06/20/2010 05:12 am ET Updated May 25, 2011

Playing (Too Hard) to Win: The Physical Risks of Teen Sports

As I watch kids playing sports these days, and watch their anxious parents watching them, it's apparent that the level of competitiveness and achievement is much higher than it was just 10 years ago. While it's important for our kids to exercise and wonderful to see young people becoming so accomplished, having raised the bar so significantly on performance also has increased the number of injuries and the intensity. In gymnastics, 10-year-olds are now executing moves that kids used to approach starting at 14 or 15. Also, the number of play and practice hours have jumped from eight or 10 hours a week to 15 or 16; and the demands can be ongoing because more and more sports like soccer that used to be seasonal are now year round. This is resulting in a virtual epidemic of overuse injuries.

The passage of Title IX of the Education Amendment made colleges award an equal number of sports scholarships to men and women. While a critical advancement in women's athletics, it has intensified competition in female sports, and girls are incurring as many injuries as boys - and in some sports, more injuries.

Perils of Sports
In sports like gymnastics, skating and dance the high level of difficulty is causing a whole spectrum of injuries that used to occur mainly at the professional level. Broken wrists, broken coccyx (tail bone), elbow dislocations, knee pain, ankle sprains and anterior cruciate ligament (ACL tears) have become alarmingly commonplace. Girls are also eight times more likely to experience ACL tears than boys. Body development and metabolism issues for girls are also on the rise because higher performance levels can impact normal menstrual cycles and hormonal development.

In football, we know that shoulder dislocations, knee injuries, fractures and concussions are common; but a syndrome called Second Impact Syndrome (SIP) is less well known. With SIP, getting a second concussion before the brain is fully healed from the first can cause death. Although well-established criteria must be met before a player can return to play, parents should know that if their teen has received a concussion, waiting until it is completely healed is imperative.

In soccer, even though "heading" is no longer allowed, if the head does come in contact with the ball or another player, the front of the brain will bang forward against the skull. This is what can cause damage, not the impact of the ball with the forehead, which even foam helmets won't help. So it's important to avoid this move.

Runners are prone to stress fractures, caused by the accumulation of normal microscopic fractures to the bones occurring at a rate faster than the body can repair them. The treatment is rest or wear a cast and a gradual return. Patience is key, no matter how anxious kids are to get back on track.

Ironically, hockey is now incurring fewer injuries because of its restrictive rules and the emphasis on safety equipment. Still, players are vulnerable to shoulder separations.

If any of these are happening to your teen, help them power down from a too-stressful regimen. When working on a new challenge or a difficult move, encourage them to approach it in sections, then put the pieces together. A balanced training regimen of stretching, strengthening and aerobic components will also help reduce the risk of injury.

If your teen complains of pain, it's their body is trying to tell them that something is wrong. Working through pain is not the answer, seeing a physician for sound medical advice is.

Artificial Help is No Solution
Taking steroids to gain a competitive edge is not the answer either, and I'd advise parents to keep an eye out for any signs of use of anabolic steroids. These are male sex hormones, basically testosterone, which can have radical side effects for anyone, but especially for developing teens. Rapid weight gain and muscle development often occurs. Severe acne is common. Boys can experience atrophy of the testicles, premature baldness and breast development. Girls can have scalp hair loss and hair growth in unwanted places such as the face and chin. Steroids also increase blood pressure and cause aggressive behavior, known as "roid rage." They can also cause premature bone growth, which ultimately leads to the individual permanently losing some height. So if you even suspect any use of steroids, put a stop to it.

But what about nutritional supplements that promise enhanced performance? There's very little useful research on performance-enhancement supplements, and what research has been done shows that they do not work. Better to leave it all alone. A healthy, balanced diet, proper hydration and an adequate amount of sleep should be sufficient.

Recipe for Success
If I had to choose the single best element for athletic success besides innate physical and biomechanical endowments, it's cross training. Anyone can be better in a chosen sport with a well-rounded cross-training workout regimen, rather than excessive training in that activity alone. Professional athletes do other activities besides their own sport because they know the value of developing a wide range of skills. In the past, USC football coaches have had their players take ballet class because developing poise and coordination in the studio makes them more effective players on the field . At the end of the day, cross training and a healthy balanced diet are the best practices. As for the emotional risks for overachieving sports teens, we'll look at those next week.