Understanding Overuse Injuries in Youth Athletes | ICA Sports & Fitness Science Council

Today’s youth athletes are busier than ever: school teams, club teams, travel seasons, private strength coaches and barely a week off all year. It’s no surprise that sports chiropractors are seeing a surge in overuse injuries in young athletes.

In this ICA Sports & Fitness Science Council podcast episode, Dr. Brant Hulsebus is joined by his longtime friend and fellow Palmer classmate, Dr. Kyle Hoeft of Fishers, Indiana. Together they break down what’s really driving overuse injuries and how chiropractors can intervene before those problems turn into fractures, ACL ruptures or long-term spinal issues.

They discuss:
• How year-round training, stacked seasons and early specialization overload young bodies  
• The role of repetitive axial loading in lumbar stress reactions and pars fractures  
• Why knee injuries and ACL ruptures are appearing earlier and more often  
• How pelvic and lumbar misalignment change loading through the hips, knees and ankles  
• Practical stretches and stabilization work for youth athletes  
• The importance of communication with parents, trainers and coaches  
• Why “no pain, no gain” needs to be retired—and what should replace it  
• The long-term benefits of cross-training and delaying specialization

Transcript

0:04

Hello, welcome to another ICA Sports and Fitness Science Podcast ICA. This is one of the episodes of the Chiro Cast that we do. This is the Sports one. I'm glad you found us. My name's Dr. Brant Hulsebus. I'm a board member of the ICA Sports and Fitness Science Council, and today we are joined by my friend and fellow Palmer Classmate, Dr. Kyle Hoeft. Do you wanna say hello? Yes thanks Brant. Brant and I have been classmates and friends for over 25 years, and we both work in the realm of sports chiropractic. And it's it's great to be able to have this opportunity to collaborate and share some stories and help other chiropractors and, and, you know, patients in general learn about how to benefit from regular chiropractic care and reducing injuries, sports injuries, and continuing to perform at a high level. Why don't you tell us a little bit about where you practice and a little bit about your clinic. Yeah. So I practice in Fishers, Indiana. It's north of Indianapolis. I've been here in, the north side of Indianapolis for just over 25 years. And I was in West Carmel for about 18 years and, about three almo a little after. A little over three years ago, I relocated. I practiced to Fishers a little closer to home, and I've maintained a strong sports chiropractic practice along with family families as well of all ages. But I have really developed a niche with my athletes and have come to help. Athletes of all different kinds of sports, whether we're talking, wrestling, baseball, basketball, hockey volleyball, soccer, football, you name it. I've had those patients and athletes in my office. And so it's been a passion of mine and, and I enjoy sharing some of the keys that the average athlete should be aware of to keep them pain free and keep them performing at a high level. So you and I are about the same age. We grew up at times when we would play multiple sports and we would try different. Things and we wouldn't just lock in on one sport year round with today's kids. I know myself, I played football. I had to be in the wrestling team.'cause if you wanted to play defense on football, our wrestling coach was a defensive coordinator for football. So if you wanted to play defense, you had to wrestle. And then we also monkey around on All East. I lived in Massachusetts with lacrosse. I imagine yourself, you grew up play multiple different sports, not just one. Correct. So I played basketball, a lot of basketball, also ran cross country, ran track and played soccer. So four sports for me. And kept me busy, but my level of busyness is no match for the today's athlete. And, that's something that I've seen more and more of in my practice and every year it seems to get more and more involved and more you know, a lot busier with these athletes. I always talk to these athletes who do the I just had one that plays basketball and club. She plays a u basketball and then she plays for high school. And I always tease her about the old episode of The Simpsons when Homer Simpsons called it the magical weekend between summer school and regular school, that they actually didn't have to do anything. And I think a lot of these athletes today, they only get like one or two weeks off a year and that's where. We wanna discuss today, we wanna dive into this, overuse injuries in young athletes. Do you find that this is a real problem in your practice? The overuse. Absolutely. You know, I've had several athletes recently playing regular sports. For instance, some patients are, are playing soccer during the season also training. Postseason. And they want to do other sports, whether it's football, whether it's baseball, basketball, and so they're doing more than one sport together. And I have seen on several occasions patients that come down with more severe injuries in, in the hip region, more severe injuries in the low back. And it's unfortunate and it, it can be avoided with with proper, proper guidance and you know, we'll talk more about that. You're threatening about, let's say a young lady that plays soccer club soccer, loves club soccer, plays it year round. Also decide to go off of the track team. Some of her friends are on the track, team on the side, and then also work with a strength. Conditioning coach, hopefully a strength conditioning coach on their own. When they're not at track, when they're not at soccer, then they're at the gym. And so you're just seeing this use and use and abuse. Correct. Yep. And it's, it's, it's very much the same story just different athlete. It doesn't matter whether it's boy or girl. It happens quite often, both sexes and yeah, we've seen quite a bit of it. So one of the biggest factors is probably the repetitive strain. You wanna hit a little bit on the repetitive strain and what happens with this discontinues over and over again. So you know, for some of these injuries, for instance, I've seen several soccer athletes they train year round and it's, it's constant running, constant jumping constant drill so that that pounding, that axial loading that occurs in the low back. It's continuous. It's month after month, year after year with no breaks. And and that's why you see a large number of lumbar fractures, for instance, pars fractures