Tips to Protect Young Athletes from Overuse Injuries with Dr. Christopher Ahmad

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

Sports are a great opportunity for children to get exercise, gain confidence, and learn about teamwork. But kids are taking athletics more seriously than ever, putting them at risk for injury.

I talked to Dr. Christopher Ahmad, Orthopaedic Surgeon at New York-Presbyterian/Columbia and the team doctor for the New York Yankees, about how young athletes can protect themselves from injuries. He shared some tips for parents to help their kids stay healthy on the field — including what research has revealed about how some elite baseball players have managed to stay injury-free.

Faith: Dr. Ahmad, thank you so much for joining us today.

Dr. Ahmad: Thank you for having me. This is a very exciting opportunity for me to be with you.

Faith: So can you break down what sort of work you do day to day? Are, are you between the hospital and Yankee Stadium?

Dr. Ahmad: I have a busy job. Many people think that because I’m the Yankees doctor, I spend my entire day and week just taking care of Yankee players. In fact, I’m seeing high school kids and college kids throughout the week. I am a surgeon. I do ACL Reconstructions and Tommy John surgery as an example. And later in the week, I do more what I call academic work. I do research, I have meetings, I run committees, things that have to do with optimizing player performance or risk reduction in all athletes.

Faith: I am so grateful to have any of your time. I feel like there are millions of Yankees fans who want me to make quick work of this, so, so you can get back to all the things you do. I’m, I’m also astonished by your stamina even just given your operating days.

Dr. Ahmad: My goal has always been to get better. Just like Gerritt Cole considers himself a student of pitching. He’s one of the best pitchers that we’ve seen in this sport, and he still considers himself a student. And I’m a student of my craft, and that is being a surgeon and executing surgery as well as possible.

Faith: So, Dr. Ahmad, some of our listeners are parents who have kids in sports. Can you tell us about some of the most common sports injuries that you see in children and adolescents?

Dr. Ahmad: That is a great question, and we could almost call it an epidemic. There are sports injuries that are rising and increasing amongst our youth athletes every year.

Faith: Hmm.

Dr. Ahmad: ACL Injuries can affect any type of athlete, whatever sport that they play, and it’s more common in female athletes. And they are still growing in epidemic proportion, and part of it is because we’re not taking advantage of the prevention strategies. So ACL injuries are devastating because once you’re injured, you’re out of your sport for close to a year before you’re really feeling comfortable, and that’s a long time for an adolescent athlete.

Faith: You mentioned that we’re not taking advantage of preventative measures, which we definitely wanna get to, but why else Is there a rise? In your many decades of doing this now, y–you personally have seen a rise in, in these sports injuries, in kids and adolescents?

Dr. Ahmad: It is consistent in our literature, our reporting, and it’s also consistent with my personal experience that the number of injuries are just getting higher and higher, and it’s got many factors, but part of the reason is our world has evolved to sports specialization and a term that I call professionalization. Our youth athletes, let’s just say a 16-year-old sophomore in high school who plays soccer, they have access to the best coaches, the best strength and conditioning coaches, nutritionists, and what they’re doing is they’re making their bodies stronger than ever and they’re also becoming specified and isolated to one sport early in life so that they’re putting more stress and more exposure on their bodies, and their bodies are not able to handle it. Their stronger, faster, quicker bodies that they’re exposing to stress just can’t tolerate it as much as we would like.

Faith: Is part of that, a cultural decision or push to ignore pain?

Dr. Ahmad: I’ll start by saying this and I’ll say it more than once. Kids who are playing sports in general should not have pain and players can have muscle soreness after a workout, but we’re talking about pain like a thrower who has elbow pain, or a young female gymnast who tumbles who has knee pain. They should not have pain like that, and sometimes, they’re encouraged to play through pain and, in fact, research that I’ve done indicates that as many as 80% of athletes experience pain as they’re playing, but here’s the tragic part of it: Out of those 80% that experience pain, 50% of them feel that they are pushed to play through pain by either parents or coaches or both.

Faith: I mean, Dr. Ahmad, when I drop my son off at the baseball center there are t-shirts for kids that say, rub some dirt on it, right? Which is funny, but, but I also, as a parent, I’m like, no, I, I don’t want you to rub some dirt on it. Tell us if it hurts, and you gotta stop playing for a little while.

Dr. Ahmad: Much of my career I’ve been studying and researching injuries, and I spend more of my time now speaking to parents and coaches because they are the biggest influencers on injury in young athletes. So what a great position to be in to be able to communicate with parents and coaches because understanding what is say normal for an athlete who say, let’s just say you’re a soccer player, you get kicked in the shin, that’s gonna be sore. You ice it, and that’s OK. But if you are developing an overuse problem, such as a thrower who’s having elbow pain, that is more serious.

Faith: Given that kids are getting these messages either explicitly or implicitly to push through pain and that they may not voice to parents or coaches that they’re in some incipient pain, what are the signs that parents need to look for that indicate that their child is, is either prone to injury or has already been injured?

