Last August, Garrett Tarbet, a kicker and defensive back on the varsity football team at Lakeside High School in Hot Springs, Ark., began feeling pain in his shins and the left foot he uses as his planting foot for kicking. The 17-year old junior didn’t want to miss practice or play, so he kept quiet and figured he’d “play through it and see if it got better.”
It didn’t. Like many young athletes, Garrett had gradually developed an overuse or repetitive trauma injury. In his case, it was a form of tendinitis. For the last six months, he has been working on an intensive rehabilitation program with his high school’s athletic trainer, TJ White. During his recovery Garrett was able to continue to play football.
Overuse injuries are caused by repetitive stress on the muscle and skeletal system without enough rest to allow the body to adapt. They are a special risk for developing bodies and immature skeletons and often happen during the adolescent growth spurt. Studies show these injuries account for more than half of pediatric sports injuries and often happen due to intensive focus on a single sport with a heavy practice and competition schedule. Unrecognized and untreated, they can sideline athletes from play and lead to more serious injuries and disability.
Now sports medicine experts are advocating a greater role for athletic trainers like Mr. White, who can help students recover without incurring lasting damage or hampering their sports activities very much. The trainers specialize in sports-related injury and rehabilitation and are licensed or otherwise regulated in 49 states and the District of Columbia.
The American Medical Society for Sports Medicine published recommendations in 2014 warning of excessive focus on early intensive training and competition, and recommended measures including limits on repetitive movements such as pitching, preventive training and conditioning regimens, and scheduled rest periods. Requiring a pre-participation physical exam to assess sport readiness and identify prior injury patterns “gives parents a better basis for making a decision about their child’s participation,” including whether it is best to consider alternative sports depending upon any particular vulnerabilities, says John DiFiori, head of the division of sports medicine at the University of California Los Angeles and lead author of the recommendations.
Access to athletic trainers in school sports programs has doubled over the last 20 years, but only about a third of high schools have full-time professionals on staff, according to the National Athletic Trainers Association. Moreover, many community programs such as soccer and gymnastic leagues don’t have athletic trainers on board. Some states are considering legislation to require a medical professional be present at high school sporting events,
Researchers are also learning more about overuse injuries. A study, published in the January 2015 Clinical Journal of Sports Medicine, found that overuse accounted for 52% of all injuries among a random sample of sports injury patients seen at Boston Children’s Hospital from 2000-2009. Some 61% of the injuries were to a lower extremity.
While overall injuries were about evenly divided between males and females, 63% of females had overuse injuries, compared with 40% of males. Anatomical differences are partly to blame for the discrepancy. Females are also more often playing in activities with higher overuse risks and less often playing in sports with collision-risk, such as football, according to co-author Lyle Micheli, director of the division of sports medicine and an orthopedic surgeon at Boston Children’s.
Another study of a large national sample of injuries reported by high school athletic trainers, funded in part by the Centers for Disease Control and Prevention, and published last March in the Journal of Pediatrics, found that overuse accounted for 7.7% of all injuries that kept players from their sport for at least a day. Overuse injuries by sport ranged from a low of 1.4% of boy’s ice hockey injuries to a high of 55.7% of boy’s swimming and diving injuries.
“Overuse injuries should never happen in first place, or they should be caught when they are so minor that rest can prevent them from turning into a medical issue,” says study co-author Dawn Comstock, an associate professor at the Colorado School of Public Health at University of Colorado Anschutz. Because coaches may discount overuse injuries and athletes may hide them for fear of missing competition, she says, it is important for athletic trainers to intervene and suggest reduced training or practice when more severe injury threatens.
At Lakeside High School, one of Garrett Tarbet’s coaches was the first to notice his knee seemed to be bothering him. He sent him to see the athletic trainer, Mr. White. At first, Mr. White had Garrett resume wearing orthotic shoe inserts he had neglected to use. That helped his shin pain, but it became apparent something more was going on, according to Garret’s father Duane Tarbet, a lieutenant in the Hot Springs, Ark., Police Department’s criminal investigations unit. “Teenagers don’t tell you a lot, but he started coming home with ice packs and complaining about pain and it was getting progressively worse,” he says.
Lt. Tarbet set up an appointment with orthopedic surgeon Lawrence Dodd, Lakeside High’s team doctor, who diagnosed patellar tendinitis, an injury to the tendon that runs from the kneecap to the shinbone and can be strained during jumping and landing. The patellar tendon attaches to the growth plate of the kneecap, and repetitive stress on the tendon can irritate and injure the growth plate in young athletes. While most growth plate injuries heal without lasting damage they can also affect bone growth.
As only one of two kickers Garrett didn’t want to let his team down, so after conferring with his parents, he says he decided to “manage it as it goes along, and as soon as football season ends, take a long rest” before starting soccer in the spring. Dr. Dodd and Mr. White consulted on a therapy routine so Garrett could play during the season. It included daily stretching and applying hot and cold therapy with an electrical stimulation device to improve blood flow to muscles and reduce pain. During football practice, Garrett kicked fewer balls and he rested for three days after each game.
Garrett, who was diagnosed at age 8 with Type 1 diabetes, wears an insulin pump under his football uniform. His father says the condition hasn’t held him back from sports and didn’t affect his overuse injury.
Don Pierce, Lakeside’s athletic director, says his coaches defer to the athletic trainers. “They know what kids can and can’t do, and if TJ says they are out or need to cut back on training we take them out or cut back,” Mr. Pierce says.
Though his football team ended up losing in the playoffs, Garrett says he is happy he got to stay in the game until the season ended last month. Though he plans to play on the soccer team in the coming spring season, he is in a rest period now. He continues to work on rehabilitation with Mr. White three to four days a week. A recent X-ray indicated there is still some space between the growth plate and bone, which is causing some pain, “but that should resolve in time,” his father says. By the time soccer starts in March, “he should be ready to play and hopefully be pain free.”
Athletic trainers play an integral role in preventing overuse injuries in young athletes, but “the horse is often out of the barn by the time the athletic trainer gets involved,” Dr. Micheli says. “We have to look at the design of our training programs before the kids get the injuries.”