Here’s an equation that doesn’t add up: Steady or declining participation in organized youth sports = a significant rise in youth sports injuries (including a 200% increase in damaged ACLs). “It’s really very disheartening to organizers and administrators,” says Joe Janosky, director of sports safety at Hospital for Special Surgery (HSS), which is ranked the #1 hospital in the country for orthopedics by US News and World Report. Joe, whose team is trying to counter the epidemic with a nationwide prevention effort, spends a lot of time talking with those in charge. “They feel compelled to take action but they simply don’t know what to do. It’s the most difficult part of the conversation.”
The long-term answer lies in education and training, he says. But he has some thoughts on what’s causing the spike in injuries and how to begin to turn it around:
Factor 1: Physical Illiteracy in Kids
The increase of sports-related injuries makes more sense in the context of other current public health issues, specifically obesity and limited physical activity. According to Joe, today’s school-age children have the poorest physical literacy in documented history. “Kids simply don’t know how to move properly, and that makes the risk of injury greater,” he says, citing a recent study that suggests a majority of 17-year-olds can’t perform basic sports-related actions properly. “Fundamental movements and the focus on injury prevention and risk management need to begin in elementary school,” Joe says. At the same time, the public school system typically stops evaluating a child’s motor skills and movement quality in fourth grade, around the ages of 9 or 10, just when sports begin to get more competitive.
Factor #2: Limited Training for Adults
“There’s not a single curriculum in the United States that fully prepares educators to conduct motor skills training,” Joe says. “Physical education teachers are well-prepared to set up a ropes course or teach kids how to dribble a basketball, but they aren’t well trained in how the human body should move.” Many parents are also missing crucial information about how to move safely. “They’re just starting to get educated about concussions,” says Joe. “But risk factors for, say, ACL injurys? Not really.”
Take warm-ups , for example: There’s often not a lot of thought put into warm-up activities. “We are working to change that, but in order to do so we need to teach coaches exactly what to do,” Joe says.
Factor #3: A Slew of Mixed Messages
For many coaches and organizers, any attempt to attack the problem is met with limited resources and conflicting messages. Parents, coaches and organizers are constantly told that kids spend too much time looking at screens and not enough in motion. Then there are also been calls to curb activity, like Little League Baseball and Ripken Baseball implementing a pitch count in reaction to elbow and shoulder injuries in young players. The conversation has been around how much young athletes should move — rather than how.
The HSS team suggests a nuanced approach: “Movement quality over movement quantity.” The theory is simple: It makes a big difference when pitches, whatever the number, are thrown properly. Ditto running 10 miles in the right shoes with the right technique, then giving your body ample time to recover. “We respect the passion to play soccer year-round,” Joe says. “But let’s understand the fundamentals that will allow you to play soccer healthily throughout that period.”
Factor #4: A Lack of Policy Setting—or the Knowledge to Enact Policy If It Is Set
“Governing bodies of sports in the U.S. don’t govern much of anything, and that’s not me talking,” says Joe. “They are the first to say they’re pretty restricted.” Many other countries have national agencies devoted to athletic development that track injuries in the hope of better understanding how to prevent them. Still, Joe acknowledges that’s no cure-all. Australia, despite a well-organized national sports ministry, still has injury rates that are similar or higher than those in the U.S. “Everyone is in the same boat, looking for practical solutions,” Joe says.
For now, most policy setting in the United States continues to fall to decision makers at the league level, who need more support and information. “We need to give organizers the tools to create policy and then implement it,” Joe says. “But we also have to give them the formal training that allows them to enforce it.”
At HSS, Joe and his team are developing such resources, including digital sports safety education series with workshops geared to organizers and administrators — as well as coaches, parents and athletes.
There is no quick fix and no such thing as total injury prevention, but with more awareness and better education at every level, perhaps we can begin to turn the tide.