. And then on top of that, we're adding our performance programs, and we're doing these heavy lifting and high intensity endurance programs.

And a lot of these are adult designed programs that we're asking our kids to participate in. And if you talk to your pediatrician on their normal visit, they'll tell you kids aren't little adults. Their bodies are different. They have open growth plates. They're developing. So, those adult programs that we see our college and professional athletes doing may not be the right thing to do for our youth athletes. And so, when they're going from practice to practice to practice to workout to workout, we're setting them up for failure of those exposures of that high intensity exercise.

Macie Jepson

Is there a safe age that they can get into these programs then?

Dr. James Voos

You know, typically what we recommend with our young athletes, when they're young, it's all about fundamentals and having fun and using your body.

We don't really, the strength training part of things and heavy lifting really isn't a need. It's really how do you control your body and balance and learn the fundamentals of your sport. There's pretty reasonable data out there that's been published both by the American Academy of Pediatrics as well as our orthopedic societies that say middle school is a reasonable time to start light, what we call resistance training. So, different than our Olympic lifting where when you're in seventh grade you have to start doing power cleans and the heaviest squats. You can do light resistance training to get your body used to doing that lifting, and then as we move into high school, do more of what we consider our classic type of weightlifting. And I think there are very good guidelines to say that that's a safe way to do it.

Pete Kenworthy

You mentioned that University Hospitals is involved with a number of schools here across Northeast Ohio, and there are programs that we track injuries. You mentioned a third of the athletes are overuse injuries. What else are we learning from that? From, from the data that comes in from tracking these athletes?

Dr. James Voos

Yeah. As we look at a lot of our data, it helps us track not only, and we think about football quite oftenly, but this is both our male and female athletes to look at what are those injury profiles that we see as someone comes in?

One, we see that as we look at the athletes that are only enrolled in one sport, and we talk to them further and they’re playing that same club sport, those athletes are more predisposed to injury than the kids that we see that are enrolled in three different sports. So, that's number one.

The second is looking at the playing surfaces that they're playing on. Are they playing on grass versus artificial turf? And we know while it's a great surface to play on with turf and you can play on it year-round and it's good for the schools to be able to have all the teams on it, it's resistant to the weather, we do know that our injuries are a little bit higher on things such as artificial turf. And that doesn't mean that we need to get rid of all the turf out there, but it does mean we need to make sure we maintain it well.

Your kids are wearing the appropriate footwear. So, there's trying to control as many of these variables as you can. That way when your child is out there participating in a sport, you know they're just out there to have fun and you're not having to worry about all the other things.

Macie Jepson

All this makes perfect sense. And yet I think it's safe to say that coaches, clubs, parents are a part of the problem. So, at the end of the day, how do we get off this crazy train?

Dr. James Voos

Yeah, I think one of the big things that I talk to a lot of parents about is rest. Take a break.

So, during the year we all think about when we used to have summer vacations, when all the sports stopped or over winter break, when all the sports stopped, that's a good thing for your kids. That's actually an active way to recover and an active way to improve your performance is to actually rest.

Now, sometimes it's hard for us to rest for months or an entire season, but even those micro breaks in between, if you can take a week off in between your seasons, that allows your body to catch up, allows you to get your mind right to switch to that other sport, to get your energy back and really refocus.

We've all seen over and over again that athlete, a young lady that played in the regional or state soccer finals here right at the end of fall on Saturday or Sunday afternoon and turns around Monday and starts basketball practice and gets injured. And that's your, your body just needs that time to catch up to, to reboot.

So, that active rest part of things, that's number 1, one of the most important things we can do and it's appalling when you think, gosh, I'm not going to be playing a sport for a couple of weeks, but it's one of the single best things we can do for our kids.

The other is look at the calendar each year and map out your sports. And I know everybody wants to do their club and their team and the same things, but map out and see what the calendar looks like. Put another sport, mix another sport in there for fun. It's a great thing to have. That way the kids can go out if they want to be a basketball player but they are going to run track or play baseball, it’s another way to move their body. They can hang out with their friends. It keeps them active. Again, it just avoids that repetitive exposure.

So, if we could say anything it would be to rest and to mix up the sports. So, look at the calendar and find days where you can have your kids participate in another sport where they can just enjoy themselves.

Pete Kenworthy

You mentioned those micro breaks, and I just want to be clear here because you talking about a week or even two weeks off is helpful for the body to recover. Is there an optimal time to rest though other than -- just because what people will do is they'll hear that and they'll say, oh, I took a week off. I'm good. Dr. Voos said take a week off. Is there an optimal time for rest for athletes?

Dr. James Voos

Yeah, there there's no documented time. And in today's day and age with busy families, I say some is better than none, and any is better than none. But I do think if you can take that week off, it really is a reasonable amount of time to let your body recover.

Now, if you've been, if you've experienced an injury or been plagued by patellar tendinitis or hamstring soreness or heel pain or Achilles tendonitis, if you've had an injury that you've been battling through the year, it may be a good thing to take further time off to really let your body recover. So, that does add another element to it. If you've had a tough season where it's been nagging you the whole time, and it's affected your performance, and you're not having fun, and we've all been there in those phone calls or in those conversations in the car after a game where the kids are unhappy and they feel like they couldn't play their best because they were hurt. And so, it's giving your kids that time if they've been through a situation like that to allow them to recover really does help.

Macie Jepson

You know, as we wrap up, I think parents clearly want what's best for their children and children will fall in line with that example, but if we can't get the message to coaches, then I feel like we're fighting a somewhat losing battle.

Dr. James Voos

Yeah. And that's the big challenge. I understand the pressure on coaches because they want to have the best athletes out there. They want to make, they want to deliver for their school or for their organization.

But I think some of the best coaches, and you'll talk to some of the coaches that have been around for years and years and years, some of the best coaches are the ones that tell their athletes to play other sports through the year. I think that's, you'll talk to some of these really well, well known coaches and one of their secrets is they like the kids, they like to athletes that play other sports. They're really dynamic athletes. They know how to move their bodies. So, that's number one is encouraging coaches that it's OK if your athlete participates in another sport. I think that's our single most important thing.

And then coming back to the rest part of things, if the school is in communication, if the soccer team is going that they can, you know, the kids are worried if I don't try out for basketball on Monday, I'm not going to make the team. But do we have that conversation at the schools where this athlete just did a great job taking their team to regionals or to State, let's give them a breather for a week and get them back into basketball from there. So, I think those are some practical things to do.

I’m a physician. I know why we're on the sidelines of a lot of our professional sports games. I am not a coach. I don't want to pretend like I'm coach, but I think we can help give coach some practical guidelines so that they have healthy athletes. And at the end of the day…this is what I tell all of our coaches…you want healthy, healthy, happy kids on the field who are going to perform for you way better.

Pete Kenworthy

All right, Dr. Voos, we appreciate your time. It has certainly been enlightening for me and hopefully for many others. Thanks for being with us.

Dr. James Voos

I appreciate it. Thank you very much.

Pete Kenworthy

A reminder, you can find our podcast on iTunes, Google Play Music, Stitcher or wherever you get your podcasts.

Macie Jepson

For more health news, advice from medical experts and Healthy@UH podcasts, go to UHhospitals.org/blog.