According to the Centers for Disease Control and Prevention, more than 2.6 million children ages 19 and younger are treated in emergency departments each year for sports and recreation-related injuries. And those are just the incidents that make it to the ED.

The injuries fall under the terms traumatic or non-traumatic (overuse injuries that develop over time), but that’s not to say one is less of a problem than the other.

“Some injuries are just a part of playing sports, but there are a good number of things we can prevent,” said Christopher Brown, M.D., sports medicine medical director for Rochester Regional Health. “Overuse injuries are responsible for up to half of all sports injuries in middle and high school kids.”

Prevention and proper treatment are key—but in the real world, it’s not that simple.

Trauma drama

“The youth sports injuries that typically occur are concussion, shoulder dislocation, and knee and ankle sprains and strains,” said Gregg T. Nicandri, M.D., an orthopedic surgeon and assistant professor in the University of Rochester Medical Center Division of Sports Medicine.

But in recent years, it’s the concussion debate that rages on, especially among parents concerned about lasting effects. According to the New York State Department of Health, “every year, about 4,000 New York children age 19 and younger are treated at hospitals for sports-related traumatic brain injuries.”

Awareness has helped. The likelihood that a concussion will be reported and treated is improving, said Robert O’Malley, president of the New York State Athletic Trainers’ Association.

“Definitely, there has been an increase in reported symptoms both to athletic trainers at schools and to parents. In addition, fewer parents are objecting to their children being removed from play due to a reported symptom compared to the past.”

Experts agree that rest is critical to recovery. “Rest” is defined as both physical and cognitive, which means eliminating or limiting reading, screen time, loud or bright environments, work and any aerobic or other physical activity that results in increased symptoms.

The problem is, many players get frustrated when they can’t jump back on the field. “Modified and high school athletes must complete a ‘return-to-play’ protocol even if they only reported symptoms of a head injury, as opposed to a physician giving a diagnosis of a concussion,” O’Malley said.

According to the University of Rochester Medical Center, “most people recover completely from a concussion in a matter of days; however, it can take up to a year or longer for some athletes to recover.”

Players want to get back in the game. But a concussion that’s ignored can result in ongoing cognitive symptoms that affect academic performance. An untreated concussion is also associated with mental health challenges, including depression and anxiety. And a subsequent brain injury before a concussion has healed can lead to permanent damage or death.

But detecting concussions isn’t simple. Some players want to “shrug it off” and keep playing if they think it might not be an actual concussion. So scientists — including Jeffrey J. Bazarian, M.D., an emergency medicine physician at UR Medicine who has gained national prominence for his research — are trying to develop definitive, on-field blood tests, and also determine how brains recover from a concussion.

Another traumatic injury affecting more and more athletes is major damage to the knee.

“The biggest trend I see currently is an epidemic of ACL injuries,” said Dr. Nicandri. The ACL is the ligament that stabilizes the knee when planting or pivoting. “An ACL tear is something that usually requires surgery to repair and typically requires a year-long recovery, which is devastating for somebody who is a high school, collegiate or professional athlete,” Dr. Nicandri said.

According to the American Academy of Orthopedic Surgeons, about 70%of sports-related ACL injuries happen through movements like pivoting, cutting, sidestepping and awkward landings, while about 30% result from collisions with other players.

Overuse it and lose it

Doctors are reporting a significant rise in preventable sports injuries among young athletes.

“What we’ve seen in the past decade is an increase in what we call overuse injuries — kids doing too much, too fast, too often without enough rest,” Dr. Brown said. “Kids involved in sports and recreation under the age of 14 are skeletally immature — they are not done growing. They are much more vulnerable to overuse and the lack of rest.”

Stress fractures, tendonitis, jumper’s knee, tennis elbow and shin splints are a few of the common overuse injuries experienced by young athletes. Even more problematic, overuse can also make a young athlete more vulnerable to a traumatic injury.

O’Malley observed that children playing one sport year-round and on multiple teams “leads to less rest and more muscle fatigue, even in children who seemingly have unlimited energy. The muscle fatigue can result in poor mechanics, and that usually results in injury,” O’Malley said.