that can be undetected. Sometimes it falls under the radar because the, the patients the athletes don't wanna report that they're in pain. And and eventually it gets to be so bad that they get in treatment. And, so yeah, those one that's, that's just one thing. We also have, you know, athletes in, in, for instance, basketball that are, again, a a u runs in some cases year round, but mostly over the summer. And then you have the regular season. So you're constantly loading the knees, you're constantly twisting the knees and on a unforgiving court surface that really strains, the knees, like the ACL and the PCL. And so we're seeing just an incredible amount of ACL injuries. I see it with football as well. A couple years ago I talked to one of the local trainers at the high school, and we were only into the second game of the season. She had already said they had on one team for one school, they had four ACL ruptures. And that was just simply unheard of, you know, when I was in school, when I was in high school, 30, 35 years ago. So you see this going on like this, what are some of the chiropractic strategies that you use to help these athletes? Because as much as we wish they wouldn't do that, we know they're gonna, so this, this patient comes into your clinic, what, what are some of your strategies you're gonna do to help this patient not have these injuries? So that's a great question. First of all, we want to identify what their schedule looks like and how often they're training. If we can modify that, if we can give them breaks, we, you know, that's one of the first things we look for because you're dealing with young athletes here that have growth plates. Growth plates that haven't fully fused and you know, that, that that can be very problematic with a with an injury when they got an unclosed growth plate. But, more specifically, we'll look at well, what kind of alignment do you have? What kind of hip misalignment will that patient have? And if they are, you know, rotated, they have some pelvic misalignment that can directly, affect the biomechanics of the lower extremity, including, you know, the hips, the knees, the ankles, the feet. So we, we we look to restore balance and symmetry in, in that area very specifically, which is. Handling all the loading. So, and then, then from there we're gonna look at stretches and exercises specifically to help hold that stabilization. And a lot of times I'm dealing with really tight really tight hip flexors on these patients. And just real general things like quadricep tightness and hamstring tightness, which can be resolved with just doing basic stretches and exercises. How often are you reaching out to their strength conditioning coaches and their athletic trainers with your findings? When I do get a patient from the high school, I, I make every effort to stay in contact. It's usually the trainer. We have a couple trainers at our local high school that I stay in, in touch with and make sure that they're aware of anything that I see that maybe they won't see with their limited, you know. Modalities and, and they don't have imaging like we do as well. So, so it's very important to, to, to communicate that stuff. I have a gym right down the street from me that's really, that actually goes into high schools and works with the kids. So when they come in the office, we, we meet every Thursday and we discuss, you know, I see a really bad L one, L two, I expect to have a really bad hip flexor on the right. Really tight piriform on the left. And we are able to communicate with them. And I think, you know, I think you can talk more about this, but you need mom and dad to make that relationship and make that urgency more than you can do it yourself. Correct. Yes. The one thing that's helped me a lot too is that being an athlete myself, I've been there in a lot of these situations, I understand the parents wanting to, you know, keep their kids active and. Especially the athletes wanting to stay active, worried that if they don't continue to practice and train that they're somehow gonna get passed up. And that's become more of a a mission where I have to explain to these patients and their athletes that that's not going to make that kind of a difference in, in many cases. Shutting it down, giving your body a week here, couple weeks there to totally rest and not do anything will benefit them Far, far more than continuing to train. A lot of times I find it's helpful to look at their, their schedule and just be realistic. Like, you got three more regular season games and the playoffs come. Which one do you want to be good for? The last three games, it'd be mediocre are awesome for the playoffs. Do you have any other strategies that you use and to tell the parent when we have to rest versus modify versus keep going. Yeah, I I always tell them, you know, you've gotta, you gotta be willing to, you know, you gotta be honest with yourself. If you have pain, discomfort, whether you're training or exercising, or in the, you know, in the weight room, you've gotta listen to your body. And if it, if it's pain, you gotta back off and just, you know, shut that down until you get to a point where you're feeling better. It's, it's really that simple. You can't push through these things and, and just expect them to magically resolve, We were. At the time period, it was no pain, no gain. And I think today the attitude is pain is telling us we need to modify or change what we're doing. And I think that mentality of no pain, no gain is, is, is going away. Do you finding that to be more and more true? It's. It is, it is starting to, but I think it, we need to keep pushing and gonna keep educating. And I think it will, the message will get brought across the more injuries we see and when families unfortunately have to deal with more severe injuries that require surgery and substantial immobilization and, you know, stoppage from playing. I, I think the point gets, gets brought across pretty well. Do you do that for patient? mean a lot of times you'll go about trying to educate our patients, but in this case, you're not gonna educate an eighth grade football. There you need to educate most of the time, mom, correct there. Or when it comes to resting, maybe educating dad why the, why the son needs to rest. Do you have any tips or tricks that you do that to help get through to the parents? One of the things I like to tell them is that less is more. A lot of times you you can, you can benefit so much more by letting your body, you know, catch up as far as these, letting