Part one of this series discussed the increased risk for injury when 18 or 19 year-old athletes are drastically increasing their volume of play, but part two addresses the athletes who fall on the other end of the spectrum- athletes like Zion Williamson. These are the athletes who have been playing since the age five, practicing daily, and playing four to six games each weekend; a volume similar to that of an NBA player. Williamson’s parents mention how exhausted they were from keeping up with his vigorous schedule; imagine how his body is feeling if they’re exhausted just from watching.
As clinicians, Athletic Trainers (ATs) know that acute injuries often occur when fatigue sets in, and that chronic injuries occur when the body cannot recover from the stress of activity as quickly as stress is being applied. The article transitions into examining what physicians and other medical professionals are seeing in this class of athletes- this sector that plays with such a vigorous schedule it rivals the professionals.
Dr. Nirav Pandya is a pediatric orthopedic surgeon whose practice has been growing rapidly. He estimated five years ago he saw 1,500 injuries a year, with 150 cases being surgical. Last year, those numbers grew to 6,000 injuries and 400 surgeries. More than half of the surgeries were performed on patients under the age of 14, almost ensuring they were performed on skeletally immature patients. He reported that five years ago, he performed an anterior cruciate ligament (ACL) reconstruction on a basketball player who was eight years-old– a first for him at that time.. That number has been steadily increasing to the point where performing the procedure while constantly x-raying to ensure growth plates are not compromised is something that feels commonplace now.
If that thought on an eight-year-old tearing their ACL wasn’t traumatizing enough, Pandya paints a picture of what these adolescents’ cartilage looks like when he views them during surgery. The cartilage is no longer smooth or white, but rather gray and rough. The texture is off as well, already softening and becoming spongey. He describes a person whose knee appears 30 years older than the age on their medical chart. As a result, he’s having to initiate the hard conversations with parents in his clinic, telling them that four to five practices a week, plus games, is too much and that their child’s knee may actually look “older” than their own. His concern lies in the fact that when he shares his thoughts with the parent, expecting shock over their child’s physical state, the parents are most shocked by the length of time off he’s prescribing.
In response to the growing number of injuries, P3 Applied Sports Science and other similar biomechanics-focused facilities opened with the model of evaluating and correcting the biomechanics of high-level athletes to try and preserve their career. These facilities say that high school athletes now account for much of their clientele. Their thought was to control what they could control. If medical professionals cannot get patients and their families to consider decreasing their volume, then they can at least try and make the athletes’ bodies more able to withstand the demands placed on them in the hopes their career won’t peak at 16 or 17 years-old, because at 26 years-old, they will no longer have cartilage left.
The words shared throughout this two-part series play right into Athletic Trainers and other medical professionals’ fears for patients, but the end of this article tells a story attempting to connect with business-minded people. They talk to Josh Johnson, a first-round draft pick, out of Kansas. Fans love to watch athletes make impressive dunks. However, Johnson was told to stop practicing these flashy acrobatic moves. The reason? “You just lost $1,000…You just threw it away from your future.” Staff members at Prolific Prep where he trained explained to him the force with which he landed on each and every dunk would contribute to earlier degeneration of his knees. This would essentially shorten his career one dunk at a time, or decrease the amount of money he’ll be able to make as a professional player. ATs and other medical professionals will never be able to prevent injuries from occurring, but if we can work to eliminate unnecessary stressors being placed on the body, we can certainly improve long term health for our patients.