Injury prevention programs, training right, play, and childhood

This weekend, I attended the Seattle Sounders Sports Science Mentorship Weekend, which is a very good event for the burgeoning field of sports scientists in the United States. The best speaker, to me, was Charlie Weingroff. I have heard Weingroff speak a couple times, including last month at the Boston Sports Medicine and Performance Group conference, and he combines common-sense thinking with loads of practical experience and intelligence to substantiate his remarks and his opinions.

The remark that I starred in my notes was about sport-specific training. Since this was a soccer conference, he referred to the en vogue training programs for a common soccer injury, sports hernias. I equated the sports hernias to ACL injuries in basketball, and especially girls/women’s basketball, though I understand there are major differences between the two injuries.

He said something to the effect of:

“There is no sports-hernia training program. I don’t understand all these sports-specific programs or injury programs. Surgeons do specific things. Train right and avoid problems.”

This followed upon comments where he had said that he does not train soccer players, basketball players, etc. He said that he trains athletes to move better and express more power with more durability. Coaches, he said, do the sport-specific work on the court or the field.

This differs greatly from the current youth sports environment which has appeared to move toward sports-specific training and injury-prevention programs. I repeatedly see trainers wanting to emphasize the specificity of their exercises rather than training general athleticism. Basketball trainers won’t do a basic lunge anymore without there being a basketball in the players’ hands.

Another speaker, Mark McLaughlin, a strength coach from Portland, Oregon, began his talk by describing his process for entering the field. He said that he noticed that children were not engaging in free play anymore. Then, he read about different severe injuries in high-school athletes, and he decided to embark on a process to become a strength and conditioning coach and eventually open his own training facility.

The irony, at least to me, is that the answer to a lack of play was specialized training. McLaughlin spoke about encouraging his clients to play multiple sports and engage in recreational activities like hiking and skiing. However, I still find it ironic that he, like many others, find fault in today’s youth sports environment of overtraining, early specialization, and lack of free play, and turn to specialized training as the answer to the faults. It is as if replacing free play with training and structured sports participation is acceptable as long as it is better, more scientific training and coaching.

During the clinic on the soccer field outside the meeting room, the faults were on full display. Children who could barely walk were engaging in some form of soccer-specific activity. I do not know who organized it or what the purpose or goal was, but the children never actually played soccer; occasionally they dribbled around cones or shot at goal, but there was no actual playing. Most of the activities appeared to be SAQ-focused: ladder drills, jumping on dots, running over small hurdles, etc. Of course, because nobody does general training anymore, all of these SAQ activities ended with a kick of a soccer ball.

I watched the activities and wondered why they did not play tag or, heaven forbid, just let them play 3v3 soccer. Who cares if they have not developed proper skill techniques? What will develop these techniques faster, playing tag or standing in line for 45 seconds before running through a ladder for 5 seconds? The problem, of course, is that nobody makes money from pick-up games or tag, so nobody markets its importance, whereas those who own specialized training facilities are heavily invested in convincing the population of the importance of the specialized training.

In a 2011 article by Myer et al. in Current Sports Medicine Reports, the authors concluded:

Regular participation in organized youth sports does not ensure that youth are adequately exposed to fitness regimens and activities that sufficiently improve health and sports-specific fitness to minimize risk of injury and promote lifelong health and fitness. Accordingly, participation in physical activity should not begin with competitive sport, but should evolve out of regular participation in a well-rounded preparatory conditioning program.

Is that necessary? Before I played in my first soccer and baseball leagues in kindergarten, I never engaged in any preparatory training programs. I played at recess. Rather than evolving out of a well-rounded preparatory conditioning program, shouldn’t youth sports evolve out of play? If the change identified as the cause of these injuries is a lack of play in one’s youth, as McLaughlin suggested, why is the answer a well-rounded conditioning program as opposed to increased free play? Wouldn’t encouraging more recess time for playing on the monkey bars, playing tag, jumping off swings, etc. provide the requisite preparation without putting children into a training mindset from the outset of their sports careers?

Myer et al. (2011) continued:

Integrative neuromuscular training programs that integrate a variety of fundamental movements designed to enhance both health and skill-related fitness may be most beneficial if initiated during pre-adolescence.

Sure. Skill-building should start in childhood. It is amazing how many high-school athletes cannot skip or perform other basic movements. Is that important to their sport-specific success? Maybe, maybe not. Does it mean that they will suffer an injury? Who knows? However, having developed greater and broader movement skills will not hold back a child from future athletic success, so if it may enhance success, participation, or injury prevention, how can anyone object?

Of course, a possible objection would be the necessity of a program versus general play. Can one develop these general fundamental skills simply by engaging in playful activities as a child? Has the lack of play become such a reality that there is no returning to a society where children play, so our best hope is to find qualified professionals to teach skills and movements that once were learned through play?

I am not opposed to injury-prevention programs or sport-specific training at the right time. However, if there are injuries in childhood to such a degree that children need formalized injury-prevention programs, I think an injury-prevention program is like applying a band-aid. There are deeper issues.

As Weingroff said, it is not about specific injury-prevention programs or sport-specific training. Train right. What is the right training for children? Under a certain age, play is the right training. As children get older and take organized sport more seriously, then there should be an increased effort to train correctly through different neuromuscular and resistance training programs.

However, the real problem is not the absence of injury-prevention programs prior to sports participation at 6 years old, the problem is the competitive sports participation at 6 years old. If a 6 year old is going to participate in organized sports, (1) it should not end his or her participation in unstructured play activities and/or (2) the organized sports should incorporate more unstructured activities like those it replaced.

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