Active Kids at Risk
"More than 30 million kids in the United States play sports at all levels today," Dr. Metzl reports. "The number of kids in formal sports participation has increased dramatically. You don't just play soccer in the backyard anymore. You join a soccer team, you go to soccer camp."
With organized sports flourishing, many kids are more active than ever, and may be more at risk. As children reach puberty and their bodies start to change, the chance of injury grows.
"Adolescents are very much a work in progress," Dr. Metzl stresses. "It's important for parents to realize that many athletic injuries are connected to the internal process of growth and development. Adolescents develop in four ways simultaneously."
Teens mature sexually, skeletally, physiologically, and psychologically. In unison with sexual maturation comes skeletal growth. "Kids start losing flexibility as they grow. When their growth spurt starts (about 12 to 16 in girls and 14 to 18 in boys), their bones start growing before their muscles. There is very rapid loss in muscle flexibility because the bones are growing faster. Overuse injuries, including stress fractures, become much more common."
"Adolescent awkwardness is just the body growing from the outside in," Dr. Metzl says. "Hands and fingers get bigger, then legs, and finally the trunk. As the body tries to approximate its normal size, of course there's adolescent awkwardness because the proportion and disproportion is much greater."
"Physiological maturity means adolescents can exercise for longer periods of time without getting tired because they have an increasing ability to generate ATP - free energy - as they go through puberty," Dr. Metzl explains. "Their heart muscles are getting stronger, the heart can pump more blood, more oxygen is available to the tissues. That's a real change. For kids 8, 9, or 10, fatigue is a limiting factor but with puberty, it no longer is. The endpoint is more often injury - muscle, tissue, or bone breakdown."
Prevent Your Teen From Getting Hurt
The physical leap from childhood to adolescence parallels the psychological. "It's important for parents to know that kids 8, 9, and 10 largely play sports because their parents want it," says Dr. Metzl. "As kids go through puberty, the process of personal identity comes into play: ‘I'm not playing soccer, but I am a soccer player.' Their endpoints - the limits to which they'll push themselves - change in a well-defined shift that parallels the shifts in growth and maturation." And as adolescents push themselves, they may be pushing themselves toward more injuries. A teenager is much more likely to play through the pain, until the pain becomes unbearable.
Teens suffer from two kinds of injury, says Dr. Metzl, macrotraumatic and microtraumatic injuries. "Macrotraumatic injuries are the big, bad injuries, fractures and ligament injuries - the acute injuries that most often end up in my office or the emergency room. Microtraumatic injuries, or repetitive use or overuse injuries, are statistically more common in adolescence, though sometimes they don't end up in the office until something bad has happened. These are not one-time injuries. This is the kid who complains of knee or foot pain on and on - not because of one particular incident - so it doesn't receive so much attention. Overuse injuries are much more common as kids go through their growth and development, as they lose flexibility, as they can push themselves further, and because they tend to push themselves further."
Dr. Metzl advises parents to look for ongoing complaints so they can catch a microtraumatic injury before it becomes acute. "I hate the term growing pains, especially in athletic kids. I do not believe in it. I've rarely seen it. Most kids complain for a reason," he says. "If this is something that's making your kid limp, or that's keeping him or her out of an activity, have the child seen by your doctor. If they're having enough pain to say, ‘I don't really feel like playing soccer or dancing,' it's important for parents to listen and have it checked out by someone who knows what they're doing." Take the teen to a pediatrician or sports medicine specialist, before the pain becomes an acute injury such as a fracture. And the reality is that repetitive use or overuse injuries left untreated do often become the more serious kinds of injuries such as fractures or ligament injuries.