Preventing Overuse Injuries in Young Athletes with Molly McDermott, DO

Intense training in a single sport often leaves young athletes broken down and burnt out. In this podcast, sports medicine specialist Dr. Molly McDermott discusses how to help your child stay injury-free and in the game as they pursue their athletic goals.

Transcript

John Horton:

Hello and welcome to another Health Essentials podcast. I'm John Horton, your host. Kids who specialize in a single sport often view that focused effort as a route to athletic success. The workload, however, often leads to a different destination, a doctor's office. Overuse injuries account for about half of all sports related medical visits for children. Research shows that kids are breaking down and burning out under the burden of unrelenting training. So how can you keep your child injury free and in the game as they chase after their goals?

Those are questions we're going to explore with sports medicine specialist Molly McDermott. She's one of the many experts at Cleveland Clinic who visit our weekly podcast to chat about health issues affecting families like yours. With any luck, listening to Dr. McDermott today will save you a visit to see her later. Welcome to the podcast, Dr. McDermott. Thanks for stopping by to talk shop.

Molly McDermott:

Hi, John. Thank you so much for having me. I'm very excited to be here today.

John Horton:

Well, we're excited that you were with us. So I think it's fair to say that most people view sports as a really healthy activity for kids. After reading up on overuse injuries, it seems like participation has taken an unhealthy turn for some. What is happening on our fields, courts and tracks?

Molly McDermott:

Yes, sports participation has definitely changed. We think athletes are facing different pressures than they were before and so that pressure for a scholarship to become a professional athlete, to become a semi-professional athlete, these are things that athletes are starting and thinking about from a much younger age. I mean, I remember even when I was growing up um some can look at me and say, "Hey, it wasn't that long ago, but when I was growing up, people played and athletes played multiple sports and now it's we're really focusing in on that one sport early on and we're seeing these overuse injuries, burnout, and just seeing over training.

John Horton:

Well, and we're going to dig deeper into that day because it really is just a growing problem.

Molly McDermott:

Absolutely.

John Horton:

So when people talk about overuse injuries, the phrase you often hear is repetitive stress. Can you walk us through exactly what that is and just why it takes such a toll on bodies.

Molly McDermott:

And repetitive stress is just that. It's these repeated stress placed on a bone muscle or tendon or where muscle attaches to bone that can cause injury, especially in these younger athletes, in these areas of weaker growth centers and we see that and we see this repeated stress over time without your body able to take a break. So I think about it a lot like if you're playing soccer and swimming, those are two sports that I played and you're playing soccer all year round and you're running and that's constant pressure on your knees, that's repetitive stress on the knees.

But if you can switch and take a break from that and then you swim and that puts more pressure on the shoulders, you're allowing that joint to rest and recover. And so this repetitive stress is small traumas to this area that can lead to these overuse injuries.

John Horton:

Well, and with repetitive stress, I'd imagine that's one of the reasons why we see so many injuries where you wonder what happens. A kid is just out there running or they make a simple cut that they've made 10,000 times before and all of a sudden they go down with an injury. And I guess the problem is that they have done it 10,000 times before.

Molly McDermott:

Exactly. And that's where if we use these different joints and we put different stresses on different joints or different parts of our body, different muscles, we know that repetitive stress is not weakening, just that one area. It's spreading out through our body and allowing our body to rest and recover in different areas. And so yeah, we can see it. We see it a lot when we get to that sport really early and that's the only thing we're focusing on.

John Horton:

Now, what are some of the most common overuse injuries that you see in young athletes?

Molly McDermott:

And that's a great question. So a lot of things that we see sometimes it's easier to link it to that sport too. So some of our more jumping sport like volleyball, basketball. We see something called jumper's knee or that patella tendon on the front gets very inflamed and very pain painful. In our gymnast, something we see, I know we name these all really well, it's called gymnast wrist. It makes it easy for us, right?

John Horton:

It does.

Molly McDermott:

Exactly. And if that repetitive stress on one of our growth centers at our wrist, we see it in our baseball players too. That repetitive stress of throwing, throwing, throwing constantly, we see that injury to the growth center in our shoulder and so these various sports can have these injuries. We also see stress injuries of the bone. We see it more commonly in the lower extremity or lower legs, but we can see it in our upper body and so that's where these stress injuries can be too much bone breakdown and not enough bone recovery and put our athletes at risk for fracturing.

