The Overuse of Youth

Young athletes are a big part of my practice.  From sprained ankles to separated shoulders to low back pain, my goal with them, as with all my patients, is to decrease pain and increase function as quickly as possible.  But with young athletes in particular, I want to try to minimize the effect that an injury has on the rest of their body long-term.  Our bodies are masters of compensation you see, so if one area becomes weak or injured or dysfunctional, another area steps up to counterbalance.  And herein lies the problem: where did the injury start?  Can we chase the dysfunction throughout the body to find the initial culprit?

Troubling trends that I’m finding amongst these young athletes are overuse injuries.  Most often, these kids are playing their primary sport nearly year-round.  Summer hockey.  Winter ball.  Indoor soccer.  In 2016, the American Orthopaedic Society for Sports Medicine released an Early Sport Specialization Consensus Statement, which you can read by clicking HERE.

AOSSM

This is my favourite part:

“The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success.”

Please take a moment to read that again.  “No evidence” of “benefit” from “early sport specialization.”  And a whole lotta downside in the form burnout and overuse injury.

Make no mistake, I love youth sport.  I’m a huge competitor and I was raised playing every sport around, as do my children.  But remember, better movers make better athletes, and your child’s body will not learn to move well if it has only been expected to do the same thing over and over again.  Multi-dimensional.  Multi-sport.  Multi-movement.  That’s the key to a well-balanced athlete, and more importantly, a healthy human body.

If nothing else, I hope this post gives you some food for thought.  Parents have thousands of choices to make throughout their children’s lives, and this one is a big one.

hockey rules


CLE, JT, and Sarah.

Ahhhhh, I feel so content.

I had a weekend with JT, and more importantly, a weekend with Sarah.  Let me explain.Justin-Timberlake-Event-2019-79c4b5dcf7

If you’ve been reading this blog over the last five years, then you’ve heard of my Sarah.  Sarah has been by my side since we were 12 years old, and although she hasn’t been physically by my side since 2002, when I moved to Toronto and she moved to Washington, DC, she’s still one of the most important people in my life.  She’s been with me through teenage angst and young adult insecurities, through many moves and graduations, through marriage and babies, through houses and careers and chaos and life.  She sent my two-year-old daughter a glasses-wearing teddy bear after her amblyopia diagnosis, and that act alone pretty much sums her up: she is generous and kind and thoughtful and giving.  She is the sister I never had.

But adultingadulting is hard and life happens; logistics simply kick in and dictate the fact that we don’t see each other as much as we’d like.  In fact, other than a quick two-hour visit over Christmas in 2016, I haven’t seen her since I spent a weekend in Washington, meeting her son Harris two years ago.  But, a few months ago, we found a great excuse to see each other: Justin Timberlake.

Cleveland is a four-hour drive for me and a one-hour flight for her, and it just so happened that JT’s March 31st concert fell on Easter weekend.  I texted her on a whim, suggesting the idea, and her yes response came back within a few minutes.  We bought concert tickets on an Amex pre-sale, booked a hotel on points, and began to plot our 24-hours together.  It all came together really quickly and really easily, but perhaps I should’ve expected that, since

it’s just so easy to be with her.

We walked, we talked, we laughed, we danced, we sang, and we cherished.  I left Cleveland late Sunday morning, only 22 hours after I arrived, and made it home in time to host 16 people for Easter Sunday dinner.  And so as I sit and write this out, only a day and a half after it happened, I realize that this stage of life is like.  Life is hauling it to Cleveland to capture moments, then hauling it back to capture more.  Life is Easter egg hunts and concert hangovers, sometimes on the same day.  Life is teamwork from my husband and cooperation from my kids, life is a potluck holiday meal, life is podcasts and gas station snacks and no lineup at the border.  Life is full, and life is good.

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Now, we know better.

This is a tale of my mom, and of advances in research and medical treatment.

know better do better quote

Maya Angelou famously said, “Do the best you can until you know better.  Then when you know better, do better.”  This statement can be readily applied to scientific advances in patient care, and in the case of my mother, low back pain.

In the 1980s, when my brother and I were very young, my mom suffered from chronic low back pain.  There was no incident that started her pain, per se, but it was a dull ache that developed into chronic pain over the years.  She was diagnosed with “degenerative disc disease,” and in 1988 had aggressive back surgery, whereby the surgeon fused four of her five lumbar vertebrae together via screws and an eight-inch metal rod.  I have vague memories of visiting her in recovery in an Edmonton hospital, a few hour’s drive from our tiny prairie town of Hughenden, Alberta.  My nine-year-old brain didn’t hold on to many of the details, just that she was in a hospital bed, and I’d never seen my invincible mother, well, not invincible.

She recovered well, and her low back pain was a thing of the past through my ego-centric teenage and young adult years.  And while her history of back pain and surgery didn’t play a conscious role in my decision to become a chiropractor, the irony is not lost on me that I treat patients like her pre-surgical self every day.  I could have helped her, and let me boldly state that she might have avoided back surgery.  You see, she had no radiculopathy (pain down the leg due to pressure on a lumbar spinal nerve), no indicators of disc bulges or herniations, and she was only 38 years old, coincidentally the exact same age that I am now.

However, her back pain is back with a vengeance now, thirty years later.  It’s worsened over the last several years, and she now has trouble being on her feet or sitting for prolonged periods of time, and struggles to lift much more than her youngest 21-lb granddaughter. It’s affecting her quality of life, despite regular rehab exercises guided by yours truly, ergonomic modifications, and other conservative treatment measures.  The thing is, for the last thirty years, her body has compensated for the lack of movement through her lumbar spine, and the segments above and below her fusion now show advanced degeneration.  Her movement patterns have changed, her core muscles have changed, her biomechanics have changed.  Her spine does not move well, and as a cumulative result, she is in pain much of the time.

She’ll tell you she feels lucky.  Lucky that her pain was mostly gone for the last thirty years.  Lucky that the post-surgical ramifications haven’t affected her much until now.  But I’ll tell you that I wish she didn’t have chronic low back pain in the 1980s, because the conservative management today would be far different.

Why do I tell you this?  Because now, we know better.  Now, we do better.  And we are really good at treating low back pain.

lumbar fusion

This is similar to my mom’s spinal surgery in 1988, although four of her five lumbar vertebrae are involved.

*** As an aside, I never use the term “Degenerative Disc Disease” as a diagnosis because I think the term creates fear-mongering and patient helplessness.  Words spoken by a medical professional carry power, a power that I do not take lightly.  Improved semantics = improved patient outcomes.  And might I remind you that there is not always a correlation between clinic imaging results and a patient’s symptomatology…..