In a world of hurt

Sure, his business is booming, but Dr. James Andrews wouldn't mind a downturn.

In recent years, the noted orthopedic surgeon from Birmingham, Ala. -- whose name has become synonymous with the Tommy John surgery to replace elbow ligaments in baseball pitchers -- has seen an alarming increase in the number of high school and youth pitchers seeking new ulnar collateral ligaments.

Andrews says the rise in such injuries is indicative of an overall epidemic of overuse injuries in youth sports, and he says premature specialization and year-round training "absolutely" are the leading culprits.

Although most researchers agree specialization is necessary for an athlete to reach elite status in any sport, experts such as Andrews worry that athletes who focus on one sport before adolescence or train year-round without significant time off from competition are at risk for a number of hazards, including overuse injuries.

"We have to figure out how we can control the inevitable with the specializing in sports," Andrews said. "We have to emphasize year-round programs that are not year-round competition and overuse.

"We probably have to fit that to the times, and we have to be realistic about what we do."

Like many experts, Andrews says he would prefer to see young athletes play multiple sports, but if the trend toward specialization is here to stay -- and he believes it is -- he urges athletes to practice "periodization," meaning they should take at least two or three months off from competition during the year. During that time, Andrews says, athletes should participate in an offseason workout program that does not mimic the motions that lead to common overuse injuries in their sport (i.e. the overhead motion that causes rotator cuff injuries in baseball pitchers, swimmers, volleyball players and tennis players.)

The American Academy of Pediatrics' Council on Sports Medicine and Fitness recommends limiting one sporting activity to a maximum of five days per week with at least one day off from any organized physical activity. In addition, athletes should have at least two to three months off per year from their particular sport during which they can let injuries heal, refresh the mind and work on strength, conditioning and proprioception (balancing exercises) in hopes of reducing injury risk.

Or better yet, they should participate in multiple sports, particularly before adolescence.

"Young athletes who participate in a variety of sports have fewer injuries and play sports longer than those who specialize before puberty," the American Academy of Pediatrics report says.

But multi-sport athletes are not immune to overuse injuries, either.

To avoid such injuries, athletes must take sufficient time off between daily activities and between sports seasons, according to the AAP. Also, athletes who participate in two or more sports that emphasize the same body parts (i.e. swimmers and baseball pitchers) are at a higher risk than those who play sports that emphasize different body parts.

Overuse injuries can run the gamut from routine (tendinitis) to severe (torn ligaments.) Some are easily remedied with a few weeks rest and don't require an athlete to stop training altogether. For example, rotator cuff soreness and elbow and wrist tendinitis are among the most common injuries among players at Van Der Meer Tennis Academy, according to head pro Justyn Schelver.

"It's something you've got to watch carefully," Schelver said. "It's really a matter of keeping in touch with the kid and making sure they're upfront with how their body is holding up. If they're having problems, you have to adjust what you're doing with that kid."

After a couple of weeks of conditioning and off-court work, players usually can return to their normal practice regimen, Schelver said.

On the other hand, some overuse injuries are more dire and can bring an abrupt end to a young athlete's career. Ian Anderson, a rising senior at Hilton Head Preparatory School, faced that possibility three years ago, when he tore his ulnar collateral ligament while pitching for a travel baseball team. The injury was the product of about three years of playing baseball year-round.

"I knew he did it," Ian's father, David, said. "Literally, you could hear a pop, and I got kind of sick to my stomach because I knew he had done something serious."

After an MRI, the Andersons were faced with two options: They could have the ligament repaired by a local surgeon, but Ian probably wouldn't pitch again, or they could ask Andrews to perform Tommy John surgery.

"We all kind of talked about it, and Ian said, 'Yeah, I'm not done pitching yet,' " David Anderson said. "So we took him to Alabama."

"It was not a fun experience," Ian Anderson said. "But if I didn't get it, I probably wouldn't have been able to play any sport at all."

The year of rehabilitation that followed was no picnic, either. Anderson returned to pitch for Hilton Head Island High School the following year, and he recently completed a solid season for Hilton Head Prep, but many players who suffer similar injuries never pitch again.

Of course, not all injuries are related to overuse, and many young athletes choose to specialize in hopes of avoiding injury. For example, Andrews points to the possibility of a promising baseball pitcher injuring his throwing shoulder playing football.

Andrews says he has given up hope of kids following the example of pitchers such as John Smoltz and Tom Glavine of the Atlanta Braves.

"They played four sports growing up, and that kept them developing their athletic skills, but it kept them from overusing their throwing arms," Andrews said. "And it has a lot to do with their longevity."

Barring a sea change in the youth sports culture, though, Andrews says he and other doctors are turning their attention to the next best thing.

"There are preventative things you can do in all those youth sports that we're trying to get into, but we probably haven't made a dent in them," Andrews said. "Hopefully we'll continue to work on them."