The COVID-19 pandemic has disrupted American life in unprecedented ways. School closures, cancelled sports leagues and shelter-in-place orders have dramatically changed how children are using their bodies. Pandemic precautions have caused children to lead more sedentary lifestyles, as they complete school work virtually and spend less time outdoors.
Overall, COVID-19 restrictions and the lack of organized sports have led to a notable reduction in broken bones and sports injuries. Pediatric fractures dropped by nearly 60% during the first days of stay-at-home orders as compared to previous years, and sports-related fractures also saw a dramatic decline. Sports-related fractures accounted for only 7.2% of all fracture cases during the first days of the pandemic, versus 26% of fracture cases in previous years.
In California, youth recreational sports are still on pause for much of the state. While guidelines released back in August 2020 allow recreational sports to conduct modified skill-building conditioning and training, with physical distancing and gathering protocols in place, full-contact and normal competitive matches are still on hold.
What will this mean for children’s young bodies? What will it mean when kids get back to competition after sitting idle for a whole year?
We can draw lessons from professional sports to anticipate what full return to recreational sports might mean for our young athletes. When professional athletes have had their preseasons cut short in past years, or their offseason fitness training reduced, injuries spiked. After the 2011 NFL lockout, when players lacked access to team healthcare providers, strength and conditioning professionals and coaches for several months during the offseason, the NFL saw a four-fold increase in Achilles tendon ruptures during the preseason. When MLB spring training was cut short because of COVID-19 in mid-March of this year and players lacked access to training facilities for 3.5 months, pitcher injuries spiked. Pitcher injuries were 50% higher than in any previous opening period (the first 10 days of the season).
These lessons from professional sports can help inform how we prepare our young athletes for a safe return to recreational sports. Children will be excited to get back out on the field. After months of being sedentary, they will be eager to perform at their previous level. They may be eager to make up for lost time and may train even harder than normal. Coaches may also be eager to make up for lost time by intensifying practices. Leagues may schedule more games to make up for lost playing time.
Our Sports Medicine Team at Shriners Hospitals for Children — Northern California expect to see a flood of pediatric sports injuries when recreational and competitive leagues resume. There will likely be a jump in injuries typically caused by inadequate conditioning – muscle strains, overuse tendon injuries and stress fractures. My prediction is that we will see more injuries than normal in young athletes whose bones and joints are developing. These include injuries of high-growth, high-stress areas like knees, shoulders, elbows, hips and ankles.
As children wait for sports leagues to resume, there are important conditioning and stretching activities they can do today to reduce their risk of injury. To prevent such injuries, young muscles and tendons will need to ease back into shape gradually. When sports resume, it will be important for parents and coaches to encourage children to slowly return to competitive activity.
We encourage young athletes, with the help from parents and coaches, to do the following:
Make a Schedule: Make a calendar of daily and weekly athletic goals. Follow the “10% rule”: increase activity by no more than 10% per week. This applies to the intensity, volume, distance and duration of workouts. Make time for rest and recovery after strenuous workouts. Don’t forget to give your body adequate nutrition and sleep.
Stretch it out. Consider adding stretching and yoga to your routine. Professional athletes understand the benefits of stretching and yoga and so should young athletes. With online resources and tutorials, yoga and stretching exercises are more accessible than ever before. Don’t forget to add stretching to your warm-up and your cool-down as well.
Get Creative. With many school and community gyms closed, find effective substitutes at home. Body weight exercises such as burpees, mountain climbers and jumping lunges are effective exercises. These three simple movements can improve cardio, strengthen, and balance while working out in small spaces. Use soup cans or water jugs for weight training. Use a large couch cushion for lower extremity balance, proprioception and strengthening exercises in lieu of a half balance ball, also known as a Bosu ball or Dome ball.
Diversify your activities. If you’re a pitcher seeking to remain at a high level of throwing, your workouts during this time should not be solely focused-on pitching. In fact, most of your training should be directed towards reinforcing the basic mechanics of throwing and addressing any kinetic chain deficits. Consider adding in additional activities like walking, jogging or biking to your routine. Improving your core strength, lower extremity balance, flexibility and cardiovascular endurance are all ways to enhance your pitching capability. This applies to all repetitive activities that are at high risk for overuse injuries. Now is a great time to incorporate injury prevention programs like FIFA 11+ and follow guidelines from organizations like USA Baseball and their Pitch Smart program.
Listen to your body. Parents and coaches should ask their young athletes about any pain, soreness or tightness. Some children may want to work extra hard to impress their coaches or make up for lost time. Encouraging them to be aware of their bodies and take note of how they feel is important. Parents and coaches should be on the lookout for any overuse injuries. Early intervention with targeted conditioning and stretching exercises or even physical therapy will be key to avoiding further injury.
When children have the green light to resume competitive sports, it will be up to parents and coaches to help them reduce their risk of injury by making sure they ease back into competitive training and play. If kids take time to ease back into full activity, follow a schedule for a safe return to play and build up their core strength before resuming competitive sports, they will be doing their growing bodies a huge favor – and will also reduce their risk of injury.
Nicole A. Friel, M.D., M.S. is an Orthopaedic Surgeon and Sports Medicine Specialist with Shriners Hospitals for Children – Northern California and UC Davis Medical Center. Dr. Friel is dedicated to providing world-class care to children in Northern California. She specializes in pediatric and adolescent sports medicine, taking care of non-operative and operative problems, including performing arthroscopic and open procedures on the knee, elbow, and shoulder. She has particular interest in shoulder dislocations, patellar instability, knee ligament reconstruction, and cartilage restoration. Dr. Friel earned her medical degree at Rush University Medical Center in Chicago. She has served as the team physician for multiple high school and collegiate teams as well as assisting in the care of professional teams including the Pittsburgh Penguins, Chicago White Sox, and Chicago Bulls.
 Bram, Joshua T. BS*,†; Johnson, Mitchell A. BSE*,†; Magee, Lacey C. BA*; Mehta, Nishank N. BA*; Fazal, Faris Z. BS*; Baldwin, Keith D. MD, MPH, MSPT*,†; Riley, Jake BA*; Shah, Apurva S. MD, MBA*,† Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic, Journal of Pediatric Orthopaedics: September 2020 – Volume 40 – Issue 8 – p 373-379