Competitive Sports and Teens

My 13-year-old daughter has started playing on a competitive soccer team. I’ve heard that girls are more prone to knee injuries from sports such as soccer. Is that true?

I can certainly understand your concern, because a female athlete’s knees are particularly vulnerable to anterior cruciate ligament (ACL) injuries. In fact, females are four to eight times more likely to sustain this serious injury than male athletes. ACL injuries are specific to sports that involve starting, stopping and pivoting, such as soccer, basketball or volleyball.

Typically, the ACL, one of four ligaments that stabilize the knee joint, gets torn in one of two ways: landing on an overly straight (hyperextended) knee, or pivoting the leg inward (internal rotation) with the foot planted, without the foot pivoting as well. Surgery to replace the torn ACL is recommended for young athletes so they can return to fully participating in the sports they love.

Female athletes are thought to be more prone to ACL injuries due to a muscle imbalance in the thigh and the way female athletes move: they tend to remain more upright with their knees less bent than their male counterparts. Female athletes also tend to let their knees lean inward rather than keeping their knees directly over their feet when jumping and landing. Both of these positions put the ACL in a vulnerable position.

Check with your daughter’s coach to find out if the team’s training sessions include an ACL injury prevention program taught by a trained physical therapist. These programs, which help athletes strengthen key muscles and teach them how to jump and land correctly, can successfully reduce ACL injury rates by up to 80 percent.

My 15-year-old son is playing football on his high school team and says his back is hurting. What could be wrong?

Your son’s back pain may well be due to a pars stress fracture. This injury usually causes low back pain on one side of the back, as opposed to in the center.

Pars stress fractures involve a small connecting bone in the lower spine. This bone lengthens during adolescence, so it’s particularly thin and weak and prone to injury. If a pars stress fracture is detected and treated early, it will heal and resolve completely without increasing the risk of future back problems. However, pars stress fractures that fail to heal can cause permanent back problems in adult life. Since a pars stress fracture is a break in the bone, only significant rest and time (usually about three months) will let it heal.

My daughter plays softball almost year-round in a competitive league. After a recent weekend tournament her shoulder was quite sore from pitching. How can I tell if she is developing an overuse injury?

It’s good to listen to your daughter when she says she’s in pain. An overuse injury may be developing if any pain is occurring more frequently and lasting longer than before. Overuse injuries generally progress as follows:

1. Soreness lasting several hours or less only after the activity.
2. Soreness or pain during and after the activity that does not improve by the next morning.
3. Soreness or pain during activities of daily living as well as during sports.

If your daughter’s symptoms show this progression, get her evaluated by a sports medicine specialist for a possible overuse injury.

How can I reduce the risk of injury for my teen athlete?

Your teen can take these common-sense steps to ensure a healthy, pain-free sports season:

• Maintain good physical conditioning during the off-season and ease into a new sports season gradually. Increase high-impact activities such as running and jumping gradually, too.
• Take at least one day a week off from competitive sports participation, and ideally several weeks off every several months.
• Avoid year-round participation in one sport or participating on more than one team in the same sport at the same time.
• Stretch and warm up before all practices and games.
• Always wear the correct protective gear and make sure all your equipment, such as shoes and pads, fit properly.
• Remember R.I.C.E. (Rest, Ice, Compression and Elevation) to soothe minor injuries.
• Ignore the “no pain, no gain” philosophy. If in pain or injured, stop playing until the pain resolves.
• Overuse injuries often develop during long weekend tournaments, week-long sports camps or during weeks of twice-per-day practices. Prevent the progression of overuse injuries by evaluating and treating symptoms when they develop.

Reviewed by: Elizabeth W. Lee, M.D.

Last reviewed: June 2019