Treating youth athletes requires special treatment, experts say. (Jed Jacobsohn/Getty Images)

Injuries to young athletes requires special treatment, experts say. (Jed Jacobsohn/Getty Images)

In sports injury news, concussions get most of the attention these days. But here’s a statistic about the other kinds of injuries: 85 percent of the 3.5 million sports-related injuries athletes under the age of 18 sustain each year don’t involve their brains. Hip, knee, and shoulder injuries have challenged the medical community to come up with new surgical techniques and rehabilitation strategies. Laura Landro addressed those developments her Wall Street Journal column, “The Informed Patient.”

BL: Lyle Micheli, the director of the Division of Sports Medicine at Boston Children’s Hospital told you: “In the past we’d put a cast on a broken leg, take it off six to 13 weeks later and send kids home.” How has that approach changed and why?

LL: Well, I think there’s a growing recognition out there that there [are] really very special rehabilitation needs – not only special surgical procedures in some cases, but special rehabilitation procedures — that are needed for children who are participating in these sports. And part of that is because of the way participation has changed. You know, you’re not just playing football for a couple of months in the fall and then going off and doing nothing for the next several months until it’s football season again, like when I was in high school. It’s basically baseball, football, soccer year round, intense training regiments … really being pushed in ways that professional athletes are.

BL: Did you get a sense talking to these folks that one of the problems is, for example, a soccer coach insisting that the kid play soccer 12 months of the year, a hockey coach insisting that a kid play hockey to the exclusion of everything else?  

LL: Well, actually, one of the most important issues that’s come up with this is this idea of single-sport concentration, and year-round play. So in single-sport concentration you would think, “Well, it’s good to get really good at that one sport.” But, in fact, you’re not cross-training in any way. That contributes to overuse because … if you’re playing hockey, you’re doing a different motion in skating than you are in soccer or in baseball. The idea is that with a single sport is: get out there, this is your sport, you’re not doing anything else – that kind of thing can really lead to these overuse injuries as well.

BL: According to your article, injuries are down in recreational activities such as bicycling, but they’ve risen by over 22 percent in football and 10 percent in soccer. What accounts for those increases?

LL: Well, I think what’s happening, again, with the reduction in the recreational use – it’s probably, you know, there’s been a lot of campaigns to have kids put helmets on. There’s been more awareness of things like trampoline safety. But when it comes to these sports, again, a lot of those injuries are from overuse: you’re playing too much, you’re playing too hard, your coach is telling you to get up and get back out there, you know, play through the pain, things like that.

But some of these overuse injuries, they’re not so obvious. Like that kid that’s out there getting rammed and rammed and rammed or throwing the pitch 50,000 times to practice, those are the things that really start to get into the slow but steady damage that could really give you a life-long disability.

BL: You learned about what one pediatric orthopedic surgeon called the “bargaining moment” which comes up when doctors treat young athletes. What characterizes the bargaining moment?

LL: What happens is kids, they might have had that minimally invasive ACL surgery, and the surgery, it might be a little sore, but they don’t feel disabled, and they’ll say, “Please, if I can’t go back to football, can I go back and do some skateboarding? Can I go out bike with my friends?” And, you know, there may be tears. Sometimes there’s crying, you know, especially when they want to get back out there, and they don’t want to miss being with their team, and so many of these kids are looking for scholarships. They want to get on the most competive team.

And, by the way, on top of all this, we know how important team sports are for kids. We know how important it is for activity and exercise, how much, you know, it really can help with the obesity epidemic, so this is in no way suggesting kids shouldn’t be out there playing team sports. But there’s some very important data out there that shows that, if they’re not trained properly, if they’re not rested properly, they can really get into trouble for the long term.