JUNE 7, 2004

PERSONAL BUSINESS

Young Athletes, Big-League Pain
By Mark Hyman

Year-round play and dreams of going pro are side-lining kids with serious injuries. All work and no play may make Jack a dull boy. But all play every day can make Jack a hurting boy. At the sports-medicine clinic of Children's Hospital Boston, where dozens of young athletes hobble in daily, doctors are finding a surprising cause for many of those aches and pains: playing too hard, too often. Swimmers report sore shoulders. Tennis players clutch their lower backs. Soccer players yelp with leg pains. All are victims of overuse injuries, a rising health crisis that is derailing or destroying promising careers.

Just 15 years ago, overuse injuries accounted for 20% of patients visiting the Boston kids' clinic, the first of its kind in the U.S. when it opened in 1974. Now it's 70% and climbing. "Places like our clinic are being flooded with overuse injuries," says founder Dr. Lyle J. Micheli.

Case in point: Gabe Klein, a 7th grader who lives in Mamaroneck, N.Y. Last spring he was playing travel soccer, rec-league soccer, and travel baseball, with a game or a practice nearly every day. During a soccer game, he attempted to kick the ball, fell to his knees, and couldn't get up. He had to be carried from the field. "I felt something pop," says Gabe. It turned out he had a chip fracture of his hip. He sat out all sports for four weeks and has since given up soccer to focus on baseball.

FEEDING THE FRENZY
Why are kids pushing sports so hard? All too often they're impelled by dreams of a college scholarship or the riches of professional sports. Media coverage of gargantuan pro contracts has more parents than ever smitten with the idea of Becky one day playing center court at Wimbledon. "It's amazing how many parents project their children at professional levels," says Vern D. Seefeldt, director emeritus of the Institute for the Study of Youth Sports at Michigan State.

Coaches feed the frenzy, too. When a soccer guru or tennis tutor urges playing another tourney or jacking up practice time, parents often don't object. "They're being told by the coach: 'Your son has amazing potential and needs to improve his serve next week.' There are few people guiding the parents who have the welfare of the child at stake," says Dr. Eric Small, head of the Sports Medicine Center for Young Athletes in Mount Kisco, N.Y., and author of Kids & Sports.

Making the injury list even longer is the trend toward sport specialization. A decade ago a peppy 10-year-old might divide his play among soccer, basketball, and baseball seasons. Now more are being channeled to one sport that they play year-round. The extra training improves skills but adds to the wear and tear. Baseball pitchers are especially at risk: Witness high school junior Paul Burnside, who recently underwent elbow surgery to save his pitching career.

For some prodigies there's no arguing with the single-sport approach. Golfing phenom Michelle Wie, 14, was a tennis player, swimmer, even a slugger on the Little League Baseball team in her native Hawaii, until she turned 9. Then her father, B.J., decided his daughter's focus would be golf. "It was clear she had more talent in golf than anything else," says B.J. Four years later she nearly won the Kraft Nabisco Championship on the Ladies Professional Golf Assn. tour.

There's more than one path to the big leagues. Soccer Olympian Mia Hamm's parents encouraged her to play different sports. When high school soccer season was over, she was a point guard on the basketball team. "I was a terrible shot, but fast," says Hamm. "My dad never said: 'Go out and work on soccer.' The decisions about playing came from me." Hamm tells kids to avoid early specialization.

For their part, sports docs advise parents to monitor closely how much time their children are putting in. Sudden spikes in hours that coaches demand can be a warning. Still, says Small, the New York doctor, "parents are so focused on their kids being superstars that they think they're doing a service when training jumps from 10 hours a week to 30. They love their child, but they have blinders on." Often those blinders don't come off until a youngster gets hurt. But by then a 12-year-old's sports career can be over.

"Tommy John" Comes To High School
By Mark Hyman

Until recently, high school junior Paul Burnside was blissfully unaware that pitchers his age could be candidates for "Tommy John" elbow surgery. Paul, son of former MLB pitcher Sheldon Burnside, knew of accomplished pitchers who had undergone arm reconstruction, but they were ailing big leaguers. That changed in March. Paul, 17, was one out shy of victory for Jefferson Davis High School in Montgomery, Ala., when he felt "something a little weird" in his elbow. A few weeks later he had the operation that is named for 26-season major leaguer John, a tendon transfer from the wrist or hamstring to the elbow to take the place of a damaged ligament.

Burnside is hardly the only teenager taking this route. Once high school heavers paid homage to their heroes by mimicking their pickoff moves and trick pitches. Now they're having the same elbow surgery -- which costs at least $10,000 and involves a long, painful rehabilitation. Even some surgeons who perform the operation are worried about the trend. They say it stems from year-round seasons, competitive pressure, and often, pushy parents and the quest for college scholarships. Says James R. Andrews, a leading orthopedic surgeon: "We ask every parent: 'Does your child really have the talent to utilize this surgery?' The problem is, every one of them says yes."

No one is sure how many high school ballplayers -- mostly pitchers and catchers, whose positions require strong throwing arms -- are having Tommy John operations. But Andrews, who practices in Birmingham, Ala., and has treated the elbows of dozens of major leaguers, including all-stars John Smoltz and Kerry Wood, thinks the numbers are soaring. From 1988 to 1994, he performed the surgery on seven high school players. In 2003 he operated on 55.

Back in 1974, when Dr. Frank W. Jobe dreamed up the operation to fix John's elbow, the idea of repairing the arm of a high school player would have been ridiculed. John's surgery was done strictly "to save a career," recalls orthopedic surgeon Lewis A. Yocum, team physician for the Anaheim Angels, who trained under Jobe. After surgery and a year off for rehab, John went on to pitch 14 more seasons.

Because of a rash of elbow injuries among high school players, however, the once-experimental procedure is being sought out by anxious parents. That has Andrews on a crusade against the cause of this epidemic -- too little preparation, too much pitching. He blames year-round play, endless summer tournaments, even rules that deny a relief pitcher the proper number of warm-up pitches.

For families who come to Andrews, Tommy John surgery is the only hope of keeping alive the dream of a college scholarship or a rich deal with the pros. Andrews says he counsels families to consider more conservative treatment, such as lengthy rest periods, and to look at elbow reconstruction as a last resort. Still, notes Rick Wolff, a youth sports expert and author of The Sports Parenting Edge: "It's a rare parent who says: 'Know what? Play ball for fun. Forget about scholarship money or a pro contract.' For most families, if surgery is the only way to move up, it's a no-brainer."

Surgeons say that before operating, they also try to determine if high school patients have the potential for a lengthy sports career. Operating on a pitcher who may play just a handful of high school games and quit after a year of difficult rehabilitation makes little sense. "Just because we have a hammer doesn't mean everything is a nail. Obviously, the surgery isn't designed for everybody," says Yocum.

Even after careful screening, the careers of most high school players who have Tommy John surgery end quickly. Out of 27 of Andrews' high school patients interviewed recently by the American Sports Medicine Institute, a research center affiliated with the surgeon's clinic, only 10 went on to pitch in college. More than half quit the sport less than two years after surgery.

Sheldon Burnside, who pitched with Detroit and Cincinnati in the 1980s, has reason to hope that Paul -- a 6-foot-4, 200-pounder -- won't be among those who quit baseball early. In the game in which his elbow gave out, Paul turned in a performance that Roger Clemens would have been proud of, allowing just three hits and notching 10 strikeouts. Recently the Colorado Rockies sent a scout to have a look at him. "No one in this city has thrown the ball as hard as Paul has," says Sheldon. If rehab goes well, Paul's next pitch is scheduled for 2005.