Read more:

Over-training is something coaches, athletic trainers and medical care providers are keeping an eye on, as well. Athletes who are approaching the over-training stage experience “prolonged muscle soreness, greater fatigue — and throwing athletes will notice decreases in velocity or accuracy,” Dr. Nicandri said. “With pitchers, it’s often grip strength that decreases.”

Dr. Nicandri warns that a young athlete can get into a state of over-training “where the muscle tissue breaks down and structurally changes to the point that, even with maximum rest, the damage can become permanent.”

The risk of both overuse and over-training injuries increases as younger and younger athletes specialize in a single sport. “Back when young people played three sports, they exercised different muscle groups in different ways and kept muscle balance throughout the body,” Dr. Nicandri explained. “With specialization, young athletes do the same thing over and over, the body system can get out of balance, and that’s a prime cause of injuries such as stress fractures, tendonitis and rotator cuff impingement.”

“In the event of an overuse or over-training injury, the affected area usually responds to rest, ice, elevation and compression,” Dr. Brown said. “Rest is part of the recovery process in anything we do, particularly as we are preparing to compete,” he said. “Our bodies need time to recover and make those strength gains.”

Dr. Brown observes that children being active in sports and recreation year-round “isn’t bad, if they are doing different things and engaging in different sports.” The risk, he said, is that “if kids engage in only one sport, then they don’t give that one body part time to rest. That’s when they get hurt.”

The most important element of recovery from any injury is to follow the advice of doctors, physical therapists and trainers. And don’t take injuries too lightly.

So how serious is it?

For many families with active kids, injuries are a part of life — a temporary interruption of an otherwise active lifestyle. But even apparently minor injuries should be watched carefully.

“If you catch an overuse injury—tendonitis, a sprain—it can be temporary. But if the injury goes on untreated, it can cause permanent damage,” Dr. Brown explained.

Even a stress fracture that is not allowed to heal can bring consequences. “Every once in a while, you’ll see somebody running and all of a sudden their tibia snaps due to a stress fracture. That’s a worst-case scenario,” Dr. Nicandri said.

“The issue with ACL tears is, we can fix the ligament and provide stability to the knee, but that injury can lead to big problems later on, mostly in the form of arthritis,” Dr. Nicandri explained. “We know there is a 50 percent chance you are going to go on to get arthritis within 20 years.”

Over-training is risky, too. “Once you reach a certain threshold of muscle injury or muscle change, sometimes the body can’t fix it again,” Dr. Nicandri explained. “When I see athletes heading in that direction, I throw up the red flag and try to make them understand, because there is nothing more frustrating than having to tell a patient, ‘This is something we can’t fix.’ ”

Prevention

How do young athletes avoid many of these negative outcomes? Preventing injury in the first place.

For example, preventing the most severe consequences of concussion is a growing priority.

“We know that the most at-risk time is the young, developing brain,” Dr. Nicandri said. “We are especially concerned about multiple, cumulative concussive blows.”

A key preventative measure is immediate removal from play, which research shows can speed recovery time and reduce the risk of re-injury.

“Everyone involved in a game, practice or physical education class can report a suspected head injury and have the child removed from the activity,” O’Malley said. “This includes the coach, athletic trainer, nurse, referee, teacher and school officials. This comes from the New York State Concussion Act of 2011.”

ACL injury prevention programs have also shown great results. “A lot of foundational exercises that focus on identifying movement dysfunction, core and hip control — especially during lower body deceleration — will reduce the rate of ACL injuries,” O’Malley said.

Dr. Nicandri agrees. “We found that we were able to decrease the rate of ACL injury by about 70% in the group of athletes that did the program.”

O’Malley said, “It cannot be looked at as a ‘six weeks and done’ part of training. For sports teams, the program needs to be included as part of a daily warm-up, with some specific exercises added weekly to challenge each athlete.”

Many sports and recreation injuries can be prevented by focusing on general health and fitness, using the right equipment, and allowing the body to rest. Dr. Brown recommends a strength-and-conditioning routine. “Just like nature, our bodies like balance between strength and flexibility in muscle groups, and it’s extremely important as our kids age and get into higher-level sporting activity.”

In addition to proper nutrition and good hydration, Dr. Nicandri urges young athletes, in particular, to get enough sleep.

“Deep sleep is when growth hormone levels spike and you get the most muscle repair and recovery. The body does most of its healing while you sleep,” he said. “And poor sleep increases the risk of injury.”