these kids, you know, give, give them a, a free week or a free couple days here and there. They're growing so fast. In some cases, the kids are growing two, three inches or more over a course of the summer. And you, their skills need a chance to catch up with their height and with their growth. And, and it's, you know, it's, it's not a bad thing to step away and just let. Let the kids be kids and you know, let them, you know, let them breathe, so to speak, and let their bodies get a chance to heal and, and, and, and, and catch up. And they're not gonna be behind you know, their, their level of athleticism is, is, is gonna still be there. And you know, I, I, I have to just, you know, keep emphasizing that because, a lot of times some of those parents, you know, I like to ask them, how much, how much did you train or when, when did you play? And a lot of them don't have they don't have the experience, so they need somebody that has been there to tell 'em, Hey, this is the way to go. This is the best way, and this is what keeps you healthy. I use a lot of imaging. You mentioned imaging earlier. I use a lot of imaging in my office and I like to pull those images up and then show the Deerfield checks let the. Parent actually see, wow, look how much they are off. And then I relate it back to the imaging. Do you find that to be helpful in your office or do you have any tips on that? Yeah. That's a, that's a good point too. I, I always like to tell the, I. the patients and the parents, you know, like if, for instance, an X-ray is a static picture in time, it does not show, motion. And so that's where you you draw in the Deerfield tests and other leg checks so that you can say, okay, so here's what we see on the x-ray and here's what we see with the movement of these joints, and see how this matches this misalignment here. And it's a very good way to show them the biomechanics and how they're off and how that can be detrimental to that athlete's performance and overall health. The light bulb goes off and you show 'em the short leg, then you bend the legs up, and then a short leg is longer and you touch, did you tender right here? And they say, oh yeah. And all of a sudden, a, the light bulb goes off. I find this to be really helpful with the, the education Yep. Exactly. You know, I could do that with the tight muscles into the lumbar spine as well. A lot of times you just by observing the soft tissue when they're lying face down or in a prone position you can show that parent, that mom or dad, see how that that left glue teal is a little bit higher than the rights. You know, so that, that is an imbalance. And then you know, I always preface. Preface it by saying if you divide the body in half, top to bottom you've got, from a biomechanical standpoint, you've got the same muscles on the left as you do the right. So that's very important to maintain the, the biomechanical symmetry Every once in a while I could predict. I'm like, I bet when you watch'em run, you notice they're taking a longer stride with I. leg than they are the right leg 'cause of the way the hips are rotated. And then finally, when you educate 'em that then all of a sudden, you know, the hardest critical lot of times is the parent watching the child. And they'll see that and then they know, oh, oh, we better get in there and get adjusted. It's yeah, very, very, very common to see that. And, and, and a lot of times patients just need to, they just need to see it or their parents just need to see it as you're working through you know, treating these patients. And it makes all the difference.'Cause most of, most of the average. People they don't know anything about how chiropractic can, you know, influence sports in a dramatic way. And many times during, during contest as well as I'm sure you're aware of being with so many sports teams that you go onsite and you have for many years, so. I always give my guests. Stage one last time for their final word. Do you have anything that we missed today that you wanted to make sure we asked? I'll give you the stage. You know, I think I think we touched on a lot of the, the main things. The biggest, the biggest thing we need to. To get across to our, our young athletes is, especially at a young age, cross training, doing different sports, not just one sport at the same time all the time. Give your body a chance to, to use different muscles in different ways. And that's how you're going to keep yourself pain free and healthy in the long run. Yeah, when you get to be, eighth grader in, in, in high school, that's probably the time you need to start narrowing down certain sports. But until then, it's it's just so much healthier to, to keep that, that wide array of sports available to the kids. And it keeps 'em, it keeps 'em happy too. You don't want 'em to get burned out in one sport. And that's, that's happened a many times too. They do one sport. You know, you know, constantly day after day, year after year and they get sick of it, so I wanna play one sport all the time. And she, she wasn't she's good, but she wasn't awesome and she switched to a different sport. She ended up making Allstate and getting a scholarship. So sometimes it's very yeah, to try a different. To sport once in a while. I know in absolutely. the, the best baseball player tend to be one of the best lacrosse players too. He just never picked up with lacrosse stick, so it's fun to Yep. So. Absolutely. Well, I hope you enjoyed this episode and thank you, Dr. Kyle for joining us. And if you liked this podcast, please like and subscribe to it. And if you are thinking about getting involved in the world of sports and chiropractic, the ICA Sports and Fitness Science Council is getting ready to announce our big symposium that we're gonna have, we're looking care, coming up at the end of the summer to come in and sit down and work with sports chiropractors, ones that take care of. Local high school athletes like Dr. Kyle does in his office. Ones that take care of bodybuilders and the strong man games and one that take care of professional athletes on different levels. This a whole ee of different levels of involvement in sports, whether it's how to do techniques for stabilization, for strength athletes, or whether it's sub-concussive forces. We're gonna have a whole team put together and we hope you can join us. please like and subscribe to this podcast. You can see more and hear more. And one last time. Dr. Kyle, thank you for joining us. Me, it's a pleasure and we'll we'll look forward to doing another one soon. Thank you.