Haley Lewis’s injuries started the summer before seventh grade with a left ankle sprain. She’d been playing soccer nearly nonstop en route to the state finals with her local Newton team, while also competing for an intense soccer club.
Then came the fracture in her pelvis, from constant kicking. Now, the 16-year-old is rehabbing a cartilage tear in her left knee; it sidelined her the entire summer. She hopes to rejoin her soccer teams later this month.
“I’m in a very competitive environment,” Lewis said. “Usually I try to play through [injuries] and I’m not sure that’s the best thing, but I do.”
Lewis has plenty of company. The phenomenon of children’s specializing in one sport at increasingly higher intensities has continued unabated, despite more than a decade of warnings from physicians and physical therapists about the harm it does to young bodies. So too, have the fractures, tears, sprains, and worn-down young joints.
About 22 percent of soccer players 14 years old and younger are hobbled by overuse injuries, according to the American Academy of Orthopaedic Surgeons’ OneSport Injury campaign, the academy’s latest initiative to reverse the trend of overuse injuries in children and teens. The percentages are even higher for young baseball (25 percent) and football players (28 percent).
“In middle school and high school kids, 50 percent of injuries we are seeing are preventable if these kids weren’t playing year-round,” said Dr. Elizabeth G. Matzkin, chief of women’s sports medicine at Brigham and Women’s Hospital and an associate professor at Harvard Medical School.
The lure of mastering a sport at a tender age to gain college scholarships or entree into the pros can be a big driver of these overuse injuries, said Matzkin. She advises children to play multiple sports throughout high school, rather than specializing in one.
“These kids and parents, they all live the dream,” Matzkin said. “I see it everyday in my clinic, and I get it. I have three kids and they all play sports. It’s their life. It’s their identity.”
Sports medicine specialists say they try to encourage enthusiasm for youth sports, which are beneficial for young bodies and minds. But they want to help kids avoid injuries and burnout, and to understand the reality: A small percentage of young athletes will be recruited to play at college, and a vanishingly small fraction make it to a professional level.
Fewer than 10 percent of high school athletes, with the exception of ice and field hockey, and lacrosse, will go on to play at college, according to the latest data from the National Collegiate Athletic Association. Fewer than 2 percent of college athletes will become professional basketball or football players, and less than 10 percent will make it to the majors in baseball and hockey.
Still, it’s often hard for some players and their parents to keep these statistics in perspective, said Haley’s father, Craig Lewis, who has coached youth soccer in Newton for more than a decade, including his three daughters’ teams. Over that time, he said, it’s been increasingly difficult to keep youngsters from playing their chosen sport constantly.
“If one kid hears another kid is doing it, then they all are doing it,” Lewis said. “We try in the summer to give our girls time off, but it’s very hard. The club team is non-negotiable. If you don’t come to 90 to 95 percent of practices, they won’t keep you on the team.”
Dr. Matthew Salzler, chief of sports medicine at Tufts Medical Center, said he has seen a fairly significant increase in hip, knee, and ankle injuries in young athletes, most typically in gymnastics and endurance running, such as cross country and track. He’s also seeing an increase in shoulder injuries in young baseball players.
“Their bodies are still developing, so stress fractures suggest that there is too much stress on the bone, and as their bodies grow, they can be at risk for stunted or abnormal growth,” he said.
Dr. Nancy Robnett Durban, a physical therapist at Cincinnati Children’s Hospital and Medical Center, and a spokeswoman for the American Physical Therapy Association, said areas around the growth plates — the places where the bone lengthens in still-growing young bodies — are often where she sees overuse injuries in young athletes.
“We see a lot of Sever’s Disease in the heel at the bottom of the foot, where they bear weight,” she said. “We see a lot of little soccer players with this.”
Sports medicine specialists say they worry that a generation of overly ambitious young athletes will face the agony of osteoarthritis, particularly in their knees, before they’re middle-aged. Of particular concern are knee injuries involving the anterior cruciate ligament, or ACL.
“ACLs, we can reconstruct them, and they will be out on the playing field again and do great,” said Matzkin, the Brigham and Women’s physician. “But 25 to 30 years from now, you will have degeneration in the knee.”
Just a couple of decades ago, it was rare to see ACL injuries in college athletes. Now, Matzkin said, it’s pretty common to see them in young teenagers, as young as 13, which means some may develop osteoarthritis in their knees in their early 30s.
Matzkin said the college athletes she sees tend to have coaches doing a better job of monitoring strength training and nutrition to help athletes adhere to proper techniques and avoid injuries. The problem, she said, is for younger athletes and their volunteer coaches, who may not have access to the same resources or information.
Matzkin and Salzler, the Tufts physician, recommend that young athletes take one day off a week from all sports to give their bodies a rest. They also suggest children try different sports to give overused parts of their bodies a break.
“Even if you are a runner or swimmer, find a day or two for another activity to build different muscles,” Salzler said.
Both specialists say proper strength training, such as squats or lunges, are fine for athletes as young as 7 or 8, but caution against weight lifting and resistance training until a child’s growth plates are closed, typically around age 13 or 14. Both physicians also advise youngsters to rest if they feel an injury coming on, and seek medical attention if the pain persists more than a week.
Haley Lewis, who is starting her junior year in Newton and wrapping up physical therapy for her knee injury, said her high school and club soccer teams are diligent about proper stretching and strength exercises before practices and games. Still, she has endured overuse injuries because, she said, she compensates when playing through her pain, placing more weight on the other side of her body and getting injured, again.
Her physical therapist has cautioned her to come back slowly, and has not cleared her to play soccer again for at least another two weeks. Lewis can’t imagine not playing soccer someday. But she realizes college competition is a long shot.
“I am just enjoying it for now, and I don’t want it to be ruined for me,” Lewis said. “I want to be a healthy person when I’m older and go to the gym.”