John Horton:

Wow. Now the stress injuries, is that an actual kind of micro fracture in the bone or is it just where you start seeing where it looks like a brake is going to come if you continue doing what you're doing?

Molly McDermott:

Yeah, great question. It's this continuum of where we see it's kind of these bone... We have bone cells that break down and bone cells that repair, and so it's very graded. We actually have a nice grading system that we use and it's something that we're always... It's a popular question I get like, "Do I really have a stress fracture?" And these stress changes that we see on a cellular level where these small micro traumas and we're not having enough time to recover, and so we can see it early on just, "Hey, we're getting pain localized," all the way to where we actually can fracture the bone. So it's this very graded system that we see.

John Horton:

Yeah. Actually we have some experience with that in our house. I had a son who ran a lot in high school and he got shut down with what looked like was going to be a break. And I still remember looking at the X-rays and you didn't see a break, but the bone looked so odd and you could see that something was not right.

Molly McDermott:

Absolutely. And that's what we want to prevent is, "Hey, we don't want to get to that point where it completely fractures, but it's at risk for doing that if we don't allow your bones to rest and recover and take care of it." Absolutely.

John Horton:

Well, it bought him about a month in a boot, which I know is a very common choice of footwear. It seems like among athletes.

Molly McDermott:

Absolutely. Boots, crutches. I tell them, don't throw them away because the second you throw them away, then you'll need them right back again.

John Horton:

And that's the problem. It's like we keep doing this to ourselves just by making the same mistakes over and over and over again.

Molly McDermott:

Yeah. Once you have an overuse injury, it does put you in that category of higher risk for having a future injury and especially an overuse injury as well.

John Horton:

And that's what I want to look at next. You think of kids and they recover from everything it seems like in a blink. But are these overuse injuries likely to become long-lasting issues that can affect them as they get older and creaky? I know how I feel most days.

Molly McDermott:

And these overuse injuries, they can be just like your son a few weeks, a few months, season ending and they can also be career ending and have implications as we move through our later life. And it really takes a toll on the body. And just as I said, once you have a risk for injury, it can put you at high risk. Interestingly, this impact is quite significant. I think it starts in that adolescent and something that we see are these athletes dropping out and that leads to problems in the future as well, not just from a musculoskeletal standpoint, but just from an overall health standpoint.

According to a recent updated article on overuse injuries by the American Academy of Pediatrics, 70% of youth athletes are choosing to discontinue participation in organized sports by 13 years of age. And I thought that was really, really interesting. I have another statistic here, I wrote these down and they also mentioned that discontinuation of sports during childhood plays a role in more than 75% of adolescents in the United States that are failing to meet these physical activity requirements.

So we talk about the obesity epidemic, we talk about obesity rates increasing. It's these athletes who were dropping out of sports and they don't want to do any activity. And so we're seeing these implications in more ways than just in our sport.

John Horton:

See, and this is what's so sad because you like to think of sports as a gateway to enjoy athletics and physical activity that you can do your whole life to stay healthy, but when you do so much and just beat your body up that much, it seems like kids are just saying, "You know what, I'm done." And that is not good long-term.

Molly McDermott:

Absolutely. Like I said, musculoskeletally, yes, we care about your bones and joints, but we truly care about these adolescents, these children as they grow and they have that relationship with health and wellness and fitness overall.

John Horton:

Now looking at kids specifically because anybody can get an overuse injury. I mean, if you just go out and do the same thing over and over and over again, you can get hurt. But I guess kids are more prone to overuse injuries than adults, right?

Molly McDermott:

Absolutely. We've seen that and that's something that we're always actively studying and we know kids are growing. They have these growth centers that all that repetitive stress that we talked about earlier places them at high risk of injuring these growth centers as they're weaker, especially as they do not have skeletal maturity yet. And so we can see these injuries in our younger population.

We also know that younger kids, they may have not perfected their form, they may have poor form. They may have lower levels of activity overall as they're starting to build, which also puts them at increased risk for having these overuse injuries.

