Injuries can occur at any point or time in sports. It's an unfortunate part of the game.
However, surgeries to repair the anterior cruciate ligament, or for the Tommy John procedure — once reserved almost exclusively for professional athletes — are becoming far too common for young athletes.
And by young it doesn't mean college-age athletes, it's high school and even middle school kids who are facing the knife.
It has become enough of a concern for the most famous knee-and-elbow doctor in the world, James Andrews, to write a book about the increase in youth injuries ("Any Given Monday: Sports Injuries and How to Prevent Them, for Athletes, Parents and Coaches — Based on My Life in Sports Medicine"). Andrews has also started a prevention program called Sports Trauma and Overuse Prevention (STOP) for young athletes.
Does the youth-surgery epidemic apply only to big cities like New York or Chicago? No.
Dr. Todd Fowler has been practicing at Watauga Orthopaedics in Johnson City for 20 years, and he's seen a worrisome increase in the type of injuries for young athletes.
“We've got so many more kids who are playing sports at a younger age, and playing year round — one sport even,” said Fowler. “People my age, when we were growing up we played football in the fall, basketball in the winter, and baseball in the spring. Your body didn't have to perform in the same exact sport year round. Your body needs rest from doing repetitive things over and over again, especially in baseball.”
The repetition and overuse — what Dr. Andrews calls “specialization and professionalism” — are key reasons why Tommy John surgery has trickled down to the high school ranks. When Fowler arrived in Johnson City, Tommy John surgery — a procedure where a surgeon replaces the injured ulnar collateral ligament with a tendon taken from somewhere else in the patient's body — was simply not on the local map.
“When I first started there were no high school kids having Tommy John surgery,” said Fowler, who has worked extensively with athletic programs at ETSU, Milligan, Tusculum and Science Hill as well as professional baseball teams in Johnson City, Bristol and Elizabethton over two decades. “Now we're seeing Tommy John in high school, and ACL tears in 11- and 12-year-old kids. We didn't use to see those ACL injuries until high school.
“We're seeing kids who have to wait for reconstructive surgery until they develop, or we're doing some strange new surgery so we don't go across the growth plates to fix the ligament in the knee.”
Andrews has stated almost half of sports injuries in adolescents occur because of overuse. He points out some athletes like Tiger Woods — who was treated like a professional golfer before he was in elementary school — can deal with the stress. But how many Tiger Woods are there in the world?
More is better — games, practices, drills — many parents may think. If they just push their kids, a college scholarship will be waiting in the future.
Fowler has seen it from both sides of the track. He's treated the injured kids, but also watched his four children and one adopted (ages 19, 18, 17, 16 and 14) play sports and have dreams of playing at the next level.
“I noticed when my kids played Little League baseball, the push was to be on a travel team to get more experience and get seen by more people,” said Fowler. “I can see parents wanting their kids to go to college on a scholarship.
“I think it's hard for all of us as parents to be completely realistic. You see Daniel Norris come out of Johnson City with the potential to be in the majors. You see Jason Witten in the NFL, and say that could be my kid. You have coaches telling you the kid has potential, and he should keep doing this. But it's like the lottery, and the odds are against it.”
Fowler said someone needs to draw a line of reason in the sand. Andrews may be that person. He said athletes need two months off each year to recover from a specific sport, preferably three to four months.
The overhead throwing motion in baseball is the biggest culprit toward a Tommy John procedure. Andrews said 30 to 40 percent of his Tommy John surgeries are on high-school kids, even those as young as 12. Andrews pleads with parents and coaches to give the kids time off, and Fowler agreed.
“The overhead throw is not natural for the shoulder,” said Fowler. “And it's not innings, it's pitches. And it goes for catchers, too.
“You need to have rest in-between seasons. You don't need to do Little League and travel ball at the same time, and then have leagues in the fall and (throwing) in the winter. The kids need rest from that throwing motion.”
Fowler said he understands the best interest of the kid is not always the popular decision.
“It's hard to get kids to stay away from a sport when the traveling team is a great team,” said Fowler. “The kids want to keep playing, the coaches want the kids to keep playing, and the parents want their kids to play. But they need to rotate sports.”
Pointing to a specific age where it's OK to relax restrictions on the kids is not easy, said Fowler.
“Kids' growth plates open at different ages,” he said. “But in general you don't want a kid throwing a curveball until he's close to having the growth plates close, which would around the age of 14 or 15 for most boys. It's better to throw only a fastball and changeup until the growth plates close.
“Secondly, pitchers and catchers need to have time off. And third, they need to stretch before and ice after — for the shoulder and elbow. If you watch major-league pitchers, they come off the mound when they are finished, and they disappear. They go to the training room and get wrapped and iced. They know the faster they get ice, the better their chance for recovery.”
Andrews added another thing for young players to avoid: the radar gun. He said it makes players want to throw harder than they are capable of throwing, leading to a potential injury.
As for the ACL injuries, overuse certainly comes into play there, too. Andrews said he wants parents and coaches to realize the implications of putting a 12- or 13-year-old through the same type of athletic work done by a 25-year-old pro athlete. Parents and coaches need to understand what the long-term effects of overuse can be.
Fowler said he looks at his own kids and sometimes gets to the point he wonders what is too much.
“How many camps?” Fowler said. “How many teams? Do we need to go to Knoxville for travel soccer? I don't know where it stops.”
At the end of the day, Fowler said there's no catch-all answer that fits every situation.
“I don't know what the answer is, but I would like to not see as many injuries to kids,” he said. “I don't mind the sprains and stuff, if we can avoid the bigger ones.”
Andrews said sports physicians are guilty of missing the point by just putting people back together and fixing things with new techniques. The real problem has been ignored, which is preventing the injuries in the first place.
The time is right to be proactive against injuries.