Dr. Ahmad: The first part of being able to observe or understand what your child is going through is having that conversation with them and developing a culture where your athlete, your child, your son, your daughter, can speak openly about how they’re feeling either about their psychological needs, the pressure, the stress, or their physical issues, the maybe discomfort or pain that they’re having. The other is, as we mentioned, if there’s certain overuse injuries, meaning they didn’t get injured, but for a baseball player, if they’re having pain and the inside part of their elbow or their hand goes numb or something unusual, it should be taken a little more seriously and shouldn’t be just brushed off. And if a soccer player falls to the ground and holds their knee and felt a pop, that’s a suggestion that they had an injury, meniscus, cartilage, and that is not one to brush off. That’s one to, to take them out of the game. It’s tricky at times. Let’s accept that it’s tricky, so we have an obligation to try to accept that challenge and be better at it.

Faith: You have contributed to research about the psychological effects of these sports injuries. What do you think parents can do in these cases to help address the psychological challenges their, their kid may face when they’ve sustained an injury?

Dr. Ahmad: Well, it is crushing and I’ve observed it so frequently, I actually have been trying to get better at delivering bad news because I have to deliver it every week. They go through a grieving state, the player and the family, it starts with denial. ‘How can that be? I, it, how could that happen to me? I, I, I don’t believe it.’ But what we did do with our research on patients who get this diagnosis that’s gonna put them out is we studied their emotional and psychological impact, and we found that if you get a diagnosis of an ACL injury, for example, you have post-traumatic stress symptoms that are approaching soldiers that have been in war.

Faith: Oh my goodness.

Dr. Ahmad: That’s how much a young child can experience or an adolescent can experience. So what’s our job once we learn that there’s massive psychological impact like that? We have to get better at managing and developing resiliency tools. Resiliency being if you have a issue, a physical or an, a challenge in your life and it could be something related to, we’re talking about sports medicine or could be something, you fail a test, so forth. Do you grow from it? Do you try harder? Do you take it as a new challenge or do you withdraw and do you isolate? And then do you become depressed? And so resiliency training is about getting people to respond and be positive, and I’m a parent of three kids and I’m sometimes accused of being a so-called helicopter parent because if they fall, we want to pick them up right away. But sometimes we have to let our kids develop their own tools to pick themselves up.

Faith: It can be really hard for parents who want to support their kids’ dreams of being an athlete but also want to preserve their child’s health. What do you recommend for parents in that situation?

Dr. Ahmad: Yeah, that’s a tricky situation for parents who want their kids to achieve their goals, and if a kid has a goal to play at the highest level, they want to support them in that effort. But I will focus on several things that we can do as parents and, and if we’re in the position to coach our kids, as well. And that is, we mentioned pain is not normal. If you are a thrower and you have pain, that is not normal. It is possibly related to an injury and that should have an evaluation, and if there is an injury, it should have adequate time to heal. And there is something about sports diversification that we can control. Sports diversification means you play multiple sports and if you are younger and you play both basketball in the winter, instead of playing baseball through the winter, your chances of getting injured later in your career is much less.

How do we know that? Researched it in professional baseball players. The professional baseball players who played multiple sports, at least one more sport in high school, their chances of needing a shoulder or an elbow injury managed, treated, diagnosed, or even surgery was much less if they played multiple sports. That’s because if you’re young and you commit to a single sport, you’re putting so much stress on specific tissues in your body that never get a chance to heal because you never stop playing that sport, that they get vulnerable to injury later on in life. It accumulates. If you take a rest from one sport and play another, use different muscle groups, different tissues get exposed to different stresses, and it’s beneficial and it probably makes you a better player in addition to having less injury risk in the future.

Faith: Yeah, and even the plasticity in your brain, right? Firing, doing new things with different parts of your body. You have convinced me to continue to encourage my 10-year-old baseball player to keep up his tap dancing lessons with this, with this tip. Are there any other kind of bullet points there that parents listening can take away?

Dr. Ahmad: Well, let’s use examples too, because we want a toolbox. If you tell a kid, ‘Hey, you should play basketball in the winter,’ and they say, ‘why?’ You can say, ‘Hey, Derek Jeter played basketball.’ In addition, his jump throw likely came from him playing basketball. His ability to move right, jump and throw left is really a basketball-type maneuver. If you want your kid to stop throwing a baseball, give him a basketball.

Faith: Is there anything else parents can do to reduce their kid’s risk of injury?

Dr. Ahmad: The other is develop the–we mentioned it and I’m just gonna highlight it again–develop a culture of open communication. Speak to your kids and make it OK to say ‘I’m not feeling good right now.’ And make it OK to have a day off from, from playing. There’s lots of things about nutrition and sleep that we should talk about too, because our athletes are high school kids. They’re under a lot of stress academically. They’re studying, they’re taking tests. They don’t sleep well and sleep is a massive influence on your injury rates and we’re in capacity to influence that as parents and coaches. So, treat your athletes like they need to eat right and they need to sleep right in order to help them both cognitively in school and both physically, with their health.

Faith: Dr. Ahmad, you have the coolest job in the world, and I am so grateful you took a little time out to talk with us today. Thank you so much.

Dr. Ahmad: You are so welcome. This is my new mission, and that is reaching out to people who are the most important to our kids, and that’s the parents.

Faith: Thank you.

Our many thanks to Dr. Ahmad.

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