In my practice recently, a dedicated hockey mom of two boys asked me, "How much hockey is too much hockey?" Her boys, 12 and 14, live and breathe the sport and she was concerned that both boys had developed overuse injuries. Their summer was jammed with hockey camps, skills training and a three-on-three summer hockey league.
The 14-year-old complained of hip pain and said his legs started to "feel heavy" after practice some time in early August. He felt the pain during and after skating, pain that sometimes lasted two to three hours once off the ice. His younger brother had back and knee pain and his mother noticed he didn't have his usual speed. The 12-year-old also started coming out of the dressing room with a limp. Heading into the 2014/2015 hockey season, all three were worried.
The mother's question is a good one. How much is too much? More specifically, what risks are young athletes taking if they focus on one sport? And what can our aspiring NHL stars do to recover quickly after exercise and prevent overuse injuries?
Kids who specialize in one sport at a young age and play it year-round train harder and longer than other young athletes who play a mix of sports and take seasonal breaks. Improved skills are often achieved through repetition and it's this repetition that may place a young athlete at risk of injury. Typically, overuse injuries result from training errors and/or excessive training. If young athletes are not given adequate time to rest and recover, instead starting a new season tired or nursing an injury, they are more likely to see their skills plateau, or spend time off the ice and on the injury list.
Parents and coaches need to be sensitive to changes in a child's performance and attitude that suggest he/she is being pushed too hard.
The boys' injuries were a result of both overtraining and poor body mechanics, a devastating combination in young athletes. Improper technique can put unsafe torque and pressure on tendons, growth plates, bones and joints. A young athlete's body is elastic – but only to a point. When the body can no longer keep up with training demands, it will compensate and the signs of overtraining start to appear. The boys had developed an inefficient short, choppy and more upright skating stride, placing stress on their lower back, hips and knees.
To avoid injury, kids need time to recover from sport. Young athletes need periods of active, short-term recovery beginning in the hours immediately after an intense workout. This recovery includes three key strategies: a proper cool-down routine, nutrition and adequate rest or sleep.
When it comes to nutrition, research has shown that early intake after exercise (within the first hour) of essential amino acids from good-quality protein foods helps to promote the increase in protein rebuilding. Adding a source of carbohydrate to this post-exercise snack will further enhance the training adaptation by reducing the degree of muscle protein breakdown (e.g., a cereal bar and cup of yogurt).
A period of long-term recovery is also important and should be built into a comprehensive, year-round training schedule. This recovery includes off-season strengthening and dedicated stretching before and after practice.
Competing in different sports throughout the year will also prevent sport-specific repetitive stress, as long as there is adequate rest between seasons. Research shows that children who play multiple sports have fewer injuries and continue to play longer and at higher levels than children who specialize in one sport before puberty.
But even with a healthy training schedule in place, there are limits to what a young athlete's body can tolerate. As a general rule, children should not train for more than 18 to 20 hours a week.
The American Academy of Pediatrics Council on Sports Medicine and Fitness recommends that children play only one sporting activity to a maximum of five days a week with at least one day off a week.
Young athletes can follow the "10-per-cent rule" to prevent injuries. This rule means that a training program can only increase by 10 per cent each week. For example, 20-minute runs three times a week can be increased to 22 minutes the following week, and so on.
In addition, kids should take two to three months off from a particular sport to allow the body to heal and the mind to recharge.
Children who are engaged in elite competition may be required to train harder and longer, in which case they should be monitored by a qualified health professional with expertise in young athletes. These kids need their growth monitored to make sure abnormalities don't occur.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Dr. Dwight Chapin, B.Sc(H)., D.C., is the clinic director of High Point Wellness Centre in Mississauga (highpointclinic.com), team chiropractor for the CFL's Toronto Argonauts and on-site clinician for employees of The Globe and Mail. Follow him on Twitter @HighPtWellness.