John Horton:

All right. Well, clearly nobody wants to push a kid to the point of an overuse injury. So Dr. McDermott, can you offer us some tips to keep young athletes healthy and in the game?

Molly McDermott:

Absolutely. I think something that's easy that we can do is just taking a break from sport for recovery. And that's not all sports, so we have plenty of athletes that play sports and they play sports all year round, but as we mentioned, it's taking a break from that sport and giving yourself a break for approximately two to three months and using at least a month increment at a time to do that.

I also think it's really important in that same vein that sure say you're only in... I keep using soccer because that's something that I know really well. And you can be on high school soccer, you can be on club soccer, you can be on travel soccer. There's a lot of soccer teams and limiting that-

John Horton:

It never ends.

Molly McDermott:

It never ends. It's like, "Oh yeah, I finished that practice and now I'm going to the other one." And so it's limiting that to one team during one season can be also really helpful.

John Horton:

Now, you mentioned taking that break and I know for a lot people the idea of shutting down and walking away from your sport for two months or three months just sounds undoable. How do you get past that?

Molly McDermott:

Yeah, I think so. That's where we talk about those playing other sports. It's hard to walk away. We want kids to be active and we talk about multi-sport participation. I think it's important that we view multi-sport participation as not doing multiple sports simultaneously. It's spacing them out. We want these multiple sport experiences distributed throughout the year.

So I think that trying to appeal to our athletes that way is key. And then also building a rest day and then telling them, and trying to get them to understand that rest is not a break and rest is really important as your overall athlete in your recovery process.

John Horton:

How many rest days should a young athlete have in a week? Is this something we should always make sure there's one day where you rest two days? Is it case by case?

Molly McDermott:

Usually, we say one to two. At least one. So one to two. It's interesting when I interview athletes and talking with them and just going over, "Hey, what is it a week look like for you?" They'll tell me, "Okay, yes. And on Sundays..." And that's typically a day they like to rest and recover. Sundays I go and I swim, or I do a light jog and that's my rest and recovery day. It's like, "No, that's still activity. That's still doing something." And so it's really focusing, I want a rest day from sport and sport specific activity.

John Horton:

So nothing on that rest day. See, I was thinking... See this? I do this where it's like you have a rest day and you go and you bike 10 miles. And it's like so that doesn't count, right?

Molly McDermott:

Right. It's refueling. It's hydration. It's sleep. It's allowing your body to truly rest and recover and the emphasis, especially in the last few years, we're really starting to emphasize that we have to let your body recover.

John Horton:

See, and I don't think people really understand that. And I know I don't. Well, I feel like I know I should do it, but yet it's just so hard to because you like being active. So just laying around and focusing on hydration and eating and getting some rest just doesn't scratch that competitive itch that a lot of us have.

Molly McDermott:

Absolutely. And it can even be looking at film, looking at reviewing something that keeps your mind still in the sport and in the game, but really allows your body to have that break so that you can perform well. We have to view that rest day not necessarily as being lazy, but allowing our body to take the necessary rest it needs to build it so that we can be stronger on that day when we're back to activity as opposed to, "Okay, hey, we still exercise our muscles and now they still haven't had that chance to fully recover."

John Horton:

I like that you have to look at it as an actual like an exercise. It is your practice, but it's just a practice where you're resting.

Molly McDermott:

Absolutely. It's building that mentality for our athletes that this recovery is a key part of being an athlete. It's not just pushing through. It's not just lifting heavy. It's also being the best at recovering too.

John Horton:

Well, looking at other tips, I know one thing I saw come up again and again was focusing on proper form. How much of a role does that play in overuse injuries?

Molly McDermott:

Pretty significant. We are always constantly looking at form at the Cleveland Clinic is to actually develop multiple different physical therapy forums and groups that specifically looks at forms for prevention of injury. We have different programs like Jump Smart, Run Right that look exactly at that form to prevent and catch injury so that we can train in that good form and then that continues to limit our risk for overuse injuries.

John Horton:

I take it if you're just off a little bit on something like you were mentioning running. If your gait is just slightly off, like you said, doing it once or twice they're going to do anything. But if you do that over a thousand miles eventually you cause an issue.

