Playing sport improves anyone’s physical condition, and young people most of all. During training and competition, though, injuries are common, and many of them are the result of a combination of psychological, physiological and biomechanical factors. That is why injury prevention has to be part of an athlete’s education from the very beginning of their sporting career.
Young athletes have always seen physical activity as a chance to compete and show what they can do in a particular discipline, while they build coordination, strength and stamina.
To get the best out of that, though, training has to be supervised by professionals in the chosen sport, and the intensity of the exercise has to match what the young athlete can actually handle.
And because teenagers are still growing, injuries can be very common while they play. In some cases those injuries can even interfere with bone development, with consequences that last well beyond the season.
Types of injury
Before talking about injury prevention, it is worth understanding the causes and the consequences of injury for an athlete, physically and emotionally, and particularly for young athletes in high-performance sport. So let us start by defining the main types.
Broadly, and following Dr José Pablo Muñoz, a specialist in paediatric orthopaedics and traumatology, injuries in teenage athletes are either acute or caused by overuse.
In both categories the injury can affect soft tissue — ligaments and muscle — as well as bone. We will start with acute injuries.
Acute injuries
These are the injuries caused by an unexpected impact in the middle of a training session or a match: a collision on the pitch, or a collision between players.
They are also known as macrotrauma, and the most common of them are sprains — ligament injuries, which can be partial or complete tears.
Then there are contusions and fractures, along with the strains that happen in tendons and muscle.
Overuse injuries
When we talk about young high-performance athletes, we mean the ones who train in a discipline with professional intentions from an early age.
That means a large part of their time goes on intense, routine training: building physical condition, learning patterns of play, working on their own or with the team.
In this group, overuse injuries are the ones that build up as microtrauma because of how often they train and play, in one sport or in several at once.
They are common, for example, in basketball players, who suffer fractures in the lower limbs, repetitive injuries to local tissue such as the metatarsals, or trauma to the lateral joint of the elbow.
The result can be chronic pain lasting months, which affects the athlete’s performance but also everything else they do in a day.
Risk factors behind overuse injuries
Because so many young athletes get injured, the Sports Medicine Clinic at Boston Children’s Hospital set out a series of factors that help establish the cause of overuse injuries in teenagers — and how to prevent them.
Those factors are: training error, anatomical misalignment, footwear, playing surface, muscle-tendon imbalance, nutritional factors, and conditions related to illness or other underlying pathology.
Training error
A young athlete who takes up a sport at moderate intensity without any previous physical preparation is more exposed to this kind of injury, because there is rarely a professional supervising the training. They end up following routines that do not match what their body can take.
Anatomical misalignment
Some people have a misalignment in the spine or the lower limbs that never caused them any trouble until they started playing a sport, and now gets in the way of their performance.
You see it in teenagers with flat feet, with one leg longer than the other, with abnormal hip rotation, and with other conditions that involve the way the bones are developing.
Footwear
Closely related to the previous factor is the use of footwear that is wrong for the sport in question.
How well the boot or shoe fits matters too, as does the type of sole and cushioning, and materials that trap heat or fail to support the back of the foot.
In the wrong shoe, all of that adds up to discomfort and then to chronic, intermittent injury.
Playing surface
When the surface an athlete plays or trains on is not right for them, pain in the lower limbs tends to increase.
Microtrauma also shows up in players who change surface very often — tennis players, for instance, moving from synthetic courts to clay.
Muscle-tendon imbalance
This is one of the most important risk factors according to Boston Children’s Hospital: injuries are very common in young athletes because of the stage of growth they are in, as flexibility drops and joints and limbs start to hurt.
Muscle-tendon imbalance has, in turn, several components that leave a young athlete exposed to particular injuries.
They are: loss of flexibility, imbalance across the joints caused by uneven gains in strength, and overload of particular tendons and muscles, which can lead to neurovascular trauma.
Nutritional factors
In some sports there is evidence of athletes being short of the calcium and the vitamins involved in bone density, which affects their growth and, of course, their performance, through skeletal injury or stress fractures.
Conditions linked to underlying illness
When a high-performance athlete starts to have symptoms and they get put down to a physical injury, it is worth checking whether they are in fact signs of something that has nothing to do with the sport.
That means doing the physical assessments, the tests and the specialist consultations needed to establish whether an illness is presenting itself for the first time.
Growth
Looking at the different factors behind overuse injuries in teenage athletes, growth itself is clearly one of the things to account for.
