Insights from Dr. John Schlechter, board-certified fellowship-trained pediatric orthopedic surgeon at Rady Children’s Hospital Orange County (Rady Children’s)
Key takeaways
- Listen to the body, not the pressure to play: Overuse injuries, acute injuries, and pain that persists are signs kids need rest. Pushing through pain can worsen damage in growing bodies.
- Proper diagnosis and recovery matter: Sprains, strains, and fractures require different care, and returning to play should be gradual, typically resting twice as long as symptoms lasted and starting back at 50% intensity.
- Prevention starts with balance and rest: Avoid early specialization, prioritize cross‑training, take breaks during the year, use proper equipment, and seek pediatric sports specialists when injuries occur.
Expert guidance on youth sports injuries
For many kids, sports are more than just a pastime—they’re a passion, a source of identity, and a vital outlet for growth, discipline, and joy. But with that passion can come risk. As youth athletes push themselves harder and start competing at younger ages, the line between healthy dedication and potential injury becomes increasingly blurred.
In this article, we turn to the expertise of Dr. John Schlechter, board-certified fellowship-trained pediatric orthopedic surgeon, specializing in sports medicine and arthroscopy for children and adolescents. He’s also the Director of the Sports Medicine Program at Rady Children’s Hospital Orange County.
Dr. Schlechter discusses the delicate balance between encouraging a child’s love for the game and protecting their growing bodies from harm, because when injuries and passion collide, both kids and parents are left navigating difficult decisions.
What types of injuries are common in youth sports?
Youth sports injuries vary by age and sport. In younger athletes, injuries often differ from those seen in older children. Overuse injuries, such as those in baseball from repetitive throwing, are common, whereas contact sports like football or quick-cut sports like soccer often lead to acute injuries, such as knee damage from twisting, cutting, or direct impact.
Early sports specialization, while often well-intentioned, can lead to overuse injuries due to repetitive stress without adequate rest. He emphasizes the importance of cross-training to reduce these risks and points to the concept of “load management,” as popularized by athletes like LeBron James, as a strategy to prevent injury by allowing the body time to recover, even when no immediate injury is present.
“That’s something I try to highlight in the office,” states Dr. Schlechter. “Trying to push through an injury is probably not the safest thing for them to be doing when their body is trying to give them a message to slow down and rest.”
Strains, sprains and fractures: Understanding the difference
There are distinct differences between sprains, strains, and fractures, and when medical attention is necessary.
- A sprain involves injury to a ligament and can range from a mild stretch (grade 1) to a complete tear (grade 3), like an ACL tear.
- A strain affects muscles or tendons and is typically treated with rest, ice, compression, and gradual return to activity. Dr. Schlechter’s rule of thumb: rest for twice the duration of symptoms and return at 50% intensity.
- A fracture is a break in the bone, which can vary in severity—from minor bone bruises to full breaks.
When in doubt, especially if symptoms persist or worsen, it’s best to consult a sports medicine physician for proper diagnosis and treatment.
The role of equipment in protecting against sports injuries
It’s important to honor the role of equipment in protecting young athletes, noting that while gear can help, it’s not always a foolproof solution. For throwing athletes aged 8–12, Dr. Schlechter’s team is studying whether elbow braces, or even something as simple as limiting throws using a bucket, can reduce stress on vulnerable growth plates.
In football, knee braces may help protect offensive linemen from impact injuries. Dr. Schlechter also emphasizes the importance of helmets across various activities, including football, biking, and riding electric scooters, stressing that proper head protection is crucial to preventing serious injury.
“We know that even with the best helmet, you still can have a shift in the brain within the skull that can lead to an injury. So, be safe, watch your surroundings, especially when you’re on an e-bicycle or e-scooter. And definitely follow the laws of the road,” he urges.
What are the best treatment options for youth sports injuries?
There’s a debate between using heat or ice for treating muscle injuries at home. Dr. Schlechter notes that there’s no definitive answer; both have valid theories. Ice may reduce inflammation by decreasing blood flow, while heat may help by increasing blood flow and flushing out inflammation. Ultimately, he recommends using whichever feels best for the child. He also mentions that muscle stimulation devices are commonly used with the goal of increasing blood flow to aid recovery.
“I usually go with whatever feels best, being a patient myself and having gone to a physical therapist,” shares Dr. Schlechter. “Typically, you heat first, do the soft tissue mobilization, the massage, some exercise, and then ice after. That seems to work for me and so that’s my approach, personally.”
Getting back on the field, court or track
Determining when a child is ready to return to sports after a musculoskeletal injury involves caution and careful assessment. A good approach is to wait twice as long as it took for symptoms to subside, then return at 50% intensity.
Dr. Schlechter emphasizes a “when in doubt, sit it out” approach and advocates for involving physical therapists and athletic trainers. Functional and dynamic testing in controlled environments can help ensure the athlete is truly ready to handle the physical demands of competition safely.
“If you can’t perform in a physical therapy center or in a practice field, then you’re probably not going to do so well in a game,” he cautions. “And, when there’s competition and an opponent, especially in a contact sport, that just puts the athlete at risk.”
Preventative measures to avoid sports injuries
Prevention is key in youth sports. Dr. Schlechter encourages athletes to listen to their bodies and not be afraid to say no to games or events when they’re not feeling their best. While pushing through discomfort can be part of training, knowing when to rest is crucial, especially given the pressures young athletes face around performance, team selection, and scholarships.
He recommends taking three months off from a primary sport each year, either consecutively or spread out, and using that time for cross-training or working with a qualified strength and conditioning coach. Injury prevention programs, like those designed to reduce ACL tears, can also be valuable during the off-season and as part of warmups.
Finally, Dr. Schlechter urges parents and coaches to really think about specialty care when it comes to sports injuries. “Seeking out the specialization of somebody who really understands children at a children’s center is probably the best bet. Urgent care centers, although they’re very useful and they’re handy in the community, sometimes don’t have the level of expertise that is present at a pediatric-centric institution.”
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