Overzealous youth athletics can result in hobbled adults later

soccerknee-300x97Here’s another painful reminder to grownups about youngsters and sports: Moderation matters, and youthful games are supposed to fun, diverting, and character building—and most definitely should not leave today’s aspiring athletes as tomorrow’s hobbled adults.

The New York Times has reported on what a pediatric sports medicine expert has described as a “dirty little secret” of orthopedics, which is “the chance of getting arthritis within a decade of tearing a tendon or a ligament in the knee is greater than 50 percent.” And more and more youths, as they participate aggressively and frequently in sports programs, are undergoing surgeries on damaged or torn anterior cruciate ligaments, a procedure well-known as the ACL repair.

The sports medicine doc says he is gathering data for a study that will show that patients at 26 children’s hospitals he has focused on underwent 500 ACL repairs in 2005, but by 2014, more than 2,500 youths had these surgeries.

He says kids need the operations after they sharply twist and damage their knees in sports like soccer and basketball. Young athletes train and compete, and intensely, in these and other sports year-round now. They may start early, in elementary school leagues, then advance through middle- and high-school programs, then on to collegiate or college intramural competition.

The wear and tear of sporting activity, especially if it requires ACL or other joint procedures, can leave young adults, relatively early in their lives, with painful and debilitating arthritis. Medical scientists are trying to determine why some patients may be more susceptible, especially since earlier generations have been equally active, if not more, but without the prevalence of knee arthritis.

Knee and hip replacements have become some of the most commonly performed procedures among Americans 50 and older. Doctors have made progress with this surgery, making it generally safer, faster, less painful, and inconvenient. No operation is risk free, and the knee and hip work can hurt a lot and leave patients off their feet or in rehabilitation therapy for weeks and months.

For younger patients with knee woes, there are further complications. The research-based evidence for many common procedures that doctors offer for knee pain is weak. They may undergo these, or get injections.

But they may be too young for the extensive, invasive help that might most benefit them: a knee replacement. Although doctors and device makers have made advances in prostheses, replacement knees aren’t recommended to last for longer than 10 or 15 years—and there are limits to how many times the surgery can be performed. That can leave a group of once spry, active, and athletic young people hobbled and likely debilitated with pain.

The New York Times, focusing on a onetime able soccer player, finds him in his 40s, wondering whether his young children should be encouraged to take up their dad’s former sports passion. How it can turn out, badly, is not a topic easy to discuss with young patients, obsessed and enthusiastic about athletics.

In my practice, I see the big harms that patients suffer while seeking medical services, including the nightmares they can encounter with hip and knee operations that too many doctors and hospitals almost dismiss these days as routine. As recently as last fall, pediatricians and sports medicine doctors warned yet again that parents and young athletes should, as much as possible, be wary of “overspecialization” in athletics. Overuse and overtraining caused by young people going deep and often in just one sporting activity can result in serious injury and burnout, the experts said.

That makes sense to me, as I see how hard parents and kids drive themselves in what should be pleasurable games and fun. Yes, sports can teach the young discipline, rigor, focus, concentration, and help them build invaluable social skills. Athletes can gain real grit and grace “on the playing fields of Eton.”

But let’s also get real: The National Basketball Association employs just 300 or so sublimely talented athletes, the Women’s NBA roughly half that number. Professional soccer is a growing sport but it, too, isn’t offering big paychecks to hordes. Youngsters may strive for pro careers or collegiate opportunities—and they should. At day’s end, though, the athletic options for most are constrained, and they need to be kept in context. Again, moderation matters.

That may be a major lesson that football is offering 21st century America. It should be eye-widening when broadcaster Bob Costas and other major commentators on contemporary sports, including Washington Post columnists Tony Kornheiser and Michael Wilbon and USA Today columnist Christine Brennan, talk about a near time when football’s no longer around. That’s because the game’s harms may be far exceeding its joys and benefit.

I see in my practice the major damage that can result from brain and spinal injuries, and I can see why even sports journalism’s elite see a future when concussion-brutal football—a dominant, pervasive game of our day—fades, as have boxing and horse racing. It’s mighty tough as a parent to push contact football as an appropriate sport for the young after seeing how damaged was the brain of Aaron Hernandez, a onetime New England Patriots star who later plunged into a fatal crime spree and who ended up killing himself. A medical expert who conducted a post-mortem exam of Hernandez’s brain said he has rarely seen such a severe example of chronic Traumatic Encephalopathy (CTE), a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma.

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