With Lake Placid fresh in their minds and the fate of the Moscow Summer Games still the subject of international controversy, Americans are paying more attention than ever to young athletes and their training. Dr. Lyle Micheli views aspects of this national interest with alarm. "I don't know of a culture," he says, "that systematically organizes children's sports to the degree we do." Since 1968, Micheli notes, physical injury (medically known as trauma) has surpassed congenital and infectious diseases as the leading cause of death and hospital admissions in children under 14. "An increasing proportion of this trauma is caused by organized competitive sports for children," says Micheli, who directs the Division of Sports Medicine at Children's Hospital Medical Center in Boston. Now 39, the doctor grew up the son of an auto parts store manager in La Salle-Peru, Ill. and played football and baseball as a boy. At Harvard his sports were football, lacrosse, boxing and rugby (a game he still plays), and he was often hurt. Micheli went on to Harvard Medical School and in 1974 founded the sports clinic with three other orthopedic surgeons. Last year, with Dr. Robert Buxbaum, he co-authored Sports for Life (Beacon Press), a guide to injury prevention. Micheli lives in Newton with his wife, Linda, who teaches at Harvard Business School, and their two daughters. In his hospital office, Micheli discussed children's sports with Gail Jennes of PEOPLE.
Why do you say the amateur sports scene today is topsy-turvy?
Just go out to the streets and look at the fitness boom. Adults are jogging, bicycling, rollerskating. These are recreational sports, which historically belonged to our children. Now they're serious business for grown-ups. And organized team sports, in the past dominated by young adult males, are today being played increasingly by boys and girls under 12.
Is that really so bad?
It is, because children are not small adults. They have special vulnerability to injury. An equestrian does not begin training a horse for jumping until the animal is fully grown. But we allow kids to engage in arduous training, oblivious to the peril to growing cartilage and the long bones of the extremities. Now people are proposing a baby Olympics!
Is it mostly early competition that bothers you?
Competitive sports training is different from plain sports training. A child who is clumsy at age 8 may become a superb athlete at 10. But if you inject competitiveness at that early age, you lose potential athletes. Self-worth can be dramatically affected by performance under the age of 16. Kids are very susceptible to harsh judgments. They don't really know if they're good or bad or what they are.
How high is the injury rate in children?
The statistics are a little haphazard. Studies seem to indicate that the relative risk of injury is low. But the potential for permanent injury is real. Neck injuries to young players on the gridiron, for example, may have long-term arthritic consequences.
What are the most common injuries?
Boys tend to get hurt at the knee, elbow and ankle, most often from football and baseball. Girls usually suffer muscle and tendon injuries, shin splints and back problems such as spondylolysis, which is a serious fracture of the spine. I'm particularly concerned about back injuries, which are becoming more widespread.
Are girls more easily injured than boys?
That's baloney. Up until age 10, boys and girls are similar in strength and fitness. A girl climbs trees and gets into the rough-and-tumble right along with boys. Then, from 10 to 16, she can get deconditioned, and be in no shape to handle rough stuff. But it's probably cultural: nurture, not nature. With proper training, girls can have as much resistance to injury as boys.
Isn't the injury rate for girls increasing?
At our clinic the number of female patients has risen from 20 percent to 40 percent. But that's mainly because more girls are playing sports.
Which sports are most dangerous?
Football causes the most injury among boys. Among girls it's running, field hockey and gymnastics, which is a real contact sport—contact, that is, with the floor.
Why is gymnastics harmful?
The constant pounding—what we call microtrauma—has ill effects over time. Microtrauma can also occur from distance running, posting on a horse or diving off a springboard. Little League elbow results from repetitive hard throwing.
Why are children particularly affected by microtrauma?
Children have special tissue. Their bodies grow sheets of cartilage on both ends of the bone. Running, for instance, puts six to eight times your body weight on those bones. Long-distance running really pounds on those sheets of cartilage, which are weak to begin with.
When can a child run a marathon?
We don't know the safe age, but I was distressed by what a Honolulu marathon official said: that they allow no one under 6 to run the 26-plus miles! I would have real concern with children in general running a marathon.
Is protective equipment the solution in competitive sports?
It's important, particularly eye protectors in racket sports and hockey, plus batting helmets and face masks and not just hand-me-down but properly fitted ski equipment. Still, the value of some equipment has been overrated. Nothing, for instance, adequately protects the knees of young football players.
What about rule changes?
Pop Warner football has taken the right step by outlawing the cross-body block, which has resulted in too many broken thigh bones. Little League already limits a pitcher to six innings a week. In baseball, growing children should also not be allowed to slide. Many injuries to the tibia, the inner larger leg bone, come from sliding.
Do elite child athletes have fewer problems than the average?
Different ones. The stresses of their training schedules, around which they fit everything else in their life, can be emotionally and physically telling. And we're seeing more kids interested in high-level performance, especially in the last year. In girl skaters and gymnasts we've seen cases of anorexia nervosa—starvation brought on by inappropriate crash diets. Where are the days of carefree childhood?
What happens when these high achievers get hurt?
It can be emotionally devastating, since their whole life is the sport. We have 14 child patients with something called reflex sympathetic dystrophy. It's a kind of pseudoparalysis—a wasting of the muscles triggered by something minor like a sprained ankle. These kids have serious emotional and physical problems brought on by the overwhelming stress of organized sports. Unconsciously, the stress inhibits their ability to recover. There's no doubt kids are less well equipped to deal with the stress of injury than adults.
Are coaches to blame?
There are no bad guys, just people who don't know things. Physicians may find their suggestions ignored or challenged by coaches, trainers and sometimes even parents. Once I lectured to some football coaches about the dangers of using the helmet as a weapon. Later I saw two of them urge a tackier to "drive your head into his breadbasket." Maybe a few coaches should try duty on a spinal injury ward.
In what way can coaches help prevent this type of injury?
They should make sure the kids are well taught. Soccer is a good example. It's very popular in the U.S. now, but technically it isn't well played. So we see a number of injuries. Coaches should praise their players as well as criticize them. This takes a degree of understanding and compassion. And they should stress conditioning and insist on flexibility exercises.
What part can parents play in protecting their young athletes?
They should watch for signs of over-stress—irritability, insomnia. They must keep the sport fun. It's crazy for a parent to threaten a child who wants to quit. I'm not interested in a permissive society, but I see kids burn out in a sport they could have grown in. The Eastern bloc countries don't have many competitions early on, which is wise because they avoid early peaking and unnecessary injury. That's one reason they win more Olympic medals than we do.
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