Molly McDermott:

Absolutely. And your body is all connected. And so I always tell people when I'm talking to them, they come in with knee pain and I'm looking at their feet and they're like, "What are you doing doctor? My pain is up here." And it's like, "Well, ground up. Everything is connected. Everything can be very impactful." And so it absolutely is. Your form and how you move, and how you walk, and the shoes that you wear, all of that plays a significant role.

John Horton:

What about as far as... We're talking about training before too. I know conditioning plays a big role in that. And it seems like there's a catch 22 here. When you need to condition to get in better shape, but you have to be in better condition to get in better shape too. I mean, you're constantly chasing something. If you go too hard too often, is this something that's just going to lead to breakdowns?

Molly McDermott:

It's a great question. Not necessarily. I think it's that balance, right? And that's where if we're constantly trying to work and work at that highest level, we're only training one type of muscle as well. And so if we're at full speed sprinting all the time, but we have different muscles, they work in different ways, we have to train our special muscles for more aerobic versus anaerobic. And so it's really where we have to have that balance of cardiovascular versus weight training to really break it up and make sure that we're giving our body the best tools to be able to perform when we need to have everything firing at the same time to perform.

John Horton:

How much of just dealing with overuse injuries is just taking care of your body and the basic needs.

Molly McDermott:

It's huge. And that's where we talk about that rest, recovery, proper hydration, drinking water. I know I'm guilty of all the carbonated water, which is okay, but really just fueling and getting that good water hydration. I think something else that's really important is just getting regular checkups as well. Seeing your pediatrician, seeing your primary care physician, making sure your body otherwise from getting the nutrient levels need, if we need any blood work, just make sure we're growing properly. All those things play a big role into prevention of these overuse injuries.

John Horton:

Now kids aren't exactly known for being open books when it comes to sharing information. So if you're a parent or a coach, what are some warning signs of potential overuse injuries in young athletes?

Molly McDermott:

It's a great question. I know sometimes I get these adolescents in my office, I'm like, "Do you have pain?" "Not really." I'm like, "So is that a yes or is that a no?" So we see a lot-

John Horton:

They never want to really tell you, yeah.

Molly McDermott:

There's no commitment. It's like, "Maybe. Are you going to shut me down or not?" is what I get a lot. And so I think sometimes it can be challenging. So looking, trusting your gut, these parents, these coaches, they know these athletes very well. So looking for some things more non-specific things like more fatigue, mood changes, which I know sometimes can be challenging in our adolescence, but just looking for maybe their academic performance has taken a hit or has dropped.

Looking for some of these more non-specific changes, especially a change in sleep. If they come to you with this kind of vague muscle or joint complaint, I would give them that attention and say, "Hey, tell me more about that. Do we need to see the athletic trainer? What's going on here?" But some of these more specific muscular complaints, but also some of these non-specific complaints, just getting your ear up, just keeping a little bit of a closer eye on them.

John Horton:

When you start looking at the muscular issues or the physical pain that kind of comes up, what are some of the big warning signs that you have an overuse injury that's kind of growing?

Molly McDermott:

Sometimes people will be like, "Okay, yeah, I hurt, and then it gets better the more I do," I'd say if it continues to hurt is something. If it's waking you up at night, that's definitely something you need to see a medical personnel for some of those injuries, something that's just not getting better. You keep trying, keep trying, you're doing. You're like, "I am trying the rehab. I am trying to stay hydrated. I'm trying to rest and recover and it's just not getting better or getting worse despite that," those are definitely signs that we need to get an evaluation.

John Horton:

Let's see where is the line with that? Because I know a lot of people, if you do a lot of physical fitness being sore and being a little achy, it comes with the territory. So I think a lot of us struggle when that pain or soreness is a problem versus when it's natural.

Molly McDermott:

Absolutely. I do think it's challenging and that's why these overuse injuries can be quite challenging. And that's where we try. We always start with rest, all these, and consider use of the anti-inflammatories. If something feels wrong or different, or it's still ongoing, you're not... It's more than muscle soreness. It starts to turn into a sharp or more uncomfortable pain is the time to say, "Hey, I'm not going to push through this. I'm going to see if I can get this checked out."

