Quarantine to competition could be a recipe for an injury

Post Nicole A. Friel, M.D.

Parents will be thrilled to see their children’s behinds heading out the door as the pandemic restrictions on school and organized sports are lifted.

Kids and teenagers with uniforms, mitts and cleats will be rushing out to the playing fields.


But those young athletes are going to be at a big risk of injury following such a prolonged hiatus, says Nicole Friel, M.D., an orthopedic surgeon and sports medicine specialist with Shriners Hospitals for Children — Northern California.

She is worried that clinicians may see a raft of patients limping and maybe rolling, into the clinic in the weeks to come.

“Kids have been sitting on their couches and playing video games for a full year,” Dr. Friel says.

“Sports are going to start, kids are going to go back and all are not ready. They won’t have great biomechanics, agility, or strength and they won’t yet have the endurance to maintain long workouts and competitions,” she adds.

“We expect to see a flood of pediatric sports injuries when recreational and competitive leagues resume.”

The experience of professional sports leagues should serve as a warning, Dr. Friel contends.

The National Football League had a player lockout in 2011. Players were barred not just from the fields but from the workout facilities as well. It lasted several months. When they returned, Achilles tendon ruptures – an injury that can end careers at worst and keep athletes sidelined for multiple months at best – increased four-fold (J Orthop Sports Ther 2011;41:702-705).

COVID-19 interrupted Major League Baseball’s spring training and delayed the start of the season for more than three months last year. When play resumed, pitchers had a spike in injuries of about 50% during training and the early season.

Dr. Friel has advice for young athletes and coaches:

1. Take it easy.

Athletes will be deconditioned after spending so long cooped up in the house. Many will want to get right back at it. That can be trouble, however. Athletes must be patient and recognize that getting ready and back to where they may have been will take time.

Dr. Friel recommends athletes make up a calendar, one with daily and weekly goals, to remind them to be patient and to help them see progress. The goals should be reasonable. Running coaches often advise never increasing distance running miles by more than 10% per week. That’s a good rule for any sport, she says. Increase the activity, intensity and duration by no more than 10% per week. 

Also, athletes must make allowance for rest and recovery after strenuous workouts; injury risk increases when athletes get fatigued.

2. Stretch, stretch, stretch.

All athletes should practice reasonable dynamic and static stretching, but particularly now when young athletes are going from couch jockey to competitor.

Pro athletes always warm up and stretch for flexibility. Many practice yoga, which not only works on flexibility, but also is isometric exercise that can build strength. It works for young athletes too.

Stretching and yoga routines are easily found on the Internet.

3. Mix it up.

Many athletes may be tempted to go out and throw, throw, throw or kick, kick, kick to make up for lost time. Now more than ever, the risk of repetitive motion is high. Training should be varied. Pitchers should run, work on their mechanics and maybe do strengthening. Runners can spend time in the gym, working on core strength, balance and flexibility. This is a great time for implementing injury prevention programs like FIFA 11+ and USA Baseball’s Pitch Smart program.

4. Soreness.

Athletes need to pay attention to their bodies and what their bodies tell them. There will be tightness, soreness, bumps and bruises. When unrecognized and unaddressed, minor problems can lead to actual injury and time away from the field again. Athletes need to be reminded to listen to the signs they are doing too much. And both coaches and parents need to monitor, question, listen and watch their athletes.

Dr. Friel says: “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 progressively return to 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 reduce their risk of injury.”

Dr. Friel, the co-director of sports medicine at the Northern California Shriners Hospital, has been team physician for multiple high school and collegiate teams. She has also worked with the Pittsburgh Penguins, Chicago White Sox and Chicago Bulls.

The sports medicine program at Shriners Hospitals for Children — Northern California has a team of physicians, physical therapists, nurses and support staff to offer the full range of sports medicine treatments and rehabilitation. Our physicians perform the latest innovative procedures, including ultra-sound guided injections, cartilage restoration, advanced patellar stabilization surgery, physeal-sparing ligament reconstructions and complex hip preservation. They offer both open and arthroscopic surgery techniques.