Keeping student athletes physically and mentally in the game

What parents need to know about keeping young athletes healthy, both physically and mentally

The progression seems natural. Your daughter makes the varsity team and works hard to get a starting position. To improve her fitness, she runs a few extra miles on the weekends. Then her coach suggests she play in a tournament; maybe spend a couple of weeks at a summer camp dedicated to her sport.

Your once-energetic daughter now appears lethargic and complains of being tired. Her knees hurt and her shin splints are acting up. She’s incredibly anxious and has trouble sleeping at night. Then, one day, she simply announces, “I quit.”

How could this have happened and what can you do to keep kids from getting injured, burning out, and giving up?

ESPN conducted a Kids in Sports study in 2013 that revealed the number one reason why girls said they gave up a sport was because it wasn’t fun anymore. The second reason girls said they quit was to focus on boosting falling grades; while boys cited health problems or injury for the reason they dropped out. By a slim margin just below academic performance, girls cited injury as the third reason why they left a sport.

Karen Collins, chair and associate professor in the Kinesiology department at the University of New Hampshire, said there are guidelines when it comes to how many hours a week a young athlete should participate in all sports combined. Not only does this help prevent injury, it could lower the risk of burnout, too.

“The rule of thumb is you should be spending fewer hours (playing sports) than the age you are. For example, a six-year-old could be doing tee ball, soccer, and karate and that could total 10 hours — and that’s too much,” she said. “The data and the research show that the incidence of injuries increases if you are participating in more hours of sports per week than your age.”

Instead of playing different sports — for example, soccer in the fall, basketball in the spring, and baseball in the fall — student-athletes are increasingly specializing in one sport year-round.

“The research shows that specializing in one sport causes a greater risk in injuries,” Collins said. “Most injuries are overuse injuries at the middle school and high school level.”

There is a reason for that, Collins added, giving the example of a high school student who might play AAU basketball every weekend from April through July, and then play the sport on the school varsity team during the winter season.

“You are using the same muscles over and over, day after day,” she said. “What multi-sport participation does is to naturally use different parts of your body, depending on that sport,” she said.

Even if athletes do switch up what sports they play, they still need adequate rest and recovery. Instead, many students move from one season to the next, with hardly a break in between.

“Those are the ones who don’t really complain until they are feeling bad,” Collins said. “They find, now I have a stress fracture in my shin because I didn’t take a break from running over three seasons. That’s manageable with rest and recovery — the hardest sports to recover from are from are those that cause head trauma or concussions.”

Dr. Pat Casey, an orthopedic surgeon with Concord Orthopaedics, who has been in practice for 16 years, agrees with Collins. He frequently treats kids who present with overuse injuries, often due to playing a single sport, year-round. In a 24-hour period this September, he treated three students with ACL tears.

“If a kid is good at one sport, they are encouraged to keep playing. The coach says, ‘we need you on the team.’ When kids excel at a sport, it becomes a self-fulfilling prophecy — they play it, they get positive reinforcement, and the coaches can put together better teams. It becomes a cycle.”

Pressure to perform

Even if student-athletes aren’t competing for Division I college scholarships, there is still pressure to be the best that you can be and that can start as early as middle school.

Whether that pressure comes from parents, coaches, or from the kids themselves, it’s something that needs to be kept in check. It all comes down to setting reasonable goals, said Collins, who also works with coaches and athletes as a sports psychology consultant to help develop a positive sport environment at UNH.

“Goals are not relative to outcome; they are relative to process. At the higher levels, while more importance is placed on winning and losing, there is still room for process goals. In middle school, it should be about development and not winning,” she said.

Coaches should instead work with students on setting process goals. For a pitcher, it could mean setting goals around types of pitches, hittable pitches, throwing what coaches and catchers are asking for, and learning how to refocus to start fresh every inning, pitching to one batter at a time, Collins said.

“Now that puts it back in control of the athlete and eliminates some of that pressure to perform,” she said.

Collins said parents can help reduce pressure to perform by being aware of how they communicate with their student-athlete. Instead of asking, “How was practice today?”, they can ask better questions such as: “What did you learn today?”, or “What was one way you impacted practice today?”

Another approach includes waiting for them to initiate the conversation related to their sport. A warning sign to look out for: If your son or daughter used to share a lot of details about sports with you, but stops.

Casey, who has a 14-year-old daughter who plays soccer, basketball, and lacrosse said there is pressure on the parents, too, because they don’t want to see their children left behind. Likewise, many coaches “sell parents a dream,” too, which could include the opportunity to earn a college scholarship, he said.

“I don’t think the coaches are doing it maliciously. They are not trying to hurt kids; they feel the excitement and they tend to put the best players out on the field all the time,” Casey said.

“I say to players and families all the time, sports are a great way to get a scholarship, but academics are, too. If you spend as many hours on physics or poetry as you do on sports, there is a good chance you might get a scholarship, too.”


Most people are aware that football players are prone to injury, particularly head injury. According to research published in the journal JAMA Pediatrics, about 78,000 concussions occur per year at the youth level.

Other contact sports in which players wear helmets — such as hockey and lacrosse — also have high impact rates. Sports that require athletes to go up and down — like gymnastics or cheerleading — likewise pose danger. But even soccer players aren’t immune to injury if they go in to “head” the ball and knock noggins with another player.

Students who seek treatment from Casey often come in with chronic, nagging pain; for example, shoulder pain, elbow pain, or stress fractures — injuries that start gradually and get worse and worse with overuse. Female athletes, particularly those in sports that involve “cutting,” or quick movements in sports like basketball, soccer or lacrosse, are most at risk.