Or if you're starting to have the pain at rest while you're not exercising or not active, if you do something you normally do or experiencing that pain, that's changing or different from you, there's definitely muscle soreness as you recover. But if this feels different, I think trusting your body is really important.

John Horton:

Now, you just mentioned shutting down. And I know if you're an athlete, that is the last thing you want to hear. And I think that's one of the driving forces in a lot of these issues that we're seeing. There's this pressure to succeed that just continually pushes people to train, and train, and train some more. And then it goes hand in hand with this belief system that if you are resting, someone else is working harder and they're going to pass you by. How do you balance all of that with the reality of overuse injuries?

Molly McDermott:

I think it's very tough. Absolutely trying to change that mindset I think is key. We talked about changing the mindset of this kind of viewing rest is not, "I'm being lazy," but is part of my actual routine as an athlete. So I think that-

John Horton:

How are you going to get better?

Molly McDermott:

Exactly. I think it's how we have to look at and view our mindset on these things. I think it's really important. Yes, how much did I lift? How much did I run? But it's also, "Hey, where's my nutrition? How many hours did I sleep? How much water have I drank today?" It's just viewing that mindset of, "Yes, I want to be the best athlete, but this is also fitness is really important for my overall health and wellbeing." And that fosters a really good relationship with activity that can keep us going for many years to come. And also will help us in our athletic performance.

Something interesting, athletes are really tied into their athletic identity. It's a huge driving force and sometimes so much so drives them into these overuse injuries. They just are so ingrained in being an athlete. I think if we can change how they view being an athlete and view the recovery and rest as part of being an athlete, I think it's really going to help them.

John Horton:

I want to go back to that statistic you brought up earlier with that high percentage of kids who just drop out of sports. And to me, that's the saddest thing I've heard in a long time because you hate this idea that kids... They have this love of a sport and yet they train so hard and so much that they walk away from it. And that could have issues with their fitness going all through their life.

So when is the right time, or how do you approach the conversation with your child about that, about getting that lifetime love of fitness as opposed to just pushing to maybe get a scholarship or turn pro?

Molly McDermott:

That's a great question. I think we also have to lead by example. I have a toddler at home and he asked me why I was working out and my first thought quickly was like, "Oh, I want to lose weight." But instead I changed my answer and it was said, "Oh, I want to get strong. Mom wants to get strong to take care of you." And so I think we have to start even how we view, and it's been ingrained in us athletes. You work hard. We've talked about you work hard. You achieve. But if we can foster that at home and listening to the athlete, if they are starting to get these injuries or they're pulling out of practice or they're withdrawing, it's saying, "Hey, do we need to take a season off? Do we need take a break off? Do we need to take that month off? Is it time for a rest period or a change?" And I think just being really open and honest and leading by example of making activity a really important part of your lifestyle is key.

John Horton:

That's perfectly said, Dr. McDermott. So before we part ways today, is there anything else you'd like to mention regarding protecting young athletes from overuse injuries and just growing their love of fitness and activity?

Molly McDermott:

I think as a parent or coach, I really think you need to trust your gut. I think that if something is not right to you, involving medical personnel early, the athletic trainer. We have many athletic trainers at school. Their primary care doctor, their pediatrician, us in sports medicine, just saying, "Hey, we want to make sure." Even just for a conversation of how to be healthy and how to continue to enjoy activity and prevent these overuse injuries is an absolutely appropriate conversation.

So I think trusting your gut. It's our job as medical professionals, parents, coaches, teammates, to really just make sure we focus on that wellness and give them the tools to be able to allow them to listen to their bodies to really help these athletes succeed.

John Horton:

Well, Dr. McDermott, I'm hoping our conversation today maybe saves a few young athletes from the overuse injuries we've been talking about.

Molly McDermott:

Absolutely. Well, thank you so much for having me. It's been a pleasure and I truly hope so.

John Horton:

Thanks a lot. The professionalization of youth sports has kids training longer and harder than ever before, and they're feeling the consequences. Take steps to protect your child from overuse injuries by building breaks under their training. Getting some rest after all may be the key to them staying active. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/agpodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.