Wearing Out Their Bodies?
For as long as anyone can remember, 14-year-old Nick Mulcahy played baseball every chance he got. "These boys come home from school, drop their bags, and they're up at the baseball diamond until supper time," says his mother, Maureen, of Malden, Mass. Baseball is Nick's only organized sport, and he plays it all the time, sometimes three or four hours a day, which helped him become a star pitcher on his Little League and tournament leagues. Until, that is, earlier this year, when he developed alarming symptoms. In addition to pains, "my elbow started to click and lock. I couldn't move it," says Nick. Diagnosed with Little League elbow in both arms—essentially wear and tear from overuse in pitching and hitting—he had surgery on both arms and is out for most of the season. "It's so boring," he says, "just sitting on the bench."
Welcome to the little big leagues. At a time when the country is confronting an obesity epidemic among youth, there is a growing awareness of a very different problem: kids, some as young as 8 or 9, who are pushing themselves so hard in a variety of sports—or playing one sport year-round instead of just seasonally—that they end up with overuse injuries that were once the province of professional athletes. Ten years ago, for example, Dr. James R. Andrews, a sports surgeon in Birmingham, Ala., had not seen any pitchers under the age of 19 who needed "Tommy John surgery," a procedure named after the former major leaguer in which a ruptured elbow ligament is replaced with a tendon from another part of the body. Last year he did 51 such operations on teens. "I shouldn't see any of those," says Dr. Andrews. "It is nearly completely preventable."
Youth baseball leagues generally set limits on how much kids can pitch in any given week to prevent overuse injuries. "The problem comes in, especially with younger players, with their participation in elite, travel-ball programs not affiliated with Little League," says Little League International spokesman Lance Van Auken, "where they have little or no oversight in how much a pitcher can be used." These days it is not uncommon for top players to play on two or even three teams, and to train every month of the year, which according to experts is the surest way to develop problems. Says Dr. Andrews: "The average kid we operated on had only the week of Thanksgiving and the week of Christmas off." Nick Mulcahy, for instance, limited his pitching to six innings a week. But for the past two years he has been playing a lot of baseball, including pitching and batting practice in the winter months, when he and his brothers would regularly go to a local indoor facility. Says his father, Steve: "Nicky's heart and soul is baseball."
Baseball pitchers are by no means the only athletes at risk. Some youth soccer players "will play six games in a weekend, three on Saturday and three on Sunday," says Dr. Jack VanderSchilden, an orthopedic surgeon in Little Rock, shaking his head. "Six games, three on two days in a row! The pros couldn't tolerate that!" Maya Richard-Craven, 11, didn't subject herself to that sort of regimen, but she was playing and practicing with her soccer team an average of two times a week, as well as playing catcher in softball, when her knee began to pop out of place on her two years ago. Her mother, Leslie Richard, who is a pediatrician, was able to pop the knee back. Eventually the problem started to happen more frequently. The low point was being carried off the soccer field and taken to the emergency room, after which Maya was diagnosed with a condition in which the cartilage moves around more than it should. "This probably wouldn't have been a problem if she had not been so active," says Dr. Jennifer Weiss, who operated on Maya last September. After six months of physical therapy, Maya still experiences pain and swelling in the knee—and wonders how long it will be before she can resume normal workouts. "I'm not as good as I was before," she says, "because I'm so out of practice."
Then there is Sophie Dulberg of Lexington, Mass., who began gymnastics classes when she was 3. By 4 she was doing handstands, and in 2003 she was invited to join a competitive gymnastics team, which entailed training at least 10 to 12 hours a week. Today, at age 9, she can do 50 inverted sit-ups, hanging by her knees from a bar, and 64 push-ups. But she also had trouble walking without pain and running during recess. In April, after she complained about her heels hurting, she was diagnosed with a condition called Sever's disease, in which the growth plates of cartilage in the heel are damaged because of repeated pounding. With rest the condition can improve, but the chances of further repetitive injury are great if she continues to pursue the sport. "Ten or 15 years ago we never saw Sever's disease in young girls," says Sophie's physician, Dr. Lyle Micheli, director of the Division of Sports Medicine at Children's Hospital Boston. Sophie has voiced an interest, once she is healed, in continuing gymnastics. Her mother and father, though, are fairly sure they do not want her to become any more competitive. "The trade-off would be way too great," says her mother. "She's a social kid and that would really diminish any sort of social life."
More than a few sports medicine specialists lay much of the blame for the growing epidemic of injuries on overbearing parents, eager to see their budding star earn a college scholarship, or—better yet—make big bucks as a professional. "Everybody envisions their kid as the next Roger Clemens or the next Michael Jordan," says Dr. VanderSchilden. "But the reality is, if you look at the data, the likelihood of achieving that level is infinitesimally small" (see box). When Dr. Andrews first meets with the parents of his young patients, he asks them to write down all the championships, camps, private instruction and so forth that make up the athlete's resume. "Then I walk out of the room," he says. "I give them about 15 minutes, and when I walk back in they've covered the board. They're proud of the kid's accomplishments. They don't see the relationship."
There is no question that many parents have high aspirations for their kids. Nick Mulcahy's mother, Maureen, for instance, only half-jokingly proclaims, "He's going to be in the starting lineup of the Red Sox one day." Steve Mulcahy acknowledges that he has done some soul searching since Nick needed surgery. "I would never do anything to hurt Nick. Maybe I was a part of the machine that pushed him a little too hard," says Steve. "I don't know." Sophie Dulberg's parents say they were unprepared for the competitive nature of organized kids' sports. Says her mother, Debi, a psychologist: "The people in gymnastics are very focused on commitment and responsibility. The culture has a life of its own."
But it's also true that the kids themselves often do the pushing. Corvin Lamb Jr., 13, is a track star in a Miami suburb who trains at least 10 hours a week and holds the national age-group record in the 400 meters. Last November he tore the anterior cruciate ligament—the ACL—in his knee in a football game, an injury rarely seen in kids. Since the surgery to repair the damage he has been cleared for light jogging but instead has started more aggressive workouts, to his parents' concern. "I cringed at first," says his father, Corvin Sr., a private school teacher and coach. "But once he's fixed something in his mind, he does exactly what he sets out to. He is very, very determined."
For Corvin Jr. his dedication is a natural outgrowth of his own lofty ambitions. "My big goal is to have a shoe named after me, like Michael Jordan or LeBron James," he says. "I want to be something in life." There is nothing wrong, of course, with aiming high. But as parents and physicians grapple with the injury epidemic, there is a newfound urgency to the old adage, slow and steady wins the race. "Some of these youngsters need to decide if they want to be all-stars as kids," says Dr. Andrews, "or all-stars when they grow up."
Bill Hewitt; Reported by Lisa Ingrassia in Maiden; Anne Driscoll in Lexington; Nancy Wilstach in Birmingham; Sharon Harvey Rosenberg in Miami; Steve Barnes in Little Rock; Shannon Richardson in Austin; Sara Libby in Los Angeles
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