“Males still injure their knees as well, but this is a female epidemic — there is not one week that goes by that I do not see a female who has torn her ACL,” he said.

Participation in sports can trigger other types of pain that parents and coaches should look out for. Hazing, although illegal, still exists. It might be as subtle as requiring freshmen to pick up all the balls or wear a costume to practice, but it still enforces a hierarchy that coaches should not promote or tolerate, Collins said.

For some athletes, their body image, whether they want to lose weight or gain muscle, can cause a different kind of pain. The images on social media don’t help, either. Parents need to pay attention to any changes in their child’s eating behavior and put the focus back on nutrition.

“They should work together with coaches and talk to the kids about what snacks they should eat before and after practice. The language should be: It’s for athletic performance — you are eating for athletic performance opposed to getting skinnier, bigger, or smaller,” Collins said.

Athletes’ feelings can also get hurt if they feel left out. Cliques do form on teams and coaches should do their best to break them up before they become harmful.

“We need to encourage the idea that everyone on the team plays an important role,” Collins said.

Getting back on the field

When student-athletes get injured, some seek specialty sports training to return to the game safely. Even after they are “cleared” by their physician, school trainer or physical therapist, many need more time and conditioning before they can compete at the same level as before.

Gerry Scaccia, manager and head strength coach at Complete Athlete Sports Performance Center in Derry, which offers sports training to both students and adults, helps athletes build up their strength and speed.

The center also offers a special post-injury training program. Kids can attend eight sessions and get personalized attention. Complete Athlete works with the athlete’s doctor or physical therapist to determine exactly where they need help in their recovery process, Scaccia said.

Complete Athlete was founded 15 years ago by Scaccia’s brother, Bob, a physical therapist and strength and conditioning coach who couldn’t believe the number of injuries he was seeing in athletes– particularly female athletes.

Why is this happening?

“A big factor is because girls are doing the exact same things as boys — and no matter what, boys are generally stronger, and their body parts are bigger — particularly the knee and ACL/MCL,” he said. “This is not to say that the boys aren’t suffering from a large number of sports-related injuries as well, but the percentage rise in females is alarming.”

Right now, Scaccia works with six athletes recovering from major injuries — all of them girls. They play different sports, and several were referred by doctors and physical therapists.

Scaccia said he sees a lot of injuries that are a result of repetitive motion, as well as ankle sprains, and inflammation in the shoulders and lower back. The main causal factors are cutting, landing and stopping as well as not engaging in proper movement mechanics. Complete Athlete teaches athletes how to perform these movements correctly, as well as how to strengthen muscle groups associated with performing these movements.

Like Dr. Casey, the number one reason why Scaccia believes kids are getting injured more often is because they are only playing one sport starting at an early age. While their skills in their preferred sports may be phenomenal, they have trouble moving their bodies in different ways and “ignore hundreds of other movements,” Scaccia said.

Many athletes that attend Complete Athlete are kids who do not have insurance plans that cover physical therapy or have high co-pays. Or worse, they go back to their sport too early and find they aren’t ready — leaving them at risk of another injury.

“We almost become the bridge between PT and their diagnosis,” Scaccia said.

Rules and regulations

To help reduce injuries and promote safety for students, high school coaches follow guidelines set by their schools and the New Hampshire Interscholastic Athletic Association, whose mission is to ensure fair play in competition and equal opportunity in the state’s interscholastic programs. Coaches with the right tools and training can help students avoid sports injuries and get the most out of their high school sports experience.

The NHIAA sets the requirements coaches must have before they step out onto the field, said Jeffrey Collins, NHIAA executive director (no relation to Karen Collins). This includes CPR and First Aid certification. Head coaches need to take a Principles of Coaching class and all coaches must take an online course that focuses on the signs and symptoms of heat-related illnesses.

“We try to get them the tools necessary, along with their athletic directors, who are fantastic and offer different types (of training),” Jeffrey Collins said.

The NHIAA adopted the “Life of an Athlete” program, created by John Underwood, a former Olympic trainer to increase healthy lifestyles among youth, including the choice not to misuse alcohol, tobacco and other drugs. The NHIAA’s Life of an Athlete New Hampshire Coaches Playbook helps coaches guide student-athletes to make good lifestyle choices that optimize performance both on and off the field.

The playbook covers topics such as the role of a coach, supporting proper sleep and nutrition, selecting and training team leaders, creating a positive team culture, and how to recognize and prevent alcohol, tobacco, and drug use. The last page of the guide includes a sample code of conduct that both parents and students can sign, pledging their adherence to high standards of ethics and sportsmanship.

At the end of the day, the best way for coaches and parents to ensure kids aren’t getting hurt is to keep the lines of communication open.

“It’s OK for kids to express their feelings. That’s essential for any kid in high school, whether they are in sports, band, or chorus. Those open lines of communication allow coaches and teachers to know what’s going on in their lives,” Jeffrey Collins said.

Parents of student-athletes need to pay attention to their kids’ personalities and overall persona relative to sports. While waiting for their X-rays, some of Casey’s injured athletes have revealed to him privately that they feel they can’t tell their parents they don’t want to play anymore.

“The biggest thing is to make sure it’s fun and they are enjoying it. If they are not enjoying it, their personality changes,” Casey said. “It affects the player mentally as well as physically. I make the parents aware that it’s easy to get caught up in the momentum and forget to say — is this really what’s best for my child or our family?”

Krysten Godfrey Maddocks has worked as a journalist and in marketing roles throughout the Granite State.

Categories: Health, Mind and Body, News