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Health Issues

Now the yin and the yang—just when you thought it was safe to exercise… The childhood overweight epidemic is a major problem in the United States without question. However, there is another major iceberg that has appeared on the opposite end of the horizon, and that is too much exercise. Yes, it’s those terrible toos again—too much obesity and too many injuries from too much pressure to exercise too much. Two major crises in our young population—obesity and overuse injuries. Who knew? Such a dilemma. We have kids pounding their faces with chips and kids pounding their bodies on the pavement. Two situations that need to find a happy medium. In our zeal to promote exercise, it is crucial to avoid falling into the societal trap of pushing kids too much once they are involved in sports or exercise activities.

On one spectrum, there are too many youngsters with a weight problem who need exercise. On the other hand, there are too many youngsters with an overexercise problem who need to cut back. It’s the “battle of the bulge with those who overindulge,” if you will. There is a substantial rise in the number of overuse injuries in our younger, active population. Just like we have kids with health problems once confined to adults, we also have injuries previously confined to adults that are now trickling down into our active youth. As kids start increasing the intensity and duration of training to adult levels, adult-type injuries begin to appear. I have noticed a substantial increase in the number and severity of youth sports injuries in my practice over the past few years. Some of these injuries are fractures, ligament tears, and concussions that are often hard to avoid, but many of the injuries are caused by outright overuse and inappropriate training. High levels of intense exercise and repetition in a young, growing body can lead to some undesirable results, especially if the increased training stems from excessive pressure or a lack of knowledge about skill development and maturation.

In my profession of pediatric and adolescent sports medicine, it is heartbreaking for me to see a 13-year-old gymnast almost at Olympic level have to end her career because of multiple overuse injuries, or an elite 12-year-old figure skater who stops her career short with a stress fracture in her leg after being spoken of as “one of the best to come along in years.” The list goes on and is always sad to see. Kids this young with ability and talent should not have to produce world-class performances at that age. Congratulations if they can, but what is the insatiable drive behind us having to see mere children achieve athletic feats at younger and younger ages? Sometimes nobody is to blame. Overuse injuries are not always from a pushy parent or coach making the athlete train excessively. Some of these injuries are caused merely by the fact that the child is in love with the sport, everyone sees potential, and the young athlete is allowed to train far more than a young body is capable of sustaining.

Of the millions of youth in our country, there is a very positive increase in the number of kids involved in exercise or sports activity. Remember, though, that there are huge numbers of estimated injuries, many of which are caused by overuse, that should be preventable. Even though it is hard to know the exact numbers, I would bet that with the amount of overuse injuries that do show up in my clinic, the true numbers must be staggering.

Sure, your child gets hurt in the backyard, at recess, and in sports. Somehow, though, injuries from sports have become more socially acceptable compared with other forms of injuries. There is no doubt that injuries do occur in activities and sports and are often just bad luck. Overuse injuries, on the flip side, should be under more control because they often occur after a significant increase in activity. If such large numbers of injuries are potentially preventable because they are caused by too much intense exercise by young bodies, this area should not be overlooked. Families may view that type of injury proudly as a sign of their child’s athletic ability, but those injuries will not look so good when they turn into arthritis at 45 or are covered up by a scar from knee replacement surgery later on—and then who is the one living with that consequence?

So, too little exercise, too much exercise…is there a happy medium? Exercise must be encouraged, but in our society, sports have become synonymous with competition, winning, and fame. (Where do you see fitness, health, and fun in that list?) Everybody wants their children to be the star athletes, the youngest star athletes, the most successful athletes, the athletes with the best scholarships to the best universities with the best sports teams, and hopefully the athletes to obtain that coveted world medal or professional sports paycheck. Somehow they must think that their children’s success will make other people see them as better parents. Think about it. Cavemen beat their chests; we shouldn’t.

With the extreme amount of focus placed on being first—and anything less being failure—it is no wonder that pressure to perform starts at earlier ages. It becomes ingrained. It becomes the norm. It becomes accepted. Our competitive nature drives us to want to be the best. That desire by itself is healthy and allows most of us to accomplish many of our life goals and have a wonderful sense of self-worth. Yet it is easy to see how that principle can become distorted very quickly, especially if the adult mentors to our youth are doing the distorting.

OK. Can we talk? As a youth sports medicine specialist, I still say that part of the reason for this overuse and over-push phenomenon is simply a lack of knowledge. I think many people have great intentions, but just do not know what a body goes through to blossom athletically at any level. Kids are not adults in kids’ clothing, so learning about how they are different can have a huge effect on their achievement and health and provide them with a positive sports experience and reality success. Much effort is needed from everyone to understand what pressures and influences are on your kids, why kids can or cannot do certain things at certain ages, and that too much exercise stress on a young, growing body can cause injury. Hopefully this understanding will decrease unnecessary stress on children and adults, encourage youth that exercise is good at all levels, prevent unrealistic expectations from parents and coaches, keep parents from achieving vicariously through their children, and decrease the number of overuse injuries in our young athletes. Knowledge is like gold. Not everyone has a lot, but what they have is very valuable.


Paul R. Stricker, MD, FAAP
Last Updated
Sports Success Rx! Your Child’s Prescription for the Best Experience (Copyright © 2006 American Academy of Pediatrics)
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