The COVID-19 pandemic has disrupted American life in unprecedented ways. School closures, canceled sports leagues, and shelter-in-place orders dramatically changed how children were using their bodies. Pandemic precautions caused children to lead more sedentary lifestyles, as they completed school work virtually and spent less time outdoors.
Overall, COVID-19 restrictions and the lack of organized sports led to a notable reduction in broken bones and sports injuries. Pediatric fractures dropped by nearly 60% during the first days of stay-at-home orders as compared to previous years, and sports-related fractures also saw a dramatic decline. for only 7.2% of all fracture cases during the first days of the pandemic, versus 26% of fracture cases in previous years.
Youth recreational sports are resuming across the nation, rapidly in many states. Beyond a potential link to , there are other concerns we need to pay attention to: What will this mean for children's young bodies? What will it mean when kids get back to competition after sitting idle for a whole year?
We can draw lessons from professional sports to anticipate what a full return to recreational sports might mean for our young athletes. When professional athletes have had their preseasons cut short in past years or their offseason fitness training reduced, injuries spiked. After the 2011 NFL lockout, when players lacked access to team healthcare providers, strength and conditioning professionals, and coaches for several months during the offseason, the NFL saw a in Achilles tendon ruptures during the preseason. When MLB spring training was cut short because of COVID-19 in mid-March and players lacked access to training facilities for three and a half months, pitcher injuries spiked. Pitcher injuries were than in any previous opening period (the first 10 days of the season).
These lessons from professional sports can help inform how we prepare our young athletes for a safe return to recreational sports. Children are excited to get back out on the field. After months of being sedentary, they are eager to perform at their previous level. They may be eager to make up for lost time and may train even harder than normal. Coaches may also be eager to make up for lost time by intensifying practices. Leagues may schedule more games to make up for lost playing time.
Our sports medicine team expects to see a flood of pediatric sports injuries as recreational and competitive leagues resume. There will likely be a jump in injuries typically caused by inadequate conditioning – muscle strains, overuse tendon injuries, and stress fractures. My prediction is that we will see more injuries than normal in young athletes whose bones and joints are developing. These include injuries of high-growth, high-stress areas like knees, shoulders, elbows, hips, and ankles.
As children resume sports and begin rejoining leagues, there are important conditioning and stretching activities they can do today to reduce their risk of injury. To prevent such injuries, young muscles and tendons will need to ease back into shape gradually. As sports resume, it is important for parents and coaches to encourage children to slowly return to competitive activity.
We encourage young athletes, with the help from parents and coaches, to do the following:
Make a schedule. Make a calendar of daily and weekly athletic goals. Follow the "10% rule": Increase activity by no more than 10% per week. This applies to the intensity, volume, distance, and duration of workouts. Make time for rest and recovery after strenuous workouts. Don't forget to give your body adequate nutrition and sleep.
Stretch it out. Consider adding stretching and yoga to your routine. Professional athletes understand the benefits of stretching and yoga, and so should young athletes. With online resources and tutorials, yoga and stretching exercises are more accessible than ever before. Don't forget to add stretching to your warm-up and your cool-down as well.
Get creative. With many school and community gyms closed, find effective substitutes at home. Bodyweight exercises such as burpees, mountain climbers, and jumping lunges are effective exercises. These three simple movements can improve cardio, strengthen, and balance while working out in small spaces. Use soup cans or water jugs for weight training. Use a large couch cushion for lower extremity balance, proprioception, and strengthening exercises in lieu of a half balance ball, also known as a Bosu ball or Dome ball.
Diversify your activities. If you're a pitcher seeking to remain at a high level of throwing, your workouts during this time should not be solely focused on pitching. In fact, most of your training should be directed towards reinforcing the basic mechanics of throwing and addressing any kinetic chain deficits. Consider adding in additional activities like walking, jogging, or biking to your routine. Improving your core strength, lower extremity balance, flexibility, and cardiovascular endurance are all ways to enhance your pitching capability. This applies to all repetitive activities that are at high risk for overuse injuries. Now is a great time to incorporate injury prevention programs like FIFA 11+ and follow from organizations such as USA Baseball and their Pitch Smart program.
Listen to your body. Parents and coaches should ask their young athletes about any pain, soreness, or tightness. Some children may want to work extra hard to impress their coaches or make up for lost time. Encouraging them to be aware of their bodies and take note of how they feel is important. Parents and coaches should be on the lookout for any overuse injuries. Early intervention with targeted conditioning and stretching exercises, or even physical therapy, will be key to avoiding further injury.
With children in many parts of the country getting the green light to resume competitive sports, it is up to parents and coaches to help them reduce their risk of injury by making sure they ease back into competitive training and play. If kids take time to ease back into full activity, following a schedule for a safe return to play and building up their core strength before resuming competitive sports, they will be doing their growing bodies a huge favor – and will also reduce their risk of injury.
, is an orthopedic surgeon and sports medicine specialist with Shriners Hospitals for Children -- Northern California and UC Davis Medical Center. Friel earned her medical degree at Rush University Medical Center in Chicago and has served as the team physician for multiple high school and collegiate teams as well as assisting in the care of professional teams.