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January 20, 2005

Younger Athletes + no off Season Yields Sports Injuries that Could Last a Lifetime

It’s widely known that young athletes – teenagers and young adults – amass injuries that could last a lifetime. For that reason, Pitt researchers are investigating if injury prevention programs should begin at adolescence.

The research is being conducted at the Neuromuscular Research Laboratory (NMRL), a Pitt applied research facility for the Department of Sports Medicine and Nutrition (School of Health and Rehabilitation Sciences) and the Department of Orthopaedic Surgery ( School of Medicine).

“Kids are starting to play sports at a younger age and, these days, there’s no off season,” said Tim Sell, coordinator of NMRL laboratory and a post-doctoral research fellow in the Department of Sports Medicine and Nutrition.

He points to the availability of numerous indoor facilities allowing young athletes to play the same sport, working the same muscles all year. Adding to the body burden are special training camps and elite player programs such as all-star teams.

According to Jim Bradley, clinical associate professor of orthopaedic surgery in Pitt’s School of Medicine, a UPMC orthopaedic surgeon and a physician with the Steelers: “The essential problem is that a young athlete is asked to do more in a growing body by coaches, parents and institutions. A young, developing body sometimes cannot stand the micro trauma in these sports.”

And that’s why rules are adjusted in baseball, Bradley said. For example, pitches are counted and monitored in professional, collegiate and high school pitchers in order for them to reduce the risk of injury. A 1996 survey conducted by the USA Baseball Medical & Safety Advisory Committee showed that most experts believed pitch counts should be kept for youth pitchers as well.

Young athletes increase their chance of injury with more intense and frequent practices and games. And that is precisely why it’s important to know how young bodies move and grow, Sell said. By the time young athletes need treatment, they usually have been playing basketball, football or baseball for at least five years.

Should clinicians intervene at, say, age 9 or 11? “We don’t know because there’s a lack of research,” said Joe Myers, assistant professor and coordinator of graduate education in the Department of Sports Medicine and Nutrition, who has specialized in shoulder injury research.

Myers’s and Sell’s research is important because if clinicians know what to look for and when, they can offer training exercises to reduce the odds for injury, Bradley said. “There are needs to be addressed while the young athletes are growing – during growth there’s potential for their bodies to repair problems. When you intervene late, it’s a whole different ball game.”

Researchers at the lab have spent the last 15 years looking at all of the neuromuscular and biomechanical (biological and muscular) activities associated with a variety of injuries: knee injuries and other damage caused by the overuse of the shoulders and elbows.

According to Myers, “We want to apply our previous research findings and methods to the youth throwing athlete and see when risk factors for injury are occurring. Then we can develop an injury prevention program and implement it into the appropriate age groups.”

The issue confronting the researchers is when early intervention can prevent injuries.

Say, a baseball pitcher’s shoulder injury is flagged at age 17. That’s not unusual, given that about 50 percent of all pitchers experience some type of shoulder or elbow pain that prevents participation in baseball at some point.

Since many shoulder injuries primarily result from repetitive movements, is there something that an athlete could have done at an earlier age to stave off future problems? Myers plans to check injury potential in baseball throwers – including pitchers and basemen.

He is studying pitchers and throwers from high school and college who have certain neuromuscular and biomechanical characteristics. Some of these athletes, after years of throwing, exhibit differences in the amount of their range of motion and shoulder blade movement patterns, he said.

For example, a young boy in a City of Pittsburgh baseball league might start pitching at about 9 years of age. By the time he is 18 years old and has played through Little League, Pony League and high school, he’s already spent nine years of pitching. “That’s a lot of pitches,” said Meyers. “And there are adaptations within the body because of a sustained activity that might contribute to injuries. We want to identify the adaptations and when they are occurring.”

Myers recently discovered that some pitchers with posterior shoulder pain exhibit certain characteristics that he thinks develops in younger individuals. In addition to his existing group of high school and college throwers, Myers also will study throwers starting those at age nine.

Sell wants to expand current research on ACL (anterior cruciate ligament in the knee) injuries in female athletes. “We will look at how females move, how they land, assess their strength, look at their balance. And we want to see how these factors change through maturation,” Sell said. He also wants to compare male and female athletes in different age groups and older females to younger females.

Sell and his colleagues in NMRL, including lab director Scott Lephart, already have produced major research demonstrating the risk factors for non-contact ACL injuries in female athletes – who are eight times more susceptible to the ACL injuries than their male counterparts — and how to prevent and reduce the risks for ACL problems.

“What we’ve been able to show is that females aren’t as strong as males — they move and land differently,” explained Sell.

According to earlier research by Lephart, female athletes are more vulnerable to ACL injuries because they have weaker quadricep and hamstring musculature supporting the knee joint. He believes the weaker supporting musculature causes women to unconsciously plant their feet differently than men – with stiffer knee position and lack of balanced neuromuscular control — during sudden cutting, jumping, landing, starting and stopping.

Training programs to prevent ACL injuries have been developed at the lab, said Sell, but there’s not a lot of information on prepubescent females.

“There’s some evidence that the ACL injury rates for younger individuals, males and females, are not that different. A lot of people believe that puberty has an effect on this.”

According to Myers, the goal is to “intervene prior to injuries. So if we know when athletes’ biochemical and neuromuscular factors develop, we can intervene.”

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