Part 3: Every parent’s favorite question: “But why?”

We’ve now established that I love working with kids and teenagers, I love working with “big kids” or grown-ups, and I have a nice PT-filled history of my own to fuel that inspiration. But we haven’t yet answered the million-dollar, highly-debated question that I’m sure you’re all asking by this point: “But why would kids need PT? Isn’t it a bad thing that all these kids are getting hurt?”  Just last week I overhead one of my grown-ups say to one of my kids “But why are you here? Oh what a shame. You’re too young to have an injury and need to come to physical therapy!”

No! Don’t say that! He just might believe you, and then I’ll be out of a job!

Just as the number of kids participating in organized sports is estimated to grow to between 30 and 40 million in the next decade in the United States, so will the number of injuries.[i]  Kids are specializing early in sports, leading to more injuries and problems as they board the bullet train toward adulthood.  While on this train, they need specialized, age-appropriate training to ensure safety as they move along the normal cognitive, motor, and emotional developmental train tracks into adulthood.[ii] The problem is that sports participation at earlier ages is skyrocketing, and subsequently, so are injuries.

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That’s me at age 9. I remember making my first regional championship qualifying time at this meet and a coach saying to my mom and me “Good news! She can travel to championship meets now!” It was at this age that I decided to quit all other sports and activities and focus on swimming.

Many people blame the media for these problems. They believe that it has influenced parents to believe their kid will be the next Tim Tebow or Kobe Bryant. They believe their kid will undoubtedly be in that top 1% to receive a college scholarship to a Division 1 school of their choice or join a professional sports league. There is the idea that this belief drives parents to push their kids, or kids to push themselves, beyond their physical and mental limits, inevitably leading to injury or burnout.

I’m not going to say that these cases aren’t out there, nor that I haven’t seen them. I have. Every day. Usually I want to give some of these parents a good all-star teenage eye roll when they swear to me that their 7th grader will definitely get a full ride to play basketball with the best basketball program. These kids don’t get the right age-appropriate training and often begin advanced skills before their bodies are physiologically capable of doing them correctly.

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Photo credit: Myer, Lloyd, Brent & Faigenbaum (2013). Kids’ “training age” must be considered when they specialize in sports and try new skills. Training age includes all of the above factors. Many of these processes are not fully developed until late adolescence or even early adulthood. Challenging the functional capacity of these processes before they’re ready can lead to injury.

Without proper integrated training, the body takes the path of least resistance to perform a skill.  I call this “cheating without knowing you’re cheating.” This eventually leads to breakdown and injury. Too much breakdown and injury without adequate rest can cause kids to burn out early. They may develop chronic physical or mental impairments that just won’t seem to get better. This gives them an “out” from their sports that is easier to swallow than feeling as if they’ve failed a parent or grown-up’s dreams for them. These patients are becoming an epidemic those of us who dare to work in this precipitous youth sports environment. See this reference about how to judge when play is too much.

That’s not to say that I haven’t encountered some elite pre-collegiate or pre-professional athletes who do, indeed, make it into the next level. Surprisingly, those patients and parents are often the most realistic in their expectations. Having been there myself, I don’t ever recall my parents or any of my swim friends’ parents having the “my-kid-is-the-next-Michael-Phelps” attitude, even though we were all undoubtedly going to swim in college. In fact, until NBC and Chico’s jumped into her life, I’m fairly certain that single mom Debbie Phelps was not outspoken during Michael’s whirlwind and very impressive teenage upbringing through the swimming world.

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Photo credit: Us Magazine

If a kid was truly on the fast track to college or professional sports greatness, we all just knew. I still see this today, now in the young athletes and families I treat. In these cases, it is often the self-driven inspiration of the child or teen himself, perhaps the influence of a fascinating coach, or possibly a natural, innate talent that drives a kid to excel at a sport at an early age.

Despite whichever belief or reason for sports participation or specialization at any age, statistics and genetics do not work in any athlete’s favor.  My college statistics professor, not at all a medical specialist, would easily tell you that injuries will always increase with increased participation in sport. Statistics would also tell us that some people are just going to be more genetically predisposed to injury than others.  This will happen regardless of whether a kid is pushed by a parent to be the next Missy Franklin, or if the kid simply just loves the sport like I did.

missy franklin

That’s me again, dressing up as Missy Franklin at age 28. I still love the sport even though I am “retired.” I can promise you my parents did not pressure me to wear this outfit.

