Changing youth sports culture
Those of us fortunate to be involved in the treatment of sports injuries among children and adolescents are often are left to ponder how much truth-telling is appropriate. In other words, how much does the athlete or parent want to hear, and are they listening to us if we do tell?
It is hard to answer such questions without first reflecting on how dramatically the culture of youth sports has changed over the past 30 years:
- The level of competition and the number of events exposing athletes to the risk of injury has increased significantly;
- Many competitive high school athletes participate year round in their sport of choice, often on 1 or 2 traveling teams in addition to the high school team;
- What used to be a family's leisure time is now spent traveling to out-of-state tournaments year-round like a collegiate or professional athlete;
- Gone are summers once spent as a family, maybe at a local country club or neighborhood pool, with parents socializing while kids splashed in the pool or played golf, baseball, soccer, basketball, or football - just for fun;
- A child's social circle, as well of the majority of his friends, is often made up entirely of teammates on his travel team;
- Parents with two or more children playing sports have to split up on the weekends to drive them to games in different locations, thus spending less time together as a family; and
- Thousands of dollars are spent by a family on travel team fees, tournaments, sports camps, and private coaches.
With a family's entire life revolving around sports, no wonder an injured athlete and his parents are driven by a desire for a quick recovery so they can return to their normal routine and circle of friends. All too often these days, parents of injured athletes, after listening to a doctor's detailed explanation of their child's injury - let's say, in this case, an ankle sprain - and the treatment protocol for a safe return to play weeks down the road, will ask, "What about the game tomorrow night?"
Not wanting to hear the truth
It would be easy to get angry at such a question and to jump to the conclusion that the parents weren't listening to anything the doctor was saying and, worse, were more concerned about getting their child back out on the playing field than about their long-term health.
To do that, however, would be to ignore the current culture of youth sports; a culture which can cloud a parent's judgment to the point that she doesn't want to hear the truth about the seriousness of an injury (which I can often tell just from the facial expressions of the teenage athlete and his or her parents).
It is one thing when the injury I am treating is minor, and the child can return to play without risking permanent impairment later in life. But what about an ACL injury with knee cartilage damage suffered by a 14-year-old girl whose parents are sure she is the next Kristine Lilly or Diana Taurasi? How much information should a doctor give the athlete and her parents? How much should a doctor tell parents about the arthritic changes their daughter is likely to develop in her knee by age 25 as a result of continued participation in competitive sports?
Wearing rose colored glasses
ACL injuries, particularly among female soccer and basketball players, have become so common that today's parents have come to think of them as simply the price their child must pay to play competitive sports. As a result, they don't always listen when we tell them that there is a 20% chance that their child's reconstructed ACL will re-tear, or that their child's good leg may suffer an ACL injury if she keeps playing competitive sports. They simply want the surgery yesterday so they can start getting ready for the next big tournament in 4 months. They are more concerned that college coaches are watching and less concerned that their child's knee heals properly, even though, as doctors, we know that her knee is not going to be even close to normal until at least 1 year after surgery.
A cautionary tale
Everyone, including other players on the team, coaches, athletic trainers, and physical therapists, has a story about the kid who played wonderfully only 4 months after ACL injury.
No one wants to talk about the athletes who never made it back, or worse, suffered a second ACL injury requiring surgery.
No one wants to hear stories like the one about Amy Steadman, who was surely going to be one of the great American soccer players of her generation. When she was only a junior in high school, Parade Magazine touted her as the "best of the best." But by the time Steadman was 21, she had undergone four ACL surgeries on her right knee, the first time while training for the Women's Under-19 World Cup. She worked tirelessly 3 to 4 hours a day for 10 months to make it all the way back after surgery.
Little did she realize that it was the beginning of the end of her soccer career. At last count, she has had 8 operations on her right knee. She walks with a limp, no longer plays soccer and doctors tell her she will likely need a knee replacement by age 30.
Perhaps it's time parents, instead of hearing about the success stories, are provided honest information. Perhaps it's time for them to listen - really listen - to a story they don't want to hear.
Updated October 18, 2011