When your favorite sport takes a toll on your knees and feet

Alice* enters the consultation room discreetly, her grandmother at her side. She is wearing a large gray plastic boot on her right foot.

On this cloudy morning, the teenager has an appointment with orthopedic surgeon Marie-Lyne Nault at CHU Sainte-Justine to follow up on an ankle surgery she underwent six weeks earlier. Alice is 16, but this is not her first consultation in sports medicine. Her ankles have already been through a lot. Both of her knees have also caused her pain: patellofemoral syndrome.

Alice has been playing soccer since she was 8 years old, spring, summer, fall, winter. She also played soccer for two years in the sports-study program.

She had surgery in May because the tendons on the side of her ankle were unstable, the result of sprains that healed poorly. “It would snap when I walked for a long time,” she says. “My ankle was hurting.” It took Alice two years to seek medical attention, because she thought it was a normal side effect.

The operation forced her to stop playing soccer for six months. “It’s a long time,” she admits, her expression downcast.

“She also had two concussions,” her grandmother whispers, as D^D Nault manipulates his granddaughter’s healed ankle.

Early specialization

Physical activity is essential. The benefits associated with sports far outweigh the risks of not doing them, says Dr.^D Marie-Lyne Nault, who also has a bachelor’s degree in kinesiology. And to become a champion, one day or another you have to train intensely in the sport you practice.

But the D^D Nault has reservations: when this specialization occurs too early, before the age of 12. When children leave aside other sports (and free play) to concentrate all year round on a single sport.

Alice is not a pure example of “early specialization” (a continuum), because she also did gymnastics and dance as a child. But she has been practicing her “favorite sport” relentlessly since she was very young, like many children who want to progress quickly or maintain their place on the team.

In a meeting room, the D^D Nault and her colleague Lydia Diliddo, a pediatric emergency physician, had a lot to say about early specialization. They work at the Pediatric Sports Medicine Clinic at CHU Sainte-Justine, which welcomes athletes from all over Quebec. Overuse injuries start around age 11 or 12 for boys, 10 for girls, sometimes 9.

The approach they advocate is that of major medical associations in sports medicine and pediatrics such as the American Academy of Pediatrics: at least until puberty, young people should try several sports, according to the seasons, with fun as the primary goal. It is by harmoniously developing all of one’s muscles and functions that one prevents injuries, they explain.

“Sometimes we treat gymnasts who can’t skate or even ride a bike: they don’t do anything else,” says Lydia Diliddo. Some are even unable to do a simple squat.

Marie-Lyne Nault and Lydia Diliddo sense it: Quebec is following the trend in the United States, where young people (and their parents) are coveting scholarships and professional careers. Coaches also want to “protect” their athletes, notes the D^D Diliddo. Yet a growing body of research suggests that early specialization is not a prerequisite for reaching the elite level and is instead associated with more dropouts, burnout, and injuries.

“When you see a child, the parents want the operation to be done tomorrow morning, because it’s their career, their life,” says Dr.^D Nault, who rarely saw this profile of child at the beginning of his career. Today, she notes, it is the norm.

Young people who specialize early in organized sports and who practice them too intensely for their age are also more likely to suffer acute trauma. During Alice’s consultation, the orthopedic surgeon asked her a question. “Do you have any friends on your team who have torn their ACL?” “Yes, two girls,” the young girl answered spontaneously.

The D^D Marie-Lyne Nault is currently seeing an “epidemic” of ACL tears, especially among female soccer players. However, there are good warm-up programs to prevent this trauma, she says. When she announces this diagnosis to the child and his family, “it’s a disaster, everyone cries,” says Marie-Lyne Nault.

Why is a 9-year-old child more likely to specialize than his 14-year-old brother? His skeleton is growing, he has growth plates and his neurological system (including balance) is still developing, explains Dr.^D Nault.

An overuse injury treated in time and adequately will not have serious consequences, but “children are tolerant of pain”, they continue to play at the same pace, without consulting, because they put pressure on themselves or are subjected to it. However, a week of rest is sometimes enough, underlines Dr.^D Nault, who raises awareness among young athletes on social networks in the podcast show The Sideline.

When injuries are left to linger, serious consequences can occur: angular deformation of the bones, unevenness of the lower limbs, osteoarthritis, lists the orthopedic surgeon. “There are players that we end up seeing at only 17 years old. On X-rays, their foot looks like a 50-year-old foot.”

*The Sainte-Justine University Hospital has asked us to preserve the patient’s anonymity.