A recent feature series in a San Francisco newspaper highlighted this very issue.

Sometimes, though, most of us cannot see the simple reality that increased sport participation inevitably leads to increased injuries.  It can be devastating when any person gets hurt, whether he or she is an athlete or not.  Parents become enraged and kids become depressed.  Kids often drop out of their sports or become more injured because at that point, their hearts just aren’t in it anymore.  Recent studies have shown that even uninjured collegiate athletes suffer from depression. [iii] [iv] [v] [vi] We need professionals to help them all along the way.

Enter the specialty field of pediatric and adolescent orthopaedics and sports medicine.  This is a growing niche that includes specialists in all different fields, including physicians, physical therapists, occupational therapists, speech therapists, mental health professionals, nurse practitioners and nurses, physician assistants, athletic trainers, strength and conditioning coaches, and dieticians.  Each has advanced training not only in sports medicine and orthopaedics, but also in pediatrics.  We treat young athletes from elementary school age through young adulthood.

Most importantly, access to these specialists is becoming easier all over the country and the world.  In addition to private practice clinicians like me, there are numerous specialty programs all over the country in places like Atlanta, Boston, Cincinnati, Los Angeles, Miami, Philadelphia, and Seattle, to name a few. Some programs are even offering telemedicine options to reach kids in rural areas who may not have access to a specialist.

I love this field. Being yelled at in a corner by a stressed out family member typically does not make me flinch.  Sure, it can be frustrating to me in the moment when I have to deliver the news of “No football for 6 weeks” and the parent or child fails to see that this news is for the betterment of the child’s health. But it’s so rewarding when I can help that same child get back to their sport safely, better than they were before, and bring comfort to a worried parent. These rewards have come in the form of hand-drawn thank you cards, art projects, homemade cookies, and the satisfaction of knowing that perhaps, that kid just might not turn into a physically or mentally injured adult. That last part is what makes all the late night tweeting worth it.

I believe that with the right passion and training, we can play our cards right and be an integral part in paving the way for a young athlete’s success story—whatever that successful outcome is.

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With the Dynamo National Team winning Speedo Junior Nationals at age 14 in Auburn, Alabama.

This is pediatric & adolescent sports medicine. All of us in this field are in it together, advocating all for same mission: to give kids a better experience in becoming more active and competitive.  To get kids back in the game.  To help them become healthy adults.  The list of inspirational mission statements goes on and on.

One of my favorite resources in this field is this consortium formed by several key sports medicine organizations and professions, advocating together to achieve our individual and team mission statements.  We recognize that despite the reason for kids’ sports participation, the reality is that we all must push kids to be active and healthy. It’s much better than the alternative, and we all have heard about the consequences of unhealthy lifestyles in kids. With this push for activity comes the responsibility of keeping kids healthy, and we must work together as a team to educate all of you on just how to do that.

The purpose of this blog is to raise public and professional awareness to this specialty field, and serve as a resource for management, prevention, and referral for youth orthopaedic & sport-related injuries.  I will cover key issues related to this field, welcome guest writers, and hopefully help spread the love on this issue for which I am so passionate.


[i] Myer GD, Kushner AM, Faigenbaum AD, Kiefer AK et al. Training the developing brain, part I: cognitive developmental considerations for training youth. Current Sports Medicine Reports. 2013; 12 (5): 304-310.

[ii] Myer GD, Lloyd RS, Brent JL, Faigenbaum AD. How young is “too young” to start training? ACSM’s Health and Fitness Journal. 2013; 17(5): 14-23.

[iii] Wojtys E. Sports specialization vs. diversification. Sports Health: A Multidisciplinary Approach. 2013; 5: 212-213.

[iv] Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C. Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2013;5(3):251-257.

[v] Weigand S, Cohen J, Merenstein D. Susceptibility for depression in current and retired student athletes. Sports Health. 2013;5(3):263-266.

[vi] Yang J, Peek-Asa C, Corlette J, Cheng G, Foster D, Albright J. Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clin J Sport Med. 2007;17(6):481-487.

One thought on “Part 3: Every parent’s favorite question: “But why?”

  1. Pingback: youthsportspt | National Cheerleading Safety Month: Why it Matters (Part 2)

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