The reason is that a young athlete has an immature musculoskeletal system, and growth cartilage is a tissue that is especially vulnerable to microtrauma.
The joints are exposed too, because of how recently they have grown — something seen often in minor-league baseball players and in teenage footballers.
Injuries that keep recurring while the body is developing can lead to conditions such as arthritis in adult life.
That is why the next section is about how to prevent those injuries, so that a young athlete can keep performing the way they want to.
How do you prevent injuries in young athletes?
Sports medicine is the field that treats and prevents injury in athletes, but young athletes themselves need to know a good deal about it: to learn their own body, to recognise their limits, and to tell apart the symptoms and the warning signs of overuse.
Paying attention to those details — knowing when to stop — is the key to avoiding injury.
There are, of course, other measures that help prevent many injuries in young high-performance athletes, and here is a summary of the main ones.
Prevention measures
- Increase the intensity of the exercise gradually.
- Have a full medical assessment before the season starts.
- Avoid having teenagers play more than two sports at the same time.
- Keep a stretching routine before every session to maintain flexibility.
- Proper preparation and professional coaches are essential to protect an athlete’s performance and reduce the risk of injury.
- Recovery and rest between sessions has to be taken seriously, so that physical condition is not pushed past what it can take.
- Match the level of training and physical demand to the age of the athlete.
- Use the protective equipment the sport calls for, along with the right footwear, and keep an eye on the conditions of the session: surface, humidity, temperature and so on.
- Eat and drink properly, to keep physical condition up and get the nutrients each session requires.
- Look after mental health too, so that the athlete can handle the stress of competition without it costing them performance.
There is no doubt that young athletes need a great deal of preparation and training, and a team of specialists around them designing a programme that fits their physical condition and their abilities.
That way training moves at the same pace as the young athlete’s physical development, with injury prevention first, so that neither their growth nor their progress in the sport is disrupted.
Finally, it is worth stressing how much it matters that parents, athletes and coaches all take an active part in learning how injuries are prevented.
They also need to recognise the value of proper rest between seasons. It gives a young athlete room to develop physically and emotionally, doing things that have nothing to do with sport and spending time with other teenagers.
Injury prevention on the way back: what “increase gradually” actually means
The first measure on the list above is to increase the intensity gradually. It is also the easiest one to skim past, because it does not say what to do. And a parent’s question in August is a specific one: the boy has not trained with a group for ten weeks, pre-season starts in a fortnight, and on day one he is going to run the same distance as everybody else.
Gradually does not mean “carefully”: it means the load of the first week has to look like the load of the last week he actually did, not like the load of the squad he is about to join. That is where the jump is. A player who stops for ten weeks does not come back where he left off, and the calendar does not know it: pre-season starts when it starts, with the same volume for the boy who trained all summer and for the boy who has not touched a ball.
The weeks before are the ones you can organise
Of everything on the list of measures, almost none of it is the family’s decision: the surface, the temperature, the number of sessions a week and how hard the group is pushed are all set by the club. What you can organise are the weeks before — and those are exactly the weeks that tend to be left empty. It is the difference between arriving on day one having already gone back to playing, and arriving from nothing.
Two items from that same list belong here, and neither is worth leaving until the last minute: the medical assessment before the season starts, which the article lists as a measure and which loses its point halfway through pre-season; and matching the physical demand to the age, which over the summer depends on whoever is running the training.
This is not a promise: progressive preparation does not prevent an injury, and nobody can claim it does. What it does is make sure the first day of pre-season is not also the first day of effort.
Why a summer camp is an answer to this
A whole summer with no structure is the shortest route back to a cold start. A programme with coaches, daily sessions and a group at the same level does what the list of measures asks for: it raises the load step by step, with somebody watching, and with rest between sessions. The options country by country are on the soccer camps page, and if the question is which kind of programme suits him — high performance or a club camp — that is answered in how to tell whether he is ready for a high-performance camp.
References
Alto Rendimiento (2017) 9 causas comunes de lesión en el deportista. Available at:
[http://altorendimiento.com/9-causas-comunes-lesion-deportista/]
Lyle J Micheli and Daniel B O’Neill (1988). Lesiones por Sobreuso en Atletas Jóvenes. PubliCE. Available at:
[https://g-se.com/lesiones-por-sobreuso-en-atletas-jovenes-688-sa-o57cfb27175822]